[AMA] COVID ICU Doctor in Sydney [closed]

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  TanyaDD on 26/08/2021 - 16:49

  Have you seen or been made aware of people taken to ICU that shouldn't have been there in the first place, and ended up worse off?
  This includes the non-covid ICU.

  • 

    shatter on 26/08/2021 - 20:28

    +1

    It might be me and being junior, but I don't think it's really black and white as to who should receive ICU level care, and who shouldn't. ICU level care also varies greatly from the highest level of care being eg. ECMO - where we literally use machines to act as the heart and lungs, to simpler things like inotropes (blood pressure support medications) or non-invasive ventilation.

    Plenty of people have done poorly in ICU, and we often talk about the risks of proposed treatment which we can expect but it's sometimes harder to say if someone shouldn't be receiving that treatment in question in the first place

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  windrc on 26/08/2021 - 17:08

  Does all the staffs who enters the ICU ward (docs, nurses, cleaners, wardmans, meal prep etc) all need regular covid testing done and how often?

  • 

    shatter on 26/08/2021 - 18:38

    I think it's all facility dependent. Right now they're trying to cut back on surveillance swabs to speed up swabs done for symptomatic swabs.

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  popsiee on 26/08/2021 - 17:10

  Are you coping ok with the crappy salary and huge work load that junior's get ?

  • 

    shatter on 26/08/2021 - 18:49

    +6

    Having pretty decent pay and good job security at a time like this is the flipside to that, and that's not that bad given how so many industry sectors can't employ staff right now

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      popsiee on 27/08/2021 - 10:43

      I'm on the side of the protesting Juniors that are over worked and underpaid .
      Salary should be double based on the years of study and the small % that have expertise and the opportunity to follow this path.

      • 

        greatlamp on 27/08/2021 - 14:31

        The don't even need higher salary, their salary is fine, it's the conditions that are bad. The large proportion of unpaid hours, and pressure to never call in sick

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  ATangk on 26/08/2021 - 17:22

  +1

  If you're in Sydney and eligible for Pfizer and AZ but have to wait 2 weeks for Pfizer, I wouldn't wait.

  Why not? With Pfizer you would be fully immunized faster than AZ.

  • 

    HumbleCat on 26/08/2021 - 17:50

    +1

    You need the second dose of Pfizer to get the full effects, with AZ you get similar protection after 1 shot.

    Both are effective against the Delta variant, Pfizer was more effective against the Alpha variant. Thats why the old statistics of 90% vs 60%.

    The new statistics were just published a few days ago.

    • 

      ATangk on 26/08/2021 - 17:52

      +3

      The old stats said 93% (69-98 2 s.d.) efficacy after 1st dose for Pfizer, and 76% (59-86 2 s.d.) for AZ.

      The new statistics also dont follow your point.

      Pfizer 1st dose is 35.6 % (22.7–46.4 for 2 s.d.)
      AZ 1st dose is 30.0 % (24.3–35.3 for 2 s.d.)

      2nd dose
      Pfizer is 88.0 % (85.3–90.1)
      AZ is 67.0 % (61.3–71.8)

      No data is given to when the dose separations are, but assuming nominal, Pfizer doses are closer together than AZ.

      With the current governments plan to rush the second dose of AZ, it can be extrapolated from speeding up doses against Alpha strain that efficacy against the Delta strain sits somewhere at 30-40% for AZ…

      The result is that twice as many people will be infected with Covid compared to if we had proper time spacing between our vaccine shots. This rush to 70-80% may have inadvertently compromised our ability to fight Covid.

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        HumbleCat on 26/08/2021 - 18:07

        This was the article I read,

        https://www.bbc.com/news/health-58257863

        And the study linked inside:

        https://www.ndm.ox.ac.uk/covid-19/covid-19-infection-survey/…

        The first shot efficiency is similar 35% vs 30%. Its just Pfizer needs that second shot for the max ~90% efficiency. Thats why the govt wants everyone to get the first shot at least. No point waiting weeks to get a slightly better vaccine if you need it right now when cases are surging. Its not like it will give you superpowers. Maybe, who knows

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          ATangk on 26/08/2021 - 18:19

          +1

          @HumbleCat: https://www.nejm.org/doi/full/10.1056/NEJMoa2108891

          If I am always at home during this lockdown, there should be little reason for me to reduce the efficacy of my protection against the delta variant from 88% to something below 50% for AZ given the current 'rushed' vaccine timings. This is what I would consider forward thinking for the future when they promise the lockdowns to end.

          If you were to take AZ, it would be best to space it out to the recommended timing between doses to get full efficacy (67%). However, that time being 12 weeks is really against our favour. And that is the reality of the situation for those taking AZ. Forever the '2nd rate' vaccine compared to Pfizer.

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        DavidFong on 27/08/2021 - 15:02

        @ATangk, interesting stats.

        Delta-specific information available from the weekly vaccine update from the University of Melbourne/RCH (https://medicine.unimelb.edu.au/school-structure/paediatrics…), 19th August 2021, slides 6 and 23

        It is to be noted that AZ is non-inferior to Pfizer in both preventing infection and serious illness, after both first and second doses.

        Some underlying data would be from the UK, which had 12-week separation in Pfizer doses. Some came from Canada, which I think had even longer separation (4 months). Personally, given the high level of effectiveness of the first dose, wide dose separation seems far more equitable to me.

