5 ms·

My biggest fear is an antivaxxer taking up an ER bed someone else might need for a real issue. IMO antivaxxers should be denied admission to a full ER for COVI

My biggest fear is an antivaxxer taking up an ER bed someone else might need for a real issue. IMO antivaxxers should be denied admission to a full ER for COVID-related morbidities if they have not taken the vaccine. If they would like to make the bodily choice of not getting the vaccine, they can also make the bodily choice of not getting emergency treatment. At some point a line has to be drawn. When resources are low, care should be prioritized amongst those that will make the most of it, or rather - those that won't spit in its face.

timbo1642 5y ago
rogerkirkness 5y ago
Omicron is much less likely to hospitalize people, it never reached a concerning level in South Africa and cases are falling fast. I could see wanting covid patients to pay for it themselves, but denying them entry is ridiculously cruel.
- xvector 5y ago
  What is cruel, is not doing the bare minimum as a member of society and needlessly taking up precious ER resources that other responsible and well-meaning members of society might need. To clarify, rather than denial of entry, I am suggesting deprioritization in the ER. If someone got into a car crash tomorrow and the ER is full, given a similar expected mortality between the crash victim and antivaxxer, the antivaxxer should be ejected to make room. Today we are already seeing that antivaxxers are saturating ERs and people have to wait hours for serious issues. I do not think it is particularly controversial to say that the antivaxxer is less deserving of care.
  - iab 5y ago
    Whether people agree with you or not isn't the real issue here IMO. If this approach were to be adopted, it would be up to the physicians and other front-line workers to make the prioritization call, which adds too much of a burden to them.
    - xvector 5y ago
      Sure, and it's probably against policy, the Hippocratic Oath, etc. But if you talk to nurses, visit r/nursing, etc - the sentiment is clear. Front line workers are sick of having to prioritize antivax bed-wasters over people with real issues.
      - iab 5y ago
        I actually agree with the sentiment, but there is just no way to realistically apply this. There will always be a significant number of people in the "gray" zone (can't get vaccinated because of some other health condition, as a simple example) and so the burden of determining who is "good" and who is no tis on the already over-burdened staff. This is why triage has historically been, and will conceivably always be, the way hospitals adjudicate care .
  - a3camero 5y ago
    I'd like to take up a different view on this issue, in the hope that this discussion helps to understand this issue from a different vantage point. Neither of us make any rules for anyone else, so this is an academic discussion anyway. I hope you're not offended by the disagreement, as it's driven only by an interest in moving toward a better position on this issue, not internet points or personal malice (& you're using a pseudonym anyway). At the moment, I don't read in this comment what seems like the right answer, but it's also a short version, and maybe my own thoughts on this are wrong - thank you at the very least for posting this, as it's given me an opportunity to think more about a different position. Below is a different point of view. -- Many people do not even do the "bare minimum" as a member of society, and they should be treated, to the greatest degree possible, like the people who do the maximum, or even just the usual. High-tax paying people, beloved teachers, famous artists, despised criminals - they should all be treated as humans, with the appropriate medical treatment according to their human needs, not their moral failures or victories. People are the product of society, and a component in it, and they should not be judged by stereotypes, or even judged at all, when it comes to responding to their medical needs. Ideally, we'd take this approach in every area of life, but this is especially justified when applied to injured and sick people. "Misguided" is a more useful frame for many people than "evil". Triage by prior behaviour is a poor basis for healthcare. Everyone has their own group of people they like less or more, according to their prior experiences. More importantly, the time to judge someone's moral behaviour is not at the point of healthcare delivery. Even if mistakes never happened, and your moral views are correct and correctly applied, it wouldn't be right to apply this rule because it would be the first step away from neutrality. The status quo of neutrality is a good rule, even if on rare occasions it results in seriously injured violent criminals receiving medical treatment ahead of sick nuns. Because almost all of the time it's the rule that is the most human, on our best behaviour. And especially so when we consider that many of our own views are not solely attributable to our individual choice but are in fact strongly influenced by our place in society. Once immoral individual behaviour is the yardstick for medical behaviour, perhaps based on views about groups, it's difficult to know when you've strayed off the moral path.
    - edmundsauto 5y ago
