"WW C"- COVID-19, GLOBAL CASES SURPASS 676 MILLION...CASES 676,609,955 DEATHS 6,881,955 US CASES 103,804,263 US DEATHS 1,123,836 8:30pm 1/28/24

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'I am scared for all of us:' Idaho hospitals move into crisis standards as COVID-19 cases surge

“The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals."

Author: Katie Terhune
Published: 5:25 PM MDT September 16, 2021
Updated: 5:25 PM MDT September 16, 2021


BOISE, Idaho — There is despair now, in Idaho's hospital hallways and ICU wards and waiting rooms and morgues.

Early in the COVID-19 pandemic, medical staff watched people pull together, staying home, wearing a mask, and fighting as one to defeat the spread of the virus.

There was hope, then, that Idaho might avoid the worst outcome: An infection rate so high and hospitals so overwhelmed by the virus that doctors will be asked to make grueling choices about which of their patients will live and which will not.

That hope ended Thursday.

Following a request from St. Luke's Health System, the Idaho Department of Health and Welfare announced the expansion of crisis standards of care to the entire state, beginning the process by which medical staff, equipment, and hospital beds may now be rationed for those who are most likely to survive.

Jim Souza, Chief Physician Executive for St. Luke's, compared a hospital's normal operation to a "high wire act." In the current crisis, the scaffolding that makes that possible has fallen apart.

"The net is gone, and the people will fall from the wire," he said. "We are not able to continue to provide a conventional care standard."

At St. Luke's, people with bladder cancer, prostate cancer, and some breast cancers are being told they will have to wait for surgery to remove their tumors. People dangerously ill with sepsis are being treated in the waiting room because there are no beds available.

Patients who can't breathe without help are being ventilated by hand - with nurses squeezing a bag to force air into their lungs for hours at a time - because all the ventilators are being used on other people.

Doctors are sending COVID-19 patients that normally would be admitted to the hospital home with oxygen, prescriptions, and a set of instructions, hoping they will be able to care for themselves "when and if they deteriorate," Souza said.

"If we continue on this course, over the next several weeks, St. Luke's Health System will become a COVID health system," St. Luke's CEO Chris Roth said. "We will consume every bed and every single resource we have with COVID patients. Our ICUs are not only full, they are overflowing."

Two weeks ago, the St. Luke's hospitals hit an all-time record high of 173 COVID-19 patients. Today, that number stands at 281. Almost all of them are unvaccinated.

"This pandemic is relentless," Roth said. "We are all tired, we are all exhausted, and sadly instead of fighting this pandemic together we seem to be fighting each other."

Crisis standards act as a set of guidelines to help hospitals "under the extraordinary circumstances of an overwhelming disaster or public health emergency" to figure out how to keep as many patients alive as possible. In some areas, that will mean a long wait for a hospital bed or the chance to see a doctor; at its darkest, the designation means some very sick or badly injured people may receive only "comfort care" because the equipment that would normally be used to treat them or keep them breathing is being used for someone else.

Lack of staff is not the issue, officials said. St. Luke's has hired 802 people, more than half of whom are clinical providers, bringing them to higher staffing levels than before the latest surge in cases began earlier this summer.

The health system has also expanded overflow areas, treating patients in the catheterization laboratory, in X-ray imaging areas, in the waiting room, and in the ER in lieu of hospital rooms. The morgue has been expanded to deal with the influx of the dead.

It is still not enough, according to St. Luke's Chief Operating Officer Sandee Gehrke.

Employees are dealing with a "heartbreaking," unending level of stress as they try to keep up with the demand, she said.

"They are working ten shifts in a row, and they don't get to see their family, and they are seeing the death and the despair that COVID is bringing to us," she said. "It is really taking a toll across the board."

Not every hospital has slipped from the wire.

Chief Medical Officer Dr. Steven Nemerson said Thursday that while Saint Alphonsus Health System is in the "most extreme of contingency standards," they have not yet begun to ration care.

According to Health and Welfare, all not all hospitals will move to crisis standards of care immediately. Facilities that are managing under their current circumstances can continue to do so for as long as they are able.

Nemerson also noted that as of Thursday, no Idahoan has been removed from life support so the equipment could be given to a patient with "a better prognosis."

