Sibylla Bostoniensis

Content warning: really emotionally rough stuff

Links only, click through to read.

2022 Jan 4: u/RNsRTheCoolest posting on r/CoronavirusUS: "Here's an ICU story that happened a few months ago. I wrote it down so I would never forget. Some that I've shared this with have found it motivating to get vaccinated" Account of an ICU patient who refuses ventilation.

2022 Jan 3: u/powabiatch posting on r/HermanCainAward: "A nurse relates how traumatic it is to take care of even a compliant unvaccinated covid patient." Account of an ICU patient who accepts ventilation. (In images, sorry, no text transcription; click left/right arrows to navigate.) Shows and discusses how shockingly non-sick someone with crashing SpO2 due to COVID can seem.

2022 Jan 4: u/SerfNuts- replying on r/HermanCainAward to previous: "A nurse relates how traumatic it is to take care of even a compliant unvaccinated covid patient." About trying to protect pediatric nursing home patients in the year before the vaccines came out.

Phone died, on other phone with tech support.

ETA: Phone tech support was duly impressed with how fuckt my phone is. I am to take it in to a T-Mobile store in person to see if they can make it better. I was assured it was under warranty, and they'll replace it if its defective.

It is caught in a boot loop.

Relevant error message:

Boot reason: RescueParty
--------
Unable to parse kernel log. For more debug information,
adb pull /mnt/vendor/op2/rbr_log
or pull op2.img

. Is that informative for anybody?

I of course google "OnePlus 9 boot loop" and I am horrified to discover an article which says that one should plan on doing a factory reset of a OnePlus 9 every few months, because its performance degrades so much and that fixes it. Well that is utterly unacceptable. Is that something people have ever heard of before??

(Re previously)

The Late Show with Stephen Colbert had CDC Director Dr Rochelle Walensky on tonight (Youtube), and she described omicron as "two to three times as transmissible as delta".

Delta had an R0 of about 8. Two times 8 is 16. Three times 8 is 24.

The R0 of measles is 16 to 23, depending on whom you ask.

Now, I don't know if "two to three times as transmissible" means you can just multiply against an R0. But R0 is a simple linear scale, so I'm guessing so...?

On Meddit, there have been for a month or two now physicians in the comments complaining that the CDC hasn't told the public that they should upgrade from cloth masks and surgical masks to N95 and KN95 respirators. They are contending that there is no longer a shortage, so the public should be encouraged to improve their protection.

I don't know if it's a product of concern about omicron, the aforementioned breaking of faith with the CDC, such grass-roots physician opinions getting traction, or what, but over the last week or so, there's been an explosion of interest in buying N95 masks.

Questions about how to find reputable vendors have shown up in multiple Reddit groups I'm part of and at least one local email list.

I ordered a box for my household directly from Honeywell (https://ppe.honeywell.com) late on Christmas Eve (Dec 24), and it got here this Wednesday, Dec 29th. Now, somebody has told me that that site is saying they are back-ordered a couple of weeks, though I am not at this moment getting that message. This is what I got, where I got it from. Contrary to what the URL says, it's for the box of 50, and it's $30 + tax + S&H. Came to $39.33 to get it to me.

I anticipate this abrupt uptick in demand from the public will result in shortages.

ETA 2022 Jan 2, 16:29 EST: Aaaaaand Google News tells me just 6 hours ago the Wall Street Journal published an article "Why Cloth Masks Might Not Be Enough as Omicron Spreads" followed by a story on Fox News and one on a local NYC outlet. Apparently there was a story on CBS New York at 13 to midnight, NYE, "With COVID Infection Numbers Surging, Health Experts Say N95 Face Masks Offer Best Protection", which may be the one to break the story, as it were.

I have updated the code and image sprite for the sharing buttons on the bottom of Siderea Posts to, going forward, have a button for posting to Reddit, and no longer have a button for sharing to the (now long defunct) Google+.

I may, eventually, get around to lovingly hand changing all the older posts to have this new arrangement, but as of right now, it is not retroactive.

