Medical Discussion of Coronavirus

[Shant]

I understand that. But if you still have Vaccine A in your system working at 75%, if you had the choice, would you recharge Vaccine A to 100% or add Vaccine B at 100%? There might or might not be some marginal benefit in adding Vaccine B, but there doesn’t seem to be much of any downside to it.

If you are suggesting alternating with a different vaccine that is currently available then I can get on board with that. I initially thought you were suggesting waiting until a new delta variant booster is available which I don't think I'd do if it had been a year since my second dose.

[Kamban]

Well since I am 64 and it has been one year since I got the Pfizer vaccine I am going to go get an additional pfizer shot when I return from Texas later this week. I have an appointment for a blood draw for the initial pfizer study on 8/14 and I will wait til after this. Anyone think I am crazy?

I don't think getting a 3rd vaccine is crazy at all. You have had the vaccine much earlier than us. The vaccine's effectiveness wanes. The question is how much it has waned in you and if you still have enough titer of antibodies to fight any COVID. Also, any news of a booster shot with an improved make up of mRNA on the horizon?

The main thing is that the vaccine is safe. So no harm even in retrospect it might have been seen as overkill. I would do the Moderna rather than 3rd old Pfizer vaccine.

[Kamban]

Sounds simple but also obviously wrong (unvaccinated and you die is incorrect for the vast majority of patients in every age group for example).

I think a simple, uniform message for all masses is the best way to get their attention. The reason I asked those questions is get to my patients the message that gets into their heads easily and cuts through all the Trump / Biden/ Fauci / CDC/infertility nonsense.

I can say that take the vaccine and you will live. Mild case or no case of COVID post vaccine, but you will live.

Don't take it and you have a very high chance of dying if you get severe COVID. There is no guarantee of a mild COVID and living after that. Don't play with fire.

We take the same approach with smoking. The warning states - Smoking kills. Smoking causes cancer ( the majority of smokers don't get cancer or get killed but pretty much all lung cancer is in smokers). The audience is not sophisticated even if they print out tons of info from the internet.

[snowcanyon]

Has anyone managed to get a third dose, and how?

[Shant]

I think a simple, uniform message for all masses is the best way to get their attention. The reason I asked those questions is get to my patients the message that gets into their heads easily and cuts through all the Trump / Biiden/ fauci / CDC/infertility nonsense.

I can say that take the vaccine and you will live. Mild case or no case of COVID post vaccine, but you will live.

Don't take it and you have a very high chance of dying if you get severe COVID. There is no guarantee of a mild COVID and living after that. Don't play with fire.

We take the same approach with smoking. The warning states - Smoking kills. Smoking causes cancer ( the majority of smokers don't get cancer or get killed but pretty much all lung cancer is in smokers). The audience is not sophisticated even if they print out tons of info from the internet.

The smoking message had three benefits that the covid vaccine messaging does not, the first is that smoking was believed to kill off half of smokers (cancers + cardiovascular etc) whereas for COVID it ranges by age from something like 25% in the very old to way less than 1% in most of the working age population. The second was that the decentralized messaging of social media and youtube didn't exist, the number of times that I have had to explain to one non-scientifically trained rabbithole friend why these "doctors who used to head up such and such unit at random pharma" are still wrong when they send me the latest iteration of the exact same BS gotcha argument finally drove me so batty that I lost it on this friend. Thirdly stopping smoking didn't have any unknown theoretical risks it was all upside, which will never be true for a medical intervention that actually works. The upshot is that the messaging has to be absolutely true to avoid being adopted as evidence of "the conspiracy".

[Jaqen Haghar MD]

I actually forgot to mention that I’ve had two patients that had Covid, then the vaccine, and now covid again. They were both OK though, and went home. Middle age, pretty healthy. I guess delta is probably different enough, so I wonder if more vaccines would really help.

[StarTrekDoc]

Well since I am 64 and it has been one year since I got the Pfizer vaccine I am going to go get an additional pfizer shot when I return from Texas later this week. I have an appointment for a blood draw for the initial pfizer study on 8/14 and I will wait til after this. Anyone think I am crazy?

Nope. Ask them to draw titer or disclose to you the result. I would even tell them your intentions and see if they will want to follow you further under a study protocol they probably have setup anyways

[G]

I actually forgot to mention that I’ve had two patients that had Covid, then the vaccine, and now covid again. They were both OK though, and went home. Middle age, pretty healthy. I guess delta is probably different enough, so I wonder if more vaccines would really help.

ugh.

good grief. sounds like the flu, except 1) I don't mind the flu shot and 2) we know quite a bit about influenza.

[Lordosis]

I'm starting to get some vaccine hold outs asking to get the antibody test as a way to see if they need the vaccine. I have been explaining that it does not matter if your antibodies are positive because you might have had at 6 or 9 months ago and are not considered protected. And just get the darn vaccine now anyway. The question I have is should I be more willing to order the test and the chance that it comes back negative and they actually get the vaccine? I would just hate for it to come back positive and feel like I've done something too convince them not to get the vaccine.

Also I have the feeling that if the test came back negative they probably would not just get the vaccine anyway. But that is probably just my pessimism.

Update on my personal story.

We are all symptom free at this point. I can return to work on thursday. And if I stick my nose in a bottle of cinnamon powder I can just barely smell it and I am very excited about that. I have warned my wife not to use the cinnamon powder.