But that day is not far off if the rate of hospitalizations continues unabated, he said.

"I am scared," Nemerson said. "I am scared for all of us, because while we are currently able to tread water and, through the mechanisms that St. Luke's has shared with you, continue to deliver reasonable standards of care, it's going to decline simply because a caregiver can't get to a patient fast enough."

Rural hospitals, unused to a deluge of patients, are also becoming overwhelmed.

Tom Murphy, the CEO of Minidoka Memorial Hospital in Rupert, said he has long relied on the larger area hospitals to take in transfers of Minidoka patients who needed a higher level of care.

Now, he watches helicopters land at his small hospital in Rupert, carrying intensive care patients from the larger facilities where there is no room.

"We just keep trying to do what we can to keep our head above the water," he said. "We are really concerned that we will be overrun before too long as well."

Acknowledging that 18 months into the pandemic they were sounding like "a broken record," the medical leaders renewed the plea for Idahoans to get vaccinated, avoid large gatherings, wear a mask in group settings, and to trust their doctors over the misinformation on COVID-19 swirling on social media.

Just over 50% of eligible Idahoans are vaccinated, while the unvaccinated make up more than 95% of COVID-19 hospital admits.

Souza pointed to the predictive modeling doctors have used to successfully forecast looming infections and hospitalization rates. If the current trend continues, he said, 9,000 people in Idaho will become infected with COVID-19 in the next week. An estimated 300 of those will end up in the hospital. Twenty-four of them will die.

Maybe they didn't have to.

"They are 24 human beings," Souza said. "Now, I don't know their names today, but some of us around the state will come to know those 24 people's names in the 9,000 that are going to acquire it this week. And we will hold their hands, and care for them, and we will know their families. They are not a statistic."

Idaho-Coronavirus-Map-USE-860x484.jpg
 

easy_b

Look into my eyes you are getting sleepy!!!
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'I am scared for all of us:' Idaho hospitals move into crisis standards as COVID-19 cases surge

“The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals."

Author: Katie Terhune
Published: 5:25 PM MDT September 16, 2021
Updated: 5:25 PM MDT September 16, 2021


BOISE, Idaho — There is despair now, in Idaho's hospital hallways and ICU wards and waiting rooms and morgues.

Early in the COVID-19 pandemic, medical staff watched people pull together, staying home, wearing a mask, and fighting as one to defeat the spread of the virus.

There was hope, then, that Idaho might avoid the worst outcome: An infection rate so high and hospitals so overwhelmed by the virus that doctors will be asked to make grueling choices about which of their patients will live and which will not.

That hope ended Thursday.

Following a request from St. Luke's Health System, the Idaho Department of Health and Welfare announced the expansion of crisis standards of care to the entire state, beginning the process by which medical staff, equipment, and hospital beds may now be rationed for those who are most likely to survive.

Jim Souza, Chief Physician Executive for St. Luke's, compared a hospital's normal operation to a "high wire act." In the current crisis, the scaffolding that makes that possible has fallen apart.

"The net is gone, and the people will fall from the wire," he said. "We are not able to continue to provide a conventional care standard."

At St. Luke's, people with bladder cancer, prostate cancer, and some breast cancers are being told they will have to wait for surgery to remove their tumors. People dangerously ill with sepsis are being treated in the waiting room because there are no beds available.

Patients who can't breathe without help are being ventilated by hand - with nurses squeezing a bag to force air into their lungs for hours at a time - because all the ventilators are being used on other people.

Doctors are sending COVID-19 patients that normally would be admitted to the hospital home with oxygen, prescriptions, and a set of instructions, hoping they will be able to care for themselves "when and if they deteriorate," Souza said.

"If we continue on this course, over the next several weeks, St. Luke's Health System will become a COVID health system," St. Luke's CEO Chris Roth said. "We will consume every bed and every single resource we have with COVID patients. Our ICUs are not only full, they are overflowing."

Two weeks ago, the St. Luke's hospitals hit an all-time record high of 173 COVID-19 patients. Today, that number stands at 281. Almost all of them are unvaccinated.

"This pandemic is relentless," Roth said. "We are all tired, we are all exhausted, and sadly instead of fighting this pandemic together we seem to be fighting each other."

