This story has been getting a lot of attention. Here are the basic facts from a local TV station:
LOWVILLE, N.Y. – Officials at Lewis County General Hospital in Lowville have announced they will stop delivering babies temporarily at the end of the month due to a staffing shortage.
Officials say it’s due to employee resignations over their requirement to be vaccinated against COVID-19.
Our sister station WWNY in Watertown is reporting 6 employees in the maternity unit resigned rather than get a COVID shot and another 7 are undecided.
According to hospital officials the hospital will be unable to safely staff the unit and will pause delivering babies after September 24.
Hospital officials are hoping this is a temporary situation and say they will work with the state Department of Health to make sure the unit doesn’t permanently close.
You have to imagine that the loss of 6 maternity unit employees leading to the closing of a maternity ward means that the hospital doesn’t deliver many babies — you’re right. This hospital had 201 babies delivered last year, while the average hospital in New York State had 1,023, and the average hospital in the nation had 589. Also, there’s a hospital 15 miles away that has won a labor and delivery excellence award three years running.
A few more questions to consider when you go beyond the headlines: who were those healthcare workers? Were they highly-skilled and hard-to-replace maternity nurses, or were they CNAs and cleaning staff who will be replaced by vaccinated workers in a couple of weeks?
Anne Laurie posted a thread by David Frum detailing how “employees gonna quit over the vax” stories have resulted in nothingburgers — the whole thread is worth reviewing. The reason almost nobody quits is because universalization of vaccine mandates means you’re fucked if you do. This is especially true for healthcare workers. Between the New York State vaccine mandate, and Biden’s national mandate for healthcare providers who accept Medicare and Medicaid, there are very few places healthcare workers can work without being vaccinated.
I have no doubt that a number of rural hospitals will have staffing issues due to the mandate, but I also don’t doubt that in a lot of rural towns a hospital job is one of the better ones on offer. There will be a few more stories like this one, but in the end, rural hospitals will be staffed, and some fools and dupes who had a decent job with benefits that are rare in rural towns will be scrambling to feed their families.
Baud
As you well know, anecdotes and outliers are all that are needed to call Democratic policy initiatives into question.
Cermet
But what narrative will the media cry about now that President Biden’s “MANDATES” are crushing the freedum of hospital workers; think of the poor workers of this ruling – they can’t freely infect others (!) and ignore the bodies piling up in morgues thanks to thug theology of death.
Suzanne
One thing I will note is that 200 births a year is pretty common for a small community hospital. And a 15-mile drive to the next hospital is a significant barrier for lots of women and can definitely result is worse outcomes.
Having said all of that, it is certainly preferable to stop deliveries there if they can’t do it safely. But if I lived in that community, I would be pissed AF. Rural hospitals usually sustain their communities, and are frequently the largest employers. Anything that endangers the hospital endangers the entire community.
r€nato
Lately I keep reminding like-minded friends that one should not mistake the volume of crybaby whiny conservatives for numbers. Pity that the so-called liberal media hasn’t waken up to this fact.
Just an educated guess, very very very few if any conservatives refused to accept Biden’s socialist stimulus check. Therefore, very very very few anti-vaxxers/Covid-deniers are going to give up a decent job with benefits to make an utterly futile gesture of quitting over a vaccine mandate. Especially since… if you work in the airline industry or healthcare industry, are you really going to give up your entire career? Chances are a new employer in the field is going to have the same mandate.
Frank Wilhoit
So, quite soon, there will be a substantial number of healthcare workers, of whatever skill, rank, or responsibility, who present false evidence that they have been vaccinated. Detection? Enforcement? If these things have not been thought through, then it is all shadow-play.
Suzanne
I will also note that rural and community hospitals are usually financially fragile, which is why they are closing in large numbers across the country. They usually don’t offer much in the way of the really lucrative services like surgery, but they have the money-losing departments (emergency). Deliveries (uncomplicated and scheduled C-sections) are often what keep small hospitals financially afloat. So this sucks for them.
I will note that:
1) it is absolutely the correct decision to pause if they can’t operate safely
2) this hospital sounds like it is already struggling
3) these employees suck and deserve to be out of a job.
matt
Yeah, around where I come from we call people washing out because they can’t follow the rules ‘meritocracy’.
dr. bloor
@Frank Wilhoit: Any health care facility that is serious about weeding out frauds will be able to do so. This is a little trickier than running a fake vaccine card past a greeter at Applebee’s.
Formerly disgruntled in Oregon
Meanwhile…
Alabama man dies after being turned away from 43 hospitals as covid packs ICUs, family says
Roger Moore
@Frank Wilhoit:
False evidence of vaccination that will convince a bouncer to let you into a bar is a lot easier to come by than evidence that will convince a hospital to give you a job. They’re going to check with a central vaccine database, not trust an easily forged CDC vaccination card.