Also has there been any evidence comparing the different vaccines at this point. I feel like we're getting quite a bit of head-to-head data. It's hard to look at it from the ground level because some areas have way more of one vaccine than another so it might seem that there's more breakthrough but that's just because more people got that particular vaccine. I think I mentioned before that my wife had the Moderna and she did not catch this plague that ripped through our house. However it might also have something to do with the fact that the morning prior to my son getting sick she was working and I spent the entire day with the kids. So maybe it was just an exposure thing.

[billy]

Also has there been any evidence comparing the different vaccines at this point. I feel like we're getting quite a bit of head-to-head data. It's hard to look at it from the ground level because some areas have way more of one vaccine than another so it might seem that there's more breakthrough but that's just because more people got that particular vaccine. I think I mentioned before that my wife had the Moderna and she did not catch this plague that ripped through our house. However it might also have something to do with the fact that the morning prior to my son getting sick she was working and I spent the entire day with the kids. So maybe it was just an exposure thing.

my wife had moderna I had pfizer- I was with her for about 70 hours continuously before she was diagnosed. No covid for me. I honestly don't think there will be much of a difference between the two re: effectiveness against the variants unless one's protection is shown to wane earlier than the other. I presume you got the vaccine first?

Happy to hear you are on the road to recovery. best wishes to your family

[billy]

https://nypost.com/2021/08/02/wv-offers-first-statewide-antibody-testing-for-fully-vaccinated/

WV offering free antibody testing for those who are older and over6 months from last vaccine dose... But what to do with the inevitable people w equivocal results?

[Lordosis]

my wife had moderna I had pfizer- I was with her for about 70 hours continuously before she was diagnosed. No covid for me. I honestly don't think there will be much of a difference between the two re: effectiveness against the variants unless one's protection is shown to wane earlier than the other. I presume you got the vaccine first?

Happy to hear you are on the road to recovery. best wishes to your family

She was a few weeks after me.

[Bellescamp]

Our hospital just shared since January we have had 1.3% of cases that have been vaccine breakthrough cases

[FIREshrink]

CDC could have done one of three things

1. Leave mask mandate on till we fully evaluated impact of delta.

2. Remove it but emphasizing that if the delta spreads it will be back on.

3. Be unvaccinated and you die.

Live and let die.

1. But after delta, there is gamma, and lambda, and probably many more coming. Can never fully evaluate impacts of each successive variant, they are sequential not concomitant, so are you saying CDC should never remove mask mandate?

2. Fairly sure overriding message from Day 1 has been couched with, as we learn more recommendations may change. Sorry, this is science. It changes. What, American public doesn't understand science? Who would've thunk it. You argue for clear messaging, then want clear message sullied by caveats, exactly the opposite of a clear message. Science changes quickly, the problem is that there is no simple, clear, truthful message for covid that the average American can understand and that is also guaranteed NOT to evolve. This is fantasyland, and exhibit A for this is that apparently no other global health agency managed to do it well, either.

3. Fine headline, except also completely untruthful. Unvaccinated and you die? Covid survival rate is 98-99%. Elsewhere argument has been that messaging must be truthful or trust in messenger is lost. Why then is your simple false message better than a more complex, but more honest message?

It's simply impossible to do what you are claiming. Reality is Covid has a 98% survival rate, public hears this and has no comprehension what that means, innumeracy means they do not understand probability/odds, laws of small or large numbers, can't comprehend that mortality rate is 10 or 100 x influenza or what that even means, and this is to say nothing of the politicization of the pandemic, CDC included, and the shoot the messenger philosophy that even doctors on this forum have adopted. Sisyphean task, saving the American people from themselves has always been a losing bet (paraphrasing Churchill: Americans will do the right thing, after exhausting all other options). We have yet to exhaust all options, CDC or no CDC, scientists in America are simply held in far too low an esteem for them to have ever saved us. In America, it needs to be Jesus, Trump, Obama, or Kim Kardashian.

[PedsCCM]

I’m not sure how well any organization in the heat of battle, in the fog of war, could successfully distill hundreds if not thousands of new research findings per week, many of them contradictory, into an easy menu of recommendations, without needing to revise prior recommendations fairly regularly. The average American has an 8th grade reading level and is functionally innumerate - this is incompatible with interpreting complex and rapidly evolving scientific notions, what is the CDC to do?

Is there another global or national health organization which readers felt has done a substantially better job? From what I follow, people in the UK and France and China don’t feel any better about the messaging they’ve been given.

Critical care is all about distilling hundreds or thousands of patient data points, many will be contradictory, into a coherent plan. I cannot wildly swing between plans and hope to have the best possible outcome or to maintain trust and respect with my patients and colleagues. Nobody intubates a patient with pneumonia and extubates 2 hours later when the ABG looks better, then reintubates 30 minutes later when the patient looks like garbage.

The CDC guidance makes large, contradictory statements over short time periods upon encountering VERY foreseeable events. https://www.cnn.com/2021/07/08/healt...-bn/index.html It is also unclear what their aim is. I would propose that their aim should be protecting overall American and world health. This requires really high vaccine uptake by living people. This is where my earlier post laying out the facts comes back into play. The CDC has encountered resistance to vaccinations. I'm now in charge of the CDC. I desperately want every American to take the vaccine so everyone stops calling me mean names. My steps:

1. Publish data. Push data out as fast as possible so that thinking individuals can start to get ahold of he concepts before I make recommendations.
2. Remove mask mandates a la 3 months ago. Vaccines are SO good that you don't have to care if your buddy hasn't gotten his. Yours will protect you. (great work, real CDC on this one)
3. Pray on your knees for another big wave. Stand firm that the vaccinated don't need masks anywhere. Recommend that unvaccinated folks mask - or don't - either way works. The vaccine still works. Let the disease provide the incentive for the unvaccinated.