Crisis standards act as a set of guidelines to help hospitals "under the extraordinary circumstances of an overwhelming disaster or public health emergency" to figure out how to keep as many patients alive as possible. In some areas, that will mean a long wait for a hospital bed or the chance to see a doctor; at its darkest, the designation means some very sick or badly injured people may receive only "comfort care" because the equipment that would normally be used to treat them or keep them breathing is being used for someone else.

Lack of staff is not the issue, officials said. St. Luke's has hired 802 people, more than half of whom are clinical providers, bringing them to higher staffing levels than before the latest surge in cases began earlier this summer.

The health system has also expanded overflow areas, treating patients in the catheterization laboratory, in X-ray imaging areas, in the waiting room, and in the ER in lieu of hospital rooms. The morgue has been expanded to deal with the influx of the dead.

It is still not enough, according to St. Luke's Chief Operating Officer Sandee Gehrke.

Employees are dealing with a "heartbreaking," unending level of stress as they try to keep up with the demand, she said.

"They are working ten shifts in a row, and they don't get to see their family, and they are seeing the death and the despair that COVID is bringing to us," she said. "It is really taking a toll across the board."

Not every hospital has slipped from the wire.

Chief Medical Officer Dr. Steven Nemerson said Thursday that while Saint Alphonsus Health System is in the "most extreme of contingency standards," they have not yet begun to ration care.

According to Health and Welfare, all not all hospitals will move to crisis standards of care immediately. Facilities that are managing under their current circumstances can continue to do so for as long as they are able.

Nemerson also noted that as of Thursday, no Idahoan has been removed from life support so the equipment could be given to a patient with "a better prognosis."

But that day is not far off if the rate of hospitalizations continues unabated, he said.

"I am scared," Nemerson said. "I am scared for all of us, because while we are currently able to tread water and, through the mechanisms that St. Luke's has shared with you, continue to deliver reasonable standards of care, it's going to decline simply because a caregiver can't get to a patient fast enough."

Rural hospitals, unused to a deluge of patients, are also becoming overwhelmed.

Tom Murphy, the CEO of Minidoka Memorial Hospital in Rupert, said he has long relied on the larger area hospitals to take in transfers of Minidoka patients who needed a higher level of care.

Now, he watches helicopters land at his small hospital in Rupert, carrying intensive care patients from the larger facilities where there is no room.

"We just keep trying to do what we can to keep our head above the water," he said. "We are really concerned that we will be overrun before too long as well."

Acknowledging that 18 months into the pandemic they were sounding like "a broken record," the medical leaders renewed the plea for Idahoans to get vaccinated, avoid large gatherings, wear a mask in group settings, and to trust their doctors over the misinformation on COVID-19 swirling on social media.

Just over 50% of eligible Idahoans are vaccinated, while the unvaccinated make up more than 95% of COVID-19 hospital admits.

Souza pointed to the predictive modeling doctors have used to successfully forecast looming infections and hospitalization rates. If the current trend continues, he said, 9,000 people in Idaho will become infected with COVID-19 in the next week. An estimated 300 of those will end up in the hospital. Twenty-four of them will die.

Maybe they didn't have to.

"They are 24 human beings," Souza said. "Now, I don't know their names today, but some of us around the state will come to know those 24 people's names in the 9,000 that are going to acquire it this week. And we will hold their hands, and care for them, and we will know their families. They are not a statistic."

Idaho-Coronavirus-Map-USE-860x484.jpg
Yup :smh:
 

lightbright

Master Pussy Poster
BGOL Investor
‘The situation is dire:’ Idaho declares crisis standards for all hospitals as COVID-19 surges

61437956841fa.hires.jpg
Ann Enderle R.N. attends to a COVID-19 patient in the Medical Intensive care unit (MICU) at St. Luke’s Boise Medical Center in Boise, Idaho on Aug. 31, 2021. Idaho declared crisis standards of care statewide on Sept. 16, 2021.

The crisis in Idaho is now widespread.

After a request from St. Luke’s Health System, the Idaho Department of Health and Welfare declared crisis standards of care statewide on Thursday morning.

Crisis standards of care mean hospitals can operate outside of normal settings, with different staff ratios and, in the worst-case scenario, ration care to save the most lives.

