Medical Discussion of Coronavirus

[Tim]

Vaccinated: Breakthroughs? yes. Mod/sev disease (hosp/death) -- still good.
UnVaccinated: same course as before; just higher numbers and with that - more chances of pulling spades with hosp/death: 1.6% all comers.

1.6% is good vegas odds and argument from the lay folk. Anyone in here arguing 1.6% is good in any medical setting needs to go back to med school.

Back to basics: NNT vs NNH - Have to weigh each action vs nonaction
1. Vaccinate
2. Mask and choice of
3. Mandates/passports/isolate/exclusions

Those who are still arguing the benefits of vaccination - Delta has really shown the difference on this -- even in the lowest risk children. Check out the Children Hospitals. Most those kids in there don't usually see the inside of hospitals in August. Harm?

Masking - yeah, I personally believe if you're not using a Vogmask or equivalent or N95, why not? Not like these things cost $100. They are readily available and may take some time to find the right fit, but really little excuse to not be using at the very least surgical mask that's fitted correctly - and worn correctly. Proper modeling and simple reinforcement works. Did at Hawaii. Did at Disney. Kids can and will wear correctly (if adults just help model and reinforce in the smallest/consistent manner).

--This Delta variant is a heck more contagious. We had been able to keep it mostly out of the office these past months. This past week, it's been knocking vaccinated folk out and putting several on exposure watch. No known in-clinic transmission yet, but I'm guessing it maybe coming this week/next week despite increased precautions. If so, I won't be surprised to see rumblings of boosting HCWs soon.

I greatly appreciate your thoughts. I would appreciate your thoughts on one point.

• Is “immunity” the key point and can it be adequately tested?

Yes, the debate between immunity acquired from prior infection vs vaccination.
https://www.google.com/amp/s/directo...infection/amp/

This is very carefully worded (which it should be but also leaves many statements and conclusions with substantial unknowns).

“Whatever the underlying reasons turn out to be, it’s important to consider that humans are routinely infected and re-infected with other common coronaviruses, which are responsible for the common cold.” This is so weak of an argument for vaccinating previously infected individuals.

Some studies lead to different conclusions. Just because a vaccine offers protection against some variants, does not equate to better. Maybe it does.

Disclosure: I read this report as an attempt at messaging in favor requiring vaccinations of previously infected persons.
That actually requires substantial costs, efforts in particular globally as well as in the USA. Using Moderna (17 yrs+) gives me pause as well.

I have bypassed the “emotional” points intentionally. It seems vaccinating previously infected could be measured for existing immunity, but that might be less cost/benefit than taking the shot, regardless.

[Tim]

Booster shots approved:

https://www.cnbc.com/2021/08/13/covid-booster-shots-fda-permits-third-dose-for-the-immune-deficient.html

Which booster would be used?

https://www.cnbc.com/2021/08/12/mayo-clinic-covid-breakthrough-risk-may-be-much-lower-with-moderna-vaccine-than-pfizer.html

Choices to be made for those getting a booster.
Delta is sure accelerating the urgency of finding answers.

[Dusn]

Is anyone considering getting a 3rd shot on their own?

Especially for older docs or docs with multiple other medical issues who got their first shot 8 months ago.

Could you just walk into a vaccine clinic and not use your insurance (which I’m guessing would not cover it)? Would they know you’re already vaccinated?

if you had Pfizer, would you get moderna, given recent data that moderna may have longer effectiveness or be more effective against current variants?

[OUSOONERDOC]

I don't disagree but this isn't a 100% or 0 % effective entity.

This is not directed to you soonerdoc but to the staunch anti maskers....

The mask argument is like arguing about wiping your a$$. Wiping does not sterilize, heck it doesn't even guarantee you remove all the feces. If you don't wipe your a$$ perfectly then its not effective and you will have residual sh*t there. How many kids do it correctly? should we just have them say heck its a losing battle just stop wiping all together...

Some things in life are about reduction not perfection. Masks are like wiping sometimes its not necessary but maybe when the sh*t is real we do it....

I get your analogy, would still say there is real benefit to wiping ones a$$ effectively for both hygiene and health reasons. That benefit is not as proven in regards to toddlers wearing masks to help prevent them from getting COVID.

I am not anti-mask by any means. Its a simple thing to do. I think it has been portrayed to the public as providing more protection then it actually offers though.

I have a 5 year old about to start kindergarten. I just think, looking bigger picture and going off the data we have, that masking these young kids could cause more harm to them then the perceived benefit. An anecdotal example is my best friend who is also a critical care physician said his 6 year old, who just finished kindergarten and had to wear a mask all year, is terrified to go into a public place this summer without her mask on for fear of getting sick. That is a 6 year old that is now afraid to go into public without a face covering.

[CordMcNally]

Is anyone considering getting a 3rd shot on their own?

Especially for older docs or docs with multiple other medical issues who got their first shot 8 months ago.

Could you just walk into a vaccine clinic and not use your insurance (which I’m guessing would not cover it)? Would they know you’re already vaccinated?

if you had Pfizer, would you get moderna, given recent data that moderna may have longer effectiveness or be more effective against current variants?

If I was in a group that they were approved and recommended for. Not until then, though.

Edit: I thought I read where they think over a million people had received unauthorized booster shots so you wouldn’t be alone in jumping the line.

[Hatton]

Is anyone considering getting a 3rd shot on their own?

Especially for older docs or docs with multiple other medical issues who got their first shot 8 months ago.

