[XogGyux]

This is triage, not ethics. The makeup of the rules of triage incorporate ethical considerations, but triage is about making the best of a bad situation.

I don't think it is quite that simple. What I have seen with covid is not so much an overwhelming rate of admission, but rather a very slow and smoldering one. The issue is, unlike the many other reasons for admission, the covid patient ends up using a lot more resources. Take for instance the typical decompensated heart failure. We admit on monday, give high doses of diuretics on monday, tuesday, and wednesday morning they can leave either home or to a nursing facility/rehab depending on their functional status. The covid patient when they are "less sick" ends up staying in the hospital 5 days minimum due to the treatment being 5 days, then... if we are lucky, we can send them home on oxygen if they are young. However, if they are older and/or weak many facilities won't take them for many more days until they either test negative or until after 10+ days of being diagnosed... so they end up in the hospital a long time.
Then lets talk about ICU. Prior to covid, my typical ICU patient was either a DKA, a stroke patient, or someone that had undergone cardiac surgery. With the exception of large strokes, vast majority of these patients would stay 2-3 days then go to regular floor.
COVID patients in the ICU are requiring maximum treatment.
Do you know what goes into a covid patient?
So they get intubated, so that is a tube down their trachea to give air to their lungs.
They get a nasogastric tube, this is a small plastic tube that is inserted inside the nose and goes all the way to the stomach to provide nutrition.
Most often than not, they also need a central line, this is a plastic catheter (tube) that is about the thickness of an iphone charger cable. It is usually inserted in the neck's vein, but sometimes it can be done in the chest or in the groin.
Then there is the foley catheter, it is inserted inside the urethra, which is the small hole in the penis (for males) or in women just above the vagina.
For feces, we have 2 widely used options. There are rectal tubes, or there is the option of just letting the patient shit on themselves and then clean them. In the case of covid, since they are intubated for such a long time, usually they get a rectal tube. And it is exactly what it sounds like, a tube that is inserted inside your rectum to evaquate your poop.
Most patient with COVID, at some point are in "shock", meaning their blood pressure is too low. This happens when your regulatory system is overwhelmed due to severe infection, this happens when you get a superimposed infection, this happens when your heart gets weak, this happens when you get a large pulmonary embolus/lung disease. Or sometimes it is just the sedatives that make your blood pressure low. Either way, most of these patients end up getting an "arterial line" which is similar to an IV, but insted of being inserted into a vein, it goes into an artery (way more painful) so that we can measure your blood pressure accurately.

Now... that is "standard" for 90%+ of covid patients.
Then we have the "extras". For instance... there is pronation therapy. In which the patient is flipped over either manually or with a machine. Pronation is oftentimes necesary because covid patients do better, oxygen requirements wise, when they are flipped and lie on their abdomens. The problem with this, is that all those cables and tubes in your face tend to put pressure on your skin, so you get nasty ulcers if the nurses are not on top of their shit (which is not rare, given that they are understaffed. Sometimes pronation is done with a super bulky and expensive machine that hospital rent out.
Then we got dialysis. Many patients in the ICU with covid end up requiring dialysis at some point. Medications that we give for covid and/or bacterial superinfections are nephrotoxic, and if your blood pressure drops (e.g. a code) this can also damage your kidneys, not to mention potentially using contrast to look for PEs. As a result, kidney failure is fairly common. Dialysis means putting a catheter in you, getting a bunch of your blood out of your body, passing it through a filter and then putting it back into your body.
THen we have ECMO. At this point you are "sick as shit", your lungs, your heart, or both are fucked up. The ICU doctor doesn't know what the fuck else to do, asks a vascular surgeon to put 2x large hose-sized tubes on you (usually groin, sometimes neck) so we can get your blood out of your body and into a machine that will do your heart and lung's work. At this point, your chances of survival are dismal at best. Perhaps you'd be one of the "lucky ones" that go for a lung transplant. This is fucked up, because lungs are notoriously hard to keep after transplant. I am not a lung transplant specialists but my understanding is that nearly 100% of them will be rejected and the real question is how lung you can survive with it.

[late]

I don't think it is quite that simple.

I suspect it is when your facility has more patients than it can handle.