North and Central Idaho have been in crisis standards of care since Sept. 6 .

The Idaho Crisis Standards of Care Activation Advisory Committee met on Wednesday and determined that the influx of COVID patients had severely impacted all of the state’s hospitals to the point of asking the director to expand crisis standards statewide.

The move comes as COVID cases and hospitalizations are at their highest point in the pandemic and show no signs of slowing.

As of Tuesday, there were more than 600 Idaho residents hospitalized with the virus as federal contract workers are being dispatched to support understaffed hospitals. There were 173 Idaho COVID patients in ICUs statewide.

Last winter, hospitals statewide saw just over 400 COVID patients at once before the surge quelled.

“Our hospitals and health care systems need our help. The best way to end crisis standards of care is for more people to get vaccinated. It dramatically reduces your chances of having to go to the hospital if you do get sick from COVID-19. In addition, please wear a mask indoors in public and outdoors when it’s crowded to help slow the spread,” Department of Health and Welfare director Dave Jeppesen said in a news release. “The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident.”

Not all hospitals will have to ration care under the declaration, as situations vary around the state and in different hospitals.

Kootenai Health has been operating in crisis standards of care for a little longer than a week, treating lower-level COVID patients in a former conference room and stretching staffing patterns to accommodate the surge.

There are 113 Panhandle residents hospitalized with the virus at Kootenai Health, and 34 of those COVID patients are in the intensive care unit.

Staffing challenges have forced the Coeur d’Alene hospital to ask the state for resources. A medical team from the Department of Defense and contracted federal workers have arrived in the last week to help the hospital treat the surge of COVID patients.

The addition of 90 staff members is helping already exhausted nurses attend to the predominantly unvaccinated COVID patients who continue to come into the hospital seeking treatment, but additional staff will not be enough to keep the hospital out of crisis standards of care.

Hospital leaders have asked Idaho residents repeatedly to wear masks and get vaccinated to help stem the tide of COVID cases and hospitalizations that continues to rise statewide.

Here’s a look at local numbers:

The Spokane Regional Health District reported 296 COVID-19 cases on Thursday and one additional death.

There have been 795 deaths due to COVID-19 in Spokane County residents.

There are 231 COVID-19 patients in Spokane hospitals.

The Panhandle Health District reported 183 new cases and 35 additional deaths on Thursday.

There have been 433 COVID deaths in Panhandle residents.

There are 113 Panhandle residents hospitalized with the virus.



'The situation is dire:' Idaho declares crisis standards for all hospitals as COVID-19 surges | The Spokesman-Review
 

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Alaska’s Largest Hospital Goes Into Crisis Mode As Patients Wait Hours To See ER Doctors
“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” an official at the hospital said.

ANCHORAGE, Alaska (AP) — Overwhelmed by a surge in COVID-19 patients, Alaska’s largest hospital on Tuesday implemented crisis standards of care, prioritizing resources and treatments to those patients who have the potential to benefit the most.
“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” Dr. Kristen Solana Walkinshaw, chief of staff at Providence Alaska Medical Center, wrote in a letter addressed to Alaskans and distributed Tuesday.

“The acuity and number of patients now exceeds our resources and our ability to staff beds with skilled caregivers, like nurses and respiratory therapists. We have been forced within our hospital to implement crisis standards of care,” Walkinshaw wrote.

Alaska, like other places, has seen a surge in coronavirus cases driven by the highly contagious delta variant. State health officials said Tuesday there were 691 new cases and six recent deaths, all Anchorage men ranging in age from 50s to 70s. A woman in her 60s from out-of-state also recently died in Juneau, the department said.
Health officials said statewide that there are 202 patients diagnosed with COVID-19 who are hospitalized, and nine additional patients are under investigation. Officials said 33 of these people are on ventilators.
The percentage of patients currently hospitalized with COVID-19 is 17.5%, the state reported.

At Providence, more than 30% of the adult patients that are hospitalized have tested positive. This also comes at a normally busier time of the year for Alaska hospitals.

