Medical Discussion of Coronavirus

[PedsCCM]

Is BMI 25-29 a clear risk for Covid complications? In otherwise healthy individuals? It doesn't seem high enough to create mechanical obstruction or pickwickian syndrome or systemic inflammatory Cascades or whatever the problem is in those 30-35++.

Probably yes. Worse obesity is definitely worse but even a BMI 25-29.9 seems to put you at greater risk for hospitalization, mechanical ventilation and death (OR for all three is around 1.3-1.4 depending on the study). Risk of death seems to be the one with the weakest link and greatest variability in study results with some showing no difference after multivariate analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825982/ has a pretty good summary of the relevant studies.

[snowcanyon]

There was an interesting article published in Nature.

The thought on mixing and matching vaccines. The adenovirus vector vaccines lead to the strongest T cell immunity. The mRNA vaccines lead to the strongest Ab mediated immunity. If you get both types, the thought is you maximize both T cell immunity and Ab immunity.

Oh well, I already got 2 Pfizer and 1 Moderna. I am going to wait for more data on risk vs benefit before I consider getting a J & J to specifically boost my T cells.

How did you get a third vaccine? I'm so frustrated over this.

[billy]

How did you get a third vaccine? I'm so frustrated over this.

Not giving this as advice, and to be clear I have not tried but do you really think any walgreens or cvs is checking your name against a database before administering shot? The country cant even get a national database for our fingerprints (well unless youve committed a crime) you think they have their stuff together enough for this?

That being said I feel the booster shot will get approved in another month or so. Just a gut feeling, no real evidence for it.

[snowcanyon]

Not giving this as advice, and to be clear I have not tried but do you really think any walgreens or cvs is checking your name against a database before administering shot? The country cant even get a national database for our fingerprints (well unless youve committed a crime) you think they have their stuff together enough for this?

That being said I feel the booster shot will get approved in another month or so. Just a gut feeling, no real evidence for it.

In my state, yes.

[billy]

https://www.statnews.com/2021/08/03/people-chasing-covid-19-vaccine-boosters-create-headaches-for-the-health-care-system/

BTW I wonder how many shots will be wasted at end of day instead of giving to people who could use a booster shot (immunocompromised) in some states. At this point if you wanted a first shot you couldve had one, there is no longer any reason for "saving a shot for someone who needs it more"

[G]

https://www.statnews.com/2021/08/03/...h-care-system/

BTW I wonder how many shots will be wasted at end of day instead of giving to people who could use a booster shot (immunocompromised) in some states. At this point if you wanted a first shot you couldve had one, there is no longer any reason for "saving a shot for someone who needs it more"

first world issues. literally.

[FIREshrink]

If I could find a doctor to give my son a shot two days before his 12th birthday, would that be legal? Would you have any concerns about doing it, either as the doctor or as the parent? Would you give him the adult dose or the proposed pediatric dose (1/3 the adult dose)? He weighs 75 pounds which makes me think pedi dose.

[CordMcNally]

If I could find a doctor to give my son a shot two days before his 12th birthday, would that be legal? Would you have any concerns about doing it, either as the doctor or as the parent? Would you give him the adult dose or the proposed pediatric dose (1/3 the adult dose)? He weighs 75 pounds which makes me think pedi dose.

Why are even smart people just losing their minds?

[billy]

If I could find a doctor to give my son a shot two days before his 12th birthday, would that be legal? Would you have any concerns about doing it, either as the doctor or as the parent? Would you give him the adult dose or the proposed pediatric dose (1/3 the adult dose)? He weighs 75 pounds which makes me think pedi dose.

he wouldn't be able to wait 2 days?

[Jaqen Haghar MD]

https://www.nbcnews.com/politics/whi...ssure-n1275860

For anyone who still thinks that the CDC hasn’t become politicized.

