Medical Discussion of Coronavirus

[StarTrekDoc]

So I'm interested in digging into the tracer data from the Provincetown's event. Specifically, of the breakthrough cases of the fully vaccinated -- did they occur from a concentrated single event or was there secondary spread events within households of fully vaccinated folk that continued to harbor high viral loads 2-3 generations.

It's troubling to see comparisons of the r0 to measles and hope it's the unique setting of the sustained time indoors+density+viral load that all contributed to the mass spread event and not just the inherent properties of the Delta variant.

Those are the details that need to be parsed out and would have benefited in posting the data and then announcing a major change.

[HikingDO]

Naturally then you are ready to provide data/evidence showing CDC is "wrong" about Delta (on science, not on PR), and/or to reach a different conclusion re: the same data they used in their latest recommendation?

https://www.sltrib.com/news/2021/05/...arsen-biggest/

if you need help with anything else, be sure to let me know.

[PedsCCM]

Naturally then you are ready to provide data/evidence showing CDC is "wrong" about Delta (on science, not on PR), and/or to reach a different conclusion re: the same data they used in their latest recommendation?

I don’t think a recommendation for universal masking is the inevitable conclusion given the data we have. Maybe it’s the correct choice. Maybe not.

1. Vaccines work to prevent a big chunk of infections, serious symptomatology and death - even in patients infected with Delta
2. Vaccines work slightly less well against Delta than against other strains
3. Symptomatic breakthrough infections cause high viral loads
4. Delta is probably pretty darn bad for unvaccinated adults - even some young adults
5. Everyone 12 and over in the US can be vaccinated if they so choose

There are a LOT of policy recommendations that can reasonably come from these facts. Universal masking is one. Aggressive PSAs and education aimed at encouraging vaccines is another. Do nothing but publish this info and let Delta act as a strong stick is an option. Recommend masking for unvaccinated is another.

The CDC is not just reporting the facts. They’re extrapolating to policy and that process is clearly embedded with values that may or may not be shared by the general population. It seems great if their values line up with yours and of course their conclusion seems logical. Others will inevitably disagree. That has nothing to do with their appreciation for science

[StarTrekDoc]

I don’t think a recommendation for universal masking is the inevitable conclusion given the data we have. Maybe it’s the correct choice. Maybe not.

1. Vaccines work to prevent a big chunk of infections, serious symptomatology and death - even in patients infected with Delta
2. Vaccines work slightly less well against Delta than against other strains
3. Symptomatic breakthrough infections cause high viral loads
4. Delta is probably pretty darn bad for unvaccinated adults - even some young adults
5. Everyone 12 and over in the US can be vaccinated if they so choose

There are a LOT of policy recommendations that can reasonably come from these facts. Universal masking is one. Aggressive PSAs and education aimed at encouraging vaccines is another. Do nothing but publish this info and let Delta act as a strong stick is an option. Recommend masking for unvaccinated is another.

The CDC is not just reporting the facts. They’re extrapolating to policy and that process is clearly embedded with values that may or may not be shared by the general population. It seems great if their values line up with yours and of course their conclusion seems logical. Others will inevitably disagree. That has nothing to do with their appreciation for science

True, and publishing data to support the policy is also extremely important these days.

It makes our jobs of getting needles into willing arms along with compliance to policy that much harder when the CDC doesn't publish the data behind the reasoning for an entire 24hour news cycle as it allows doubt to filter into the equation

The institution has been tarnished over the past year of more than a few missteps and keeps tripping over its own feet.

[Tim]

Naturally then you are ready to provide data/evidence showing CDC is "wrong" about Delta (on science, not on PR), and/or to reach a different conclusion re: the same data they used in their latest recommendation?

The CDC has no data. CDC ceased tracking on May 1.
Break through (ceased)
Hospitalized
Deaths
Were tracked for fully vaccinated individuals.
They stopped. The reason for fully vaccinated to mask given is because they are now in the break through category.

