Medical Discussion of Coronavirus

[Tim]

Trump vaccine rallies maybe? It's not ideal from the point of view of gathering before immunization but it might grab a decent chunk of people, as well as draw favorable press in desirable places.

Remember “Covid Parties” and Spring Break?
Hookers and blow, get a tat and add in a couple of shots with vaccine chaser? Mardi Gras, Slam Dunk Contests.

Mom, Dad. I have something to tell you. I got vaccinated.

If Happy Meal Toys sell burgers, we need someone like Elon to run CDC’s marketing campaign.

[Lordosis]

I get the whole idea behind the mask. It cuts down the rate of transmission and even if it has low effectiveness if used in large numbers it can help prevent surges and peaks in cases. It seems we are past the "flatten the curve" period. Health systems in this country can handle the burden in the community at this point.

It was never really discussed just how effective masks are?? I remember hearing 10-20%. Which is low but when it is all you have it is better then nothing. And when this was increasing exponentially even a small decrease in transmission can make a big difference.

But with the vaccine having effectiveness in the 95% range and areas with lower infection rates adding a mask really does not move the needle much at all.

It makes sense to lift any mask restrictions for vaccinated individuals however the enforcing this would be near impossible. It would be impossible for every business or venue to check vaccine status for routine daily use. And trusting people to voluntarily follow the rules is not a good plan. Those who refuse vaccine overlap greatly with those who refuse masks.

[Tim]

I get the whole idea behind the mask. It cuts down the rate of transmission and even if it has low effectiveness if used in large numbers it can help prevent surges and peaks in cases. It seems we are past the "flatten the curve" period. Health systems in this country can handle the burden in the community at this point.

It was never really discussed just how effective masks are?? I remember hearing 10-20%. Which is low but when it is all you have it is better then nothing. And when this was increasing exponentially even a small decrease in transmission can make a big difference.

But with the vaccine having effectiveness in the 95% range and areas with lower infection rates adding a mask really does not move the needle much at all.

It makes sense to lift any mask restrictions for vaccinated individuals however the enforcing this would be near impossible. It would be impossible for every business or venue to check vaccine status for routine daily use. And trusting people to voluntarily follow the rules is not a good plan. Those who refuse vaccine overlap greatly with those who refuse masks.

I agree with you completely. The question is when do you stop requiring a mask in order to protect the those that fall into the last category, unmasked and unvaccinated? Fourth of July?
Labor Day? Christmas? Forever? The burden is on which group?
81.8% 65 and older have at least one shot
54.2% 18 and older have at least one shot

At one point Fauci mentioned 60-65% as herd immunity. Understandably, 100% is really the goal. But there is not consensus target AND it keeps changing.

This is similar to the “how much is enough to retire” question. More is better.

CDC is not using science, Perfect is the enemy of good. I have no clue what the metric should be. There is a large contingent (science based) that think CDC doesn’t know either and is way behind the curve.

I would love to know the true opinions of the true CDC scientists. Not the appointed administrators. Unfiltered zero edits.

[wideopenspaces]

You can’t convince the vast majority of people of anything with logic. You convince them with emotional arguments and stories. Look at every argument on every side of every issue. People are programmed to respond to emotion and stories.

I can quote a thousand papers to a patent, but what convinces them in the end is a tale of what happened to my sister, or my best friend, or another patient, or something like that..

I tried to convince my mom to get a vaccine by telling her she could come visit us if she did. Several weeks later . . . Nothing. She wasn't an antivaxxer prior to Trump. All 6 of her kids are fully vaccinated. I don't think there's any way to reach some people. I fear this is quite literally her hill to die on and I just don't get it.

[StarTrekDoc]

Most don't seek perfect. Most make a best guess on what is needed and then set goals to get to there.

Masks will become a local issue like no shoes no shirt no mask. No service. Really when does no shoes or shift make a safety issue more risky than no mask at this time?

I believe no mask stil riskier at this time and few businesses will have the resources to check immunization status....so a rough policy like no shirt no shoes no mask will be in place.

Eventually the business can make a choice to remove it. some counties can and will dictate that safety too when they hold permitting control. It may be that in some areas in the future.

For big companies like Disney. I can see masking remain for the remainder of the year.

[Tim]

Most don't seek perfect. Most make a best guess on what is needed and then set goals to get to there.

