[pilowsky]

Happy new year everyone. Let's hope that 2021 sees the back of all this madness.

If we triple the price of fuel so that no-one can afford to drive anywhere and use the money to pay for health education and welfare (and Bridge) will we simultaneously solve COVID, climate change and poverty?

[thepossum]

 pilowsky, on 2020-December-31, 05:19, said:

Happy new year everyone. Let's hope that 2021 sees the back of all this madness.

If we triple the price of fuel so that no-one can afford to drive anywhere and use the money to pay for health education and welfare (and Bridge) will we simultaneously solve COVID, climate change and poverty?

Its a classic elitist approach to trying to solve a problem, massively increasing the power and privilege of the wealthy elites. Sums up most approaches (recently) to the big problems you raise. I think if you want a fair approach everyone should look at their footrpint (more generically their contribution) to all those problems and reduce it accordingly

I actually have a thought on how to imporve poverty. Maybe look at some of the unnecessary studies being conducted all over the world under the guise of a pandemic and put them into more productive areas of the economy where people can actually work and earn and pay their bills rather than being grateful for lousy handouts

I know I risk disrepesct even daring to comment, but I do actually (like everyone) have a right and in my case also a responsibility to comment when I see problems in this world

But Happy New Year to everyone and I'm hoping the trend to global techno-fascism is not beyond the point of no return. But when I see so many people in the world, even those of a more political bent being so taken in by some propaganda I am very concerned

[pilowsky]

 thepossum, on 2020-December-31, 18:58, said:

Its a classic elitist approach to trying to solve a problem, massively increasing the power and privilege of the wealthy elites. Sums up most approaches (recently) to the big problems you raise. I think if you want a fair approach everyone should look at their footrpint (more generically their contribution) to all those problems and reduce it accordingly

I actually have a thought on how to imporve poverty. Maybe look at some of the unnecessary studies being conducted all over the world under the guise of a pandemic and put them into more productive areas of the economy where people can actually work and earn and pay their bills rather than being grateful for lousy handouts

I know I risk disrepesct even daring to comment, but I do actually (like everyone) have a right and in my case also a responsibility to comment when I see problems in this world

But Happy New Year to everyone and I'm hoping the trend to global techno-fascism is not beyond the point of no return. But when I see so many people in the world, even those of a more political bent being so taken in by some propaganda I am very concerned

It was a joke, my friend. Let's hope 2021 is an improvement on last year

[cherdano]

In the other thread, I wished Sunetra Gupta, Carl Henaghan and Rishi Sunak a wonderful retirement in their special place in hell. I would like to apologize to Michael Yeadon for excluding him. https://twitter.com/...137365325651974

Why care about the opinions of such nutjobs as Yeadon? Because unfortunately they've been way too influential in the UK debate, garnering media appearances and influence among conservative backbenchers, making it politically harder for the UK government to respond appropriately and quickly.

[cherdano]

But to switch to a more pressing issue than places in hell, at the moment I feel as if I live in an alternate reality where the huge majority has not realised the consequences of "B 1.1.7 is 50%-70% more transmissible".

• There is now big and reliable data behind this claim. (E.g. you can compare the growth rate of the new strain with the previous variants in all English regions, and get a similar figure for each of them).
  
• This means that just to keep R at 1, we have to do measures that would have moved R to 0.6-0.66 for the old variant; I know of no Western country that has achieved this.
  
• The UK sequences a much bigger proportion of its positive cases than almost any other country - about 10%. One exception is Denmark, which has sequenced a similar proportion of its cases in December. They found that B 1.1.7 accounted for 0.2% of all cases in week 49, 0.5% in week 50, 0.9% in week 51, and 2.3% in week 52. https://twitter.com/...299161118343174 At that pace, it'll take 6 weeks for the new strain to dominate in Denmark, and I am not sure there is any reason to believe that any country with a decent amount of travel from the UK is in a very different position.

E.g. I have seen calls to close schools in the UK for two more weeks after the break, and I just think "You really think schools will reopen as normal before Easter?"

It's now a race, we will reach herd immunity after all and the only question is what proportion of the needed 80% or thereabouts comes from vaccinations, and what from natural infections. And how many will die because there is no capacity to treat them. (See here for pictures of ambulances queuing in front of a London hospital. Now imagine numbers doubling once more, and then once more. And I'll stop there just to be kind.)

