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  • Originally posted by billy View Post

    Im still amazed (not really, I know how horrible the bureaucracy is) that big school systems like NYC didnt publicly do a massive overhaul of their ventilation systems- kids are out, you know they will have to come back at some point, you know air turnover helps, etc etc. Same goes for the big name restaurants.
    Hygiene theater and the culture wars over masks have made it hard to focus and prioritize. I was talking about ventilation last feb/march. Droplet or airborne, doesnt matter the more you put air turnover towards infinity the better it is. And we have ways to do so, seemed like a no brainer, but alas. If I was a restaurant I'd do the same, and advert our ability like mad.

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    • Originally posted by Zaphod View Post

      If I had control of the school my main priority would be to increase ventilation where you could get massive air turnovers in each classroom and common area, where it could be absolutely cranked and would push cranking of turnovers > filtration even. Dont need to filter fresh virus free air and filtration always reduces airflow.

      In fall open windows while you can, then crank the ventilation until you have as much as possible air turnovers per hour.
      I can attest to this. As a pathologist, last year I used to work in a medical examiner facility where the Chief performed autopsies on decedents who had died of Covid-19, and he did so barefaced, without wearing a mask. Naturally they didn't wear them in the office areas either. Nobody ever got Covid from work, so far as I know. The ventilation in that place was terrific - must have been 15-20 air changes per hour in the autopsy room - you could always feel a breeze in there! The office areas were also well ventilated. The importance of good ventilation cannot be overstated.

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      • Originally posted by AndrewPath View Post

        I can attest to this. As a pathologist, last year I used to work in a medical examiner facility where the Chief performed autopsies on decedents who had died of Covid-19, and he did so barefaced, without wearing a mask. Naturally they didn't wear them in the office areas either. Nobody ever got Covid from work, so far as I know. The ventilation in that place was terrific - must have been 15-20 air changes per hour in the autopsy room - you could always feel a breeze in there! The office areas were also well ventilated. The importance of good ventilation cannot be overstated.
        That is disgusting. As a surgeon, I will never not wear a mask or eye wear, because I dont want fluids on me reasons 1-9999, that it may benefit the pt, thats also nice.

        15-20 is every 3-4 minutes, that is super impressive.

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        • Originally posted by Zaphod View Post


          In fall open windows while you can, then crank the ventilation until you have as much as possible air turnovers per hour. Electric costs will soar but thats a small cost in the overall. Make the inside like the outside is the biggest easiest preventative measure right now. Plus lots of jobs.
          I agree, it seems like ventilation has been largely overlooked. To my knowledge there hasn't been much direction on this coming from well, anywhere. The droplet vs aerosol battle has been ongoing and initially the droplet camp was dominant (which is where the 6 foot distancing and plastic barriers came from) which I think slowed down the focus on ventilation.

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          • Originally posted by snowcanyon View Post
            1. I am seeing way more Pfizer than Moderna breakthrough
            2. I was Pfizerized
            3. Anyone getting a booster, illicitly or not?
            4. Should I switch to Team Moderna?
            Trying to separate the wheat from the chaff in this thread...

            As stated, breakthrough depend on what percentage of the community was vaccinated with what vaccine. I don't think one mRNA vaccine is superior to the other, so far.

            I got Pfizer but won't get a booster unless I see some evidence of published declining antibody titters that were clinically significant Just a decline in antibody titer is expected after every immunization as time passes and I expect memory cells to boost antibody protection should there be a reinfection.

            I would like to see the severity of infection in people with the delta variant in people who have been fully vaccinated by Moderna / Pfizer and some evidence that the booster shot is effective in preventing those infection. Rather than take a 3rd shot of the same old, same old vaccine I would take a third vaccine only if it has been engineered to protect me from these new variants. Otherwise I am just adding to the coffers of Pfizer and Moderna. I don't trust their CEOs statement about the need for a booster. I need to see peer reviewed studies before I get yet another vaccine.


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            • I have to come clean.

              Pfizer #1 December 15, 2020
              Pfizer #2 January 5, 2021
              Moderna #1 July 24, 2021

              I have been reading so many studies, most of the data is simply too preliminary. There is no good answer to my question. But I work in the ED, not just the ICU. When I am in the ED, we often make our best decision based on limited information. So that is what I did today, I made my best decision based on limited information.

