Coronavirus and Walt Disney World general discussion

[Wendy Pleakley]

A telemedicine call doesn’t result in a hospital changing course of action. It’s for certain issues and I know of people who have been told they need to be seen in person. There’s plenty to learn about a patient in an intensive care unit for COVID-19. Just basics like their vitals. How they have or are responding to other measures.

Given that the prescribing doctor seems to think ivermectin is essentially magic, I am not inclined to give the benefit of doubt that he requested and received the patient’s medical records and information on his current status and then sat down and made a considered decision that this off label use was worth a try.

Yeah, this doctor seems to be an idiot, but I'm looking at this with the assumption that most such cases would involve a competent doctor. I don't know that a judge with no medical expertise should be a factor here. Is there no governing body of doctors with the ability to say, no, you cannot treat a COVID patient with something that is not a treatment for a virus and could do more harm than good?

What if the situation were somehow reversed? A patient who can't be moved is being refused a reasonable treatment? There could be cases where someone is desperately calling a good doctor for help because their current setting is failing them.

 

[Wendy Pleakley]

My post which you all responded to was only two questions. Questions, not declarations. Questions that in no way said vaccines are not affective or that I'm anti vax. Instead of an answer, you chose to twist the words around and spew venomous nonsense about misinformation. How is a question misinformation?

You view my questions as some type of attack against vaccines or debate strategy, but they were just questions. The questions clearly offended you. There's no discussion to be had with people of your mindset.

And, @helenabear , while its tragic that you feel sick to your stomach about people asking questions, I'm actually proud of you for typing out a post in which you refuse the temptation to mention that you were in a vaccination test group. If we all had a dollar for every time you mentioned it, we could each buy a direct DVC contract.

@Parker in NYC , its quite clear that this virus is more of a political issue for you rather than the health and well being others. Enjoy that.

I don't know what your intent was, but "just asking questions" is a common tactic to sow doubt and discord under the guise of being inquisitive.

The problem with “just asking questions”

Asking questions is generally a good thing. Indeed, questions are the very foundation of science. People become scientists because they are curious and like to ask questions, and science itself is …

thelogicofscience.com

 

[Casper Gutman]

Please don’t. Compring the two is even less productive or helpful or accurate than comparing Covid with the Spanish Flu/influenza/H1N1, etc. Numbers can say what we want them to say if we are selective. We have enough challenges right now with Covid without doing this.

I fail to see why it’s not helpful. People, even here, remain convinced Covid is no big deal. Contextualizing the numbers helps challenge that false assertion.

 

[correcaminos]

From an article linked below: Ivermectin is used in humans to treat some parasitic worms, and there are topical (on the skin) formulations for head lice and skin conditions like rosacea. Ivermectin is not an anti-viral (a drug for treating viruses).

The patient was prescribed the drug by a doctor. Not, apparently, a good one, but a doctor none the less. The judge wasn't making a medical decision, merely allowing a patient to take a drug they had been prescribed.

I guess if a patient has two doctors with differing opinions, the patient is entitled to choose.

At least the patient is getting the human version. A lot of people are trying to buy the Ivermectin that is for horses.

Why You Should Not Use Ivermectin to Treat or Prevent COVID-19

Using the Drug ivermectin to treat COVID-19 can be dangerous and even lethal. The FDA has not approved the drug for that purpose.

www.fda.gov

I had a prescription to get the chicken pox vaccination, not all places agreed to administer it because I was an adult. I finally found someone who would. They could shop around hospitals or somewhere to administer.

And if the ivermectin causes complications (it isn't a particularly pleasant medication to take), is the judge going to recommend how to proceed from there?

I thought it said they agreed the hospital would not be held liable.

We can almost 100% prevent colorectal and cervical cancer, yet people still refuse the HPV vaccine, pap smears and colonoscopies.

BTW, the antivaxx talking points that were circulating when the HPV vaccines were first marketed are the same one's I'm hearing now for the COVID-19 vaccines, but magnified by 1 million due to social media and a less-than-honest news network.

My mom died of cervical cancer in her 40s - granted nothing was typical and yes not all are caused by HPV especially in the vaccines. I was disappointed when it was suggeted that women only go every 3 years for paps. Mine still does yearly. I'm also beyond the age (and was when the vaccine came out) they recommend. I am slightly disappointed there isn't more focus on paps and such. Check ups after menopause is needed too, but we tend to ignore. My kid has his first dose of HPV - pandemic delayed it on accident - will get 2nd this winter.

