NYT: Biden Mandates Vaccines for Workers, Saying, ‘Our Patience Is Wearing Thin’

[MudPuppy]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

[Wolfpack Mustachian]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

I just want to say that I'm not saying all of this to generate sympathy for people against hospitals making mandates. I just think people aren't seeing the reality of the situation, which is a seriously, seriously bad one.

[Kris]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

[MudPuppy]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

I just want to say that I'm not saying all of this to generate sympathy for people against hospitals making mandates. I just think people aren't seeing the reality of the situation, which is a seriously, seriously bad one.

I didn’t think you were. I did hospital operations for several years as my full time job, and I know exactly what the repercussions are. Hell, I am a statistic myself as I just quit my patient-facing job due to Covid burnout. Increased vaccination rates are the only way out of this hellscape.

[iris lily]

Why can’t daddy Joe exercise whatever powers he has to affect healthcare and put in a hefty fee for Medicare patients who haven’t had the Covid shot?

Also you would think he can manipulate the Obama care plans in someway to impose the same fee.

Yes, if it is justified as mentioned up thread that hospitalizations are straining the system and we are paying for it.

[iris lily]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

I just want to say that I'm not saying all of this to generate sympathy for people against hospitals making mandates. I just think people aren't seeing the reality of the situation, which is a seriously, seriously bad one.

I do think you’re right that most of us who never enter a hospital, are not part of a healthcare delivery system, don’t see what’s happening.

I will say though that I hear such varying statistics I wonder what emergency “capacity “really is.

I hear that Florida ICU’s and emergency care facilities are at 95%.

I thought I read a year and a half ago that most facilities operate at 90- 95% occupancy anyway, pre covid.

I absolutely understand fatigue of those providing emergency care, and I appreciate their dedication and I worry about them. But I tire of what seems to be changing information, mis-information, false emergencies, crying wolf.Media to blame here, not so much medical facilities. The Oklahoma Doctor Who claimed ICUs are full of ivermectin overdoses is one of those problems though.

[PeteD01]

Spoke to a friend yesterday who is an intensivist at one of the largest healthcare systems in the US. He told me about one incident a while back when almost the entire physician staff of one of the larger ICUs in the system were infected at a staff meeting were several unvaccinated nurses were present. The nurses subsequently fell ill with COVID as did the physicians. The physicians were vaccinated and only developed relatively mild disease but it did cause problems with the call schedule. It was subsequently determined that the incident would have been critical if it had occurred under surge conditions.
Shortly after, a patient death was traced to an unvaccinated nurse with initially asymptomatic COVID.
These two incidents led to a systemwide introduction of a vaccine mandate.
It was estimated that the mandate would lead to a 10% resignation rate among the clinical staff and a decision was made to blacklist any employee resigning due to vaccine refusal to preclude any future employment by the system.   

The Biden order may decrease the number of resignations as the employees in question cannot find employment in other systems competing for employees.
It also means that those who made a wrong career choice will be weeded out quickly.

The problem, though, is in some areas, 10% loss can be almost unmanageable due to short staffing. Hospitals could well have to reduce capacity, and for obvious reasons, they can't do that at this time. There's really no way to win, and I wonder what they will do.

There is resentment building up and that can be even more detrimental to operations. Dealing with 10% loss might be the better solution.
The Biden orders will likely reduce the losses because they effectively eliminate alternative employment opportunities.
Most will just give up and take the vaccine. Who would risk their livelihood and career for what was essentially a hobby and a way to feel important?
And those who quit anyway - good riddance, we will cope.

edit: let me explain the resentment that is building up using the events at the health care system I reported above. What do the vaccinated nurses think about their unvaccinated colleagues when they now have a hard time to get a physician to the bedside because the physicians have been sickened by them?
What do you think the vaccinated nurses think about their unvaccinated colleagues when they learn that one of the patients they took care of died because of them?
How could an administration not respond to such concerns brought up by vaccinated  employees who are already under severe stress and could find other employment at higher pay on a moments notice?
Vaccination rates of nurses and physicians in the acute care setting are really high now, especially when compared to longer term care settings. The presence of unvaccinated staff may have become more disruptive to operations than what their presence is worth. We´ll have to see how quickly things develop but elimination of all unvaccinated staff in patient contact is imminent.

I do get what you're saying. I also want to point out that I am vaccinated am for vaccines and am not against companies mandating their employees be vaccinated as a concept. However, I don't agree with your conclusions in this situation. I'm sure hospital workers are frustrated at their unvaccinated peers. However, I don't think everyone is really that frustrated. It's kind of a theoretical idea versus a practical one. Theoretically are those staff members a risk to infect others, absolutely. From a large scale statistical standpoint, they're causing these problems. However, that's very heady. From a practical standpoint, hospitals are maxed out. Workers are already working overtime to keep up. Eliminate 10%, much less 15-20%, which at present it seems very possible could happen, and you've gone from a currently unstable situation to an abysmal one. Hospitals are still going to need to operate at high capacities, so the thing that will break is likely more overtime for employees, at least as I see it/understand it. The practical consequences of this will more than weigh out against the heady theoretical consequences of, well, those people could have infected others. Overloaded people are more likely to quit, and the problem gets worse. I don't know that this will happen, but I'm fairly certain if I were in that situation, I wouldn't be good with it because from a theoretical standpoint, keeping unvaccinated employees away from patients is a good thing. I would be thinking, How do I get childcare with all of the mandantory overtime/fill in time slots for the recently fired, etc?

Again, I am not against any of this. I just think it's a no win situation, and if it does get pushed and employees don't back down and are let go in droves, there will be significant consequences.

First of all, the vaccination rates among critical care relevant employees are very high compared to longer term care settings. Therefore the 10% quit rate will not affect the acute care setting as much as longer term settings. Second, in the critical care setting, we are talking about highly educated, highly skilled and highly motivated staff used to work in collaborative teams. These people do not take disruption lightly.
Protecting these difficult to recreate operations is of critical importance to any administration and, in the large coastal metropolitan areas, the tide has long turned against the unvaccinated.
A healthcare system faced with the choice of upsetting their critical care operations at a time like this or their longer term care operations will chose to upset the longer term operations every time.
The Biden orders will help to minimize the impact of resignations and the employees who still quit will have to change careers, no loss here.
Of course, the areas ravaged by Delta right now will go through some hard times until normalization inevitably occurs.

[Wolfpack Mustachian]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

I just want to say that I'm not saying all of this to generate sympathy for people against hospitals making mandates. I just think people aren't seeing the reality of the situation, which is a seriously, seriously bad one.