[XogGyux]

I suspect it is when your facility has more patients than it can handle.

Then I am very glad you are not a physician in the facility that I work.
Let's start with the logistics of this nonsense. How do you reckon we would discriminate between vaccinated and non-vaccinated people? The card? I had one, it was a piece of cardboard with some random's person handwriting on it. Something that anyone could easily print on a printer, not that sophisticated.
How do you think we know who is vaccinated and who isen't? It is not that hard. We ask them, and they tell us. It is self-reported the vast majority of time. Meaning, they could just lie. In fact, if whether they get care or not, depended on lying about having got the vaccine, I promise you most of them would lie. This in turn would mean that the efficiency of the vaccine would be perceived to be vastly inferior because now there are a bunch of people getting sick, which "supposedly" they got vaccinated. Now we have a bigger problem, we don't know the real efficiency of the vaccine, and now you have a bunch of people that didn't want to get the vaccine in the first place, now they are "justified" because the vaccine is perceived to be less efficacious.
Again, even if we forget the ethical and legal implications of this nonsense... the reality is that we cannot even enforce it and even if we could enforce it, we don't have the staff needed to properly do it.
This is nonsense.
Then... you are suggesting we do not treat a anti-vaxxer with covid... what about the drunk driver that crashed and injured another person? That drunk driver does not get treatment either? What about the diabetic that was not taking his medications... surely he cannot get treatment right?

[Rancid]

Apparently there is a doctor in Alabama that has refused to treat non-vaccinated people. Apparently a few of hi patients have decided to get the vaccination as a result.

[Politics_Observer]

@Rancid

I figured it would eventually come to a point where doctors would start refusing to treat unvaccinated patients. I am not surprised. That what I call a little bit of "tough love" from the doctor.

[late]

T

Then... you are suggesting we do not treat a anti-vaxxer with covid...

Not at all.

You pick those with the best chance of survival, some of those that don't make the cut won't have gotten the vaccine.

[XogGyux]

Not at all.

You pick those with the best chance of survival, some of those that don't make the cut won't have gotten the vaccine.

What about an antivaxxer with good chance of recovering vs an old guy that got the vaccine but is not doing so well?

How would you approach this. Lets say you are the critical care doc.
Your icu has 1 spot left. you already had a guy in the ventilator, his chances are not too good but earlier in the day you had called the family explaining the plan you had for him. Now you got 2 more, perhaps with slightly higher chances. Who gets the other free room?

Then there is the issue of how you judge who is more likely to make it... The covid patients that make it all the way to the vent, are the sickest. They are all critical. ICU stands for "CRITICAL" unit. Yes with experience you might be able to "guestimate" who is more likely to make it. But it is just an estimation. The reality is we don't know. The young guy with no comorbidities may throw a pulmonary embolus on day 14th and throw a wrench on your plans.

[AFAIK]

@XogGyux
Why are you unable to look up people's medical records on computers?

What if someone tells you they're DNR, blood type O, allergic to insulin? Do you just take their word for it?

[Igor Antunov]

None of these are medically approved inoculations. They've been allowed for use by governments. Long term effects are unknown and many of the side-effects mimic the long term effects of the virus itself. Doctors are ethically obligated to let every person taking the inoculation know this. Giving it to kids and younger people is a probable crime and I am eager to see those responsible punished in future.

[XogGyux]

@XogGyux
Why are you unable to look up people's medical records on computers?

What if someone tells you they're DNR, blood type O, allergic to insulin? Do you just take their word for it?

Ofcourse we take their word for it. DNR is their choice, even if the records from a different hospitalization says they were "full code" if today patient comes to me and says they are DNR, they are in fact DNR. In the US, we might take the additional precaution of having them sign a paper right there in the hospital just so that the family does not come later to sue us... but that precaution is technically not necessary, all the patient has to do is to say they don't want to be recusitated and thats the end of the discussion.
The allergies is something that mostly comes out of the patient. It is rare for the allergic reaction to occur while in the hospital and the healtcare staff to be the first to document it. More often than not, it is the patient that states their allergies from prior exposures. Oftentimes it is inaccurate, it appears most people are "allergic to penicillin" and they will keep that incorrect "allergy" in their records forever until there is either a mistake and they get it and nothing happens (and it is removed subsequently from the "listed allergies") or until a baller doctor says "enough is enough" and removes it based on the reported reaction (e.g. "nausea and vomiting" is not an allergic reaction), this does not happen often however.

