By Lambert Strether of Corrente.
Patient readers, after reading this post, you may well decide to throw a flag on a Betteridge’s Law violation, but hear me out. Clearly, one goes to a hospital to be tested, or to be treated and hopefully cured; Caveat Patiens should not be part of the deal. However, for nosocomial infection (also known as Hospital-Acquired Infection, HAI, which at CDC stands for Hospital-Associated infection, neatly removing agency) Caveat Patiens does seem to be part of the deal, at least in the United States, which I find more than a little troubling.
In this post I’ll take a quick look at HAI generally, and then HAI in relation to Covid. Both are troubling. I had hoped to go further, and lay hold of the institutional factors behind our health care system’s failures to recognize aerosol transmission and support universal masking, but — sadly, like the New Yorker writer who entered the swamp on the trail of a thought-to-be-extinct bird, and never found the bird — I’m reduced to mere speculation, and I did try. (That I can’t hold anybody in accountable for demonstrable failure is in itself an interesting data point; perhaps some kind readers will help out with pointers in links, or throw some hospital administrator’s PowerPoint over the transom. Your anonymity is guaranteed. But perhaps all the real decisions are taken out on golf courses, where private equity goons chat among themselves!)
The newest HAI scare — Cordyceps fans, take note — is a fungus. And it is scary. From NBC:
A drug-resistant and potentially deadly fungus has been spreading rapidly through U.S. health care facilities, a new government study finds.
The fungus, a type of yeast called Candida auris, or C. auris, can cause severe illness in people with weakened immune systems. The number of people diagnosed with infections — as well as the number of those who were found through screening to be carrying C. auris — has been rising at an alarming rate since it was first reported in the U.S., researchers from the Centers for Disease Control and Prevention reported Monday.
The absolute numbers, however, are small compared to Covid, which would lead a certain type of mind to conclude that, even though C. auris is nasty, the CDC is trying to change the subject:
Since November, at least 12 people have been infected with C. auris with four “potentially associated deaths,” [MIssissippi’s] epidemiologist Dr. Paul Byers, said in an email. “By its nature it has an extreme ability to survive on surfaces,” he said. “It can colonize walls, cables, bedding, chairs. We clean everything with bleach and UV light.”
The same sort of mind would conclude that CDC is very happy to get back to fomite transmission. More:
It’s important to stop the pathogen so it doesn’t spread beyond hospitals and long-term facilities like the drug-resistant bacteria MRSA did, Snyder said.
So MRSA and CDC have form on HAI. And it’s not good. In fact, things aren’t good with HAI generally. CDC:
Although significant progress has been made in preventing some healthcare-associated infection types, there is much more work to be done. On any given day, about one in 31 hospital patients has at least one healthcare-associated infection…. There were an estimated 687,000 HAIs in U.S. acute care hospitals in 2015. About 72,000 hospital patients with HAIs died during their hospitalizations.
Granted, 72,000 deaths a year isn’t all that big a number — Joe Biden really hit the death ball out of the park at 700,000 and counting — but it’s still a lot. WaPo blames budgets:
The health system faces financial challenges and severe staffing shortages that make infection control more difficult, said Akin Demehin, senior director of policy at the American Hospital Association. “That is why we continue to advocate for needed financial support to hospitals, and for supportive workforce resources and policies across all levels of government,” Demehin said in a statement.
Hospital accreditation organizations and federal regulators require infection-prevention specialists at acute-care hospitals, experts say, but do not set standards for staffing or funding. And the rules are looser in other health-care settings
Frankly, I find AHA crying poor just a wee bit unpersuasive. Stoller writes:
The amount of cash pouring into health care is quite high. In the U.S., we spend about 20% of our GDP on health care, which is between two to three times as much as other countries. But we get worse results. Why? The answer is monopolization and cheating. As one article in 2003 noted, “It’s the Prices, Stupid.” In terms of hospital beds, physicians, and nurses, we provide fewer than most rich countries for our citizens. We pay more, and get less, because of insider skimming.