Doug R
@Suzanne: Where I live we have a larger regional hospital and 2 smaller hospitals. One is 30ish miles away, the other is 40ish. There is a bus that runs between them once or twice a week. It’s basically so the smaller towns can go for cancer treatments.
Fair Economist
OB wards have been closing, especially in rural areas, for years, for a number of reasons – decreasing birth rates, rural abandonment, increasing liability, and lately states defunding them by refusing Medicare expansion. Also, a major factor right now is the astronomical bonuses being paid to staff to work in the COVID wards overflowing because of antivaxxers and antimaskers.
Geeno
New York State has a very good registry of administered vaccines. Hospital just has to check if the name is in that database.
Steeplejack
@Baud:
Like Hillary’s emails, they are “shadowed by a cloud”* of something something.
* Verbatim from NYT story way back when.
Betsy
@r€nato: Same reason that when they have their right wing demonstrations, they do it in vehicles and motor boats.
When we do it, we turn out 10,000 people or more. On foot. We don’t need cars and boats to make our teensy little 15-person gatherings look bigger than they are. Nor do we need to hide our whining behind steel and fiberglass.
bcw
All those articles about Houston Methodist, the first hospital that required staff vaccinations, never pointed out the the 150 people fired corresponded to 0.5% of their employees. That’s astonishing since in any group you expect at least 10% to be bat-shit crazy.
Betsy
@Frank Wilhoit: it’s pretty straightforward to check against the database. There’s a wonderful employee vax policy in Wake county North Carolina that talks about this.
Ken
The Frum thread confirms my suspicion, that people who quit over vaccine mandates will not be eligible for state unemployment and other benefits. If I were a front-pager, I’d insert that meme of Willy Wonka screaming “You get nothing!”
germy
https://thenib.com/save-yourself/
God-Man will save them
(cartoon by Ruben Bolling)
Jay C
And in other COVID-related news:
COVID Patient at Center of Ivermectin Debate at Chicago-area Hospital Dies
Veronica Wolski, 64: noted anti-mask/anti-vaxx/QAnon activist: she was the patient whose (?family/friends/hangers-on?) sued the hospital to force them to administer ivermectin. Kind of a moot case by now, I guess.
Her “lead attorney”, the execrable Lin (The Kraken’s Tentacle) Wood has already tweeted out that this was a “medical murder”, and the hospital has, reportedly, been bombarded with threats (death, bomb, damage), etc.
Lovely.
Four Seasons Total Landscaping mistermix
@Suzanne: Yeah, my dad (retired MD) keeps me informed about the hospital in our rural home town. Don’t want to diminish the 15 mile ride, but his old hospital, still afloat, is 100 miles from the nearest OB ward. Maintaining quality of care at his old hospital is a constant struggle. It’s in a red state so who knows how many will quit….
Baud
@Jay C:
Hospital should sue for defamation.
lowtechcyclist
@germy: He used to do Tom the Dancing Bug, didn’t he?
Victor Matheson
@Suzanne: I would be extremely pissed if I were a vaccinated employee in labor and delivery and the closure of the unit due to unvaccinated dipshits just cost me my job.
Baud
@germy:
That is apt. Thanks.
Booger
If a medical employee quits to protest a vaccine mandate, are they eligible to get on the waiting list for a nose transplant to replace the one they cut off in spiting their faces? Asking for a friend.
Keith P.
@bcw: LOL I know one of the people there who quit. The whole family is anti-vaccine, in spite of them all getting COVID several months back, putting one of them in the hospital. I know a nurse from another hospital who quit over the vaccine as well.
The worst part of it is that every time we get together, I have to f’n hear about it. Incessantly. Well, that and “I don’t watch any sports any more except for UFC since they’re all woke now”. They have to bring it up over meals, over PPVs, over beers….it’s quit exhausting.
germy
@lowtechcyclist:
Same guy.
Baud
@Keith P.:
Can’t you go on offense? Talk about culturally conservative things that you hate?
Barbara
@Suzanne: Yes and no. Basically, we have to rethink the whole issue of rural health care, and what it means for a service to be accessible. As it turns out, the causes of hospital closure in rural areas are often quite complex. In addition to having to provide services to uninsured in states that refused to expand Medicaid (which is a huge issue), there are many other issues — including one that had never occurred to me until I read a thorough review on the issue, and that is: people preferring to go to more comprehensive hospitals because of perceived quality differences.
So yes, while some people might find a 15 mile drive to a maternity hospital to be a barrier, many others will make that drive even if the service could be available around the corner within walking distance. Because people in rural locations also understand care differential, and when they have a choice, they go to the facility that they perceive to be superior. Which means that rural hospitals are going to continue to operate on the knife’s edge until we redefine what their role and mission should be and provide them with the financial means to stay afloat without requiring them to compete with more comprehensive facilities, which really should be the preferred place for most people for most services.
And relatedly, transportation should not be the barrier it has become to accessing a superior institution. Don’t get me started on the built in limitations to ambulance services. If we think of it as a public good that helps get people to the right place, maybe we can stop thinking of it as a profit center by which various public and private entities gouge unsuspecting individuals and government programs.
