Medical Discussion of Coronavirus

[artemis]

The stomach degrades it is the short answer.

The longer answer is that poliovirus is a gastrointestinal virus. The oral polio vaccine you remember is actually a weakened strain of poliovirus; it infects the GI tract, but is (normally) too weak to cause any further disease. Most illnesses we vaccinate against are not gastrointestinal viruses, and so we can't administer the vaccine via the mouth; as Lordosis says, the acid in the stomach just destroys the vaccine.

Some vaccines to respiratory viruses can be administered by nasal mist (since the nasal tract is where the virus initially infects the person), but we don't yet have a nasal mist vaccine for COVID-19.

[Tim]

"“There’s a perception that people who work in hospitals would be less afraid of needles, because they’re surrounded by them all the time, but one study found 27 percent of hospital employees who did not take the flu vaccine said it was because of needle fear or they did not like needles,” said Jennifer McLenon, an infection preventionist at Henry Ford Hospital in Detroit who completed the study while getting her master’s degree in epidemiology."

Not saying it is rational. When refusals reach 20%-30% levels, that approaches the point of hindering herd immunity. I was actually incredibly surprised that one would not sign up for a waiting list, let alone show up for the shot. It is NOT an experience based reaction, it is just an uncontrolled aversion, an instinctive reaction. I know, it's just a little shot and really doesn't cause pain, more of a discomfort. These are in the adult population, not anti-vaxers or extreme views. Want to stay healthy, but afraid or the dark (needles), If 20% of your patients are holding back on vaccinations, might be anecdotal evidence. The only thing I can think of is a needle in the skin does not cause pain, Less than a pinch on your arm. Deal with it.

[nephron]

Why isn't everybody prescribing fluvoxamine for covid? The preliminary evidence looks better then any of the preliminary stuff for hydroxychloroquine. I just heard about it from 60 minutes. I hear about all the good covid stuff from the news. Doesn't seem like a lot of risk to prescribe a 15 day course of the stuff even if the subsequent trials end up being negative.

https://jamanetwork.com/journals/jama/fullarticle/2773108

https://www.cbsnews.com/news/fluvoxamine-antidepressant-drug-covid-treatment-60-minutes-2021-03-07/

[CordMcNally]

Why isn't everybody prescribing fluvoxamine for covid? The preliminary evidence looks better then any of the preliminary stuff for hydroxychloroquine. I just heard about it from 60 minutes. I hear about all the good covid stuff from the news. Doesn't seem like a lot of risk to prescribe a 15 day course of the stuff even if the subsequent trials end up being negative.

https://jamanetwork.com/journals/jam...rticle/2773108
https://www.cbsnews.com/news/fluvoxa...es-2021-03-07/

Awesome. Another thing patient's are going to be demanding because they saw on the news. I also liked the nugget "they found fluvoxamine stopped sepsis" in the article. I can already tell this will go well.

[FIREshrink]

The anti inflammatory and CNS neurotrophic Effects of fluvoxamine have been out there for a long time (sigma 1 agonist and inducer). Preliminary studies have looked at its use in delirium, learning, inflammation. Some recent studies on covid. But don't give it to your patient with bipolar 1!!

[billy]

Well it took a year but it happened. Despite both of us being vaccinated (a full month out), my immunocompromised wife tested positive for COVID after getting checked for a fever. I suspect an unmasked MRI for 30 minutes for her cancer (she tested negative for covid the day before it) was the culprit, but who knows as it could have just as easily been me unknowingly giving her asymptomatic spread. Or one of the new variants? I'm hoping the vaccine offered at least a little benefit to her (she feels fine minus yesterdays chills/fever, and she's currently afebrile), but her antibody test (which includes spike protein) was negative. I wonder if the chemo negated some of the vaccine effectiveness, or if she is part of the few who still catch it after being fully vaccinated. Are any oncologists on here seeing similar with their patients? Hoping she clears this soon and the vaccine +having caught it gives her double immunity.

[StateOfMyHead]

Well it took a year but it happened. Despite both of us being vaccinated (a full month out), my immunocompromised wife tested positive for COVID after getting checked for a fever. I suspect an unmasked MRI for 30 minutes for her cancer (she tested negative for covid the day before it) was the culprit, but who knows as it could have just as easily been me unknowingly giving her asymptomatic spread. Or one of the new variants? I'm hoping the vaccine offered at least a little benefit to her (she feels fine minus yesterdays chills/fever, and she's currently afebrile), but her antibody test (which includes spike protein) was negative. I wonder if the chemo negated some of the vaccine effectiveness, or if she is part of the few who still catch it after being fully vaccinated. Are any oncologists on here seeing similar with their patients? Hoping she clears this soon and the vaccine +having caught it gives her double immunity.