        AZ effectiveness against any infection 60-67% (30-67% after single dose)
        Pfizer effectiveness against any infection 39-88% (36-57% after single dose)

        AZ effectiveness against hospitalization and death 92% (71-88% after single dose)
        Pfizer effectiveness against hospitalization and death 75-96% (78-94% after single dose)

        (some of the stats you quoted look familiar, and I think were not really comparing like-with-like e.g. some studies for Pfizer only tested patients for COVID if they were asymptomatic, whereas some AZ studies checked patients symptomatic or not. The UK and Canada have had the opportunity to compare Pfizer and AZ head-to-head)

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          ATangk on 27/08/2021 - 15:18

          @DavidFong: The numbers you are looking at are the spreads at 2 s.d., but does not specify the mean values, which is why I quoted them in the post 2 comments above. Having a larger spread which entails lower percentages does not mean its worse, this is how you can bend the narrative by showing only part of the facts.

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            DavidFong on 27/08/2021 - 16:25

            @ATangk: There is a reason why the University of Melbourne/RCH (and other) figures quote a 'spread' of uncertainty around the point estimate (which might be a 'confidence interval' with two standard deviations, but more on that later…). That is because it expresses the uncertainty of the original estimate! The considerable overlap between these spreads suggests there is no significant difference in effectiveness between the two vaccines in the outcomes of interest.

            By the way, there are several statistical assumptions you have made about the numbers quoted:

            1. The 'single-point' estimates you quoted is not the arithmetic mean in the exact middle of the quoted range (e.g. with two standard deviations on each side). It is likely the original statistic is from a ratio (odds-ratio or risk-ratio), and so the confidence interval will not be symmetric around the point estimate.

            2. The range of values might not be derived using frequentist statistics (which uses 'standard deviations'). Thanks to computing power, Unimelb/RCH may be using Bayesian statistics, which are actually more intuitively understandable ('range of likely values') than frequentist ('expression of uncertainty').

            3. UniMelb/RCH article doesn't actually explicitly say how they derive their range of likely values. Maybe they are using some other statistical technique I've never heard of. This is particularly since UniMelb/RCH seem to be compiling the results of several studies (a 'meta-analysis'), and I'm afraid I haven't done that statistics class.

            (If you look at one of the underlying studies in the UniMelb/RCH presentation, the Canadian study, AZ appears to be superior to Pfizer. But that could easily be 'luck of the draw')

            short summary - look at the spread of uncertainty. Variation in point estimates are easily misleading.

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              ATangk on 27/08/2021 - 17:04

              @DavidFong: If these absolute values are too complicated for one to interpret sufficiently, there are relative comparisons which are easy to see.

              This relative comparison is the difference between the rushed administration of AZ compared to the WHO recommended 8-12 week gap.

              Efficacy with different interval between doses in UK:
              12+ weeks: 82.4% (2.7-91.7)
              <6 weeks: 54.9% (32.7-69.7)

              Regardless of the efficacy of either AZ or Pfizer, it is clear that rushing AZ as we are here in Aus is giving much less protection than AZ is designed to do. Unless you want to look at that 2.7% number and then tell me nothing works anymore.

              • 

                DavidFong on 27/08/2021 - 19:14

                @ATangk: I agree, that, of the '4 to 8 week' range currently recommended in NSW to have an AZ vaccine, I'd opt for 8 weeks, especially since the first dose provides more than 50% of the two-dose protection.

                btw - the NEJM article quoted is using case:control statistics, so will mostly likely be using an odds-ratio. Thanks for providing the link. It should be noted that the NEJM's Pfizer statistics are also from the UK, which used a 12-week separation in Pfizer doses, not 3 weeks.

                Does a 12-week interval work better for Pfizer? I can't find any studies which investigate the question of clinical effectiveness (any illness, severe illness, hospitalization etc.), but only intermediate outcomes (antibody levels). Apparently 12-week intervals in Pfizer doses do result in higher antibody levels, but again, that is an intermediate outcome rather than a clinical outcome.

                The WHO also leans towards Pfizer being given at 12-week dose intervals ("Interim recommendations for use of the Pfizer–BioNTech COVID-19 vaccine, BNT162b2, under Emergency Use Listing", June 2021 https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccin…) on equity grounds.

                Politically, I suspect 12-week gap for Pfizer would be rather difficult to Australia if not enough people are sufficiently equity-minded.

                The NEJM article is also referenced in the 'aggregate' statistics presented by the University of Melbourne/RCH at https://medicine.unimelb.edu.au/school-structure/paediatrics… , it is worth a read.

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                  ATangk on 27/08/2021 - 19:39

                  @DavidFong: From what I have read, Pfizer efficacy doesnt get affected by time between dosages, due to the different methodologies via which these vaccines provide protection. That is why the dosage separation is a big issue with AZ, but not mentioned much with Pfizer.

                  12 weeks between dosages is used when supply is limited. Rather here, we want full immunisation as soon as possible, which is more in line with the manufacturer recommended 3-6 week separation.

                  That being said, I have recently known people to have 8 week separation between Pfizer doses, something applied to more recent bookings.

