Medical Discussion of Coronavirus

[Tim]

I have to believe that a super majority of America will listen to a consensus committee of chiefs of top universities. Heck, get the wildcats and crimson tide chiefs in there to boot and give them the microphone and pulpit.

To date haven't seen that happen.

If you don’t think top universities haven’t been politicized, well that is a whole different topic.

[Sampter]

I believe I've read 10 of the 316 pages of this thread, so maybe this has been brought up.

I think people don't understand their own health status. We've all taken histories of "do you have any medical problems" "no" "then what are these medications x, y, and z." But in a broader sense, people who just have obesity as their main health condition probably don't see it as a health condition, and may not even realize they're obese. So overall, people don't understand their own potential risk status (mainly mid 20 to mid 40 year old overweight to obese Americans) for severe disease, and may not get vaccinated because "the young don't usually die of this."

Sorry if this makes no sense. Just trying to type this out between COVID radiographs. Luckily, I've got a macro now.

1000% consistent with my experience through the pandemic. Even older obese patients act like they have nothing to worry about. Not talking about BMI 29 even, 40+. Weight is so hard to talk about, worse now when a patient has already made up their mind to not get vaccinated. I can’t imagine the Press Ganey comments if you busted out, “you do know you are super high risk because you are so fat.”

On a positive note in my area, more people are getting vaccinated now as they are seeing family and friends get hospitalized/die unfortunately.

Moving forward only way to make progress is to get more vaccinated in a non-judgmental way along with monoclonals. Social distancing and masks help, but clearly the people doing those at this point are the ones already vaccinated.

[StarTrekDoc]

STD, that made me chuckle, my internet friend.

Hope springs eternal. 😍

@sampler - very true hard to talk about weight. Ironically has been easier this year. Get more neg PG on simply trying to get people to take statins for primary prevention than anything else.
it's amazing how.many ct calcium scores are needed to been done to get specific individualized information to even get some folk off their antistatin stance.

Beautiful thing about primary care. I get multiple chances to win them over 🤙😎😀

[Rando]

My vote is get rid of Fauci first. He’s become a total joke.

Then get a committee of 5-10 academic types from the name institutions. Keep every name anonymous if possible so these guys won’t be tainted by the political blowback from colleagues and the public.

Then see what consensus recs can come from them.

To me the main trouble with Fauci is one side treating him as a saint and the other side as the devil, so it's just inviting discord to have him speak.

Your idea with the academics is as good as any. I think most governors are on board with at least recommending the vaccine, maybe get the governor and top ID doc together in each state and run some public service announcements.

[CordMcNally]

I think people don't understand their own health status. We've all taken histories of "do you have any medical problems" "no" "then what are these medications x, y, and z." But in a broader sense, people who just have obesity as their main health condition probably don't see it as a health condition, and may not even realize they're obese.

Big is beautiful and healthy...or so I've been told.

[burritos]

Big is beautiful and healthy...or so I've been told.

Truthful but not helpful:

[G]

Truthful but not helpful:

His Press Ganeys will be perpetually in the toilet....

Good thing that reimbursement and employment is not related to how much patients like us.

Oh. Wait.

[Tim]

Could someone help me put Covid risk in context. We can use statistics. Risk of dying and hospitalization.
My hypothesis is that cars are much more dangerous than Covid. Cars are a public health menace? Should the country be required to limit driving?
I understand that minimizing death, hospitalization and permanent injury is the goal.
In 2020, without vaccines were the risks similar?
With vaccines, it would seem the eliminating or restricting miles driven would provide huge public health benefits. Less deaths, hospitalizations, and permanent injuries.

https://www.mackinac.org/for-most-people-coronavirus-presents-similar-risks-as-car-accidents

I would suggest we have a recency bias with Covid. Car accidents are preventable, just don’t drive. Is it possible that we are regulating life on an “hot topic basis” rather than setting priorities based upon public health and safety?

Sensitivty versus severity is the question. 2021 is different. Are we fighting the last war?

[Zaphod]

Shrug. Your desire to shoot the messenger regardless of message says more about your biases than theirs.

But it's ok, recognizing your cognitive biases is the first step toward restructuring.

From a bayesian standpoint, the CDC cannot be trusted to have accurate studies without double checking, and certainly they have no reputation from which to blindly believe anything at this point.

They have bungled, misinterpreted, and been just flat out wrong on most of this. Now theyre trying to play interdimensional chess when they cant play checkers.

It appears (from outside) they did the mask thing to try to reverse the vaccine messaging they had prior and I guess the hope was they'd get ahead with vaccinations to where it wouldnt matter. However, anitvaxxers and a certain type werent wearing and werent going to, and arent now either. And this was when delta was obviously on the horizon.