[hrothgar]

Here's what I find completely incomprensible

Here in the US, we apparently have a case where a pharmacist deliberately spoiled 500 doses of the vaccine

https://www.theguard...d-vaccine-doses

The numb nut needs to get tried for some combination of terrorism or multiple counts of attempted murder

[Cyberyeti]

 cherdano, on 2021-January-02, 04:57, said:

But to switch to a more pressing issue than places in hell, at the moment I feel as if I live in an alternate reality where the huge majority has not realised the consequences of "B 1.1.7 is 50%-70% more transmissible".

• There is now big and reliable data behind this claim. (E.g. you can compare the growth rate of the new strain with the previous variants in all English regions, and get a similar figure for each of them).
  
• This means that just to keep R at 1, we have to do measures that would have moved R to 0.6-0.66 for the old variant; I know of no Western country that has achieved this.
  
• The UK sequences a much bigger proportion of its positive cases than almost any other country - about 10%. One exception is Denmark, which has sequenced a similar proportion of its cases in December. They found that B 1.1.7 accounted for 0.2% of all cases in week 49, 0.5% in week 50, 0.9% in week 51, and 2.3% in week 52. https://twitter.com/...299161118343174 At that pace, it'll take 6 weeks for the new strain to dominate in Denmark, and I am not sure there is any reason to believe that any country with a decent amount of travel from the UK is in a very different position.

E.g. I have seen calls to close schools in the UK for two more weeks after the break, and I just think "You really think schools will reopen as normal before Easter?"

It's now a race, we will reach herd immunity after all and the only question is what proportion of the needed 80% or thereabouts comes from vaccinations, and what from natural infections. And how many will die because there is no capacity to treat them. (See here for pictures of ambulances queuing in front of a London hospital. Now imagine numbers doubling once more, and then once more. And I'll stop there just to be kind.)

Good post, but one quibble. Reopening schools is a political decision at least as much as it's a healthcare decision. I don't think even if it's the right thing to do from a healthcare point of view, the schools will be allowed to stay closed till Easter. Our figures in Norwich (and Norfolk) have risen alarmingly over the last few weeks, more than 1/4 of all the deaths from the pandemic in my local hospital were in December (61 out of a little over 200).

Will be interesting to see how fast they can get the vaccinations out and whether they change the targeting a bit. It surely makes sense to get the people at most risk of getting infected and passing it on jabbed ahead of some people at slightly higher risk of serious damage if they catch it, but much lower risk of catching it. As it stands on the gov site 14M people have to be vaccinated before I get my jab as a 55 year old diabetic. I've been in personal T4 or equivalent since March (barring Christmas day, but that was done sensibly), my only risk is at the supermarket. I would much rather all teachers were done before me and possibly people like customer facing supermarket staff as well.

[shyams]

The sequencing/prioritising of population for a vaccine is never a simple solution. It will include political (fraught with risk of backlash) and economic factors. I think these are unwinnable decisions as far as the health authorities are concerned.

What is, however, controllable is the speed with which the vaccinations are administered to the eligible population. Here I'm afraid the Govt will insist on sticking to protocols and procedures. For example, a typical vaccine injection should take under 15 seconds to administer. Yet I suspect the NHS centres will take between 5 and 10 minutes per dose.

Recently I was told by my GP to take a (seasonal) flu jab and that the receptionist will call to arrange an appointment. During this call, the receptionist offered me a few time slots that were 10 minutes apart. I asked her whether it will really take 10 minutes to get my jab done and was told that sometimes there is a wait. The actual jab took under 5 seconds; the total time at the GP premises was approx. 12 minutes. And the next person to get a jab did not get called in for at least 4-5 minutes after I exited.

If the Govt. cannot expedite the administering of COVID jabs, we might easily see an unnecessary delay being introduced into the entire programme. The newly approved vaccine doesn't even need ultra-cold storage --- it should be so much easier to manage the logistics. The Health authorities should focus more on simplifying these logistical matters.

Edit: BBC link that describes the bureaucracy linked to vaccine administration As expected, the NHS senior management is all in favour of such important ( ) bureaucratic hurdles.

This post has been edited by shyams: 2021-January-02, 13:27

[cherdano]

 Cyberyeti, on 2021-January-02, 06:21, said:

Good post, but one quibble. Reopening schools is a political decision at least as much as it's a healthcare decision.

