Medical Discussion of Coronavirus

[Kamban]

I am not sure at all what it means for me personally. My FP does not know either. Should I revaccinate later with the same one or use a different vaccine (assuming several get approved). Should I repeat the test?

I would wait to hear from Pfizer if you got the placebo or the vaccine. If placebo - get the Pfizer vaccine

If you got the vaccine - repeat the antibody test to see if you were in the unlucky 5 % with no response. If you have the antibody - no further vaccination. If the antibody is still negative - get the Moderna vaccine.

[Tim]

I am getting confused about science versus opinions that are from scientists.
•Much was made about how effective “screening for Covid” was a basic precaution to prevent the spread.
•Much was made about how effective shutting down schools to prevent the spread.
•Much was made about how effective “fast” antigen tests would prevent the spread.

Follow the facts and follow the science!
Each of the above seems to be on a little shaky ground as science. By that my simple brain reverts to a 50/50 toss up, at best, on the antigen test.

Would it be wrong to say airport screenings are ineffective and a waste of resources? CDC seems to think so.

https://www.google.com/amp/s/www.yahoo.com/amphtml/lifestyle/the-cdc-covid-19-airport-screenings-ineffective-stay-safe-flying-151301994.html

It’s difficult to distinguish science as a fact vs opinion.

[Tyche]

Read in one of my physician spouse groups that TX, RI, TN, and NM health care professionals will be offered the Pfizer vaccine as early as next week. Does anyone here know about this?

[StarTrekDoc]

Read in one of my physician spouse groups that TX, RI, TN, and NM health care professionals will be offered the Pfizer vaccine as early as next week. Does anyone here know about this?

Wonder how Pfizer is going to do that. They are haven't trouble coordinating with large systems getting the cold link deliveries setup timely and recurring deliveries.

The 'last mile' is up to the local systems at least for Pfizer. Warp speed hasn't contacted us at all. My guess with Warp speed (Moderna) is that they will be coordinating through county level officials.

Tim - the messaging isn't prevent the spread. It's slow the spread. subtle, but very important messaging and understanding that these are mitigation efforts. The initial efforts with screen and contact trace was with a lower prevalence -- Identify hot spot, isolate and trace. That is long gone as there's local community spread throughout the country.

Right now it's about trying to slow the rapid rising so not to overtop health systems. It's March all over again, but not isolated to a few urban populations this time. That's why the numbers are so high yet the reports of crumbling health systems aren't there --yet. We have Thanksgiving coming up and a lot of college -virus carrying vector kids coming home after a semester for 1 month. Those with multi-generational households will have to be especially careful with this.

We recommend testing upon arrival; isolate 5 days separately; and test again to mitigate as much risk as possible.

Luckily our school is adopting this 'break' also by going fully online for a week after both holidays to lower campus exposure and transmission risks.

[Rando]

Read in one of my physician spouse groups that TX, RI, TN, and NM health care professionals will be offered the Pfizer vaccine as early as next week. Does anyone here know about this?

The four states will not receive vaccine doses earlier than other states by virtue of the pilot, nor will they receive any differential consideration, Pfizer said.

https://www.reuters.com/article/us-health-coronavirus-usa-pfizer-idUSKBN27X09A

[gap55u]

I read about repeated almost universal testing with rapid antigen kits — home, school, work testing. This wouldn’t completely rule out disease, but it WOULD catch the highly infectious. You would still do PCR tests when indicated. The thing is, the cost of a program like this is less than the economic impact of shutdowns. Not that there is much political will in much of the country to actually do a shutdown. I also very much agree with the argument that we are making a mistake to shut schools when we don’t shut places like restaurants and bars and limit large indoor gatherings.

of course in my county they won’t shut down a school unless they get a 30% positive rate and if a kid is next to an infectious kid separated by plexiglass then they are “not a close contact” and therefore families are not notified of a positive contact. Only notified if15 minutes of not masking occurs basically. Ugh. Supposedly a dashboard of cases by school updated weekly, but this is known to be inaccurate. And in my state in the south there is no chance of a repeat shutdown.

[Tim]

StarTrekDoc
From what I read, the airport screening was deemed ineffective. Forget the messaging.
The scientists were expressing opinions, not science.
As far as the schools, we seemed to have a variety of opinions about what level is appropriate. There is some debate, depending on the location.
NYC reached 3% positive rate. The schools are at like .2%. The Catholic schools are at .003%. Do scientists say schools are absolutely the safest place to be?
Antigen test at 50% effective alone doesn’t seem to be sufficient. Maybe it is. The scientists seem to say if your positive, cool we immediately isolate and go from there. If negative, well you might be a super spreader. Don’t ask me.

