Coronavirus

[pilowsky]

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

 

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

 

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

 

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

 

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

 

Medicine is different from Bridge or buying fish and chips or a big Mac. It is obvious from your post that you lack insight into what goes into 'giving a simple jab'.

A minimally competent doctor should go through the following steps before injecting any foreign agent into a person:

1. Greet the person and confirm that they have no allergies.

2. Confirm their identity and medical history.

3. Check their heart rate and do a quick assessment.

4. Check to make sure that they haven't already had the jab.

5. Document everything (remember you have to come back for a second 'jab'.

6. Gather whatever other information is need by the local health authority.

7. How long did it take to read all this carefully?

8. Make sure that the patient knows to come back for a second injection.

9. Carefully explain (possibly with the aid of an interpreter) the possible side-effects and which ones to be concerned about and which ones not to worry about.

10. Answer empathetically whatever questions or concerns they might have.

That's just for a young fit, healthy person.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

[shyams]

lengthy text...

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

 

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

 

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

 

Please don't rant needlessly.

[cherdano]

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

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

[pilowsky]

 

Please don't rant needlessly.

 

I agree.

[pilowsky]

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

 

This statement is incorrect. In the same way that your student's work may be done while you are not there, it is still done 'under your supervision'. It's the same with medicine. The doctor may not be in the room when the service is provided, but it is still done 'under their supervision'.

If someone gives me an injection, somewhere in the background - whether you can see them or not - is a qualified medical practitioner ready to carry the can.

 

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

[johnu]

Here's what I find completely incomprensible

 

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

 

https://www.theguardian.com/world/2020/dec/31/wisconsin-health-worker-deliberately-spoiled-500-covid-vaccine-doses

 

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

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

[Winstonm]

This statement is incorrect. In the same way that your student's work may be done while you are not there, it is still done 'under your supervision'. It's the same with medicine. The doctor may not be in the room when the service is provided, but it is still done 'under their supervision'.

If someone gives me an injection, somewhere in the background - whether you can see them or not - is a qualified medical practitioner ready to carry the can.

 

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

 

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

 

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

[sfi]

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

 

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

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

 

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

[Winstonm]

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

 

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

 

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

[cherdano]

This statement is incorrect. In the same way that your student's work may be done while you are not there, it is still done 'under your supervision'. It's the same with medicine. The doctor may not be in the room when the service is provided, but it is still done 'under their supervision'.

If someone gives me an injection, somewhere in the background - whether you can see them or not - is a qualified medical practitioner ready to carry the can.

 

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

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

 

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

[pilowsky]

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

 

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

 

All of this is true, BUT they are doing this task AND following guidelines set down by a medical practitioner.

If they deviate from those guidelines and there are adverse consequences THEN they will be in trouble.

The guidelines are established by qualified medical practitioners.

The medical practitioner does not have to be the person that you see when you have an ingrown toenail.

In the case of vaccinations, it obviously isn't.

 

This is not a random rant about the importance of health care workers that are not doctors.

I have personally suffered considerably because of the 'care' afforded to me by doctors in whom I have placed my trust.

The health care system is only as strong as it's the weakest link. Just like every other system.

 

I am a supporter of the principle that every member of an organisation should be trained to act 'to the limit of their competence' and not beyond it.

Who determines what the limit of competency is in the health care system? People with medical qualifications.

As in any other organisation measurement and certification of competence can be devolved to others that have a 'demonstrated level of competence'

 

Dr Fred Hollows training of health care works to perform sight-saving cataract removal surgery is a famous example.

In America, my understanding is that an 'anesthesiologist' who is a medical practitioner can be responsible for the activity of several 'anesthetists' in a group of operating theaters.

When a person receives a vaccination in the USA who is responsible - the FDA. The FDA is famous (pre-Trump) for its care and integrity. It is because of the FDA that thalidomide was not registered for use in pregnant women in the USA, although clinical trials in the USA did have the inevitable tragic consequences.

There are countless examples of how this works.

 

In the cloistered realms of Australian (it may be different in other countries) academia where I spent my working life it is different.