Walkinshaw noted that the state’s COVID-19 dashboard, which is routinely updated with numbers related to the virus, “isn’t equipped or designed to demonstrate the intricacies of providing medical care during this unprecedented time.”
At Providence, one of only three hospitals in a city of about 300,000 residents, officials have developed and enacted procedures to ration medical care and treatments, including dialysis and specialized ventilatory support.

The emergency room is overflowing at Providence, and she said patients wait for hours in their cars to see a doctor for emergency care.
Walkinshaw noted that what happens at the Anchorage hospitals affects the entire state since specialty care can often only be provided in the state’s largest city.
“Unfortunately, we are unable to continue to meet this need; we no longer have the staff, the space, or the beds,” Walkinshaw wrote. “Due to this scarcity, we are unable to provide lifesaving care to everyone who needs it.”
That has left patients across the state sitting in local hospitals since Providence can’t accept them for transfer.
“If you or your loved one need specialty care at Providence, such as a cardiologist, trauma surgeon, or a neurosurgeon, we sadly may not have room now. There are no more staffed beds left,” she wrote.
Walkinshaw said they expect an increase in COVID-19 cases in the next two to four weeks, causing an already stressful situation to possibly “rapidly progress to a catastrophe,” she said.
She said the single most important thing people can do is to get vaccinated. Alaska was the first state to open vaccinations to all residents. As of Monday, 56.5% of eligible Alaskans have been vaccinated.
Alaska Gov. Mike Dunleavy, a Republican who has recovered from COVID-19 and been vaccinated, said employees at Alaska hospitals are working long hours, some have left their jobs and there are capacity concerns.

Dunleavy, who never imposed a statewide mask mandate, has faced criticism in the past from some who say he hasn’t come out forcefully enough in support of vaccination.
“I urge, and I hope you guys print this, I strongly urge folks to get a vaccine, strongly urge them to do that,” he told reporters Tuesday.
Walkinshaw also asked that everyone wear masks, even if they are vaccinated and avoid unmasked activities. She also urged people who are sick or have been exposed to get tested and asked people to avoid potentially dangers activities and situations that may increase the need for emergency services of medical care.
“Unfortunately, if you are seriously injured, it is possible that there will not be a bed available at our trauma center to save your life,” Walkinshaw wrote.
___
Associated Press journalist Becky Bohrer contributed to this report from Juneau, Alaska.

Alaska’s Largest Hospital Goes Into Crisis Mode As Patients Wait Hours To See ER Doctors | HuffPost
 

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Alaska’s Largest Hospital Goes Into Crisis Mode As Patients Wait Hours To See ER Doctors
“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” an official at the hospital said.

ANCHORAGE, Alaska (AP) — Overwhelmed by a surge in COVID-19 patients, Alaska’s largest hospital on Tuesday implemented crisis standards of care, prioritizing resources and treatments to those patients who have the potential to benefit the most.
“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” Dr. Kristen Solana Walkinshaw, chief of staff at Providence Alaska Medical Center, wrote in a letter addressed to Alaskans and distributed Tuesday.

“The acuity and number of patients now exceeds our resources and our ability to staff beds with skilled caregivers, like nurses and respiratory therapists. We have been forced within our hospital to implement crisis standards of care,” Walkinshaw wrote.

Alaska, like other places, has seen a surge in coronavirus cases driven by the highly contagious delta variant. State health officials said Tuesday there were 691 new cases and six recent deaths, all Anchorage men ranging in age from 50s to 70s. A woman in her 60s from out-of-state also recently died in Juneau, the department said.
Health officials said statewide that there are 202 patients diagnosed with COVID-19 who are hospitalized, and nine additional patients are under investigation. Officials said 33 of these people are on ventilators.
The percentage of patients currently hospitalized with COVID-19 is 17.5%, the state reported.

At Providence, more than 30% of the adult patients that are hospitalized have tested positive. This also comes at a normally busier time of the year for Alaska hospitals.

Walkinshaw noted that the state’s COVID-19 dashboard, which is routinely updated with numbers related to the virus, “isn’t equipped or designed to demonstrate the intricacies of providing medical care during this unprecedented time.”
At Providence, one of only three hospitals in a city of about 300,000 residents, officials have developed and enacted procedures to ration medical care and treatments, including dialysis and specialized ventilatory support.

