Skip to main content
Update
Non-financial boards have been closed.

Non-financial boards have been closed but will continue to be accessible in read-only form. If you're disappointed, we understand. Thank you for being an active participant in this community. We have more community features in development that we look forward to sharing soon.

Fool.com | The Motley Fool Community
Message Font: Serif | Sans-Serif
 
No. of Recommendations: 4
From NYT, they linked to this poll. Repugs are less concerned about COVID than Dems, though both are concerned about their children falling behind both academically and socially.

https://assets.morningconsult.com/wp-uploads/2022/01/2415042...

NYT did some analysis, but it's behind a paywall. Evidently BOTH Repugs and Dems have made this political at this point, with one person (in the article, not the poll) being quoted as saying that they are proud that wearing a mask identifies them as not conservative.

Which is totally stupid. The virus doesn't care about politics. It is apolitical. For either side to make it political is dumb. It's a public health issue, and shouldn't be used to make any political statement at all. As to whom is correct, a disproportionate number of dead conservatives answers that question.
Print the post Back To Top
No. of Recommendations: 2
It is very frustrating that at two years into this, we still don't have clear policies.

My kid tested positive. Vaccinated, not boosted. Sore throat and sniffles for two days. Isolated for five days. Back to school on Monday. But how do we get him back into swim practice?

Coach says he needs a negative test, so I take him to the doctors. They say, OK, we'll do it, but it will likely be positive, and it was. Could be positive for weeks. Doctor says he can go back to swim 10 days after first symptoms.

Waiting to hear from the athletics director. Poor kid has worked hard all season and might miss championships over this.
Print the post Back To Top
No. of Recommendations: 2
Tough spot to be in. On the plus side, evidently your kid is OK.

Our daughter is grown now. But I can imagine trying to get classes remotely. Very difficult. A parent would need to be diligent to prevent the kid from goofing off at home. And social interactions would be altered (how much? don't they all use Twitter and Snapchat now?).

It sucks. And, frankly, clear policies won't matter. Conservative pundits will declare them against FREEDUMB, and their followers won't follow the policies. Including many governors, as it happens.

1pg
Print the post Back To Top
No. of Recommendations: 5
Coach says he needs a negative test, so I take him to the doctors. They say, OK, we'll do it, but it will likely be positive, and it was. Could be positive for weeks.

Of course a PCR test will be positive. What you want is an antigen test. One of those home kits will do fine. When it's negative you're no longer infectious.

There's no such thing as "a test". They're testing for different things.

-IGU-
Print the post Back To Top
No. of Recommendations: 0
I take him to the doctors. They say, OK, we'll do it, but it will likely be positive, and it was.

One would think that the docs would be very familiar with your situation, having been through that scenario with other families prior, and would have known of the correct test to perform and not one that would reflect positivity for weeks when no longer infectious (which is what is important).
Print the post Back To Top
No. of Recommendations: 1
Of course a PCR test will be positive. What you want is an antigen test. One of those home kits will do fine. When it's negative you're no longer infectious.

It was an antigen test. Home test will not do. Has to be proctored.

Daughter had to have a negative PCR or proctored antigen test to return back to college dorm last week. Alternatively, they would accept the student self-certifying they had recovered from a COVID infection in the last 90 days...oh my.

We got her a PCR test since we had all been exposed.
Print the post Back To Top
No. of Recommendations: 0
It was an antigen test. Home test will not do. Has to be proctored.

Okay. So use a home antigen test until he tests negative. Then get a proctored antigen test. That should be the fastest. Will very likely be negative by day 10. Might turn negative days sooner.

-IGU-
Print the post Back To Top
No. of Recommendations: 0
The Daily podcast this morning is about the poll.

TL:DL
- Republicans underestimated risk of getting sick.
- Democrats overestimated the risk.
- Boosted people express high level of concern.
- Unvaccinated express low concern.
- Unvaccinated are at mortal risk and dismissive of it.
- Unvaccinated adults 10% D vs 40% R
- Partisanship is dominant.
- Message: live your life that reflects you are vaccinated. Mortality risk for vaccinated is very low.

I do see a lot of hand wringing from vaccinated people, and the opposite from the unvax I know.

Update on my kid and swimming - coach contacted us, asked why he wasn't at practice. Didn't we know championships are on Saturday? Yes, we said, but you said he had to test negative. No, says coach, misunderstanding. If he can go to school, he can go to swim.

Our son is #1, 2 or 3 on the team, depending on event. Coach getting worried about the team's performance...and making my point for me - two years in we still don't have clear rules.
Print the post Back To Top
No. of Recommendations: 6
I do see a lot of hand wringing from vaccinated people, and the opposite from the unvax I know.

This is my experience too.

For a vaccinated and boosted person, your risk of death from Covid is 110 times lower than your risk of death in a car accident at this point. But the people who continue to advocate for masks and distancing and social restrictions are generally the ones who got vaccinated in the first place.

It seems to me we've moved beyond limiting infections or "flattening the curve". Omicron is super contagious and out in the wild, and some people simply refuse to take practical steps to protect themselves, so the virus will be here longer than we can afford to isolate. I don't love wearing a mask but it isn't that big a deal. At the same time, if it boils down to me doing something I don't love to protect people from their own refusal to protect themselves, why should I? As the president has said a number of times, it's largely a pandemic of the unvaccinated at this point.

I'd say the biggest issue is preventing the hospitalizations of unvaccinated people from interfering with the care of folks with more traditional medical needs. People having a heart attack or needing assistance after an accident shouldn't be waiting for care because somebody chose to sacrifice a chicken to prevent Covid rather than taking an available vaccine. I'm not a medical ethicist, but I wonder if there a practical way to say "We'll reserve X% of our beds as a Covid ward and when it's full, you wait because the rest of our facility is providing normal care to responsible people"?

Steve
Print the post Back To Top
No. of Recommendations: 3
But the people who continue to advocate for masks and distancing and social restrictions are generally the ones who got vaccinated in the first place.

Yeah, in my case it's a contradiction. I don't want any more suffering and death, on the one hand, but on the other hand I am so sick of the COVIDiocy that I can't help but wish all the deniers and antivaxxers would just get COVID and die.

Two incompatible positions, and I hold both of them.

1poorguy (boostered)
Print the post Back To Top
No. of Recommendations: 1
I'm not a medical ethicist, but I wonder if there a practical way to say "We'll reserve X% of our beds as a Covid ward and when it's full, you wait because the rest of our facility is providing normal care to responsible people?"

I think that would be really hard to do. Partially because there are serious ethical issues in denying care even to unvaccinated people. But also because there's a fairly large absolute number of hospitalizations of vaccinated people. Proportionally this is now a pandemic of the unvaccinated - but since most adults are vaccinated, and since most hospitalizations are among the elderly and the elderly are overwhelmingly vaccinated, there are still large numbers of breakthrough hospitalizations.

The CDC doesn't seem to publish the absolute numbers. I can understand why, because the absolute numbers aren't adjusted for population size or for the fact that the elderly are both overwhelmingly vaccinated and the highest risk for serious medical effects from Covid - so they give a misleading picture about the effectiveness of the vaccine. However, some states publish the raw numbers. So for Minnesota, for example, it looks like about a third of hospitalizations are breakthrough cases among the vaccinated:

https://www.health.state.mn.us/diseases/coronavirus/stats/vb...

Albaby
Print the post Back To Top
No. of Recommendations: 1
The problem is that the unvaccinated are taking up beds for people that are sick but didn't do anything stupid. Like heart patients. Cancer patients (as I've mentioned before, this one was relevant to me/1poorlady). The unvaccinated are filling up wards because they're too stupid, and are therefore jeopardizing people that didn't volunteer to get sick.

I mentioned that actual law regarding this, but as I recall it applied to ERs. So the ER has to accept you, but the hospital doesn't have to admit you. Though it was a little gray (again, as I recall).

Breakthrough infections, I have no problem with. Stuff happens. It's not 100%. If you made the effort to keep yourself and others safe by getting vaccinated, that's all you could do. Be admitted and get treated. No question.

1poorguy
Print the post Back To Top
No. of Recommendations: 5
The unvaccinated are filling up wards because they're too stupid, and are therefore jeopardizing people that didn't volunteer to get sick.

I mentioned that actual law regarding this, but as I recall it applied to ERs. So the ER has to accept you, but the hospital doesn't have to admit you. Though it was a little gray (again, as I recall).


Well, there's some serious ethical problems even if there aren't any legal requirements to admit patients. And there's a lot of precedent for accepting patients who are in the hospital because 'they're too stupid' to take simple measures to avoid hospitalization.