Anoniminous
The development of Messenger RNA vaccines is an absolute triumph of Molecular Biology and the work of Katalin Karikó.
An Invisible Sky Daddy had nothing to do with it.
Ken
@Baud: Sue Lin Wood for defamation? They’d have to get in line. And remind me, is Wood the one who tried the “no one could have believed the outrageous things I said” defense?
Steeplejack
@Keith P.:
Question: Why are you “getting together” with unvaccinated assholes?!
jonas
Lowville is a charming little town — home of the Kraft cream cheese plant, incidentally. The county has a 60% or so vaccination rate, which isn’t bad for deep-red rural Trump territory (it’s in Elise Stefanik’s district, iirc) Still, finding six new maternity ward employees on the fly in this pretty remote area won’t be easy. Hospitals, especially smaller rural ones, rely on birth care for a lot of revenue. Having to turn away patients for weeks or months while they rehire and retrain staff is going to hurt.
Suzanne
@Victor Matheson: Yep.
Rural places are just more fragile, in many ways. They don’t have as much redundancy. Anti-vax shenanigans are more dangerous there.
Part of why I will never live in one.
Roger Moore
@Keith P.:
Those things are probably connected. A lot of people who have already gotten sick say they don’t need the vaccine because their natural immunity from getting sick should be enough. It’s a more comprehensible reason than most of the other anti-vax arguments.
It’s true, for example, that I don’t need to get vaccinated against chicken pox because I got it as a child, so you can understand how someone would feel the same way about COVID. OTOH, I do need to get a flu shot every year no matter how many times I’ve been sick with the flu, so not all vaccines are the same. In this case, there’s good reason to think the natural immunity is less effective and less durable than vaccination immunity, so there’s still a good reason for people who caught COVID to get vaccinated.
trnc
@Cermet: Probably safe to assume that Doosey the Lesser will ask a leading question about this, Psaki will ask him what percentage of OB/GYN nurses this makes up and then give him the answer, and he’ll start trying to recover from stepping on his own dick.
Suzanne
@Barbara:
There is a significant demographic differential as to who goes to major medical centers vs. smaller community hospitals. I don’t know anything about this town’s socioeconomic level, but it is pretty typical for people with less money to go to community hospitals and people with relatively more means to go to major medical centers. This is a nationwide pattern. So the 15-mile barrier is NBD to someone middle-class, but a bigger barrier to someone who has to take a bus. Healthcare is just as class-stratified as everything else.
Anoniminous
COVID-19 reinfection: a rapid systematic review of case reports and case series
Four Seasons Total Landscaping mistermix
@jonas:
This may be true, but you also need to look at it from the perspective of the 6 bitter quitters. Where are they going to find jobs that pay as well, and have benefits as good? Every healthcare worker in NYS must be vaccinated. They’re looking at night shift at the cheese plant or day shift clerking at the Stop and Save. My prediction is that the competent ones will be back at the hospital soon.
Betsy
@Suzanne: where do you live? I’m trying to make a considered decision about relocating and it sounds like this is a topic you’ve given some thought.
Roger Moore
@trnc:
Doocey doesn’t care that Psaki keeps owning him. His goal is to inject Republican talking points into the discussion, and he will doggedly continue to pursue it. Hell, he’s probably happy that Psaki’s takedowns are so memorable, since it makes those clips more memorable and gives them broader reach. The people who are going to ignore anything the Democrat says will get the message he’s trying to send.
trnc
Yeah, that was right up there with “Questions continue to swirl …” which only happened because the villagers kept asking the questions that had already been answered, mostly when the answer was “You know that didn’t actually happen, right?”
Ken
Unfortunately, this just means you trade the chickenpox vaccine for the shingles vaccine.
Roger Moore
@Ken:
It’s still better than not having the shingles vaccine available.
Suzanne
@Barbara:
Many (probably most) rural hospitals are also classified as critical access hospitals. As such, they get additional federal funding. This is because they usually cannot compete with major medical centers.
Hospitals offer a variety of service lines, some are profitable and some are not, and they hope to balance each other. Surgery, especially specialty surgery, is profitable, and yes, is a “destination” service that draws people from a larger “catchment area”. If you need complicated brain surgery, you’re not going to the 30-bed hospital down the street. OB is falling in profitability for lots of reasons, but it is usually the service line that sustains most rural hospitals. Yes, some people with means choose to go to a bigger hospital (I do this, in fact) than one that is close by. That’s fine for me, but it isn’t fine for those for whom a drive is problematic. That’s the specific niche rural and critical access hospitals fill: being that first stop for people who can’t get around.
Steeplejack
@Roger Moore:
Also, Fox News edits the clips so it looks like Doocy is pwning Jen Psaki. You can see it in the comments on right-wing Twitter.
