Medical Discussion of Coronavirus

[Hatton]

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

I think this is the question I have. It is no problem for me to mask for a 2-3 day trip. If nothing else I think it will make my brother comfortable. It is hard to know what to do sometimes in real life situations.

[ObgynMD]

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

I have a vaccinated patient who tested Covid+. Not privy to her contact tracings, but I have a hard time believing that someone with symptoms doesn’t have a high enough viral load to be contagious. She has mild sx, thankfully, and getting better. Fully vaccinated with Pfizer in March.

No harm in masking around an immunocompromised brother, I think.

[FIREshrink]

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.

Data from Israel raises serious questions about waning vaccine efficacy especially given thousandfold viral loads, including against serious disease. Are these not important facts to report? I don't follow your rationale that the biggest takeaway about Delta is media sensationalism.

[ENT Doc]

Data from Israel raises serious questions about waning vaccine efficacy especially given thousandfold viral loads, including against serious disease. Are these not important facts to report? I don't follow your rationale that the biggest takeaway about Delta is media sensationalism.

Yes but other data shows high efficacy rates for the mRNA vaccines. So while Delta is more infectious it is much more likely, similar to the original strain, to infect and cause death in unvaccinated people. Media where I live reported on a “surge!” and 70% increase in cases. Sure, that’s the case when measured from the nadir and going from something like 19 to 34 cases in a day, most of whom we know are in unvaccinated individuals. So the message should be “get vaccinated” not reporting on “surging” numbers and asking the governor if he’s going to institute indoor mask mandates again.

[StarTrekDoc]

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

No; no reported so far. All presumed to be from an outside source as household presents same time vs daisy-chain timeline. The breakthrough cases we've seen have load viral loads and we've stopped doing them routinely ~April.

We take the general position that vaccinated breakthroughs tend to be terminal points for virus transmission.

[StarTrekDoc]

So why recommend N95 wearing during travel if vaccinated?

??? You still can CATCH it.

If you're flying on a plane of 100% vaccinated folk and all have no symptoms - sure; dump the mask and go buy a lottery ticket too.

[StarTrekDoc]

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.

-. Turn off the media sensationalism -- 24/7 news cycles gotta talk about something and taking a reasonable stance simply doesn't get/maintain eyeballs.
-. We (WCI forum especially, and medical community at-large) can do better than media talking heads and share/spread common knowledge and acceptable best practices.
-. Aside from the Israel data, there does NOT appear to be a large scale failure of immunized protection to hospitalization/ICU/death. We're in the middle of the surge now but don't see a change of ratios unvaccinated/vaccinated admissions skewing to immunized yet.


CDC/FDA still have NOT recommended vaccinated folk to alter behavior. They have recommended all the while in large in-door settings that even vaccinated folk should consider wearing a mask. That was true before DeltaV and remains even moreso with the recent surge. People really should reconsider masking indoors in unfamiliar settings if you don't want to be at risk of catching Covid-19.

So for the PUBLIC POLICY standpoint -- For the vaccinated folk - I do believe a general masking requirement is excessive. Then again, it's PUBLIC POLICY we're talking about and that's for the GENERAL GOOD -- not the individual good. So while 60%+ maybe vaccinated -- 35%+ aren't. Good public policy measure would be a general masking order for in-doors to slow the general spread and reduce consumption of public resources.

For the INDIVIDUAL vaccinated person - the risk remains relatively low unless underlying medical conditions, which in that case, the vaccinated person at-risk really should be practicing added individual protective measures.

[Kamban]

Kamban what are you advising your cancer patients to do if they showed no antibody response (on testing) to initial vaccines? (I apologize in advance if I mistook your specialty)

So far none of my cancer patients who have had both the vaccines have had any antibody testing.

The question would be if the initial 2 doses did elicit antibody response that has now waned. If so, there is logic in having a booster vaccine. But if there was no response to the initial 2 doses, then the 3rd dose of the same might or might not work. In that case using a different mRNA vaccine might be better than giving the original vaccine.

[FIREshrink]

-. Turn off the media sensationalism -- 24/7 news cycles gotta talk about something and taking a reasonable stance simply doesn't get/maintain eyeballs.
-. We (WCI forum especially, and medical community at-large) can do better than media talking heads and share/spread common knowledge and acceptable best practices.
-. Aside from the Israel data, there does NOT appear to be a large scale failure of immunized protection to hospitalization/ICU/death. We're in the middle of the surge now but don't see a change of ratios unvaccinated/vaccinated admissions skewing to immunized yet.