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                    DavidFong on 27/08/2021 - 21:52

                    @ATangk: Yes, it is good that Pfizer first-dose vaccine effectiveness does not appear to deteriorate significantly if increasing the dose interval to twelve weeks, and that effectiveness after the second-dose is thought to be non-inferior after a 12-week interval compared to a 3-week interval.

                    Individuals want full immunization (of themselves) as soon as possible. However society (and public health decisions) requires a different calculation.

                    Note that University of Melbourne/RCH summary reports suggest that more than 50% of the total effectiveness of the Pfizer vaccine occurs after the first dose. In that case, priority should be giving as much 'first-dose' coverage as possible, before giving the second dose to people at the same risk level. To quote the WHO "Interim recommendations for use of the Pfizer…", page 2, https://apps.who.int/iris/handle/10665/341786

                    "During an initial period of limited vaccine supply, prioritizing distribution of first doses of vaccine to as many highly vulnerable individuals as possible will avert more deaths than covering fewer such people with two doses - so long as the effectiveness of a single dose against COVID-19 mortality is at least half that of two doses and does not wane below this level before receipt of the second dose."

                    This is an application of equity microeconomics, even using a 'conservative' utilitarian social welfare function (let alone a 'progressive' Rawlsian social welfare function). Equity microeconomics are described by Gruber's 'Equity' lecture (MIT economics professor, the architect of 'RomneyCare' in Massachusetts, and some say the father of 'ObamaCare') in https://ocw.mit.edu/courses/economics/14-01sc-principles-of-… starting from about 7:25 (A few years later I was a student in a course he lectures, he said much the same thing).

                    In a simple thought experiment, if you had enough to vaccinate everyone in a given population once (effectiveness 50% each), or vaccinate half the population twice (effectiveness 95%), what is the most equitable distribution?

                    (Assume - weakly - enough doses to vaccinate everyone twice will be available later, after there is time, potentially to vaccinate individuals twice. Also assume there is an active 'threat' against which the vaccination will provide protection.)

                    A 'conservative' utilitarian social welfare function (which just sums up the utility of individuals) would favour vaccinating everyone once over vaccinating half of the people twice, even if utility is just the same as effectiveness (rather than a declining increase in utility with increasing effectiveness).

                    And that policy emphasizing equity was chosen not only by UK (12 week gap), Canada (4 month gap https://www.aamc.org/news-insights/canada-took-risk-delaying…) but also New Zealand (extended gap from 3 to 6 weeks, on 12th August, several days before the current outbreak https://www.health.govt.nz/news-media/media-releases/time-be… )

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                  greatlamp on 28/08/2021 - 09:28

                  @DavidFong:

                  the first dose provides more than 50% of the two-dose protection.

                  You can't interpret the stat like that, unless you are talking about the population as a whole.

                  The 1st dose protects against COVID (i.e. 100% protection) in 50% of people.

                  You aren't getting half the effect, half the people who receive it got no effect.

                  With that in mind, look at the the choice between a short gap and long gap between doses

                  With the long gap protocol, the % of your population without COVID protection remains high for a lot longer.

                  • 

                    DavidFong on 28/08/2021 - 11:34

                    @greatlamp: Thanks for your interest in this question, @Shacktool.

                    You are right, population statistics are not always immediately instructive about what an individual should decide in their own self-interest.

                    I know this is OzBargain, not OzEquity, but in this question of the distribution of a public good (vaccines), paid for by taxpayer funds, and provided for free as part of a public health program, then consideration of outcomes at a population level using population level statistics becomes more relevant.

                    Using as a thought experiment the information mentioned earlier from the University of Melbourne's Weekly Vaccine Report, 26th August, Slide 7 https://medicine.unimelb.edu.au/school-structure/paediatrics…

                    Pfizer effectiveness against any infection : 39-88% two doses, 36-57% single dose
                    Pfizer effectiveness against hospitalization and death : 75-96% two doses, 78-94% single dose

                    (not relevant to this example, but the AZ figures are against any infection 60-67% for 2 doses, 30-67% for 1 dose. against hospitalization and death 92% for 2 doses, 71-88% single dose)

                    For simplicity's sake, let's say the actual effectiveness in our example population of 1000 people is right in the middle of the estimated ranges. We'll take the outcome measure as 'any infection', but the example happens to be even more stark if we use the outcome of 'hospitalization/death'

                    (Pfizer) against any infection - 63.5% for two doses, 46.5% for one dose (single-dose effectiveness is 73% of the two-dose effectiveness)

                    In this example we have 1000 people and 1000 Pfizer vaccines. In eight weeks time, we will have another 1000 Pfizer vaccines. That is, there is a 'waiting time' for everyone to be vaccinated, because of supply or delivery constraints. Which happens to be the situation now, for Pfizer vaccine. And has been the situation in just about every country which has used Pfizer vaccine until 70% of the eligible population has been vaccinated. In the meantime, we have an active 'threat', everyone will be exposed to the virus in five weeks time, which is enough time for 500 people to be vaccinated twice, or everyone to have one vaccine. Assume that exposure levels are so high that everyone exposed will be infected if not for vaccination.

