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Covid, the "lockdowns" etc.

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HappyDaze:

--- Quote from: 3catcircus on January 17, 2022, 05:50:23 PM ---
--- Quote from: HappyDaze on January 17, 2022, 05:37:27 PM ---
--- Quote from: 3catcircus on January 17, 2022, 12:44:04 PM ---
--- Quote from: HappyDaze on January 17, 2022, 08:50:15 AM ---
--- Quote from: 3catcircus on January 17, 2022, 08:28:11 AM ---
--- Quote from: Mistwell on January 16, 2022, 10:01:31 PM ---
--- Quote from: 3catcircus on January 14, 2022, 09:04:37 AM ---
--- Quote from: HappyDaze on January 14, 2022, 12:04:35 AM ---
--- Quote from: 3catcircus on January 13, 2022, 08:21:56 PM ---
--- Quote from: HappyDaze on January 13, 2022, 05:08:21 PM ---
--- Quote from: 3catcircus on January 13, 2022, 04:22:22 PM ---
--- Quote from: jhkim on January 13, 2022, 03:08:38 PM ---
--- Quote from: 3catcircus on January 13, 2022, 10:18:55 AM ---This is what is happening in many places. Let's say they have 100 available beds, but only enough staff for 50 beds.  They can declare (and several have done so) themselves to be over capacity with 51 patients occupying beds. 

This is why you can't trust anything coming from hospital administrators without seeing it for yourself.

We have situations where they've fired unvaccinated nurses and doctors while simultaneously ordering vaccinated but infected ones to come back to work *while still contagious*.  Meanwhile all of those fired nurses and doctors are making 2x, 3x, or more salary by being traveling medical practitioners - either going elsewhere or actually being contracted by the hospital that fired them - as independent contractors, they don't have to be vaccinated because they're not employees...
--- End quote ---

When you say "we" here, 3catcircus, do you also work in health care and saw this yourself? If so, where do you work? If not, what is your source?

I don't doubt that dumb shit has happened. The question is what is the norm? I don't have first-hand knowledge, but people I know in health care seem to think it's roughly real. I'll buy that mainstream liberal-leaning media is biased, but even if I'm reading on Newsmax, I see stuff about hospitals being overwhelmed by the Omicron surge.

https://www.newsmax.com/newsfront/covid-omicron-hospital/2022/01/07/id/1051414/

--- End quote ---

CNN (lack of staff resulting in inability to use all their beds):

https://www.cnn.com/2022/01/13/health/us-coronavirus-thursday/index.html

Yahoo (sick healthcare workers ordered back to work):

https://news.yahoo.com/hospitals-reeling-california-tells-covid-130036030.html

travelnursing.org (job opps for traveling nurses):

https://www.travelnursing.org/covid-updates-for-travel-nurses-january-5-2022/

CBS News (no vaccine required to be hired as a nurse).

https://www.cbsnews.com/news/nebraska-job-ad-nurses-no-vaccination-requirement/

--- End quote ---
My hospital just opened 3 new floors on a tower, so 120 new inpatient beds. We've been trying to hire staff for the past year and we still only have about 1/3 what we need for the new beds (many new hires we redirected to cover gaps in other units) and even with traveling nurses, we can only staff 2/3 of those beds right now.

--- End quote ---

Right. The question is if your hospital will report over capacity if they put more bodies in beds than they have staff for, or only if they start stacking them in hallway gurneys because every other bed in an actual room is full.

Who knows if it is hospital administrators being disengenuous or if the media is (as is typical) not reporting factual information.

--- End quote ---
Hospitals don't choose which statistics to report or how they do so, they report them in the format they are told to do so by CMS and other authorities. This might be in terms of licensed beds, operational beds, or staffed beds.

Hallway beds are not an inpatient thing, they exist in the EDs d/t the requirements of EMTALA that no patient seeking emergent care be turned away until it can be determined that they no longer have an emergent condition (or that they never did).

Your "who knows" line is the kind of bullshit that doesn't help at all because it implies that nobody knows. I'm telling you facts from within the system and you're still going with "who knows" kind of shit. I know, and so do many others workign in healthcare.

--- End quote ---

If you're not in hospital administration and you don't think they would spin the numbers to fit a narrative, you're a fool.