Naturally, some of the deaths in that 72,000 aggregate are from Covid. From the International Journal of Environmental Research and Public Health:
According to several reports, the SARS-CoV-2 hospital-acquired infection rate is 12–15%. Hospital-acquired COVID-19 represents a serious public health issue, which is a problem that could create reluctance of patients to seek hospital treatment for fear of becoming infected.
(No kidding.) Granted, these figures are from 2021, with different variants and higher transmission, but just to keep on Mr. Spike’s bright side, we’re not tracking anything any more, and we’re relaxing non-pharmaceutical interventions like masking, as we are about to see. So maybe it all evens out!
So our health care system’s performance on HAI is bad, and it’s performance on Covid HAI is also bad. Now let’s turn the specifics of Covid HAI with respect to masking, also bad. Readers of my long-ago ObamaCare coverage may recall a metaphor I often used: “In any system as baroque and Kafaesque as ObamaCare, some citizens will get lucky, and go to HappyVille; others, unlucky, will go to Pain City.” Well, our healthcare system has gone all baroque and Kafaesque on masking in hospitals, too, so whether you are more or less likely to catch Covid as an HAI — less politely, whether your hospital is a death trap — is random.
If we roll the tape back to 2020, we’ll find stories like this: “Frontline healthcare workers are locked in a heated dispute with many infection control specialists and hospital administrators over how the novel coronavirus is spread – and therefore, what level of protective gear is appropriate“:
The topic has been deeply divisive within hospitals, largely because the question of whether an illness spreads by droplets or aerosols drives two conflicting sets of protective practices, touching on everything from airflow within hospital wards to patient isolation to choices of protective gear. Enhanced protections would be expensive and disruptive to a number of industries, but particularly to hospitals, which have fought to keep lower-level “droplet” protections in place.
The hospital administrators and epidemiologists who argue that the virus is mostly droplet-spread cite studies showing it is not as contagious as an illness like the measles and spreads to a small number of people, like a cold or a flu. Therefore, N95 respirators and strict patient isolation practices aren’t necessary for routine care of Covid-19 patients, those officials say. On the other side are occupational safety experts, aerosol scientists, frontline healthcare workers and their unions, who are quick to note that the novel coronavirus is far deadlier than the flu – and argue that the science suggests that high-quality, and costlier, N95 respirators should be required for routine Covid-19 patient care.
Fast forward to 2023. The CDC lifted the federal mandate requiring masks in health care facilities in September 2022. (For the fantastically destructive role the CDC has played in hospital infection control during Covid, see NC here.) This is what happened in the state of New York:
This month, New York became the latest to join the growing list of states that have ended their requirements for routine masking in hospitals and other healthcare settings.
In response, at least one of the state’s largest hospital systems is throwing off the mask despite the continued high level of virus transmission in New York City and most of the rest of the state. NYU’s Langone hospital system decided that — outside of the Emergency Room — patients would generally only be required to mask “if they have fever and cough” (query what percentage of individuals with recent COVID-19 infections did not have this specific combo of symptoms — spoiler: it’s probably high). Similarly, the hospital announced that masking by direct care staff was optional in most situations, with masks required mainly during certain procedures, in particular patient rooms, or — more cryptically — when “there is concern for exposure to infectious aerosols.”
Indeed, even as New York dropped its mask mandate, the state’s Department of Health advised hospitals and other healthcare settings to continue to require masks at this time, and major institutions such as New York City’s public hospital system and Memorial Sloan Kettering announced they would keep masking in place.
So, New York has gone fractal; baroque and Kafka-esque. Ditto Illinois:
Dr. Robert Citronberg, executive medical director of infectious disease and prevention at Advocate Health Care said that the mask-optional policy applies to both visitors and staff members.
Citronberg also said during a press conference this morning that the liberalizing of policies is not in place at Aurora Health Care, the larger system’s facilities in Wisconsin. He said that they use the same metrics as Illinois’ Advocate, but that state-level community transmission is not as low in Wisconsin.
He said that despite other local health systems maintaining more restrictive policies, he does not think the move is premature.
Ditto the state of Washington:
Patients, staffers and visitors will continue to be required to mask up inside many health care clinics and facilities throughout the Puget Sound region, a group of Washington hospital and public health leaders decided Friday.