Hospitals almost invariably accept patients who have contributed to the medical conditions that require admission. Leave aside the fact that we live in a country where a sizable fraction of our population suffers medical ailments due to preventable obesity. Overdoses of illegal drugs, injuries caused by not wearing a seatbelt or helmet (or doing something particularly dumb), conditions that worsen due to patient non-compliance with prior medical orders, illnesses from smoking or drinking - all of these things can land you in the hospital, and you'll generally be admitted despite the fact that you made non-health-optimal choices.

Albaby
Print the post Back To Top
No. of Recommendations: 6
And where are the ethical problems with people not getting vaccines, and then demanding attention when people with other serious conditions did nothing wrong and cannot get care?

This is not comparable to obesity. When people with cancer can't get the care they need because other people were irresponsible, that is a problem. Obese patients aren't clogging hallways of hospitals because there are no beds available.

Two years ago, when we had this problem, there was no vaccine. So I couldn't blame anyone. Today, there is a vaccine. So I can blame the people that are refusing it. They should suffer the consequences of that decision, not (for example) your wife when she has an emergency and can't find a bed because of the sick antivaxxers.

I have no ethical problem with it at all. No vaccine, no admittance (barring valid medical reason not to get the vaccine).

To me the question is entirely a legal one. If a hospital can do it legally, they probably should for the sake of all the other non-COVID patients who need care urgently.

1poorguy
Print the post Back To Top
No. of Recommendations: 2
This is not comparable to obesity. When people with cancer can't get the care they need because other people were irresponsible, that is a problem. Obese patients aren't clogging hallways of hospitals because there are no beds available.

Because we built more beds. We've built out hospital capacity to (hopefully) accommodate the general expected medical needs of patients coming in, with the understanding that some non-trivial number of those patients will be there due to issues that result from their own poor choices. We could certainly free up some hospital beds if we denied care to obese patients, or those who have damaged their bodies with illegal substances, or those who are suffering from conditions aggravated by failure to comply with prior medical advice. Not so obvious to keep out the unvaxxed to make space for a cancer patient who's there because of their lifetime of smoking, for example.

COVID is fast, relatively speaking. We've spent decades expanding our healthcare infrastructure to treat the poor health choices that people have been making - this is a poor health choice that's having consequences in a much shorter time frame. But that's the only real difference. There's no particular reason to deny only the unvaxxed if we're going to start denying care based on poor decision-making. If you take all the folks who are there with diabetes and heart disease and deny them care on an equal footing with the unvaxxed, you'll free up even more beds.

When you start to think about it that way, you can see why hospitals don't do that. Denying medical care because you disapprove of the choices someone has made can become very fraught very quickly. Which is why hospitals try not to do that unless they are forced to by very exigent circumstances.

Albaby
Print the post Back To Top
No. of Recommendations: 2
When you start to think about it that way, you can see why hospitals don't do that. Denying medical care because you disapprove of the choices someone has made can become very fraught very quickly. Which is why hospitals try not to do that unless they are forced to by very exigent circumstances.

But you answered your own objection. "COVID is fast....forced to by very exigent circumstances". Yes, and yes. So hospitals should deny admittance to unvaxxed -for other than medical reasons- persons. Yeah, if we had 50% more beds, and 50% more staff, that would be fine. We don't, and that isn't on the immediate horizon. So we need to treat cancer and heart patients instead of irrational unvaxxed people. It's not right that their intransigence could cost you your wife or one of your kids because there were no beds available.

Many doctor's offices are already doing it. No vaccine, the doctor will not see you.

1poorguy
Print the post Back To Top
No. of Recommendations: 0
So we need to treat cancer and heart patients instead of irrational unvaxxed people. It's not right that their intransigence could cost you your wife or one of your kids because there were no beds available.

But why are we excluding today all the other people that are there because of their own poor choices?

If we've got a shortage that now forces us to do triage on who gets an ICU bed, there's no ethical reason to distinguish between the anti-vaxxer or the drug overdose or the obese patient suffering their third heart attack after being noncompliant on their diet and meds. Their need for urgent medical intervention was caused in no small part by their own poor choices. Sure, in the past we would overlook that for the OD or obese patient - but now that there's tight supply, why would we just deny admission to the anti-vaxxer?

Many doctor's offices are already doing it. No vaccine, the doctor will not see you.

I'm not sure about "many" - there have been some, but it doesn't appear to be widespread. But are you suggesting that people who aren't vaccinated should be denied access to a hospital for any reason? Those doctors are refusing patients because they want to reduce the risk to themselves and their staff and their other patients - an unvaccinated patient is more likely to be infected and infectious. But if an unvaccinated person gets in an auto accident, are you saying they shouldn't be admitted to a hospital?

Albaby
Print the post Back To Top
No. of Recommendations: 3
...why would we just deny admission to the anti-vaxxer?

Because...
a) they are a hazard to everyone else, even the vaxxed (since the vaccine isn't 100%).
b) they are occupying a bed that could be used for other critically ill people that do have their shots.

If it wasn't a full-on pandemic, I think you could make the argument. We don't refuse people who didn't get the influenza vaccine because the hospitals are not overflowing with influenza patients. If they were, and there was an effective vaccine available for that variant, then I would be OK with refusing admittance then also.

I'm a bit older than you. My mother still older, obviously, remembers when these vaccines were not available. She made sure I got every shot known to man. I remember a couple of kids growing up that had polio. 1poormom remembers dozens. Today, it's unheard of (1poorkid has never seen one). If it were up to me, you get ALL shots -barring medical reason-, or you can be triaged right out of school, hospitals, airplanes, cruise ships, or wherever else you pose a hazard to other people. Once you enter a public space, you become a public problem (if you're unvaxxed). If you stay locked-up in your home, then it's not my problem. Once you go outside, it is.

If I owned a restaurant I would require proof of vaccination for you to be seated. No shirt, no shoes, no vaccine, no service. :-)

1poorguy
Print the post Back To Top
No. of Recommendations: 1
Because...
a) they are a hazard to everyone else, even the vaxxed (since the vaccine isn't 100%).
b) they are occupying a bed that could be used for other critically ill people that do have their shots.


But:

a) ...is true of anyone who goes to the hospital that has Covid, even the vaccinated. It's hard to say at this point whether a random unvaccinated person whose infection status is unknown is more of a hazard than a vaccinated person in the hospital with a breakthrough case. The latter is not as contagious, likely, as an unvaccinated person with Covid - but the former is pretty unlikely to have Covid at any random time.

b) ...is true of any person in the ICU. Beds are 'exclusive' - any person who is in a bed is occupying a bed that could be used for other critically ill people that do have their shots. A person who's in that bed for a drug overdose is keeping someone else from using that bed.

To put the dilemma a little more starkly, consider a small ICU with only three free beds. Four patients are brought in:

a) a vaccinated person without Covid that has had a heart attack.
b) a vaccinated person who has overdosed on heroin.
c) an unvaccinated person who was hit by a car.
d) a vaccinated person suffering a serious breakthrough Covid infection.

Who gets the beds?

Patient A has done nothing and wrong and poses no danger - but the other three violate one of the two things you mentioned above. Patient B caused their own medical crisis. Patient C is blameless (we assume) for their condition, but they're not vaxxed. Patient D is blameless, but they probably pose more of a hazard to everyone else than the other three patients.

So who gets excluded?

Albaby
Print the post Back To Top
No. of Recommendations: 2
Public health is a different thing from private health. Public health matters in an exceptional way because nothing else comes close when it comes to cutting suffering, death, costs, and chaos. And public health policy during epidemics, in any sane polity, takes urgent priority because when it comes to epidemics each person's well being depends on everyone elses, and so historically there is NO RIGHT to opt out of masks, vaccines, quarantine routines, tests if you want to be out in our shared public space.

But we have lost that argument to the anarhic charlatans who are making careers and money from destroying the public sense of community and the rules and regulations dependent on that shared sense.

Obesity, smoking, drugs and alcohol putting you into hospital is nothing like unvaxxed covid putting into hospital. NOTHING like. Because your obesity etc does not infect me. But in the Alice in Wonderland world of the current USA, well, fuggidabatit.

Glad I am now living in Mexico.


David fb
Print the post Back To Top
No. of Recommendations: 0
albaby1 - apologies for intruding on this thread, but I understand a recent story correctly - Florida wants to become a unvaxxed haven and recent bill, if passed, will do away with all mandatory vaccination requirements, even those typically required for children?

Regards, JAFO
Print the post Back To Top
No. of Recommendations: 1
JAFO: apologies for intruding on this thread, but I understand a recent story correctly ---

Heh. I think you were around back in the day when one would say, "FMFJI ..." "Pardon me for jumping in ..."

CNC
Print the post Back To Top
No. of Recommendations: 2
apologies for intruding on this thread, but I understand a recent story correctly - Florida wants to become a unvaxxed haven and recent bill, if passed, will do away with all mandatory vaccination requirements, even those typically required for children?

