Omicron variant

[9873210]

So, this massive surge in positive tests cases must, in the majority, be Delta.

I’m not convinced your conclusion is correct. My eye is drawn towards the phrase “confirmed omicron cases”. I assume here that confirmed means a positive swab has actually been sequenced as opposed to simply displaying S-gene dropout which wouldn’t merit “confirmed” but rather “strongly suspected” or “very likely”.

Something seems very wrong here. Important information is not being used.

What we need is not the number of confirmed Omicron case, but the number of confirmed Omicron cases AND the number of confirmed Delta (and others) cases. Assuming random sampling or testing everyone of whatever population they decide to sequence that should give a good idea of the prevalence of each strain. The same can be done with the S dropout for "suspected cases". The number of S dropouts detected v. the number of tests that could detect the S dropout but don't.

There would still be a lag, but not the nonsense of saying "40 confirmed Omicron cases". There's a big difference between "We sequenced 41 cases and 40 of them are Omicron" and "We sequenced 4000 cases and 40 of them were Omicron."

* And dammit they should be doing random sampling. This type of surveillance is by far the most valuable use of tests, at least of the first few thousand a week.

[nicodemusboffin]

Really? And would you withdraw treatment from or charge overweight diabetic patients? Or smokers? Or people who crash when going above the speed limit? Those injured when drunk? Practitioners of dangerous sports? Overly adventerous ladder users?

And this kind of divisive suggestion is made on the basis of an anecdote that suggests 60% of those in hospital with COVID are vaccinated!

Quite possibly yes, if any of the examples you give were clogging up the NHS, possibly having a massive impact on the health others in society and causing huge economic damage to the country. It is Darwinian, we should let the unvaccinated bear the consequences of their choices and not the rest of society.

Let me be really clear

I am not suggesting that we deny treatment for the obese, or those who smoke, or vape, or do hard drugs, or avoid vaccines BECAUSE they do those things

I am suggesting that when it comes to triage in the case of a resipiratory pandemic, where resources are limited, that these factors need to be considered
- that choosing to have not taken the vaccine will be a deprioritising factor if someone presents at hospital needing respiratory care
- that where there is competition that machine will go to a patient who did have the vaccines

Surely that's not too controversial?
It's the kind of ethical decision we have to make all the time when triage is necessary; you prioritise the resources based on the chance of positive outcomes
- if there's one bed available and it comes down to a choice between a 20 year old vaccinated otherwise fit non-smoker and an obese non-vaccinated 75 year old smoker - who do you think gets the ventilator?

Now.... what if that "20 year old vaccinated otherwise fit non-smoker" caught it from his "20 year old UN-vaccinated otherwise fit non-smoker" flatmate who also needs treatment in the single available ventilator?
- toss a coin?

I'd prefer to have a health system that doesn't require that kind of consideration
- but that's not the case

- sd

So where does your suggestion that as an alternative to denying treatment we 'at least charge them for it' fit in? You seem to be suggesting that someone's ability and willingness to pay should help determine whether or not they are prioritised for life-saving treatment.

Let me be absolutely clear - medical practioners should not be expected or allowed to make value-judgements about people's life choices when deciding whether or not to provide potentially life-saving treatment. The only consideration, if forced to make a choice between two individuals, should be on the basis of which one is more likely to benefit from the intervention.

[swill453]

There would still be a lag, but not the nonsense of saying "40 confirmed Omicron cases". There's a big difference between "We sequenced 41 cases and 40 of them are Omicron" and "We sequenced 4000 cases and 40 of them were Omicron."

Nicola Sturgeon said yesterday that they expect Omicron to be the dominant variant in Scotland by today (Friday). I haven't seen the figures, but presumably that sort of thing is behind it.

Scott.

[Wizard]

Quite possibly yes, if any of the examples you give were clogging up the NHS, possibly having a massive impact on the health others in society and causing huge economic damage to the country. It is Darwinian, we should let the unvaccinated bear the consequences of their choices and not the rest of society.

Let me be really clear

I am not suggesting that we deny treatment for the obese, or those who smoke, or vape, or do hard drugs, or avoid vaccines BECAUSE they do those things

I am suggesting that when it comes to triage in the case of a resipiratory pandemic, where resources are limited, that these factors need to be considered
- that choosing to have not taken the vaccine will be a deprioritising factor if someone presents at hospital needing respiratory care
- that where there is competition that machine will go to a patient who did have the vaccines

Surely that's not too controversial?
It's the kind of ethical decision we have to make all the time when triage is necessary; you prioritise the resources based on the chance of positive outcomes
- if there's one bed available and it comes down to a choice between a 20 year old vaccinated otherwise fit non-smoker and an obese non-vaccinated 75 year old smoker - who do you think gets the ventilator?