      Triage by prior behavior is effectively prioritizing by who got there first. I don't think that's optimal. When hospital resources become limited, I support prioritizing people who took bare minimum steps to prevent being in that situation. Not to mention the associated dangers to staff that come along with the non-vaccinated population. My sister is an ICU nurse in a C19 ward, and has been threatened many times, screamed at countless times, by families of people with C19. They are all, as near as she can tell, of a certain tribe.
- dredmorbius 5y ago
  South Africa has an epidemiologically sophisticated population. That is, most people have already been exposed to Covid-19, conveying natural immunity, despite low vaccination rates (of about 25%). Extrapolating SA findings to other countries may be premature, though the actual severity of the Omicron variant remains an area of intense interest and investigation. Mild or otherwise, the US will all but certainly know within a month. Wishing for the more convenient answer may prove harmful or deadly to many.
throwaway488392 5y ago
postsantum 5y ago
How come resources are still low two years into the pandemic? If the situation is so grave, wouldn't something be done by now? Could it be possible that you're attacking wrong people?
- dredmorbius 5y ago
  The problem with infectious disease is that incidence rates vary tremendously over time. Growth is initially exponential. In the case of the Covid Omicron variant, doubling times are 2.3 days, giving 10x growth in 1 week, 100x growth in 2. Any reasonable capacity is immediately overwhelmed. With uncontrolled spread, major fractions of the population are infected at the same time, and even with "mild" variants of a disease, a small fraction of a very large number remains a large number. The excess capacity required to serve a severe outbreak is necessary only for those periods of peak outbreaks. China saw emergency treatment facilities built within two weeks, and demolished several months later. Structures can be scaled with some efficacy. Staff and equipment (remember the ventilator shortages) not so much. And again, the peak loads are far above any long-term maintenance level. Graphically represented here: https://en.wikipedia.org/wiki/COVID-19_pandemic#/media/File%3A20200410_Flatten_the_curve%2C_raise_the_line_-_pandemic_(English).gif https://en.wikipedia.org/wiki/COVID-19_pandemic#/media/File%...
- dude187 5y ago
  Hospitals are strained most Winters. There's really nothing special about right now
muzika 5y ago
- xvector 5y ago
  If curing your obesity was as easy as getting a free shot, then yes, you should be deprioritized in the ER for obesity-related issues if you refused said shot. > We are not running out of ER beds. It’s all propaganda This is insane. I know someone who had a burst appendix and couldn't be seen for hours because the beds were full of anti-vaxxers. Have you visited an ER recently? Talked to a nurse?
  - muzika 5y ago
    Took my son to ER about 2 months ago. We were the only ones in the lobby when we came in. There were very few patients, most rooms were empty. Granted that’s only one data point here.
ifyoubuildit 5y ago
> My biggest fear is an antivaxxer taking up an ER bed someone else might need for a real issue. There is a lot of fear to go around. Someone out there has as their biggest fear being forced to have a medical procedure that then gives them lifelong medical problems, problems that might be shrugged off by doctors/family/friends, and even if they can find someone to believe that their plight is real, they can't find anyone that can fix it. Is that a likely outcome? It doesn't look like it to me or you. But someone out there has that fear just like you have yours. You may believe your fear to be more justified, and it may even be so. But that doesn't change that other people have their fears that they can't get away from, and that no proclamations like yours will cure them of. Put aside for a second what all the talking heads and the bureaucrats and the internet commenters are saying, and remember that there are people, actual living and breathing people behind such a one dimensional label as "antivaxxer". Whatever cartoon character you dream up when you hear that word, you can bet that it misses more folks than it hits.
- xvector 5y ago
  Sure, I see what you mean. And a crippled alcoholic may truly and desperately believe that her alcoholism does not cause liver problems. Yet, she will still be deprioritized for a liver transplant when compared to a fit individual. We cannot take people's delusions into account when giving care. But what we can take into account is "will they make the most of this care?" And for both the alcoholic and antivaxxer, the answer is a resounding and objective "no."
  - landemva 5y ago
    To the list of denying care to antivaxxer and alcoholic, would it be reasonable to add the obese? Being fat is a co-morbidity and often a lifestyle choice.
    - xvector 5y ago
      We do in fact deprioritize transplants to the obese. The average waiting time for a kidney transplant for an obese person is 5 years, as opposed to 3 years for a healthy person. And if curing your obesity was as easy as getting a shot, of course you should be deprioritized for related morbidities.
dude187 5y ago
That's an evil stance to take

timbo1642 5y ago

rogerkirkness 5y ago

Omicron is much less likely to hospitalize people, it never reached a concerning level in South Africa and cases are falling fast. I could see wanting covid patients to pay for it themselves, but denying them entry is ridiculously cruel.

