[AMA] COVID ICU Doctor in Sydney [closed]

Hey everyone, long time lurker here.

I'm a junior doctor in a COVID ICU of one of Sydney's tertiary hospitals.
Wrote this post to hopefully shed some light on what it's like inside the unit, since rarely does the general public have a chance to see or get a feel for what goes on inside the unit.
COVID ICUs are very strictly regulated units - most hospital staff are forbidden to enter (and wouldn't want to be there anyway)

I should probably describe what it's like to be a patient inside COVID ICU.
- there probably aren't good windows, so you don't have much access to natural light and don't know if it's day or night
- we give you dexamethasone which helps reduce the inflammation in your lungs, but it gives you insomnia
- your family cannot visit you at all
- you can't recognise anyone who is coming into your room because of all the PPE we have on
- the usual reason for ICU admissions is oxygen support which can range from uncomfortable (having large volumes of oxygen jetted up your nose - high flow nasal prongs), very very uncomfortable (having pressurised oxygen pushed into you via a tight mask - it feels like trying to breath with your head outside the window of a moving car), or completely intubated.

If there's one thing I want to say, it's please get vaccinated! I have not looked after a single fully vaccinated patient.
If you're in Sydney and eligible for Pfizer and AZ but have to wait 2 weeks for Pfizer, I wouldn't wait.

Some questions I can answer, some questions I can't
I'm studying at the same time as this, so sometimes can take some time to answer, sorry!
Opinions here are my own

Addit - I am closing this AMA, thank you for your questions. There's a number of questions that keep being recycled, which I can't answer eg. Opinion on novel drugs and I am being DM'd for specific health advice. I cannot provide that information to you responsibly on the internet, I am sorry. Please ask your local doctor/attend ED if especially concerned.

closed Comments

  • +20

    In your opinion, what is the best way to convince anti-vaxxers to get a jab? Appealing to their common sense and responsibility towards community does not seem to cut through "what they read on the internet".

    • +112

      I don't know. People much smarter than me have not managed to work this one out.
      The University of Sydney recently published a paper on the psychology of 'non-compliers'

      You can read about it here - https://www.sydney.edu.au/news-opinion/news/2021/07/30/what-…

      They basically said
      1. More effort should be put in to regulate misinformation ie. patrol the internet - pretty difficult to do
      2. Frame public health messages to appeal to self interest.

      Someone suggested paying people to get vaccinated. From purely an economic standpoint, it might have some grounds, the cost of a COVID ICU bed is really expensive, many thousand dollars a day. From a moral standpoint - essentially bribing our civilians to do their civic duty to look out for one another - I don't know about that

      • +9

        Thank you for your answer, and even more for your service during these times.

        I do agree, that bribing non-compliers in bid to have them get a jab is a one-time solution. Instead of changing their mind, it just gives them an incentive to behave differently to their internal beliefs this one time. Almost like trying to teach a child socially acceptable behavioral patterns by purely bribing them every single time.

        That paper was was a dynamite to read! Thank you for linking it - I will share it in my network, to increase awareness of the problem.

        • +35

          Part of the problem is that society has lost its value for pluralism — Rather than respecting that people have different perspectives and engaging in reasoned debate, it is common to devalue the personhood of those with conflicting perspectives. So walls go up on all sides, most end up in a tribal bubble and real communication evaporates.

          • +6

            @Scrooge McDuck: You can’t argue against stupid.

            When you have thousands and thousands of doctors and scientists saying one thing on one hand and a youtube video and alan jones on the other and they choose youtube and alan jones… what do you do?

            I guess natural selection will do its thing. In the meantime the anti vaxxers are putting us all at risk.

            Edit: also, you don’t have to respect differing opinions when the opposing view is dangerously wrong.

            • +23

              @Vote for Pedro: The point is that calling people stupid will not change minds.

              You will just make them more resistant.

              We gotta stop this urge to demonise and devalue people.

                • +24

                  @Vote for Pedro: You are part of the problem mate.

                    • +7

                      @Vote for Pedro: What are the long term side effects of any of the vaccines? If people have any side effects, who is liable?