I do think you’re right that most of us who never enter a hospital, are not part of a healthcare delivery system, don’t see what’s happening.

I will say though that I hear such varying statistics I wonder what emergency “capacity “really is.

I hear that Florida ICU’s and emergency care facilities are at 95%.

I thought I read a year and a half ago that most facilities operate at 90- 95% occupancy anyway, pre covid.

I absolutely understand fatigue of those providing emergency care, and I appreciate their dedication and I worry about them. But I tire of what seems to be changing information, mis-information, false emergencies, crying wolf.

I, too, am curious how those numbers are handled. I don't know from a statistical standpoint or large-scale standpoint how people get the numbers. What I'm thinking of is less about 95% capacity or whatever all of that means and more along the lines of hospitals literally turning people away because there is literally 0 capacity so there's no room for ambiguity.

[MudPuppy]

At my own facilities, everything elective is closed down. The same day surgery and another surgical holding area have been converted to surge ICU space. Patients waiting days in the ER until a bed opens up is not unusual.

[PeteD01]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

I just want to say that I'm not saying all of this to generate sympathy for people against hospitals making mandates. I just think people aren't seeing the reality of the situation, which is a seriously, seriously bad one.

I do think you’re right that most of us who never enter a hospital, are not part of a healthcare delivery system, don’t see what’s happening.

I will say though that I hear such varying statistics I wonder what emergency “capacity “really is.

I hear that Florida ICU’s and emergency care facilities are at 95%.

I thought I read a year and a half ago that most facilities operate at 90- 95% occupancy anyway, pre covid.

I absolutely understand fatigue of those providing emergency care, and I appreciate their dedication and I worry about them. But I tire of what seems to be changing information, mis-information, false emergencies, crying wolf.Media to blame here, not so much medical facilities. The Oklahoma Doctor Who claimed ICUs are full of ivermectin overdoses is one of those problems though.

You are hearing right. Critical care operations always operate at 90-95% and they expand until they have gobbled up all of the resources of a hospital and then there is a crisis. They also contract to nearly nothing when there is no business.
The 95% is by design because it is so expensive to have staffed beds on standby.
That also means that, when you hear that a hospital is at or exceeding 100% ICU capacity, things are very bad indeed and triage has kicked in.

[lost_in_the_endless_aisle]

Just talked to someone who finally got a vaccine. They regret it and say they’ve been sick for two weeks, blamed it on the vaccine, and say they won’t be back for the second shot.

I asked about the symptoms. Totally consistent with a mild case of COVID.
I asked what precautions they had been taking. “We’ll, none.”
I asked if they had been tested. “No, I know it’s the vaccine.”

This person still believes they are having a maybe 1 in 10,000 vaccine reaction rather than the alternative hypotheses that they picked up COVID while running around unvaccinated and taking zero precautions whatsoever during a peak in the pandemic. They are processing information in a way that will lead to them not seeking medical care AND not taking precautions to avoid spreading the disease to others.

Why do otherwise intelligent people think this way? He shared some internet fake news articles and noted that the vaccines were a multi-billion dollar industry. In other words the internet primed him to distrust science and government, to the point he overlooked the obvious.

I recently had an exchange with someone who said they have stopped using sunblock because it gave them skin cancer.

Conspiracy thinking is a hell of a drug.

I wouldn't be so cavalier about sunscreen. Here are some concerns:

https://www.cnn.com/2021/07/17/health/sunscreen-recall-cancer-wellness/index.html
"The voluntary recalls and pause in sales came after an independent lab tested 294 samples from 69 brands of sprays, lotions, gels and creams designed to protect the skin from the sun or care for the skin after sun. Of those, 78 samples tested positive for benzene....

....the FDA does not require companies to test ingredients for contaminants, nor does it require testing for such chemicals at a finished product stage"

The problem may extend far beyond benzene contamination:

https://www.ewg.org/sunscreen/report/executive-summary/
"Four studies published in 2020, after the FDA proposal, support previous findings that oxybenzone can act as an endocrine disruptor and may increase the risk of breast cancer and endometriosis.
....
The FDA proposed that all spray and powdered sunscreens be tested to ensure they cannot be inhaled deep into the lungs, where they could do irreversible damage. In pilot testing, the agency found that three of 14 sprays would not meet its proposed standard but did not say which products consumers should avoid. EWG recommends that consumers avoid all spray and powder sunscreen products."

It's not entirely clear yet how dangerous some of the additives in sunscreen products might be. I use physical sunscreen (TiO2 based) to lower the risks associated with these unknowns. It also makes me look like a white ghost on mountain trails which alarms others--a bonus!

[Kris]

Just talked to someone who finally got a vaccine. They regret it and say they’ve been sick for two weeks, blamed it on the vaccine, and say they won’t be back for the second shot.

I asked about the symptoms. Totally consistent with a mild case of COVID.
I asked what precautions they had been taking. “We’ll, none.”
I asked if they had been tested. “No, I know it’s the vaccine.”

This person still believes they are having a maybe 1 in 10,000 vaccine reaction rather than the alternative hypotheses that they picked up COVID while running around unvaccinated and taking zero precautions whatsoever during a peak in the pandemic. They are processing information in a way that will lead to them not seeking medical care AND not taking precautions to avoid spreading the disease to others.

Why do otherwise intelligent people think this way? He shared some internet fake news articles and noted that the vaccines were a multi-billion dollar industry. In other words the internet primed him to distrust science and government, to the point he overlooked the obvious.

I recently had an exchange with someone who said they have stopped using sunblock because it gave them skin cancer.

Conspiracy thinking is a hell of a drug.

I wouldn't be so cavalier about sunscreen. Here are some concerns:

https://www.cnn.com/2021/07/17/health/sunscreen-recall-cancer-wellness/index.html
"The voluntary recalls and pause in sales came after an independent lab tested 294 samples from 69 brands of sprays, lotions, gels and creams designed to protect the skin from the sun or care for the skin after sun. Of those, 78 samples tested positive for benzene....

....the FDA does not require companies to test ingredients for contaminants, nor does it require testing for such chemicals at a finished product stage"

The problem may extend far beyond benzene contamination:

https://www.ewg.org/sunscreen/report/executive-summary/
"Four studies published in 2020, after the FDA proposal, support previous findings that oxybenzone can act as an endocrine disruptor and may increase the risk of breast cancer and endometriosis.
....
The FDA proposed that all spray and powdered sunscreens be tested to ensure they cannot be inhaled deep into the lungs, where they could do irreversible damage. In pilot testing, the agency found that three of 14 sprays would not meet its proposed standard but did not say which products consumers should avoid. EWG recommends that consumers avoid all spray and powder sunscreen products."