I agree with all your comments except the appointed administrators. I do not feel that they are making "best guess". I think some intentionally interpret their responsibilities differently. This can be a very valid debate. Simply using a different standard. Happens regardless of affiliation. Real world dynamics.

[Shant]

https://www.nature.com/articles/s41586-021-03553-9

Yikes on the effects of COVID on all-causes mortality in the 6 months following recovery. 50% higher. The burden of this disease is going to be substantial for a long time.

[FIREshrink]

I tried to convince my mom to get a vaccine by telling her she could come visit us if she did. Several weeks later . . . Nothing. She wasn't an antivaxxer prior to Trump. All 6 of her kids are fully vaccinated. I don't think there's any way to reach some people. I fear this is quite literally her hill to die on and I just don't get it.

You cannot argue with a delusional person. Some vaccine hesitancy is rational; some is frankly delusional. In the latter camp it's either Haldol or forget it.

Here's my latest story of vaccine conversion. Young, reasonable, rational, person. Had been vaccine deferrer. Had cited all kinds of borderline conspiracy reasons without totally buying into any of them. This week, he's gotten his first shot. Why? He says, I figure you got it, my other doctors got it, my family all got it. If the vaccine kills everyone in 2-3 years, I wouldn't want to be alive because everyone important to me would be dead. What kind of life would that be? So I got the vaccine, figure that way if everyone dies I'd rather be dead, too.

Whatever it takes...

[G]

Masks will become a local issue like no shoes no shirt no mask. No service. Really when does no shoes or shift make a safety issue more risky than no mask at this time?

A) No shoes. You clearly don't remember your patients from back in the days of your ER rotation!
B) No shirt. Depending on the service being offered and the particular shirtless customer, this has "industrial accident" written all over it.

[pulmdoc]

I agree with you completely. The question is when do you stop requiring a mask in order to protect the those that fall into the last category, unmasked and unvaccinated? Fourth of July?
Labor Day? Christmas? Forever? The burden is on which group?
81.8% 65 and older have at least one shot
54.2% 18 and older have at least one shot

At one point Fauci mentioned 60-65% as herd immunity. Understandably, 100% is really the goal. But there is not consensus target AND it keeps changing.

This is similar to the “how much is enough to retire” question. More is better.

CDC is not using science, Perfect is the enemy of good. I have no clue what the metric should be. There is a large contingent (science based) that think CDC doesn’t know either and is way behind the curve.

I would love to know the true opinions of the true CDC scientists. Not the appointed administrators. Unfiltered zero edits.

There is no perfect number of vaccinations that guarantees herd immunity, because the number of unvaccinated/natural immunity is difficult to count and fluid, and because all assumptions about what it takes to get herd immunity depend on a static R0, when R0 for this disease fluctuates wildly depending on the specific circumstance. 500 people taking walks through the park outside is not the same as 500 people singing indoors for an hour in terms of transmission risk. Needing 60-65% of the population vaccinated to bring the case counts to a sustainably low level is a highly educated guess that will probably bear out.

People crave certainty and think "the message has changed" is somehow a sign of intellectual weakness not to be trusted. Instead, I see it as the quintessential mark of a good scientist that if the available data changes, your opinion should change accordingly to account for that data. I don't think the CDC did a great job in messaging, but not because they weren't trying to do science, it's because science with its infinite iterative process doesn't make for good sound bites.

[pulmdoc]

https://www.nature.com/articles/s41586-021-03553-9

Yikes on the effects of COVID on all-causes mortality in the 6 months following recovery. 50% higher. The burden of this disease is going to be substantial for a long time.

My biggest concern with the methodology is that they started with 30 day survivors. Lots of people who die of COVID (especially since steroids became standard) will die past 30 days of their acute illness, although they never clinically recovered. All those people would be lumped into the "recovered but eventually died" category instead of the "got sick and died" category.

That being said, I am seeing a tsunamai of referrals for post-COVID in my pulmonary clinic now. At least 50% of the referrals over the past month have been for post-COVID. Lots of patients who were hospitalized but never critically ill are still needing home O2 3,4, 6 months after discharge. Those who were critically ill have been through the wringer and are just being discharged to home after months in rehab. I'm filling out so many disability forms for previously healthy, functional, working age adults it's crazy. I feel like this is one story that hasn't gotten much attention; an epidemic of disability in working adults due to getting COVID.