                      • -7

                        @brendanm: No one is forcing you.

                        • +5

                          @Vote for Pedro: For how long?

                          • -4

                            @brendanm: Making things up to complain about again?

                            Edit: seems like you’re hunting for outrage that doesn’t exist

                            • +6

                              @Vote for Pedro: Sorry? You literally just said:

                              And finally, don’t want the vax? Don’t expect hospital treatment for covid.

                              On top of that, with "vaccine passports", and how other countries are treating them, it seems like its only a matter of time before it's not optional.

                              • @brendanm: You’re right. I did say that and i stand by it. You don’t want to take what health professionals are recommending but the want the help from those same health professionals to treat the thing they tried to prevent you from getting.

                                On the vaccine passports you still have options. You can choose to get vaccinated or not avail yourself of the services that requires a vaccine. It’s your choice.

                                Choice doesn’t mean you always get to have it your way.

                                Living in a wider society means you have obligations to that society. But again, you can choose not to be part of that society. Choices are amazing aren’t they.

                                • +3

                                  @Vote for Pedro:

                                  they tried to prevent you from getting

                                  The vaccines don't prevent you getting covid though?

                                  On the vaccine passports you still have options

                                  Yeah, you can go to the shop, or you can't. Seems pretty reasonable.

                                  Having to take a vaccine (that no one knows the long term effects of, if anything, and that the makers have no liability to) , that doesn't actually stop you from getting, or spreading, a virus with a 99.9% survival rate for most people, so that you can do normal, everyday things. Does that sound ok to you? Should get someone onto making up little star badges for the "antivaxxers".

                                  • +5

                                    @brendanm: It's funny though, everyone thinks there is only one side to this. Like Pedro said, "You don’t want to take what health professionals are recommending", excuse me, ever heard of confirmation bias? So let's ignore ALL the other health professionals on the other side, say they have gone rouge etc. etc. Let's just ignore them because WHY?

                                    To think people give more weight to one health professional and IGNORE the inventor of mRNA technology. I find it absolutely fascinating how hypocritical these people are.

                                    So much ignorance it's amazing!

                                  • @brendanm: Yes. It does sound ok to me. You know why? Science.

                                    Lol @ health professionals on the other side. You use the same argument against climate change.

                                    You know what beats science? Better science. You know what doesn’t? A YouTube video.

                                    Also, stop spreading the lie that you’re being forced. Give me an example of you being forced and I’ll give you the choice you have.

                                    • @Vote for Pedro:

                                      You know what beats science? Better science.

                                      People who don't understand science say this. Science is objective. The objective thing, is that because we haven't actually had much time pass since these vaccines have been available, we don't know if there are any long term issues. This is a fact, this is science. You are fine with accepting that risk, which is fine. I am not, which is also fine. People have different risk/reward calculations, and that's fine.

                                      • @brendanm: Peer reviewed science comrade peer reviewed only - not ‘scientists’ feels.

                                        Still waiting on an example of forced vax?

                                        • @Vote for Pedro: Unsure if serious. Please show me some peer reviewed science that guesses what may happen in the future?

                                          Ask an actual scientist to guarantee there will be no long term issues. They won't, as science is based on actually observing something, and as long term has bit yet come, it is impossible to observe whether or not there are long term issues.

                                          Who is liable if there are any long term effects? No one, everyone has washed their hands of liability.

                                  • @brendanm: Take a societal view. Most people who take this view do it because they simply think "they'll survive" COVID if they get it or a are serial devil's advocate arguers. Which one are you?

                                    • @serpserpserp:

                                      Which one are you?

                                      Yet another black or white person. I'm the person that doesn't know if there will be any long term issues from a vaccine that has never been used in humans outside of trials. I'm the person that wonders why, if it's so safe (who knows how they can see the future), why would the pharmaceutical companies have indemnity?