You know, you've made three posts in the year 2021, and in two of them you say you disagree with something I said, except I did not say it.
Of course reopening schools is a political decisions. But even a government that has to rely on nutty Brexit backbenchers won't reopen schools while cases are rising and ambulances are queueing in front of hospitals.

Yes schools will reopen before Easter, but not without major changes - either hybrid (e.g. cutting effective attendance in half), or with a thorough highly frequent testing system in place.

In the week before Christmas, ONS estimated that 3% of all secondary school children in England were PCR positive.

[Cyberyeti]

 cherdano, on 2021-January-02, 07:53, said:

You know, you've made three posts in the year 2021, and in two of them you say you disagree with something I said, except I did not say it.
Of course reopening schools is a political decisions. But even a government that has to rely on nutty Brexit backbenchers won't reopen schools while cases are rising and ambulances are queueing in front of hospitals.

Yes schools will reopen before Easter, but not without major changes - either hybrid (e.g. cutting effective attendance in half), or with a thorough highly frequent testing system in place.

In the week before Christmas, ONS estimated that 3% of all secondary school children in England were PCR positive.

You have more belief in the government's handling than I have. I think they will get the schools open come hell or high water. It is sadly absolutely normal for ambulances to be queuing outside hospitals this time of year although it's going to be worse this year. I thought highly frequent testing in schools was already announced so that was a given, how thorough it will be is anybody's guess.

[pilowsky]

 shyams, on 2021-January-02, 07:40, said:

The sequencing/prioritising of population for a vaccine is never a simple solution. It will include political (fraught with risk of backlash) and economic factors. I think these are unwinnable decisions as far as the health authorities are concerned.

What is, however, controllable is the speed with which the vaccinations are administered to the eligible population. Here I'm afraid the Govt will insist on sticking to protocols and procedures. For example, a typical vaccine injection should take under 15 seconds to administer. Yet I suspect the NHS centres will take between 5 and 10 minutes per dose.

Recently I was told by my GP to take a (seasonal) flu jab and that the receptionist will call to arrange an appointment. During this call, the receptionist offered me a few time slots that were 10 minutes apart. I asked her whether it will really take 10 minutes to get my jab done and was told that sometimes there is a wait. The actual jab took under 5 seconds; the total time at the GP premises was approx. 12 minutes. And the next person to get a jab did not get called in for at least 4-5 minutes after I exited.

If the Govt. cannot expedite the administering of COVID jabs, we might easily see an unnecessary delay being introduced into the entire programme. The newly approved vaccine doesn't even need ultra-cold storage --- it should be so much easier to manage the logistics. The Health authorities should focus more on simplifying these logistical matters.

Edit: BBC link that describes the bureaucracy linked to vaccine administration As expected, the NHS senior management is all in favour of such important ( ) bureaucratic hurdles.

Medicine is different from Bridge or buying fish and chips or a big Mac. It is obvious from your post that you lack insight into what goes into 'giving a simple jab'.
A minimally competent doctor should go through the following steps before injecting any foreign agent into a person:
1. Greet the person and confirm that they have no allergies.
2. Confirm their identity and medical history.
3. Check their heart rate and do a quick assessment.
4. Check to make sure that they haven't already had the jab.
5. Document everything (remember you have to come back for a second 'jab'.
6. Gather whatever other information is need by the local health authority.
7. How long did it take to read all this carefully?
8. Make sure that the patient knows to come back for a second injection.
9. Carefully explain (possibly with the aid of an interpreter) the possible side-effects and which ones to be concerned about and which ones not to worry about.
10. Answer empathetically whatever questions or concerns they might have.
That's just for a young fit, healthy person.

Note that Trump walked to the helicopter, constantly ranted while in hospital and was given everything they could lay their hands on. He is exactly the sort of patient doctors worry about. Someone convinced that because he did a bit of googling he knows everything. Much as I dislike people such as Piers Morgan and Boris Johnson, I would still offer them the same level of care that I offer anyone else. Small mistakes can have devastating consequences - usually made through lack of care and sometimes through lack of adequate training. These are the memories that stay with you after decades. Keeping you awake and worried that you could have done more.

Possibly untrained people have the impression from the media that 'rolling out the jab' is like delivering a book from Amazon. It isn't. Most books can't make you sick or kill you.

