Medical Discussion of Coronavirus

[Zaphod]

My big takeaways from Delta:
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.

This is a simple herd immunity calculation, and it is more 'concerning', not meaning more deadly or anything, just that prior herd immunity levels to stop spread arent going to cut it and the pediatric population and unvaxxed so far are too large to keep it from spreading in kids.

School starts soon.

[artemis]

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.

Hygeine theater and masking are relatively cheap. Upgrading ventilation systems (while more beneficial both now and in the event of future pandemics) costs a lot more money. We’re being penny wise and dollar foolish, as usual.

[FIREshrink]

Number 5 is my biggest takeaway.

Viral load averages 1000 fold higher than wild type. Your biggest takeaway is that this is a media sensation?

[ENT Doc]

This is a simple herd immunity calculation, and it is more 'concerning', not meaning more deadly or anything, just that prior herd immunity levels to stop spread arent going to cut it and the pediatric population and unvaxxed so far are too large to keep it from spreading in kids.

School starts soon.

Serious question, do we know what the level of herd immunity is that would stop the spread? That includes previous infected parties as well as vaccinated parties.

[StarTrekDoc]

Herd immunity - don't know. Clearly not there. LA is best bell weather for this with high combined natural and vaccinated; yet spiking with Delta -- still primarily in the unvaccinated (unclear prior infection) population.

Interim initial data did show mild improvement of neutralizing ab with a third mRNA shot. The question is whether it makes an impact or not on the breakthrough cases -- simply don't know and won't unless it's significantly late in the game.

I would treat this 'booster' scenario like how we treat seasonal flu -- best guess on upcoming strains and immunize against it.

That's why my opinion that 'booster' is a misnomer more than updated vaccine for those previously immunized. If I were CDC/FDA - would ask manufacturers to start making multi-valent now.

@WBD- If I were in your situation and higher risk exposure of viral load AND underlying risks -- yes. take a 'booster' now as you're frontline and much higher viral load exposure

Hatton - general risk. N95 mask during indoor travel transit.

@rest of us -- stand pat. watch next 2 weeks on how LA county and rest of breakthrough cases play out with the July 4th surge.

Data point -- San Diego: May/June: 50 cases/day; End June post reopening: 100-200 cases/day; Last week ending Friday - post July4th bump: upward trend: 500>700>1200. Most hospitalizations are all unvaccinated. A few vaccinated with underlying conditions.

[Perry Ict]

Viral load averages 1000 fold higher than wild type. Your biggest takeaway is that this is a media sensation?

Well, the question in my mind is, does the vaccine still work? If you are vaccinated and you are most likely going to be asymptomatic (with the delta variant) or in some cases have common cold-like symptoms, then in my mind, the vaccine still works, period, and the message from the media, rather than fear mongering, should be something like "if you are vaccinated, good job, no need to panic, but if you aren't vaccinated, get vaccinated now". On the other hand, if the vaccine doesn't work, then that opens a whole new can of worms.

[artemis]

We know the vaccines work, largely preventing severe illness and death in immunocompetent people. But a lot of those who are not getting vaccinated focus on the fact that it doesn’t completely prevent ALL illness (which is silly; I’d rather have a cold than end up in the ICU).

I hope the FDA grants full approval to at least the mRNA vaccines ASAP. That will undercut another worry: that the vaccines are “experimental” because they only have an EUA rather than full FDA approval.

(And I hope the FDA updates its approval process to take into account the speed with which new vaccines can now be made as a result of these new technologies. Rushing approval is dangerous, but approving vaccines too slowly is dangerous, too.)

[Perry Ict]

We know the vaccines work, largely preventing severe illness and death in immunocompetent people. But a lot of those who are not getting vaccinated focus on the fact that it doesn’t completely prevent ALL illness (which is silly; I’d rather have a cold than end up in the ICU).

Exactly. This, in my opinion, is partly a result of a significant error in the messaging. When talking about efficacy, we should be emphasizing that the vaccines keep you out of the ICU. If we make a big deal of it every time a vaccinated person gets symptoms of the common cold with Covid, it undermines the efforts to get more people vaccinated.

