6 ms·

If they are unvaccinated and they die, so what? They made their choice. The doctors ought to be saying "Well, well, well, if it isn't the consequences of your o

by umvi 5y ago

If they are unvaccinated and they die, so what? They made their choice. The doctors ought to be saying "Well, well, well, if it isn't the consequences of your own actions" not trying to force people to do something in order to save them from themselves. Then you always hear "well the real problem is that the unvaccinated are taking up ICU beds from non-covid patients that need them, etc." Ok, how long have we known about this problem now? Why are ICU beds such a fixed resource? Why can't we make temporary wards for unvaccinated covid patients to alleviate ICU beds? If this problem happened in the tech world it would be lambasted. "Please stop making requests to X website, it makes the server crash and then the people that really need to access it can't". Yeah DDoS attacks happen and are hard to prevent downtime, but if the server loading problem still persisted over a year and a half later people would be outraged that the company did nothing to try to meet the load. In the tech world when servers can't handle its load we start scaling (either automatically or manually) until the server can meet the load (or otherwise take some sort of mitigating action to alleviate the DoS). Hospitals need to innovate a way to do the same, "please don't get sick with covid because we have no way of scaling to meet load spikes" is such a crappy way of operating.

swader999 5y ago
Well you can't easily scale staff of course, especially when some of them take a decade to train.
- umvi 5y ago
  True, that is one limitation, but there are tons of other things you could do. A little innovation is required here. I do not believe it is an impossible problem. I think what's happening is that hospitals don't really want to innovate and are hoping to just wait for covid to blow over so then can return to "normal" operation and business-as-usual. But I say they need to innovate because this isn't the last pandemic that will ever happen, and hospitals need a way to deal with loading spikes and denial of service just like every other system susceptible to those things.
  - orra 5y ago
    > A little innovation is required here You can't 'innovate' a doubling of trained medical staff, not in a matter of months.
    - umvi 5y ago
      Innovation involves working around limitations. I already conceded that medical staff was a limitation. So how do you work around it? Training covid-specialized temps, perhaps? I don't know the answer because I'm not an expert in that problem domain. But I've innovated around similar limitations in my current domain expertise so I believe it is possible.
      - ben_w 5y ago
        > Training covid-specialized temps, perhaps? You can’t. That’s the point. Nursing, even at the lowest level, is not a trivial skill. The only people you could scale up at short notice like that — if there wasn’t also a general all-sector labour shortage — is nursing assistants, who have to generally do their thing under supervision of a registered nurse, which is an Associate degree or a Batchelor degree. (There is an intermediate level of Licensed Practical Nurse who can be unsupervised but can’t supervise others, which is “just” a one year vocational course). > But I've innovated around similar limitations in my current domain expertise so I believe it is possible. Unless you’ve innovated around a crippling multi-state demand spike, during a general labour marked supply shortage, in a sector where getting things wrong is literally lethal and where people sue for malpractice even for sub-lethal errors despite the government mandated minimum qualification levels, I think you are making an error in thinking your experience is transferable. (If you do have that experience, please share, as that sounds like one heck of an anecdote!) That said: One thing you could “innovate” that would technically work is making a roving vaccination drone that hunts down and forcibly vaccinates people that don’t want a vaccine. Even ignoring medical ethics, I don’t think that’s a great idea. But technically…
        umvi 5y ago
        > You can’t. That’s the point. Hmm, funny. I'm pretty sure I could train a non-programmer to do a specialized type of programming task in a few months if it were a crisis even though that person doesn't have a computer science degree. I don't see why healthcare is so much more difficult to train temporary specialists. Didn't we do it during WW2 (rapidly train medical specialists in a matter of months, aka medics, without a 4 year degree)? > Unless you’ve innovated around a crippling multi-state demand spike, during a general labour marked supply shortage, in a sector where getting things wrong is literally lethal and where people sue for malpractice even for sub-lethal errors despite the government mandated minimum qualification levels, I think you are making an error in thinking your experience is transferable. Yeah that's the real problem. Any innovations that alleviate the problem are going to run afoul of some bureaucratic, regulatory, and legal red tape put in place over the last century. So let me rephrase - I could probably innovate and solve this problem if I were a medical professional. But not without running afoul of some red tape somewhere. But I say red tape is meant to be broken in times of crisis.