Hoodie
@Barbara: The presence of a larger, highly rated hospital 15 miles away (probably with a fancy birthing center) may be part of the reason why they’d be hard to replace. No one wants to stay down on the farm if they only have to drive (or move) a few miles to work at the better hospital. My mom was an OR director at a large regional med center that was an original Hill-Burton hospital and has now grown into a ginormous regional hospital network. When my mother worked there, there were always some podunk hospitals in the coverage area of the med center that might have been closer for some individuals, but people would easily drive 15 minutes to get surgery or a delivery at her place because it was perceived as better. According to my mom, it was with good reason. A lot of those smaller community hospitals had limited services and/or were pretty bad. They’d give staff privileges to docs who couldn’t cut it at (or were run off from) the med center, and their employees generally were of lesser skill and had less inservice training, etc. If such a hospital is all you have, it’s better than nothing, but having to drive a few miles further is not a big deal (Lowville isn’t like the wilds of eastern Montana). My guess is that the other hospitals in the area can absorb any deliveries that the hospital in question can’t handle, seeing as they do less than one per day.
trnc
I think that was Sydney Powell, but I’m sure Wood wondered why he didn’t think of it.
trnc
@Keith P.: This isn’t meant to sound judgy, but personally, I’d probably stop getting together with those people.
Sister Machine Gun of Quiet Harmony
@Suzanne: Rural communities don’t have public buses. Larger towns might have Greyhound. That’s about it. They have to take their older cars and hope the gas doesn’t cost too much and it doesn’t break down in route. Alternatively, they have to beg a neighbor or relative to give them a ride.
Suzanne
@Betsy: I moved to Pittsburgh last year, from Phoenix.
My in-laws literally closed on a new farm an hour further outside of the small city they live in (Fayetteville, AR)…. just in time for my FIL to get a cancer diagnosis (among other significant health challenges). The oncologist he has seen at their local place is apparently not great, so I am working with him to get him to a destination medical center, likely Mayo Clinic in Rochester, MN. My in-laws are comfortably middle-class, but transportation is going to be a major barrier for him. He has epilepsy and cannot drive.
burnspbesq
@trnc:
He does it so often, one might think he likes it.
Kelly
Interesting example. You do need a vaccination against shingles if you’ve had chicken pox. No shingles vax if you were vaccinated and never got chicken pox. Is shingles is a chicken pox reinfection?
jeffreyw
@Roger Moore:
Fox will play the question and then go to their own panelists for the answer. I think calling on him is an own goal.
mvr
– Story on top
Except in my state where the state has listed not getting vacced as one of the perks of the nursing jobs it is trying to hire for.
Nebraska is Recruiting Unvaccinated Nurses – NYT
trnc
“That one weird trick to …”
Sister Machine Gun of Quiet Harmony
@Kelly: Once you have chicken pox it never really goes away. It stays dormant in your body until your immune system dips, then re-emerges. That is what shingles is. Supposedly, it is really painful.
jonas
@Four Seasons Total Landscaping mistermix:
Kraft is an employer with more than 100 employees — even the cream cheese workers need the jab. (*sad trombone*)
Suzanne
@Hoodie:
Yep. The prestigious hospitals really are better. They are usually trauma I or are affiliated with a research institution, can handle higher-risk cases, attract better clinicians, can reduce transferring….
But community hospitals still have an important place, and their closing in large number is very problematic. Like everything else, their loss will affect poor people much more than rich people. And often, rural hospitals are the largest employer in their town, so there will be a significant economic effect.
Elizabelle
@Jay C: Veronica will live on forever on reddit’s Herman Cain Award page. Surely, her life was not in vain.
Rest in Paranoia, Ronnie.
burnspbesq
@Hoodie:
Closer than you might think. Upstate University Medical Center in Syracuse is at least 90 minutes away in good weather. Don’t want to think about what that drive could be like in February.
Eunicecycle
My daughter used to be a labor and delivery nurse and she was shocked at how many of her former co-workers were not vaccinated. They all work for a very large health care system and their hospital has over 5,000 deliveries a year. They haven’t announced yet that they’re going to require vaccinations but I’m sure they’re going to have to.
Betty
@Barbara: Redefining the role and mission of rural hospitals is so critical. Thank you for bringing that up. Way back when during Carter years, efforts were made in this direction, but every hospital and doctor wanted to be able to do it all. So impractical.
Betty
@Sister Machine Gun of Quiet Harmony: Providing transportation could be a service offered by the facility of the small hospital is part of a network. Would require a re-think by health policy types.
Suzanne
@Hoodie: The important role that community hospitals play is:
1) keeping “easy stuff” out of the major medical centers (stitches, rashes, things we call “ESI 4 or 5”), and
2) being a first step/front-door in a network so they can triage something more complicated, like a stroke, and get you moved on to a bigger place.
The first is really critical in communities where lots of people are poor.
Barry
@Four Seasons Total Landscaping mistermix: “My prediction is that the competent ones will be back at the hospital soon.”
Or not. If this is a requirement, then they are unhirable for any decent place. They’d have to work for a more ‘casual’ company.
