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Comment by jlawson | Hacker News Reader

Absolutely not, that's not how it works.

You won't be denied tramua treatment for a gunshot because your doc told you to stop playing with guns.

You won't be refused heart medicine because you didn't stop eating bacon when your doctor told you to 5 years earlier.

You won't be denied ER treatment because you were drunk when you crashed your car.

There is no rule where we have to treat all patients equally (including mass murderers) except those who didn't accept n earlier-offered treatment or who did something that caused their own medical condition (i.e which probably includes most medical conditions).

Medical care is not an exploding offer.

Honestly - shame on you for trying to sneak in an absurd exception just so you can abuse the medical system to hurt people you don't like. That's not what hospitals are for.

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I think if we really ran out of health care capacity, it might make sense to prioritize people who took preventative measures over those who didn't.

Especially with COVID: if you're at the point of triage and rationing resources, you need to consider likely outcomes, and people with the vaccine presenting at hospital are more likely to survive than those presenting without.

It seems like we're not going to bump into those limits, though, so it's moot.

> people with the vaccine presenting at hospital are more likely to survive than those presenting without

In my opinion, that logic is flawed.

The currently available COVID-19 vaccines vastly reduce the likelihood of developing severe symptoms from a SARS‑CoV‑2 infection. They also somewhat reduce the risk of getting infected in the first place.

So, getting vaccinated against COVID-19 makes you far less likely to need to be hospitalized, should you contract the virus, which apart from of course being beneficial to yourself also helps with keeping the healthcare system from being overwhelmed.

However, if you've already been hospitalized, it is because you've developed severe symptoms, which in turn means that, in that situation, for you, the vaccine has failed.

At that point, all other factors being equal, your likely outcome is no different from that of a person who hasn't been vaccinated. Therefore, using vaccination as a criterion for triage (which - like you said - is all about rationing resources, not passing judgement) doesn't make sense.

Now, it could very well be possible that being vaccinated improves your outcome even once you've already developed symptoms sufficiently severe to require hospitalization. However, I'm not sure there's conclusive evidence suggesting that is indeed the case.

> Now, it could very well be possible that being vaccinated improves your outcome even once you've already developed symptoms sufficiently severe to require hospitalization. However, I'm not sure there's conclusive evidence suggesting that is indeed the case.

Current data seems to show that fully vaccinated people who require hospitalization have hospital stays that are 33% shorter and are also about 33% less likely to die (despite having more comorbidities on average than unvaccinated hospitalizations).

So, if you have one bed left, and can put either an unvaccinated or vaccinated person in it-- all else being equal-- the vaccinated person is less likely to die with hospital care, and is more likely to free up the bed for someone else soon.

(We don't know, though, if you deny hospital care to both what the death rate for each would be-- here's where you have to guess. If you assume both die without hospital care, then you should give the bed to the vaccinated patient).

It seems like we're not going to bump into those limits, though, so it's moot.

Only because people who got the vaccine are significantly less likely to require hospitalization though. At the start of the pandemic there was a very real possibility that we'd actually run out of ICU beds and ventilators. Much of the 'flatten the curve' effort was to protect healthcare services.

You won't be refused heart medicine because you didn't stop eating bacon when your doctor told you to 5 years earlier.

Yes, you would. Doctors refuse to give people treatment until they've lowered their weight, reduce their cholesterol, given up smoking or drinking, or increased their level of exercise all the time.

There is no point giving someone life-saving medical treatment if it isn't going to work because of some other factor. That's a waste of time and money. In every case the patient has to show that they're willing to do their part. Medicine is not just popping a few pills or turning up for surgery. There's effort required in order to get better.

In the case of Covid, having the vaccine is part of that effort. Someone who hasn't tried to improve their long-term health by, for example, giving up smoking, and someone who hasn't tried to improve their long-term health by having the Covid vaccine are basically the same - they're both putting their health at risk unnecessarily. Doctors should consider that when they're prioritizing treatment.

If a collapsed lung from a gunshot wound was contagious you sure would.

