Medical Discussion of Coronavirus

[FIREshrink]

It's good to see Christie out. He had a few risk factors.

Saw a diagram of 2/2021 - 390k deaths; but if 95% mask compliance -- 310k.

While 80k is substantial (40% reduction) , it's amazing with even 95% compliance (pipedream) still 100K more deaths between now and 4 months. I hope they are dreadfully wrong on that and winter people will simply sequester among themselves instead of merging into giant clusters.

I think the issue is it is endemic everywhere now so even with 95% masking there is likely to be widespread household transmission and starting from a high base enough ongoing community transmission to keep m&m unsatisfactorily high.

Had we really crushed this in the spring then masking would likely have led to an exponential decrease in transmission and mortality. That's what they have in E Asia and to a lesser extent Europe, though the latter is slipping backward. At our current numbers in some communities contact tracing and isolation aren't feasible so we lose that weapon from our armamentarium.

[Rando]

I don’t think he’s contagious. Again this is an example of the media and others applying a different standard to him because he’s trump. CDC guidelines state he is no longer contagious regardless of what his test status is. He did not have a severe case of CV19. His test status is irrelevant because we know that many people will persistently test positive because of the ability of pcr to detect viral fragments and the extreme sensitivity of pcr especially depending on the number of pcr cycles the test is using. From what I read his viral load has trended down, the number of pcr cycles needed to detect virus has increased, he has been afebrile and asx for many days, and he doesn’t have presence of genomic mRNA which is a proxy for active viral replication. Basically he’s has been more thoroughly evaluated than any covid patient in the country. It is what it is.

The CDC guidelines define severe disease as O2sat <94% on room air or RR > 30. These guidelines seem pretty strict to me as by the eyeball test Trump did not appear to have severe disease, but I believe his O2sat did drop to 94% or lower. Strictly speaking it comes down to whether he had severe or moderate disease. The CDC guidelines lump together a guy walking around at 94%, a level where many would not even seek medical attention, with a guy on a ventilator.

Bottom line though is I doubt he's contagious.

[StarTrekDoc]

The CDC guidelines define severe disease as O2sat <94% on room air or RR > 30. These guidelines seem pretty strict to me as by the eyeball test Trump did not appear to have severe disease, but I believe his O2sat did drop to 94% or lower. Strictly speaking it comes down to whether he had severe or moderate disease. The CDC guidelines lump together a guy walking around at 94%, a level where many would not even seek medical attention, with a guy on a ventilator.

Bottom line though is I doubt he's contagious.

Exactly - he straddles the definition and further clouded by extraneous testing that muddies the waters. I doubt he's contagious either.

Hope all his travel entourage stay safe.

[StarTrekDoc]

Interesting reads on the vaccines and status with the new FDA guidance on board.

Ironically, the one from motley fool has some pretty detailed interim end points and decision data points that reflect Pfizer's advantage to get to market faster and the financial underpinnings to all this with Warp Speed and FDA interplay.

https://www.politico.com/news/2020/1...ion-day-428371
https://www.fool.com/investing/2020/...ve-coronaviru/

https://www.pfizer.com/science/coronavirus/vaccine

https://www.modernatx.com/cove-study

Pfizer - 36,576 enrolled; 28,146 received 2nd dose - getting really close to the 30k; and 7 day check after 2nd day for efficacy.

Moderna: 28,618 enrolled; 22,194 received 2nd dose.

[Tim]

https://www.beckershospitalreview.com/pharmacy/moderna-covid-19-vaccine-trial-slowed-too-few-minority-participants.html

Disconnect between the modernatx website and what the CEO was quoting.

[fatlittlepig]

I really think there’s enough mortality to justify approving the vaccine(s) as expeditiously as possible without waiting for every single modicum of safety data. (Every day of regulatory hurdles and delay potentially = 1000 deaths). I say we start vaccinating SNF patients now upon admission and all hospital patients at discharge.

[StarTrekDoc]

I'd actually vaccinate the factory food processing workers very first line as they are really unable to do PPE effectively and lower SES with higher rate of multigenerational systems.

Then frontline staff workers of the SNF.

Vaccinate the entry point levels.

Outpatient Clinic workers like myself a lot lower risk with universal masking and selective bias and able to lower exposure risks

--The question though -- which vaccine to use? Moderna vs Pfizer vs J+J. And interactions if you take both or all three? That's the crazy decisions to make

[PedsCCM]

I really think there’s enough mortality to justify approving the vaccine(s) as expeditiously as possible without waiting for every single modicum of safety data. (Every day of regulatory hurdles and delay potentially = 1000 deaths). I say we start vaccinating SNF patients now upon admission and all hospital patients at discharge.

I already worry about convincing people to get the vaccine assuming absolute transparency and no shortcuts. Skip any safety steps and have just one person coincidentally get GBS or transverse myelitis soon after the vaccine and you've got the makings of a PR disaster.

[fatlittlepig]

I already worry about convincing people to get the vaccine assuming absolute transparency and no shortcuts. Skip any safety steps and have just one person coincidentally get GBS or transverse myelitis soon after the vaccine and you've got the makings of a PR disaster.

Yes from a vaccine confidence standpoint (especially since it has become politicized) you would be correct. However from a strictly numbers standpoint I believe the benefits of early implementation (ie the Russia approach) would outweigh the risks especially in high risk groups (eg nursing home patients in facilities with known cases.)

[fatlittlepig]

somebody isn't messing around, from today's NYtimes:

"The Chinese city of Qingdao is testing all of its 9.5 million residents after it recorded the country’s first locally transmitted cases of the virus in almost two months.

The authorities said that a dozen people in Qingdao, a seaside city in Shandong Province, had tested positive for the virus as of Sunday. Officials said the cases appeared to be linked to the Qingdao Chest Hospital, which has been treating people who test positive for the virus after arriving in China from abroad. The hospital has since been placed under lockdown."

[Tim]

“The authorities said that a dozen people in Qingdao, a seaside city in Shandong Province, had tested positive for the virus as of Sunday.”

Would be interesting to know the current protocol for the positives.

[StarTrekDoc]

For positives forced quarantine. For direct contacts too and testing. Double edged sword of a their system. Swash the virus but trample on individual rights to get there. It is the way.

[StarTrekDoc]

Trump tested negative multiple days -- really good and decisive data where few can oppose a robust public campaign next 21 days.

https://www.foxnews.com/politics/white-house-physician-releases-results-of-president-trumps

[Tim]

Trump tested negative multiple days -- really good and decisive data where few can oppose a robust public campaign next 21 days.

https://www.foxnews.com/politics/white-house-physician-releases-results-of-president-trumps

Or a robust opposition, right?

[StarTrekDoc]

Vaccine news:
J+J Paused -- That's another Adenovirus vaccine on pause 2/2 ADR

Looks like Moderna and Pfizer inside tracks continue