First I’ve heard of it, but it wouldn’t surprise me.

The Florida Legislature let’s legislators file any bill they please. Which means every session is filled with stupid bills that are submitted just for show. Most never get a single committee hearing. So you can’t really assume that a bill is an actual legislative proposal just because some random state rep filed it. Not a lot of thought gets put into how those “bills” would actually work or what the consequences would really be. It gets even sillier in an election year.

Albaby
Print the post Back To Top
No. of Recommendations: 1
If we've got a shortage that now forces us to do triage on who gets an ICU bed, there's no ethical reason to distinguish between the anti-vaxxer or the drug overdose or the obese patient suffering their third heart attack

Valid.

And leads me to wonder if, in cases of scarcity, if we should not ALSO be triaging those patients.

If we agree that there is scarcity, and a decision must be made on who gets treatment - do we focus on:

1. Those most in need?
2. Those most likely to survive?
3. Those least likely to be at fault for their own predicament?
4. A combination of the above?
Print the post Back To Top
No. of Recommendations: 2
And leads me to wonder if, in cases of scarcity, if we should not ALSO be triaging those patients.

David gave a great answer to albaby's retort, so I'll just say "ditto".

But, yes, if there is enough scarcity then we have to start triaging those patients too. First out the door is the unvaxxed (in this public health crisis). Then probably the drug addict. And if scarcity persists, then least likely to survive (i.e. treating the folks most likely to be able to go home to their families). I can't imagine it ever reaching that stage. But at that point you're making really hard choices.

1poorguy
Print the post Back To Top
No. of Recommendations: 2
1. Those most in need?
2. Those most likely to survive?
3. Those least likely to be at fault for their own predicament?
4. A combination of the above?


First #2, then #1 then #3. With the proviso that Republican politicians and Right Wing media pundits go to the very very back of the line.
Print the post Back To Top
No. of Recommendations: 1
With the proviso that Republican politicians and Right Wing media pundits go to the very very back of the line.

I know that was a quip, but that would effectively be the case because many of them are antivaxxers. No shot, no admittance. Which was the whole point of this discussion.
Print the post Back To Top
No. of Recommendations: 12
Reiterating in bold something I wrote upthread to see if any dissenters want to rebut?

....public health policy during epidemics, in any sane polity, takes urgent priority because when it comes to epidemics each person's well being depends on everyone elses, and so historically there is NO RIGHT to opt out of masks, vaccines, quarantine routines, tests if you want to be out in our shared public space.

Public places and public goods are not blank nullities unowned by anyone and so freely exploitable by everyone. They are the essence of civilized human habitation and life, invaluable, and created by and owned by all through observation and mutual enforcement of the laws, rules, and norms that create them and keep them in existence.

That during the epidemic I have found I need to keep explaining and reiterating this shows the deeper trouble we have fallen into.

You do not want to mask or vax? Fine. STAY HOME in your wonderfully private sphere and stop screwing around with, burdening, and effectively destroying the public spaces vital to all the rest of us.

The ancient Greek word for a city state is polis, but the main meaning of that word anciently was NOT a collection of habitations and businesses, but rather of a place where it was safe to live as a civilized humans in a society of civilized humans. The indo-european root of the word, the original meaning, meant some form of "shared place of safety".


David fb
Print the post Back To Top
No. of Recommendations: 1
No rebut. You're dead-on correct.

I think the unvaxxed should be quarantined. My aunt was quarantined back in the 40s. Mom and her dad couldn't go home for something like a month. G-ma and my aunt couldn't go out. They posted a sign. There was no need to guard the house, they knew what they should do and they did it.

I suspect you'd have to put an armed soldier outside most people's homes today to make them comply. And then they might just shoot the soldier.

As a society, if we are just a bunch of rugged individualists, our society will fail.

1poorguy (wondering why you chose Mexico instead of Spain, since you say you have homes in both places)
Print the post Back To Top
No. of Recommendations: 5
Reiterating in bold something I wrote upthread to see if any dissenters want to rebut?

....public health policy during epidemics, in any sane polity, takes urgent priority because when it comes to epidemics each person's well being depends on everyone else's, and so historically there is NO RIGHT to opt out of masks, vaccines, quarantine routines, tests if you want to be out in our shared public space.


Not a rebuttal, since I agree with the above at a very high level. But obviously what constitutes a reasonable public health response to an epidemic depends greatly on the specific nature of the epidemic. And those specifics have been changing over time.

Early in the pandemic, there were plenty of things about Covid that warranted a very intrusive public health response. It was: i) contagious; ii) very lethal to large segments of the population; iii) untreatable; iv) without a vaccine; and v) novel and almost entirely unknown. All of those things warrant exceedingly robust public health measures and potentially massive infringements on the privileges of society. And all of those things mean that those public health measures are likely to be very consequential in avoiding death and illness.

But circumstances have changed. We now know much more about the virus' transmission vectors (which is why we're no longer wiping our groceries). We now have fairly effective vaccines against the dominant strain of Covid. They are extremely effective at preventing death, very effective at preventing hospitalization, and modestly effective (we think) at restricting transmission. Because of those specific attributes of the vaccine, coupled with recent variants' much higher level of contagiousness, your well-being is less dependent on other people's behavior as it used to be. Both because you can provide yourself a lot of protection against the worst consequences of the illness and because changing the behaviors of others (short of actual lockdowns) now offers less protection against exposure. Delta and then Omicron are so contagious that testing and ordinary masking are not nearly as effective tools to constrain transmission. Because Omicron is so contagious, the vaxxing status of people you encounter is far less determinative of whether they have Covid.

I don't know whether it's true anymore whether excluding unvaccinated people from a public space offers a significant public health benefit to vaccinated people within that space. Certainly some benefit, of course - a vaccinated person is marginally less likely to be infected than an unvaccinated person, and an unvaccinated person will deliver higher loads of the virus to people around them. But given how small the former difference is, the likelihood of my getting exposed to Covid in a group of 19 vaxxed people and 1 unvaxxed person versus a group of 20 vaxxed people is markedly different under Omicron than it was under Delta. And given how effective the vaccine is at preventing the worst medical outcomes, the harm I would suffer from being exposed is much lower today than at any prior time in the pandemic.

Which is why, of course, we have different public health policies today than we did earlier in the pandemic. And why your categorical statement at the top of this post is true, but dependent on the specific types of public health measures and the specific nature of the epidemic.

Albaby
Print the post Back To Top
No. of Recommendations: 2
Albaby,

thanks for the solid intelligent response.

Thought experiment -- what if we incubate (could easily happen) a new variant that is even more virulent than omicron, but even milder in outward symptomology, but far far worse in terms of long term covid organ destruction and other chronic problems?

Epidemics need robust public health response, and we need to keep the tools sharpened and ready to use, and even more we need a public that gets it or at worst accepts that they WILL BE coerced into obeying the laws and regulations.


David fb
Print the post Back To Top
No. of Recommendations: 1
"both are concerned about their children falling behind both academically and socially"

What could be more socially backwards than being a Republican? Being a dog kicker? Being a person who steals from a charity for children with cancer? What?
Print the post Back To Top
No. of Recommendations: 2
The problem is that the unvaccinated are taking up beds for people that are sick but didn't do anything stupid. Like heart patients. Cancer patients (as I've mentioned before, this one was relevant to me/1poorlady). The unvaccinated are filling up wards because they're too stupid, and are therefore jeopardizing people that didn't volunteer to get sick.

Many of the people with heart disease and cancer spent a lifetime doing stupid things. Few are willing to say it out loud, but a big part of our American health crisis is people who volunteered to be sick.

Risk factors for heart disease: https://www.cdc.gov/heartdisease/about.htm
Diabetes
Overweight and obesity
Unhealthy diet
Physical inactivity
Excessive alcohol use

Risk factors for cancer: https://www.cdc.gov/cancer/dcpc/prevention/other.htm
Smoking
Sunburn
Excessive alcohol use
Overweight and obesity
Hepatitis C
Print the post Back To Top
No. of Recommendations: 1
That is true, but not really the same thing (as we discussed up-thread).

I tried, but was unable, to find statistics on how many excess people died of various ailments during the COVID years. I found individual anecdotes, like a guy that couldn't get dialysis because there were no open beds, and by the time he got a bed his kidneys were shutting down. Lots of stories like that, but no actual data that I could find.

1pg
Print the post Back To Top
No. of Recommendations: 6
a big part of our American health crisis is people who volunteered to be sick.


Yes, sort of, but not really. Why do I say that? Because almost no individual person makes such choices on their own but overwhelmingly as members of a culture, a social setting, and blah blah blah. Individual responsibility is a high virtue, but is not a given. Most people imitate responsibility but are literally unable to respond to their circumstances in any significant fashion UNLESS the culture set around them enables them and models for them.