Your trips you should be completely fine with a paper mask sold at Target. That is the “official” science direction. Is that your opinion? No airport screenings.

Lowering the curve is critical but so distorted to the point of quackery. More kindly, SWAG that isn’t reliable either.
What’s with New York? State plan, NYC plan, school plans AND I saw the teachers union was behind the school closings with a list of demands that the mayor wants Biden and the Dept of Ed to support. All under the umbrella of lowering the curve.
I don’t see science here at all. I doubt one more expert will add science, just one more opinion.

https://www.google.com/amp/s/www.usn...%3fcontext=amp
The delivery programs are described here for the four states. California isn’t on the list. My understanding is that these aren’t being held up by the FDA. I doubt seriously that any location other than a pilot location has any idea. News flash, if it was delivered for trials, it can be delivered. Our delivery system isn’t set up, similar to CDC trying to do all the testing. My guess multiple “last mile” for vaccinations. Some more costly than others. I can see delivery to Vaccine locations and even mobile units delivering the shots. Same as testing was deployed, but with cold storage requirements.

The storage units are already manufactured, ready to go.

Another example, what is science vs opinion? WHO or FDA?

https://www.cnbc.com/2020/11/19/coronavirus-who-tells-doctors-dont-use-gileads-remdesivir-splitting-with-fda.html

[Rando]

The scientists were expressing opinions, not science.

I'm not sure I'm totally following where you're going, but the reality is that with COVID-19 "science" as we traditionally think of it has not been possible and most of the direction scientists are giving are (hopefully) educated guesses. For those of us that have bought into evidence-based medicine, this is a big change. And scientists do disagree on things. Most of us on this site have a basic understanding of infectious disease and epidemiology and I think everybody makes their comments here in good faith, yet you see different opinions.

COVID-19 is an illness that the great majority of people survive, and if you use survival as an endpoint you would need a huge number of participants in a study to show therapeutic significance in the usual way. Demanding randomized clinical trials, which generally have been the gold standard in medicine, isn't practical right now. To me most of the recommendations coming out of CDC or WHO are analogous to USPTF Class C or I recommendations, which you should take with a grain of salt.

There have been a lot of very weak studies coming out, and the media is unable to distinguish between a good study and an awful study. And frankly in my opinion many of the medical experts on TV are clearly biased. This is true whether the network is left or right leaning. Often they are asked political or economic questions they have no training for, and sometimes I've even heard them get some pretty basic medical stuff wrong. Of course the politicians are generally even worse.

This leads to people being able to claim "science" for almost any standpoint they hold. When I hear people say "listen to the science" I often roll my eyes as the phrase has almost become meaningless.

Having said all that I think proceeding based on educated guesses is appropriate, as long as the guesses are truly educated. We can compare COVID-19 to other similar viruses, and there has been a good amount of observation of the disease by now. And there are areas like vaccines where I think we can truly claim science has been applied in the right way. Overall though I think I agree with you in that many are claiming a level of certainty about science as it applies to COVID-19 that just doesn't exist.

[nephron]

Why isn't it big news that after Pfizer submitted a request for vaccine approval, the FDA said that they will make a decision about it on December 10th? I understand about waiting for data to arrive and be analyzed before approving a vaccine, but if Pfizer submitted data and the FDA plans to just sit on it until December 10th, it seems a bit arbitrary. It seems like something you would want to look over and make a decision about over a day or so, particularly if it is as good as the news reports make it sound like and you are not planning on receiving any additional data from now until December 10th. I can imagine the people at the FDA receiving the data, stating that much of their staff will be taking long Thanksgiving vacations so placing an arbitrary date of review as December 10th so people can arrive back in their offices and look over the data during normal business hours. This whole pandemic has just been on governmental failure after another.

[PedsCCM]

You should listen to this:

https://podcasts.apple.com/us/podcast/conversations-with-dr-bauchner/id410339697?i=1000494207535

I’m pretty happy with the FDA only needing 3 weeks to analyze hundreds or thousands of pages of data. I would be skeptical if we got results much quicker than that.

[Tim]

•“This whole pandemic has just been on governmental failure after another.”
•”To me most of the recommendations coming out of CDC or WHO are analogous to USPTF Class C or I recommendations, which you should take with a grain of salt.”
•“Overall though I think I agree with you in that many are claiming a level of certainty about science as it applies to COVID-19 that just doesn't exist.”
The simple “messaging” is a necessity for a succinct clear communication to impact needed behavior changes. Lost in that is the limitations.
When data is not available, there will be changes.
We’re there failures? Depends on the expectations. Perfection it clearly was not.