At best CDC has a snapshot of data related to this variant. Please provide CDC data. Statistically, break through cases were insignificant and not worth tracking. Now, vaccinated people need to wear masks. The hospitalizations and deaths are still insignificant. They don’t have statistics. They have a PR problem in vaccine acceptance. Deal with it. This is an emotion based recommendation. No stats.

https://www.kff.org/policy-watch/cov...om-the-states/

https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e3.htm

[FIREshrink]

https://www.sltrib.com/news/2021/05/...arsen-biggest/

if you need help with anything else, be sure to let me know.

Suffice to say you ignored the question about how you would interpret the recent data differently, you are very focused on your ad hominem attacks against the CDC. However it's been clear for some time that you are unable to debate in good faith so I'll just let it go.

[FIREshrink]

I don’t think a recommendation for universal masking is the inevitable conclusion given the data we have. Maybe it’s the correct choice. Maybe not.

1. Vaccines work to prevent a big chunk of infections, serious symptomatology and death - even in patients infected with Delta
2. Vaccines work slightly less well against Delta than against other strains
3. Symptomatic breakthrough infections cause high viral loads
4. Delta is probably pretty darn bad for unvaccinated adults - even some young adults
5. Everyone 12 and over in the US can be vaccinated if they so choose

There are a LOT of policy recommendations that can reasonably come from these facts. Universal masking is one. Aggressive PSAs and education aimed at encouraging vaccines is another. Do nothing but publish this info and let Delta act as a strong stick is an option. Recommend masking for unvaccinated is another.

The CDC is not just reporting the facts. They’re extrapolating to policy and that process is clearly embedded with values that may or may not be shared by the general population. It seems great if their values line up with yours and of course their conclusion seems logical. Others will inevitably disagree. That has nothing to do with their appreciation for science

Yes absolutely one can disagree with CDC recommendations based on one's interpretation of the available data. What HikingDO wrote was that he ignores pretty much everything the CDC has to say. Those really aren't the same thing.

[FIREshrink]

At best CDC has a snapshot of data related to this variant. Please provide CDC data. Statistically, break through cases were insignificant and not worth tracking. Now, vaccinated people need to wear masks. The hospitalizations and deaths are still insignificant. They don’t have statistics. They have a PR problem in vaccine acceptance. Deal with it. This is an emotion based recommendation. No stats.

The lines of evidence they relied on are, presumably:

1. Approximate 1000x viral load with Delta vs earlier strains (china and others)
2. Evidence of widespread infection, including symptomatic infection, in vaccinated (US, Israel)

3. Evidence of high viral load even in vaccinated (US)

4. Evidence of waning immunity with mRNA vaccines especially in elderly and immunocompromised (Israel)

Perhaps they have access to other data as well but the above is all widely known as of today.

So this seems like much more than a PR problem to me. Without access to nearly as much data as the CDC could have, I had concluded weeks ago that delta was a legitimate threat. What steps have I taken?

1. My kids have been wearing N95s in indoor spaces (and largely avoiding indoor spaces) since second week of July because they are not fully vaccinated.

2. This fall, two weeks before Thanksgiving and family gatherings with older and immunocompromised vaccinated adults, we will be minimizing contacts with others and all of us will be wearing N95s for any indoor activity for those two weeks, even though the four of us will all be fully vaccinated.

3. I am encouraging my MIL and sister with cancer to talk with their doctors about booster shots, and hoping those are approved soon.

4. If community spread gets high enough, we will cancel Thanksgiving travel/gathering.

5. My sister with cancer is debating moving from a state which prohibits school mask mandates to a state which requires masks for all. She is rightly worried that her children will pick up COVID and bring it home to her, since exactly zero children in her kids' schools will be vaccinated.

What data do you have to support your claim that the CDC "has no data" and this is an "emotion based recommendation?"

[StarTrekDoc]

The issue is the CDC has a trust issue now more than ever.

Before it was those who have been burned by the CDC on nondisclosure or lack of informed consent.

The CDC simply cannot issue policy guidance without clear reasoning and explicit data supporting their declaration of new policy.

Otherwise they are only preaching to the choir and will fail in getting to the two standard deviation mark what public policy should reach.

Yes they made calculated poor decisions and too slow to rectify missteps. Early testing protocols, honesty on masks and protecting supply lines, pivoting to aerosol guidances and ventilation benefits.