Individualism is really important, but in the USA today individualism is mostly bunk, a slogan and act put on by sheep.

It isn't the gene pool that needs pruning of stupidity, it is the cultural meme pool that needs it. You see, the story of homo sapiens is the story of the immense power of evolution shifting over from the painfully slow process of chemically based genetics (hello homo erectus) to the stunningly more powerful and and staggeringly more rapid and flexible mechanisms of language/meaning based cultural/social evolution.

Our cultural evolution in the USA has gone into reverse. We are destroying community. Why? Because people have discovered they can gain status and make money by undermining community.


David fb
Print the post Back To Top
No. of Recommendations: 0
Thought experiment -- what if we incubate (could easily happen) a new variant that is even more virulent than omicron, but even milder in outward symptomology, but far far worse in terms of long term covid organ destruction and other chronic problems?

In that case, you might want to increase the strength of your public health measures. Or you might not. It depends on what we're talking about, because the overall amount of public health burden of this new variant can be either higher or lower than Omicron, depending on how much worse the long term effects are compared to the far milder short term symptomology. And depending on how you weigh health costs in the future compared to the present day. And a host of other things.

It's insanely complicated to compare the benefits of avoided health consequences compared to the costs of preventative measures, even before you get into the thorny problems arising from the fact that different groups of people (in different time periods) reap the benefits or bear the costs.

Albaby
Print the post Back To Top
No. of Recommendations: 1
Because almost no individual person makes such choices on their own but overwhelmingly as members of a culture, a social setting, and blah blah blah.

Exactly. A lot of people don't have any choice, either. There are places (so I've read) where you can't find fresh ingredients. The term "food desert" is often applied. Or what you can find, you can't afford. So it's the McD's dollar menu for them.

1poorguy
Print the post Back To Top
No. of Recommendations: 0
Yes, sort of, but not really. Why do I say that? Because almost no individual person makes such choices on their own but overwhelmingly as members of a culture, a social setting, and blah blah blah. Individual responsibility is a high virtue, but is not a given. Most people imitate responsibility but are literally unable to respond to their circumstances in any significant fashion UNLESS the culture set around them enables them and models for them.

Absolutely agree. I like the way you phrased it. And this is one of the reasons why I push back a little bit on the idea that the unvaccinated should be denied medical treatment because of their choices. Because while they certainly are making a bad choice, no one makes choices completely isolated from their immediate culture and environment.

Albaby
Print the post Back To Top
No. of Recommendations: 1
Albaby: It's insanely complicated to compare the benefits of avoided health consequences compared to the costs of preventative measures,

Yes, but trying to do that is silly, because the costs benefits involved are comparatively tiny compared to the incomparable value of maintaining a culture that is powerfully capable of fighting pandemics, and pays the necessary monetary costs and far more importantly ethical, moral, and communal work and investment to do so.

That to me is The Point.


David fb
Print the post Back To Top
No. of Recommendations: 5
At this point I will throw in my constant whine that people in the USA have literally no idea, not a clue, as to what a public health system is and what it could do for us because the AMA and the Pharma Corporations have waged war against not only an actual Public Health system but even a knowledge of the possibity of such.

Instead, people in the USA think their health is primarily a private matter. They have no idea that this notion is considered crazy everywhere else. And we are paying the price in so many ways.

For a good reference on Public Health System thinking outside the USA see https://www.euro.who.int/en/health-topics/Health-systems/pub...

David fb
Print the post Back To Top
No. of Recommendations: 2
Yes, but trying to do that is silly, because the costs benefits involved are comparatively tiny compared to the incomparable value of maintaining a culture that is powerfully capable of fighting pandemics, and pays the necessary monetary costs and far more importantly ethical, moral, and communal work and investment to do so.

It's not silly, because figuring out the appropriately proportionate public health measures is necessary to maintaining a culture that is powerfully capable of fighting pandemics.

As The Week wrote last month, defending the CDC's updated (and more realistic) guidance on addressing Covid:

But realism about how people actually behave should enter into CDC recommendations, as should other considerations that don't strictly involve the virus. Epidemiologists can give sound advice about how to slow the spread of infectious disease. They are not experts in economics or how to organize human society. When their advice doesn't weigh factors too, it is often doomed to fail.

Propagation of the unrealistic idea that people can be isolated and the economy largely shuttered until vaccines and other elements of the pandemic response are perfected has helped undermine confidence in public health experts rather than bolster faith in their directions. The resulting skepticism has increased popular defiance of the CDC and officials like Dr. Anthony Fauci, especially on such matters as masks and vaccines.


https://theweek.com/coronavirus/1008474/in-defense-of-cdc-re...

If you want the public to continue to give the government the power to require massive sacrifices in support of the common good, the government has to always show that it is willing and capable of exercising that power appropriately. People will differ about what that means, of course, and the government will never be able to satisfy everyone that they are engaged in appropriate public health policy. But that doesn't mean that they can abandon the effort to balance competing costs and benefits altogether.

The reason the CDC modified their guidance to shorten the isolation periods for asymptomatic Covid-positive individuals is because they realized that people wouldn't follow the longer periods.

On CNN, Walensky also said the CDC took into account "what we thought people would be able to tolerate," noting "we have seen relatively low rates of isolation" during the pandemic and that the agency wanted to ensure it had guidelines in place that "people were willing to adhere to."

https://theweek.com/coronavirus/1008466/cdc-director-address...

You lose your credibility - the culture that you're trying to inculcate - if your public health policy prescriptions don't take into account what level of 'cost' the public is willing to actually bear to fight an epidemic.

Albaby
Print the post Back To Top
No. of Recommendations: 4
I'm not a medical ethicist, but I wonder if there a practical way to say "We'll reserve X% of our beds as a Covid ward and when it's full, you wait because the rest of our facility is providing normal care to responsible people"?

The caveat being that the restriction only applies to pandemics.

My city has no hospital. My county has one semi-comprehensive hospital. Doctors around here refer patients to hospitals in LA and San Fran for procedures when they feel the local hospital lacks the experience/facility. Our hospital just announced they are postponing most elective surgeries because they cannot handle the strain Covid is putting on their facility.

I'm all for erecting a tent in the outer parking lot for the anti-vaxxers. They can have all the HCQ, horse de-wormer, bleach and oleander (pillow guy) they want.
Print the post Back To Top
No. of Recommendations: 4
Overdoses of illegal drugs, injuries caused by not wearing a seatbelt or helmet (or doing something particularly dumb), conditions that worsen due to patient non-compliance with prior medical orders, illnesses from smoking or drinking - all of these things can land you in the hospital, and you'll generally be admitted despite the fact that you made non-health-optimal choices.

Yeahbut.... they won't get considered for organ transplants because they aren't worthy in the eyes of the hospital review boards.

If "they" can be discriminated against for organ transplants because of their lifestyles and life choices , why not for willful rejection of EMERGENCY pandemic mitigation measures?
Print the post Back To Top
No. of Recommendations: 4
We could certainly free up some hospital beds if we denied care to obese patients, or those who have damaged their bodies with illegal substances, or those who are suffering from conditions aggravated by failure to comply with prior medical advice.

Again, we already discriminate against all of those people when transplants are needed.
Now we have a new class of patients who put allll others at risk because of their moronic ideologies.
Print the post Back To Top
No. of Recommendations: 0
If "they" can be discriminated against for organ transplants because of their lifestyles and life choices , why not for willful rejection of EMERGENCY pandemic mitigation measures?

A hospital could decide to refuse ICU admission to people who have made deliberate choices that worsen their health outcomes, in order to ensure capacity for folks who have made good health choices. That's a policy that raises a whole host of other moral issues, ones that we're comfortable with in the specific context of organ transplants where survivability is in doubt, but perhaps less so just to keep beds open for more 'deserving' patients.

But it's a far more ethically fraught policy to refuse ICU admission only to anti-vaxxers and not to illegal drug overdosers or folks who didn't wear their seatbelts or drunk drivers or whomever. Because then you're not merely making a judgment that folks who have contributed to their emergencies should be categorically be denied care - you're also making a judgment about which of those folks should be denied care. It's not clear whether drawing that line at anti-vaxxing is supportable. For all its stupidity, vaccines are still not mandatory the way refraining from illegal drugs or driving sober is. Even in the bluest of blue states, no governmental body has made the determination that individuals are required to get vaccinated. If we will treat people who caused their own injuries and actually committed a crime doing so - and in the case of drunk drivers and other people who are injured during certain criminal acts have also materially and immediately endangered others as well - on what grounds do you deny treatments to anti-vaxxers alone?

Albaby
Print the post Back To Top
No. of Recommendations: 4
If we will treat people who caused their own injuries and actually committed a crime doing so - and in the case of drunk drivers and other people who are injured during certain criminal acts have also materially and immediately endangered others as well - on what grounds do you deny treatments to anti-vaxxers alone?