Martin
FYI, the first proper private spaceflight is scheduled for this Wed. It’s a SpaceX Crew Dragon, and will spend 3 days in orbit. The billionaire funding it (and going on the flight) is doing this as part of a fundraising campaign for St Jude Hospital. He’s also a trained pilot and will command the flight. None of the passengers are SpaceX employees.
$50M per seat, which is surprisingly expensive. A launch costs $62M, and there are notable costs for the recovery of the Dragon and refurbishing it, but SpaceX should be turning a tidy profit on this. I doubt they’ll be doing this very often, and while it’s a vanity flight for the billionaire, he’s kept this surprisingly low-key.
Cacti
After watching the first NFL Sunday, and seeing fans packed, shoulder to shoulder, unmasked, around the country I’ve come to the conclusion…
We’re never going reach herd immunity for Covid
Gravenstone
@Frank Wilhoit: It’ll take a bit of legwork by enforcers, but you can track where people have been vaccinated. If they present false vaccination cards and its shown either no vaccination was offered at the recorded location/date, or the claimed vaccine lot(s) was not used, then those fucks should be charged with fraud on top of whatever penalties incur with their employer for failing to comply with the vaccination mandate.
Kay
I wonder why there isn’t more study of this. From the 1990’s to Obamacare Democrats continually expanded access to health care for both lower income mothers and children. “From the 1990’s on”, so we have tons of info about the effects of that and it’s a HUGE group. Tens of millions of pregnant women and children. If I were a Democrat I would commission the studies myself- it’s life changing, big enough to to be one of the few things the US did right on health care and big enough to mitigate some of the effects of the rest of our shitty health care system in international comparisons, so we suck less than we would have.
Pelosi has been around long enough and was powerful enough one could credit her, specifically, with a lot of it.
Roger Moore
@Suzanne:
Of course the underlying problem is treating medical care as something that should be profitable in the first place. The bigger regional hospital trying to poach profitable specialties from the smaller hospitals is sign of a bigger underlying problem with the way the system is set up, or rather the lack of system in the way our healthcare is delivered. At the very least, those smaller hospitals should be part of a system with the regional hospital so they’re cooperating on keeping the local healthcare functioning, rather than trying to run each other out of business.
Dorothy A. Winsor
I’d be horrified by having my baby delivered in a place with unvaccinated workers.
Ken
@mvr: Interesting that Nebraska feels its hospital system can do without Medicare and Medicaid funds. I suppose the state government will find a way to plug the gap.
Roger Moore
@Kelly:
Not technically a reinfection but a flare-up. Despite the name, chicken pox is not a pox virus; it’s a herpes virus. Herpes viruses actually integrate into the host’s DNA and lie dormant, but they can flare up if and when the immune system is weakened. Cold sores are when herpes simplex I flares up, and shingles are when chickenpox flares up.
Suzanne
@Betty:
The consolidation into larger health systems that has taken place in the last forty years has reduced this strategy. There is a lot more specialization now than there used to be, because it is more profitable to consolidate service lines if they aren’t going outside the health system.
lowtechcyclist
@Sister Machine Gun of Quiet Harmony:
No ‘supposedly’ about it. I had shingles about 5 years ago, and it was easily the worst pain I’ve ever experienced.
(Wasn’t vaccinated for shingles then. I’ve rectified that since. Wouldn’t want to have that happen twice.)
Kelly
@Sister Machine Gun of Quiet Harmony: Ah yes now I remember, Chicken pox/shingles is a herpes virus and like other herpes you’re stuck with it.
way2blue
Plus. Who would want to utlize a medical center whose staff refused to be vaccinated? Totally the wrong temperment to be working in the health field.
Martin
@Sister Machine Gun of Quiet Harmony: Depends on how severe your flare up is. I’ve had 3 bouts of shingles, and fortunately I get pretty mild cases of it. Yeah, it hurts, but in my case it’s bearable. It’s like every nerve has its sensitivity turned up to 11 and you just don’t want anything touching you.
But I know a number of people that get more severe cases and they’re fucking miserable and in a great deal of pain. I don’t get rashes on my face, but that’s pretty common, and extremely unpleasant given how sensitive the nerves in your face tend to be.
narya
@Kay: The Federally Qualified Health Center (FQHC) program does exactly this–and every FQHC has to submit a massive data report every year, by February 15. If you really want to see the data, search for UDS data–you can drill down to specific health centers. We all have to provide data about a bunch of quality measures, including info around prenatal care, births, deliveries, and childhood vaccinations. More than 26 million people served last year–and it’s probably much higher than that, because the covid testing and vaccination only gets reported here if it’s for a “patient,” i.e., someone with whom one of the providers had a visit/encounter.
cckids
@mvr: Oh. My. God. I’m currently in Omaha, hanging with/caring for my brother who had a bone marrow transplant 50 days ago. That is the absolute LAST thing anyone needs.