Or you could have an ineffective jab, or die of anaphylactic shock because you were too busy being grumpy and attempting a time-management efficiency check on people that are risking their lives being exposed to a deadly virus. At the same time, you kvetch about waiting a few minutes.

The vaccine is an entirely new foreign agent developed very recently. It has been thoroughly tested and works most of the time. None of that means that the doctor who gives it too you abrogate all normal responsibility for your management.

The 'jab' as you put it is not a condom or an aspirin. It always needs to be given after taking due care.

Were you aware that during the 'flu pandemic 100 years ago the white house surgeon-general recommended doses of aspirin that were so high that many people died from aspirin-induced pulmonary oedema?

There's a reason why doctors get paid, and consumers don't. They had to spend at least a decade becoming minimally competent. Even if another health-care worker administers your 'jab', they still doing it under the supervision of a doctor who will ultimately take the blame if they do it incorrectly.

If it takes 12 minutes, you are getting off lightly.

[shyams]

 pilowsky, on 2021-January-02, 14:03, said:

lengthy text...

This is a random rant simply because you believe you are qualified (I am not disputing it, you may very well be) in this particular field.

I know about anaphylaxis. I also know that the 2-3 seconds I talked about is the actual activity of the jab and that it is usually accompanied by a few questions, a confirmation and a speech.

You may not believe me, but I do understand the difference between jabs, condoms, aspirin, and books bought off Amazon. So please keep your inane and digressive examples to yourself. If you believe that each jab should take at least 12 minutes (and per your statement that I got off lightly in 12 minutes, I assume you expect it to take significantly longer than 12 minutes), then the requisite population of my nation to achieve herd immunity (say 65% or 80% or whatever) will not be vaccinated for about 3 years.

Please don't rant needlessly.

[cherdano]

 pilowsky, on 2021-January-02, 14:03, said:

There's a reason why doctors get paid, and consumers don't. They had to spend at least a decade becoming minimally competent. Even if another health-care worker administers your 'jab', they still doing it under the supervision of a doctor who will ultimately take the blame if they do it incorrectly.

You know, shyams lives in the UK. I've been to quite a few vaccinations under NHS regime, either my own or my children's, and they were never done under the "supervision of a doctor who will ultimately take the blame". Next time, maybe make sure you are right before you are putting yourself on the high pedestal of speaking from authority.

[pilowsky]

 shyams, on 2021-January-02, 15:01, said:

Please don't rant needlessly.

I agree.

[pilowsky]

 cherdano, on 2021-January-02, 15:45, said:

they were never done under the "supervision of a doctor who will ultimately take the blame". Next time, maybe make sure you are right before you are putting yourself on the high pedestal of speaking from authority.

This statement is incorrect. In the same way that your student's work may be done while you are not there, it is still done 'under your supervision'. It's the same with medicine. The doctor may not be in the room when the service is provided, but it is still done 'under their supervision'.
If someone gives me an injection, somewhere in the background - whether you can see them or not - is a qualified medical practitioner ready to carry the can.

When a nurse or other health care worker makes a decision they are doing so 'under supervision'. In real life, nobody is an island entire unto themselves, but when the bell tolls it tolls for the doctor.

[johnu]

 hrothgar, on 2021-January-02, 06:04, said:

Here's what I find completely incomprensible

Here in the US, we apparently have a case where a pharmacist deliberately spoiled 500 doses of the vaccine

https://www.theguard...d-vaccine-doses

The numb nut needs to get tried for some combination of terrorism or multiple counts of attempted murder

Certainly nowhere near the criminal behavior of the Manchurian Presidents plan to do nothing and let "Herd Mentality" (sic) kill hundreds of thousands in the US when that would completely collapse and overwhelm the health care systems in the US. Or his refusal to take mask wearing seriously and actually encouraging wingnuts on the right fringe spread conspiracy theories about some kind of moral right to not wear masks and gather in large maskless groups.

[Winstonm]

 pilowsky, on 2021-January-02, 16:45, said:

This statement is incorrect. In the same way that your student's work may be done while you are not there, it is still done 'under your supervision'. It's the same with medicine. The doctor may not be in the room when the service is provided, but it is still done 'under their supervision'.
If someone gives me an injection, somewhere in the background - whether you can see them or not - is a qualified medical practitioner ready to carry the can.