The drunk drivers and criminals will be penalized for their crimes. Penalize the anti-vaxxers for their crimes against society by letting them walk the walk.

Anti-vaxxers are different than your other 'what-abouts' in that the "what-abouts" are 1) not swamping the healthcare facilities and driving the personnel to utter exhaustion to the detriment of society, and 2) present the risk of contagion to everybody in the healthcare facility, their families and friends, the community at large.

I've only been admitted to an ER once (chop saw vs finger). At that time there were other assorted customers; a lady having a psychotic episode howling (drug freak-out?), a man being observed for a possible coronary situation, etc. Normal variety, average volume. Nothing that flustered the ER staff. No ambulances lined up waiting, no frantic families in the parking lot denied admittance with their loved ones.
Print the post Back To Top
No. of Recommendations: 1
Penalize the anti-vaxxers for their crimes against society by letting them walk the walk.

Remember, this discussion concerns the ethics of a decision by a hospital to exclude people from the ICU. Hospitals aren't in the business of 'penalizing' people for crimes. Hospitals don't refuse to admit people based on whether they've committed a crime or whether their injuries were caused by/suffered during a crime.

If society wants to consider not being vaxxed a crime (it doesn't, formally), and if society wants to penalize them, then the institutions that do that sort of thing can do so ethically. It's not clear that hospitals can.

Anti-vaxxers are different than your other 'what-abouts' in that the "what-abouts" are 1) not swamping the healthcare facilities and driving the personnel to utter exhaustion to the detriment of society, and 2) present the risk of contagion to everybody in the healthcare facility, their families and friends, the community at large.

True, but not really relevant. If the healthcare facilities are overloaded, then you can start triaging them - but there's a real ethical problem if your triage only includes the anti-vaxxers rather than all the people who are landing in the ICU 'by their own hand.' Just because we've gotten used to the various crises caused by lack of good health decisions stemming from substance abuse (including smoking), obesity and other self-harms that flood our system doesn't mean those people have any claim to priority over the more recent ones. If you need to clear out 20% of the ICU admissions so that staff can adjust, those folks don't 'deserve' a pass over the anti-vaxxers.

The risk of contagion is present, but not likely as material a factor in this ethical decision anymore. There are just too many breakthrough cases. Maybe close to half of all cases, and a third or so of hospitalizations for Covid, are breakthrough. We're not presently in a position to keep Covid out of the hospitals any more - so that can't be an ethical justification for denying admission to someone who needs treatment so badly they have to be admitted. Omicron is too contagious, and BA.2 might be even more contagious, for that type of exclusion to be based in real harm prevention at this point.

"Let 'em die" isn't really a great ethical standard for a hospital admissions policy, no matter how satisfying it would be to let the anti-vaxxer die in the parking lot - any more than to let the OD'ing criminal or the drunk driver who killed a few folks on the way to suffering their own injuries die from lack of treatment.

Albaby
Print the post Back To Top
No. of Recommendations: 3
A hospital could decide to refuse ICU admission to people who have made deliberate choices that worsen their health outcomes, in order to ensure capacity for folks who have made good health choices. That's a policy that raises a whole host of other moral issues, ones that we're comfortable with in the specific context of organ transplants where survivability is in doubt, but perhaps less so just to keep beds open for more 'deserving' patients.

But it's a far more ethically fraught policy to refuse ICU admission only to anti-vaxxers and not to illegal drug overdosers or folks who didn't wear their seatbelts or drunk drivers or whomever.


Repeat David's reply.

Plus, we're dealing with a scarce resource, be it organs or ICU beds. When the scarcity becomes acute, we have to triage. Organs are very scarce, so that is a matter of course. We don't even really think about it, but lots of folks are turned away (and often die). We're not used to having a shortage of hospital beds, so this is novel (just like the virus!). We're not used to triaging who gets one. Anti-vaxxers should be #1 to be booted. They were stupid, and because they are not vaxxed they pose a hazard to everyone else. Plus...you know...pandemic. If scarcity demanded it, at some point the overdose would be refused admittance.

The load would be manageable if they excluded the first group (i.e. unvaxxed). They probably wouldn't have to go any further down the list of "undeserving" (to use your term). But it isn't the unvaxxed alone, they're just first in line to be booted. If that doesn't fix the scarcity problem (which it probably would), we need to move on to the next group, and the next...

1poorguy
Print the post Back To Top
No. of Recommendations: 0
The load would be manageable if they excluded the first group (i.e. unvaxxed).

But that's the heart of the ethical problem. Can the hospital ethically decide to make the unvaxxed, exclusively, the first group?

We might loathe their poor choices - but they are not the only ones in the hospitals due to poor health choices. And unlike anti-vaxxers, some of those other choices were either criminal (illegal drug complications, drunk driving and other criminal behavior) or otherwise prohibited by law (driving without a seatbelt, or helmet in some locations).

The unvaxxed are novel, but they're not the only ones that are complicit in their own medical emergencies. And a bed is a bed is a bed - you don't create any more space by booting (or barring) an anti-vaxxer from the ICU than by booting the OD patient. The fact that we've had all these other forms of self-harm for longer than Covid anti-vaxxing - or that we've expanded our ICU's and ER's to accommodate the social burden that self-harming substance abusers and preventably obese people and other folks have baked into the system over the years - doesn't give them any moral claim to be treated before the unvaxxed.

Albaby
Print the post Back To Top
No. of Recommendations: 2
But that's the heart of the ethical problem. Can the hospital ethically decide to make the unvaxxed, exclusively, the first group?

Already addressed that. As sano pointed out, we do that all the time with regard to organs. At least for the duration of the pandemic, we need to exclude the unvaxxed (who are unvaxxed without good medical cause, of course). That will take the pressure off the system, and provide better care for everyone (except the unvaxxed, obviously).

It really no different than any other triage of any other scarce commodity. In a perfect world, we wouldn't have to make those choices, either for organs or ICU beds. But the reality is we do. So do we get a bed for an unvaxxed person who (predictably) came down with COVID, or the dialysis guy I mentioned before? (The dialysis guy died, by the way.)
Print the post Back To Top
No. of Recommendations: 1
Already addressed that.

No, you haven't.

This ethical issue isn't simply whether hospitals could ethically exclude the unvaxxed from a necessary triage situation. The issue is also whether hospitals could ethically decide that only the unvaxxed would be excluded. That of the universe of patients who have engaged in choices that created their need for medical intervention, that only the unvaxxed would be singled out for exclusion from treatment.

So do we get a bed for an unvaxxed person who (predictably) came down with COVID, or the dialysis guy I mentioned before? (The dialysis guy died, by the way.)

If we have to triage, I'd choose the dialysis guy. But the same would be true of the drug abusing person who (predictably) ended up needing a trip to the ICU.

And if there's two beds and three patients (dialysis guy, unvaxxed guy, drug abuse guy) it's easy to come up with an ethical basis for making sure dialysis guy got one of the beds - but less of a valid basis for only excluding the unvaxxed guy instead of the drug abuse guy.

Albaby
Print the post Back To Top
No. of Recommendations: 4
Yes, I did. It is not only the unvaxxed. They're just the first to get the boot. If further triage is required, then it is. I doubt it would be since hospitals were never slammed prior to 2020. So, in effect, it perhaps would be "only" the unvaxxed because that is all that would be required.

...but less of a valid basis for only excluding the unvaxxed guy instead of the drug abuse guy.

Again, refer to David's eloquent reply which you said you liked. The unvaxxed guy has broken the social contract, PLUS he is a contagious danger to staff and visitors and patients. So, of course he has to be refused over the overdose guy.

The real problem is, once admitted, can you toss them? I think the key is triage so they never get admitted. Once they're in, it's difficult to wheel them to the curb. Plus staff and other patients have already been exposed to the biohazard that is the unvaxxed person.

At least for the duration of this pandemic, hospitals need to be able to do that. If/when things calm down so that coronavirus is just a background thing, like influenza, then medical ethicists can debate whether such prohibitions are appropriate. In the middle of a pandemic where almost 1M USians have died in two years, it shouldn't even be a question. ICU beds are (presently) a scarce resource, and have to be allocated in a similar manner that organs are allocated.
Print the post Back To Top
No. of Recommendations: 2
Can the hospital ethically decide to make the unvaxxed, exclusively, the first group?

Again, since that is the demographic that is pushing healthcare facilities to the brink of collapse, yes.

The fact that we've had all these other forms of self-harm for longer than Covid anti-vaxxing

Again, they are not equal. This is a pandemic being exacerbated by an ideologically driven demographic.