“The CDC Issues an Eviction Declaration”.
https://www.cdc.gov/coronavirus/2019...claration.html

The CDC appears to just be a political organization at this point. This seems incredibly unlawful. The CDC should have also issued a proclamation that “by the power of Marcus Welby” the the federal government is now required to pay the rents of tenants facing eviction at the same time.

When I saw this, I was really puzzled. I didn’t think the CDC had the authority to delve into real estate law. The interesting thing is that private landlords and small companies are now going belly-up as tenants living in rentals without paying rent can’t be dislodged. They are selling out to hedge funds who are buying the properties at hearty discounts. I’m sure everything will be much better in the future when large, powerful, lawyered-up hedge funds are squeezing profits out of the same rental units.
…..unintended consequences lie ahead.

[Tim]

J&J Vaccine has the one shot advantage. But the contracts with the government were structured differently. Not under the WARP speed model. More upfront mfg cost guarantees and less dependent on volume incentives.

https://www.google.com/amp/s/www.cnbc.com/amp/2021/08/04/cvs-health-stops-offering-jj-covid-vaccine-at-its-pharmacies-available-at-select-minuteclinics.html

•CVS is dropping the J&J vaccine.
•From a business standpoint, it seems like the J&J vaccine volumes will drop substantially.
•From an effectiveness standpoint, it seems like the J&J vaccine is less effective for the variants as well as the original.

Never once have I heard any “messaging” that Moderna and Pfizer are better or that J&J was not as good or inferior. Is that the case in reality? I wonder if this was known but for whatever reasons not disclosed? Would anyone recommend J&J? No shortage now.

If this is a conspiracy theory, so be it. I am just an observer. I just am not convinced that the best recommendations have been made.
Yes, any vaccine is better than none.

Not offering J&J solves that problem.

[CordMcNally]

J&J Vaccine has the one shot advantage. But the contracts with the government were structured differently. Not under the WARP speed model. More upfront mfg cost guarantees and less dependent on volume incentives.

https://www.google.com/amp/s/www.cnbc.com/amp/2021/08/04/cvs-health-stops-offering-jj-covid-vaccine-at-its-pharmacies-available-at-select-minuteclinics.html

•CVS is dropping the J&J vaccine.
•From a business standpoint, it seems like the J&J vaccine volumes will drop substantially.
•From an effectiveness standpoint, it seems like the J&J vaccine is less effective for the variants as well as the original.

Never once have I heard any “messaging” that Moderna and Pfizer are better or that J&J was not as good or inferior. Is that the case in reality? I wonder if this was known but for whatever reasons not disclosed? Would anyone recommend J&J? No shortage now.

If this is a conspiracy theory, so be it. I am just an observer. I just am not convinced that the best recommendations have been made.
Yes, any vaccine is better than none.

Not offering J&J solves that problem.

J&J vaccine has always been inferior to the mRNA vaccines in terms of efficacy, however, it still offered some protection and at the time we were needing as many vaccines as we could get. That was one of the big outcries when they started talking about sending the J&J vaccine to more rural areas because it was a one shot vaccine and was more easily stored (at the time). Some people started turning that into an argument that the lower class was getting the less effective vaccine when it was really a logistic issue.

[FIREshrink]

he wouldn't be able to wait 2 days?

We will be overseas by then and having even one shot will considerably simplify our lives

[billy]

I would not risk my license over an inconvenience for a patient's trip. Granted I'm an anesthesiologist, but this seems like a slippery slope, with no real defense.

[Sampter]

If I could find a doctor to give my son a shot two days before his 12th birthday, would that be legal? Would you have any concerns about doing it, either as the doctor or as the parent? Would you give him the adult dose or the proposed pediatric dose (1/3 the adult dose)? He weighs 75 pounds which makes me think pedi dose.

This is no different than prescribing any medication off label IMO which happens all the time in America, especially drugs in pediatrics. The only considerations are that the Pfizer vaccine is not fully FDA approved and also paid for by the federal government.

You can bypass a doctor and just get vaccinated at a pharmacy or even a health fair.....no one will care.