Medical Discussion of Coronavirus

[PedsCCM]

If viral load in vaccinated and unvaccinated are similar, then does the case for mandated vaccination fall apart a little?

https://www.medrxiv.org/content/10.1....31.21261387v1

I don't think so. 67% of Dane county is vaccinated but vaccinated individuals made up only 38.5% of symptomatic cases. Prevention of symptomatic disease is important. Prevention of severe disease is also important. Unvaccinated individuals have roughly 29x the rate of hospitalizations when compared to vaccinated.

[Shant]

No because the vaccine is still highly protective and breakthrough infection is still quite rare. https://www.kff.org/policy-watch/cov...om-the-states/

[StarTrekDoc]

Our survey showed asymptomatic positive breakthrough cases have significantly lower viral loads and prevalence than unvaccinated, but still there unlike pre delta variants. Ten fold. Still 0.1% but that's much higher than before.

This is why we restarted masking even among vaccinated to minimize as much as possible the inclinic transmission.

[FIREshrink]

The last three responses all make a good argument for individuals to choose to be vaccinated. My question is about mandates, which can only exist to protect others. If vaccinated and unvaccinated have the same viral loads they may be equally capable of shedding and spreading. In that case, I'm not protecting anyone else by getting vaccinated, only myself, and I don't see how a free society could mandate individuals take medicine which only protects themselves.

[Shant]

Your premise is false, perhaps I expressed myself poorly. If you are vaccinated you are far less likely to become infected and therefore far less likely to ever start shedding the virus in the first place even though the small minority of vaccinated with breakthrough cases may shed a lot. If 1% of the fully vaccinated get a breakthrough infection that is just as dangerous as infection in the unvaccinated then that is enormous protection to the public by preventing spread from the other 99%. (Also the data on viral load is still emerging, the preliminary data I saw showed that the fully vaccinated shed virus for a much shorter timeframe than the unvaccinated.)

Also, society is not mandating that you take the vaccine. You are free to choose to not take it and to find a job where it's not a duty to those in your care. (I guess the one exception is the armed forces where you're not allowed to leave, but where you also already agreed to take on far higher risks than vaccination for the sake of the country.)

[FIREshrink]

Yes agree it's too early to know if this will hold up, but it was meant as a thought exercise. If efficacy against asymptomatic infection and mild infections continues to collapse, then this scenario is not so far fetched.

If vaccinated and unvaccinated carry and shed the same amount of virus, then I don't think there is a "societal good" case for vaccinating. There are great reasons for individuals to be vaccinated, but then I'd liken it more to seatbelt laws or motorcycle helmet laws. They are mandated for the privilege of driving or riding, but not for more fundamental rights like holding a job. My entire state has mandated vaccines for HCWs, even in private practice, but what is the justification for that if it turns out I am not less contagious after vaccination?

[Shant]

Aren't you forgetting something? Like booster shots?

[Sundance]

Yes agree it's too early to know if this will hold up, but it was meant as a thought exercise. If efficacy against asymptomatic infection and mild infections continues to collapse, then this scenario is not so far fetched.

If vaccinated and unvaccinated carry and shed the same amount of virus, then I don't think there is a "societal good" case for vaccinating. There are great reasons for individuals to be vaccinated, but then I'd liken it more to seatbelt laws or motorcycle helmet laws. They are mandated for the privilege of driving or riding, but not for more fundamental rights like holding a job. My entire state has mandated vaccines for HCWs, even in private practice, but what is the justification for that if it turns out I am not less contagious after vaccination?

The argument now since the virus doesn’t stop transmission is resource utilization in the unvaccinated. But I don’t think that argument holds up as much when one is debating the need to vaccinate kids..

[Lordosis]

I really don't get the problem. I agree with Tangler despite my political leanings which seem very similar to his I don't see why it's a big deal to mandate this. We are not forcing anybody to take it just those who are in specific situations where it will affect other people. We have numerous examples where this is already in effect. Most recently it was flu shots but free years now is a requirement to be vaccinated to go to public school college or work in the healthcare field. How is this any different? It's just the next vaccine to come along.