It's not entirely clear yet how dangerous some of the additives in sunscreen products might be. I use physical sunscreen (TiO2 based) to lower the risks associated with these unknowns. It also makes me look like a white ghost on mountain trails which alarms others--a bonus!

Yes.

But, none of that has anything to do with skin cancer.

And also, there are plenty of sunscreens without that ingredient.

Please stop giving credibility to those claims.

[GuitarStv]

https://www.ewg.org/sunscreen/report/executive-summary/
"Four studies published in 2020, after the FDA proposal, support previous findings that oxybenzone can act as an endocrine disruptor and may increase the risk of breast cancer and endometriosis.
....
The FDA proposed that all spray and powdered sunscreens be tested to ensure they cannot be inhaled deep into the lungs, where they could do irreversible damage. In pilot testing, the agency found that three of 14 sprays would not meet its proposed standard but did not say which products consumers should avoid. EWG recommends that consumers avoid all spray and powder sunscreen products."

Interesting (and unrelated to your previous comment) tidbit . . . the EWG is not a scientific group and has a history of getting it's facts and information wrong.  It's also heavily funded by the organic lobby.

I just found that out last year, previously had thought that they were pretty legit.

[Abe]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

I just want to say that I'm not saying all of this to generate sympathy for people against hospitals making mandates. I just think people aren't seeing the reality of the situation, which is a seriously, seriously bad one.

I do think you’re right that most of us who never enter a hospital, are not part of a healthcare delivery system, don’t see what’s happening.

I will say though that I hear such varying statistics I wonder what emergency “capacity “really is.

I hear that Florida ICU’s and emergency care facilities are at 95%.

I thought I read a year and a half ago that most facilities operate at 90- 95% occupancy anyway, pre covid.

I absolutely understand fatigue of those providing emergency care, and I appreciate their dedication and I worry about them. But I tire of what seems to be changing information, mis-information, false emergencies, crying wolf.

I, too, am curious how those numbers are handled. I don't know from a statistical standpoint or large-scale standpoint how people get the numbers. What I'm thinking of is less about 95% capacity or whatever all of that means and more along the lines of hospitals literally turning people away because there is literally 0 capacity so there's no room for ambiguity.

Hospitals operate at around 90% capacity normally. That is due to a variety of reasons, and they affect operations both pre and during COVID.

The most common (in order) are:
1) Staffing - especially nurse staffing. Attrition is currently extremely high due to repeated COVID surges.
2) Operations being performed - most money for hospitals come from elective surgery, so we try to keep this as high as possible. During the COVID surge, most hospitals have reduced their caseloads to compensate since OR, post-operative recovery areas and ERs can be used as ICUs since those nurses are trained in critical care (to some extent). This has almost never happened pre-COVID except after mass-casualty events (i.e. 9/11 in NYC area, Katrina in Gulf Coast).
3) ER admissions - this varies seasonally. During winter it goes up due to influenza. In summer it goes up due to gun/knife violence. When the hospitals reach a capacity threshold (around 95%, but varies from hospital to hospital), the ER goes on "diversion" - they will not accept EMS. However, walk-in / drop-off patients cannot be refused care so there will still be people who need admission (hence the 5% buffer). During COVID, ERs have been hit with a lot of walk-ins along with EMS. Unlike pre-COVID, regions are facing a crisis not previously seen in the US: what to do when all the hospitals in a region are on diversion? For example, my hospital recently accepted people from 400 miles away who were critically ill and airlifted in. This was because all the hospitals between there and us were on diversion.

Also, we have to separate critical care and floor (non-critical care) capacity. This is important because by definition (except for select surgery cases), critical care is not elective. We have to provide capacity, otherwise people will just literally die. For example, in Houston we have a high % of critical care to floor beds because of the number of referral/safety net hospitals. Even then, we are at 150% of standard critical care capacity due to COVID. We are now using 100% of ICUs in the city and 50% of the OR/recovery/ER.

With COVID, this distinction is not as clear-cut. We don't expect people with normal pneumonia or whatever illness to rapidly deteriorate in-hospital and need ICU care. Otherwise they'd be in the ICU to begin with. With this surge, that isn't an option so people who normally would be in the ICU cannot be, so they deteriorate on the floor and then hopefully by then someone in the ICU has died and freed up a bed. We try to keep at least 1 ICU bed empty for these in-hospital emergencies (but with surges that isn't always possible). What do we do then? Try to provide ICU care on the floor and hope that person doesn't deteriorate further (i.e. need intubation or central lines). But if they do, they do. Nothing much we can do about it till someone in the ICU dies.

What does this mean? If someone comes to the ER in critical condition, they stay on a gurney in the ER until a room is available in the ICU. If all the rooms in the ER are filled with critically ill, then the non-critical patients either wait in the lobby (upwards of 1 day) or if they do require emergency care, are seen in gurneys literally in the hallway. So now we are taking care of heart attack and stroke victims in the hallways, snaking equipment around so there's enough space for people to walk.

If you aren't seriously ill (i.e. actively dying) and come to the ER in Houston or most places in Texas, you will likely not be seen by a physician or NP for at least 24 hours. You may stay in the ER for the entirety of your stay. If you need a major operation that is not an emergency or cancer-related, you will not have that operation for the foreseeable future. If you need a transplant, that will not be happening (except critically ill liver, lung or heart - that's a complicated story). If you need heart-lung bypass for a non-emergency heart or liver surgery, that will not be happening.

That is what those numbers mean.

Why is this different than normal?
In a normal situation, our 90-95% capacity is predictable because we know what to expect for influenza, and can scale back elective surgery if needed to provide additional ICU and non-ICU beds. That works out because elective operations decrease to some extent during the winter months. If it's an especially bad influenza season, there is some amount of surge capacity that can be temporarily provided. However, with COVID there are two issues:

1) even critically ill influenza patients are usually not as sick as critically ill COVID patients. Only the very sickest develop multi-organ failure, whereas it is relatively common to see that with COVID. For reference, in the Houston area (which has world-renown cardiopulmonary care - i.e. people come here from other countries for cardiac surgery, etc) there is a 9% mortality associated with admission to a hospital for COVID. For influenza it is usually around 3-4%. The H1N1 strain resulted in 6-7% in-hospital mortality, still lower than COVID.

2). The surges are more extreme on a population and individual level. Currently 1/3 of critically ill patients in Houston are in the ICU because of COVID. On average for flu season this is <10%.