            • @Vote for Pedro: You have lost your humanity and are what I call a Vaxhole. No one , not you , not the government has a right to force or coerce someone to undertake a medical intervention. No one, not even you Pedro. Several surveys show vaccine hesitancy is higher within those that have a higher education. Pedro if you are vaccinated why are you worried about the unvaccinated. You have protection right ? But I guess you are aware what is happening in Iceland and Israel, probably the two most vaccinated populations in the world and the number of people that are dying even though they are double vaccinated. Pedro you will have to start relying on boosters as indicated by the Pfizer CEO recently given the efficacy has dropped to about 40% after 6 months…. you might just become a Covid vaccine junkie in the years ahead looking to get your next fix :)

              • @pch2966:

                Pedro if you are vaccinated why are you worried about the unvaccinated.

                Their vaccination apparently only works if everyone else is vaccinated.

                you might just become a Covid vaccine junkie in the years ahead looking to get your next fix :)

                A possible reason for the vaccine aggressiveness.

                You immunity system will be subscription-based 😄

                • +3

                  @ozhunter: You know why we no longer have polio, chicken pox and measles right? Science.

              • +1

                @pch2966: Happy to be called to a vaxhole.

                No one is forcing you to get it. Stop spreading lies. You have a choice. You might not like that choice but you can’t stomp your feet crying to always get your way.

                As for the higher education bullshit, rubbish.

                • +1

                  @Vote for Pedro: love how all these guys spout out these %
                  So do you guys not know anyone that are old or susceptible to the disease then? or think about how you are putting them at risk?
                  even if you quote the efficacy of the vaccine dropping to 40% without a booster shot that is still better than not being vaccinated where the risk of catching covid is much higher. All it means is the risk of you catching the disease while vaccinated has increased but it still has a high % of protecting people from getting seriously sick or dying.

                  Even if you arent dying from covid you are a drain to the hospital resources if you do get sick. There was a recent video of a Dr in Sydney outlining the impacts of ICU covid patients. They spend on average 3 weeks in ICU compared to the normal average of 3 to 4 days. Not only that, the nurses and Dr need to be kitted out in PPE just to look after these patients.

                  If you guys feel like you dont think you need the vaccination then I guess you dont need hospital care if you do get sick from covid right? bet you that any of you guys who say u dont need the vaccination will be going into hospital asking for care when you need it. Just like Vote For Pedro sick of people who say they dont need the vaccination and then clog up the health system when they get sick.
                  Anyways this guy in this video sums it up better than I can about this situation where he says if you dont trust the medical field enough to get vaccinated and prevent you from getting Covid why run to the hospital and trust them to cure you from it when you do get sick.

                  https://youtu.be/fAXTuU2vymM?t=113

                  Hopefully you idiots who dont want to vaccinate also choose to stay at home and not be a burden to the hospital when you need it

      • +27

        People are too nice.

        Take them on a tour of ICU and let them watch an intubation.

        It is a problem when you live in the "lucky" country because people have no idea how lucky they are. They take it as a given.

        • +12

          Those people in ICU had weak bodies, nothing is going to happen to me because I believe in Jesus - Antivaccer

          • +6

            @BuyOrNot: If they can fit microchip (Bill Gates conspiracy) into a syringe, Jesus can fit in there.

          • +2

            @BuyOrNot: Antivaccer - Congratulations, you've won a holiday to Wuhan. :)

            For everyone else - the cost of this airfare will pay for itself not having to waste valuable ICU beds on those that refuse to listen to medical and scientific evidence. Natural selection ftw!

          • +3

            @BuyOrNot: That is such a Christophobic comment. Why did you single out the Christian religion?

            • +4

              @pch2966: Doesn't want to risk getting banned by mentioning the other ones.

        • +8

          It is a problem when you live in the "lucky" country because people have no idea how lucky they are. They take it as a given.

          I think this pretty much hits it on the head.

          I also think people lack identity today. Movements like anti-vax and anti-lockdown give people a current and simple (jab vs no job, lockdown vs 'freedom') issue to identify with, which makes them feel part of something. Being in the minority that's opposing the man and the masses probably has a certain 'rebellious' appeal for some.

          • +2

            @PurchaseAnxiety:

            I also think people lack identity today

            You are pretty much right. But I don't really see distributing information and going protesting as gaining an identity. Maybe they should volunteer at COVID19 ward without PPE (offered), worse thing that can happen is they end up dying or proving it is just the flu.