[Tim]

There is no perfect number of vaccinations that guarantees herd immunity, because the number of unvaccinated/natural immunity is difficult to count and fluid, and because all assumptions about what it takes to get herd immunity depend on a static R0, when R0 for this disease fluctuates wildly depending on the specific circumstance. 500 people taking walks through the park outside is not the same as 500 people singing indoors for an hour in terms of transmission risk. Needing 60-65% of the population vaccinated to bring the case counts to a sustainably low level is a highly educated guess that will probably bear out.

People crave certainty and think "the message has changed" is somehow a sign of intellectual weakness not to be trusted. Instead, I see it as the quintessential mark of a good scientist that if the available data changes, your opinion should change accordingly to account for that data. I don't think the CDC did a great job in messaging, but not because they weren't trying to do science, it's because science with its infinite iterative process doesn't make for good sound bites.

Your 60-65% guesstimate for herd immunity is exactly where the estimate started. I have no problem with CDC not accepting every reputable study. I have no problem with CDC intelligently setting guidelines. I have no problem with CDC significantly changing based upon new data. I have no problem with CDC identifying "educated opinions" vs "science". I do have a problem with CDC claiming that everything is based on "science".

Go to the doctor and get test results back and try something else. That is not what the "appointed" CDC is doing. FDA has done a better job in staying in their lane.
EAU is fine. It is preliminary "we have more work to do". Shutting down schools is an example. It made sense, with no data. If schools had not opened up on their own, CDC would likely not have changed. Even when they changed based on the actual science, they walked it back for non-scientific reasons. There were absolutely no new studies. They just changed their opinions. The multitude of changes have mostly been opinions and other factors. Back to the big one, the public does not need to mask but now they need two masks. Really? The "talking heads" at CDC are the ones delivering opinions rather than guidance. I wish they would go back to being scientists. It's not certainty, its "talking heads". What is with CDC imposing travel restrictions and staying silent on only one travel option? Is that science?

[Jaqen Haghar MD]

The CDC recently announced that if you’ve had your vaccines, you can now go outside without a mask on.... Well, if that’s not hard-core scientific thinking, then I don’t know what is...

I can’t wait until we’ve all had 4 vaccines, so they can stop wiping the shopping carts at the grocery store with tap-water before I grab one. Or 6 vaccines when they’ll lift the requirement for laser forehead temperature checks at the yoga store.

Every time I think of the CDC, I now also think of the Batman from the college humor videos...

Because, ...science.

[jfoxcpacfp]

You cannot argue with a delusional person. Some vaccine hesitancy is rational; some is frankly delusional. In the latter camp it's either Haldol or forget it.

Here's my latest story of vaccine conversion. Young, reasonable, rational, person. Had been vaccine deferrer. Had cited all kinds of borderline conspiracy reasons without totally buying into any of them. This week, he's gotten his first shot. Why? He says, I figure you got it, my other doctors got it, my family all got it. If the vaccine kills everyone in 2-3 years, I wouldn't want to be alive because everyone important to me would be dead. What kind of life would that be? So I got the vaccine, figure that way if everyone dies I'd rather be dead, too.

Whatever it takes...

First LOL of the day - I may use that logic on someone myself. Thank you.

[Rando]

People crave certainty and think "the message has changed" is somehow a sign of intellectual weakness not to be trusted. Instead, I see it as the quintessential mark of a good scientist that if the available data changes, your opinion should change accordingly to account for that data. I don't think the CDC did a great job in messaging, but not because they weren't trying to do science, it's because science with its infinite iterative process doesn't make for good sound bites.

This was talked about earlier in this thread. Fauci revised his estimates upwards of what would be an adequate vaccination rate to achieve herd immunity, despite the vaccine actually working much better than originally predicted. In interviews he said that he had revised the estimates partially on what he thought the country was ready to hear.

I don't interpret that as intellectual weakness, I interpret that as a lack of honesty, especially coming from someone that is portrayed as the definitive voice on the scientific aspects of the pandemic. He slipped from a field he's an expert in - infectious disease - into a field he is not - messaging. I felt that he lost some credibility, and he deserved to. Giving different numbers based on what you think people are ready to hear is not science.

https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html

Related to this, what constitutes herd immunity is still not well defined. Listening to some of Fauci's comments he seems to be hoping to almost eradicate COVID, while others I've read regard adequate herd immunity as providing morbidity/mortality equivalent to an average flu season.