Medical Discussion of Coronavirus

[StarTrekDoc]

Curious. Are any of you ed folk infusing vaccinated folk with monoclonal?

[Jaqen Haghar MD]

Curious. Are any of you ed folk infusing vaccinated folk with monoclonal?

Yes, every day.

[Tim]

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 the are mostly doing well. Admitting young, unvaccinated, heavy people.

https://www.healthsystemtracker.org/brief/covid-19-continues-to-be-a-leading-cause-of-death-in-the-u-s-in-june-2021/

342 covid deaths for the month of June. Important would be the number of infections that require hospitalization. The capacity problem could come into play.
The unvaccinated seem to be the critical path.
50% vaccinated and how many have had covid and would fall into the group that will likely not need hospitalization? Seems to be a large number. Your guess is better than mine. I wish CDC would model this.

Delta may be a blessing in disguise. Young unvaccinated heavy people and the propensity to spread may solve the problem. Delta will find you and the question is survival.
Delta may force herd immunity much faster than we think. June to July should be tracked and publicized. Vaccinate or take a fatal risk? Faced with that choice, many unvaccinated would choose to get vaccinated. The breakthrough cases don't really seem to be a factor. Slicing and dicing those numbers would eliminate the need for using a small sample and models and any type of forecast. If CDC would go back to tracking rather than making policy decisions, messaging would not be needed. Event driven data would guide the policy decisions. That is not CDC's role, They screwed up by dropping data collection and taking short cuts. The data drives the choices, not the unreliable models and sampling.
Mother nature may have provided the avenue to herd immunity in the form of Delta. Masks are not the issue, data would provide the emotional ammo. Vaccinate or stand in front of the freight train. CDC has screwed up by declaring WAR without a basis. No one trusts models on Covid anymore. Mother nature will win. Breakthrough cases and masks are not the focus clearly. We as a country screwed up by messaging rather than using data. June, July, August will be whatever path Delta chooses.
The controllable factor is getting vaccinated. The healthcare capacity is legitimate. This may be over by September. Until the next variant comes up.

[FIREshrink]

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.

This is reasonable, though I'd say the unknown unknowns warrant more deference than you've given. Influenza for ages 0-2 clearly worse than covid. Age 10, 14, 18? From what I read both relatively low risk, but covid probably worse and more importantly, there is much more unknown.

[CordMcNally]

Curious. Are any of you ed folk infusing vaccinated folk with monoclonal?

No.

[Perry Ict]

What was the point of the lockdown in the masking? It was to slow down the spread of the virus. This was initially done so we did not overwhelm the healthcare system. Then that mantra pivoted to stopping the spread until a vaccine was available. And then it was until everybody had a chance to get the vaccine. Now it is until people have better vaccines or more data on boosters.

We really do need an end game for this. We need a Target. something that is achievable. Not something stupid like 100% vaccination rates. But really at this point if you want to be vaccinated you can be. And if you're vaccinated even if you do get the variant it will likely be not very significant.

I agree with this. It isn't even just that targets (if they exist at all) are being constantly moved, it's the way it's being done. There's no method or thoughtfulness it seems, but rather chaos and sentimental decision-making.

One example is the about-face of the CDC director on masks. She was confronted a couple months ago on loosening of mask rules by a certain sensationalist corporate media host, and her answer (if I recall correctly) was something to the effect of, the vaccines are effective, thus the rule change (a totally reasonable stance, in my view). Now just a couple months later, suddenly we are heading in the opposite direction? For lay people who were told that the loosening of mask mandates were due to efficacy of the vaccine, what is their logical conclusion when that decision is suddenly reversed? It seems like another unforced error that undermines public trust. There needs to be a coordinated effort here to layout reasonable, achievable goals and communicate them in a clear way to the public.

[Zaphod]

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-...213203164.html

Why do people keep saying its less lethal than the flu? From the same documents that show over 500 pedi deaths in a year with lock downs and many schools being closed, is more than most flu season confirmed (with tests) deaths, and is even more than most with their adjusted model deaths. Which, we should only compare apple to apple confirmed lab cases or else we need to also use an adjusted basis covid deaths rate.