Every individual academic is responsible for what they say and do. It is almost impossible to unseat an academic even if they say the most outrageous things (and boy do they).

 

Obviously, injections are given by people other than medical practitioners. Clearly, this is a good thing.

But it is not the point.

 

At the top of the responsibility pyramid, there will be a qualified medical practitioner. The nurse/pharmacist etc may be acting out of the line of sight of a medical practitioner that does not mean that the actions they take are not ultimately sanctioned by medical practitioners.

It sounds like your syllogism has an undistributed middle term. - medizinischterminologischermittelschmerz perhaps .

[hrothgar]

 

At the top of the responsibility pyramid, there will be a qualified medical practitioner.

 

 

At least in the US, the top of the pyramid is your insurance carrier (and those are staffed by accountants and not medical practitioners)

[cherdano]

So, "you can't speed up vaccinations because there HAS to be a doctor present who is paid good dollar for a reason because he HAS to go through the following list" has turned into "nurses administering a vaccination are under the supervision of a doctor who is responsible" which then turns into "nurses administering a vaccination follow guidelines written by doctors". I mean, not even the last one is 100% true, RCN guidelines aren't just written by people with a medical degree, but even leaving that aside - I would propose just admitting being wrong would have been easier?

[sfi]

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

That's basically the same as here. Qualifications are recognised nationally (and there are provisions for recognising international qualifications from certain countries), but accreditation - the right to work as a nurse or doctor - was state-based until a decade or so ago. Since the accreditation was nationalised, you can work anywhere in Australia under the conditions provided by the accreditation.

 

Your description of the example is essentially the same as how the liability works in Australia. If there was an egregious breach that the hospital did not deal with appropriately, there are (state-based) bodies that deal with complaints. As an aside, the patient needs to make the complaint because they need to approve release of their medical records to the authority before they can investigate (I presume there are ways to deal with approval in the event of incapacity or death of the patient).

[sfi]

I mean, not even the last one is 100% true, RCN guidelines aren't just written by people with a medical degree

These guidelines are generally written by a committee. A variety of skills would be represented on this committee, both medical and non-medical. They would be approved by someone with authority for that organisation (nation, state, individual practice or other organisation with knowledge, expertise and credibility in that area), who may or may not be a doctor.

[barmar]

Here in the US, I think the majority of people get flu vaccines at pharmacies (all the major drug store chains offer them), not at doctors' offices. I also got the shingles vaccine at Walgreens.

 

Most of my time was spent filling out paperwork (I did it online the night before, but didn't realize I had to print it out and bring it with me) and waiting for the pharmacist who was busy with other customers. So about 10 minutes waiting, a couple of minutes for the actual jab.

 

I think when COVID-19 vaccines go widespread, they're expecting the big pharmacies to be involved similarly.

[Zelandakh]

I would propose just admitting being wrong would have been easier?

Have you actually seen that happen yet in the year or so of forum membership, Arend? There was that one time where a fake admission was made but an actual, genuine admission of being wrong on anything (despite countless times when this was the case)?

[y66]

This simple chart shows why the new variants of the coronavirus — first detected in Britain and South Africa — are so worrisome:

 

 

The chart compares the spread of the virus in each of those two countries with the spread in a group of nearby countries. As you can see, cases have surged in Britain and South Africa since the variants first surfaced — while holding fairly steady in the rest of western Europe and southern Africa.

 

The new variants may not be the only reason. Britain and South Africa differ from their neighbors in other ways, as well. But there is no obvious explanation for the contrast besides the virus’s mutations.

 

This suggests the rest of the world may now be at risk of a new Covid-19 surge.

 

The variants already seem to have spread around much of the world. More than 30 other countries, including the U.S., have diagnosed cases with the variant first detected in Britain, which is known as B.1.1.7. Scientists say that it could soon become the dominant form of the virus.

 

The B.1.1.7 variant appears to be between 10 percent and 60 percent more transmissible than the original version. One possible reason: It may increase the amount of the virus that infected people carry in their noses and throats, which in turn would raise the likelihood that they infect others through breathing, talking, sneezing, coughing and so on.