                    Plan 1 - vaccinate 500 people twice, 500 people are not vaccinated.
                    Outcome 1 - (500 * .365) = 182 of the vaccinated people are infected, (500 * 1) = 500 of the non-vaccinated people are infected. Total infected - 682

                    Plan 2 - vaccinate 1000 people once
                    Outcome 2 - (1000 * 0.535) = 535 of the 'single' vaccinated people are infected. Total infected - 535

                    The example becomes more pronounced if exposure was throughout the time period (so even the double-dose population is only 'part' protected for three weeks) and also more pronounced if using the effectiveness estimates of prevention of serious illneess and death (where a single dose of Pfizer vaccine is very effective, for many weeks after the first dose, compared to two-dose protection).

                    That is why organizations such as the WHO tend towards longer dosing periods (https://apps.who.int/iris/handle/10665/341786) and governments in the United Kingdom, Canada (https://www.aamc.org/news-insights/canada-took-risk-delaying…) and New Zealand (https://www.health.govt.nz/news-media/media-releases/time-be…) have all moved towards longer dosing periods for Pfizer.

                    This is based on a very conservative 'utilitarian' view of social welfare, and not on a progressive valuation of social welfare, such as Rawlsian.

  • 

    Ryk on 27/08/2021 - 09:51

    you can get the second for both in 4 weeks.

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      ATangk on 27/08/2021 - 12:30

      Did you read anything else that I said though? Receiving AZ in 4 weeks significantly reduces effectiveness of your vaccine. Pfizer has little to no effect on protection at 4 weeks.

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  mrvaluepack on 26/08/2021 - 18:16

  Have you ever administered or seen covid patients been given remdesivir?

  • 

    shatter on 26/08/2021 - 18:49

    +2

    Every day

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      mrvaluepack on 26/08/2021 - 19:10

      Ooo interesting, how about anti-parasitics like chloroquine and ivermectin? Are they being administered as well?

      • 

        shatter on 26/08/2021 - 20:17

        +3

        i have not prescribed those drugs, nor seen them prescribed

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          D Money on 26/08/2021 - 23:51

          @shatter: Do the patients receive pain management? I understand it can be very painful?

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  Herbse on 26/08/2021 - 18:29

  +1

  What are your thoughts on NSW easing restrictions in 2 weeks given the case numbers are predicted to be in multiples of thousands? What stress will this put on the hospitals?

  • 

    shatter on 26/08/2021 - 18:52

    +4

    Yeah…I'm usually supportive of what decisions the government makes, since they have all the numbers and epidemiologists and I'm not them. That said, with case numbers still climbing, I don't know if this projected plan is feasible, but at least the plan is two weeks in the future and there's plenty of time to cancel

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  ipiok on 26/08/2021 - 18:46

  +4

  I'm not anti-vax but I feel the media has really scared the shit out of everyone. Each day they could easily report the number of people who recovered from the virus…. and going off the official numbers here: https://www.arcgis.com/apps/dashboards/bda7594740fd402994234… you literally have a 98% chance of surviving.

  • 

    shatter on 26/08/2021 - 18:56

    +14

    You're quite right, the media has totally scared people off AZ. It's a real shame

  • 

    Pete10001 on 26/08/2021 - 19:09

    -2

    Interesting video about this. Covid Dr in the US speaking to an Australian MP. https://www.ourfreedomtube.com/watch/briantyson-save-lives-w…

  • 

    Mario1234 on 26/08/2021 - 19:31

    If it was a free for all 2% of Australia's population would be 507,200 deaths and 2% of the worlds population would be 153,480,000 deaths

    Seeing the numbers puts the 98% survival figure into perspective

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      [Deactivated] on 26/08/2021 - 22:31

      +2

      Also that 2% death rate quickly climbs when the health care system is overrun. We only have so many ICU beds. Once you hit that limit we have strategies in place to quickly have more available, but there's always that limit on staff. At some point you're trying to teach surgeons how to manage a patient on a ventilator from that 3 months experience they spent in ICU as a junior 20 years ago and you know your case fatality rate is about to explode.

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        serrin on 27/08/2021 - 08:42

        +1

        Also as people start dying because they can't get an ICU bed after their massive MI/stroke/MVA as COVID-19 pts start occupying those beds people start dying from other previously treatable conditions.

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        DavidFong on 28/08/2021 - 11:54

        Yes, and if ICU beds are depleted, the stress levels on both sick patients and family members (and hospital staff members) will be quite awful.

        Knowing a (somewhat useful) treatment is short distance away, but not actually available, makes for a very emotionally expensive death.

        Compared to the flu pandemic of 1918/1919, we also die very 'expensive' from a dollar and cents perspective.

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  Punda on 26/08/2021 - 18:47

  Have you heard of any adverse side effects to the vaccines?

  • 

    shatter on 26/08/2021 - 19:03

    Anecdotally from my own practice, or any of my colleagues, no

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    mincemeat on 27/08/2021 - 08:38

    Have you had the vaccine? If you are really worried about side effects go to the bigger vac centre, its like a mini hospital and you can stay there and be observed under the best care

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  Johhny 2 balls on 26/08/2021 - 19:44

  +1

  Being worried about receiving a vaccine makes me think these people never attended a party in thier 20's.
  Certain substances were ingested.
  Made by far less reputable people than who are making covid vaccines.
  If you survived that then you should be good to go.
  Oh and the idea that there is a good chance I would be unable to post this without the other vaccines and medical treatments I've received in my life, because I'd already be dead.

  • 

    trapper on 27/08/2021 - 11:08

    Certain substances were ingested.