CDC/FDA still have NOT recommended vaccinated folk to alter behavior. They have recommended all the while in large in-door settings that even vaccinated folk should consider wearing a mask. That was true before DeltaV and remains even moreso with the recent surge. People really should reconsider masking indoors in unfamiliar settings if you don't want to be at risk of catching Covid-19.

So for the PUBLIC POLICY standpoint -- For the vaccinated folk - I do believe a general masking requirement is excessive. Then again, it's PUBLIC POLICY we're talking about and that's for the GENERAL GOOD -- not the individual good. So while 60%+ maybe vaccinated -- 35%+ aren't. Good public policy measure would be a general masking order for in-doors to slow the general spread and reduce consumption of public resources.

For the INDIVIDUAL vaccinated person - the risk remains relatively low unless underlying medical conditions, which in that case, the vaccinated person at-risk really should be practicing added individual protective measures.

I'm an optimist too, and Israel is an outlier - but they also had the earliest successful mass mRNA vaccination program in the world. If these vaccines lose efficacy over time, whether because of waning immunity or new variants, Israel may be the canary in the coal mine.

[ENT Doc]

??? You still can CATCH it.

If you're flying on a plane of 100% vaccinated folk and all have no symptoms - sure; dump the mask and go buy a lottery ticket too.

This was always the case that you can still catch it. So do you think we should all go around wearing N95s from now on? What’s your end point? I’ve not noted any organization advocating for everyone, including vaccinated people, to wear N95 masks for traveling or indoor activity.

[ENT Doc]

-. Turn off the media sensationalism -- 24/7 news cycles gotta talk about something and taking a reasonable stance simply doesn't get/maintain eyeballs.
-. We (WCI forum especially, and medical community at-large) can do better than media talking heads and share/spread common knowledge and acceptable best practices.
-. Aside from the Israel data, there does NOT appear to be a large scale failure of immunized protection to hospitalization/ICU/death. We're in the middle of the surge now but don't see a change of ratios unvaccinated/vaccinated admissions skewing to immunized yet.


CDC/FDA still have NOT recommended vaccinated folk to alter behavior. They have recommended all the while in large in-door settings that even vaccinated folk should consider wearing a mask. That was true before DeltaV and remains even moreso with the recent surge. People really should reconsider masking indoors in unfamiliar settings if you don't want to be at risk of catching Covid-19.

So for the PUBLIC POLICY standpoint -- For the vaccinated folk - I do believe a general masking requirement is excessive. Then again, it's PUBLIC POLICY we're talking about and that's for the GENERAL GOOD -- not the individual good. So while 60%+ maybe vaccinated -- 35%+ aren't. Good public policy measure would be a general masking order for in-doors to slow the general spread and reduce consumption of public resources.

For the INDIVIDUAL vaccinated person - the risk remains relatively low unless underlying medical conditions, which in that case, the vaccinated person at-risk really should be practicing added individual protective measures.

I disagree to some extent. All individuals have had ample opportunity to get vaccinated at this point. It’s a rare thing that there’s some medical reason that can’t occur. Vast majority are individual choice. So how long, given their stubbornness, should the rest of us going around wearing masks? I don’t see an endpoint here. At some point we need to tolerate risk and get on with our lives.

[CordMcNally]

At some point we need to tolerate risk and get on with our lives.

I’m hoping that the CDC has realized we can’t just yo-yo back and forth between mask mandates and not. A few cities haven’t realized it but some cities have luckily come out and point blankly said that mask mandates aren’t on the table. We’re nearly a year and a half into this thing. The cities that are going back to mask mandates have no plan or basis in reality.

[Tim]

-. Turn off the media sensationalism -- 24/7 news cycles gotta talk about something and taking a reasonable stance simply doesn't get/maintain eyeballs.
-. We (WCI forum especially, and medical community at-large) can do better than media talking heads and share/spread common knowledge and acceptable best practices.
-. Aside from the Israel data, there does NOT appear to be a large scale failure of immunized protection to hospitalization/ICU/death. We're in the middle of the surge now but don't see a change of ratios unvaccinated/vaccinated admissions skewing to immunized yet.