This is effective as of my last post. If you see the G+ icon instead of the Reddit icon, please do a force-refresh of your tab (most browsers this is is holding down the shift key while clicking the reload button), and if that doesn't fix it, please let me know what browser and OS you're using. I'm effecting this change by means of what I think of as a dodgy CSS hack, and I have concerns about browser compatibility.

This is, I am told, a photograph, taken by Melanie Lueras, a surgical tech at this hospital, Good Samaritan, in Colorado on an iPhone 12:



h/t r/Collapse - Content Warning: Memetic Hazard

[Cut and paste from my email because this has now failed to post twice. Will fix later.]

2021 Dec 24: The Times of Israel: "UK agency: Pfizer booster’s ability to prevent symptomatic COVID wanes within weeks": "Data shows 3rd shot 70% effective in preventing illness after 2 weeks but only 45% after 10 weeks; Moderna seems to offer more durable protection,
staying at 70% after 10 weeks":

The UK Health Security Agency (UKHS
A) reviewed 68,489 Omicron cases in the country. It assessed that Pfizer and Mo
derna vaccines were around 70 percent effective at preventing symptomatic disea
se 2-4 weeks after getting a third shot (down from some 90% effective against t
he previously dominant Delta variant)

With Pfizer boosters, this dropped to 45% by 10 weeks, but Moderna booster effe
ctiveness stayed at around 70% for at least 9 weeks.

Note, take wi
th a grain of salt because I haven't gotten the actual research yet to review.

But that said, there's been little bits of evidence all along that Moderna is b
etter than Pfizer, and even maybe some evidence that cross-vaccinating with dif
ferent vaccines is superior to mono-vaccinating, so if you have Pfizer, maybe s
eriously consider getting a Moderna booster. (I was Pfizer vaccinated and got
myself a Moderna booster.)

I am nominally on vacation this week, in that I told all my patients that I'm taking the week off and not meeting with them. I am, nevertheless, still doing a lot of work-related things, including trying to write a Siderea Post to get out for December. We'll see how that goes. I've been struggling with exhaustion and low mood and poor concentration, which has made writing challenging. I'm definitely experiencing some burnout, in large part, I think, because I didn't take adequate time off this year. I'm going to try to do better about taking breaks in the coming year.

Also, I've had a critical weakness in my self-care game, which I am now realizing I need to get serious about. I saw a new PCP in November who quite reasonably asked me what I did for fun, and I was like, "Oh, hmmm, fun... I remember doing that..." The problem is that while I am not incapable of experiencing enjoyment, I've lost either the capacity or opportunity to enjoy most things I used to do for pleasure. Like, you know, ensemble voice and woodwind music-making and going out for fine dining and shows. Obvious stuff like that, but also unobvious stuff that is apparently an effect of being a therapist. Like I'd noticed many years ago that being a therapist really seemed to diminish my pleasure in movies and fiction; I once said in a movie review, "this is like my job, only boring". I'm not incapable of enjoying books and movies, but the odds that I will enjoy any particular one have gone way, way down, and the odds that it will bore me or stress me out have gone way, way up.

More recently, I've discovered that I am radically less able to emotionally tolerate reading non-fiction therapy-related things that discuss bad things happening to people, which, like, is all the non-fiction therapy-related things I want to read. I've got a book on my nightstand by a really interesting author about a topic I am very interested in, but it has to do with child abuse (comparatively mild child abuse even!) and I am coping with the case studies so badly – my mood has taken a nosedive after every chunk I read – that I've realized I need to at the very least not read it on vacation. So apparently I can't be doing that for fun, like I used to (don't judge) anymore either.

I came to realize more consciously that I've been in a state of not being able to do any of the things that seemed like they would be enjoyable and not able to enjoy any of the things I was able to do. Well... maybe not any.

Realizing I needed to do something to approximate recreation I pulled my harp out of the closet, and I've started practicing daily. And, yes, it is turning out that playing harp is better than not playing harp. I'm four days in, and am making an intention of doing it every day. Unfortunately, I can't do it much, because I have lost a lot of hand strength and stamina, and if I overshoot, I'll fall back into repetitive strain hell, so my practice sessions are necessarily pretty short. But the only way past that is through it, so onward.