Now.... what if that "20 year old vaccinated otherwise fit non-smoker" caught it from his "20 year old UN-vaccinated otherwise fit non-smoker" flatmate who also needs treatment in the single available ventilator?
- toss a coin?

I'd prefer to have a health system that doesn't require that kind of consideration
- but that's not the case

- sd

So where does your suggestion that as an alternative to denying treatment we 'at least charge them for it' fit in? You seem to be suggesting that someone's ability and willingness to pay should help determine whether or not they are prioritised for life-saving treatment.

Let me be absolutely clear - medical practioners should not be expected or allowed to make value-judgements about people's life choices when deciding whether or not to provide potentially life-saving treatment. The only consideration, if forced to make a choice between two individuals, should be on the basis of which one is more likely to benefit from the intervention.

That is an opinion, and no more. There are alternative approaches, such as when drugs are not approved for use in the NHS on cost grounds, even though they would be effective for individuals.

[servodude]

Let me be really clear

I am not suggesting that we deny treatment for the obese, or those who smoke, or vape, or do hard drugs, or avoid vaccines BECAUSE they do those things

I am suggesting that when it comes to triage in the case of a resipiratory pandemic, where resources are limited, that these factors need to be considered
- that choosing to have not taken the vaccine will be a deprioritising factor if someone presents at hospital needing respiratory care
- that where there is competition that machine will go to a patient who did have the vaccines

Surely that's not too controversial?
It's the kind of ethical decision we have to make all the time when triage is necessary; you prioritise the resources based on the chance of positive outcomes
- if there's one bed available and it comes down to a choice between a 20 year old vaccinated otherwise fit non-smoker and an obese non-vaccinated 75 year old smoker - who do you think gets the ventilator?

Now.... what if that "20 year old vaccinated otherwise fit non-smoker" caught it from his "20 year old UN-vaccinated otherwise fit non-smoker" flatmate who also needs treatment in the single available ventilator?
- toss a coin?

I'd prefer to have a health system that doesn't require that kind of consideration
- but that's not the case

- sd

So where does your suggestion that as an alternative to denying treatment we 'at least charge them for it' fit in? You seem to be suggesting that someone's ability and willingness to pay should help determine whether or not they are prioritised for life-saving treatment.

Let me be absolutely clear - medical practioners should not be expected or allowed to make value-judgements about people's life choices when deciding whether or not to provide potentially life-saving treatment. The only consideration, if forced to make a choice between two individuals, should be on the basis of which one is more likely to benefit from the intervention.

That is an opinion, and no more. There are alternative approaches, such as when drugs are not approved for use in the NHS on cost grounds, even though they would be effective for individuals.

There is a private market for most things; ventilators included

If someone has means to treat themselves and not remove care from someone else then I can't see how we can ethically stop them?
That's essentially self insurance?
I don't have private health care myself - but I don't begrudge those that do
And I do have access to a non-invasive ventilator just in case someone in my close circle needs it and can't get a hospital bed

-sd

[csearle]

If we trained some artificial intelligence up to do triage based on the goal of optimising lives saved with finite medical facilities it would be interesting to see whether it homed in on prioritising the vaccinated or the rest. C.

[Wizard]

If we trained some artificial intelligence up to do triage based on the goal of optimising lives saved with finite medical facilities it would be interesting to see whether it homed in on prioritising the vaccinated or the rest. C.

I suspect it would not be the main factor, that would probably be age. But my view is not based on health outcomes, it is based on allocating the consequence of the actions of a minority to that minority and not the rest of society. I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

[csearle]

I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

What about those who for medical reasons can't take any of the vaccines? Or, perhaps those that have serious conditions that, whilst able to take the vaccine, are deeply worried that it might worsen their condition? (I know someone in this last category.) C.

[servodude]

If we trained some artificial intelligence up to do triage based on the goal of optimising lives saved with finite medical facilities it would be interesting to see whether it homed in on prioritising the vaccinated or the rest. C.

I suspect it would not be the main factor, that would probably be age. But my view is not based on health outcomes, it is based on allocating the consequence of the actions of a minority to that minority and not the rest of society. I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

Indeed and you are entitled to your view
I find it an interesting day when general misanthropy and spite aligns with standard medical ethics but hey ho, that's the times we find ourselves in
- isn't it shite?
-sd

[servodude]

I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

What about those who for medical reasons can't take any of the vaccines? Or, perhaps those that have serious conditions that, whilst able to take the vaccine, are deeply worried that it might worsen their condition? (I know someone in this last category.) C.