Gravenstone
@Kelly: Same virus, different manifestation of illness.
Steeplejack
@cckids:
Yikes! Sending healing thoughts for your brother.
EmbraceYourInnerCrone
@burnspbesq: No lie! My daughter used to live in Syracuse and my niece lived in Watertown at the time. Daughter said the Lake effect snow bands used to blow in off the Great Lakes some times when she was driving back from Watertown. flurries and then a few miles south BAM, snowing an inch or more an hour/white-out conditions.
raven
@Sister Machine Gun of Quiet Harmony: goddamn right it is
Jinchi
I don’t know why Doocey gets called on as often as he does, or whether it’s just the typical amount for any person there.
But since Fox News is an active purveyor of the type of lies that routinely get people banned from Twitter and Facebook, I’m not sure why he’s in the room at all.
Gin & Tonic
Long time ago I was treated for a relatively minor accident at that hospital. It is *small* – basically a walk-in clinic.
Hoodie
@Suzanne: Yes, this is a problem in places where larger centers are several hours away, but I’m not sure about the wisdom of keeping open bad hospitals. I imagine among the reasons that rural hospitals are dying is that many of the areas they serve are also depopulating and dying. Might be better served by improved transport, emergency services, telemedicine, mobile clinics, etc.
Barry
@Sister Machine Gun of Quiet Harmony: “That is what shingles is. Supposedly, it is really painful.”
one co-worker and one friend have had it. The latter described the unexpected places where it hurts like a m-f.
lowtechcyclist
@Martin:
Yeah, my case of shingles hit the trigeminal nerve on the left side of my face. For the most part, pain isn’t something I remember for long afterwards, but I sure remember this one.
Hoodie
@burnspbesq: My dad’s buddy in Montana would drive further than that to go bowling.
topclimber
@Roger Moore: I have no problem with a profit that is a reward for something useful. If your development office pays people big bonuses but they tap money that would not be in the government channel, OK by me.
If private management (or faux non-profit management) does the administrative job for an ROI comparable to large corporations (say 5%), OK by me.
What is left unsaid, too often–perhaps not by you–is that most of the “profit” is going to providers like doctors and other medical staff. They expect a certain level of compensation and they get it, particularly those on the top of the pecking order.
I think this explains most of the large differential in costs between US and other developed nations in health care.
Gin & Tonic
@Suzanne: In that area you have to drive 15 miles just to get a pack of smokes.
EmbraceYourInnerCrone
@Dorothy A. Winsor: And apparently the Maternity department was not the only one to have people quit:
“Mr. Cayer, who spoke at a news conference on Friday afternoon in the county board room, said 30 people have resigned from their health care roles since the vaccine was mandated on Aug. 23, 20 of whom worked in clinical positions like nurses, therapists and technicians, totaling 70% of the resignations so far.”
Lewis County Health Systems to pause deliveries
cckids
@Steeplejack: Thank you! He’s lucky (?) enough to have SIX vaccinated sisters who are taking it in turn to come & be with him when his fiancé can’t. I’m sure this would have been his teenage self’s worst nightmare.
It has been a surprisingly good visit though. I am sick of locals telling me how lucky I am to be back in “God’s Country” though. They truly think Seattle is just a hellhole ??
Soprano2
@trnc: I’m not Keith P, but it’s not always that easy. Sometimes it’s members of your family, or a group around something your kids are involved in. Plus, I can tell the people who live in mostly liberal areas of the country, because they think it’s easy to avoid TNG supporters. Where I live, I cannot avoid TNG supporters; easily half the people I work with voted for him!
Anoniminous
Lancet: Considerations in boosting COVID-19 vaccine immune responses
trollhattan
I truly think they’re fucking with us just because reasons.
This is where I’m obliged to ask “What could possibly go wrong?”
Barbara
@Suzanne: CAH is a Medicare designation that allows hospitals that qualify to get Medicare reimbursement based on their costs. A key component of the definition is that they have to be 35 miles away from the closest hospital, though there are some exceptions for difficult terrain or if the facility has been grandfathered.
I am not contesting that “certain people” are more likely to use a small rural location, what I am contesting is that they should be trapped into using that facility because of transportation difficulties when they need more advanced services. And lots of people live way more than 15 miles from a hospital, and lots more will as we allow a policy of negligence to foster the decline and attrition of smaller hospitals.
Steeplejack
@cckids:
I hope your brother is also vaccinated, or did the transplant circumstances interfere with that?
trollhattan
@lowtechcyclist:
My granny suffered shingles on and off her last couple decades and even for the World’s Toughest Woman it was debilitating.
I had the jab (first gen) even not knowing if I ever had chicken pox. (And that motherfucker hurt like battery acid.)