My todo list never seems to get any shorter, for at least two really irritating reasons. First of all, every single thing on it takes longer and is more involved than even my cynical/paranoid estimates allowed for.

For instance, one of the banks where I have bank accounts was bought by another bank. They sent me a little torrent of mail about the change over, telling me to watch my mail for the new ATM card I would be receiving. Of course the ATM card never shows up so eventually I look through the mail to see what I'm supposed to do, and there's a phone number you are to call if you don't get a card; I call it, and it is a recording saying that if you didn't get a card in the mail, to present in person at a branch during normal banking hours. Swell. So I eventually managed to take some time during the business day away from my job to spend an hour in a branch to get an ATM card. As a side note, while I'm there, they of course look up to see if I were issued a card in the first place, and it turns out: nope. There is no card number to cancel because, despite the half dozen or more mailer saying I was going to be shipped one, they never issued me one. (The teller has the temerity to then say, "Well, did you even have an ATM card with the old bank?" I just took out my wallet and plucked out my old ATM card and put it on the counter.)

Everything has been like that lately.

The other thing is that the government keeps throwing rocks at my head. Some of this is federal law changes that pertain to health care practitioners – I'll tell you about the No Surprises Act in a moment – and some of it is things like the fact that yesterday, I checked my mail and discovered I have a summons to jury duty. Le sigh.

The entire profession of psychotherapy just woke up to the fact that there's something called the No Surprises Act that goes into effect Jan 1, 2022. Americans, you will be seeing a lot of press about how wonderful it is and how it will protect you, the consumer. Some of it is even true. Some of it, not so much.

The best, most charitable spin I can put on it is that it is a well-meaning law that maybe works great for medical care in hospitals, which is what everyone seems to always imagine when it comes to health care, and they just failed to think about what it would look like to apply to psychotherapy.

But I'm not feeling really charitable.

The law is supposed to prevent patients from getting stuck with large bills "by surprise", after having received medical care.

But the law only applies in the case of patients who don't use their insurance. It actually specifies that these protections are only for people who are uninsured or otherwise self-pay. If you use your insurance to pay for medical services – or try to – then these protections don't pertain to you.

Well, just one little problem with that. At least in psychotherapy. I can't say how this works in the rest of medicine, but in psychotherapy, surprise bills are basically something that only can happen to patients who use insurance.

Psychotherapy is, to my knowledge, the only branch of medicine in the US for which there is a very large self-pay market. Those of use who don't take insurance, we don't issue surprise bills. In fact, many of us don't bill at all. I, personally, have never billed a patient, at all, ever. I don't need to, because like many other psychotherapists who are strictly self-pay (also called private pay), I run my practice as pay-as-you-go. I tell my patients on intake that I do not allow patients to carry unpaid balances except by advance arrangement, entirely so that they don't abruptly get socked with a huge bill later on. And unlike in the rest of medicine, I, the actual healthcare provider herself, as is typical for private pay private practice psychotherapists, discuss my fees and the cost of receiving treatment from me directly and forthrightly with my patients. Frequently, even. I do not ever want my patient to get surprised by our financial dealings, except maybe happily, so I not only am super transparent and clear about fees and costs, I work overtime to keep the channel of communication open about money, so that if a patient has a financial problem, I know about it so I can lower my rates.

No, surprise bills in psychotherapy are almost entirely the product of a patient trying to use their insurance to pay for psychotherapy and it not working. Surprise bills come from insurance companies misleading their insureds about therapy being covered, and the insured booking appointments with a therapist under the impression the insurance is going to pay for it, only, oopsie doodle, the insurance company decides eventually that nope, they don't feel like doing that, so now you're on the hook for months of weekly therapy sessions. "Oh, did we list that therapist as being in-network for your plan on our website? Our bad! So sad. It was an honest mistake, you know how hard it is to keep track of which therapists are actually taking our insurance product. But, I'm sure you understand, we're not going to pay for all the therapy you had over the last three months while we came to this conclusion."