As noted above, mortality is higher for COVID, but people don't die quickly. For most types of severe pneumonia, critical illness  translates to patients slowly dying over multiple weeks (all the while taking up ICU space). Thus, these two issues combined result in more people on the "glide-slope" to death at any given time during the influenza surges. This is another factor leading to the high ICU utilization rates for COVID.

I no longer do critical care for multiple reasons, though am qualified (and volunteered for the February COVID surge -didn't need to work since it died down fairly quickly). Several of my friends do, and most have pushed up their retirement ages significantly as a result. Two of my friends are pediatric critical care, and are being pulled for adult critical care due to burn-out of the standard teams. On a normal night when I covered ICUs, we'd have maybe 1 code (cardiac arrest) out of 30-40 patients per night. In the COVID units that's more like 3-4. Also, they keep coming back (since they are younger with this surge - but gross oversimplification) and families are not ready to let go, so they get re-coded several times. So basically someone is coding at any given moment, all night.

We are not crying wolf. Luckily, like all things, this too will end. And the coffins will be stacked. And the same nonsense will happen again. Except every time there will be fewer people willing to waste the good parts of their lives caring for people who don't care about their own. When I covered the ICU it was for post-operative patients and I knew in general they had no say in what happened to them. Many of my friends feel the same way and are realizing that medicine is a calling, but not a mandate. They can and will make a living in other, more useful ways.

[seattlecyclone]

Thanks @Abe for the interesting and horrifying information.

[kanga1622]

We all agree this is the beginning not the end right?

Do those who support the Authoritarian actions of Biden, also support:

Annual mandates for Covid vaccines?
Mandates for boosters? Up to how many per year?
If I refuse a booster, should I be fired?
Should we mandate Flu shots that work 50% of the time? Flu is more deadly for kids, so if it saves one life?

My god, I wish this country had the balls to actually enforce vaccines.  All the kids who die because of their dumbass anti-vax parents and never got a choice would thank you, if they were actually alive.

I'm going to say it: authoritarian != actually enforcing policy.  Unless you want to say it is authoritarian that we require all kids to get a K-12 education (if you don't it is a legal crime called abuse.)  Otherwise locking someone up for murder is authoritarian (how dare you infringe on the murderer's right to liberty!)  The right likes to pretend any policing of their dumbassery is going to turn the US into the Peoples Republic of US.  That's a strawman and not even worth debating.

I would love mandates for all vaccines with only medical exceptions (no religious exceptions, your beliefs do not effect reality.)  I think you should be fired if you refuse to comply, because you don't get to endanger me because you are stupid anymore.  And yes, we should mandate flu shots, mandate childhood vaccination.  This is all great public health policy and will save lives with barely any inconvenience except the bruised egos of the ignorant.

In Biden's words, "our patient is wearing thin" indeed.

Brutal honesty I love it.

What should we do with that 10-15% of our population who holds out? The current prescription ( no pun intended) is the weekly test or financial ruin. Is that really good enough ? I mean with a large enough amount of unvaccinated they still put us at risk.

There have been vaccine mandates in place for as long as I have been alive. You have to have them in order to attend school. Have you always been against vaccine mandates, or is it specific to vaccines against covid?

Which vaccine does your employer mandate you have ? Never once in my near 40 years on this planet have I had any employer ask me to provide proof of vaccination. Granted I’m not in healthcare or working in an old age home. Bless those that do.

I have had to provide proof of MMR vaccination or positive titers after measles had a big outbreak probably 15 years ago.

I firmly expect (based on my own gut reaction) that COVID yearly boosters will go along with flu shots. But I have a feeling that is a few years down the line when COVID mutates into less virulent strains.

[ender]

Thanks @Abe for the interesting and horrifying information.

There are two major longer term outcomes I am worried about with covid:

• Ability to respond effectively to far more deadly pandemics in future
• Long term staffing in hospitals

I wonder what % of healthcare workers have hated working in healthcare over the last year and a half. I certainly feel like the 24/7/365 insanity of the last few years has to be causing meaningful attrition, which only exacerbates the problem for those who remain.

[SunnyDays]

^^^^^^^^

Assuming it mutates into less virulent strains.  No evidence of that so far.  For the biologists etc out there, is it possible that Delta (or worse) will be the most common strain?  And "dominant" does not necessarily mean most prevalent, does it?  Doesn't it depend on the number of other strains circulating and their relative proportions?

[PeteD01]

Thanks @Abe for the interesting and horrifying information.

There are two major longer term outcomes I am worried about with covid:

• Ability to respond effectively to far more deadly pandemics in future
• Long term staffing in hospitals

I wonder what % of healthcare workers have hated working in healthcare over the last year and a half. I certainly feel like the 24/7/365 insanity of the last few years has to be causing meaningful attrition, which only exacerbates the problem for those who remain.

1) Pandemics are always going to be messy. This one allowed for all these antics because of relatively low morbidity and mortality in the US. When the bodies pile up in the streets and are dealt with using dump trucks and mass graves, when medical care is out of reach and people have to take care of their dying families themselves, vaccine hesitance and lockdown resistance tends to be low. A pathogen of higher virulence would absolutely put medical care out of reach for most, and possibly makeshift hospice care as well. So all that remains to do is hunker down and hope for the best, while waiting for the vaccinators to hopefully show up. Delta created this scenario in parts of India and possibly Indonesia.
The good news is that vaccine tech has gotten a boost and combined with improved international disease surveillance could make a difference.
But when Trumpism (Responsibility? Me?) meets a pathogen - all bets are off.

2) Attrition due to burnout is likely far more important than any attrition due to workplace vaccine requirements. (I am a retired pulmonary/critical care and decided not to volunteer. I am older and less likely to suffer from burnout but I would have inevitably been pushed into a position of leaning hard on more junior staff to provide a lot of inappropriate care. I have been in a similar position before (minus the inappropriate care) due to chronic understaffing and that is one of the reasons I retired early. Sorry, no deal)

[ender]

1) Pandemics are always going to be messy. This one allowed for all these antics because of relatively low morbidity and mortality in the US. When the bodies pile up in the streets and are dealt with using dump trucks and mass graves, when medical care is out of reach and people have to take care of their dying families themselves, vaccine hesitance and lockdown resistance tends to be low.

I'm not worried about the subset of people reacting appropriately, I'm worried about a massive segment of the population distrusting the government as a result of covid and making the problem significantly worse.

And not all countries have had the issues the USA did with the pandemic. While I believe there are many structural/organizational issues in the USA making it worse here, those only increase the importance of responding cohesively and swiftly to future much more virulent pandemics.

