The COVID-19 pandemic

[panamaniac]

Here’s hoping it costs the doctor his career.

[ac3r]

He has been doing this all week. Since 2014, he has been forbidden to prescribe narcotics by the College of Physicians and Surgeons of Ontario. In 2018, his house was repossessed. His personal website is full of "the pandemic isn't that bad" rhetoric, mixed with all sorts of pseudoscience about how you can just supposedly boost your immune system to fight viruses. The guy clearly fell off the wagon at some point in life. I imagine he's fed up with his life and this is his way of going out with a bang. Hopefully he loses his license, even if his end goal is to just retire and fuck off.

[ijmorlan]

Fortunately it's being investigated now, but I worry there's doctors out there doing the same but better at covering their tracks.

It should be trivial to identify targets for investigation: anybody who has more than some specific small fraction of their patients exempted should be carefully investigated. Maybe a higher threshold for somebody in a specialty where it would make sense for lots of their patients to be exempted.

Of course, I’m assuming we have even a basic electronic health record …

[jeffster]

Current (Thursday) Covid-19 cases per 100k

• Chatham-Kent Public Health 94.1
• Windsor-Essex County Health Unit 64.5
• Eastern Ontario Health Unit 63.2
• Brant County Health Unit 52.8
• Wellington-Dufferin-Guelph Public Health 46.8
• Lambton Public Health 45.1
• Niagara Region Public Health 40.2
• City of Hamilton Public Health Services 39.2
• Ottawa Public Health 37.1
• York Region Public Health 35.7

• Region of Waterloo Public Health and Emergency Services 28.2

• Porcupine Health Unit 13.2
• Northwestern Health Unit 12.5
• Kingston, Frontenac and Lennox & Addington Public Health 11.8
• Haliburton, Kawartha, Pine Ridge District Health Unit 11.1
• Algoma Public Health 10.5
• Grey Bruce Health Unit 8.8
• Leeds, Grenville & Lanark District Health Unit 6.9
• Renfrew County and District Health Unit 6.4
• North Bay Parry Sound District Health Unit 6.2
• Thunder Bay District Health Unit 0.0

• TOTAL ONTARIO 31.3

Ontario continues to trend down, which is great news.

[jeffster]

Looks like some people in the region are already willing to start punishing local businesses by ordering food and then not going to pick it up. This was occurring in other provinces too. It doesn't even make sense: https://www.reddit.com/r/waterloo/commen...ting_this/

Aren’t orders usually prepaid these days?

Whenever I order, it's not prepaid.

[Bjays93]

I honestly don't understand doctors willing to inappropriately hand out medical exemptions. My mother is surrounded by people who are "alternative care practitioners" or healthcare professionals who have been saying from the start this vaccine came out too quick and we shouldn't get it, yet none of them will issue false medical exemptions. They understand that exemptions are limited to the 2 things outlined by the province and nothing more and they respect that. 

Even purely from a business standpoint how is issuing exemptions when you shouldnt going to make you any money or anything. You have literally nothing to gain and everything to lose it makes no sense. 

Rant end

[ac3r]

Doctors are humans like the rest of us. They all have different beliefs. Science itself is objective, but those who practice it are not always themselves. Some - like the guy mentioned above - seem to have some screws loose and this is the hill he wants to die on. Others are a driven by ideology, others are driven by politics, others are driven by profit, others are driven by quack alternative beliefs etc. There's a lot of research out there on the psychological, political and ideological toll this pandemic has had on people. Even doctors, who may have otherwise been pretty rational, have begun to have certain reactions to everything which is why you find them out there speaking out against vaccines, lockdowns and masks.

It'll be interesting to read about all of this in the coming years as we try to figure out what the hell went wrong and how we can better avoid making these mistakes during the next pandemic we face.

[jeffster]

• Chatham-Kent Public Health 84.7
• Eastern Ontario Health Unit 67.6
• Windsor-Essex County Health Unit 63.8
• Brant County Health Unit 50.9
• City of Hamilton Public Health Services 44.8
• Lambton Public Health 44.3
• Wellington-Dufferin-Guelph Public Health 43.0
• Niagara Region Public Health 40.2
• Ottawa Public Health 37.6
• Peel Public Health 34.4

• Region of Waterloo Public Health and Emergency Services 26.7

• Public Health Sudbury & Districts 15.6
• Porcupine Health Unit 15.6
• Kingston, Frontenac and Lennox & Addington Public Health 13.2
• Haliburton, Kawartha, Pine Ridge District Health Unit 11.6
• Algoma Public Health 9.6
• Leeds, Grenville & Lanark District Health Unit 7.5
• Grey Bruce Health Unit 5.9
• North Bay Parry Sound District Health Unit 5.4
• Renfrew County and District Health Unit 1.8
• Thunder Bay District Health Unit 0.7

• TOTAL ONTARIO 30.9

[jeffster]

This is what gives the anti-vax crowd more fuel for their beliefs. And is super unhelpful for the vaccine hesitant.

https://www.owensoundsuntimes.com/news/l...s-underway

[tomh009]

There is no harm in receiving an expired vaccine. In fact, Health Canada extended the dates on some of the early AZ vaccines that we received, as I recall.

