Medical Discussion of Coronavirus

[Hatton]

Update: Brother / surgeon

My brother got the pulse ox i mailed him. For a vaccinated dude who is thin and was running 5-7 miles a day he is pretty sick.

Says he can feel his lungs filling up with fluid, and when he lays supine he cannot stop coughing.

Guess this is why prone ventilation is helpful.

Fortunately he is not sob and sats ok. As i said before, he was vaccinated and wearing N95, so be careful out there. especially watch out for the old.

Luckily very few vaccinated folks are dying but unfortunately a few still get pretty miserable.

This is scary.

[billy]

Telling him to lay prone as much as possible?

[pulmdoc]

Masks should be a parents decision for their kids. Should not be mandated. It is not based any any proven science that masking kids helps anything.

disagree strongly on multiple levels.

1) "COVID isn't dangerous for kids." It is not nearly as lethal as it is for adults, but hospitalizations are 3-5x what they are for influenza, and kids get long COVID just like adults.

2) "Masking doesn't work" I'll keep saying this until I am blue in the face; well-fitted masks that are consistently worn to cover both nose and mouth and not leaking are extremely effective at reducing both spread and exposure to COVID. A cloth mask that slips down over your nose every 10 seconds so you yank it down under your chin=not masking, not a failure of masks.

3) "Kids won't wear the masks anyway so why bother." My 4 and 7 year olds wore masks all last school year, in person 5 days/week. They were diligent about the masks and always wore them. Even through the height of the pandemic winter 2020-21, they were able to keep going to school with their masks on and although there were individual cases, there were no outbreaks within the elementary school. Adult modelling of behavior is key; if the adults are laissez-faire about masks, the kids will be too.

A social experiment is about to begin in my state. Last year, most of the area private schools mandated masks and stayed in-person 5 days a week. The public schools all did a A/B schedule with 2 days/week in person. This coming year, the public schools will be in person 5 days/week and the governor has forbidden mask mandates. The private schools are continuing mask mandates. We'll find out quickly who is right here.

[G]

Masks should be a parents decision for their kids. Should not be mandated. It is not based any any proven science that masking kids helps anything.

So I honestly don't know if masks help, but I will paraphrase pulmdoc that there is good anecdotal evidence that they do. Anyhow, this BS is why you have mask mandates [today from a local TV station about my kid's school]:

The health district issued a statement saying that a student who tested positive for COVID-19 attended school for two days after being notified of a positive test result.

The parent of the student refused to communicate this to school staff, the health district said.

[StarTrekDoc]

The health district issued a statement saying that a student who tested positive for COVID-19 attended school for two days after being notified of a positive test result.

The parent of the student refused to communicate this to school staff, the health district said.

And that's where this whole 'individual choice' grandstanding falls apart. The most vocal supporters are about their OWN choice, not respecting other's individual space. -- I'm driving down the middle of the road cause I want to and no one stopping me. My road. My land. my everything. Just my own opinion - those parents should be tatoo'd "slow code me/Triage level 5"

[Tim]

Innocent questions:
1) The typical surgical mask or cloth mask is not very effective in preventing infection due to the size of the particles. True or false?
2) The typical surgical mask or cloth mask prevents the large spread that results from larger particles (coughing etc) but not the smaller particles like breathing or talking.
True or false?
3) RSV is common and not related to Covid. The data for Covid may accompany RSV with the RSV being the actual cause of hospitalization or death? (Basically, Covid may not be related to the significant health issue and the reporting shows Covid). True or false?
(64m infections and 160k deaths per year)
4) My understanding is that no other country(or the majority of western countries) are mandating or considering masking requirements for schools and seem perplexed that the US has made this such a contentious issue. True or false?

These may be disinformation. Please explain in the words a second grader (I feel like a first grader) in simple terms. These may be stupid questions, but several that are floating around.

The answers influence many thoughts about whether masks actually impact the surges and how Covid spreads and rotated through predictable cycles in different locations.

I agree we will find out quickly, one way or another.

[Jaqen Haghar MD]

There was a great segment with a medical guy on CNN talking about masks and the Rand Paul suspension from YouTube. He couldn’t really say that Rand Paul was kind of correct on air, but he did go through some mask evidence.

Basically it seems cloth masks give you a few minutes of protection at best, and with a well fitting N95 mask, you can spend a full day in a closed room with a Covid patient and be protected. Wish I could find the evidence he quoted, in a nonpartisan way.
(I’ve been stuck in a hotel room for 3 days now with nothing to do but watch the news and the weather channel).

Side note: I actually believe masks work along a continuum as he described.

[snowcanyon]

There was a great segment with a medical guy on CNN talking about masks and the Rand Paul suspension from YouTube. He couldn’t really say that Rand Paul was kind of correct on air, but he did go through some mask evidence.