              Shot #1 was likely 10,000:1 benefit to risk, shot #2 was likely 200:1 benefit to risk. Shot #3, who knows the benefit to risk ratio? But I decided that it is likely >10:1, so I did what I did. 10 hours post I have a sore arm and a slight headache, a bit of mild chills, but my better half always likes the AC way lower than I do.

              Wish me luck....

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              • Wow reading these last two posts from Kamban and WBD I am confused. Is there really any good evidence that fully vaccinated people are getting seriously ill from Delta. I mean ICU sick. I am asking since I am planning my first airplane trip since COVID in 2 weeks. I am going to visit my brother outside of Austin who is in liver failure. I guess I could go get shot 3 but I was just planning to mask.

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                • Originally posted by Hatton View Post
                  Wow reading these last two posts from Kamban and WBD I am confused. Is there really any good evidence that fully vaccinated people are getting seriously ill from Delta. I mean ICU sick. I am asking since I am planning my first airplane trip since COVID in 2 weeks. I am going to visit my brother outside of Austin who is in liver failure. I guess I could go get shot 3 but I was just planning to mask.
                  No there isnt, and taking minor safety precautions while being vaxxed just increases the efficacy greatly. It wasnt hard not to get covid before and just being a smidge safe and vaccinated should be nearly perfect.

                  Trick is people lie about their risk, they go to friends, a long unventilated exposure with unknowns, etc...keep to yourself for a couple weeks prior, n95 on the flight, etc...it should be zero difference.

                  We have seen a slight increase in side effects with increasing shots so I dont think there should be a rush to get a booster, in fact, its pretty pointless, what we should have is 1st and 2nd shots amongst the unvaxxed, that would do far more good.

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                  • Originally posted by Hatton View Post
                    Wow reading these last two posts from Kamban and WBD I am confused. Is there really any good evidence that fully vaccinated people are getting seriously ill from Delta. I mean ICU sick. I am asking since I am planning my first airplane trip since COVID in 2 weeks. I am going to visit my brother outside of Austin who is in liver failure. I guess I could go get shot 3 but I was just planning to mask.
                    I agree with Zaphod . I can understand a bit the need to give booster shots in immunocompromised people who did not have a good antibody response to shot #1 and #2. But we are all immunocompetent people who would have had a good response to the 2 doses that a 3rd dose of the same vaccine might not do much good, especially if we are trying to develop immunity against a new variant.

                    As regards to annual flu vaccine, we do that because each year the viral strains are different. In case of COVID-19 I can understand the same logic if we had a booster that worked against Brazilian, S. African, delta and maybe an emerging strain. But we are giving the same vaccine without any evidence that boosting the antibodies will help against these strains, compared to just being satisfied with the original 2 doses. I am willing to change my mind if a 3rd dose of the same vaccine protects immunocompetent people more in controlled studies. But until then, it may be all side effects and no benefits ( except for the makers of the vaccine).

                    I think mask and sensible precautions should be enough for you while on the plane and airport and closed spaces.

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                    • Originally posted by White.Beard.Doc View Post
                      I have to come clean.

                      Pfizer #1 December 15, 2020
                      Pfizer #2 January 5, 2021
                      Moderna #1 July 24, 2021

                      I have been reading so many studies, most of the data is simply too preliminary. There is no good answer to my question. But I work in the ED, not just the ICU. When I am in the ED, we often make our best decision based on limited information. So that is what I did today, I made my best decision based on limited information.

                      Shot #1 was likely 10,000:1 benefit to risk, shot #2 was likely 200:1 benefit to risk. Shot #3, who knows the benefit to risk ratio? But I decided that it is likely >10:1, so I did what I did. 10 hours post I have a sore arm and a slight headache, a bit of mild chills, but my better half always likes the AC way lower than I do.

