Medical Discussion of Coronavirus

[Tim]

• "This is all happening while teachers remain underpaid in this country, she added." The drumbeat has begun.
• Got Moderna today. Need second dose after 2/2/20. County does not have appointments available at all now. What this means is the 2nd dose is NOT being held in reserve now. And you have no appointment.
• Appointments for 1st and 2nd doses will raise competition.
• Hospital systems are still getting the vast majority of the shipments. Using their own priority systems has brought out warnings that future shipments will be reallocated to other locations that are efficiently distributing.
• This is morphing into guideline not being followed, some hospital systems making their own rules and destroying the credibility of guidelines. The "public" will adopt the attitude of "every person is on their own".
• Guidelines for zip codes and counties are specifically prohibited from being enforced.
• Inquiries have been received about crossing state lines (specifically California to Texas) due to 1A still in home state.
• Shortages are expected but a lack of hospitals to vaccinate their own staff is overwhelming the process. Who would have thought that a hospital could not vaccinate it's own staff? Who would have thought that a pharmacy could not vaccinate people. This should have been a slam dunk. The stick will be vaccine will be distributed to providers that vaccinate. Supplies will be restricted due to results, vaccinating the population. All this mental gymnastics for intelligently allocating vaccines will go by the wayside due to the "human element" to add value. Unintended consequences. Four weeks is a long time not to have a known quantity identified for 1A healthcare workers. The unfortunate will compete with the general public (which was not the intent).
• I personally have not problem taking the 2nd shot from a healthcare worker that had supply restricted. My target is early February.

What should I tell a relative that wants to go the RV route? Can California residents use vaccine in another state? Free for all introduced by healthcare providers having vaccine and not using it. 1/3 vaccinated of delivered will not cut it. The flood gates will open.If nothing else, the shelf life is limited. I hope the hospital systems start working on volumes. It takes longer to fill out the forms than give the shots!

Just an anecdote tale of the day.

[Bellescamp]

Treating COVID-19 has been an exercise in humility.

This is what I feel every day at work. A lot of times, futility in addition to humility.

[Bellescamp]

I got my second dose of Pfizer early today. I feel fine so far. Maybe some mild body aches. Mildly sore deltoid.

At the moment, I am still planning on mountain biking tomorrow at dawn unless some significant symptoms develop overnight.

Please update tomorrow. The listed incidence shouldn’t be that high, not sure we all got hit so hard by this. I hope you do well. More anecdotes - people that had COVID seem to get worse symptoms.

[MaxPower]

[LIST][*]Shortages are expected but a lack of hospitals to vaccinate their own staff is overwhelming the process. Who would have thought that a hospital could not vaccinate it's own staff? Who would have thought that a pharmacy could not vaccinate people.

Just an anecdote tale of the day.

I’m not sure what your source is for this, but it probably doesn’t matter. The question is, how should a hospital, particularly for the many that are completely overwhelmed right now, have enough staff to vaccinate? Many are out with covid. Many are working well past their normal hours to treat covid patients plus all of the other patients. Should the hospital workers that were told early in this pandemic that there wasn’t enough PPE to protect them, or that they shouldn’t wear masks to avoid frightening patients, volunteer to come in and give vaccines for no pay? Or maybe just cut staffing in other overburdened areas to provide vaccines?

I’m glad that people are pushing back. For far too long executives and pencil pushers have taken advantage of physicians and nurses by adding job duties on top of job duties without added reimbursement, because they know that the job will always get done. Maybe some of the 7 or 8 layers of management between me and the CEO can come in and give shots on weekends or after hours.

[Tim]

The problem is NOT the physicians or staff.

https://www.dshs.texas.gov/immunize/covid19/COVID-19-Vaccine-Data-by-County.xls

The approach taken by the two major hospital systems was an internal prioritization, 1A. Then 1B got thrown into the mix. A central prioritization “invitation” approach was chosen. Mistake. First shipment to one hospital was 9000. Administrative nightmare. One system has 30k employees.
283k 1A and 490k 1B in one county.
The physicians in the system (outpatient) are just getting contacted and NO system for 1B.
The only 1B has been a brief invitation only event for late this week.

Rather than make vaccine available, the hospital systems are still struggling with who to invite and scheduling the time. A doctors appointment approach.

The pharmacy approach with a wider distribution dealing with the public.
5.2 m to do (1A ,1B) and 790k delivered 377k administered. Four weeks of work. The hospital and physicians office approach is failing. They should have chosen the drive thru covid testing method.

“And late Tuesday, the administration said it would accelerate a plan announced in November to distribute coronavirus vaccines through retail pharmacies. Nearly 40,000 sites are participating in the program, but distribution will start with just 3,000 to 6,000 pharmacies, a senior HHS official said.”

The key is that this is a two part administrative process. Get on a list and confirm your appointment when available. The hospitals (as designed) are still struggling with their own employees. One just announced a $500 bonus in March if they got vaccinated. That is Houston Methodist. 1A is priority but it is a bottleneck. There will be a priority window.

Vaccines are being delivered to pharmacy/clinics in 100 batches. Hospitals in thousands. The imbalance will work out. Hospitals aren’t setup for anything but a confirmed doctors appointment.

[White.Beard.Doc]

Please update tomorrow. The listed incidence shouldn’t be that high, not sure we all got hit so hard by this. I hope you do well. More anecdotes - people that had COVID seem to get worse symptoms.

So my morning update after Pfizer #2 yesterday... Had some myalgias overnight, a bit of slight chills, and a very mild headache this morning. Nothing that was significant enough to disrupt a good night of sleep. And those symptoms led to a very rare event for me. I took acetaminophen 650 mg upon arising and now feel better as I head out to the woods to greet the dawn with my group for our daily mountain biking ritual.