Basically it seems cloth masks give you a few minutes of protection at best, and with a well fitting N95 mask, you can spend a full day in a closed room with a Covid patient and be protected. Wish I could find the evidence he quoted, in a nonpartisan way.
(I’ve been stuck in a hotel room for 3 days now with nothing to do but watch the news and the weather channel).

Side note: I actually believe masks work along a continuum as he described.

In Europe high filtration masks are available OTC.
It's a travesty we haven't done that here on a national level.

[Tangler]

Telling him to lay prone as much as possible?

Yes! But Billy remember, he is a surgeon…….

Identical twin brother, and i love him, but there are goats less stubborn.

He has always liked sleeping supine, strange because i prefer prone and we are twins.

He is trying to sleep prone, he’s just grouchy.

[pulmdoc]

Innocent questions:
1) The typical surgical mask or cloth mask is not very effective in preventing infection due to the size of the particles. True or false?
2) The typical surgical mask or cloth mask prevents the large spread that results from larger particles (coughing etc) but not the smaller particles like breathing or talking.
True or false?
3) RSV is common and not related to Covid. The data for Covid may accompany RSV with the RSV being the actual cause of hospitalization or death? (Basically, Covid may not be related to the significant health issue and the reporting shows Covid). True or false?
(64m infections and 160k deaths per year)
4) My understanding is that no other country(or the majority of western countries) are mandating or considering masking requirements for schools and seem perplexed that the US has made this such a contentious issue. True or false?

These may be disinformation. Please explain in the words a second grader (I feel like a first grader) in simple terms. These may be stupid questions, but several that are floating around.

The answers influence many thoughts about whether masks actually impact the surges and how Covid spreads and rotated through predictable cycles in different locations.

I agree we will find out quickly, one way or another.

Cloth masks are not nearly as protective or prevent spread compared to surgical masks, both because they are typically non-fitted (a surgical mask will be able to be pinched at the nose and tight elastic around the ears) as well as the materials involved. N95/KN95 masks will give incremental improvement again. I only wear surgical/N95 masks and recommend that my patients do the same.

Many respiratory viral panels will test for RSV at the same time as COVID. I can order a standalone COVID test for reasons like pre-op, or I can order a respiratory pathogen panel for undifferentiated sick person and get COVID, RSV, flu etc in a single specimen. RSV very rarely will cause radiographic pneumonia in adults, although it is a major cause of COPD exacerbations every winter which can put people in the hospital. Definitely not 160k deaths/year, at least not in the US. Definitely not rampant misdiagnosis where patient is thought to die of COVID but they actually died of RSV.

I don't know about all the countries in Europe, but I can tell you from speaking to my friend who lives in England that mask mandates for schools ended in May when Boris Johnson declared victory over COVID, and it has been EXTREMELY controversial that he has refused to reconsider that position as the UK has a big summer Delta wave just like the US. So it's wishful thinking that we are the only country with divided opinions.

[wideopenspaces]

We're like a week into school in some places and schools are already shutting down due to covid, moving to virtual or enacting mask mandates. Huh, if only we could have predicted this would happen! I just can't handle how stupidly short sighted anti maskers are. If you want schools open, everyone needs a mask. Magical thinking does not change reality.

[Dusn]

Any good recommendations for small toddler sized masks for daycare (small 2 year old kid)? Most toddler masks seem to big.
A High filtration mask would be great - she got sick constantly in daycare, even before covid.

[wideopenspaces]

Any good recommendations for small toddler sized masks for daycare (small 2 year old kid)? Most toddler masks seem to big.
A High filtration mask would be great - she got sick constantly in daycare, even before covid.

I just did a search as we'll be doing preschool for my 4 yo in the fall ( I think). These are supposed to be good and are supposed to restock soon:https://www.amazon.com/Kids-KN95-Fac.../dp/B08Q8J5MNQ

And these are pretty cute, I'm going to order a 30 pack to test them out:

https://shopvida.com/products/kids-fda-registered-kn95-face-mask

It says they’re for kids 3 and up so not sure they'd fit as well as you'd like.

[cyrano7]

This is some disappointing news from the Mayo Clinic. It looks like the vaccines either lose their efficacy over time (more quickly than originally though) and/or they are not much less effective against Delta variant than we’d all hoped.

https://www.axios.com/coronavirus-vaccines-pfizer-moderna-delta-biden-e9be4bb0-3d10-4f56-8054-5410be357070.html

[StarTrekDoc]

Not surprised. Moderna chose a higher dosing regimen than Pfizer. Had more side effects. And now less breakthrough as longer presumably lasting titers.

That's why the guidance for booster shots forthcoming to get titers back up.

The good thing is titers sufficient to keep from hosp/death still which is primary endpoint.

Have to balance global issue with recs booster usage vs sending supply to rest of world. I believe that's why CDC starting off only with immunocompromised instead of 65+ and immunocompromised which the data is supporting.

Then theres the HCW pool that will need one.