Hey did I ever tell you about how BCBS of MA, back when I worked for a clinic, refused to pay for the therapy of a patient of mine for months because apparently – as best our billing specialist could figure out – the patient had a first name like "Mary Ann" but somewhere in their system someone had once entered it as "Ann Mary" so even though we had all the right insurance ID numbers for that patient, and the name in our computer matched the name printed on the patient's insurance card, the insurance company kept insisting they had no idea who this patient was and clearly their medical bills were none of their problem? Yeah.

Yeah, in psychotherapy, surprise bills are a product of the insurance industry and, with the exception of the odd private pay psychotherapist who doesn't run on a pay-as-you-go model (WHY?) don't happen to self-pay patients.

So the patients who need this protection don't get it, and those of us whose patients don't need it get to do additional, Kafka-esque paperwork that doesn't even make sense in the case of psychotherapy. I get to spend my vacation making up a new form and making versions for every patient on my caseload. And my patients get more mystifying, confusing paperwork, which even if they wish to opt out of receiving, they can't.

Also, apparently there's something in there about having to have an arbitration services in case a patient objects to one of the bills I don't send them? Good times.

Meanwhile, coming soon to media near you: painting healthcare providers who complain about any of this as rascals who have been caught ripping off their patients.

So there's that.

The pandemic continues apace. I have a lot I feel I should apprise you of, but also I am so very tired of having to cover it, and would really like to share my thoughts on other things, instead. This is one of the great bummers of global catastrophes: the emergent need to focus on survival really sucks up all the oxygen in the room. Sometimes literally.

Anyhoo, I should get back to doing that. It's not like I don't have a lot to say about the pandemic.

Americans, the US just approved Pfizer's Paxlovid, the first COVID medication one can take at home.

Here's the critical information to know:

0. It only works if you take it within five days of the onset of symptoms. Ideally you take it in under three days. But it will be by prescription. To quote the below article:

Patients will need a positive COVID-19 test to get a prescription. And Paxlovid has only proven effective if given within five days of symptoms appearing. With testing supplies stretched, experts worry it may be unrealistic for patients to self-diagnose, get tested, see a physician and pick up a prescription within that narrow window.

“If you go outside that window of time I fully expect the effectiveness of this drug is going to fall,” said Andrew Pekosz, a Johns Hopkins University virologist.

1. Supplies are very limited, and will be rationed, going to the hardest hit areas and reserved for those with the most risk factors:

The Food and Drug Administration authorized Pfizer’s drug for adults and children ages 12 and older with a positive COVID-19 test and early symptoms who face the highest risks of hospitalization. That includes older people and those with conditions like obesity and heart disease, though the drug is not recommended for patients with severe kidney or liver problems.

2. It's authorized for children down to age 12, but

Children eligible for the drug must weigh at least 88 pounds (40 kilograms).

Here's the source:

2021 Dec 21: AP: "Pfizer pill becomes 1st US-authorized home COVID treatment" by Matthew Perrone:

WASHINGTON (AP) — U.S. health regulators on Wednesday authorized the first pill against COVID-19, a Pfizer drug that Americans will be able to take at home to head off the worst effects of the virus.

[...]

The drug, Paxlovid, is a faster way to treat early COVID-19 infections, though initial supplies will be extremely limited. All of the previously authorized drugs against the disease require an IV or an injection.

An antiviral pill from Merck also is expected to soon win authorization. But Pfizer’s drug is all but certain to be the preferred option because of its mild side effects and superior effectiveness, including a nearly 90% reduction in hospitalizations and deaths among patients most likely to get severe disease.

“The efficacy is high, the side effects are low and it’s oral. It checks all the boxes,” said Dr. Gregory Poland of the Mayo Clinic. “You’re looking at a 90% decreased risk of hospitalization and death in a high-risk group — that’s stunning.”

The Food and Drug Administration authorized Pfizer’s drug for adults and children ages 12 and older with a positive COVID-19 test and early symptoms who face the highest risks of hospitalization. That includes older people and those with conditions like obesity and heart disease, though the drug is not recommended for patients with severe kidney or liver problems. Children eligible for the drug must weigh at least 88 pounds (40 kilograms).