    Injecting less common though ;)

  • 

    this is us on 27/08/2021 - 11:23

    We don't have to go back to the 20s. Some people (all ages) don't take the vaccine because they don't trust the manufacturers and the studies, but they buy drugs from multiple random unknown and untrustworthy drug dealers (not sure if there is such a thing as a trustworthy drug dealer, but I wanted to specify that the buyers don't know the dealers) without worrying much.

    But, yes, the problem is the vaccine.

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  bobkin on 26/08/2021 - 19:49

  +1

  What is your ‘decontamination’ technique at the end of the shift or when you get home? Are you having to do anything to keep family/housemates safe?

  • 

    shatter on 26/08/2021 - 20:30

    +8

    We basically all shower before going home. Some of my friends have gone the extra step and moved out of home to prevent them from coming in contact with their families

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      Indomietable on 27/08/2021 - 00:20

      Do they get any help (ie rent payments) if they choose to move out?

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  justgooddeals on 26/08/2021 - 20:04

  +2

  Thanks Doc.

  Thank you to all frontline workers, all the health professionals, nurses, Paramedics and doctors. Thank you, those medical workers behind the scenes doing research to find patterns of the disease that help eventually lead to cures.

  Your courage and devotion to your craft is outstanding and those of us who are not in your place will never fully comprehend the risk you face but with all sincerity praise you for who you are and what you are doing and will do.

  Thank you.

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  1000101BIN on 26/08/2021 - 20:11

  +3

  Thanks for your work and the AMA. I admire your ability to admit when you are unsure of things and leaving it to others. Too many people on the internet being experts of everything these days.

  Keep it up!

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  StonedWizard on 26/08/2021 - 20:24

  If AZ and Pfizer had the same availability and case numbers weren't an issue.

  Is there any reason to get AZ over Pfizer or even Moderna?

  You read/hear a lot about the negatives of AZ, but nobody talks about the positives.

  • 

    DavidFong on 27/08/2021 - 15:14

    Well, I didn't have an AZ vaccine, administer AZ vaccine to my parents, and administer AZ vaccine to hundreds of patients for fun, even if there was no 'current' COVID outbreak in Victoria. There is a presumed inevitability that COVID-19 virus variants will periodically sweep through the community. I presumed at the beginning of the year that there will be a Victoria 2020 sized outbreak somewhere in Australia in 2021, or worse.

    Both AZ and Pfizer have a small number of contra-indications (i.e. reasons not to give, or only give after serious consideration). Both of those sets of contra-indications are very rare. As in, out of hundreds of patients that I regularly see as patients, none of them have a contra-indication to AZ (well, other than pregnancy. Even that is not an absolute contra-indication, and AZ is being given to many pregnant women around the world). There is a small number of reasons not to have the Pfizer vaccine, and to use the AZ vaccine preferentially. These conditions should be enquired about prior to administration of the Pfizer vaccine.

  • 

    ozfool on 27/08/2021 - 16:58

    AZ actually seems to maintain it's efficacy longer than pfizer which drops a bit faster. After a year or two AZ might be substantially better.

    It's also a more 'normal' vaccine technology that you might trust more than the relatively new mRNA technology of the pfizer. The clot is a relatively well known feature of similar virus-particle-based vaccines, it's just a fluke of the immune system, the adverse events of pfizer are a bit more mysterious (albeit still rare).

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  mdavant on 26/08/2021 - 20:37

  -1

  How effective is a pfizer vaccine in elderly people in North Queensland with no medical contraindications to AstraZeneca in preventing ICU admissions in Western Sydney?

  • 

    shatter on 26/08/2021 - 21:32

    +2

    Well geographically speaking, probably no relation between North Queensland and Sydney provided you have no plans on coming over to the very locked down Western Sydney

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  jeeg on 26/08/2021 - 20:42

  +1

  With the covid issues in NSW and obviously the hospitals are swarmed, I am wondering if this will affect those (non-covid) patients who originally had surgery schedules lined up previously? Say someone who originally had heart surgery or something scheduled, will the current pandemic cause these patients to defer their surgeries?

  • 

    shatter on 26/08/2021 - 21:34

    +6

    Yeah many elective surgeries are being postponed, but from what I hear (aneecdotal, I'm not a surgeon or surgically inclined) the important elective surgeries continue to go ahead eg. hemicolectomies for people with colorectal cancer for which cure is possible now, but if we wait 3 months, then incurable

    • 

      turbochris on 27/08/2021 - 09:18

      -1

      Amazing that that could be considered elective surgery.

      • 

        zoob on 27/08/2021 - 09:35

        +3

        Elective in a medical sense just means it can be planned for a particular point in the future, whereas emergency means the patient has to be admitted right now and operated on ASAP. Elective procedures can be just as essential as emergency procedures, it's just the timeline that's different.

      • 

        wallet72 on 27/08/2021 - 12:18

        +2

        It really bugs me that the label 'elective' is used.
        From a medical point of view it means it can be scheduled and not an emergency.
        Politicians imply that elective means its a choice and not vital.

        No one ever chooses to have a knee replaced or a hysterectomy or a cancer removal for fun.

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  Mdjz76 on 26/08/2021 - 20:51

  +1

  Not sure I’d agree with this advice “ If you're in Sydney and eligible for Pfizer and AZ but have to wait 2 weeks for Pfizer, I wouldn't wait.”