About 20 public health departments and health care systems around the region made the announcement a couple weeks before the state’s remaining indoor masking requirements are set to come to an end on April 3. Most of the Department of Health’s masking mandates have expired, except those in health care or correctional facilities.
“Many,” but not all. I have not been able to find national data on mask usage in hospitals in the United States. I do see a lot of anecdotes, the first being more representative on my extremely unrepresentative Twitter timeline:
The hospital where I work in OR is ditching masks on Apr 3. Should make for any interesting late Apr/May…WA however is doing the right thing. Seattle & King Co hospitals all still masking.
— AndyAF🎧🔮 (@CactusAndy) March 25, 2023
But the second:
Husband had surgery in Nov '22 at MUSC in SC….. They have no mask mandate. It was glorious to be able to see most people's faces from nurses to doctors, to everyone !
— JustWee (@Tinybutfierce1) March 27, 2023
Back to the “heated dispute” in 2020. You will recall that both administrators and hospital infection control epidemiologists were united in favor of droplet dogma and against aerosol transmission (hence against masking). By 2023, the administrators and epidemiologists are split, with the epidemiologists following the science. (There’s plenty of evidence that masking substantially reduces aerosol-borne HAI, including Covid; see here, here, and here). From Infection Control & Hospital Epidemiology, “Hospital approaches to universal masking after public health ‘unmasking’ guidance“:
We surveyed healthcare epidemiologists in the United States following release of the updated CDC healthcare COVID-19 guidance to understand their facilities’ planned approach to universal masking and unmasking outside of patient care areas. The survey also explored the rationale for maintaining universal masking.
Among 44 healthcare epidemiologists invited to participate, the 34 respondents (response rate, 77.3%) represented health systems from diverse US regions. Most worked for health systems with multiple acute-care hospitals (n = 26, 76.5%) or facilities with ≥500 beds (n = 6, 17.6%).
Overall, 33 respondents (97.1%) reported that their facility has no immediate plans to discontinue universal masking, and 1 respondent (2.9%) reported their facility had discontinued, or planned to discontinue, universal masking if or when community transmission levels of COVID-19 were not high. No respondents reported that their facility had discontinued or would discontinue universal masking regardless of community transmission levels. Preventing non– SARS-CoV-2 seasonal respiratory viruses (90.9% of respondents) and impact on employee staffing capacity (72.7% of respondents) were the most cited reasons for continuing universal masking regardless of county-specific SARS-CoV-2 transmission levels (Table 1). The “other” reasons described by 7 facilities include several themes: standardizing approach across facilities; the operational challenges of variable or changing masking policies between facilities, within a facility, or as community transmission levels change; and the presence of high-risk individuals (Supplementary Materials online). Also, 7 respondents specifically cited inaccessibility to patients (or visitors) as defining locations where unmasking is permitted in patient care areas.
And from an epidemiologists’ trade association, the Association for Professionals in Infection Control and Epidemiology:
The Association for Professionals in Infection Control and Epidemiology (APIC) is concerned that a recent report questioning the value of masks to prevent COVID-19 could weaken the ability to mitigate future outbreaks of respiratory infectious diseases.
“The benefits of masking have been shown in healthcare and can be critical in preventing the spread of infection – but this depends on proper and consistent use,” said 2023 APIC President Patricia Jackson, RN, BSN, CIC, FAPIC. “The use of respiratory protection – including well-fitting N95s and surgical masks — is a critical public health tool in our arsenal to protect the public and healthcare workers when severe respiratory infections are spreading. APIC will continue to advocate for the value of masks and respirators in reducing transmission of respiratory infections.”
And Jackson specficiallly trashes, as she ought to have done, the “fool’s gold” Cochrane study:
“Despite Cochrane’s reputation for producing credible health reviews, the many factors and details that go into successfully using masks and respirators as a public health intervention weren’t all reflected in this review,” said Jackson.
This makes me happy. I take back everything bad I ever sad about hospital infection control departments; as it turns out, the vile and hegemonic Dr. John M. Conly — corresponding author of the Cochrane study — was an inappropriate proxy or synecdoche for the field.