bena 5y ago
> Why are ICU beds such a fixed resource? Because resources are finite. Not to mention, even if you have some extra to handle variable demand, exceptional circumstances are by their nature exceptional. It's irresponsible to carry that much more capacity when you'll only need it once a century. Take for example the recent Hurricane Ida. There's still trash and debris to pick up. There's still damage to be fixed, houses to be rebuilt, etc. Insurance claims to process and pay out. Why? Because there's going to be over 2 million cubic feet of vegetation to dispose of. Just in my parish. That's not considering the other parishes. Or other types of debris. There are trucks from several states and they've been working most days. And we still need to get rid of downed trees. Because every house is going to have a claim. Every house is going to need some form of repair. Thousands of houses. All at once. We aren't prepared to handle that sort of scale. And having the resources to handle that sort of scale is just going to languish when its not needed. It'll be waste. Same deal with COVID. COVID is filling ICUs at a scale that is wasteful to keep on hand during normal operations. And I'm sorry, saying they "need to innovate" is just the laziest criticism one can make. It exposes the fact that you have not thought of the problem at all beyond noticing the obvious lack of resources. Congratulations for noticing the obvious. How are they supposed to innovate? How do you know they haven't created temporary wards (they have where they could)? What does it take to make a site appropriate for an ICU ward? Etc, etc. There are problems that you don't even know exist because you don't know the problem domain. And that's ok. You're not expected to. But don't armchair quarterback the domain experts who have been working on this problem for the past year. It's not as smart as you think it is.
- umvi 5y ago
  > Because resources are finite. Okay, then why are hospital resources more finite than non-hospital resources that can scale? > It's irresponsible to carry that much more capacity when you'll only need it once a century But you need it for at least 2-3% of the century it seems, so the current model of "please don't overload our beds for 2-3 years" doesn't seem very sustainable either. It's almost like you want Amazon-style "elastic" resources that only kick in when you need them. > Same deal with COVID. COVID is filling ICUs at a scale that is wasteful to keep on hand during normal operations. So don't keep them on hand. Figure out a way to mobilize the resources when you need them. > What does it take to make a site appropriate for an ICU ward? For one thing, maybe making "a site appropriate for an ICU ward" is too stringent a requirement in times of crisis and overloading? My solution: Setup circus tents in the parking lot reserved for unvaccinated covid patients where they can sleep on army cots with fewer ICU resources and where they die at higher rates than the normal ICU. Bam, problem solved. Now the normal ICU is at normal capacity again and unvaccinated covid patients can still receive some limited form of care. If they die at higher rates, oh well, that's a consequence of not getting vaccinated and the direct result of their own choices. And it's better than letting vaccinated heart attack patients die because their unvaccinated comrades took up all the beds and it's also better than taking away everyone's freedom and forcing the vaccination upon everyone. Because now everyone is happy. The unvaccinated still have their freedom, the vaccinated still have their ICU beds. I'm sure people more familiar with the problem domain could come up with something much better than circus tents in a parking lot. My point was that everyone seems to have accepted that hospitals are inflexible and that the only way to solve the problem is to flatten the curve indefinitely and I don't accept that. Sure, flatten the curve initially, but only until you figure out a better long term solution to dealing with loading spikes.
robotresearcher 5y ago
> If they are unvaccinated and they die, so what? Every infected person is host to the evolution of the virus. It is likely to become vaccine resistant given enough reproduction cycles. And it could become more, or less, deadly. If it starts killing children quickly, like measles, and is vaccine resistant because we let it simmer in 35% of the population, we will be very sorry. Our best defense against this is to vaccinate as quickly as possible. Measles now rarely kills our children, due to vaccination.
- swader999 5y ago
  Measles is fundamentally different. Asymptomatic transmission and zootic reservoirs have no impact. It's not a leaky vaccine and we aren't in the midst of a measles pandemic. Long lasting sterile immunity is provided by the measles vaccine. It makes a lot of sense to mass vaccinate for measles.
  - deleted 5y ago
    [deleted]
crooked-v 5y ago
> Why are ICU beds such a fixed resource? Because there are only a limited number of trained nurses and doctors available. "ICU beds" as a metric actually means the number of patients the staff is able to care for, not the literal number of physical beds.