The pills from both Pfizer and Merck are expected to be effective against omicron because they don’t target the spike protein where most of the variant’s worrisome mutations reside.

Pfizer currently has 180,000 treatment courses available worldwide, with roughly 60,000 to 70,000 allocated to the U.S. The company said it expects to have 250,000 available in the U.S. by the end of January.

Federal health officials are expected to ration early shipments to the hardest hit parts of the country. Pfizer said the small supply is due to the manufacturing time — currently about nine months. The company says it can halve production time next year.

The U.S. government has agreed to purchase enough Paxlovid to treat 10 million people, and it will be provided free to patients. Pfizer says it’s on track to produce 80 million courses globally next year, under contracts with the U.K., Australia and other nations.

[...]

Pfizer’s pill comes with its own challenges.

Patients will need a positive COVID-19 test to get a prescription. And Paxlovid has only proven effective if given within five days of symptoms appearing. With testing supplies stretched, experts worry it may be unrealistic for patients to self-diagnose, get tested, see a physician and pick up a prescription within that narrow window.

“If you go outside that window of time I fully expect the effectiveness of this drug is going to fall,” said Andrew Pekosz, a Johns Hopkins University virologist.

The FDA based its decision on company results from a 2,250-patient trial that showed the pill cut hospitalizations and deaths by 89% when given to people with mild-to-moderate COVID-19 within three days of symptoms. Less than 1% of patients taking the drug were hospitalized and none died at the end of the 30-day study period, compared with 6.5% of patients hospitalized in the group getting a dummy pill, which included nine deaths.

Pfizer’s drug is part of a decades-old family of antiviral drugs known as protease inhibitors, which revolutionized the treatment of HIV and hepatitis C. The drugs block a key enzyme which viruses need to multiply in the human body.

The U.S. will pay about $500 for each course of Pfizer’s treatment, which consists of three pills taken twice a day for five days. Two of the pills are Paxlovid and the third is a different antiviral that helps boost levels of the main drug in the body.

Commentary:

I think the claim that because it doesn't target the spike protein, it should be as effective against omicron is absurd on the face of it: omicron comes on faster than other strains, and if the med has to be taken within a certain time period of onset of symptoms that timespan will almost certainly be shorter with omicron. Which means the "notice you're sick, turn around a PCR test and fill a prescription" process has to be acquitted in even less time with omicron.

2021 Dec 15: CNN: "'This is not normal': Extreme weather events stun CNN meteorologist" [video] Tom Sater, meteorologist. "Extreme Weather: Severe weather ahead for central U.S., southern plains".

Summary: weather forcast across US shows: most of the lower 48 having temps 20ºF to 40ºF over normal, shattering records; enormous rain, mudslides in southern CA and massive snowfall in the Sierras have already happened and the storm which caused them is entering Colorado with wind gusts 90 to 100 miles an hour ("It looked like a sandstorm moving in"); hurricane-force winds, high tornado threats, and unprecedented fire risks predicted in various areas of the middle of the country which basically add up to the whole middle third.

Basically, if you live in the US east of the Continental Divide and west of the Ohio river – from El Paso to the UP of Michigan – you should be tuned into the weather and expect the unexpected.

Follow-up:

2021 Dec 16: CNN: "More than 400K have no power across the central US after storms delivered a record spate of hurricane-force gusts" by By Travis Caldwell, Jason Hanna and Brandon Miller. The embedded video is incredible. It does, in fact, look like a sandstorm moving in. It looks like a sepia-tone photo. It looks like the Dust Bowl.

See also:

2021 Dec 16: CNN: "Climate scientist makes dire prediction about monster storms" for talking-head video with a climate scientist who very politely doesn't say "WTYS" or act in the least bit smug, and who delivers a nice, "this is the new normal" explanation. Probably nothing here you haven't already heard and believe, it's mostly of interest in a tracking what degree of forthrightness about the climate catastrophe the news media allow to be expressed on air.