        • You're not even talking the same language already, they don't believe it's real, don't think they'll be impacted, or just don't care because the government is asking.

          Anyone motivated to walk a tour of ICU aren't the ones avoiding the jab.

          • @peterpaoliello: If it isn't real then mopping the floor in the COVID ward PPE free won't be a problem would it?

      • +6

        To me bribing has a negative connotation.

        I’m not a fan of monetary incentives either - but that’s exactly how I would frame it.

        • +2

          instead of paying them, take away a portion of the Centrelink from unvaxxed, increase the % rebate for childcare, I can guarantee there are nice benefits they are already receiving to sit on their arse and go on facebook all day.

          • @mincemeat: I think there is already no childcare rebate for unvaccinated kids (not covid vaccine though), that's what I heard from an antivaxxer few years ago

      • Bribe the reluctant, but give double the amount to the folks who did their civic duty voluntarily and hopefully watch the uptake soar.

        • Settle down Blinky Bill

        • +1

          Please tell me you have a very clear understanding of how these vaccines work. E.g. do you really know about cells, rna, mrna, t-cells etcs?
          **(profanity) keyboard

        • +3

          And where does your scientific opinion come from? Which university, faculty and course?

        • +9

          The antibodies don't attack healthy cells.. I just.. can't believe how dumb people are. Just shut up.
          We need to get some university qualification checks before you can post.

          • @w37hsyea: I think he is talking about ADE but hasn't described it properly at all. Thus far, no evidence of ADE is occurring with these vaccines… yet.

        • +10

          source: trust me bro

      • +1

        More effort should be put in to regulate misinformation ie. patrol the internet

        this is one of the biggest things that has pushed me to not want to get a covid vaccine. keep doing it.

    • +13

      save ur time, Darwinism!

      • +23

        There are at least 2 types of non-compliants: those that are worried about unintended health consequences, and those that are off with other ideas such as tracking chips and whatnot. I would not spend any time on that second group but IMO the first group are ripe for frank discussion.

        • +31

          Agreed, I see too often when someone raises any concerns about the COVID vaccinest they immediately get put into the tin foil hat conspiracy theory category or at the very least get labeled antivax (which implies against all vaccines)

          • -2

            @FireRunner: At this point anyone who is concerned about COVID vaccines isnt listening to the broad scientific, and medical consensus.

            And if someone ends up on a ventilator, does it matter if they are there because they had genuine concerns and wanted to wait for the vaccine to be in market for 2 years.. or because they thought Bill Gates wants to control their mind?

            • +6

              @brandt: I don't understand why the government is dragging it heels on a no-fault vaccine injury compensation scheme, I think that would get so many people over the line.
              If it's safe and effective then stand by it. Giving indemnity to doctors but nothing for patients doesn't send that message.

              I think a lot of people out there are thinking, "I know the chance is minuscule, but what if I do get TT, what will happen to my family?". With a VICS that question is answered.

              • +1

                @havabeer: 100% hit the nail on the head.

                Lack of transparency. That's because you say anything bad about these vaccines, you create hesitancy.

                But when reporters start dying (Lisa Shaw from BBC https://www.theguardian.com/media/2021/aug/26/bbc-presenter-…) or get heart inflammation (Denham Hitchcock https://www.instagram.com/p/CTBCWyyBhaI/), yeah, governments trust and all that goes out the window. Many people sharing similar experiences, but you don't hear about it.

                And everyone thinks OH WHY DON'T YOU PEOPLE FOLLOW THE ADVICE? Well, how can we trust them when they don't give you all the information to make an informed consent? Now, anyone got the vaccine, did they go through all the side effects with you? Curious.

                All you hear is, oh, that's tragic that person is dead, but it's so rare, you have a greater chance of turning into Goku. Yeah, tell that to their families.

                Just be honest ffs!