To conclude, or at least to end, for patients the key point is that masking requirements will vary not merely by state but by hospital. If you are lucky, good health in Happyville. Unlucky, a death trap in Pain City. Such is our health system, the finest in the world!
That said, I am not clear at all where the health care system, taken as a whole, stands on masking in hospitals, or how much masking is still taking place. It is clear that at the Federal level, CDC — cognitively captured, no doubt, by anti-mask elites — would like to do away with masking entirely. It is also clear that many states, though not all, are following CDC’s lead. No doubt our complaisant, superspreading press — who are building the depressing anti-mask narrative I read, after all — follows CDC as well (see under Gridiron club). However, mask policy is ultimately a hospital’s decision. The survey I quoted reported that 97.1% of hospital epidemiologists surveyed[1] reported that their hospital had retained universal masking, so the machinations of the CDC and the states were for nought. If this is true, that means that hospital administrators listened to their epidemiologists[2]. And presumably the hospital owners or boards listened to the administrators. But I’m not sure whether to believe that study or not, not least because at this point I’m very suspicious of good news. And the Twitter say that things are a lot worse than that survey says.
All I can do is throw the matter open to readers. Readers, are hospitals requiring universal masking in your area? If so, what kind of masks?
NOTES
[1] The methodology: “From participants in an informal e-mail–based list serve, we invited one representative from each US-based, nonfederal, acute-care hospital or health system.” “Informal” seems a little weak.
[2] And their lawyers? From Harvard Law: “Science, law, and the principle of “do not harm” all concur about the path to keeping patients safe from disease and hospitals safe from liability: at a minimum, continue requiring masks amid the ongoing COVID-19 pandemic. Otherwise, hospitals are proceeding at their own risk — and that of their patients.”
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Youngest had an outpatient tonsillectomy at the local Tier 1 trauma center last week.
Our pediatricians had HEPA air cleaners in every room of their practice (waiting room, exam room, nurses’ station, etc).
At the hospital/trauma center (masking required), the pre-op area, post-op area, waiting rooms all had no air filter machines—or the hospital is using the world’s most powerful cubic-feet-per minute, yet silent, HEPA/Covid-busting central ventilation system.
Guess I’ll give the hospital the benefit of the doubt.?.?
Read recently that hospitals have HVAC systems that are designed to cycle each room 10x per hour with outside air . That said, big fan of open windows for patient rooms.
Why is going to the hospital is looking more like a DnD dungeon crawl than not?
Use 2D6, roll 12, Die of COVID, roll 10 or higher, Die of MRSA, roll 8 or more get… use D100, get snake eyes, thrice in a row, escape with your Life and Soul, Debt Free from the Demon of Billing.
Just saying.
the hospital I go to the most has universal masking, but everybody uses procedure mask
My rural area has two hospitals. The smaller, lesser-regarded hospital is part of a small system and is still requiring masking, half-heartedly, with only the cheapest surgical masks they can find. The slightly larger, slightly better regarded but also for-profit hospital unofficially stopped masking c. spring 2022. Not sure whether it’s officially required still, but not enforced or really required.
I’m not convinced that any mask below the P100 level provides meaningful protection. And the real answer in hospitals would seem to be properly filtered ventilation, not masking with “for appearance” surgical masks. And maybe also separating the highly vulnerable populations from the rest.
> And maybe also separating the highly vulnerable populations from the rest.
Since #CovidIsAirborne, it travels everywhere, including waiting rooms, examination rooms, hallways, etc. Further, as we see from Osterholm (if you accept his elevator theory) even a fleeting contact is enough (and there are other similar cases in Australia). And of course the spread is asymptomatic, so it’s not like masking up around coughing people is enough. Hence, it’s really not possible to “separate the highly vulnerable.” The solution has to be facility-wide.
Florence Nightingale insisted on outside air through windows:
I speculate that the paradigm for modern hospital infection control is very much the opposite of Nightingale: The hospital is not thought of as open to the outside, but as an arrangement of closed spaces with varying degrees of protection. Surgical theatres are highly protected; aerosols come only from aerosol-generating procedures, not from breathing or talking. Special wards are also protected. Normal rooms are less protected, hallways and offices less so, and so on. The concept is to separate out the space in which measures must be taken, and not to think of air circulating through the entire facility.