Martin
@trollhattan: At least they were able to unload it. Last count of the number of container ships waiting to be unloaded at Port of LA/LB is 49. The port is running at max capacity, it’s just unable to keep up.
smith
You may have worked in different hospitals than I have, but I spent most of my career in hospital settings, both public and private. I had administrative positions just high enough in the machinery to see how things actually worked. What I saw in private hospitals was that most of the profits went to top administrators who had a wide array of amazing schemes to skim whatever was skimmable. These were people who took trips to the Caymans every 6 months to visit their money.
cckids
@Steeplejack: He can’t be yet.
cckids
@Steeplejack: Not yet, between chemo & transplant it wasn’t recommended yet.
oy. Duplicate!
StringOnAStick
@Roger Moore: I think people don’t realize that different virus types are, well, different. Chicken pox only requires one vaccine or having had it in the past, because it is stable and doesn’t mutate enough to render the vaccine useless. Influenza has many strains and they are constantly mutating, which is part of why there is a newly formulated vaccine every year. From reading about the Spanish Flu epidemic, it appears that running wild the world over, it mutated into something much less virulent.
Covid is somewhere in the middle. It doesn’t appear to mutate as fast as the flu, but it mutates a whole lot more than Chicken Pox. We’re lucky that so far the mutations are still something the mRNA and adenovirus vaccines can counter, but there’s no guarantee that will stay true. I did see that another vaccine in trials right now has as it’s target a part of the Covid virus structure that is much more stable (meaning less likely to mutate/evolve) than the spike protein that is the current target.
eclare
@cckids: Best of luck to your brother! He is very fortunate to have a large, caring family close by.
dr. bloor
@EmbraceYourInnerCrone: Interestingly, Lewis County is at 46% vaccination rate this morning, juuuuust a little lower than the statewide 69%. I wonder if the typical resident right now is standing in solidarity with those workers even though it means watching their health care services slip away.
StringOnAStick
@Kelly: This has probably already been answered, but shingles is from latent Chicken pox virus that sticks around long after you’ve had Chicken Pox. I think I remember reading that the virus lives in the spinal cord/fluid.
I got the shingles vaccine two years ago, once the new Shingrex vaccine was released. The prior vaccine was maybe 60% effective and Shingrex is over 90%; another medical miracle.
trollhattan
@Martin: Makes you wonder how much of our electronic component shortage is just “stuck in transit.”
Just in time seemed so clever in 1985.
smith
Why not? The Goobers have already demonstrated their willingness to sacrifice their children, so what’s a little health care?
topclimber
@smith: Don’t get hung up on the word profit. Think proceeds. Provider care is what is the big cost driver in US health care. Just like staff salaries are what make education “expensive.”
Full disclosure: I have worked at no hospitals at all. But I have followed the subject for several decades, back to the days when HMOs were the flavor of the day.
lowtechcyclist
@trollhattan:
I put off my shingles vax long enough to get Shingrix when I got mine. Sounds like I’m lucky I waited!
Side effects: sore shoulder of course (though not nearly as bad as Moderna), and had chills the rest of the day and no energy whatsoever, but fine the next day both times. A price well worth paying to never have that trigeminal pain ever again.
Roger Moore
@trollhattan:
It sounds as if container ships that size travel through the Suez canal all the time. The one that got stuck last year was unlucky, and the problem it had wasn’t because it was too big.
Suzanne
@Hoodie:
Partially, yes. Part of it is also that rural areas are also disproportionately older people who are expensive to care for, and Medicare reimburses less than private insurance. Mayo Clinic doesn’t take Medicare any more, for example.
There’s no reason to keep open a bad hospital, but community hospitals can have an important role as essentially big urgent care and triage stations. The problem is, of course, that they cannot financially survive that way, unless they get bought by a bigger system. But the bigger systems don’t necessarily want to buy them if there isn’t a strategic reason to do so.
Suzanne
@Barbara:
No, of course they shouldn’t be trapped into anything that isn’t good. But that often isn’t the option for them. The choice is often, for many poor people, between barely adequate care and nothing. Middle-class and rich rural residents can travel, poor rural residents struggle to do that.
And, honestly, for most of the things that people need medical care for, “adequate” care is sufficient. A rash, a cut on your finger, a tetanus shot…. a community hospital is fine for that. And losing that access is a big loss.
Martin
@trollhattan: Quite a lot of it is.
JIT is still a good approach. There is no social benefit to increased warehousing and shipping – it’s just cost, emissions, and stupid uses for land.
I would argue the real fault here lies in the lack of infrastructure to get cargo out of the port. That’s the bottleneck as I understand it. If they could run the port with a modern freight rail terminal and unload to rail, they could increase dock capacity. We have some of this with PHL, but it’s supposed to be electrified and it’s not (the track is, the locos aren’t), and it’s throughput is insufficient. Only about ¼ of the cargo gets out that way, and there are real challenges with loading trucks that quickly. They’re moving 1100 TEUs an hour right now.
