Medical Discussion of Coronavirus

[billy]

We have had 3-4 employees, out of about 2,000 hospital employees immunized with Pfizer, come down with COVID after being fully immunized. In every case, it behaved like a cold. No treatment beyond bed rest was needed. Not too shabby! The hospital has arranged to have their samples typed, so we can see if any of the new variants are involved.

Is anyone starting to see upticks in their admissions due to the the rising prevalence of variants? We're seeing an uptick in our admissions. It's nothing like the last wave (thank God!), but the trend is definitely heading the wrong way. We have around 18 COVID patients in house now, up from a low of 4. Fingers crossed that opening up vaccination eligibility to all adults ages 16+ will keep this mini-surge from becoming a full-sized one.

last week we started seeing the uptick in admissions again. Assume travel + kids+ variants. Like I mentioned before I know of a few people who were fully vaccinated and not immunocompromised get it- one no symptoms, one a cold, one a cold + loss of smell. NY/NJ area.

[Rando]

I keep a pretty close watch on the numbers in my region of the state (over a million people). A couple weeks ago we were down to zero COVID patients on the vent in the region which was pretty amazing, unfortunately it's back up to 10 so there's definitely an uptick. At the peak in December it was around 60.

[mamaham]

Sorry if this was asked before, I haven't read all the 270 pages of comments... Has anyone had the J/J vaccine? Any side effects? I only know people that have had Moderna and majority had symptoms after second shot.

[StarTrekDoc]

Have had three J+j patients in clinic so far. Same typical headache fever soreness. No rashes like the moderna yet.

Uptick of local cases yes. Admissions mostly stable still. The fully immunized still minimal diagnosis . Among staff only 1 reported case of fully immunized in past two weeks.....staff sitting about 85% vaccinated now.

[Hatton]

Sorry if this was asked before, I haven't read all the 270 pages of comments... Has anyone had the J/J vaccine? Any side effects? I only know people that have had Moderna and majority had symptoms after second shot.

My next door neighbor did the J&J vaccine trial. Local injection site pain and very mild flu like symptoms only.

[mamaham]

My next door neighbor did the J&J vaccine trial. Local injection site pain and very mild flu like symptoms only.

Thanks for info. I guess I will find out. Had my vaccine this am. It was so strange to be around so many people. It was well organized mass event at stadium, but still I haven't been around that many people (or any people really - apart from talking outside with neighbors distanced, grocery store distanced, and some family interactions) in over a year. Was very surreal. I hadn't expected that feeling at all. It just hit me as I was in the long winding line. Kind of like reverse culture shock.

[pysibal]

This came up today: I've mild cold symptoms (sore throat, runny nose, mild fatigue) which are almost assuredly related to my kid getting an infection at day care. Of note, kid had COVID in October and I've been fully vaccinated since December.

Are there any guidelines about how to deal with mild respiratory sx/colds s/p vaccination? I can't imagine an eternal policy of quarantining for this kind of thing but with the variants around I wonder if anyone has ideas.

[mamaham]

From cdc post vaccination website “

• You should still watch out for symptoms of COVID-19, especially if you’ve been around someone who is sick. If you have symptoms of COVID-19, you should get tested and stay home and away from others.”

It also says “If you’ve been around someone who has COVID-19, you do not need to stay away from others or get tested unless you have symptoms”

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html

[artemis]

Are there any guidelines about how to deal with mild respiratory sx/colds s/p vaccination? I can't imagine an eternal policy of quarantining for this kind of thing but with the variants around I wonder if anyone has ideas.

You have symptoms. Get tested.

[Tim]

Pausing J&J vaccine.

https://www.cnbc.com/2021/04/13/us-regulators-reportedly-call-for-pause-in-use-of-johnson-johnson-vaccine-due-to-clotting-issues.html

Good from a safety perspective, bad from progress in vaccine shots in the arm.

My understanding was CDC was already reviewing. Did they find something that led to a pause? They issued some guidance.

”“People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider,” the FDA and CDC said.”

[artemis]

The issue appears to be that six women developed central venous sinus thrombosis, per the WP article: https://www.washingtonpost.com/healt...e-blood-clots/

I wonder why this thrombosis issue is only being seen to date in the adenovirus vector vaccines, which use two entirely different adenoviruses as the carrier, and not in the mRNA vaccines?

And I wonder if OCPs play a role, since the events seem to be happening in premanopausal women.

What worries me is that the general public is innumerate and would fail a Probability and Statistics course, And hearing about an extremely rare dangerous vaccine side effect may put a lot of them off of getting vaccinated (even though the vaccine is still likely safer than a COVID infection is).

[Tim]

What worries me is that the general public is innumerate and would fail a Probability and Statistics course, and hearing about an extremely rare dangerous vaccine side effect may put a lot of them off of getting vaccinated (even though the vaccine is still likely safer than a COVID infection is).

Less than 1% of the population can make an informed decision. Independent accurate recommendations base on objective scientists to interpret data has sustained a lot of damage. Actual justified interpretations or second opinions have been compromised. The "complete confidence" in what is described as "science" no longer exists in the minds of the general public. This is neither pro nor con. Statistically, confidence has dropped.

[Kamban]

The issue appears to be that six women developed central venous sinus thrombosis, per the WP article: https://www.washingtonpost.com/healt...e-blood-clots/

I wonder why this thrombosis issue is only being seen to date in the adenovirus vector vaccines, which use two entirely different adenoviruses as the carrier, and not in the mRNA vaccines?

And I wonder if OCPs play a role, since the events seem to be happening in premanopausal women.

What worries me is that the general public is innumerate and would fail a Probability and Statistics course, and hearing about an extremely rare dangerous vaccine side effect may put a lot of them off of getting vaccinated (even though the vaccine is still likely safer than a COVID infection is).

My take on talking with patients who have yet to get the vaccine.

1. Almost no one wants J & J vaccine.
2. They don't like Moderna but would take it if there is no other option. They now have enough info about its more frequent side effects compared to Pfizer's with bth haing similar efficacy.
3. Most are willing to take Pfizer vaccine without too much worries about long term side effects.
4. A quarter of the people, especially < 40 years, still want to adopt a wait and see policy.
5. No one will pass a statistics exam.

[artemis]

Another thought: I wonder if these thrombotic events involve women who have a hereditary defect predisposing them to hypercoagulability (Protein C or S deficient, Factor V Leiden, etc.)? I could see how having an increased baseline risk of hypercoagulability + OCPs + vaccine to a virus that is itself is known to screw up the coagulation cascade could be a bad combination in a few unlucky individuals.

[Kamban]

Another thought: I wonder if these thrombotic events involve women who have a hereditary defect predisposing them to hypercoagulability (Protein C or S deficient, Factor V Leiden, etc.)? I could see how having an increased baseline risk of hypercoagulability + OCPs + vaccine to a virus that is itself is known to screw up the coagulation cascade could be a bad combination in a few unlucky individuals.

Most thrombotic events result from a two hit mechanism. There is some sort of underlying hypercoagulable state that increases but does not on its own cause the thrombosis. And then a second hit like the OCP, pregnancy, ortho fractures, major surgeries and immobilization provides the push and it precipitates the clot. Maybe the vaccine provides the second hit in the vulnerable population.

We have a natural tendency to make clots ( otherwise we can bleed to death with simple cuts) but we also have the mechanism to lyse the clots in time. The failure to not break them up ( hardened Factor V due to Leiden mutation or Protein C / S deficiency) causes those clots to accumulate and become symptomatic with the precipitating factor sometimes being something simple like OCP. Maybe the vaccine is the culprit here. Let us see what the work up shows. .