Here's numbers from HHS... doesn't look like they're in a crisis at all.

--- End quote ---

I have a question for you.

You're in the financial services industry, not the medical industry. You're telling a guy who works in the medical industry that you know how his hospital works better than he knows how his hospital works, based purely on your gut instinct and what matches your world view.

My question is: How the fuck?

--- End quote ---

First of all, I'm an engineer. My assessment is data-based.  So, yes, based on the data, I am telling him how hospitals, by and large, are not in crisis. 

Secondly, while not as well-versed as dkabq in aerosol studies specifically, my work focuses on system-of-systems activities, so I've been involved in several air wake studies - even if you reduce risk to someone directly in front of you, no one in the real world sits there face-to-face in close proximity for hours at a time. The fact remains that you're sharing your exhalate to everyone behind and to the side of you. And that non-laminar flow ensures that anything hanging out in your exhalate is going to float along for quite some time.

--- End quote ---
You're a blind man describing an elephant.

Does your data show you the changes in ED accessibility? Does your data show you the multiple aspects of staffing difficulties (including retention and retraining)? Does your data show you the effects of disrupted supply chain on medical supplies and pharmaceuticals? Does your data show the impact of the pandemic on post-acute care options (which complicates discharges)? Does your data show you the impact any/all of these on patient experience/satisfaction scores (which directly impacts hospital reimbursement)?

It might surprise you to know that we in the healthcare industry know how to work with data too, and we weigh all of the above when we say hospitals are in a crisis.

--- End quote ---

Actually, ya don't.

The healthcare industry has, for decades, operated on razor-thin margins of material supplies in hand and on staffing bench depth.  Administrators have been rewarded for minimizing costs, even when it meant having not enough supplies in reserve and not enough employees to do the work - before covid happened.  Because, god forbid, they'd have had to have people employed to manage and rotate stocks of perishables and to survey levels of non-perishable supplies and might have had to pay people with nothing to do on slow shifts other than catch up on endless paperwork. When your model has been "just in time" delivery of stuff coming from China and "almost but not quite enough staff," and you don't change when you can see that supply chain issues will get worse (we knew this almost two years ago) and you purposely fire unvaxxed staff but then order vaxxed staff who are positive and possibly still contagious back to work, you deserve to get fired.

--- End quote ---
So, blind man, tell me again what an elephant is.

--- End quote ---

That you can't refute my statements says everything...

--- End quote ---
I can refute several of your points, but only for specific hospital systems. That's not saying your points are necessarily correct or incorrect, but they are sweeping generalizations. Further, any fool can point out flaws in a system without identifying feasible fixes. Do you have a magic fix beyond "just do better at everything?"

Mistwell:

--- Quote from: Eirikrautha on January 17, 2022, 12:19:11 AM ---
--- Quote from: Mistwell on January 16, 2022, 10:11:03 PM ---
Cloth masks still reduce the radius of your breath outward. As someone who has played D&D before, you fully understand and appreciate the importance of the radial spread of a breath weapon. This is provable, and can be seen with your own eyes if you care to conduct an experiment.

--- End quote ---

You just compared Covid to a breath weapon?  And you call other people out of touch with reality...

The preponderance of the evidence suggests that Covid spreads from person to person primarily as an aerosol, and not via droplet transfer.  There are indications that both the likelihood of infection and some severity is based on viral load due to prolonged exposure, and not singular spread due to being coughed on or sneezed on.  So the idea that a mask, especially a cloth mask, is doing anything is total wishful thinking.  You have far more to worry about from recycled air in buildings, which contains particles of virus far too small for your mask to do anything about.  But you'd know all that, if you actually cared about the actual "science" of the virus' spread...

--- End quote ---

Still a ton of droplet transfers of this virus, and LOTS of studies demonstrate that. Strongest dosage has been shown to be from sneezing and coughing, both of which has it's radial spread reduced by any mask. I'll be happy to post studies the moment you back up your bullshit "preponderance of the evidence" claim. Which we both know you won't. Because you spew whatever bullshit comes to your mind and then move on with a dismissal.