Frikkin Sarah "Palin in March disclosed that she had been diagnosed then with the coronavirus, and recently said that she will get a Covid-19 vaccine “over my dead body.” Glad to oblige. Straight to the tent.
Print the post Back To Top
No. of Recommendations: 3
albaby1: "The reason the CDC modified their guidance to shorten the isolation periods for asymptomatic Covid-positive individuals is because they realized that people wouldn't follow the longer periods."

If true, that is, take your pick: (a) pandering, (b) leading from behind, or (c) leading by poll, and not the kind of leadership that is generally admired or very scientific in method.

It is true that sometimes half a loaf is better than no loaf, but is what the CDC should aspire to do?

Regards, JAFO
Print the post Back To Top
No. of Recommendations: 2
They're just the first to get the boot.

Why? Why are they first?

Again, refer to David's eloquent reply which you said you liked. The unvaxxed guy has broken the social contract, PLUS he is a contagious danger to staff and visitors and patients.

The overdose guy has broken the social contract far more clearly than the unvaxxed person. He's actually committed a crime, perhaps even a felony - one of the clearest violations of the social contract. Unlike the unvaxxed guy, who actually has an argument that he hasn't violated the social contract, since no jurisdiction (that I'm aware of) has actually adopted a formal requirement that people get vaccinated. The social contract requires that in order to receive the benefits of society, we have to follow the rules of society. But no jurisdiction has actually made getting vaccinated in itself a formal rule, even in the most sapphire-blue of states. It's certainly strongly encouraged...but then again, we are strongly encouraged to maintain a healthy weight and avoid abusing legal substances like alcohol. It's not breaking the social contract to be preventably obese or an alcoholic, though.

(The part I liked about David's post, BTW, cuts against your argument. He was noting that while individual decisions might look like purely autonomous choices, they always take place within a culture and social framework that influences them, sometimes even to the point where the person who seems like they're making a choice isn't really exercising much choice at all. I like that observation, and note that it applies also to how much culpability we assign to the apparently-independent but not-completely-isolated choice whether to get the vaccine.)

As for whether the unvaxxed guy is a danger to staff and visitors and patients, that's debatable at this point. About half of cases are breakthrough cases these days. A random unsymptomatic unvaxxed person isn't particularly likely to materially contribute to your chance of getting Covid in a public place like a hospital ward. Especially since the wards will still be filled with lots of vaccinated Covid cases, since about a good 30% or so of hospitalizations for Covid are for breakthrough cases. It is exceptionally unlikely that the unvaxxed person poses a material enough increase in the threat of exposure to justify the potentially fatal denial of care to them.

It's not an easy ethical call, and it's no surprise that no hospital (that I'm aware of, at least) has refused admission to the unvaxxed on that basis.

Albaby
Print the post Back To Top
No. of Recommendations: 2
If true, that is, take your pick: (a) pandering, (b) leading from behind, or (c) leading by poll, and not the kind of leadership that is generally admired or very scientific in method.

It is true that sometimes half a loaf is better than no loaf, but is what the CDC should aspire to do?


Yes.

The science says that a person is still potentially infectious as long as 10 days after contracting the disease. Most people are no longer infectious after 5 days. But a minority (about 20%, IIRC) are still somewhat infectious for up to another 5 days. That's the biology.

But the biology isn't the only thing that affects transmission. Human behavior does as well. Most people can't, and won't, stay isolated for 10 days after infection - even if you tell them they should. A vastly larger number of people will stay isolated for 5 days after infection if you tell them to stay isolated for 5 days.

So in fashioning the guidance, the test should be what will result in the greatest reduction in transmittal? If everyone would comply 100% with the guidance, the obvious answer is 10 days isolation. That's what the science says. But the science - social science - also tells us that 100% of the people won't comply with the guidance. And that fewer people will comply with the guidance if it seems unreasonable or disconnected with the reality of their lives - both because it doesn't seem possible to do so and because the agency loses credibility. So issuing a 5 day guidance will almost certainly result in fewer people rejecting the guidance out of hand.

In that case, the best guidance takes into account both parts of the science - the science of the disease transmission and the science of human behavior. If you say five days instead of ten, some number of people will get exposed by the small number of people who would have complied with a ten day isolation period but went out into the world on Day 6; but another group of people will be protected from exposure from the number of people who wouldn't have isolated at all with a ten day isolation period but were willing to isolate for five days.

Albaby
Print the post Back To Top
No. of Recommendations: 0
albaby1: "The science says that a person is still potentially infectious as long as 10 days after contracting the disease. Most people are no longer infectious after 5 days. But a minority (about 20%, IIRC) are still somewhat infectious for up to another 5 days. That's the biology.

But the biology isn't the only thing that affects transmission. Human behavior does as well. Most people can't, and won't, stay isolated for 10 days after infection - even if you tell them they should. A vastly larger number of people will stay isolated for 5 days after infection if you tell them to stay isolated for 5 days.

So in fashioning the guidance, the test should be what will result in the greatest reduction in transmittal?"

I agree with this last statement.

"If everyone would comply 100% with the guidance, the obvious answer is 10 days isolation. That's what the science says. But the science - social science - also tells us that 100% of the people won't comply with the guidance. And that fewer people will comply with the guidance if it seems unreasonable or disconnected with the reality of their lives - both because it doesn't seem possible to do so and because the agency loses credibility. So issuing a 5 day guidance will almost certainly result in fewer people rejecting the guidance out of hand."

But does that change lead to the greatest reduction in transmittal?

Virtually all the people who would have isolated for more than 5 days instead of the full 10 days, will reduce their isolation time (better compliance but more transmissions). And those who were never going to isolate will not change their behavior. And some percentage of those who might have isolated (but not necessarily for 10 days) will conclude that CDC does not know "anything", become disillusioned, and now begin ignoring CDC advice altogether.

Regards, JAFO

PS - Have you any thoughts about whether private employers may choose not to hire the unvaxxed? Being unvaxxed is not, if I understand correctly, a disease or medical condition requiring accommodation under the ADA. I also understand that asking about vax status is not a HIPAA violation.

A recent conversation about a 20+ college educated accountant working a summer internship who is also not vaxxed made me wonder whether her employer could safely choose not to offer a full-time position as a result. I know that for me I question the judgement of of those who remain unvaxxed if they have no medical reason (e.g., immunocompromised).

Lying about vaxx status on an application would likely be grounds for subsequent dismissal when discovered.
Print the post Back To Top
No. of Recommendations: 0
But does that change lead to the greatest reduction in transmittal?

Virtually all the people who would have isolated for more than 5 days instead of the full 10 days, will reduce their isolation time (better compliance but more transmissions). And those who were never going to isolate will not change their behavior. And some percentage of those who might have isolated (but not necessarily for 10 days) will conclude that CDC does not know "anything", become disillusioned, and now begin ignoring CDC advice altogether.


Don't know. I can't find the article now, but my recollection is that the CDC's surveys of isolation compliance found that only a very small fraction of people were isolating for more than five days under the old guidance. That's part of what led them to reduce the time frame - almost no one was following it to begin with. So it seems likely that this would help.

Have you any thoughts about whether private employers may choose not to hire the unvaxxed? Being unvaxxed is not, if I understand correctly, a disease or medical condition requiring accommodation under the ADA. I also understand that asking about vax status is not a HIPAA violation.

I am not a labor lawyer, so major grains of salt here. I'll assume that neither the state nor federal governments have adopted any rules definitively addressing the issue (ie. we're not under a new OSHA regulation or a state law prohibiting this type of hiring criteria). In that case, I think the answer is probably "Yes, but...."

Yes, in the sense that employers are generally allowed to set whatever criteria they want for hiring a new employee so long as the criteria isn't prohibited by some law or rule. There were already some jobs that had some vaccination requirements for some workers (ie. health care workers getting vaccinated for measles and whatnot).

But...., in the sense that there may be circumstances where refusing to hire someone because of their vax status might run afoul of some law or rule. Being unvaxxed is not itself a disability, but there might be some people who are unable to get a vaccine due to a condition that is covered by the ADA. Not sure how the law applies there. I'm sure someone will argue that where vaccine refusal is ostensibly based on religious belief, the employer should have to accommodate it; but I'm not sure that will be successful.

Albaby
Print the post Back To Top
No. of Recommendations: 0
It is true that sometimes half a loaf is better than no loaf, but is what the CDC should aspire to do?

My pappy used to say, "Half a loaf is better than no rest at all."

CNC
Print the post Back To Top
No. of Recommendations: 1
I am not a labor lawyer, so major grains of salt here. I'll assume that neither the state nor federal governments have adopted any rules definitively addressing the issue (ie. we're not under a new OSHA regulation or a state law prohibiting this type of hiring criteria). In that case, I think the answer is probably "Yes, but...."

I'm not any kind of lawyer, but I would think the issue would be medical privacy. If I were an employer, I could not ask if someone had epilepsy (for example). So could I ask him if he has a vaccine? At least with respect to schools, there is some precedent (i.e. when I was in school, there were no waivers that I'm aware of...you had to tick all the boxes for required vaccines, or you couldn't attend school).