Chris,
your friend needs to speak to a good professional as soon as possible. They're going to put themselves in a position where very soon the anxiety from this new variant could itself be a contributing factor to a lot of conditions.

-sd

[servodude]

If we trained some artificial intelligence up to do triage based on the goal of optimising lives saved with finite medical facilities it would be interesting to see whether it homed in on prioritising the vaccinated or the rest. C.

I'd expect a lumped cost function.

Vaccination was about 90% effective against serious illness and death; that's about equivalent to being 24years younger
- everything else would have similar mappings

I always see them as cascaded gains in a transfer function

-sd

[csearle]

...your friend needs to speak to a good professional as soon as possible. They're going to put themselves in a position where very soon the anxiety from this new variant could itself be a contributing factor to a lot of conditions.

I shall pass this on. Actually it's a touchy subject with her so citing a third party provides me with a way forwards without, hopefully, falling out. Ta. C.

[NotSure]

..... I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

I'm not sure how clogging up beds with people who are just going to die, while clogging up morgues with those could be easily saved is going to benefit anyone, vaccinated or otherwise?

[csearle]

I'd expect a lumped cost function.

Vaccination was about 90% effective against serious illness and death; that's about equivalent to being 24years younger
- everything else would have similar mappings

I always see them as cascaded gains in a transfer function

Had to do a bit of googling to appreciate that. C.

[servodude]

I'd expect a lumped cost function.

Vaccination was about 90% effective against serious illness and death; that's about equivalent to being 24years younger
- everything else would have similar mappings

I always see them as cascaded gains in a transfer function

Had to do a bit of googling to appreciate that. C.

...or a series of guitar overdrive pedals? (which is how I see gain stages in a control diagram)

[Wizard]

I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

What about those who for medical reasons can't take any of the vaccines? Or, perhaps those that have serious conditions that, whilst able to take the vaccine, are deeply worried that it might worsen their condition? (I know someone in this last category.) C.

In my first post I did include “except those unable to for good medical reason” or similar wording, so I certainly would not refuse treatment to them. In terms of your second group I would say it is the view of the doctors that is important. If they are told it is fine and they should take the vaccine, but they decide they know better than all the medical experts then, yes, I would refuse treatment to them as well. I saw a care worker who was losing her job due to refusal to take the vaccine, she had a condition where there was a universal medical view that the vaccine was safe, she decided is wasn’t. No basis for her opinion other than “I have decided”.

[servodude]

..... I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

I'm not sure how clogging up beds with people who are just going to die, while clogging up morgues with those could be easily saved is going to benefit anyone, vaccinated or otherwise?

Indeed!
And that's why it's not done [deleted by moderator]
You'll get a bed if there's one available and you are (more) likely to respond to it.

I do think that vaccination IS part of that calculation and it would be generally helpful to make people aware of that (or to have made them aware of it)

-sd

Moderator Message:
Name-calling deleted. (chas49)

[Wizard]

..... I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

I'm not sure how clogging up beds with people who are just going to die, while clogging up morgues with those could be easily saved is going to benefit anyone, vaccinated or otherwise?

I wouldn’t advocate clogging up beds, if there is a vaccinated person with a 50% chance of survival if treated I would prioritise those over the vaccinated person with the 1% survival chance.

As far as I have seen reported we have yet to see any risk of morgues being overwhelmed. But there is a lot of concern hospitals soon will be.

[Wizard]

..... I would give a bed to a vaccinated person with a 1% chance of survival over an unvaccinated person with a 99% chance of survival. I know others will have a different view, but that is my view.

I'm not sure how clogging up beds with people who are just going to die, while clogging up morgues with those could be easily saved is going to benefit anyone, vaccinated or otherwise?

Indeed!
And that's why it's not done except in the minds of [name calling deleted].
You'll get a bed if there's one available and you are (more) likely to respond to it.

I do think that vaccination IS part of that calculation and it would be generally helpful to make people aware of that (or to have made them aware of it)

-sd

Would you give a bed to an unvaccinated person with a 51% chance of survival over a person who been vaccinated, and generally done all they can to avoid being infected, but who for other reasons has a 50% chance of survival?

[CliffEdge]

To save time why don't we just shoot those who refuse the vaccination? I'm sure we'd have no problem finding people willing to pull the trigger.