Corrections from readers welcome on this!
Always worth mentioning, I think, that Florence Nightingale regarded the idea of contagion as absurd. She was miasma all the way.
The treatment of miasma theory as superstitious and superceded by the germ theory was never valid in the realm of praxis, and as was observed from the very beginning (because who hasn’t seen smoke or mist?) miasma theory is not incompatible with the germ theory of disease, but rather is informed by germ theory – now we have a much better handle on what a ‘miasma’ is.
You can see a read only version of ASHRAE Standard 170 Ventilation of Health Care Facilities, at ASHRAE.org.
Technical resources tab on the top, then Free Resources on the right, then scroll down to Preview ASHRAE Standards.
That would be Free Resources on the left.
Am back in the ER with my mom, who caught covid in this same hospital two weeks ago. Everyone on staff was wearing masks, but…off the nose, dangling off the ears, etc…and no enforcement with visitors.
As she was checking out they told her her roommate had tested positive, and to take a home test when she got home. She is 82. And here we are again…
I hope your mom is okay. And that you don’t catch it.
Ask a commercial insurance broker and / or underwriter the class of business where they see the most mold and legionella claims – and why that is.
To be more realistic, you should classify the bills from a hospital as some form of stressor/killer too.
The CDC and others won’t list that 72K deaths per year in their top factors (see below). HAIs would rank as #9. I’m sure if someone dies of an HAI when the patient has, say, heart disease, then heart disease becomes the cause of death.
https://www.cdc.gov/nchs/fastats/deaths.htm
Number of deaths for leading causes of death:
Heart disease: 695,547
Cancer: 605,213
COVID-19: 416,893
Accidents (unintentional injuries): 224,935
Stroke (cerebrovascular diseases): 162,890
Chronic lower respiratory diseases: 142,342
Alzheimer’s disease: 119,399
Diabetes: 103,294
Chronic liver disease and cirrhosis: 56,585
Just finished C.J. Hopkins latest collection of essays, where he wrote that the CDC counted every patient that tested positive for Covid at the time of death, regardless of whether or not it was the cause, as a Covid-19 death. If this is true can we believe the numbers (416,893)?
Perhaps slightly off topic,- but adjacent.
It is ironic to have maintained strict precautions to avoid Covid for 3 years only to get hit by a truck, but yeah. A Frontover.
Slow moving, huge truck, maybe an F150. Driver, 5’6”, did not see my wife, also 5’6”. Going so slow we thought he was waiting for us to cross. Turned our backs to him and …
Then she’s on the ground screaming, wheel has her leg pinned, about to drive over it. I’m throwing myself at the windshield yelling for him to back up. Fortunately he did. Thought he’d hit a patch of snow.
Nothing broken. Able to limp away. Bumped head with no loss of consciousness. He drove us home.
We did not go to the emergency room, did not call 911.
Head to toe assessment. Hematoma City. Leg black and blue all the way down. Pulses in feet positive.
Neuro checks ok. Used Yunnan Baiyao, a homeostatic each Viet Cong soldier carried around their neck in case they were shot. (Should be in every medicine cabinet IMO.) A bit of Cabernet, ( recommended in the instructions.) Added bromelain (pineapple enzyme) the next day. (A specific Anti-inflammatory effect if taken on an empty stomach. Of course there have been no big RCT studies on anything we did. Just a couple thousand years of in vivo study.) Also Ibuprofen. Saw the acupuncturist/ herbalist the next day and weekly thereafter.
Weeks of checking edema (swelling) levels, measuring circumference of each leg for comparison. Checking pulses.
She taught her T’ai Chi classes. Missed none. 40 yrs practice, boxing, sword, etc. Keeping the nose and navel aligned kept vertigo at bay. (Since resolved.)
We did not go to the emergency room, did not call 911. Tales from colleagues and friends who’d recently been to the emergency room of the hospital where I used to work ruled that out with minimal discussion.
Risk of Nosocomial Covid infection was a factor as well as just the shambles the place seemed to have become.
In three days it will be three months since the accident. It looks like she will make a “full recovery.”
Thank God. It could have been so much worse.