Pat:

--- Quote from: Mistwell on January 17, 2022, 10:43:18 PM ---
--- Quote from: Eirikrautha on January 17, 2022, 12:19:11 AM ---
--- Quote from: Mistwell on January 16, 2022, 10:11:03 PM ---
Cloth masks still reduce the radius of your breath outward. As someone who has played D&D before, you fully understand and appreciate the importance of the radial spread of a breath weapon. This is provable, and can be seen with your own eyes if you care to conduct an experiment.

--- End quote ---

You just compared Covid to a breath weapon?  And you call other people out of touch with reality...

The preponderance of the evidence suggests that Covid spreads from person to person primarily as an aerosol, and not via droplet transfer.  There are indications that both the likelihood of infection and some severity is based on viral load due to prolonged exposure, and not singular spread due to being coughed on or sneezed on.  So the idea that a mask, especially a cloth mask, is doing anything is total wishful thinking.  You have far more to worry about from recycled air in buildings, which contains particles of virus far too small for your mask to do anything about.  But you'd know all that, if you actually cared about the actual "science" of the virus' spread...

--- End quote ---

Still a ton of droplet transfers of this virus, and LOTS of studies demonstrate that. Strongest dosage has been shown to be from sneezing and coughing, both of which has it's radial spread reduced by any mask. I'll be happy to post studies the moment you back up your bullshit "preponderance of the evidence" claim. Which we both know you won't. Because you spew whatever bullshit comes to your mind and then move on with a dismissal.

--- End quote ---
You've never backed up those or similar claims in the past, even when I've linked studies and run down the evidence showing otherwise.

Covid-19 is primarily transmitted via aerosolization. The chance of getting the disease from fomites or large droplets that quickly precipitate from the air is negligible.

dkabq:

--- Quote from: Mistwell on January 17, 2022, 10:43:18 PM ---
--- Quote from: Eirikrautha on January 17, 2022, 12:19:11 AM ---
--- Quote from: Mistwell on January 16, 2022, 10:11:03 PM ---
Cloth masks still reduce the radius of your breath outward. As someone who has played D&D before, you fully understand and appreciate the importance of the radial spread of a breath weapon. This is provable, and can be seen with your own eyes if you care to conduct an experiment.

--- End quote ---

You just compared Covid to a breath weapon?  And you call other people out of touch with reality...

The preponderance of the evidence suggests that Covid spreads from person to person primarily as an aerosol, and not via droplet transfer.  There are indications that both the likelihood of infection and some severity is based on viral load due to prolonged exposure, and not singular spread due to being coughed on or sneezed on.  So the idea that a mask, especially a cloth mask, is doing anything is total wishful thinking.  You have far more to worry about from recycled air in buildings, which contains particles of virus far too small for your mask to do anything about.  But you'd know all that, if you actually cared about the actual "science" of the virus' spread...

--- End quote ---

Still a ton of droplet transfers of this virus, and LOTS of studies demonstrate that. Strongest dosage has been shown to be from sneezing and coughing, both of which has it's radial spread reduced by any mask. I'll be happy to post studies the moment you back up your bullshit "preponderance of the evidence" claim. Which we both know you won't. Because you spew whatever bullshit comes to your mind and then move on with a dismissal.

--- End quote ---

What is the effectiveness of masks, in terms of redirecting spread, compared to covering your mouth when you cough or "vampire" coughing, or sneezing into a tissue? I would posit that they are effectively equivalent.

3catcircus:

--- Quote from: HappyDaze on January 17, 2022, 08:08:36 PM ---
--- Quote from: 3catcircus on January 17, 2022, 05:50:23 PM ---
--- Quote from: HappyDaze on January 17, 2022, 05:37:27 PM ---
--- Quote from: 3catcircus on January 17, 2022, 12:44:04 PM ---
--- Quote from: HappyDaze on January 17, 2022, 08:50:15 AM ---
--- Quote from: 3catcircus on January 17, 2022, 08:28:11 AM ---
--- Quote from: Mistwell on January 16, 2022, 10:01:31 PM ---
--- Quote from: 3catcircus on January 14, 2022, 09:04:37 AM ---
--- Quote from: HappyDaze on January 14, 2022, 12:04:35 AM ---
--- Quote from: 3catcircus on January 13, 2022, 08:21:56 PM ---
--- Quote from: HappyDaze on January 13, 2022, 05:08:21 PM ---
--- Quote from: 3catcircus on January 13, 2022, 04:22:22 PM ---
--- Quote from: jhkim on January 13, 2022, 03:08:38 PM ---
--- Quote from: 3catcircus on January 13, 2022, 10:18:55 AM ---This is what is happening in many places. Let's say they have 100 available beds, but only enough staff for 50 beds.  They can declare (and several have done so) themselves to be over capacity with 51 patients occupying beds. 