If having your head split open in a DWI accident was contagious you would.

Like 99% of the arguments against vaccination this isn't nearly as pithy as you think.

After seeing what going through the initial wave of COVID in a medical provider in the ER did to my mother I could not care less about how many loopholes in efficacy people want to tout.

Vaccines help reduce severity in some capacity. If you can be vaccinated (and not everyone can), and you chose not to because you know better, ask your YouTube doctor of choice to patch you up.

Honestly - shame on you for treating self-preservation as some sort of moral judgement against people someone doesn't like. People don't like to risk their lives for people who won't help themselves.

> People don't like to risk their lives for people who won't help themselves.

That's an entirely reasonable position that I can understand - my advice to those people would be to avoid careers in which they are required to risk their lives for people who won't help themselves.

There's a good reason I'm not a police officer, doctor, fireman, etc. The risk/reward payoff in those careers is far, far too low.

What on earth are you blathering about?

Comparing armed police sent in to deal with possibly armed suspects... firefighters who get sent into infernos... with doctors.

The risks doctors normally face from one patient to another are identical, so it was nonsensical to say they were risking their life for a specific patient. Especially since we've known how to protect from _normal_ bloodborne and airborne pathogens for a long time. The difference is COVID had no vaccine and treatment was limited at the time, it was repeatedly a death sentence.

That's why COVID already forced a rethinking of how far we expect providers to go to save someone: https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006...

There's a good reason you're not a doctor, let's leave it at that.

You seem to have very strong views on this and I don't but as a natural follow up from your arguments, how do you propose we deal with the obesity crisis under the lens of people who don't self preservate and have all sorts of cardiovascular issues and bring healthcare costs to unbearable highs for everyone else?

To be clear my position is that you should treat everyone, fatties, smokers, antivax, whatever, merely because I don't know when I'm going to find myself in one of the "wrong" groups and I'd like to get treatment then, so I think they should get it too.

The data I saw suggested these people are actually significantly cheaper in total for society since they die so much earlier. YMMV depending on the details of your social system of course.

This is not that complicated:

Is a heart attack going to infect your provider?

Is neck cancer going to infect your provider?

We have a vaccine that significantly reduces the odds of putting our healthcare providers at risk and becoming part of the group of people crippling our ability to provide emergency medical care... if you don't take it not because you're ineligible, but because you've decided you know better, you should not be a priority.

And really this is already how it works. When ICUs get overwhelmed, people with COVID who code might not get resuscitated.

The massively increased risk to the provider combined with the chances of recovery mean you will just die:

https://www.cdha.nshealth.ca/system/files/sites/documents/co...

And I guess saying I have strong feelings supposed to be some backhanded ad hominem? I mean clearly you have strong feelings as well, writing tirades about the "fatties", the difference between us is what I write is based on reality

I understand your point about infectiousness I think it's good and I agree.

My comment was as a follow up to your statement: "Vaccines help reduce severity in some capacity", there's a lot of behaviors that reduce severity in some capacity, and doing those would translate in lots of time savings and less pressure on the healthcare system in the same way as the vaccines do, the vaccines just have the extra "bonus" of being able to infect healthcare workers, so their negative effects compound. But if your argument is about first principles, any sort of self preservation has the same problem. So I was just commenting on that.

You're right the bit about feeling strongly was probably a subconscious dig, sorry about that, but I was amused at the "shame on you" and had a moment of weakness, my bad.

Also I didn't intend much with the fatties, I find it eandearing and have been a fatty myself at times in my life and have many I like, if that offended I'm sorry and I wish I hadn't used the term, but that's life and these are just internet comments.

Your examples are not the same, you're presenting cause and treatment. The parent comment discussed one treatment over another: refusing preventive treatment over curative treament.

Problem is that there is not enough capacity for curative treatment only. In this case it would make sense to allocate some hospital capacity for people without vaccination, and more capacity for people that have been vaccinated (maybe in the same ratios as population vaccination).

And also allocate some hospital capacity for people with other diseases so they're not impacted by the fact that some people refuse vaccination.

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