                      Wish me luck....
                      Good luck. I consider my covid booster to be the many covid patients a shift I’m seeing now who cough directly in my face, and want to have long, drawn out conversations about covid in closed spaces with me. They help keep my lymphocytes properly stimulated. Cases are picking up fast now. Whole 4-generation families of 5-8 members were carpooling to the ED and all checking in at the same time today.

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                      • Originally posted by Hatton View Post
                        Wow reading these last two posts from Kamban and WBD I am confused. Is there really any good evidence that fully vaccinated people are getting seriously ill from Delta. I mean ICU sick. I am asking since I am planning my first airplane trip since COVID in 2 weeks. I am going to visit my brother outside of Austin who is in liver failure. I guess I could go get shot 3 but I was just planning to mask.
                        The confusion is definitely there. For all of us. There is no solid evidence to support a healthy, older doc with high exposure getting a booster at this point.

                        But deep in the darker recesses of my brain, I remain traumatized by the death and destruction that has surrounded me over these last 17 months. On the surface it isn’t there, but deeper down, I know it lurks.

                        Things are fine here in the land of the first and worst killer wave of COVID. Now almost every single one of our sick and dying admissions are unvaccinated. We had one vaccinated patient admitted to hospital this week, but he is going to be one of the lucky ones, one of the survivors.

                        I want to feel safe in an unsafe world. I feel my decision was a bit rash, but this thought has been creeping around in my mind to do this for the last few weeks. Given the current resurgence, yesterday I just did it.

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                        • I’ll let you know in the next 7-10 days how the vaccines work. Just spent 8 days in NYC with 4 other people, 3 of them vaccinated—my son is 10 and therefore too young to be vaccinated. My daughters are now about 3 weeks out from their second doses, while the wife and I are months out.

                          We rode the subway everywhere and took a few buses. Yankee game unmasked. Most tourist sites (that expressly allowed it) unmasked. Unvaccinated son was encouraged to wear his mask everywhere, but he’s 10 and compliance was an issue. We did wear them all the time on the subway. I would say there was 80%+ mask wearing on public transit, and mostly the young who weren’t masked, despite it being “required.” I would say less than 10% wore masks in tourist places that allowed for vaccinated people to go unmasked. A few places (MoMA, the Met, American Museum of Natural History) were strict on everyone wearing masks. We also ate out for every meal except breakfast, which we ate in the room or in Central Park after picking something up and walking.

                          Edit: hopefully this post isn’t used on one of those r/leopardsatemyface posts about flaunting travel recommendations and getting then dying from Covid…

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                          • “I want to feel safe in an unsafe world. I feel my decision was a bit rash, but this thought has been creeping around in my mind to do this for the last few weeks. Given the current resurgence, yesterday I just did it.”

                            I greatly appreciated your risk:benefit comments and admittedly calling it a bit of a rash decision. More likely overprotective, but a personal choice.

                            To me, this was purely a protective instinct call. Not much benefit, but in your mind better to be safe than sorry. You will never know.

                            Be careful driving next week. There are a lot of accidents looking for a place to happen. Pay attention! Just channeling my overprotective tendencies. You can’t be too careful.

                            @Kambam raises a very legitimate point. A third shot globally has a huge price tag. A real world problem. Is it a waste of money? Definitely diminishing returns it appears.No one is directly paying for these shots, but we will. They aren’t free.

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                            • Originally posted by Hatton View Post
                              Wow reading these last two posts from Kamban and WBD I am confused. Is there really any good evidence that fully vaccinated people are getting seriously ill from Delta. I mean ICU sick. I am asking since I am planning my first airplane trip since COVID in 2 weeks. I am going to visit my brother outside of Austin who is in liver failure. I guess I could go get shot 3 but I was just planning to mask.
                              My big takeaways from Delta:
                              1. Double mRNA vaccine is highly effective at preventing severe illness (94% Pfizer in recent NEJM study out of England)
                              2. Higher spread potential
                              3. Not more severe illness
                              4. Unvaccinated are the problem
                              5. The media loves to fear monger
                              6. We don’t *know* that this situation is worse for kids because 50%+ of the population has been vaccinated. It’s comparing apples to oranges - the population changed in terms of spread potential.

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                              • Thanks to all for the input on my upcoming trip to Austin. I will mask up and try not to worry,

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