by umvi 5y ago

swader999 5y ago

Well you can't easily scale staff of course, especially when some of them take a decade to train.

umvi 5y ago
True, that is one limitation, but there are tons of other things you could do. A little innovation is required here. I do not believe it is an impossible problem. I think what's happening is that hospitals don't really want to innovate and are hoping to just wait for covid to blow over so then can return to "normal" operation and business-as-usual. But I say they need to innovate because this isn't the last pandemic that will ever happen, and hospitals need a way to deal with loading spikes and denial of service just like every other system susceptible to those things.
- orra 5y ago
  > A little innovation is required here You can't 'innovate' a doubling of trained medical staff, not in a matter of months.
  - umvi 5y ago
    Innovation involves working around limitations. I already conceded that medical staff was a limitation. So how do you work around it? Training covid-specialized temps, perhaps? I don't know the answer because I'm not an expert in that problem domain. But I've innovated around similar limitations in my current domain expertise so I believe it is possible.
    - ben_w 5y ago
      > Training covid-specialized temps, perhaps? You can’t. That’s the point. Nursing, even at the lowest level, is not a trivial skill. The only people you could scale up at short notice like that — if there wasn’t also a general all-sector labour shortage — is nursing assistants, who have to generally do their thing under supervision of a registered nurse, which is an Associate degree or a Batchelor degree. (There is an intermediate level of Licensed Practical Nurse who can be unsupervised but can’t supervise others, which is “just” a one year vocational course). > But I've innovated around similar limitations in my current domain expertise so I believe it is possible. Unless you’ve innovated around a crippling multi-state demand spike, during a general labour marked supply shortage, in a sector where getting things wrong is literally lethal and where people sue for malpractice even for sub-lethal errors despite the government mandated minimum qualification levels, I think you are making an error in thinking your experience is transferable. (If you do have that experience, please share, as that sounds like one heck of an anecdote!) That said: One thing you could “innovate” that would technically work is making a roving vaccination drone that hunts down and forcibly vaccinates people that don’t want a vaccine. Even ignoring medical ethics, I don’t think that’s a great idea. But technically…
      - umvi 5y ago
        > You can’t. That’s the point. Hmm, funny. I'm pretty sure I could train a non-programmer to do a specialized type of programming task in a few months if it were a crisis even though that person doesn't have a computer science degree. I don't see why healthcare is so much more difficult to train temporary specialists. Didn't we do it during WW2 (rapidly train medical specialists in a matter of months, aka medics, without a 4 year degree)? > Unless you’ve innovated around a crippling multi-state demand spike, during a general labour marked supply shortage, in a sector where getting things wrong is literally lethal and where people sue for malpractice even for sub-lethal errors despite the government mandated minimum qualification levels, I think you are making an error in thinking your experience is transferable. Yeah that's the real problem. Any innovations that alleviate the problem are going to run afoul of some bureaucratic, regulatory, and legal red tape put in place over the last century. So let me rephrase - I could probably innovate and solve this problem if I were a medical professional. But not without running afoul of some red tape somewhere. But I say red tape is meant to be broken in times of crisis.

