Medical Discussion of Coronavirus

[Lordosis]

I found this amusing

https://www.tiktok.com/@hotvickkrishna/video/6937457241968643334

[artemis]

This time last year was the beginning of The Great Shutdown. Going back to the start of this thread and re-reading the first dozen pages is a stark reminder of just how much we didn’t know at the onset of this pandemic, and how worried and (dare I say) frightened we all were about what we would soon be facing. And now, with multiple effective vaccines rapidly becoming available and reasonably effective treatment protocols established, everything is different. What a strange and horrible year 2020 turned out to be!

I hope this thread can somehow be archived, as testimony to what we all experienced. It has some real historic value.

[Tim]

This time last year was the beginning of The Great Shutdown. Going back to the start of this thread and re-reading the first dozen pages is a stark reminder of just how much we didn’t know at the onset of this pandemic, and how worried and (dare I say) frightened we all were about what we would soon be facing. And now, with multiple effective vaccines rapidly becoming available and reasonably effective treatment protocols established, everything is different. What a strange and horrible year 2020 turned out to be!

I hope this thread can somehow be archived, as testimony to what we all experienced. It has some real historic value.

Everything is quite different now. From a global pandemic standpoint, there was a clear spike in early January.

https://www.worldometers.info/coronavirus/

Sometimes we don’t know what we don’t know.
What caused the huge ramp up and what caused the decline on a global basis?
I doubt the initial rollout of vaccines or masks or social distancing or washing hands or changes in what businesses were open or closed can account for the global spike with drastic changes in behaviors. The vaccines are a game changer, but many of the precautions don’t seem to have slowed the spike. Not so sure we understand C-19 and the flare ups and how to prevent them.

Point of confusion: Vaccine distribution (published) for the FEMA and federal pharmacy direct programs has “disappeared”. No allocations so it went for three weeks. The appointment links disappeared as well. I hope this is actually that these programs have continued to shot #2 for the next 3 weeks. Optimistic. The hub and state pharmacies supplies have resumed for shot #1.

2+m shots per day is a good thing. Pressure will mount to share.
“The United States has fallen far behind China, Russia and India in the race to marshal coronavirus vaccines as an instrument of diplomacy. At the same time, Mr. Biden is facing accusations of “vaccine hoarding” from global health advocates who want his administration to channel supplies to needy nations that are desperate for access.
Insisting that Americans come first, the president has so far refused to make any concrete commitments to give away American-made vaccines.”.
Just another complication.Like getting teachers vaccinated for in time for summer vacation. Apologies in advance to those with teachers that have a vested interest in vacation. The point is it looks like all that want to be vaccinated by summer will be accommodated. Reasons for optimism.

[billy]

Everything is quite different now. From a global pandemic standpoint, there was a clear spike in early January.

https://www.worldometers.info/coronavirus/

Sometimes we don’t know what we don’t know.
What caused the huge ramp up and what caused the decline on a global basis?
I doubt the initial rollout of vaccines or masks or social distancing or washing hands or changes in what businesses were open or closed can account for the global spike with drastic changes in behaviors. The vaccines are a game changer, but many of the precautions don’t seem to have slowed the spike. Not so sure we understand C-19 and the flare ups and how to prevent them.

Point of confusion: Vaccine distribution (published) for the FEMA and federal pharmacy direct programs has “disappeared”. No allocations so it went for three weeks. The appointment links disappeared as well. I hope this is actually that these programs have continued to shot #2 for the next 3 weeks. Optimistic. The hub and state pharmacies supplies have resumed for shot #1.

2+m shots per day is a good thing. Pressure will mount to share.
“The United States has fallen far behind China, Russia and India in the race to marshal coronavirus vaccines as an instrument of diplomacy. At the same time, Mr. Biden is facing accusations of “vaccine hoarding” from global health advocates who want his administration to channel supplies to needy nations that are desperate for access.
Insisting that Americans come first, the president has so far refused to make any concrete commitments to give away American-made vaccines.”.
Just another complication.Like getting teachers vaccinated for in time for summer vacation. Apologies in advance to those with teachers that have a vested interest in vacation. The point is it looks like all that want to be vaccinated by summer will be accommodated. Reasons for optimism.

I'd venture to say worldwide many cultures celebrate traditional family gathering events in December (add Nov for the US)- thanksgiving, christmas, Hanukkah, festivus, NYE, etc. Add to it likely increase in testing for travel or 'to be safe' which presumably picked up a few asymptomatic positives also- led to the clear spike in numbers.

In regards to my wife- still having fevers but the cough is vastly improved- both in frequency and in sounds that I can hear from a room away. Now more of a runny nose, sore throat picture. She's 40 hours out from the monoclonal antibody infusion, so I'm certain it helped. Thankfully she was able to get infused 4 days after symptoms started, I hear 3-5 days is ideal but they will still do the infusion up to 10 days after symptoms present in immunocompromised patients. Vaccine + monoclonal antibodies, its the best she'll ever get. And if anyone is wondering, getting the vaccine is not a CI to getting the antibodies- no need to wait like you would if the order was reversed. The CDC has a paragraph in one of their COVID updates addressing this.