I don't know if that is already established law. Maybe 60 years ago they were requiring polio vaccines to work for some companies. No idea.

1poorguy
Print the post Back To Top
No. of Recommendations: 1
I'm not any kind of lawyer, but I would think the issue would be medical privacy. If I were an employer, I could not ask if someone had epilepsy (for example).

True, because they're not allowed to discriminate in hiring based on your medical condition - and so they're not allowed to ask generically about your health or any disabilities that would be covered under the ADA.

However, they are allowed to ask you whether or not you meet any lawful physical requirements of the job. For example, if the job requires you to lift a heavy object or stand for long periods of time, they can ask you if you're able to do that.

If the employer establishes a requirement for vaccination as a condition of the workplace, and that requirement is itself lawful (ie. the ADA doesn't prevent you from requiring it as a condition of working), then they probably can ask you about your vaccination status.

Where you might possibly run into trouble is that a few states have laws prohibiting employers from asking about or conditioning employment on lawful behavior outside of work. Depending on how those laws are drafted, they might limit the ability of an employer to insist that an employee or candidate do something off-duty.

Albaby
Print the post Back To Top
No. of Recommendations: 4
albaby1:

JAFO: <<<Have you any thoughts about whether private employers may choose not to hire the unvaxxed? Being unvaxxed is not, if I understand correctly, a disease or medical condition requiring accommodation under the ADA. I also understand that asking about vax status is not a HIPAA violation.>>>

"I am not a labor lawyer, so major grains of salt here."

I am not either; I think we generally practice in similar or related sand boxes. Grains taken.

"I'll assume that neither the state nor federal governments have adopted any rules definitively addressing the issue (ie. we're not under a new OSHA regulation or a state law prohibiting this type of hiring criteria)."

My unstated assumptions, no problem,


"In that case, I think the answer is probably "Yes, but...."

Yes, in the sense that employers are generally allowed to set whatever criteria they want for hiring a new employee so long as the criteria isn't prohibited by some law or rule. There were already some jobs that had some vaccination requirements for some workers (ie. health care workers getting vaccinated for measles and whatnot).

But...., in the sense that there may be circumstances where refusing to hire someone because of their vax status might run afoul of some law or rule. Being unvaxxed is not itself a disability, but there might be some people who are unable to get a vaccine due to a condition that is covered by the ADA. Not sure how the law applies there. I'm sure someone will argue that where vaccine refusal is ostensibly based on religious belief, the employer should have to accommodate it; but I'm not sure that will be successful."


That was really the issue I was wondering about. I know that ideally the courts do not judge the sincerity or validity of the religious belief, but given (a) that most people have taken other vaccines and (d) that at least for denominationally oriented religions (Roman Catholic, Greek Orthodox, Russian, Orthodox, Episcopalian, Methodist), I am unaware of ant major ones that have issued any such proclamation. I am not familiar enough with Islam, Judaism or Hinduism to have any real sense of their faith response. It seems like only congregational (Evangelical) churches have claimed such exemptions and I am uncertain how much is actually "religious" faith as opposed to "political" opposition. IOW, if DJT had truly favored vaccinations I suspect that much of the "religious" exemptors would haves been fine taking vaccinations and we would have been left with the much smaller opposition from those who are opposed to most or all vaccinations.

Regards, JAFO

Regards, JAFO
Print the post Back To Top
No. of Recommendations: 0
It seems like only congregational (Evangelical) churches have claimed such exemptions and I am uncertain how much is actually "religious" faith as opposed to "political" opposition. IOW, if DJT had truly favored vaccinations I suspect that much of the "religious" exemptors would haves been fine taking vaccinations and we would have been left with the much smaller opposition from those who are opposed to most or all vaccinations.

Perhaps.  But I think the weakness of the anti-vax argument here, though, isn't so much in the sincerity of the faith.  Since that's almost entirely interior to the individual, it's not going to be easy for an employer to disprove that this is a 'sincerely held religious belief,' and that path is likely a minefield for employers.

The bigger problem for anti-vaxxers is that employers typically only have to accommodate religious practices or belief if doing so will not cause an 'undue hardship' to the employer, and workplace safety is one of the things that employers are expressly allowed to prioritize over religious belief (at least according to the good folks at Foley & Lardner):

https://www.foley.com/en/insights/publications/2021/08/manda...

Now - if an employer could easily work around the safety issue with a low-cost accommodation, there might be an issue for them.  For workers that can and do work remotely, employers might have to jiggle things around to allow remote work for non-vaccinated employees with a religious objection.  But for most other folks, that's not going to be necessary....



Except.........



We're still new to Omicron.  It is not yet entirely clear whether an unvaccinated employee, merely by being unvaccinated, still poses a greater risk to other employees than does a vaccinated employee.  As I mentioned upthread, the CDC is cagey about releasing raw data on breakthrough infections - but when I looked up the data for Minnesota, new cases of Covid were roughly split 50/50 between vaccinated and unvaccinated population.  Minnesota's about 67% vaccinated.  It's probably a mistake to just apply those numbers directly, given that case reporting figures are going to be so non-representative of actual infections.  But it certainly looks as though the vaccines are only modestly effective at preventing people from contracting Covid.  Which makes it harder to justify a mandatory vaccine as a significant element of workplace safety.  If 90% of your office is vaccinated and 10% is not, if you catch Covid at work you're more likely to have caught it from a vaccinated co-worker than an unvaccinated one - and removing the unvaccinated ones and replacing them with vaccinated co-workers only marginally reduces your risk of exposure.

Enough to take this outside of the EEOC guidance?  Don't know.

Albaby
Print the post Back To Top
No. of Recommendations: 3
Albaby,

Seems to me you keep ignoring the fact that this situation has not existed in our lifetimes until this pandemic occurred. No war or natural disaster has impacted the US healthcare system as have Covid pandemic anti-vaxxers.

Again...this is a novel event in our lifetimes, and everybody knows it's being exacerbated by the anti-vaxx demographic.

If we have to triage, I'd choose the dialysis guy. But the same would be true of the drug abusing person who (predictably) ended up needing a trip to the ICU.

Again, were it not for the anti-vaxxers, we would not be forced into making triage decisions in hospitals from coast to coast. We wouldn't be calling out thousands of military personnel to fill the holes in hospital shifts.

It's not as if a meteor hit earth and thousand need instant admission through an ER. This is a tidal wave of anti-vaxxers. Absolutely avoidable.
Print the post Back To Top
No. of Recommendations: 4
we do that all the time with regard to organs. At least for the duration of the pandemic, we need to exclude the unvaxxed (who are unvaxxed without good medical cause, of course). That will take the pressure off the system, and provide better care for everyone (except the unvaxxed, obviously).

That.

If an anti-vaxxer declares they will continue to refuse vaccination post-hospitalization, "over my dead body" let that be their choice. They have ascertained that they will squander the benefit of a fully equipped hospital bed and the hospitals best efforts.
Print the post Back To Top
No. of Recommendations: 2
It seems like only congregational (Evangelical) churches have claimed such exemptions and I am uncertain how much is actually "religious" faith as opposed to "political" opposition. IOW, if DJT had truly favored vaccinations I suspect that much of the "religious" exemptors would haves been fine taking vaccinations and we would have been left with the much smaller opposition from those who are opposed to most or all vaccinations.

Perhaps. But I think the weakness of the anti-vax argument here, though, isn't so much in the sincerity of the faith. Since that's almost entirely interior to the individual, it's not going to be easy for an employer to disprove that this is a 'sincerely held religious belief,' and that path is likely a minefield for employers.

The bigger problem for anti-vaxxers is that employers typically only have to accommodate religious practices or belief if doing so will not cause an 'undue hardship' to the employer, and workplace safety is one of the things that employers are expressly allowed to prioritize over religious belief (at least according to the good folks at Foley & Lardner):

https://www.foley.com/en/insights/publications/2021/08/manda...

Now - if an employer could easily work around the safety issue with a low-cost accommodation, there might be an issue for them. For workers that can and do work remotely, employers might have to jiggle things around to allow remote work for non-vaccinated employees with a religious objection. But for most other folks, that's not going to be necessary....



Except.........



We're still new to Omicron. It is not yet entirely clear whether an unvaccinated employee, merely by being unvaccinated, still poses a greater risk to other employees than does a vaccinated employee. As I mentioned upthread, the CDC is cagey about releasing raw data on breakthrough infections - but when I looked up the data for Minnesota, new cases of Covid were roughly split 50/50 between vaccinated and unvaccinated population. Minnesota's about 67% vaccinated. It's probably a mistake to just apply those numbers directly, given that case reporting figures are going to be so non-representative of actual infections. But it certainly looks as though the vaccines are only modestly effective at preventing people from contracting Covid. Which makes it harder to justify a mandatory vaccine as a significant element of workplace safety. If 90% of your office is vaccinated and 10% is not, if you catch Covid at work you're more likely to have caught it from a vaccinated co-worker than an unvaccinated one - and removing the unvaccinated ones and replacing them with vaccinated co-workers only marginally reduces your risk of exposure.