When a nurse or other health care worker makes a decision they are doing so 'under supervision'. In real life, nobody is an island entire unto themselves, but when the bell tolls it tolls for the doctor.

I can't speak for nursing in the United Kingdom or Australia but here in the U.S.A. your statement is not accurate. As a retired registered nurse, we were held accountable for our actions. While it is true that registered nurses act on the orders of the physicians, the physician are not held liable for an error made by a nurse as long as the orders were within the scope of a nurse's responsibilities.. Same thing applied to registered nurses in that they supervised practical nurses but as long as what the practical nurse was told to do was within her or his scope of responsibilities, the registered nurse could not be held accountable for an error of the practical nurse.

That is what supervision actually means in regards to nursing in the U.S.

[sfi]

 Winstonm, on 2021-January-02, 23:35, said:

I can't speak for nursing in the United Kingdom or Australia but here in the U.S.A. your statement is not accurate. As a retired registered nurse, we were held accountable for our actions. While it is true that registered nurses act on the orders of the physicians, the physician are not held liable for an error made by a nurse as long as the orders were within the scope of a nurse's responsibilities.. Same thing applied to registered nurses in that they supervised practical nurses but as long as what the practical nurse was told to do was within her or his scope of responsibilities, the registered nurse could not be held accountable for an error of the practical nurse.

That is what supervision actually means in regards to nursing in the U.S.

Having discussed it with someone who is actually qualified to talk about the situation in Australia, in fact the liability resides with the medical practice in this country. The practice owners are responsible for ensuring appropriate practices are in place and for ensuring staff are appropriate qualified. If an error occurs, it gets managed within the employee-employer relationship, since nurses are typically employed by a medical practice. There are governing bodies where the patient can lodge a complaint if it is not dealt with appropriately by the practice, but they would typically only be looking at quite serious cases.

A trained nurse can even provide certain things like vaccine shots without any doctor supervision at all. However, the practice cannot bill Medicare if that happens, which is why a doctor will generally make a brief appearance. This does not open the doctor to questions of liability for actions taken by the nurse - just by the doctor themselves.

[Winstonm]

 sfi, on 2021-January-03, 00:11, said:

Having discussed it with someone who is actually qualified to talk about the situation in Australia, in fact the liability resides with the medical practice in this country. The practice owners are responsible for ensuring appropriate practices are in place and for ensuring staff are appropriate qualified. If an error occurs, it gets managed within the employee-employer relationship, since nurses are typically employed by a medical practice. There are governing bodies where the patient can lodge a complaint if it is not dealt with appropriately by the practice, but they would typically only be looking at quite serious cases.

A trained nurse can even provide certain things like vaccine shots without any doctor supervision at all. However, the practice cannot bill Medicare if that happens, which is why a doctor will generally make a brief appearance. This does not open the doctor to questions of liability for actions taken by the nurse - just by the doctor themselves.

Interesting. Here in the U.S. there is standardized national testing for licensing of all nurses, practical and registered, and the test ensures a minimum level of competence. As an example, if a registered nurse delegated (supervised) to a practical nurse the medicine pass of 8 patients, that would be within the practical nurse's scope of competence and if that nurse then erred and gave insulin to a non-diabetic patient for example, the practical nurse who gave the injection to the wrong patient would be responsible and the hospital would most likely be sued but neither the doctor who ordered the insulin for a different patient nor the registered nurse who properly delegated the task would have any liabilities.

[cherdano]

 pilowsky, on 2021-January-02, 16:45, said:

This statement is incorrect. In the same way that your student's work may be done while you are not there, it is still done 'under your supervision'. It's the same with medicine. The doctor may not be in the room when the service is provided, but it is still done 'under their supervision'.
If someone gives me an injection, somewhere in the background - whether you can see them or not - is a qualified medical practitioner ready to carry the can.

When a nurse or other health care worker makes a decision they are doing so 'under supervision'. In real life, nobody is an island entire unto themselves, but when the bell tolls it tolls for the doctor.

Nurse practitioners are much more independent in the NHS than in other healthcare systems. E.g. here the RCN states "There is no reason for a medical practitioner to be on site when vaccines are being administered." https://www.rcn.org....-administration

Health visitors inject 8-week olds during home visits. Some vaccinations are done at pharmacies.