 

[Chi84]

The prescriber was not affiliated with the hospital prior to this. Even though I work for a hospital, I don't work on the in-patient side, so I do not have admitting privileges. If my own patients are admitted, I can't just order medications for them or contradict what the attending physician is doing. I trust their judgement enough not to interfere (which I can't do anyway...). Not having privileges at a hospital is a huge red flag and liability issue. And will this provider then assume care moving forward? Is he/she familiar with all the hospital procedures for ordering tests, referrals, transfers, discharges, etc? This is so much more complicated than just one medication being ordered by someone else.

I don't dispute any of what you're saying; just noting that there are times when medical treatments have been court-ordered so I'm sure there is precedent for handling the issues you mention. I think it's most frequently done when the patient is incompetent to manage their own care, either because of mental impairment or where the patient is a minor and the parents disagree. I know it's happened with religious objections to treatments. That said, it's hard to figure out what happened in this case because very few facts have been made public.

 

[lazyboy97o]

Yeah, this doctor seems to be an idiot, but I'm looking at this with the assumption that most such cases would involve a competent doctor. I don't know that a judge with no medical expertise should be a factor here. Is there no governing body of doctors with the ability to say, no, you cannot treat a COVID patient with something that is not a treatment for a virus and could do more harm than good?

What if the situation were somehow reversed? A patient who can't be moved is being refused a reasonable treatment? There could be cases where someone is desperately calling a good doctor for help because their current setting is failing them.

I know there have been cases where there are fights about changing facilities and doctors. In those cases the patient is being transferred to someone else’s care and that person became responsible. This is a doctor being ordered not just to transfer or stop care, but administer a specific form of care with which they disagree and is not up to standards (and knowingly not providing the standard of care is illegal for most licensed professionals). That is all made worse because the treatment not only off-label but specifically and very publicly being disavowed by the FDA.

I’m honestly just as surprised that the doctors complied with the order and didn’t appeal that they were being order to act in a manner that likely threatened their professional regulations.

 

[sullyinMT]

Yeah, this doctor seems to be an idiot, but I'm looking at this with the assumption that most such cases would involve a competent doctor. I don't know that a judge with no medical expertise should be a factor here. Is there no governing body of doctors with the ability to say, no, you cannot treat a COVID patient with something that is not a treatment for a virus and could do more harm than good?

What if the situation were somehow reversed? A patient who can't be moved is being refused a reasonable treatment? There could be cases where someone is desperately calling a good doctor for help because their current setting is failing them.

This is a more reasonable way to approach the problem at hand, IMO. If a hospital/its providers either aren’t capable of or refuse to provide a specific treatment, the patient/DPA should then either request a transfer or sign out AMA and “self transfer” to the new facility. Assuming you find such a receiving facility and your current hospital refuses transfer of care, that’s when attorneys and judges should get involved as you have a right to medical decisions for your own behalf (or where you have legal authority over someone). If all of the hospitals in your area refuse to admit an intubated COVID patient and administer ivermectin, perhaps that should tell you something. Certainly more than what the crackpot doc, your ambulance chaser attorney, and various talking heads have told you. I seem to remember a case of whether a young woman was “dead” some years back, and whether medical staff or the young woman’s parents had the final authority to withdraw care. But that’s different than essentially forcing a hospital/health system to abide by a non-admitting provider’s plan of care.

 

[Heppenheimer]

Yeah, this doctor seems to be an idiot, but I'm looking at this with the assumption that most such cases would involve a competent doctor. I don't know that a judge with no medical expertise should be a factor here. Is there no governing body of doctors with the ability to say, no, you cannot treat a COVID patient with something that is not a treatment for a virus and could do more harm than good?

What if the situation were somehow reversed? A patient who can't be moved is being refused a reasonable treatment? There could be cases where someone is desperately calling a good doctor for help because their current setting is failing them.

The easiest solution to this problem is to transfer care to another attending provider (of course, only possible if there is more than one hospitalist on duty). When there's some kind of personal conflict between doctor and patient, this happens fairly frequently.

If this isn't an option, or if another provider will not take on the patient, most hospitals will have the ability to perform an internal ethics consult. If this doesn't reach the patient's or family member's (its usually a family member- we called this the "Out-of-town daughter syndrome") wishes, then they will try to facilitate transfer to another facility, if possible.

In my past life working as a hospitalist, I've been involved in one of these cases. The patient was in decompensated congestive heart failure. A family member wanted him transferred to a facility that could perform a valve repair, but our team was of the opinion that he was too unstable to transfer, and even if lived through the ride, he was unlikely to survive the procedure. The hospital where the family member wanted the patient sent initially refused, but after some back and forth , they agreed to take him. He died not 10 minutes after the ambulance left our hospital.

I've never previously heard of a situation requiring the action of a judge.