[PeteD01]

I'm not worried about the subset of people reacting appropriately, I'm worried about a massive segment of the population distrusting the government as a result of covid and making the problem significantly worse.

And not all countries have had the issues the USA did with the pandemic. While I believe there are many structural/organizational issues in the USA making it worse here, those only increase the importance of responding cohesively and swiftly to future much more virulent pandemics.

Distrust of the authorities during epidemics is actually the rule and not specific to COVID. Also the collective amnesia setting in after deadly epidemics is remarkable.
People just want to move on. I believe that this works both ways; not much will be learned by the general public and neither will the experience of COVID make the next pandemic worse.
The key is that well funded institutions tasked with disease surveillance and response are in place and that international cooperation is assured.
That´s why I hope that it is not again Trumpism in charge when the next pandemic hits.
Increased virulence tends to sharpen risk perception and so is somewhat its own corrective. People are more likely to do the right thing and not listen to demagogues if they perceive risk correctly.
With COVID the problem is that many did and still do not want to believe that we are living under exceptional circumstances. Delta is currently correcting that misperception for many who are now realizing that "when you get sick you go to the hospital and they fix you" doesn´t really work so well. 

[J Boogie]

Just an update that my employer (S&P 500 company) where we've been working from home for over a year now will indeed be requiring vaccination for all employees.

I have a feeling we might get a small wave of retirements. Employer is in St. Paul but a good chunk of my coworkers live in rural Wisconsin and have rural Wisconsin sensibilities and are of that age.

[FrugalToque]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

[the_fixer]

At the monthly safety meeting today first thing out of the highest level manager was a rant on the Biden vaccine mandates and not to worry because the company is not going to enforce it and it will be a long time before it makes it through the courts if at all.

Closed the meeting by saying job safety is priority number one. The company, your family and friends are counting on you to work safely.

Talk about not seeing the forest for the trees…


Sent from my iPhone using Tapatalk

[Kris]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

That makes sense, then.

[jrhampt]

My company (fortune 500 health insurance) was one of the first to mandate vaccines for anyone coming to work onsite.  This was weeks ago.  I work remotely (even prior to covid) but support this mandate.  I don't want to have to go to work in an unsafe environment - no one should have to work in an unsafe environment when the remedy for it is so easy - and if I am called into an onsite meeting at some point in the future, I am pleased that I will be meeting with vaccinated people.

Now that it is an OSHA requirement (thank you, finally), I assume even the remote workers will need to be vaccinated.  I am totally fine with this.  I wish this had happened sooner, but a lot of us have to learn our lessons the hard way.

I do not GAF about anyone who is unvaccinated by choice at this point and whining about these mandates, and this includes immediate family members.  I do not want to know you, I do not want to see you, I do not want to talk to you at all if you are that selfish and can't do this one small thing.  I do not care if you lose their job as a result; choices have consequences.  There are plenty of people who will not do the right thing for any reason at all if they are given a choice.  And as a patient, you can be damn sure that I don't want to have to see medical staff who are unvaccinated.   

In response to Tyler's questions, sure - I am fine with booster shot mandates and flu shot mandates and financial ruin of those who choose to remain unvaccinated.  Absolutely.

[iris lily]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

“”Cancel culture is very real. You have to almost actively avoid the news articles to think it’s not real.

Like most things there is nuance. Sure some people in high places scoff at any criticism and that’s BS. The pendulum seems to be swinging into crazy territory with some of it.

Dave Chappell can see It.

https://twitter.com/NetflixIsAJoke/status/1166032594305265666?s=20. “

…Tyler Darden, cancelled on MMM 9/12/2021

[J Boogie]

To commemorate the forumnal death of Tyler Durden, we can all take a moment and listen the Pixies classic hit "Where is my mind."

[GuitarStv]

To commemorate the forumnal death of Tyler Durden, we can all take a moment and listen the Pixies classic hit "Where is my mind."

Regardless of forum bickering, the Pixies should make up a regular part of any balanced musical listening.

Gigantic, Wave of Mutilation, Hey, Debaser, Digging for Fire, Here Comes Your Man, Monkey Gone to Heaven . . . what a stunningly awesome group.

[EvenSteven]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

“”Cancel culture is very real. You have to almost actively avoid the news articles to think it’s not real.

Like most things there is nuance. Sure some people in high places scoff at any criticism and that’s BS. The pendulum seems to be swinging into crazy territory with some of it.

Dave Chappell can see It.

https://twitter.com/NetflixIsAJoke/status/1166032594305265666?s=20. “

…Tyler Darden, cancelled on MMM 9/12/2021

Wait, that's what cancel culture is?

[Sibley]

Nurses' refusal to vaccinate has led a hospital system to pause maternity services. Guess what, antivaxxers, now you're putting women's and infants' lives in danger (since, honestly, no one unvaccinated should be around newborns. Jesus.). I am not feeling charitable towards these immature, selfish, unpatriotic assholes at all.

Lewis County Health System to “pause” maternity services due to staff unwilling to vaccinate (NNY360.com)

Don't have a firm source, but I did read that hospital was going to be closing their maternity ward due to declining birth rates anyway. I saw it on Reddit, and there was an article attached, but not even going to try to find it now.

[Kris]

To commemorate the forumnal death of Tyler Durden, we can all take a moment and listen the Pixies classic hit "Where is my mind."

Regardless of forum bickering, the Pixies should make up a regular part of any balanced musical listening.

Gigantic, Wave of Mutilation, Hey, Debaser, Digging for Fire, Here Comes Your Man, Monkey Gone to Heaven . . . what a stunningly awesome group.

I will sign on to this. My fave band ever.

[iris lily]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

“”Cancel culture is very real. You have to almost actively avoid the news articles to think it’s not real.

Like most things there is nuance. Sure some people in high places scoff at any criticism and that’s BS. The pendulum seems to be swinging into crazy territory with some of it.

Dave Chappell can see It.

https://twitter.com/NetflixIsAJoke/status/1166032594305265666?s=20. “

…Tyler Darden, cancelled on MMM 9/12/2021

Wait, that's what cancel culture is?

Yeppers! thank me for educating you!

[Kris]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

“”Cancel culture is very real. You have to almost actively avoid the news articles to think it’s not real.

Like most things there is nuance. Sure some people in high places scoff at any criticism and that’s BS. The pendulum seems to be swinging into crazy territory with some of it.