  If you wait 2 weeks for Pfizer, you can be fully vaccinated in 5 weeks total. However If you have the AZ you’re in for a 12 week wait to be fully vaccinated?

  • 

    mdavant on 26/08/2021 - 21:23

    +2

    You can get az booster in 6 weeks.

    Will they have enough Pfizer to offer the booster at 3 weeks or will it be extended to 6 weeks as proposed weeks ago as an option?

    How much Pfizer will be available in 2 weeks? I bet not enough to meet demand.

    So today Gladys was saying

    Early to mid October for 70%

    I wonder if anyone else thought about this too?

    I doubt it.

    Effectively 7 weeks to get from 60% single vax to 70% fully vax.

    That means that the 10% MUST be Pfizer AND the first dose MUST be administered within the next couple of weeks AND the booster MUST be given at 3 weeks (considering another 2 weeks after that to actually be effective)

    Another con. If they can deliver it I will donate 500 to the state liberal party.

    • 

      ATangk on 26/08/2021 - 21:44

      +1

      When you book 1 dose, you also book the second dose at 3 weeks. If you cant book the second dose, they dont let you take the first dose's booking.

      • 

        mdavant on 26/08/2021 - 21:48

        There was a proposal to give Pfizer at 6 weeks.

        If they cannot get enough Pfizer in to vaccinate from 60-70 percent then the target looks extremely iffy. I just worry they won't have enough Pfizer to do that.

        Let's see

        I hope i am wrong.

        • 

          kkcool on 26/08/2021 - 23:57

          +1

          @mdavant: Yes, there are many groups I think are having their jabs extended to 6-8 weeks. I believe the Year 12s are having their jabs at 6-8 week apart.

          https://education.nsw.gov.au/covid-19/advice-for-families/hs…

          Those who are in high risk LGAs (those aged 16-39) are also needing to wait up to 8 weeks between jabs.

          https://www.nsw.gov.au/covid-19/health-and-wellbeing/covid-1…

          So in these cases, I guess they don't have to wait long initially for the first jab, as you almost get a booking straight away, but you do wait for your second dose.

          • 

            mdavant on 27/08/2021 - 05:16

            @kkcool: So it looks like supply catching up with demand.

            Makes early to mid October look difficult

            Edit:

            Looks like national cabinet could add from 12 up to the rollout today?

            That will make the target so much harder as they can ONLY have Pfizer.

    • 

      mincemeat on 27/08/2021 - 08:36

      She knows though that her 6 million target means they will be double dosed by her October projection

      • 

        mdavant on 27/08/2021 - 11:53

        +1

        I hope you are right, but I think it will take longer due to math.

  • 

    ATangk on 26/08/2021 - 21:45

    +2

    They're rushing the second dose of AZ, but as per my comment slightly above, this reduces the efficacy of your protection against Covid, especially the delta variant, to somewhere between 30-40%.

    i.e.
    if you were going to get COVID originally, youre only 30-40% likely to be protected against COVID. This is compared to an efficacy rate of 88% if taking the Pfizer vaccine. That is why people are holding out for Pfizer because it IS the better vaccine.

    • 

      rlf on 27/08/2021 - 01:49

      +2

      This is misinformation. UK reports state after 8 months the AZ dose has higher efficacy than Pfizer.

  • 

    shatter on 26/08/2021 - 21:58

    +2

    You're quite right, there is a timing interval difference. That interval reduces for AZ if in an affected area. I guess it is your own estimated risk based on where you live, but that said - if you don't know when you'll be receiving Pfizer's shot, or its not in the very very near future, (speaking for myself here living in Sydney) - would still take AZ. In clinical experience inside ICU - have not had a single fully vaccinated patient, the un-vaccinated outnumber patients with a single dose probably about 10:1 so having a shot now in my opinion, is better than no shot.

    Addit; looked at the stats today in NSW
    102 unvaccinated patients of the total 116 inside intensive care - so it's about 7:1 - un-vaccinated vs (1 dose or fully vaccinated)

  • 

    DavidFong on 27/08/2021 - 15:19

    +1

    The first dose of either AZ or Pfizer vaccine provides more than 50% of the protection (against delta-variant) of the full two-dose course.

    AZ effectiveness against any infection 60-67% (30-67% after single dose)
    Pfizer effectiveness against any infection 39-88% (36-57% after single dose)

    AZ effectiveness against hospitalization and death 92% (71-88% after single dose)
    Pfizer effectiveness against hospitalization and death 75-96% (78-94% after single dose)

    from https://medicine.unimelb.edu.au/school-structure/paediatrics… ("COVID-19 Weekly Vaccine Updates" by University of Melbourne/Royal Children's, 19th August 2021, slides 6 and 23)

    Given that >50% of the protection is with the first dose, in a really equitable society, no one would receive their second dose until everyone at the same risk level has had a chance to receive their first dose.

• 

  PhatChedda on 26/08/2021 - 20:56

  +2

  So I got the fizer vaccine and my floppy disk turned into a hard drive

  • 

    RSmith on 26/08/2021 - 21:43

    +3

    One more dose will convert into an SSD.

• 

  clairedelune on 26/08/2021 - 21:18

  +1

  Hello!