Thank you Rando and PedsCCM. I am sticking with CDC and the FDA. At a minimum they are adjusting as new data becomes available. WHO seems to have influences other than science and data.
As a side note, have you noticed the nose problem with mask wearing? Keeps slipping off and has gaps. The mask is always straight across, ear to ear. Do good masks have nose bridge with a little reinforcement piece for fit? A lot of room for protection by getting a decent mask.

bamlanivimab has been declined by our County Hospital System (Private Hospital systems dominate). The reason is (sarcastically) too resource intensive. That is the same resource message prior to C-19. But that is also the “expert”
that has the voice in lockdowns. So public health in one of the largest cities in the country will be denied access as a policy. Difficult problems but that will lead to “social/economic” differences, put forward by the same “experts” that made both the availability and shutdown decisions.
It is confusing, not sure it’s a failure.

[Hatton]

•“This whole pandemic has just been on governmental failure after another.”
•”To me most of the recommendations coming out of CDC or WHO are analogous to USPTF Class C or I recommendations, which you should take with a grain of salt.”
•“Overall though I think I agree with you in that many are claiming a level of certainty about science as it applies to COVID-19 that just doesn't exist.”
The simple “messaging” is a necessity for a succinct clear communication to impact needed behavior changes. Lost in that is the limitations.
When data is not available, there will be changes.
We’re there failures? Depends on the expectations. Perfection it clearly was not.

Thank you Rando and PedsCCM. I am sticking with CDC and the FDA. At a minimum they are adjusting as new data becomes available. WHO seems to have influences other than science and data.
As a side note, have you noticed the nose problem with mask wearing? Keeps slipping off and has gaps. The mask is always straight across, ear to ear. Do good masks have nose bridge with a little reinforcement piece for fit? A lot of room for protection by getting a decent mask.

bamlanivimab has been declined by our County Hospital System (Private Hospital systems dominate). The reason is (sarcastically) too resource intensive. That is the same resource message prior to C-19. But that is also the “expert”
that has the voice in lockdowns. So public health in one of the largest cities in the country will be denied access as a policy. Difficult problems but that will lead to “social/economic” differences, put forward by the same “experts” that made both the availability and shutdown decisions.
It is confusing, not sure it’s a failure.

Tim I say this with no studies to quote but if the mask is not covering your nose then it is ineffective. Better mask do have a nose bridge. I really like my Vogmask as recommended by Star Trek Doc because it actually comes in sizes and fits.

[Tim]

Tim I say this with no studies to quote but if the mask is not covering your nose then it is ineffective. Better mask do have a nose bridge. I really like my Vogmask as recommended by Star Trek Doc because it actually comes in sizes and fits.

I bought two and I am deeply appreciative of StartrekDoc and your recommendation. Planning on at least two more for family members and one for my son in hopes he can make a holiday trip.
Etiquette question:
He might bring a significant other for the Christmas trip. Would it be overbearing to send one for her? 93 year old MIL that has been “isolated” since March. My anxiety would be less if we took the step of getting a good mask. I would tremble seeing her for the first time and seeing a paper disposable mask slipping off the nose. Can you imagine the urge to isolate a guest?
Can you imagine how difficult “millennials” would have understanding a mask lecture or even a mention?
Hatton, please give me your etiquette recommendation. I would even take your advice for the ladies choice!
I am hopeful of preventing a guest from unintentionally catching c-19 and invading our space. I tend to think it’s reasonable to provide a good mask and ask that it be used for the plane flight.

[billy]

I just bought an envo mask for my wife. Will let you know how well it works. Not stylish at all though, but for her face will likely provide a better seal than N95s. Anyone here use them?

Tim- your son's SO is probably trembling at meeting the whole family for the first time, so as long as your son expresses his/your wishes of "wear a good mask to protect my grandma" I'm certain she'll comply.

[Tim]

I just bought an envo mask for my wife. Will let you know how well it works. Not stylish at all though, but for her face will likely provide a better seal than N95s. Anyone here use them?

Tim- your son's SO is probably trembling at meeting the whole family for the first time, so as long as your son expresses his/your wishes of "wear a good mask to protect my grandma" I'm certain she'll comply.

Daughter has met her twice. If need be I would use the alternate route. My spouse complains the it is harder to breathe with the Vogemask. I think it is an adjustment, haven’t been breathing filtered air.