 

[Timmay]

I fail to see why it’s not helpful. People, even here, remain convinced Covid is no big deal. Contextualizing the numbers helps challenge that false assertion.

No, it doesn’t. You’re leaving out important numbers and facts when dealing with service member deaths during a war. It’s hypocritical to dismiss comparisons of annual Covid deaths vs cancer or heart disease and then turn around and push the comparisons to the number of deaths during wars, especially when leaving out important information. Comparisons at this point are worthless.

 

[Wendy Pleakley]

No, it doesn’t. You’re leaving out important numbers and facts when dealing with service member deaths during a war. It’s hypocritical to dismiss comparisons of annual Covid deaths vs cancer or heart disease and then turn around and push the comparisons to the number of deaths during wars, especially when leaving out important information. Comparisons at this point are worthless.

I don't read it as comparing the two scenarios directly, but just pointing out the sheer number of people who have died from and continue to die from COVID, and emphasizing it's more significant than many people seem to acknowledge.

 

[Heppenheimer]

. I seem to remember a case of whether a young woman was “dead” some years back, and whether medical staff or the young woman’s parents had the final authority to withdraw care.

If we're thinking of the same case, I believe that one was a dispute between the parents and the husband over who had the medical power of attorney. The medical staff, other than voicing their opinion, would have followed the directives of whoever had the decision rights, and I believe it was ultimately decided that this lay with the husband (as it usually does in such matters).

And incidentally, if I remember correctly, that case was in Florida.

 

[mmascari]

No, it doesn’t. You’re leaving out important numbers and facts when dealing with service member deaths during a war. It’s hypocritical to dismiss comparisons of annual Covid deaths vs cancer or heart disease and then turn around and push the comparisons to the number of deaths during wars, especially when leaving out important information. Comparisons at this point are worthless.

It's a scale question. People have problems with really big numbers. The comparison is to give the number scale and the size a context.

How does the number of yearly deaths from cancer or heart disease compare? How big is that number?

We spend a fortune every year trying to combat cancer and heart disease in their many different forms. How does say the number of deaths from a single type of cancer compare? What's the deadliest cancer? And is is transmissible? We also spend a fortune and have a gazillion regulation around preventing environmental pollution that's linked to causing cancer.

 

[Casper Gutman]

No, it doesn’t. You’re leaving out important numbers and facts when dealing with service member deaths during a war. It’s hypocritical to dismiss comparisons of annual Covid deaths vs cancer or heart disease and then turn around and push the comparisons to the number of deaths during wars, especially when leaving out important information. Comparisons at this point are worthless.

People have difficulty grasping big numbers. It’s hard to wrap your head around them. Comparing the numbers to something they already know is significant can help with that. How would you convey the scale of the pandemic to someone unable or unwilling to grasp it?

 

[Patcheslee]

And if the ivermectin causes complications (it isn't a particularly pleasant medication to take), is the judge going to recommend how to proceed from there?

The judge ordered 30mg daily for 3 weeks but the doctor who prescribed it, has previously stated the typical treatment works out to 9 3mg daily for 4 days in hospitalized patients weighting 200Lbs.
Is the judge going off on his own, or has this doc chosen to experiment?
Also his admiting privileges are for Kettering Medical Center.

 

[hopemax]

If we're thinking of the same case, I believe that one was a dispute between the parents and the husband over who had the medical power of attorney. The medical staff, other than voicing their opinion, would have followed the directives of whoever had the decision rights, and I believe it was ultimately decided that this lay with the husband (as it usually does in such matters).

And incidentally, if I remember correctly, that case was in Florida.

I think you are thinking about two different cases.

The FL case, and the one you are referring to, was Terry Schiavo, and was the first of these type of cases to reach national prominence. After a long court battle with her family, the husband was allowed to remove her feeding tube.

The other case, which is the one I think @sullyinMT is referencing was a teenage girl in CA, Jahi McMath, who was declared brain dead after a tonsillectomy in 2013. After legal battles and mediation, the hospital transferred her to the coroner, who issued a death certificate, but with her life support lines still intact, so the coroner transferred custody to the parents and she was transferred to an unknown facility. In 2018, the family finally came to terms and removed her from live support.

 

[MisterPenguin]

Number comparisons also have to be linked to results and effects.

If .02% of the population will contract an infectious rash that's slightly itch and goes away, who cares much if 656,000 Americans or one and half million people world wide catch it?

But if it's 656,000 Americans, or one and half million people around the world that die from a disease with the same infection rate in just one year... then it's a very significant statistic.


But its easy to make such numbers look 'small' by ignoring the significance of what the numbers mean (namely, human beings dead).