                • @RocketSwitch:

                  But when reporters start dying (Lisa Shaw from BBC

                  TTS from Astrazeneca is widely known.

                  or get heart inflammation (Denham Hitchcock

                  The small chance of it happening isn't a secret

                  Covid is 'four times more likely to cause heart inflammation than the Pfizer vaccine in adults', real-world study in Israel suggests
                  https://www.dailymail.co.uk/news/article-9929045/Covid-FOUR-…

                  And

                  FDA adds warning about rare heart inflammation to Pfizer, Moderna Covid vaccines
                  https://www.cnbc.com/2021/06/26/fda-adds-warning-of-rare-hea…

                  Well, how can we trust them when they don't give you all the information to make an informed consent?

                  The information is there is you look for it from trustworthy sites (no the Daily Mail isnt one but the headline was easy to quote)

                  Governments can give all the information they want to help people give informed consent. That doesn't stop people saying the government is lying so they can secretly inject us with tracking chips and then turning to non trustworthy sources for 'facts'

            • @brandt:

              And if someone ends up on a ventilator, does it matter if they are there because they had genuine concerns and wanted to wait for the vaccine to be in market for 2 years.. or because they thought Bill Gates wants to control their mind?

              Yes it matters. That person takes up a hospital bed for no reason, it's selfish.
              Because of that person other people that actually need an ICU bed and ventilator cannot have one.

              How would you feel if someone in your family with a genuine health condition died because they couldn't get a hospital bed because the hospital was full of unvaccinated COVID patients?

              Look at Florida where nearly 20% of patients in one hospital are there because they are unvaccinated.
              That's 200 beds that could have come to people with a genuine health condition.
              People are dying because other people are choosing not to have a vaccine then catching COVID and taking up a bed.

              Covid patients are now occupying nearly 200 of Tampa General Hospital’s 1,041 beds as of Tuesday, according to data provided by the hospital, which serves western Florida and the greater Tampa Bay region. Sixty-one patients are in the ICU. The surge in patients, most of them unvaccinated
              https://www.cnbc.com/2021/08/11/florida-hospitals-are-overru…

              • @spaceflight: by that logic fat people should be refused health care too?

                • @Ghos7: Not all people are fat because they choose to be.

                  Obesity can occur for a number of reasons that are not simply because a person chooses to eat poorly or not exercise.

                  For example people with enduring mental health problems are two to three times more likely to develop obesity.

        • +9

          -3. They just aren't worried about catching covid. Just there are those that don't get the flu vaccine.

          -4. They don't trust the health "experts".

        • +3

          For the first time yesterday I heard a doctor say that side effects from any type of vaccine happens within the first weeks and that there has been no demonstrable long term effects - other than helping you not get dead.

          So the argument of who knows what it’ll do in 10-20 years is misleading.

          Ps. Proudly double dosed!

          • +1

            @Vote for Pedro:

            For the first time yesterday I heard a doctor say that side effects from any type of vaccine happens within the first weeks

            How many mRNA vaccines has this doctor been involved with?

          • +1

            @Vote for Pedro: Actually, it's 8 weeks.

            However, FDA is possibly classifying these in a similar category as gene therapy. It's not gene therapy exactly because mRNA has been designed to degrade rapidly in the body, so it won't change your DNA, but it uses genetic material.

            So that's why there are 13 ongoing studies for the next 2-3 years and a 5 year follow up for the risk of heart inflammation for infants.

        • +1

          There are other types as well: People who refuse on "religious or cultural grounds".

          The worst kind IMO.

        • -3

          Read the research?

          What is the most hesitant group? - It's those with science based PhD's … wonder why?

          Can't have anything to do with mRNA technology (that permanently changes your DNA) that has never been tested or used before :P

          (yes I am IGG+, ie carry the antibody, which is the whole goal of vaccination)

          • @7ekn00: No, it doesn't change your DNA, the mRNA has been designed to deteriorate rapidly in the body, so it doesn't have a chance to. Whether studies showing later on in some cases it doesn't, who knows, but no evidence of that.

      • -1

        The problem is many of the anti-vaccers are less than 50 years old and will most likely survive the virus but in the process, spread it to older and vulnerable people.

        • +35

          Vaccinated people can spread the virus too.

          https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3897733

          • @ozhunter: Yea, you sound like one of those antivaxers

          • +8

            @ozhunter: Vaccinated people can spread covid, but using that as an argument against vaccination is nonsensical because they are far less likely to spread it than unvaccinated people

            • +9

              @bobkin: How much less? Have you seen Israel's cases lately?