As for blood-type, most people don't know their blood type. This is not important anyways as in the US we routinely do type and screen before giving any blood products and if it is an emergency we just use blood that is O-.

Then there is the issue of eMAR communication between institutions. There is almost none. We are in the 21st century, I can take a 4k slow motion video with augmented reality of my junk, I can edit it on my phone and add some embellishments and send it over cellular network from the comfort of my recliner at the beach. Do you know how we share records between hospitals? We get the patient to sign a form, we fax this form to the other hospital. The other hospital sees the form, looks up the patient, prints the records, then scan the records, then fax the records to the hospital that requested it, then a nurse grabs the records and puts them into the patient's physical chart. Sometimes, after patient is discharged, when the physical chart goes to medical record departments, someone scans those documents and buries them inside some sort of file system that nobody knows how to access . This is not a highly sofisticated system as you can imagine. As far as I know, there is no universal/national or state database of vaccines given. A patient might have gotten their vaccine at their PCP, at their CVS pharmacy, at their Walmart pharmacy or at a drivethrough... if you think all of these places keep nice records that are readibily sharable with other healthcaare providers you are in for a surprise... they are not.

So yes, we do take their word for it. It is the only practical way available.
If you go to the hospital and say you have atrial fibrillation and you take 125mcg of digoxin and 5mg of eliquis twice daily and 40mg of furosemide daily, chances are that is what you are going to be given during the admission (unless there is some other contraindication and/or reason not to give it). You are not likely to have a doctor go sherlock holmes on you and trying to get "your records" unless it is absolutely necessary or if what you are saying makes absolutely no sense (e.i "I take 5mg eliquis BID as an anti-rejection medicine for my kidney transplant"... that wouldn't make sense, and that should prompt any doctor to inquire further.

[Patrickov]

I think there are very few circumstances that a request of treatment can be refused.

To illustrate, even if Carrie Lam accidentally fell off the roof of the HK Government Headquarters (her official residence a bit too low-rise) and sustain significant injury, the doctors do have the responsibility to treat her.

Not vaccinating oneself and getting Wuhan Pneumonia as a result is a comparatively petty offence.

[AFAIK]

@XogGyux
What if they're unconscious or not lucid? Do you just treat them as a "Jane Doe"?
Why don't insurance companies coordinate information?

[Rich]

What hypocrites so many people both off and on the forum are. Are you racists? Because if you really believed that the vaccines are as wonderful as you claim how can you tolerate vaccine apartheid? If you really believed in the vaccines and really cared about your fellow humans, you would demand, you would insist that the vaccines be rolled out across the world going to the highest priority people first, whether that be health care workers or the old or those with pre existing medical conditions. if you really cared about your fellow human beings, if anything it should be the poorest countries that get the vaccines first, because they don't have the health care systems to deal with Covid sickness, their citizens don't have the wealth and they don't have the governmental capacity for welfare to support sustained lockdowns.

If you really believe what you say about the vaccines you were and are consigning hundreds of thousands if not millions of people in poorer countries to their deaths. You want to force vaccines down the throats of young westerners, while in poorer countries, health, workers, the elderly and those with serious medical conditions are denied access to vaccines. You claim that people are being selfish for refusing the vaccine. Sure all human beings are selfish, normal people put their perceived interests of themselves, the family and their friends before others. But the selfishness of the vaccine sceptics pales compared with your selfishness. You callously deny vaccines to the rest of the world, but are happy to steamroller over individual liberties of your own country's citizens, because that is what is you think maximises your self interest.

You are Nazis. You are national socialists. This was German national socialism, if there's a shortage of food then the rest of the world must starve, but at home every individual liberty must be crushed for the sake of the nation. Just like the German Nazis you are obsessed by the health of the nation demanding that all individual autonomy must be sacrificed in it name. And of course like the Nazis any voice that opposes you, nay any voice that even questions you, wants to pause to consider must be silenced. For the Nazis the enemies were Jews and Marxists, for you the enemies are vaccine sceptics, climate sceptics and those who refuse to bend the knee. The Nazis started off by demanding that Jews be silenced and segregated. as you demand that vaccine sceptics, mask sceptics and lock down breakers be silenced and segregated. its pretty obvious where the logic of your argument is going.