The emergency room is overflowing at Providence, and she said patients wait for hours in their cars to see a doctor for emergency care.
Walkinshaw noted that what happens at the Anchorage hospitals affects the entire state since specialty care can often only be provided in the state’s largest city.
“Unfortunately, we are unable to continue to meet this need; we no longer have the staff, the space, or the beds,” Walkinshaw wrote. “Due to this scarcity, we are unable to provide lifesaving care to everyone who needs it.”
That has left patients across the state sitting in local hospitals since Providence can’t accept them for transfer.
“If you or your loved one need specialty care at Providence, such as a cardiologist, trauma surgeon, or a neurosurgeon, we sadly may not have room now. There are no more staffed beds left,” she wrote.
Walkinshaw said they expect an increase in COVID-19 cases in the next two to four weeks, causing an already stressful situation to possibly “rapidly progress to a catastrophe,” she said.
She said the single most important thing people can do is to get vaccinated. Alaska was the first state to open vaccinations to all residents. As of Monday, 56.5% of eligible Alaskans have been vaccinated.
Alaska Gov. Mike Dunleavy, a Republican who has recovered from COVID-19 and been vaccinated, said employees at Alaska hospitals are working long hours, some have left their jobs and there are capacity concerns.

Dunleavy, who never imposed a statewide mask mandate, has faced criticism in the past from some who say he hasn’t come out forcefully enough in support of vaccination.
“I urge, and I hope you guys print this, I strongly urge folks to get a vaccine, strongly urge them to do that,” he told reporters Tuesday.
Walkinshaw also asked that everyone wear masks, even if they are vaccinated and avoid unmasked activities. She also urged people who are sick or have been exposed to get tested and asked people to avoid potentially dangers activities and situations that may increase the need for emergency services of medical care.
“Unfortunately, if you are seriously injured, it is possible that there will not be a bed available at our trauma center to save your life,” Walkinshaw wrote.
___
Associated Press journalist Becky Bohrer contributed to this report from Juneau, Alaska.

Alaska’s Largest Hospital Goes Into Crisis Mode As Patients Wait Hours To See ER Doctors | HuffPost
 

lightbright

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Never elect someone named "Tate"...... they're already starting off wrong.... sounding like a redneck mechanic

sidebar: these fucks didn't even get hit a quarter as hard and fast as we did..... he had time to dig this hole here.... :hmm:

Mississippi Surpasses New Jersey as Worst State for Covid Deaths

Mississippi has overtaken New Jersey as the state with the highest per-capita death toll from Covid-19.

Since the end of June, Mississippi has been among the states hardest-hit by the latest wave of infections, fueled by the fast-spreading delta variant. In that period, Mississippi’s cumulative deaths rose by about 22% to 306 per 100,000 residents, according to the U.S. Centers for Disease Control and Prevention.

In other words, about one out of every 327 Mississippians has died from Covid-19 since the pandemic began last year. In New Jersey, it’s closer to one-in-328.

Hardest Hit
Mississippi's per capita Covid death toll is now the worst in the nation


Early on, the virus blindsided the densely populated U.S. Northeast when testing and treatment were extraordinarily limited. But it has now exacted an even steeper toll in Mississippi, the state with the highest poverty rate and largest proportion of Black residents -- a stark reminder of how deep-seated inequities stack the deck against some Americans.

CONTINUED:
Mississippi Surpasses New Jersey as Worst State for Covid Deaths - Bloomberg
 

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Three Texas Karens bring their crap to New York and assault hostess over mask mandate


Caught On Video: Carmine’s Hostess Attacked After Asking Tourists For Proof Of Vaccination



Caught On Video: Carmine’s Hostess Attacked After Asking Tourists For Proof Of Vaccination – CBS New York (cbslocal.com)

And a hearty shoutout and da fuck you to the dude near the end that suggested that maybe we need to try "something else."

An employee being assaulted over a policy is not an indicator that you should listen to the other sides' argument. Hell, imagine if they had required a suit jacket or something "insane" like that. That hostess might have gotten stabbed.

What this is is an indicator that the people that are prone to resort to violence over this need some perspective. And maybe an awareness of the rules and laws of the places they visit. But there's no excuse for resorting to violence over not getting to eat in the place you want.
 

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