              • +6

                @ozhunter: I was really surprised by the answer to your question when I looked it up. I was expecting the rate of transmission to be significantly reduced, but it seems this is not the case with delta. There are several caveats and other things to consider however. This recent summary from John Hopkins explains it well:
                https://publichealth.jhu.edu/2021/new-data-on-covid-19-trans…

                Overall they still certainly advocate for vaccination. They make the following points:

                1) Vaccines remain highly effective at preventing severe disease.

                2) Breakthrough infections among vaccinated individuals remain uncommon.

                3) The majority of new COVID-19 infections in the US are among unvaccinated people.

                It seems logical that risk of transmission is lower when the potential recipients are also vaccinated.

              • +2

                @ozhunter: Haven't followed the whole discussion, but majority of cases in Israel are of children, teens and unvaccinated.

                • @BargainCowboy: Don't follow it. Ozbargain is full of anti-vaxers or those that get vaccinated but still like to spread anti-vax propaganda.

              • @ozhunter: What's with your obsession with case numbers? Do you not understand how viruses work in a heavily vaccinated population?

                Clearly don't have any understanding of the human body.

                • +2

                  @Orico: I don't but you guys do. I agree the case numbers are pointless. Only reason seems to always be mention is to scare people

    • +31

      From my interactions with friends who are in the "not getting the vax" camp, I think it basically comes down to a level of fear involved with the "what ifs" of getting vaccinated. My feeling is that people with this line of thought will not change their mind until the level of fear of the virus itself outweighs the possible negative implications of taking the vaccine.

      Things wont change until they are either forced/coerced to do so, or their experience with the virus starts to affect their circle of friends/family/themselves.

      Basically, they will not jump the scary gap until they can see and hear the rabid dog directly behind them.

      • +7

        They seem to not be able to judge the probability well. They will say 'i have a tiny chance of catching COVID, and if I do, a tiny chance of dying'. But then they are worried about the clot deaths from AZ or even the risks of Pfizer (even though no deaths(?) have been caused by Pfizer).

        • +11

          I think it also relates to the feeling that they are able to make their own decision as to whether they want to risk any side effects from a vaccine, if they take the vaccine there is 100% risk in their heads that there is a chance they may suffer some ill effects. If they don't take it then there is a zero % chance of vaccine risk. A chance of a chance so to speak.

          They may also feel that their own actions will prevent them from catching the virus.. "It's ok. I'm being super careful.. plus that's why I have an immune system".

          Then there's those that don't think the virus is actually that bad at all or a concocted fake, and hence they do nothing about it and don't take any precautions.

      • +4

        My concern is the hesitation over getting the AZ and waiting for the Pfizer.

        Ignoring the rollout issues with Pfizer - its just so sad to see people in their 30's or even 60's passing away from Covid, unvaccinated.

        Surely in areas where Covid where is prevalent (where ~1% of ppl have covid), and a 1% risk of passing away from covid… surely the 1 in 1million chance of dying from the vaccine is soooo much better than a 1:10,000 chance of catching covid and dying from the disease?

        • +16

          Yep number 1 reason when asked why they were not vaccinated -> 'I was waiting for Pfizer, I had my Pfizer booked in next month'

          • +3

            @shatter: Darwin awards right there.

            we totally cocked up the messaging and the media made it even worse, anti vaxxers felt vindicated due to it. and now we are in this mess.

            the UK used astra for a huge portion of their vaxxing, somehow australian house wives and lay abouts think we deserve better (or deserve to die)

      • +10

        As much as I've had many other vaccines in the past (or I'm not an anti-vaxxer), I was hesitant about getting the COVID one, because of the potential unknown long term side affects. Living in SA, I'm fortunate enough that our TOTAL EVER cases count is far less than NSW's 24 hour count so there was no urgency from my point of view.
        However I bit the bullet and had my 1st Pfizer last week under the logic that the risks of trusting science are probably tiny compared to the risks of catching the actual virus.

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