Dave Chappell can see It.

https://twitter.com/NetflixIsAJoke/status/1166032594305265666?s=20. “

…Tyler Darden, cancelled on MMM 9/12/2021

Honestly, I can't see Tyler getting booted off a private forum as meeting even the lowest bar of "cancel culture," but okay...

[iris lily]

Nurses' refusal to vaccinate has led a hospital system to pause maternity services. Guess what, antivaxxers, now you're putting women's and infants' lives in danger (since, honestly, no one unvaccinated should be around newborns. Jesus.). I am not feeling charitable towards these immature, selfish, unpatriotic assholes at all.

Lewis County Health System to “pause” maternity services due to staff unwilling to vaccinate (NNY360.com)

Don't have a firm source, but I did read that hospital was going to be closing their maternity ward due to declining birth rates anyway. I saw it on Reddit, and there was an article attached, but not even going to try to find it now.

That news about imminent closing would not fit the favored narrative here on MMM and elsewhere. Please stifle talk about that. We need to push the idea that mommies and babies cannot be served due to stupidity of health workers who will not get vaccinated.  Think about the children!

Yes, I am Big Mad at the moment but will get over it.

[ender]

I am a little curious about why he was kicked off given we, imo, have far more problematic posters here on the forum who remain active.

Maybe there were a bunch of posts he made elsewhere which were removed.

[Psychstache]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

“”Cancel culture is very real. You have to almost actively avoid the news articles to think it’s not real.

Like most things there is nuance. Sure some people in high places scoff at any criticism and that’s BS. The pendulum seems to be swinging into crazy territory with some of it.

Dave Chappell can see It.

https://twitter.com/NetflixIsAJoke/status/1166032594305265666?s=20. “

…Tyler Darden, cancelled on MMM 9/12/2021

Honestly, I can't see Tyler getting booted off a private forum as meeting even the lowest bar of "cancel culture," but okay...

+1. If he was doxxed and lost his job or something, this would be a different concern. This is basically the equivalent of being kicked out of a Wendy's because you refused to wear pants.

[CodingHare]

Nurses' refusal to vaccinate has led a hospital system to pause maternity services. Guess what, antivaxxers, now you're putting women's and infants' lives in danger (since, honestly, no one unvaccinated should be around newborns. Jesus.). I am not feeling charitable towards these immature, selfish, unpatriotic assholes at all.

Lewis County Health System to “pause” maternity services due to staff unwilling to vaccinate (NNY360.com)

Don't have a firm source, but I did read that hospital was going to be closing their maternity ward due to declining birth rates anyway. I saw it on Reddit, and there was an article attached, but not even going to try to find it now.

That news about imminent closing would not fit the favored narrative here on MMM and elsewhere. Please stifle talk about that. We need to push the idea that mommies and babies cannot be served due to stupidity of health workers who will not get vaccinated.  Think about the children!

Yes, I am Big Mad at the moment but will get over it.

So you are saying it doesn't matter that these unvaccinated nurses are walking out because there wouldn't be any births there anyway?  Trying to understand what you are mad about.

[iris lily]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

“”Cancel culture is very real. You have to almost actively avoid the news articles to think it’s not real.

Like most things there is nuance. Sure some people in high places scoff at any criticism and that’s BS. The pendulum seems to be swinging into crazy territory with some of it.

Dave Chappell can see It.

https://twitter.com/NetflixIsAJoke/status/1166032594305265666?s=20. “

…Tyler Darden, cancelled on MMM 9/12/2021

Honestly, I can't see Tyler getting booted off a private forum as meeting even the lowest bar of "cancel culture," but okay...

Aren’t you the person who had, in her signature for years, an insulting direct attack on one poster here? I think that was you. I was wondering how that was allowed to stand but hey it was a pretty free and open atmosphere back in those days I guess.

Now I need to go find the rules of engagement for this forum and re-educate myself on what is allowed and what is not.I mean this latter sentence sincerely, I don’t recall what are grounds for dismissal.

[Psychstache]

I am a little curious about why he was kicked off given we, imo, have far more problematic posters here on the forum who remain active.

Maybe there were a bunch of posts he made elsewhere which were removed.

I also agree with this. I found TD annoying in his methods, but nothing I saw reached the level of ban worthy.

That said, I'm not a mod and I appreciate everything they do for us and concede they see more of this forum than I do, so I doubt I have the full picture.

[Psychstache]

Nurses' refusal to vaccinate has led a hospital system to pause maternity services. Guess what, antivaxxers, now you're putting women's and infants' lives in danger (since, honestly, no one unvaccinated should be around newborns. Jesus.). I am not feeling charitable towards these immature, selfish, unpatriotic assholes at all.

Lewis County Health System to “pause” maternity services due to staff unwilling to vaccinate (NNY360.com)

Don't have a firm source, but I did read that hospital was going to be closing their maternity ward due to declining birth rates anyway. I saw it on Reddit, and there was an article attached, but not even going to try to find it now.

That news about imminent closing would not fit the favored narrative here on MMM and elsewhere. Please stifle talk about that. We need to push the idea that mommies and babies cannot be served due to stupidity of health workers who will not get vaccinated.  Think about the children!

Yes, I am Big Mad at the moment but will get over it.

I also saw this thread on Reddit. It's certainly plausible, but there was no source given on an inveitable closure, just the word of some redditors.

[iris lily]

I am a little curious about why he was kicked off given we, imo, have far more problematic posters here on the forum who remain active.

Maybe there were a bunch of posts he made elsewhere which were removed.

I also agree with this. I found TD annoying in his methods, but nothing I saw reached the level of na worthy. That said, I'm not a mod and I appreciate everything they do for us and concede they see more of this forum than I do, so I doubt I have the full picture.

None of us know went on behind the scenes of moderation.

I am going through Tyler’s posts and reading  each one. I’m about a quarter of the way through and see nothing worth banning. But perhaps things heated up in the past year. So far I’m seeing a thoughtful poster touching on many ideas of FIRE in thoughtful ways.

[iris lily]

It makes a huge difference. On a normal day, staffing runs right on the edge of safety (and often on the worse side) and presently hospitals in many if not most places are at or over their actual capacity. It makes a bad situation worse.

Still can’t muster a single fuck to give about the “mandate” pearl clutchers, though. If we ever want out, this is what needs to happen.

I just want to say that I'm not saying all of this to generate sympathy for people against hospitals making mandates. I just think people aren't seeing the reality of the situation, which is a seriously, seriously bad one.

I do think you’re right that most of us who never enter a hospital, are not part of a healthcare delivery system, don’t see what’s happening.