I can't answer your question but wanted to say I hope she feels better soon.

[StarTrekDoc]

Sorry to hear billy. Prayers to her pulling through this difficult time.

We really haven't tested for seroconversion post immunization. I would be interesting to see now that we're getting into the bulk of medically needed vaccinations

[Kamban]

I wonder if the chemo negated some of the vaccine effectiveness, or if she is part of the few who still catch it after being fully vaccinated. Are any oncologists on here seeing similar with their patients? Hoping she clears this soon and the vaccine +having caught it gives her double immunity.

Even though I have told all my patients to have the vaccine, I expect my multiple myeloma and CLL patients to have some decreased response to the vaccine, depending to their stage of the disease and if active therapy is being administered. I also expect some impaired response in other cancers getting active chemotherapy, especially if they have significant bone marrow suppression. I am not sure how much impairment will be there in patients who are in remission or have non chemotherapy treatments that does not affect their lymphocytes or plasma cells very much.

[billy]

Even though I have told all my patients to have the vaccine, I expect my multiple myeloma and CLL patients to have some decreased response to the vaccine, depending to their stage of the disease and if active therapy is being administered. I also expect some impaired response in other cancers getting active chemotherapy, especially if they have significant bone marrow suppression. I am not sure how much impairment will be there in patients who are in remission or have non chemotherapy treatments that does not affect their lymphocytes or plasma cells very much.

Yeah she's actively on chemo q 2 weeks so even timing the vaccine was hard- they timed it the day after a neupogen shot to try to help. Her nurse said the cancer center has seem some test positive for it after the vaccine, but not sure how far out from the vaccine it was.

And thanks to all for the well wishes.

[CordMcNally]

Hope she gets better soon! The data is strong for the vaccine minimizing effects and so far nobody has died that received the vaccine in the clinical trials.

[jfoxcpacfp]

Well it took a year but it happened. Despite both of us being vaccinated (a full month out), my immunocompromised wife tested positive for COVID after getting checked for a fever. I suspect an unmasked MRI for 30 minutes for her cancer (she tested negative for covid the day before it) was the culprit, but who knows as it could have just as easily been me unknowingly giving her asymptomatic spread. Or one of the new variants? I'm hoping the vaccine offered at least a little benefit to her (she feels fine minus yesterdays chills/fever, and she's currently afebrile), but her antibody test (which includes spike protein) was negative. I wonder if the chemo negated some of the vaccine effectiveness, or if she is part of the few who still catch it after being fully vaccinated. Are any oncologists on here seeing similar with their patients? Hoping she clears this soon and the vaccine +having caught it gives her double immunity.

Oh, dear, so sorry to hear this and please keep your WCI family posted!

[gap55u]

Even though I have told all my patients to have the vaccine, I expect my multiple myeloma and CLL patients to have some decreased response to the vaccine, depending to their stage of the disease and if active therapy is being administered. I also expect some impaired response in other cancers getting active chemotherapy, especially if they have significant bone marrow suppression. I am not sure how much impairment will be there in patients who are in remission or have non chemotherapy treatments that does not affect their lymphocytes or plasma cells very much.

We are able to order a vaccine immunity specific IGG that's only spike. Our covid infection looks at <some antibody I forget> and if positive checks a spike. If both positive, past infection. if discordant, reported as such and recommend retesting in a few weeks. Our allergist has already said she'll be testing select immunodeficiency patients after vaccination, in part to help guide their level of concern about reentry to more normal activities. I'm not an oncologist, but I've seen a few patients with onc-related immunosupression who had covid and didn't mount antibodies later, and one who took 5 months to test NP PCR negative.

I'm hoping for the best for your wife, Billy

[StarTrekDoc]

gap55u - nucleocapsid antibody; that's what most test for and not spike. We have been slow to change ours specifically to lower the temptation to 'check my antibodies' request from patients. We do have the spike ab under special order menu that's not visible to the regular docs --- kind of a plausible deniability to defer testing.

[Hatton]

gap55u - nucleocapsid antibody; that's what most test for and not spike. We have been slow to change ours specifically to lower the temptation to 'check my antibodies' request from patients. We do have the spike ab under special order menu that's not visible to the regular docs --- kind of a plausible deniability to defer testing.

Aha. Now it all makes sense.