  Besides getting vaccinated and obeying the PHO, what can we do to help frontline staff such as yourself? (E.g. donations, pay it forward coffees, food deliveries etc.)?

  Thank you!

  • 

    shatter on 26/08/2021 - 22:02

    +3

    Not much! As long as you're doing the best you can within yourself and getting your friends and household to do the right thing, that 's it!

• 

  davyu on 26/08/2021 - 21:27

  Do you reckon the government (NSW and Federal etc) have been doing the right things in general? Granted we are all "learning as we go" and some bad calls are inevitable. Anything you think could be done better?

  • 

    mdavant on 26/08/2021 - 21:28

    +2

    Enforcing the mockdown would have been a good start!

    • 

      davyu on 26/08/2021 - 21:32

      Fair call. I mean, I can see why they've tried to let people make their own judgment because I don't think it's possible nor the best idea to define everything as black and white. Purely from a medical point of view for sure, but it is a valid point that it defeats the purpose if people end up dying from starvation instead or something. Kind of on the fence on this one.

      I guess the issue is how do you differentiate between people who have legitimate but unlisted reasons to go out vs ones who are simply defying because they can.

      • 

        mdavant on 26/08/2021 - 22:22

        +2

        Well for a start you could ask them.

        Almost zero compliance officers for the first 6 weeks and still none in a lot of places with cases

        • 

          davyu on 26/08/2021 - 22:44

          @mdavant: Maybe I'm a bit biased and perhaps lenient on this one because I too (in hindsight naively) banked on common sense and people just doing the right thing. So, yes in hindsight I agree.

  • 

    shatter on 26/08/2021 - 22:19

    +12

    I honestly don't know, as I'm not one of the states epidemiologists!
    My opinion here -
    I think 1) hindsight is perfect 2) it's very easy to say 'we could have vaccinated earlier' or 'we could have locked down earlier' or we 'could have brought the military in sooner to enforce the lockdown', but these would certainly have been fraught with challenges in themselves.
    Just as some examples-
    - where could we have received our vaccine supply from? noting AZ was plentiful but the community was unwilling to accept them at the time
    - locking down, whilst beneficial for health which is obviously important, has to be weighed against all the economic costs and human cost as well - how will a non-essential worker carry on with their financial situation on the support package? how will the government (which is us as a population btw) eventually pay for all of this?
    - I'll say this in particular about the police and military action - how sad is it that the police and military need to deployed to protect civilians from themselves and each other in a democratic nation? - that could not have been an easy decision either

    I can easily see how all the decisions made by the NSW state government have been difficult, and while one side may be better than the other and maybe we chose wrongly at one point or another, nobody has a crystal ball to always choose the better decision.

    TL;DR
    1) I don't know what we could have done better as I'm not a state epidemiologist
    2) I don't think we ought to get our pitchforks out as they can't predict the future perfectly
    3) I reckon it would have gone badly one way or another
    4) All we can really do now is do our best, work together to try to dig ourselves out of this hole

    Someone smarter than me who has the stats will come up with ideas, but that isn't me unfortunately

    • 

      davyu on 26/08/2021 - 22:47

      Thanks. Definitely not trying to flash pitchforks here. I do feel despite some hiccups they were generally in the right direction.

      There definitely was no winning for anyone no matter how they did it.

  • 

    this is us on 27/08/2021 - 12:32

    I hate the "right thing" terminology. They use this as if there was the right way to respond to the pandemic when there is so much we don't know yet.

    There are just different views and unknown long term consequences.

    What I think is wrong is screwing the vaccination rollout, but AZ has always been available. That's the big mistake Australia did because of the low numbers since the beginning. That's the federal government's huge mistake, including advertising, but we are finally on track.

    Apart from the obvious need to vaccinate as much as we can as soon as possible, everything else is subjective.

    If we believe in people's freedom and right to make their own decisions, we offer vaccine to everyone, recommend them to avoid risky behaviour, and that's it.

    We don't control people's use of condoms to avoid STDs, or the amount of alcohol that people can drink, or smoke, sugar, salt, fat… People have access to information and they make their own decisions. One Gonorrhoea or HIV positive person, aware or unaware of the status, could potentially have lots of unprotected sex and spread the bacteria / virus to other individuals. No one is checking if everyone is wearing condoms. Aware of the risks, most people wear condoms, but others still don't.

    Australia doesn't have a bill of rights but we assume this is a free country and people are responsible for their own actions.

    Of course, covid is also transmissible and affects people around us more than alcohol and sugar. However, there are consequences in terms of public health:

    "Approximately 5,500 deaths and 157,000 hospital admissions are attributed to alcohol consumption in Australia each year, and alcohol-related harm costs the economy more than $14 billion per annum."

    "Tobacco smoking is the leading cause of preventable diseases and death in Australia."

    "… research showing that smoking led to 20,000 preventable deaths and accounted for $136.9 billion in social costs in 2015-16."

    Why do we accept these numbers? Why don't we ban alcohol and tobacco? And sugar? Why do we spend money treating health issues caused by people's decision to drink and smoke? Why don't we make smoking cessation mandatory? Maybe, just maybe, hospitals would be empty after a few decades if people didn't have access to alcohol and tobacco?

    We might be able to eliminate most external/environmental risk factors but we choose not to, and that's fine, right?

    People know the risks and they make their own choices. We've always paid for that, and that's how society works.