I will say though that I hear such varying statistics I wonder what emergency “capacity “really is.

I hear that Florida ICU’s and emergency care facilities are at 95%.

I thought I read a year and a half ago that most facilities operate at 90- 95% occupancy anyway, pre covid.

I absolutely understand fatigue of those providing emergency care, and I appreciate their dedication and I worry about them. But I tire of what seems to be changing information, mis-information, false emergencies, crying wolf.

I, too, am curious how those numbers are handled. I don't know from a statistical standpoint or large-scale standpoint how people get the numbers. What I'm thinking of is less about 95% capacity or whatever all of that means and more along the lines of hospitals literally turning people away because there is literally 0 capacity so there's no room for ambiguity.

Hospitals operate at around 90% capacity normally. That is due to a variety of reasons, and they affect operations both pre and during COVID.

The most common (in order) are:
1) Staffing - especially nurse staffing. Attrition is currently extremely high due to repeated COVID surges.
2) Operations being performed - most money for hospitals come from elective surgery, so we try to keep this as high as possible. During the COVID surge, most hospitals have reduced their caseloads to compensate since OR, post-operative recovery areas and ERs can be used as ICUs since those nurses are trained in critical care (to some extent). This has almost never happened pre-COVID except after mass-casualty events (i.e. 9/11 in NYC area, Katrina in Gulf Coast).
3) ER admissions - this varies seasonally. During winter it goes up due to influenza. In summer it goes up due to gun/knife violence. When the hospitals reach a capacity threshold (around 95%, but varies from hospital to hospital), the ER goes on "diversion" - they will not accept EMS. However, walk-in / drop-off patients cannot be refused care so there will still be people who need admission (hence the 5% buffer). During COVID, ERs have been hit with a lot of walk-ins along with EMS. Unlike pre-COVID, regions are facing a crisis not previously seen in the US: what to do when all the hospitals in a region are on diversion? For example, my hospital recently accepted people from 400 miles away who were critically ill and airlifted in. This was because all the hospitals between there and us were on diversion.

Also, we have to separate critical care and floor (non-critical care) capacity. This is important because by definition (except for select surgery cases), critical care is not elective. We have to provide capacity, otherwise people will just literally die. For example, in Houston we have a high % of critical care to floor beds because of the number of referral/safety net hospitals. Even then, we are at 150% of standard critical care capacity due to COVID. We are now using 100% of ICUs in the city and 50% of the OR/recovery/ER.

With COVID, this distinction is not as clear-cut. We don't expect people with normal pneumonia or whatever illness to rapidly deteriorate in-hospital and need ICU care. Otherwise they'd be in the ICU to begin with. With this surge, that isn't an option so people who normally would be in the ICU cannot be, so they deteriorate on the floor and then hopefully by then someone in the ICU has died and freed up a bed. We try to keep at least 1 ICU bed empty for these in-hospital emergencies (but with surges that isn't always possible). What do we do then? Try to provide ICU care on the floor and hope that person doesn't deteriorate further (i.e. need intubation or central lines). But if they do, they do. Nothing much we can do about it till someone in the ICU dies.

What does this mean? If someone comes to the ER in critical condition, they stay on a gurney in the ER until a room is available in the ICU. If all the rooms in the ER are filled with critically ill, then the non-critical patients either wait in the lobby (upwards of 1 day) or if they do require emergency care, are seen in gurneys literally in the hallway. So now we are taking care of heart attack and stroke victims in the hallways, snaking equipment around so there's enough space for people to walk.

If you aren't seriously ill (i.e. actively dying) and come to the ER in Houston or most places in Texas, you will likely not be seen by a physician or NP for at least 24 hours. You may stay in the ER for the entirety of your stay. If you need a major operation that is not an emergency or cancer-related, you will not have that operation for the foreseeable future. If you need a transplant, that will not be happening (except critically ill liver, lung or heart - that's a complicated story). If you need heart-lung bypass for a non-emergency heart or liver surgery, that will not be happening.

That is what those numbers mean.

Why is this different than normal?
In a normal situation, our 90-95% capacity is predictable because we know what to expect for influenza, and can scale back elective surgery if needed to provide additional ICU and non-ICU beds. That works out because elective operations decrease to some extent during the winter months. If it's an especially bad influenza season, there is some amount of surge capacity that can be temporarily provided. However, with COVID there are two issues:

1) even critically ill influenza patients are usually not as sick as critically ill COVID patients. Only the very sickest develop multi-organ failure, whereas it is relatively common to see that with COVID. For reference, in the Houston area (which has world-renown cardiopulmonary care - i.e. people come here from other countries for cardiac surgery, etc) there is a 9% mortality associated with admission to a hospital for COVID. For influenza it is usually around 3-4%. The H1N1 strain resulted in 6-7% in-hospital mortality, still lower than COVID.

2). The surges are more extreme on a population and individual level. Currently 1/3 of critically ill patients in Houston are in the ICU because of COVID. On average for flu season this is <10%.

As noted above, mortality is higher for COVID, but people don't die quickly. For most types of severe pneumonia, critical illness  translates to patients slowly dying over multiple weeks (all the while taking up ICU space). Thus, these two issues combined result in more people on the "glide-slope" to death at any given time during the influenza surges. This is another factor leading to the high ICU utilization rates for COVID.

I no longer do critical care for multiple reasons, though am qualified (and volunteered for the February COVID surge -didn't need to work since it died down fairly quickly). Several of my friends do, and most have pushed up their retirement ages significantly as a result. Two of my friends are pediatric critical care, and are being pulled for adult critical care due to burn-out of the standard teams. On a normal night when I covered ICUs, we'd have maybe 1 code (cardiac arrest) out of 30-40 patients per night. In the COVID units that's more like 3-4. Also, they keep coming back (since they are younger with this surge - but gross oversimplification) and families are not ready to let go, so they get re-coded several times. So basically someone is coding at any given moment, all night.

We are not crying wolf. Luckily, like all things, this too will end. And the coffins will be stacked. And the same nonsense will happen again. Except every time there will be fewer people willing to waste the good parts of their lives caring for people who don't care about their own. When I covered the ICU it was for post-operative patients and I knew in general they had no say in what happened to them. Many of my friends feel the same way and are realizing that medicine is a calling, but not a mandate. They can and will make a living in other, more useful ways.

Before I get lost in the weeds of another unrelated topic, I want to thank you for this post. I appreciate the time you took to write it out. These are tough times.

[GuitarStv]

I am a little curious about why he was kicked off given we, imo, have far more problematic posters here on the forum who remain active.