Could you just walk into a vaccine clinic and not use your insurance (which I’m guessing would not cover it)? Would they know you’re already vaccinated?

if you had Pfizer, would you get moderna, given recent data that moderna may have longer effectiveness or be more effective against current variants?

I am 64 and participated in the Pfizer trial. I got vaccinated in august and september of last year. I am having some follow up bloodwork for the study Wednesday. I plan to go to a nearby CVS and get a third shot of whatever they are giving after that. I doubt I am in a database so I dont think insurance is going to be an issue. Whitebearddoc has posted that he has got 2 pfizers and a third moderna.

[Hatton]

Israel is already giving #3 pfizer to all over 60 and likely to lower this to 50.

[Tim]

I get your analogy, would still say there is real benefit to wiping ones a$$ effectively for both hygiene and health reasons. That benefit is not as proven in regards to toddlers wearing masks to help prevent them from getting COVID.

I am not anti-mask by any means. Its a simple thing to do. I think it has been portrayed to the public as providing more protection then it actually offers though.

I have a 5 year old about to start kindergarten. I just think, looking bigger picture and going off the data we have, that masking these young kids could cause more harm to them then the perceived benefit. An anecdotal example is my best friend who is also a critical care physician said his 6 year old, who just finished kindergarten and had to wear a mask all year, is terrified to go into a public place this summer without her mask on for fear of getting sick. That is a 6 year old that is now afraid to go into public without a face covering.

You have a well known point. Early in life the development physically, emotionally, and personality are much more rapid and often permanent. There has been little consideration of the higher impact on children than adults due to mandates simply due to how the environment and rate of growth impact them.
I’ll let geriatric, peds, and different psychs handle it. Kids react differently and are probably impacted more by the pandemic and the changes in the environment.
There will be after effects that last a long time, one way or another.

Counterpoint is keep them well and alive.

[FIREshrink]

masking these young kids could cause more harm to them then the perceived benefit. An anecdotal example is my best friend who is also a critical care physician said his 6 year old, who just finished kindergarten and had to wear a mask all year, is terrified to go into a public places to this summer without her mask on for fear of getting sick. That is a 6 year old that is now afraid to go into public without a face covering.

Are you a pediatrician? A developmental psychologist? A child psychiatrist? Can you cite studies showing widespread enduring psychological harm to children from wearing a mask? None of the child psychiatrists or psychologists or therapists or pediatricians i know have articulated concerns about lasting developmental damage. Many children and adults have developed anxiety about contagion but that fear should be blamed squarely on the pandemic and the nasty covid virus, not on the mitigation efforts necessary to combat it.

On the other hand about 50,000 minor children have had a parent die from COVID-19. I wonder what affects a child more: wearing a mask in public places for a few months or a year, or having a dead parent?

https://www.nbcnews.com/health/health-news/thousands-young-children-lost-parents-covid-where-s-help-them-n1271728

[snowcanyon]

Israel is already giving #3 pfizer to all over 60 and likely to lower this to 50.

Lowered to 50 today plus healthcare workers, prisoners, other vulnerable groups.

[Lithium]

Is anyone considering getting a 3rd shot on their own?

Especially for older docs or docs with multiple other medical issues who got their first shot 8 months ago.

Could you just walk into a vaccine clinic and not use your insurance (which I’m guessing would not cover it)? Would they know you’re already vaccinated?

if you had Pfizer, would you get moderna, given recent data that moderna may have longer effectiveness or be more effective against current variants?

I’m not in a rush to get a third shot, but if you think mixing and matching leads to greatest immune response, I’d probably get J+J.

Not sure how you go about shopping around for particular vaccines though. Is there a website?

[FIREshrink]

If I was in a group that they were approved and recommended for. Not until then, though.

Edit: I thought I read where they think over a million people had received unauthorized booster shots so you wouldn’t be alone in jumping the line.

What, no impugning his ethics? Not accusing him of lying, or teaching his children to lie? Missed opportunity, I'm disappointed. 😉

[burritos]

Are you a pediatrician? A developmental psychologist? A child psychiatrist? Can you cite studies showing widespread enduring psychological harm to children from wearing a mask? None of the child psychiatrists or psychologists or therapists or pediatricians i know have articulated concerns about lasting developmental damage. Many children and adults have developed anxiety about contagion but that fear should be blamed squarely on the pandemic and the nasty covid virus, not on the mitigation efforts necessary to combat it.

On the other hand about 50,000 minor children have had a parent die from COVID-19. I wonder what affects a child more: wearing a mask in public places for a few months or a year, or having a dead parent?

https://www.nbcnews.com/health/health-news/thousands-young-children-lost-parents-covid-where-s-help-them-n1271728

Good point. People seemed to have survived the masking in the Spanish flu pandemic. I think if masks are going to be life destroying for kids, what else will this cohort not tolerate down the line?

[Sampter]

What, no impugning his ethics? Not accusing him of lying, or teaching his children to lie? Missed opportunity, I'm disappointed. 😉

Please rate the following below in terms of least to most ethical:
--Getting an 11.5 year old vaccinated by lying about age
--Getting a booster when fully vaccinated when not immunocompromised
--A millionaire using welfare as part of a tax management strategy

[Sundance]

Please rate the following below in terms of least to most ethical:
--Getting an 11.5 year old vaccinated by lying about age
--Getting a booster when fully vaccinated when not immunocompromised
--A millionaire using welfare as part of a tax management strategy

Let’s also add in:

- not vaccinating your child when it was CDC recommended because you wanted to see how other children were effected first… when he admitted that after his postings I just laughed.