Also, you could literally just compare them head to head last year. Flu basically disappeared, covid killed more than a normal flu season. Flu is far less contagious, and far less of a problem overall.

Also, the cdc's flu stats were always bad, frankly bs, and now we have no reason to trust these prior stats anyway with how bad their modeling is known to be. Only confirmed deaths/tests should be considered from here on out. Especially since we'll now have a much stronger/faster/better testing and data network.

[Tim]

If you think vaccinations are difficult in the US, the supply of the vaccines is not going to be the global issue. I certainly wish WHO and the government would have focused on the global distribution roadblocks. Everyone "knew" supply would catch up, getting shots in the arms for hard to reach populations should have been priority #2 in each country and globally. By now, there should have been a "straw man" plan for distribution for every hard to reach population in the world from a public health perspective.
But that is not short term or politically advantageous. It is likely a 5 year or decade of work. No headlines there.

https://news.yahoo.com/where-vast-global-vaccination-program-114409919.html

World health has always been an issue. Available vaccines are not the gate, available delivery of vaccines to arms will be the roadblock. Nothing new there. Not a new problem, but one may run into travel restrictions out of necessity.

[CordMcNally]

For lay people who were told that the loosening of mask mandates were due to efficacy of the vaccine, what is their logical conclusion when that decision is suddenly reversed? It seems like another unforced error that undermines public trust. There needs to be a coordinated effort here to layout reasonable, achievable goals and communicate them in a clear way to the public.

I'm honestly curious who puts out all the tweets, press releases, etc. for the CDC. Even if you compare from one day to the next, sometimes it looks like completely different people that don't ever talk are responsible for interacting with the public from various platforms.

[FIREshrink]

One example is the about-face of the CDC director on masks. She was confronted a couple months ago on loosening of mask rules by a certain sensationalist corporate media host, and her answer (if I recall correctly) was something to the effect of, the vaccines are effective, thus the rule change (a totally reasonable stance, in my view). Now just a couple months later, suddenly we are heading in the opposite direction?

Are recommendations not allowed to change when new facts come to light?

I'm not taking a position on CDC recs but I'm struggling to understand how/why physicians are demanding static recommendations when covid research is likely the fastest growing field of medical investigation in the history of humankind.

[billy]

Curious. Are any of you ed folk infusing vaccinated folk with monoclonal?

My wife was infused with the monoclonals, and I'm thankful she was. If the patient was a candidate for monoclonals prior to vaccination, it shouldn't change post vaccine. You don't know what kind of response the high risk patients had to the vaccine, so after catching COVID, they should be treated as if they never had the vaccine. I looked it up back in march, and I think the monoclonal EUA fact sheet addressed this. Now when I do a google search I cant find it, so dunno if anything changed.

[CordMcNally]

I'm not taking a position on CDC recs but I'm struggling to understand how/why physicians are demanding static recommendations when covid research is likely the fastest growing field of medical investigation in the history of humankind.

I think all we ask for is some consistency and a little bit of foresight of how your decisions and statements today could affect any potential changes tomorrow.

[billy]

I think all we ask for is some consistency and a little bit of foresight of how your decisions and statements today could affect any potential changes tomorrow.

common sense is not so common...

[G]

Yes, every day.

We are not, vaccinated or not. I don't know what happens to them upstairs.

JH, what is your process?

And it's been a few months since I looked at the data--at that time, they weren't particularly compelling. Any new info?

[G]

Are recommendations not allowed to change when new facts come to light?

I'm not taking a position on CDC recs but I'm struggling to understand how/why physicians are demanding static recommendations when covid research is likely the fastest growing field of medical investigation in the history of humankind.

Yes, the situation changes. But one must not ignore the forest for the trees.

And as I have said for over a year now, some of us expect better from the best scientists and best funded operation (?) on the planet.