xvector 5y ago
What is cruel, is not doing the bare minimum as a member of society and needlessly taking up precious ER resources that other responsible and well-meaning members of society might need. To clarify, rather than denial of entry, I am suggesting deprioritization in the ER. If someone got into a car crash tomorrow and the ER is full, given a similar expected mortality between the crash victim and antivaxxer, the antivaxxer should be ejected to make room. Today we are already seeing that antivaxxers are saturating ERs and people have to wait hours for serious issues. I do not think it is particularly controversial to say that the antivaxxer is less deserving of care.
- iab 5y ago
  Whether people agree with you or not isn't the real issue here IMO. If this approach were to be adopted, it would be up to the physicians and other front-line workers to make the prioritization call, which adds too much of a burden to them.
  - xvector 5y ago
    Sure, and it's probably against policy, the Hippocratic Oath, etc. But if you talk to nurses, visit r/nursing, etc - the sentiment is clear. Front line workers are sick of having to prioritize antivax bed-wasters over people with real issues.
    - iab 5y ago
      I actually agree with the sentiment, but there is just no way to realistically apply this. There will always be a significant number of people in the "gray" zone (can't get vaccinated because of some other health condition, as a simple example) and so the burden of determining who is "good" and who is no tis on the already over-burdened staff. This is why triage has historically been, and will conceivably always be, the way hospitals adjudicate care .
- a3camero 5y ago
  I'd like to take up a different view on this issue, in the hope that this discussion helps to understand this issue from a different vantage point. Neither of us make any rules for anyone else, so this is an academic discussion anyway. I hope you're not offended by the disagreement, as it's driven only by an interest in moving toward a better position on this issue, not internet points or personal malice (& you're using a pseudonym anyway). At the moment, I don't read in this comment what seems like the right answer, but it's also a short version, and maybe my own thoughts on this are wrong - thank you at the very least for posting this, as it's given me an opportunity to think more about a different position. Below is a different point of view. -- Many people do not even do the "bare minimum" as a member of society, and they should be treated, to the greatest degree possible, like the people who do the maximum, or even just the usual. High-tax paying people, beloved teachers, famous artists, despised criminals - they should all be treated as humans, with the appropriate medical treatment according to their human needs, not their moral failures or victories. People are the product of society, and a component in it, and they should not be judged by stereotypes, or even judged at all, when it comes to responding to their medical needs. Ideally, we'd take this approach in every area of life, but this is especially justified when applied to injured and sick people. "Misguided" is a more useful frame for many people than "evil". Triage by prior behaviour is a poor basis for healthcare. Everyone has their own group of people they like less or more, according to their prior experiences. More importantly, the time to judge someone's moral behaviour is not at the point of healthcare delivery. Even if mistakes never happened, and your moral views are correct and correctly applied, it wouldn't be right to apply this rule because it would be the first step away from neutrality. The status quo of neutrality is a good rule, even if on rare occasions it results in seriously injured violent criminals receiving medical treatment ahead of sick nuns. Because almost all of the time it's the rule that is the most human, on our best behaviour. And especially so when we consider that many of our own views are not solely attributable to our individual choice but are in fact strongly influenced by our place in society. Once immoral individual behaviour is the yardstick for medical behaviour, perhaps based on views about groups, it's difficult to know when you've strayed off the moral path.
  - edmundsauto 5y ago
    Triage by prior behavior is effectively prioritizing by who got there first. I don't think that's optimal. When hospital resources become limited, I support prioritizing people who took bare minimum steps to prevent being in that situation. Not to mention the associated dangers to staff that come along with the non-vaccinated population. My sister is an ICU nurse in a C19 ward, and has been threatened many times, screamed at countless times, by families of people with C19. They are all, as near as she can tell, of a certain tribe.
dredmorbius 5y ago
South Africa has an epidemiologically sophisticated population. That is, most people have already been exposed to Covid-19, conveying natural immunity, despite low vaccination rates (of about 25%). Extrapolating SA findings to other countries may be premature, though the actual severity of the Omicron variant remains an area of intense interest and investigation. Mild or otherwise, the US will all but certainly know within a month. Wishing for the more convenient answer may prove harmful or deadly to many.