Roger Moore
@Steeplejack:
What you need is for the donor to have been vaccinated. The whole idea behind a bone marrow transplant is that you’re replacing the recipient’s immune system with a healthy one from someone else. I don’t know for sure, but I would guess that 50 days post-transplant is probably still too soon to give a vaccination, but if the donor had been vaccinated they probably would have donated their immunity with the rest of their immune system. In any case, someone that soon after a transplant is going to be very vulnerable regardless of vaccination status; their immune system will not be back to full function.
Martin
@lowtechcyclist: I got my first shingrix shot along with a tetanus shot. Couldn’t lift my arm for 3 days.
I get shingrix #2 later this month. Hoping it’s better without tetanus.
J R in WV
@Cacti:
While the NFL stadia were packed, there are only ~16 or 17 games a weekend. You should have watched some College football on Saturday, just as packed, just as unmasked, and probably hundreds of them all day Saturday from coast to coast. Much worse than pro-level games!
Roger Moore
@Martin:
There is a danger from JIT, which is that it makes the whole system less resilient to supply chain disruptions.
mvr
@Ken: I think they advertised before Biden’s speech and there was a lot of pushback to the state’s ad. OTOH, the governor is among the idiots saying that they are going to sue over mandates.
Suzanne
@Roger Moore: You are correct. And I will note that the loss of rural hospitals is essentially the healthcare equivalent of JIT. Redundancy has costs but it also has value. There’s a reason that loss of rural hospitals results in worse outcomes:
mvr
@cckids:
Omaha and Lincoln are better than the rest of of the state vaccination wise. Here in Lincoln we seem to be the most vaccinated at 72%. But it gets less good as you get less urban. And the state politics is bad enough that they took down the dashboards in those counties because the guv thinks there is no longer a crisis.
Best of luck to you and your brother!
cckids
Thank you!@mvr:
Geoduck
@lowtechcyclist: Boeling still does the Dancing Bug toons, they get posted over on Boingboing, if not other places.
Barbara
@Suzanne: It is a big loss. The issue is how to make it sustainable, and the “old approach” is what you describe, which is to give it the ability to offer multiple service lines and hope a few are profitable enough to sustain the enterprise. Unfortunately, that is getting harder and harder to pull off. There are a lot of reasons that pile up one on top of another, but if we really want to preserve rural access, it will have to be like utilities in rural areas — you either commit to making a regulated minimum service available, and subsidize it, or you end up with a de facto market oriented approach that will result in more and more facilities closing.
Suzanne
@Barbara: The old approach obviously is failing. The issue is that there is not really a new approach in existence. There are plenty of ideas. But nothing really significant that is real.
I get frustrated by comments like, “What if we did more telemedicine? What about mobile clinics?”. Well, no shit. As the old saying goes, if my aunt had balls, she’d be my uncle. The issue is that this doesn’t happen at scale at this time because no one has figured out how to make it financially feasible yet. Hopefully, Covid will improve this situation with telemedicine, but that remains to be seen.
In the meantime, hospitals continue to fail, and health outcomes continue to get worse in these areas rather than better. So I am not so sanguine about it.
prostratedragon
@trollhattan: Well let’s see… we’re in the first quarter moon, so there’ll be a full one on the 20th …
J R in WV
@trollhattan:
No, it didn’t. We have a 2019 Mazda SUV with no bumpers at a body shop, waiting for one of those cargo ships to dock and unload at LA/LB. Also a rear passenger side mirror with radar sensors inside.
Fake Irishman
@bcw:
Not only was it 0.5 percent of their employees, but very few of those were actually front line folks. I believe there were two nurses, most of the rest were back half admin.
Kent
My wife works for a big HMO. All of their employees are members of same HMO and have their entire vaccination records included in their electronic medical records.
At least as far as her workplace is concerned. There is no faking it. They will know whether or not you got the shot because they are the ones who would have given it and kept the original records.
Kent
Another problem is that in our system of private healthcare, most of the profits in medicine are in expensive elective surgeries and non-urgent procedures. Stuff like hip replacements, for example. And small rural hospitals simply can’t compete with larger suburban and urban hospitals for that sort of high-margin care because they don’t have the facilities or specialists or volume to actually do it. So they get left with the low-reimbursement Medicare and Medicaid patients that bleed them dry.
Also, the mid-career middle aged folks who have both good private insurance and are in need of more frequent care tend not to live in rural areas so much anymore. Your typical 40-something white collar worker is much more likely to live in the suburbs. Or, if not, they live in the exurbs and commute. They aren’t going to go to some tiny rural hospital for say a $150,000 heart valve replacement paid for by private insurance. They are going to go to some big regional heart hospital.
burnspbesq
@mvr:
Let ‘em. There isn’t a single non-frivolous argument in favor of their positions.
You get sanctioned! You get sanctioned! All the plaintiffs’ lawyers get sanctioned!
Jaysails
@Sister Machine Gun of Quiet Harmony:
Shingles is the single most painful experience I’ve ever been through. And I got the extra aded fun of neuropathy everywhere I had the rash. Three years in, that’s getting better, slowly, but I am the biggest f’ing shingles vaccine evangelist on the planet.