They are supposed to learned from these errors, yet unforced errors continue. They do have a PR problem and need to be that much better on data reinforced policy announcements.

[Tim]

Yes absolutely one can disagree with CDC recommendations based on one's interpretation of the available data. What HikingDO wrote was that he ignores pretty much everything the CDC has to say. Those really aren't the same thing.

What data is CDC using? Provide a link.
Number of vaccinated x infection rate x reduction due to mask usage x factor for infecting non-vaccinated individuals = benefit
The benefit is statistically insignificant. This is a deflection from the issue, failure to achieve their goals for vaccinations.
Yet, a vaccinated person has to have a negative test to return the the states. But they ignore a million people enter through specific locations.
CDC is throwing crap against the wall and seeing what sticks. Yes, "high probability of additional restrictions before the end of the year".

I really would like statistics rather than messaging and a "New War". Exactly who are they fighting? The population or Covid? Show me the numbers please.

[HikingDO]

Suffice to say you ignored the question about how you would interpret the recent data differently, you are very focused on your ad hominem attacks against the CDC. However it's been clear for some time that you are unable to debate in good faith so I'll just let it go.

Suffice to say you ignored what I actually said when I made my post, you are very focused on your ad hominem attacks against me. However it’s been clear for some time that you don’t have adequate reading comprehension skills so I’ll just let it go.

[xraygoggles]

Has anyone here gotten a 3rd shot? Or a double dose of both the Pfizer/Moderna vaccine?

Apparently, a 3rd dose of the Pfizer vaccine increases immunity against delta variant. It seems to make sense immunologically.

[Rando]

I don't want to go down a masking rabbit hole again, but if Delta is as contagious as they say simple masks may not be adequate (if they ever were adequate). I think a lot of us were dubious about cloth masks before, combined with the high numbers of poorly fitted masks and people wearing them improperly. With the very high transmissibility of Delta I would expect cloth masks to be less effective than with prior COVID strains..

I think the easy answer is get everybody vaccinated, the catch being that a lot of people aren't going to get vaccinated. Since masking and lockdowns are about the only other tools governments have, that's probably what we'll see regardless of their efficacy or other adverse effects.

As far as the CDC goes they are poorly equipped to manage a pandemic. That's not really a criticism, they're just being asked to be something they aren't. They hate risk and are being asked to balance risks. Something bad will happen to someone no matter what they do. What has traditionally been a slow moving deliberative risk-averse organization is being asked to think on its feet. Now it is a reasonable question to ask after a year and a half why aren't they better.

On Fauci, for a lot of my patients he is not trustworthy. We can argue about whether that's fair or not, but it's the way it is and if I were the government I would have him working off-camera.

[CordMcNally]

Has anyone here gotten a 3rd shot? Or a double dose of both the Pfizer/Moderna vaccine?

Apparently, a 3rd dose of the Pfizer vaccine increases immunity against delta variant. It seems to make sense immunologically.

As with most things, I’d prefer to see the data first.

[snowcanyon]

I don't want to go down a masking rabbit hole again, but if Delta is as contagious as they say simple masks may not be adequate (if they ever were adequate). I think a lot of us were dubious about cloth masks before, combined with the high numbers of poorly fitted masks and people wearing them improperly. With the very high transmissibility of Delta I would expect cloth masks to be less effective than with prior COVID strains..

I think the easy answer is get everybody vaccinated, the catch being that a lot of people aren't going to get vaccinated. Since masking and lockdowns are about the only other tools governments have, that's probably what we'll see regardless of their efficacy or other adverse effects.

As far as the CDC goes they are poorly equipped to manage a pandemic. That's not really a criticism, they're just being asked to be something they aren't. They hate risk and are being asked to balance risks. Something bad will happen to someone no matter what they do. What has traditionally been a slow moving deliberative risk-averse organization is being asked to think on its feet. Now it is a reasonable question to ask after a year and a half why aren't they better.

On Fauci, for a lot of my patients he is not trustworthy. We can argue about whether that's fair or not, but it's the way it is and if I were the government I would have him working off-camera.

Who would patients find more trustworthy?