Frontovers are a thing.
https://www.consumerreports.org/cars/car-safety/stop-frontovers-act-eliminate-dangerous-front-blind-zones-a1009105623/
Whew, glad you’re both OK! Those gigantic trucks really are a menace. Unfortunately, menacing is how a lot of us ‘mericans prefer to roll these days.
This may well have been linked on NC already, but even if so, I think it bears repeating:
https://www.businessinsider.com/trucks-are-getting-taller-heavier-and-more-dangerous-for-pedestrians-2023-3?op=1
Key quotes:
“an M1 Abrams battle tank had a better sightline than some everyday trucks.”
“pedestrians are getting killed by vehicles at the highest rate in 40 years, growing from 4,109 deaths in 2009 to 7,485 in 2021.”
I am glad that your wife is ok. I understand your hospital avoidance, see my note further down about personal experiences with HAI. With regard to big vehicles…There is no doubt that vehicles are becoming bigger and more dangerous to pedestrians. I was out running with a friend many moons ago, there weren’t as many big SUVs in those days but there were some. We were crossing a busy school driveway, a driver in an Escalade was waiting to pull out. I made the mistake of assuming the driver had seen us and started to cross in front of the vehicle from the passenger side. There was still oncoming traffic so she couldn’t pull out. But as we started to cross, me first, she slowly (thankfully) pulled forward (perhaps to see better) and just barely bumped me, knocking me on my keester. Now I was in front of her, on the ground, out of her site as she continued to ease forward because she had not even felt the bump of hitting me. As I was desperately crab walking backwards trying to get out of her way, my friend was pounding on her front hood from beside her and yelling stop. She finally sensed something and hit her brakes. I was fine, a tad bruised. She was highly apologetic and contrite, especially after I took some of the blame for not being attentive enough. Lo these many years later I still wait to make full eye contact with a driver before I cross in front of a stopped vehicle. Two things have always stayed with me. The size of that vehicle and the fact that she was so insulated she didn’t feel anything when she bumped into me.
I am currently shopping for a new vehicle and I thought I might like a small SUV (to accommodate my gardening hobby, easier to transport plant and other purchases). Even the ones the car industry calls compact seem huge to me. I have switched focus and am now looking at hatchback cars.
In my region (TN and NC), despite required masking in hospitals, cheap, poorly fitted surgical masks (or worse) were mostly used. To make matters worse, many staff and visitors wore their masks loosely, with nose partly or fully exposed. So now, the pretense is largely ending.
While I support and wear well fitted masks for my own benefit, I sadly doubt if abandoning mask requirements will make much difference in overall disease rates.
But we probably won’t be sure, due to decreasing rates of testing and vaccinations.
Once a month, I drive 10 miles to collect wild spring water from the bush.
When I get sick, I stop eating, for days, weeks……. (water fasting)
If worried about fungus infections, do not eat the starches and sugars that the fungi thrive on. (duh)
If worried about airborn disease, avoid places like airplanes…
If not trusting big pharma, do not fall for, any of their “cures”.
Avoid hospitals, doctors, drug stores, “like the plague”.
Take responsibility for your own health and wellbeing. It is too precious to be given away to all and sundry, who will only traipse about, and then send you a hugeeee bill. (the latest Wunderwaffe miracle cure (innovation!)). …. lucky you….
>>>Avoid hospitals, doctors, drug stores, “like the plague”.
I am not sure why it took so long, but I just realized that until just over a century ago, that was good advice until medicine improved enough; today, everyday hospital conditions have deteriorated enough to where this is prudent advice again.
Nice to see that “trust the science” and “free markets” is rolling hospital safety to pre 1900 conditions.
In Montreal surgical masks still required in hospitals. Most worn correctly.
The same for Montevideo
The same for New Brunswick, Canada.
Local hospital (big, fancy one) in King County, WA, cited above as one of the bright spots, still requires masks for everybody even after lifting of the statewide mandate. But they require hospital-supplied masks, i.e. baggy blues. I haven’t needed to go there recently so I’m not sure how they react to people with N95 or N100s. I hope I don’t need to.