Enough to take this outside of the EEOC guidance? Don't know.

Albaby
Print the post Back To Top
No. of Recommendations: 1
Absolutely avoidable.

Of course. That's not at issue.

But it's not the only avoidable thing that creates the need for emergency medical intervention. The massive, almost criminal amount of medical resources that are used to treat critical illnesses caused by preventable obesity - or the calamity that is smoking.

So the question is that now that we have a massive rapid rise in demand for medical services, do these irresponsible people who have also been causing absolutely avoidable medical crises get to 'hold onto their spot' and eat up medical resources as they always have - or should they also, as participants in absolutely avoidable medical catastrophes have to participate in the shared burden of triage? What is the ethical justification for shielding their equally avoidable and equally poor choices from that shared burden? Just because they've been undermining the health care system for decades first, but more slowly, so we've had the time to build out the medical infrastructure they forced us to add through their own disregard for their own health?

Albaby
Print the post Back To Top
No. of Recommendations: 7
The massive, almost criminal amount of medical resources that are used to treat critical illnesses caused by preventable obesity - or the calamity that is smoking.

Again, lacks the caveat; swamps healthcare facilities, exhausting personnel, depriving others of necessary routine care.

I believe I pinched a nerve last month so when I raise my head paddling, get pins and needles in my left arm. Going to an orthopod/imaging/physical therapy/possible procedure for cervical radiculopathy exposes me to greatly increased risk of exposure to C-19.

Put them anti-vaxxers in a tent on an idle military base somewhere in 'zona or east Texas.
Print the post Back To Top
No. of Recommendations: 5
But it's not the only avoidable thing that creates the need for emergency medical intervention. The massive, almost criminal amount of medical resources that are used to treat critical illnesses caused by preventable obesity - or the calamity that is smoking.

Of course. But…also part of the ‘strain’ issue is contagion, too.

One cannot catch obesity, or any of the illnesses caused by smoking, through hospital admittance.

COVID presents differently by tying up many more prophylactic healthcare resources.

Pete
Print the post Back To Top
No. of Recommendations: 1
I've recently been thinking of leprosy. It is contagious (bacterial), and those that had it had to be isolated from everyone else because they were a hazard. Well...the unvaxxed. They're lepers. They are a hazard to everyone else. We mostly didn't actively kill them, but they needed to go away lest the guy that applies leeches for the community gets overwhelmed with lepers.

This analogy only falls down because it was a real problem, but I don't think it affected large numbers of people, and there were no hospital wards to swamp. So people didn't have issues getting leeches.

The Black Plague is probably closer, where entire villages shut down and "strangers" were not welcome lest the be carrying the Plague.

BTW, sorry to hear about the pinched nerve. You might try chiropractic. There are some good ones out there who might be able to un-pinch the nerve without need to a scalpel.
Print the post Back To Top
No. of Recommendations: 0
1pg: Ive recently been thinking of leprosy. It is contagious (bacterial),

I have been wondering a bit myself. Are bacteria alive? They can be killed? I believe a virus is not actually alive. (Someone will kindly correct my misapprehension?)

CNC
Print the post Back To Top
No. of Recommendations: 3
The supreme importance of controlling epidemics to legitimate governance is summarized by Roman Cicero, himself looking back to even earlier governments:

https://en.wikipedia.org/wiki/Salus_populi_suprema_lex_esto

Salus populi suprema lex esto (Latin: "The health (welfare, good, salvation, felicity) of the people should be the supreme law", or "Let the good (or safety) of the people be the supreme (or highest) law", or "The welfare of the people shall be the supreme law") is a maxim or principle found in Cicero's De Legibus (book III, part III, sub. VIII).

Anglo Saxon common law often departs from Roman law, but the principle of Salus Populi has been repeatedly reaffirmed within English law since ancient times and also in USA colonial and then federal law since the colonies were established and the constitution ratified.


History of salus populi in USA: https://yalereview.org/article/law-salus-populi

"The Massachusetts Bay Colony established quarantines for vessels when yellow fever broke out in Barbados in the 1640s. And soon after American independence, a yellow fever epidemic chased President George Washington out of the then-capital, Philadelphia, and led the city’s authorities to establish a Board of Health. For the next century, state and local health commissions exercised broad powers to quarantine the sick, to condemn unsanitary properties, to exclude infectious and potentially infectious immigrants, and to compel vaccination for diseases like smallpox. In the name of 'the life and health of its citizens,' as two prominent officials put it at the end of the nineteenth century, such commissions coerced 'the ignorant, the selfish, the careless and the vicious.'”


David fb
Print the post Back To Top
No. of Recommendations: 8
Obesity, smoking, drugs and alcohol putting you into hospital is nothing like unvaxxed covid putting into hospital. NOTHING like. Because your obesity etc does not infect me.

Other people's smoking affects me. Second-hand smoke causes cancer. So what did society do? Banned smokers from public spaces. Perfectly logical.

Likewise, other people's drinking affects me when they drive drunk. So there are severe penalties for doing so.

Why should it be different for COVID? If you’re unvaccinated, you’re much more likely to be a spreader. So get outta here.
Print the post Back To Top
No. of Recommendations: 7
The ancient Greek word for a city state is polis, but the main meaning of that word anciently was NOT a collection of habitations and businesses, but rather of a place where it was safe to live as a civilized humans in a society of civilized humans.

Precisely. Also, the ancient Greeks had a word for individuals who failed to respect the polis and its inherent obligations: an idiot.
Print the post Back To Top
No. of Recommendations: 1
Also, the ancient Greeks had a word for individuals who failed to respect the polis and its inherent obligations: an idiot.

It is interesting where the term 'ostracize' came from. The ancient Athenians would hold a vote to determine whether they thought a separate vote was necessary to get rid of some miscreants in the polis that year. Several months later they would hold the actual ostracism, which gets its name from ostraka, which were pottery shards on which the Athenians would write the name of their victim. Whoever had the biggest pile of ostraka would be banished, providing the number of shards reached a certain number.

https://en.wikipedia.org/wiki/Ostracism

I go back and forth as to whether this was a good system for ridding the community of rapscallions.

Pete
Print the post Back To Top
No. of Recommendations: 2
I go back and forth as to whether this was a good system for ridding the community of rapscallions.

If they did that 100 years ago in the US, atheist would have been banished. How you define "miscreant" is crucial.

I try to keep that in mind. It's one thing if someone is acting against the public good. It's another to penalize "thought crime".

In this particular instance, with COVID, it is acting against the public good. Alas, we have nowhere we can ship them. Nobody else would want them.

Maybe we could establish COVID Colonies. Full of antivaxxers and COVID deniers; akin to leper colonies a long time ago.
Print the post Back To Top
No. of Recommendations: 2
Alas, we have nowhere we can ship them. Nobody else would want them.

Mississippi will take them. They’ll take anything but liberals.
Print the post Back To Top
No. of Recommendations: 6
1poorguy: "Maybe we could establish COVID Colonies. Full of antivaxxers and COVID deniers; akin to leper colonies a long time ago."

I think the states are mostly self-segregating.

https://usafacts.org/visualizations/covid-vaccine-tracker-st...

States and D.C. with more than 70% fully vaccinated:

Single Dose Fully vax. (much blue)

D.C.    	93%	70%	
Washington 79% 70%
Virginia 83% 71%
New Jersey 88% 73%
Maryland 84% 73%
New York 88% 74%
Massachusetts 95% 76%
Hawaii 85% 76%
Connecticut 93% 77%
Maine 89% 78%
Rhode Island 95% 79%
Vermont 92% 79%

States with 55% or less fully vaccinated (mostly red - led/anchored by Alabama)

Alabama 61% 49%
Mississippi 58% 50%
Wyoming 57% 50%
Idaho 60% 52%
Louisiana 60% 52%
Arkansas 65% 53%
Georgia 64% 53%
Tennessee 61% 53%
Indiana 60% 53%
Missouri 65% 54%
North Dakota 64% 54%
Oklahoma 69% 55%
South Carolina 66% 55%
Montana 64% 55%


with fully a 30% difference between the leaders (Vermont and RI) to anchor Alabama

Regards, JAFO
Print the post Back To Top
No. of Recommendations: 0
I go back and forth as to whether this was a good system for ridding the community of rapscallions.

And those who were unpopular. Socrates and hemlock come to mind.

DB2
Print the post Back To Top