[AR]

I hope the FDA grants full approval to at least the mRNA vaccines ASAP. That will undercut another worry: that the vaccines are “experimental” because they only have an EUA rather than full FDA approval.

As far as I can tell, this is not a worry that any actual people have. It's an excuse rather than an actual reason to not get vaxxed. I'd be surprised to meet someone who is not getting vaxxed for that reason and will suddenly get vaxxed the day full approval comes through. Such people will just have another explanation for why they don't want to get it. I'm sure there are rare exceptions out there, but it's a very small number of people for whom that is the critical issue.

I think the main function of full approval is that it gives entities that want to make vaccinations mandatory in certain spaces better legal footing to do that.

[Hatton]

Herd immunity - don't know. Clearly not there. LA is best bell weather for this with high combined natural and vaccinated; yet spiking with Delta -- still primarily in the unvaccinated (unclear prior infection) population.

Interim initial data did show mild improvement of neutralizing ab with a third mRNA shot. The question is whether it makes an impact or not on the breakthrough cases -- simply don't know and won't unless it's significantly late in the game.

I would treat this 'booster' scenario like how we treat seasonal flu -- best guess on upcoming strains and immunize against it.

That's why my opinion that 'booster' is a misnomer more than updated vaccine for those previously immunized. If I were CDC/FDA - would ask manufacturers to start making multi-valent now.

@WBD- If I were in your situation and higher risk exposure of viral load AND underlying risks -- yes. take a 'booster' now as you're frontline and much higher viral load exposure

Hatton - general risk. N95 mask during indoor travel transit.

@rest of us -- stand pat. watch next 2 weeks on how LA county and rest of breakthrough cases play out with the July 4th surge.

Data point -- San Diego: May/June: 50 cases/day; End June post reopening: 100-200 cases/day; Last week ending Friday - post July4th bump: upward trend: 500>700>1200. Most hospitalizations are all unvaccinated. A few vaccinated with underlying conditions.

Just ordered a box of american made N95s from Walmart. No longer a short supply

[Hatton]

My main concern is my brother is in liver failure and I certainly do not want to expose him to anything. He is vaccinated with Pfizer and so am I.

[ENT Doc]

Herd immunity - don't know. Clearly not there. LA is best bell weather for this with high combined natural and vaccinated; yet spiking with Delta -- still primarily in the unvaccinated (unclear prior infection) population.

Interim initial data did show mild improvement of neutralizing ab with a third mRNA shot. The question is whether it makes an impact or not on the breakthrough cases -- simply don't know and won't unless it's significantly late in the game.

I would treat this 'booster' scenario like how we treat seasonal flu -- best guess on upcoming strains and immunize against it.

That's why my opinion that 'booster' is a misnomer more than updated vaccine for those previously immunized. If I were CDC/FDA - would ask manufacturers to start making multi-valent now.

@WBD- If I were in your situation and higher risk exposure of viral load AND underlying risks -- yes. take a 'booster' now as you're frontline and much higher viral load exposure

Hatton - general risk. N95 mask during indoor travel transit.

@rest of us -- stand pat. watch next 2 weeks on how LA county and rest of breakthrough cases play out with the July 4th surge.

Data point -- San Diego: May/June: 50 cases/day; End June post reopening: 100-200 cases/day; Last week ending Friday - post July4th bump: upward trend: 500>700>1200. Most hospitalizations are all unvaccinated. A few vaccinated with underlying conditions.

Why are you suggesting N95 mask wearing for indoor travel?

[StarTrekDoc]

My main concern is my brother is in liver failure and I certainly do not want to expose him to anything. He is vaccinated with Pfizer and so am I.

No worries. We've studied and followed this closely.in our system. If vaccinated AND no symptoms, the risk of presume/asx carrier is neglible. We watched this very closed in our system

[ENT Doc]

No worries. We've studied and followed this closely.in our system. If vaccinated AND no symptoms, the risk of presume/asx carrier is neglible. We watched this very closed in our system

So why recommend N95 wearing during travel if vaccinated?

[billy]

No worries. We've studied and followed this closely.in our system. If vaccinated AND no symptoms, the risk of presume/asx carrier is neglible. We watched this very closed in our system

Have you seen any vaccinated patient with symptoms become presumed spreaders to family, etc?