If you wear their hospital-supplied mask over your own N95 or N100, will they be satisfied with your show of obedience to their orders? Or do they demand you remove your N95 or N100 mask to show compliance with their desire to infect you?
On the bright-er-ish side, this analysis makes the gun violence situation not seem quite as alarming; at least by comparison.
The thought also occurs that perhaps in a twisted way our elites are nudging the general population in the direction of lifestyle adjustments that reduce the need for medical care. This thought is offered only partly tongue-in-cheek. The lifetime $$$,$$$ value of not requiring US medical care is so high that it might be a good career move for the young to specialize in avoiding the things that predispose the US population to many of its comorbidities.
Speaking of this: “Frontline healthcare workers are locked in a heated dispute with many infection control specialists and hospital administrators over how the novel coronavirus is spread – and therefore, what level of protective gear is appropriate“:
The exact same thing happened with SARS. Great video of what happened here.
Husband and i together and separately have been to been to NYC’s Cornell-Weill, Mt. Sinai, and Hospital for Special Surgery several times in the past few weeks, including this week. Masking and distancing are in effect and enforced. Same in testing facilities and doctors’ offices. Reassuring!
Not unrelated. I talked to a retired colleague last week, a physician. I told him I had stopped with two shots (Pfizer). The primary reason was that I was immunosuppressed leading into 2022 and for most of last year and just didn’t want to complicate things. But he asked me if my reluctance was because of the Great Orange One. No, I told him. The vaccines prevent neither transmission nor infection, so they do not work. Especially on current variants. Anyway, Donald Trump lives rent free in the heads of the PMC, and that provides meaning in their lives.
KLG, read the comment above yours. Good insight as to why people still believe what they do. It makes them feel better. Regardless of effectiveness.
Lambert, you may want to look at Joint Commission https://www.jointcommission.org.
https://www.jointcommission.org/resources/patient-safety-topics/infection-prevention-and-control/hospital-infection-prevention-and-control
They have data specifically on nosocomial infections in the facilities they accredit. https://www.jointcommission.org/resources/patient-safety-topics/infection-prevention-and-control/hospital-infection-prevention-and-control
> Joint Commission
Oooh, a standards body! Thank you very much!
JCAHO is the body the facilities jump for.
(Once sanctioned, the facility cycles in a conscientious manager and the number of bedsores goes down. JCAHO clears facility, cycle in do-nothing alcoholic and the bonuses go back up. JCAHO sanctions…)
LA county will continue to require masking inside healthcare facilities through September 2023. Our facility provides free throw-away surgical masks at most entrances. Anecdotally, many, but not all, physicians wear N95s (including my PCP), but most healthcare staff wear surgical masks. We get the daily Covid dashboard for the entire institution, including the medical center and its satellites, and there are continual cases throughout. I’ve never been able to access a statistic for HAI, for Covid, however.
Starting this Thursday, the County PHD will stop its daily Covid case reports and only provide weekly updates. As everyone probably knows, Johns Hopkins just dismantled its Covid website. A stated key reason is lack of data. Corrupt, dysfunctional government institutions?
Separately, interesting article from Lancet examines factors affecting interstate differences (in the U.S.) in standardized cumulative death rates.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00461-0/fulltext
> that provides meaning in their lives
Apparently, Man’s Search for Meaning is reduced to the friend-or-foe distinction. This is not a well society.
More concerning would be if hospitals were still using remdesiver as a treatment protocol, indicating intransigence to updating protocols with current knowledge .
I remember a conservation with my wife surgeon one time when she was admitted to the hospital for a fractured hip. He said he wanted to get her home as soon as possible because hospitals aren’t the safest place to be. He was referring to acquiring an infection in the wound while in the hospital. That was several years ago when people weren’t looking for an excuse to sue.
This is not just about COVID. Hospital acquired infection has been a problem for a very long time. My mother-in-law had COPD. She was quite frail and ill the last couple of years of her life, she died in 2016. Her doctor was always very slow to decide to hospitalize her because of worries about HAI, not to mention how difficult it is for anyone over 80 to regain strength and abilities after being bed ridden for even a short time. We used to joke that the hospital was no place for a sick person. My father and a friend’s mother-in-law both acquired c. difficile infections while in hospital. My Dad died in 2016, my friend’s MIL in 2017. Sadly my friend’s MIL could not have one her last wishes honoured because of the infection. She wanted to leave her body to the nearby medical school but they will not take bodies infected with c. diff.