 

As I’ve explained before, the biggest factor that will determine how many more people die from the virus isn’t likely to be the precise effectiveness of the vaccines or even the speed of their rollout. The biggest factor is instead likely to be how much we reduce the spread of the virus over the next few months, through a combination of mask wearing, social distancing and expanded testing. Those efforts can cut caseloads — and, by extension, deaths — more rapidly than a mass vaccination campaign can.

 

But the U.S. was struggling to hold down new infections even before the variants appeared, and they will probably make the job more difficult. “I dismissed the news initially because viruses mutate all the time and there have been too many baseless ‘mutant-ninja virus’ doomsaying headlines this year,” Zeynep Tufekci wrote in The Atlantic last week. “However, as data on the new variant roll in, there is cause for real concern.”

 

My colleague Apoorva Mandavilli, in a piece explaining what scientists do and don’t know about the variants, writes that they may end up “exacerbating an unrelenting rise in deaths and overwhelming the already strained health care system.”

 

In recent days, the number of Americans hospitalized with Covid-19 symptoms has risen to more than 123,000, up from about 95,000 a month ago and 50,000 two months ago. The virus is still winning.

[y66]

One year ago today, Stat News published an article by Helen Branswell with this headline: “Experts Search for Answers in Limited Information About Mystery Pneumonia Outbreak in China.” Today, Stat has published a Q. and A. with Branswell putting the last year in perspective.

[Zelandakh]

Just to put that chart in perspective.

[AL78]

Just to put that chart in perspective.

 

That clearly shows how bad the situation is in the UK.

 

It is partly lack of action this time last year that has put the UK amongst the worst affected globally by this pandemic. Our wonderful prime minister is showing he hasn't learnt a damned thing by fannying about wondering whether to implement a full lockdown again in the face of this new strain and soaring cases. Just do it if the data suggests that is the best thing to do, delaying isn't going to do anything productive.

[cherdano]

You have more belief in the government's handling than I have.

Well, you won that argument. For those not in the UK:

- Sunday, last day of school holidays, with most primary schools in England set to open the next day: Johnson gives an interview in which he says "Yes, schools are safe, everyone should absolutely send their children to school tomorrow."

- Monday evening, press conference: Johnson announces national lockdown including closing schools at least until early February.

 

No, no surprising data came out overnight, indeed the numbers are pretty much spot on the trajectory anyone with some good sense would have predicted on December 20.

 

It's as if the government wanted to play a caricature of itself: always waiting with great determination until the last moment when they have no choice at all whether to act.

[Cyberyeti]

Well, you won that argument. For those not in the UK:

- Sunday, last day of school holidays, with most primary schools in England set to open the next day: Johnson gives an interview in which he says "Yes, schools are safe, everyone should absolutely send their children to school tomorrow."

- Monday evening, press conference: Johnson announces national lockdown including closing schools at least until early February.

 

No, no surprising data came out overnight, indeed the numbers are pretty much spot on the trajectory anyone with some good sense would have predicted on December 20.

 

It's as if the government wanted to play a caricature of itself: always waiting with great determination until the last moment when they have no choice at all whether to act.

 

We'll see, I'm not surprised by a lockdown NOW, I said they would get people back to school BEFORE EASTER come hell or high water. The lockdown lasts till Feb half term, what happens then will determine whether I was right or wrong.

 

Interesting piece of info I heard from a medical professor on the radio this morning and can't verify. The "schools are safe" message comes from a study done in September/October on a whopping 53 teachers. **facepalm**

[y66]

Arlington County Virginia is finally taking registrations for vaccines as of yesterday (I think).

[johnu]

Here in the US, I think the majority of people get flu vaccines at pharmacies (all the major drug store chains offer them), not at doctors' offices. I also got the shingles vaccine at Walgreens.

Major grocery store chains like Safeway have in store pharmacies, as do big box stores like Costco and Walmart. You can get flu and some other vaccines at most of these. I believe it is the pharmacists that give the shots, but maybe it is possible that other pharmacy employees have been trained to give shots. Costco sometimes has had flu shot clinics where they set up a dedicated area just to give flu shots.