[Godstud]

Cute rant, @Rich. Are you off your medication?

Nothing you said makes sense. It's like yelling at a doctor for saving a life because he hasn't saved everyone. Asinine to the extreme, but cute that someone like you could be so sanctimonious.

[AFAIK]

@Godstud He's arguing that vaccinating the worried well in 1st world countries ahead of frontline medical staff overseas is selfish.

[Godstud]

Yes, @AFAIK, everyone who calls for vaccinations is a Nazi because we didn't mention the right, specific people.

[AFAIK]

Well it's Rich. He doesn't take half measures. He doesn't take full measures. Everything is a triple-double for him.

[Potemkin]

Cute rant, @Rich. Are you off your medication?

Nothing you said makes sense. It's like yelling at a doctor for saving a life because he hasn't saved everyone. Asinine to the extreme, but cute that someone like you could be so sanctimonious.

@Rich often makes some interesting, and even a few correct, points, but he seems to have only one mode of address: moralistic ranting. This is probably a symptom of his upbringing in a strict Christian household; he may have rejected the message, but he still cannot escape the medium.

[Rich]

but he seems to have only one mode of address: moralistic ranting.

No I'm responding to moralistic ranting. Since soon after this crisis has begun there's been nothing but moralistic ranting against anyone who has questioned, lockdowns, masks or vaccines. It has been endless and relentless. "Selfish, selfish, selfish", "stupid, stupid, stupid", 'ignorant, ignorant, ignorant".

And the measures have been extreme, Regimes have imprisoned enslaved and killed countless millions, but never in human history has such infringements of individual liberty been imposed on the majority of the population. Now I'm not suggesting that my sufferings because of these measures compare with the terrible sufferings of people in history, or peoples now in other less fortunate parts of the world, but still the measures imposed are extreme, all meetings to discuss these measures were banned, all protests against these measures were severely repressed, while while approved demonstrations like Black Lies Matter were given de-facto permission to go ahead. Not one arrest, the same goes for the IRA funeral. This is not the rule of law. It is police stateism, where the police decide who they will arrest based on the whims of the government. it is not hyperbola to call it fascistic.

I have never denied being selfish, selfishness is inescapable, both in every day life and in politics. I am merely exposing the hypocrisy of those who implicitly claim to be unselfish. its not me that made this a disrespectful hate filled, moralistic slanging match. Right from the start the Liberal establishment has attempted to delegitimise any questioning of their agenda. They have never sought to engage in respectful debate. They seek to ban us from sharing our views on social media, and demonetise and hide those those they can't ban. They insult us and constantly seek to lump us all in as one group think. I've actually met Piers Corbyn, he seems like a nice guy, but just because we are both lock down sceptics doesn't mean share all or even most of his views.

So to reiterate the essential point from the beginning the vaccinators have claimed the moralistic high ground, but that is completely punctured by their failure to give out the vaccines across the world on the basis of need, rather than a nationalistic grab bag. Having spent over a year on the end of their moralistic attacks, I confess has not put in me in a charitable mood to such people.

[Godstud]

And the measures have been extreme, Regimes have imprisoned enslaved and killed countless millions, but never in human history has such infringements of individual liberty been imposed on the majority of the population.

The hyperbole is strong with you. Wearing a mask is akin to wearing a seatbelt, only it doesn't just protect you. I suppose you demonstrated when restaurants put up signs that said, "No Shit. No shoes. No service.", right?

Enslaved? Killed? Where are you getting these lies from? Is Alex Jones your spirit animal?

demonstrations like Black Lies Matter were given de-facto permission to go ahead.

Nice racist rhetoric. If you don't understand what Black Lives Matter is, and why those protests were necessary, your hood isn't fitting over your foil hat.

You rant at others for not caring enough, while telling us that you are selfish. It's no wonder you don't like moralistic attacks, when you don't even know what morality is.