Adjacencies and consequences…
Daughter had a 13 hour wait in an ER for her baby. Longer exposure times increase transmission. But Covid is subsequent to staffing shortages, seen in Federal suppression thru $10k/day fines in mentioning the problem.
We view medical facilities as vectors. My first medical procedure in over a decade was postponed when the doctor landed in the hospital for *undisclosed* and won’t be back for months. No slack in the system.
Beware of those who jack with stable meds. Our local Arkham Sandman liked doing that with psych meds and tallied a body count. Janet’s NP refused a refill on a med she’s taken for four decades because she ‘wasn’t comfortable’ and that was the end of the conversation. So she applied her Vitamin I skills and ordered from India. Backwash for Big Pharma.
Janet was a nurse for 45 years, now over 600 days into retirement. Every day I tell her…
… I’m so glad you’re out.
Amazing that some still trust CDC data.
I’m experiencing limited internet access due to a combination of weather-related outages/slowdowns and some intrafamily quarantining, otherwise I might reel off a gigantic comment on this topic.
To cut things down to bare bones, in my opinion ruling class hostility to proper infectious disease control, particularly as regards airborne transmission, is an extension of their centuries-old war on the commons. Industrialists, and even just owners of large stables, have been infringing on their fellow citizens natural rights with noxious vapors since prehistory. This holds true even for those who are nominally Communist.
I’m in rural WA state. The local clinic here thankfully still requires everyone to be masked, although most workers and patients are wearing the flimsy surgical types. My wife and I continue to wear N95s whenever we go out but often we are the only ones. However I was shopping in Seattle at some Asian grocery stores last week and saw lots of masks among both customers and staff.
We live in Richmond Hill, Ontario, Canada, in a detached home area. The footpaths are approximately 4 ft wide with a grassed margin about 6 ft wide. Over 90% of Asian people mostly Chinese wear masks about 1/3 N95 the rest blue surgical masks. They also distance, some onto the grassed area and a few right across the road. My German wife and myself (Irish) wear no masks on residential sidewalks but wear N95 in busier commercial areas or indoors. We are obviously old which might account for the social distancing of the mostly younger Asians. We do avoid unmasked Caucasians by going into driveways as they pass.
The item that disturbs me most is any hospital that has stopped testing for Covid at admission, and also makes no effort to separate Covid and non-Covid patients. I’m waiting to see the news story about someone shooting their way in to a hospital in order to deliver a HEPA filtering unit to a loved one’s bedside.
I am truly growing weary of being yet another voice in the scientific chorus in the wilderness
with regard to UV-C’s efficacy against air-borne pathogens.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102977/#:~:text=UVC%20light%20is%20well%20known,materials%20(16%2C%2017).
Money quote:
“UVC LED Irradiation Effectively Inactivates Aerosolized Viruses, Bacteria, and Fungi in a Chamber-Type Air Disinfection System”
Although, conspiratorial minds may contemplate how much it would cost to install these systems in hospitals (mine covers at least my living room and kitchen and only cost $150) and the fact that those who succumb to air-borne pathogens are generally on Social Security or some other form of public benefits.
> those who succumb to air-borne pathogens are generally on Social Security or some other form of public benefits.
So you’re with the people who think death (and hospitalization) are the only metrics?
Where did you buy your system? Or did you make it?
I was reinjured in a low speed auto accident in December that took place 2 blocks from a major ER, I did not venture into the hospital because reported wait times were 6-8 hours due to the number of people with respiratory illnesses.
RSV, Flu and Covid.
I’m nearly 70 and a cancer survivor with COPD and a wonky heart.
My last encounter with an HAI happened during chemo and I spent 3 days in ICU and two days on the ward, short of a compound fracture there’s no way I’m going to visit an ER.
And no, I haven’t recovered.
These days when your physician asks you how many painkillers you want you know there’s a serious problem ( Not many, I’ve been down that road)