Maybe there were a bunch of posts he made elsewhere which were removed.

I also agree with this. I found TD annoying in his methods, but nothing I saw reached the level of na worthy. That said, I'm not a mod and I appreciate everything they do for us and concede they see more of this forum than I do, so I doubt I have the full picture.

None of us know went on behind the scenes of moderation.

I am going through Tyler’s posts and reading  each one. I’m about a quarter of the way through and see nothing worth banning. But I agree, I could’ve heated up in the past year. So far I’m seeing a thoughtful poster touching on many ideas of FIRE in thoughtful ways.

I don't agree with much of what Tyler was posting, but also didn't see too much that struck me as ban-worthy.  But the important thing is the first part that you identified.  We don't know what went on behind the scenes.  My experience with moderators on this forum has been thoughtful, respectful, open to discussion over uncomfortable subjects, and generally light handed.

This leads me to conclude that something was going on behind the scenes that maybe wasn't so visible to the rest of us.

[iris lily]

Nurses' refusal to vaccinate has led a hospital system to pause maternity services. Guess what, antivaxxers, now you're putting women's and infants' lives in danger (since, honestly, no one unvaccinated should be around newborns. Jesus.). I am not feeling charitable towards these immature, selfish, unpatriotic assholes at all.

Lewis County Health System to “pause” maternity services due to staff unwilling to vaccinate (NNY360.com)

Don't have a firm source, but I did read that hospital was going to be closing their maternity ward due to declining birth rates anyway. I saw it on Reddit, and there was an article attached, but not even going to try to find it now.

That news about imminent closing would not fit the favored narrative here on MMM and elsewhere. Please stifle talk about that. We need to push the idea that mommies and babies cannot be served due to stupidity of health workers who will not get vaccinated.  Think about the children!

Yes, I am Big Mad at the moment but will get over it.

So you are saying it doesn't matter that these unvaccinated nurses are walking out because there wouldn't be any births there anyway?  Trying to understand what you are mad about.

Pretty much.

 If  the previous poster was correct:

An organization  planning to close it’s birthing support operation closes earlier rather than later. This fact is a political pawn in the Covid information wars as to what reasons foe closure are emphasized.

This is not what I am Big Mad about, I am indifferent to this news story itself of a closing.

[CodingHare]

Nurses' refusal to vaccinate has led a hospital system to pause maternity services. Guess what, antivaxxers, now you're putting women's and infants' lives in danger (since, honestly, no one unvaccinated should be around newborns. Jesus.). I am not feeling charitable towards these immature, selfish, unpatriotic assholes at all.

Lewis County Health System to “pause” maternity services due to staff unwilling to vaccinate (NNY360.com)

Don't have a firm source, but I did read that hospital was going to be closing their maternity ward due to declining birth rates anyway. I saw it on Reddit, and there was an article attached, but not even going to try to find it now.

That news about imminent closing would not fit the favored narrative here on MMM and elsewhere. Please stifle talk about that. We need to push the idea that mommies and babies cannot be served due to stupidity of health workers who will not get vaccinated.  Think about the children!

Yes, I am Big Mad at the moment but will get over it.

So you are saying it doesn't matter that these unvaccinated nurses are walking out because there wouldn't be any births there anyway?  Trying to understand what you are mad about.

In summary, and if the previous poster was correct:

An organization  planning to close it’s birthing support operation closes earlier rather than later.

This is not what I am Big Mad about, I am indifferent to this news story that takes political sides in which “side” it emphasizes.

Ah, the Big Mad is Tyler's ban, then?  Got it.

I guess I still see these nurses walking out as a bad thing.  They could potentially be rehired at another hospital and expose patients there.  It's my feeling that if a medical professional is too stupid to get vaccinated, they probably should have failed med school and shouldn't be anywhere near a patient.

I know nurses are hard to find and the profession is shortstaffed, but if the medical boards are letting people like this through then their gatekeeping role is obviously not working.   But that is just yet another are where American healthcare is breaking down.  I am reminded of the "This is fine" dog.

[iris lily]

Maybe there were a bunch of posts he made elsewhere which were removed.

This leads me to conclude that something was going on behind the scenes that maybe wasn't so visible to the rest of us.

I agree and would like to know behind-the-scenes facts because it is disruptive to have THIS conversation in the open on this thread, and for this I apologize. This thread should not be a referendum on moderation, it needs to be a referendum on our President’s actions around vaccine mandate.

But see, I cannot contact Tyler Durden to get any facts from his side of the story because HE IS BANNED. See how that works?

[Kris]

[MOD NOTE: Tyler Durden is banned]

U serious?

Whoah.

Echo chamber taking place here.

I will say, I’d like to know what he did that was a bannable offense. He was pretty irritating, true. But I haven’t seen anything that merited muting or banning him.

There were previous warning on previous topics, not just this one.  None of us make these decisions lightly.

Toque.

“”Cancel culture is very real. You have to almost actively avoid the news articles to think it’s not real.

Like most things there is nuance. Sure some people in high places scoff at any criticism and that’s BS. The pendulum seems to be swinging into crazy territory with some of it.

Dave Chappell can see It.

https://twitter.com/NetflixIsAJoke/status/1166032594305265666?s=20. “

…Tyler Darden, cancelled on MMM 9/12/2021

Honestly, I can't see Tyler getting booted off a private forum as meeting even the lowest bar of "cancel culture," but okay...

Aren’t you the person who had, in her signature for years, an insulting direct attack on one poster here? I think that was you. I was wondering how that was allowed to stand but hey it was a pretty free and open atmosphere back in those days I guess.

Now I need to go find the rules of engagement for this forum and re-educate myself on what is allowed and what is not.I mean this latter sentence sincerely, I don’t recall what are grounds for dismissal.

I don't recall that. I suppose it is possible.

But if I had been kicked off for something like that, I certainly wouldn't have considered it "cancel culture."

[Jenny Wren]

I agree and would like to know behind-the-scenes facts because it is disruptive to have THIS conversation in the open on this thread, and for this I apologize. This thread should not be a referendum on moderation, it needs to be a referendum on our President’s actions around vaccine mandate.

But see, I cannot contact Tyler Durden to get any facts from his side of the story because HE IS BANNED. See how that works?

Or you, know, learn that not everything is your business?  Or start your own thread to whine about the moderation on a PRIVATE forum, instead of derailing this thread? Or start your own forum with your own rules? Just some ideas....

[MudPuppy]

This is a private forum, none of us are owed participation opportunity here. If there was a previous warning and he was again in violation of whatever that warning was for, I don’t see any issue.