And punishing only the vaxxed isnt helpful, again, masks need nearly 100% compliance if it isnt n95 so useless, and if delta is so much more infectious (maybe, but reopening is larger issue) masks are even less effective.

Now they try to go back to universal but its too late, the people that need to wear it the most are most likely to refuse.

They tried playing game theory left and right but were always doing it the dumbest way.

[Lordosis]

From a bayesian standpoint, the CDC cannot be trusted to have accurate studies without double checking, and certainly they have no reputation from which to blindly believe anything at this point.

They have bungled, misinterpreted, and been just flat out wrong on most of this. Now theyre trying to play interdimensional chess when they cant play checkers.

Do they even know that they should let the wookie win?

[Tim]

Do they even know that they should let the wookie win?

Gimme a break! We might have data and find out how accurate the secret model is in 120 days.

https://www.c-span.org/video/?c4967013/user-clip-biden-120-days-give-break

[Lithium]

Unfortunately we did not write the rules, nature(?) wrote the rules; we're just playing the game.

No one's seriously talking lockdowns, so that is just being thrown around as a strawman. Yet even today regional health care systems are at capacity because of delta and because of behavioral choices their populations have made. Every indication things will worsen near term without intervention. Should anyone do anything about that?

Increasingly the vaccinated are fed up with unvaccinated adults, who've had their chance. Were it only them, i think society ready to move on. Unfortunately, the unvaccinated include kids 11 and under who haven't had their shot, so to speak, and in the context of a new variant with much higher viral load and intuitively more likely to cause severe illness even in younger or previously healthy (not yet established). School starting across the country. I see any attempts at societal mitigation as really driven by a desire to protect that group. Agree or disagree, but that's the last group in America who are unvaccinated not by choice. Rules prohibiting school mask mandates truly bewildering. Let's find every way possible to keep kids in school full time, that means limiting outbreaks/contagion and for a group that can't be vaccinated, masks an important part of a multi-prong mitigation strategy.

Finally, issue of boosters for elderly and immunocompromised, already settled in Israel, boosters approved. How long will we wait to do the same? Once that happens (ie I'm betting it will) then again, a few months and everyone who wants a shot gets one and we don't need to have measures in place to protect them.

It's no one's fault delta is reversing our gains, this is the game we are forced to play.

While any long term harm that occurs to someone under 12 is especially tragic, I think that considering how benign it is overall in this age group, it is pretty dubious to use that as a justification for public restrictions writ large. The delta variant is a new curveball but in terms of virulence, would you prefer your kid under 12 get that or influenza? From what I understand, influenza is more dangerous in the young, and it’s not like we mask up every winter to keep the kids from catching that.

as for boosters, as Cord mentioned, we can mask up until the elderly and immunosuppressed get their third shots in a few months, but we’ll just be playing whack a mole indefinitely, with the next variant(s) bound to show up in 2022.

at some point we have to start treating this like an endemic disease since all signs show that’s the direction we’re heading.

[StarTrekDoc]

Most folk familiar with the nature of coronaviruses recognize that the long game of this is a constant revision of vaccine to keep up with mutations. This isn't a poxvirus or measles. The realty is trying to keep rate of mutation down so we only have to revise once a year like the flu shot.

Luckily the mRNA vaccines have been so effective for this virus and looks.like the current way forward for updated sequences and boosters. There still are other vaccines in the pipeline that maybe better suited...see novavax vaccine...and these mutations ,or not.

We are definitely not out of the woods. We are simply entering a period of the whack-a-mole and reupping/updating as we go and get the world production up to speed to allow for slowing the mutation rate.....or until this mutates to a less lethal but highly virulent common cold.

[Rando]

While any long term harm that occurs to someone under 12 is especially tragic, I think that considering how benign it is overall in this age group, it is pretty dubious to use that as a justification for public restrictions writ large..

I agree with this, but it's going to be a really tough concept for parents to accept and understand. Recently Rochelle Walensky in speaking about deaths in pediatric COVID said "Children are not supposed to die, so 400 is a huge amount" (compared to 600k adult deaths) and on social media I am seeing that being picked up on. Any physician knows that the risk to kids can never be zero and never was zero, way before COVID was around. Even though it appears to be less lethal than the flu, it looks like the head of the CDC still feels that risk is unacceptable.

https://news.yahoo.com/children-not-supposed-die-cdc-213203164.html

[Jaqen Haghar MD]

Well, that escalated quickly. Here we are at the new peak of the pandemic. Highest case numbers and highest hospitalizations of the entire pandemic, but this time with all time record ED volumes day after day, not like the low patient volumes during the past peaks. Hold onto your hats. Delta moves pretty fast. I see multiple vaccinated infections every day now, but they are mostly doing well. Admitting young, unvaccinated, heavy people.