[ac3r]

In fact, a significant amount of drugs in existence are fine well past their expiration date. The US Air Force did a huge study back in the mid 1980s on the viability of extending the shelf life of drugs. They came to the conclusion that many of them are completely fine even years after the printed expiration date. The DOD and FDA then went on to create a program called the Shelf Life Extension Program to gather data and save drugs that would have otherwise been thrown out. In 2021, the FDA has been conducting research on the viability of extending the shelf life of SARS-CoV-2 vaccines as well and were able to extend the shelf life of some of them. Not sure if Health Canada has done the same, but they may have.

More research would definitely be needed to determine how long they could stretch them out, but it seems like even SARS-CoV-2 vaccine shelf life can be extended a bit already. I've often heard criticisms that the reason why most drugs have shelf lives is - obviously, not all are safe in long term storage - but that it lets pharmaceutical companies earn a profit. No doubt the media just wanted to run a clickbaity story about giving Indigenous communities expired vaccines because it creates outrage and profit. I'm Indigenous myself and if the vaccines are still usable, there is no reason to not use them. When it comes to healthcare it's ideal to use the best of the best, but there are still times when you can make concessions to that.

ProPublica has a good article on it that I've often shared when discussing this topic: https://www.propublica.org/article/the-m...tion-dates

[jamincan]

Looks like some people in the region are already willing to start punishing local businesses by ordering food and then not going to pick it up. This was occurring in other provinces too. It doesn't even make sense: https://www.reddit.com/r/waterloo/commen...ting_this/

Aren’t orders usually prepaid these days?

Arabesque allows you to order online, but you pay when you pick it up.

[ijmorlan]

In fact, a significant amount of drugs in existence are fine well past their expiration date.

I would assume that the expiry date is the date to which the drug is known to be good, just like the approved population and dosage is the population and dosage for which it is known to be safe and effective.

So just as drugs will often be safe in populations which haven’t been studied and in doses which haven’t been studied, so to will they continue to be effective a certain amount of time past their due date.

This is inevitable given the nature of drug research: to develop a drug which can be used. That doesn’t require fully researching just exactly how long it lasts, only establishing that it lasts long enough.

Really this is just engineering. Every engineered structure in existence can take more weight than it ever does (well, except for the occasional screw-up); but the weight it takes is one that is established to be safe. Same thing with drugs.

[danbrotherston]

In fact, a significant amount of drugs in existence are fine well past their expiration date.

I would assume that the expiry date is the date to which the drug is known to be good, just like the approved population and dosage is the population and dosage for which it is known to be safe and effective.

So just as drugs will often be safe in populations which haven’t been studied and in doses which haven’t been studied, so to will they continue to be effective a certain amount of time past their due date.

This is inevitable given the nature of drug research: to develop a drug which can be used. That doesn’t require fully researching just exactly how long it lasts, only establishing that it lasts long enough.

Really this is just engineering. Every engineered structure in existence can take more weight than it ever does (well, except for the occasional screw-up); but the weight it takes is one that is established to be safe. Same thing with drugs.

The "occasional screw up" is one major reason FOR the safety factor.

But this is somewhat different from safety factors in engineering. While we might guess (and are probably right) that a drug is safe and effective past the expiry date (it's unlikely that we hit the real expiry right on, and it's likely it's a gradual dropoff anyway), we have no actual data to show that it is. This is different from safety factors in engineering, where we KNOW a design is adequate for say 2x it's estimated loading, because that is what we designed it to be because we might have miss-estimated the loading factor.

Or I should say, that is my understanding, I don't actually know how expiry date for drugs are estimated, I don't THINK that they empirically measure the effectiveness of the drug (either in vivo or vitro) at different points past manufacture time and choose the point in time where efficacy drops below a targeted amount. But I suppose it is possible that they do.

[ac3r]

I would assume that the expiry date is the date to which the drug is known to be good

Yeah, according to what the pharmaceutical companies published at least.

The US Air Force studies - amongst others - demonstrated that there are a ton of drugs out there that are still good well past their dates. It's just that nobody (namely the developers) bothered to do long term studies on them, since the goal of a pharmaceutical company is to develop a product ASAP and get it out onto the market for profit. It took independent studies to say, wait a second, these drugs are still fine way past the printed date...why are we spending millions/billions buying more? And that was the goal of the Shelf Life Extension Program: to stop wasting drugs and save money, rather than continually buy new ones from the manufacturers simply because the manufacturers stated that they expire on XX-XX-XXXX.