bena 5y ago

> Why are ICU beds such a fixed resource? Because resources are finite. Not to mention, even if you have some extra to handle variable demand, exceptional circumstances are by their nature exceptional. It's irresponsible to carry that much more capacity when you'll only need it once a century. Take for example the recent Hurricane Ida. There's still trash and debris to pick up. There's still damage to be fixed, houses to be rebuilt, etc. Insurance claims to process and pay out. Why? Because there's going to be over 2 million cubic feet of vegetation to dispose of. Just in my parish. That's not considering the other parishes. Or other types of debris. There are trucks from several states and they've been working most days. And we still need to get rid of downed trees. Because every house is going to have a claim. Every house is going to need some form of repair. Thousands of houses. All at once. We aren't prepared to handle that sort of scale. And having the resources to handle that sort of scale is just going to languish when its not needed. It'll be waste. Same deal with COVID. COVID is filling ICUs at a scale that is wasteful to keep on hand during normal operations. And I'm sorry, saying they "need to innovate" is just the laziest criticism one can make. It exposes the fact that you have not thought of the problem at all beyond noticing the obvious lack of resources. Congratulations for noticing the obvious. How are they supposed to innovate? How do you know they haven't created temporary wards (they have where they could)? What does it take to make a site appropriate for an ICU ward? Etc, etc. There are problems that you don't even know exist because you don't know the problem domain. And that's ok. You're not expected to. But don't armchair quarterback the domain experts who have been working on this problem for the past year. It's not as smart as you think it is.

umvi 5y ago
> Because resources are finite. Okay, then why are hospital resources more finite than non-hospital resources that can scale? > It's irresponsible to carry that much more capacity when you'll only need it once a century But you need it for at least 2-3% of the century it seems, so the current model of "please don't overload our beds for 2-3 years" doesn't seem very sustainable either. It's almost like you want Amazon-style "elastic" resources that only kick in when you need them. > Same deal with COVID. COVID is filling ICUs at a scale that is wasteful to keep on hand during normal operations. So don't keep them on hand. Figure out a way to mobilize the resources when you need them. > What does it take to make a site appropriate for an ICU ward? For one thing, maybe making "a site appropriate for an ICU ward" is too stringent a requirement in times of crisis and overloading? My solution: Setup circus tents in the parking lot reserved for unvaccinated covid patients where they can sleep on army cots with fewer ICU resources and where they die at higher rates than the normal ICU. Bam, problem solved. Now the normal ICU is at normal capacity again and unvaccinated covid patients can still receive some limited form of care. If they die at higher rates, oh well, that's a consequence of not getting vaccinated and the direct result of their own choices. And it's better than letting vaccinated heart attack patients die because their unvaccinated comrades took up all the beds and it's also better than taking away everyone's freedom and forcing the vaccination upon everyone. Because now everyone is happy. The unvaccinated still have their freedom, the vaccinated still have their ICU beds. I'm sure people more familiar with the problem domain could come up with something much better than circus tents in a parking lot. My point was that everyone seems to have accepted that hospitals are inflexible and that the only way to solve the problem is to flatten the curve indefinitely and I don't accept that. Sure, flatten the curve initially, but only until you figure out a better long term solution to dealing with loading spikes.

robotresearcher 5y ago

> If they are unvaccinated and they die, so what? Every infected person is host to the evolution of the virus. It is likely to become vaccine resistant given enough reproduction cycles. And it could become more, or less, deadly. If it starts killing children quickly, like measles, and is vaccine resistant because we let it simmer in 35% of the population, we will be very sorry. Our best defense against this is to vaccinate as quickly as possible. Measles now rarely kills our children, due to vaccination.

swader999 5y ago
Measles is fundamentally different. Asymptomatic transmission and zootic reservoirs have no impact. It's not a leaky vaccine and we aren't in the midst of a measles pandemic. Long lasting sterile immunity is provided by the measles vaccine. It makes a lot of sense to mass vaccinate for measles.
- deleted 5y ago
  [deleted]

crooked-v 5y ago

> Why are ICU beds such a fixed resource? Because there are only a limited number of trained nurses and doctors available. "ICU beds" as a metric actually means the number of patients the staff is able to care for, not the literal number of physical beds.