This is why you can't trust anything coming from hospital administrators without seeing it for yourself.

We have situations where they've fired unvaccinated nurses and doctors while simultaneously ordering vaccinated but infected ones to come back to work *while still contagious*.  Meanwhile all of those fired nurses and doctors are making 2x, 3x, or more salary by being traveling medical practitioners - either going elsewhere or actually being contracted by the hospital that fired them - as independent contractors, they don't have to be vaccinated because they're not employees...
--- End quote ---

When you say "we" here, 3catcircus, do you also work in health care and saw this yourself? If so, where do you work? If not, what is your source?

I don't doubt that dumb shit has happened. The question is what is the norm? I don't have first-hand knowledge, but people I know in health care seem to think it's roughly real. I'll buy that mainstream liberal-leaning media is biased, but even if I'm reading on Newsmax, I see stuff about hospitals being overwhelmed by the Omicron surge.

https://www.newsmax.com/newsfront/covid-omicron-hospital/2022/01/07/id/1051414/

--- End quote ---

CNN (lack of staff resulting in inability to use all their beds):

https://www.cnn.com/2022/01/13/health/us-coronavirus-thursday/index.html

Yahoo (sick healthcare workers ordered back to work):

https://news.yahoo.com/hospitals-reeling-california-tells-covid-130036030.html

travelnursing.org (job opps for traveling nurses):

https://www.travelnursing.org/covid-updates-for-travel-nurses-january-5-2022/

CBS News (no vaccine required to be hired as a nurse).

https://www.cbsnews.com/news/nebraska-job-ad-nurses-no-vaccination-requirement/

--- End quote ---
My hospital just opened 3 new floors on a tower, so 120 new inpatient beds. We've been trying to hire staff for the past year and we still only have about 1/3 what we need for the new beds (many new hires we redirected to cover gaps in other units) and even with traveling nurses, we can only staff 2/3 of those beds right now.

--- End quote ---

Right. The question is if your hospital will report over capacity if they put more bodies in beds than they have staff for, or only if they start stacking them in hallway gurneys because every other bed in an actual room is full.

Who knows if it is hospital administrators being disengenuous or if the media is (as is typical) not reporting factual information.

--- End quote ---
Hospitals don't choose which statistics to report or how they do so, they report them in the format they are told to do so by CMS and other authorities. This might be in terms of licensed beds, operational beds, or staffed beds.

Hallway beds are not an inpatient thing, they exist in the EDs d/t the requirements of EMTALA that no patient seeking emergent care be turned away until it can be determined that they no longer have an emergent condition (or that they never did).

Your "who knows" line is the kind of bullshit that doesn't help at all because it implies that nobody knows. I'm telling you facts from within the system and you're still going with "who knows" kind of shit. I know, and so do many others workign in healthcare.

--- End quote ---

If you're not in hospital administration and you don't think they would spin the numbers to fit a narrative, you're a fool.

Here's numbers from HHS... doesn't look like they're in a crisis at all.

--- End quote ---

I have a question for you.

You're in the financial services industry, not the medical industry. You're telling a guy who works in the medical industry that you know how his hospital works better than he knows how his hospital works, based purely on your gut instinct and what matches your world view.

My question is: How the fuck?

--- End quote ---

First of all, I'm an engineer. My assessment is data-based.  So, yes, based on the data, I am telling him how hospitals, by and large, are not in crisis. 

Secondly, while not as well-versed as dkabq in aerosol studies specifically, my work focuses on system-of-systems activities, so I've been involved in several air wake studies - even if you reduce risk to someone directly in front of you, no one in the real world sits there face-to-face in close proximity for hours at a time. The fact remains that you're sharing your exhalate to everyone behind and to the side of you. And that non-laminar flow ensures that anything hanging out in your exhalate is going to float along for quite some time.