    To be clear, I don't think we should ban anything. I believe people should be free to make their wise or stupid decisions, and face the consequences.

    For the fully vaccinated, having unvaccinated individuals around is probably not a big issue according to current research. Vaccinated people will be infected but are unlikely to develop significant symptoms or die. The unvaccinated are making their own choice.

    Some people can't be vaccinated due to medical reasons but they probably can't get the flu shot either. They are exposed to a bunch of viruses and bacterias and will have to be managed differently, as they have always been.

    • 

      davyu on 27/08/2021 - 12:46

      I think there are "right" things, some "not so sure if it's right or wrong but maybe we should do it just to be safe" things, and some "clearly not the best idea" things.

      I also don't think we should (have to) ban things at all. People should not be deterred from murdering people because of the penalties, but because it's "clearly not right". Unfortunately it still happens.

      The argument as I see has always been, yes you have a choice to live your life freely, but in doing so you are potentially (with a substantial probability if you're a believer) stripping me of my right to be alive. Legality aside: Don't wear a seatbelt? Your choice. Drive at 120km/h in a residential area? Not just your personal problem anymore. There's a clear difference between "I don't know if this is right or wrong" and "I don't care if a hundred people get covid from me and die".

      • 

        this is us on 27/08/2021 - 13:09

        +1

        I understand, but we can't be in lockdown forever "just to be safe" without considering all the consequences, including financial, mental health, physical health, etc.

        Setting the legal speed limit to 30 is safer than 60 or 100km/h, but we still accept the risks of driving at 70km/h or 100km/h on some streets or roads.

        If you are vaccinated, and at this stage everyone should have been, someone's choice to live freely is unlikely to affect your right to be alive.

        What I think should happen is: 31st October (max)… Everyone has access to vaccine, which protects from hospital admission and death. We are opening and lockdown won't happen anymore.

        Don't want to get vaccinated? You* are safer at home. It's your* choice.

        • 

          davyu on 27/08/2021 - 13:33

          @this is us: LOL I'm slightly confused whether we are "debating" or not. I feel we are largely agreeing in principle but just perhaps have different views when it comes to details and where to draw the line (which is to be expected)

          • 

            this is us on 27/08/2021 - 14:09

            +1

            @davyu: Yes, I think we are agreeing… 🙂

• 

  Veyron27 on 26/08/2021 - 21:32

  +1

  Thank you for doing this!

  What has been the most eye opening event from what you've experienced so far in the ICU?

  • 

    shatter on 26/08/2021 - 22:25

    +22

    So many young patients in the ICU with no medical history, who have young children. If dad ends up in the ICU, that leaves mum (who has been next to dad the whole time) scared she has COVID, scared to give it to the kids, yet somehow try to look after them.
    Oh man, some of the phone calls I make at work honestly break my heart, like when I have to ring a patient's husband or wife of the patient to tell them things are going badly, and that we might have to intubate, and no, that they can't come in to see them before we do it.

    I'm not one to cry, but I tear up writing this

• 

  irajohn90 on 26/08/2021 - 21:47

  Have you ever come across Remestemcel-L and has it been trialed here in Australian hospitals?

  • 

    shatter on 26/08/2021 - 22:26

    I have not, but that said, I'm pretty junior so the sample size here should not be representative of the whole

• 

  Haha Hihi Hoho on 26/08/2021 - 21:58

  +2

  thanks for your service ! do you know how ex premmie kids react to Covid? My daughter was a 26 weeker with chronic lung she is 5 now with low stamina and got tired very easily. i keep on hearing that kids seems to be doing better than adults in general, but it may not apply to ex premmie kids?

  • 

    shatter on 26/08/2021 - 22:27

    I don't know, unfortunately I cannot help with this - I have only looked after adults. That said I share your concern, and it would not be unreasonable to ask your GP to look into this for you

• 

  da1andonly on 26/08/2021 - 21:58

  What is your opinion on Dr. Robert Malone's view on the vaccine? For the people that don't know who Dr. Robert Malone is; he's one of the original creators of this MRNA technology you see in these vaccines.

  • 

    idonotknowwhy on 26/08/2021 - 23:02

    +1

    C'mon man he's advocating any vaccine you can get asap, as he sees what's happening in the ICU every day.

    • 

      da1andonly on 26/08/2021 - 23:22

      +1

      No he's not, he's saying you can't vaccinate your way out of a pandemic and only vaccinate the most vulnerable people.
      https://youtu.be/4jAZuNwopIM

      • 

        idonotknowwhy on 27/08/2021 - 12:28

        By "he", I was referring to OP, not Dr Robert "Novax4U" Malone

  • 

    DingoBilly on 27/08/2021 - 06:23

    +4

    The usual seems to apply for antivaxxer "experts" like Robert Malone.

    That is, the overall evidence is that they are wrong and it's an important message that you should always think about your sources and not rely on a single source.

    Also, any time someone starts bringing up a person's credentials as evidence my critical thinking alarm bells go off. It usually means their evidence/facts will be weak or wrong if they need to bring up who they are to justify their point. Evidence should stand for itself.

    • 

      da1andonly on 27/08/2021 - 10:18

      Ummm… He's not an antivaxer

    • 

      bobkin on 27/08/2021 - 11:32

      Fellow SGU listener?

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