And its easy to make such numbers look 'small' by comparing them to arbitrarily big numbers:

"But 7 billion people survived!!" ​

"Millions of people die every year all the time!!" ​

The attempt to trivialize such numbers can be countered by comparing them to arbitrarily small numbers: "There's a serially killer out there who's killing 1000 people a year, but, since that's nothing compared to the number of deaths by car accidents, we're not going to bother to try to catch them or stop them!!!"

Yeah... we tend to try real hard to stop deaths when we're able. Even if it's only a thousand murder victims a year.

 

[Timmay]

It's a scale question. People have problems with really big numbers. The comparison is to give the number scale and the size a context.

How does the number of yearly deaths from cancer or heart disease compare? How big is that number?

We spend a fortune every year trying to combat cancer and heart disease in their many different forms. How does say the number of deaths from a single type of cancer compare? What's the deadliest cancer? And is is transmissible? We also spend a fortune and have a gazillion regulation around preventing environmental pollution that's linked to causing cancer.

If that were the case, one would have to have the numbers on people that served vs people that were deployed vs people in combat…on and on. There isn’t any context when simply saying more people have died from Covid than all US service members during warfare last century, especially when people don’t know what that number is, or even why that number is what it is. If you are knowledgeable about such things, you realize the post does a disservice to the severity of Covid, because deployed troops in WWI and WWII had a higher chance of dying (1-40) than someone infected with Covid does (1-61), and roughly the same as Covid in Viet Nam (1-58)

Here is a real simple way to make a better impact- More people have died in the US from Covid than people attend any single NFL teams home games annually.

 

[Virtual Toad]

If that were the case, one would have to have the numbers on people that served vs people that were deployed vs people in combat…on and on. There isn’t any context when simply saying more people have died from Covid than all US service members during warfare last century, especially when people don’t know what that number is, or even why that number is what it is. If you are knowledgeable about such things, you realize the post does a disservice to the severity of Covid, because deployed troops in WWI and WWII had a higher chance of dying (1-40) than someone infected with Covid does (1-61), and roughly the same as Covid in Viet Nam (1-58)

Here is a real simple way to make a better impact- More people have died in the US from Covid than people attend any single NFL teams home games annually.

Except that the NFL example is confusing. Attendance varies by team. Are you saying people who attend a single game? The same people attending multiple games? Or attendance as a whole? What is that number? Is it the team with the most attendance or average attendance throughout the year? Preseason and postseason games included?

Your example also conjures up the visual image of a single full football stadium, when even if that’s not what you intended, it gives the perception that the image of a single full football stadium represents the total number of COVID deaths.

All those questions muddle the precise number you are comparing COVID to, and paint a less dire situation or at least a comparison that conjures up more confusion than clarity.

 

[GoofGoof]

What do the people Who are double vaccinated and lying on their death bed, dying from covid say?

Or what would you say to the people who have gotten the vaccine and suffer from life changing side effects?

Since you asked for an answer to your questions:

#1 I can’t say for sure because I’m not in that situation but I would assume that a person in that situation would at least know they did everything they could to avoid being in that situation. Unlike the unvaccinated person from the post you quoted who in most cases will have some real regrets from not getting vaccinated. I know that’s how I would feel if it happened to me.

#2 I wouldn’t have any reason to say anything to someone who is sufferIng from life changing side effects from the vaccine. I would love to see some actual statistics on how many of these people exist, but I’m sure whatever numbers are out there would be disputed. The vast majority of adverse reactions involved arm pain and flu like symptoms which were hardly life changing.

The bottom line is vaccination is a risk/reward decision. If the reward of getting the vaccine is significantly greater than the risks involved than it’s a no brainer (which is this situation). When I’m talking risk/reward I am talking about society in general and not on an individual basis. Far more people would die and/or have life changing effects from getting covid than would from getting the vaccine and that doesn’t even factor in the impact to the economy, to children’s education or to the health of our hospitals and medical workers.

 

[Timmay]

Except that the NFL example is confusing. Attendance varies by team. Are you saying people who attend a single game? The same people attending multiple games? Or attendance as a whole? What is that number? Is it the team with the most attendance or average attendance throughout the year? Preseason and postseason games included?

Your example also conjures up the visual image of a single full football stadium, when even if that’s not what you intended, it gives the perception that the image of a single full football stadium represents the total number of COVID deaths.

All those questions muddle the precise number you are comparing COVID to, and paint a less dire situation or at least a comparison that conjures up more confusion than clarity.

It’s a far better example. Is it perfect? No. I never claimed it was. But it certainly has more of an impact. Most everyone knows what a full pro football stadium looks like. Multiply that over 8 games. Yeah…pretty clear.