CDC/FDA still have NOT recommended vaccinated folk to alter behavior. They have recommended all the while in large in-door settings that even vaccinated folk should consider wearing a mask. That was true before DeltaV and remains even moreso with the recent surge. People really should reconsider masking indoors in unfamiliar settings if you don't want to be at risk of catching Covid-19.

So for the PUBLIC POLICY standpoint -- For the vaccinated folk - I do believe a general masking requirement is excessive. Then again, it's PUBLIC POLICY we're talking about and that's for the GENERAL GOOD -- not the individual good. So while 60%+ maybe vaccinated -- 35%+ aren't. Good public policy measure would be a general masking order for in-doors to slow the general spread and reduce consumption of public resources.

For the INDIVIDUAL vaccinated person - the risk remains relatively low unless underlying medical conditions, which in that case, the vaccinated person at-risk really should be practicing added individual protective measures.

Well, your explanations and the written CDC recommendations are not the same tone that comes across in the same manner.
I wish they would present it like "If 20 vaccinated people are in a gathering where Covid is present, ONE of them will likely catch it. If in doubt, wear a mask. Don't let it be you and don't accidentally pass it on."

Same with vaccines. A voice of reason rather than "You are a killer" and doing everything possible to encourage businesses to "require vaccinations", requesting tech "shut down " accounts that they view as "disinformation", wanting to read individuals emails and text messages. None of those are in the CDC guidelines. The official CDC guidelines for surgical masks is that they do not prevent in any way contracting covid. However they advertise to "protect you and prevent spread" without any scientific evidence nor policies to support it. Not supported by the official guidelines, but the Director and advertising campaign get a pass for "disinformation". From a PUBLIC POLICY standpoint would you tell them to just give the facts and stop lying (no offense, intentional misrepresenting is a fib). Maybe you can take a new job. "Pubic information Officer Extraordinaire". I'll let you calculate the chances of someone getting Covid and labeling them as a "killer".

Now on a lesser note: What is the replacement for the "Wong–Baker Faces Pain Rating Scale". You know the one, that uses facial expressions to judge the level of pain. Useless with masks!.

StarTrekDoc . thank you for you information and presentation skills. And thanks again for the help on getting vaccines in SD.

[Kamban]

Dr. Anthony Fauci said bringing back mask mandates—even for vaccinated Americans—is "under active consideration."

"If you're asking if I'm part of the discussion, yes I am," he said to host Jake Tapper while speaking on CNN's State of the Union Sunday.

It is one thing to give an advisory. It is another thing to mandate it. No wonder people are jaded, some openly rebellious and we are not progressing much in bringing an end to this pandemic. It is now becoming ( or become) an endemic.

[StarTrekDoc]

This was always the case that you can still catch it. So do you think we should all go around wearing N95s from now on? What’s your end point? I’ve not noted any organization advocating for everyone, including vaccinated people, to wear N95 masks for traveling or indoor activity.

Risk mitigation - if one listens closely to the vast majority of public health officials - the mask recommendations are gradated. Cloth < Surgical masks < N95. NPR had a good segment that aired today exactly on this when talking about individual choices and recommendations. We as physicians should know the difference between these types and relative risks to match the level of risk mitigation needed.

Absolutely agree that there's truly no teeth in public 'mandates' at this point.. I also dislike any labeling of any group of people -- regardless of their choice. So how to proceed? Each individual person and company making their own rules and enforcement. I absolutely believe Target and Walmart and any company has the right to make their safety rules and right to refuse entry/service based on that safety rules -- just like that individual person electing to follow or not follow those rules upon entry.

There's a nuance in personal choice and one professing the right to that has to equally defend the other person's opposite choice to the fullest degree no matter how one disagrees. It cuts both ways.

eg my current MO and what I rec to pts: : being vaccinated and masking
If I'm going into a grocery store at 3AM with no one nearby -- no mask
If I'm going into a place where I believe there's a relatively good chance of sustained exposure - like trader joe's in the mid-afternoon/weekend -- bring my valved vogmask for my protection
If I'm going to a place with known potential and high risk of sustained contact -- airplane ride/indoor concert/movie theater -- new vogmask or n95 .

Prudence based on individual risk scenarios.

Are we going to Disneyland still in 4 weeks? Yep. and bringing my mask for indoor portion of rides too. <---so how is this not living life?