--- End quote ---
You're a blind man describing an elephant.

Does your data show you the changes in ED accessibility? Does your data show you the multiple aspects of staffing difficulties (including retention and retraining)? Does your data show you the effects of disrupted supply chain on medical supplies and pharmaceuticals? Does your data show the impact of the pandemic on post-acute care options (which complicates discharges)? Does your data show you the impact any/all of these on patient experience/satisfaction scores (which directly impacts hospital reimbursement)?

It might surprise you to know that we in the healthcare industry know how to work with data too, and we weigh all of the above when we say hospitals are in a crisis.

--- End quote ---

Actually, ya don't.

The healthcare industry has, for decades, operated on razor-thin margins of material supplies in hand and on staffing bench depth.  Administrators have been rewarded for minimizing costs, even when it meant having not enough supplies in reserve and not enough employees to do the work - before covid happened.  Because, god forbid, they'd have had to have people employed to manage and rotate stocks of perishables and to survey levels of non-perishable supplies and might have had to pay people with nothing to do on slow shifts other than catch up on endless paperwork. When your model has been "just in time" delivery of stuff coming from China and "almost but not quite enough staff," and you don't change when you can see that supply chain issues will get worse (we knew this almost two years ago) and you purposely fire unvaxxed staff but then order vaxxed staff who are positive and possibly still contagious back to work, you deserve to get fired.

--- End quote ---
So, blind man, tell me again what an elephant is.

--- End quote ---

That you can't refute my statements says everything...

--- End quote ---
I can refute several of your points, but only for specific hospital systems. That's not saying your points are necessarily correct or incorrect, but they are sweeping generalizations. Further, any fool can point out flaws in a system without identifying feasible fixes. Do you have a magic fix beyond "just do better at everything?"

--- End quote ---

Then please do so. For every hospital system that you can do this for, there is an equal number that you can't. Multiple points of the same condition is not a sweeping generalization - it's pointing out that when the majority of hospitals are doing the same thing and it's not working, then they need to change how they do business.

As to how to identify fixes?  A couple of methods exist.  None of them are ready. Most of them require looking beyond a fiscal ledger sheet.

1. Actually negotiate with suppliers rather than try to maintain a comfortable relationship. Your goal isn't to be their friends - and the harder you negotiate, the more you can buy for the same price which means you can maintain higher stock levels.
2. Performance-based logistics works for some things, but not others. It uses desired outcomes as a measure of success.  If that means you order from suppliers, great. If it means you establish your own logistics organization, then do so - if you manufacture your own supplies, you never have to worry about paying to outbid your competition when dealing with a supplier.
3. Demand accurate record-keeping of things you know need to be kept track of, not just what is mandated to be kept track of. You can't know unless you measure, and too often, it gets blown-off.
4. Hire the best person for the job, regardless of background.  Right now, there is an emphasis on diversity hiring just to check a gender/color/race box even when a better candidate exists.  Pay them well or otherwise compensate them (time off, perks, specific job assignments, etc.) based upon what they value as compensation - not just what the market average is, but what you expect they'll be worth in a year or two - the goal is retaining people rather than scrimping on compensation so you don't have to recruit and train people in a never-ending cycle.  The goal is not to match newly-minted doctors and nurses just to fill the req, if they are going to take a long time to develop only to have them leave before you get to take advantage of their development and growth.  The goal is to have a solid bench of people who you can interchange in a surge/flex situation while having sufficient reserve that they aren't going to be burnt out too quickly.  This only happens when people want to come to work because they see themselves being promoted and earning more compensation 5-10 years down the line rather than "it's a job and I gotta pay the bills."  This is a bigger problem in LTCs than in hospitals.
5. Be willing to look at the organization and be ready to make redundant as many administrative staff as possible if they are not value-added and not willing to perform.  You don't need three supervisors if you have one with the authority to act and a willingness to do so.  Your legal counsel and HR director should not be more highly compensated then your licensed medical staff.  They're support staff and are part of your overhead costs and are not bringing in business, research dollars, etc.

These are all very simple things that are very hard to execute - mostly because top-heavy organizations all have to weigh in on policy and procedure.  Authority and decision-making should be driven down to the lowest possible level.

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