[pilowsky]

cherdano, on 2021-January-03, 10:41, said:

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]

pilowsky, on 2021-January-03, 14:27, said:

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]

Winstonm, on 2021-January-03, 09:13, said:

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]

cherdano, on 2021-January-03, 17:01, said:

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]

cherdano, on 2021-January-03, 17:01, said:

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]

David Leonhardt at NYT said:

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]

David Leonhardt at NYT said:

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]

Zelandakh, on 2021-January-04, 07:52, said:

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]

Cyberyeti, on 2021-January-02, 08:25, said:

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]

cherdano, on 2021-January-05, 07:32, said:

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]

barmar, on 2021-January-03, 17:55, said:

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.

[thepossum]

pilowsky, on 2020-December-31, 21:11, said:

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

Indeed, Happy New Year. But its been crazy so far

[barmar]

johnu, on 2021-January-10, 14:19, said:

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.

I doubt they're letting people without medical training do it.

However, due to the urgency of the pandemic, a number of US states are relaxing their laws to allow medical, dental and nursing students to administer COVID-19 vaccines. And some are also enlisting firefighters.

[shyams]

I thought I will post some data I recently found about Covid in my London borough.

* Slightly over 5% of the borough population was recorded to have contracted Covid so far (i.e. Mar '20 thru Jan '21)
Note this only includes population who was tested or formally assessed to have been Covid positive. People who contracted it in early 2020 (i.e. before widespread testing) and recovered without going to a doctor OR people who contracted it without manifesting any symptoms are not counted in the official figures.

* The current wave is so bad that approx. 2% of the borough population is currently registered as active Covid cases (i.e. 40% of all cases in the borough are recent). The official numbers are as of early Jan (i.e. about a week worth of data is yet to come).

* Further, it is estimated that an additional 0.7% of the borough contracted Covid in the past week.

This is getting frighteningly out-of-control.

[Cyberyeti]

shyams, on 2021-January-11, 06:38, said:

I thought I will post some data I recently found about Covid in my London borough.

* Slightly over 5% of the borough population was recorded to have contracted Covid so far (i.e. Mar '20 thru Jan '21)
Note this only includes population who was tested or formally assessed to have been Covid positive. People who contracted it in early 2020 (i.e. before widespread testing) and recovered without going to a doctor OR people who contracted it without manifesting any symptoms are not counted in the official figures.

* The current wave is so bad that approx. 2% of the borough population is currently registered as active Covid cases (i.e. 40% of all cases in the borough are recent). The official numbers are as of early Jan (i.e. about a week worth of data is yet to come).

* Further, it is estimated that an additional 0.7% of the borough contracted Covid in the past week.

This is getting frighteningly out-of-control.

Norfolk is not that bad but pretty bad, the figures suddenly increased massively. We were around 100 cases per 100K with some parts of rural Norfolk half that when we were put into T2, it's now just dipped below 500 for the whole of Norfolk and is just above for Norwich.

[shyams]

shyams, on 2020-May-14, 03:18, said:

Some stats from the UK Govt. Office of National Statistics

                   Deaths in     Avg. deaths    2020 higher
                     2020         prev 5 yrs    or lower

Weekly avg.         11,943         12,410         - 467 
 weeks 1-8
Week # 9            10,816         11,183         - 367
Week #10            10,895         11,498         - 603
Week #11            11,019         11,205         - 186
Week #12            10,645         10,573         +  72

and then the numbers start getting impacted by Covid
Week #13            11,141         10,310       + 1,011
Week #14            16,387         10,305       + 6,082
Week #15            18,516         10,520       + 7,996
Week #16            22,351         10,497       +11,854
Week #17            21,997         10,458       +11,539
Week #18            17,953          9,941       + 8,012

Note: Numbers exclude Scotland and Northern Ireland.

So our Govt. said that Covid deaths as of 01 May 2020 across the UK were 27,510. The excess deaths {in England and Wales only, excludes Scotland and N. Ireland} as per the ONS report were 46,500 a massive difference. And if one were to extrapolate, we might have had excess 55k-60k deaths in the UK since the Covid outbreak took hold.

I think this is terrible mismanagement by the UK Govt.

So allow me to revisit the topic of UK's mishandling of Covid. The BBC today published an article on "Excess deaths in 2020" (link here). In it, the headline message is that UK saw 91,000 excess deaths which is 15% higher than the past 5 year average.

The article then goes on to ameliorate the disaster by including some fluff about "when the age and size of the population is taken into account, 2020 saw the worst death rates since the 2000s". In other words, giving some credit to the Govt. by pretending it's not an absolute disaster. Unfortunately, this is a superficially researched piece with very little effort gone into analysis of the underlying data.

If one looks at the data even for 5-10 minutes (which the BBC should have), it is obvious that the death rates in the first 8-12 weeks of 2020 were running below normal (about 3K fewer deaths in Jan-Mar than the 5-yr average). So the entire spike in deaths (of 91K extra) occurred in the later 36 weeks --- they haven't even included December yet. To summarise, the actual excess deaths (during the real Covid period) are approx. 25% higher, not the 15% touted by the BBC.

And unlike the USA, where deaths from overdoses and suicides have allegedly spiked, there are no known reports of other factors (like overdoses) that have materially impacted death rates. In other words, it is highly likely that Covid alone contributed to the 25% rise in death rate!

I never understood why the British media is not more harsh on the Govt's mishandling.