[snowcanyon]

Mmm. I am delighted to have received my vaccine.
I am pretty concerned that it won't protect against the South African variant.

[Panscan]

Please update tomorrow. The listed incidence shouldn’t be that high, not sure we all got hit so hard by this. I hope you do well. More anecdotes - people that had COVID seem to get worse symptoms.

Did you have covid ? Maybe you mentioned and I missed, if so my apologies

[NationalPark]

I had heard from friend that had covid and had pretty significant but typical side effects from the first vaccine dose.

South African variant in spike protein: Ugh. Just ugh. Are we going to be chasing our tails with this virus indefinitely? Mutations followed by vaccine tweaks. I’m bummed.

[fatlittlepig]

i wouldn't take apap or other antipyretics for vaccine related symptoms, as it may blunt vaccine immunogenicity.

[Kamban]

i wouldn't take apap or other antipyretics for vaccine related symptoms, as it may blunt vaccine immunogenicity.

This has been said on and off that I researched it and here is the conclusion from a study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027726/

The answer to the question of whether antipyretic analgesics have a clinically significant impact on vaccine response has significant public health implications. Although generating a great deal of interest in the topic, the 2009 Prymula study did not answer the question because the acetaminophen-associated antibody blunting that was observed following vaccination still resulted in protective antibody levels. Additionally their follow up study showed a robust antibody response following booster vaccine doses. The studies included in our review reported no significant blunting of the immune response in papers published prior to the 2009 Prymula study, but since that report there have been several studies that have suggested immune blunting. One study showed lower response to a novel influenza strain following vaccination; however the difference was not statistically significant.²⁶ Thus, at this time, there is no clear answer as to whether antipyretic analgesic administration blunts the immune response to a degree that could result in vaccine failure.

[G]

i wouldn't take apap or other antipyretics for vaccine related symptoms, as it may blunt vaccine immunogenicity.

Our ID guys are recommending pre-treating with NSAIDs. Not sure I'd go that far, but....

[White.Beard.Doc]

This has been said on and off that I researched it and here is the conclusion from a study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027726/

Regarding immunization blunting with APAP, that same study concluded:

"This effect has only been noted following primary vaccination with novel antigens and disappears following booster immunization."

So I only took a single dose of APAP after my second booster vaccination. I did not need it after vaccine dose #1. I wonder if that truly would have an effect on my immunity. Intuitively I wouldn't think so, I wonder what the mechanism might be for reduced immunity.

[shady]

Admin was in my office yesterday eyeing a small (maybe 6x8' exam) room attached to my office. The room fits one chair and is occasionally used to provide IV infusions. We try not to use it because it shares a wall and false ceiling with my office and exam rooms and voices travel right through. In any event, they decided they want to run an outpatient COVID infusion center out of that room. It is 6'' from my office door, 2' from my nurses' desks, and immediately adjacent to all of my exam rooms. Furthermore, there is no special ventilation, the ceilings are false tile ceilings, and the clinic is not a large area. ie nobody can distance from anyone because we are tucked back in a corner. Despite having an entirely empty 4th floor, numerous more isolated empty offices/exam rooms, and a building down the street which has dozens of empty rooms they choose a tiny room, in a corner, in the Urology clinic.

I told them absolutely not, but wanted to ensure I'm not overreacting? There's no way this isn't some type of OSHA, department of health, CDC, violation? I had to move a case into a special OR yesterday because they were persistently COVID positive (asymptomatic and recovered) from COVID in September due to CDC guidelines, but somehow they can march actively infected COVID patients into my office for infusions and that's not against some guideline? Also one of my nurses is pregnant so they are removing her from my team (no replacement) due to risk of exposure. How they somehow thought this was a reasonable idea and is in anyway safe at all is beyond me. Completely undue risk to my nursing staff, healthy patients, and myself. Would anyone else stand for this? Perhaps I'm overreacting and this is the new normal we need to accept with COVID?

[Panscan]

Admin was in my office yesterday eyeing a small (maybe 6x8' exam) room attached to my office. The room fits one chair and is occasionally used to provide IV infusions. We try not to use it because it shares a wall and false ceiling with my office and exam rooms and voices travel right through. In any event, they decided they want to run an outpatient COVID infusion center out of that room. It is 6'' from my office door, 2' from my nurses' desks, and immediately adjacent to all of my exam rooms. Furthermore, there is no special ventilation, the ceilings are false tile ceilings, and the clinic is not a large area. ie nobody can distance from anyone because we are tucked back in a corner. Despite having an entirely empty 4th floor, numerous more isolated empty offices/exam rooms, and a building down the street which has dozens of empty rooms they choose a tiny room, in a corner, in the Urology clinic.

I told them absolutely not, but wanted to ensure I'm not overreacting? There's no way this isn't some type of OSHA, department of health, CDC, violation? I had to move a case into a special OR yesterday because they were persistently COVID positive (asymptomatic and recovered) from COVID in September due to CDC guidelines, but somehow they can march actively infected COVID patients into my office for infusions and that's not against some guideline? Also one of my nurses is pregnant so they are removing her from my team (no replacement) due to risk of exposure. How they somehow thought this was a reasonable idea and is in anyway safe at all is beyond me. Completely undue risk to my nursing staff, healthy patients, and myself. Would anyone else stand for this? Perhaps I'm overreacting and this is the new normal we need to accept with COVID?

It doesnt seem like you're overreacting to me