throwaway488392 5y ago

postsantum 5y ago

How come resources are still low two years into the pandemic? If the situation is so grave, wouldn't something be done by now? Could it be possible that you're attacking wrong people?

dredmorbius 5y ago
The problem with infectious disease is that incidence rates vary tremendously over time. Growth is initially exponential. In the case of the Covid Omicron variant, doubling times are 2.3 days, giving 10x growth in 1 week, 100x growth in 2. Any reasonable capacity is immediately overwhelmed. With uncontrolled spread, major fractions of the population are infected at the same time, and even with "mild" variants of a disease, a small fraction of a very large number remains a large number. The excess capacity required to serve a severe outbreak is necessary only for those periods of peak outbreaks. China saw emergency treatment facilities built within two weeks, and demolished several months later. Structures can be scaled with some efficacy. Staff and equipment (remember the ventilator shortages) not so much. And again, the peak loads are far above any long-term maintenance level. Graphically represented here: https://en.wikipedia.org/wiki/COVID-19_pandemic#/media/File%3A20200410_Flatten_the_curve%2C_raise_the_line_-_pandemic_(English).gif https://en.wikipedia.org/wiki/COVID-19_pandemic#/media/File%...
dude187 5y ago
Hospitals are strained most Winters. There's really nothing special about right now

muzika 5y ago

xvector 5y ago
If curing your obesity was as easy as getting a free shot, then yes, you should be deprioritized in the ER for obesity-related issues if you refused said shot. > We are not running out of ER beds. It’s all propaganda This is insane. I know someone who had a burst appendix and couldn't be seen for hours because the beds were full of anti-vaxxers. Have you visited an ER recently? Talked to a nurse?
- muzika 5y ago
  Took my son to ER about 2 months ago. We were the only ones in the lobby when we came in. There were very few patients, most rooms were empty. Granted that’s only one data point here.

ifyoubuildit 5y ago

> My biggest fear is an antivaxxer taking up an ER bed someone else might need for a real issue. There is a lot of fear to go around. Someone out there has as their biggest fear being forced to have a medical procedure that then gives them lifelong medical problems, problems that might be shrugged off by doctors/family/friends, and even if they can find someone to believe that their plight is real, they can't find anyone that can fix it. Is that a likely outcome? It doesn't look like it to me or you. But someone out there has that fear just like you have yours. You may believe your fear to be more justified, and it may even be so. But that doesn't change that other people have their fears that they can't get away from, and that no proclamations like yours will cure them of. Put aside for a second what all the talking heads and the bureaucrats and the internet commenters are saying, and remember that there are people, actual living and breathing people behind such a one dimensional label as "antivaxxer". Whatever cartoon character you dream up when you hear that word, you can bet that it misses more folks than it hits.

xvector 5y ago
Sure, I see what you mean. And a crippled alcoholic may truly and desperately believe that her alcoholism does not cause liver problems. Yet, she will still be deprioritized for a liver transplant when compared to a fit individual. We cannot take people's delusions into account when giving care. But what we can take into account is "will they make the most of this care?" And for both the alcoholic and antivaxxer, the answer is a resounding and objective "no."
- landemva 5y ago
  To the list of denying care to antivaxxer and alcoholic, would it be reasonable to add the obese? Being fat is a co-morbidity and often a lifestyle choice.
  - xvector 5y ago
    We do in fact deprioritize transplants to the obese. The average waiting time for a kidney transplant for an obese person is 5 years, as opposed to 3 years for a healthy person. And if curing your obesity was as easy as getting a shot, of course you should be deprioritized for related morbidities.

dude187 5y ago

That's an evil stance to take