[Tim]

Seems one vaccine has a flare up. Possible that politicalization vaccine risk has created an environment of expectations.

https://www.astrazeneca.com/media-centre/press-releases/2021/update-on-the-safety-of-covid-19-vaccine-astrazeneca.html

“AstraZeneca vaccine suspended by several European nations as blood clot reports investigated”

https://www.cnn.com/2021/03/11/europe/astrazeneca-vaccine-denmark-suspension-intl/index.html

[Peds]

Seems one vaccine has a flare up. Possible that politicalization vaccine risk has created an environment of expectations.

https://www.astrazeneca.com/media-centre/press-releases/2021/update-on-the-safety-of-covid-19-vaccine-astrazeneca.html

“AstraZeneca vaccine suspended by several European nations as blood clot reports investigated”

https://www.cnn.com/2021/03/11/europe/astrazeneca-vaccine-denmark-suspension-intl/index.html

Which is hilarious because I know someone in those countries that when they heard the clinic had to throw out the vaccines actually went to go get it since they weren't in a qualifying tier yet.

[Panscan]

If the numbers are as claimed and they are really halting it for ~ 40 thrombotic events among 17 million that would seem like a very questionable public policy move.

[artemis]

If the numbers are as claimed and they are really halting it for ~ 40 thrombotic events among 17 million that would seem like a very questionable public policy move.

Especially since COVID infection itself produces thromboembolic events.

[Tim]

Out of an abundance of caution, the “governments” on the advice of their “experts” are taking actions. What could go wrong?

https://www.cnbc.com/2021/03/16/europes-suspension-of-astrazenecas-covid-vaccine-is-damaging.html

The messaging has been done. The seeds of doubt about vaccine safety have been planted.
Expected results will spill over to all vaccines.
WHO, scientists, CDC and drug companies have had credibility severely damaged.

“It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you'll do things differently.”
Warren Buffett

I wish the scientific community had stayed out of the messaging and political business.

[artemis]

The seeds of doubt about vaccine safety have been planted.

The seeds of doubt were already there. All this does is give the doubters a "fact" to glom on to.

Most people don't objectively study evidence and then come to a reasoned opinion. Most people cherry-pick in order to support a position they already hold for emotional reasons. Facts don't sway them because their opinion wasn't initially derived from reason.

Unfortunately, that is what we've been up against all year. And now it's going to continue with regards to vaccines. "COVID is just the flu!" is going to morph into "COVID vaccines are more dangerous than COVID is!", and for the same (non)reasons.

[PedsCCM]

Tim, phase IV studies have always fallen under the oversight of expert scientists and physicians. If they’re concerned enough to pause the distribution, I’m willing to give them the benefit of the doubt. Remember AZ has had several errors in roll out and reporting and still doesn’t have US approval.

The message delivered can just as easily be: “Look at how incredibly careful and vigilant we are with these novel vaccines. The ones that have passed that kind of scrutiny must be quite safe.”

[Tim]

Tim, phase IV studies have always fallen under the oversight of expert scientists and physicians. If they’re concerned enough to pause the distribution, I’m willing to give them the benefit of the doubt. Remember AZ has had several errors in roll out and reporting and still doesn’t have US approval.

The message delivered can just as easily be: “Look at how incredibly careful and vigilant we are with these novel vaccines. The ones that have passed that kind of scrutiny must be quite safe.”

The countries were acting independently of the EMA the EU medical approved.
EMA seems to take a neutral position as opposed to the WHO’s contrary position.
Yes, the US CDC process hasn’t approved it.
The Oxford-AstraZeneca group seems focused on EMA approval for obvious reasons.

The question is which experts and scientists to believe. If memory is correct, Oxford-AstraZeneca had to combine two studies for the initial EMA approval and there were some real “scientist” challenges to whether the approval process was followed. Countries, EMA, WHO and the CDC all have vested interests. A consensus based on process and evidence has not yet emerged. It will, but make no mistake, in the absence of conclusive evidence, this is not a confidence builder. I have no idea if the problems encountered are actually caused by the vaccine in an amount greater than the normal occurrence.

The reality is the perception is that the “heads” of the official healthcare groups have become too involved as political animals. No knock on the scientists doing the work. It is difficult to distinguish between the two messages. This is a negative message in regards to Vaccine safety.

Would you trust a scientist that say a regular mask protects you from getting the virus?

“Masks Protect You & Me”
Much was made of wearing a mask was necessary to “lower the curve”. It was acknowledged that it is most effective in preventing the spread, but did very little to prevent infection. PPE for healthcare workers.

The official public relations messaging is masks protect you and prevents spread. Why was the message changed? Marketing. You have to convince the public by misleading information to get mask acceptance. False sense of security.
The end justifies the means. Just another change from “the public doesn’t need to wear masks”. Science is good, misleading messaging creates issues. A lot of conflicting messages regarding Oxford-AstraZeneca.

[PedsCCM]

With respect, you're conflating medical decisions, even for populations, with political messaging. Phase IV evaluations have utilized similar outcomes for decades. How that is reported to the citizens of any given country varies widely over time, location and situation. Most of the time it is completely ignored by the populace. Now admittedly I know almost nothing about how member nations' medical authorities interact with the EMA but a quick Google search leads me to believe that most of the power resides with the member nations (https://www.ema.europa.eu/en/about-u...n't-do-section). Those groups have decided that the adverse events in patients who receive AZ are potentially outside of what is expected in the population as a whole. I want them to make those types of determinations and you should too.

[Peds]

funny i mentioned something similar: https://www.cbsnews.com/news/health-...ot-vaccinated/

[billy]

Just updating- 12 days later, my wife is completely recovered. 4 days of no fevers, cough basically non existent. The monoclonals biggest effect seemed to be on her cough and general malaise.

I'm also still seeing vaccine hesitancy amongst nursing, but it has improved (more nurses getting vaccinated now) at my workplace. There may be FOMO soon, but I also think us physicians reinforcing general knowledge about vaccines in a non paternalistic way helps too.