Here's a question for those old enough to have gone through it. How is it we were able to deal with smallpox decades ago? What is different now?

It seems very similar to me. We have a very contagious virus with high enough mortality rates to be concerning and the plan was to vaccinate the world. Back in the 50s and '60s we were able to do it why can't we do it now?

Is it social media?

Is it that covid is just not virulent enough to be scary to most people?

Have people fundamentally changed in some way?

Is it specifically the way the covid vaccine was handled politically?

[Lordosis]

The argument now since the virus doesn’t stop transmission is resource utilization in the unvaccinated. But I don’t think that argument holds up as much when one is debating the need to vaccinate kids..

Just making up numbers here but let's say the vaccine has a 50% chance of preventing you from catching covid. That alone is a 50% decrease in transmission because half the people who would have caught it did not.

Chances are it's way better than 50%.



This argument reminds me of IUDs causing a higher rate of ectopic pregnancy. Even though when you think about it the rate of pregnancy overall is far decreased leading too far fewer ectopic pregnancies. The absolute number is incredibly low but the relative rate when it does happen is slightly higher. The second part is picked up and that's what people remember because it is scary.

You can't have an ectopic if you don't get pregnant in the first place.

You can't spread covid if you don't get covid in the first place.

[Lithium]

I really don't get the problem. I agree with Tangler despite my political leanings which seem very similar to his I don't see why it's a big deal to mandate this. We are not forcing anybody to take it just those who are in specific situations where it will affect other people. We have numerous examples where this is already in effect. Most recently it was flu shots but free years now is a requirement to be vaccinated to go to public school college or work in the healthcare field. How is this any different? It's just the next vaccine to come along.

Here's a question for those old enough to have gone through it. How is it we were able to deal with smallpox decades ago? What is different now?

It seems very similar to me. We have a very contagious virus with high enough mortality rates to be concerning and the plan was to vaccinate the world. Back in the 50s and '60s we were able to do it why can't we do it now?

Is it social media?

Is it that covid is just not virulent enough to be scary to most people?

Have people fundamentally changed in some way?

Is it specifically the way the covid vaccine was handled politically?

Things have changed dramatically even since WWII. The best comparison is the polio vaccine. They gave it to millions of kids. Some of the vaccines were tainted, and there were kids who became paralyzed and died. Imagine that happening now.

polio seems ten times worse than covid 19, but It’s hard to imagine we could get it eradicated as we did back then. It’s easy to blame social media and widespread mistrust in institutions. But I’m not even sure if you could have gotten everyone to take that vaccine in the 1970s. This country wasn’t the same after Vietnam, Watergate and the growth of just the mainstream media.

America has always been terrible about getting annual flu shots by the way. I agree with your political take. These aren’t really “mandates” if you can opt out of them.

[jfoxcpacfp]

Haven’t been monitoring this thread much since I presume the doctor-mods are (and I wouldn’t have much time to read anything else if I hung around on this one); just dropped in to see what jacoavlu has been saying (stirring up 😉) sInce coming off hiatus. I realize politics are difficult to keep out of the discussion at this point, but pleasepleaseplease let’s continue to all keep it friendly, guys.

[Tim]

“Have people fundamentally changed in some way?

Is it specifically the way the covid vaccine was handled politically?”

We are a product of our environment. The Vietnam War was actually a symbolic change in public sentiment. The sentiment wasn’t Vietnam, it was more government power over individuals and choices.
The personal interest was the draft and the ability to choose your own battles and wars. Individual choice became the foundation of virtually every thought process and value.

Under the draft, deferment meant two options:
enlist for 3 years and have influence on what type of soldier you would be or 2 years as cannon fodder. Only for men, no pronouns allowed. Fight or flight.

This freedom of choice was channeled through out our society. Education, recreation, employment, sex and politics. This “freedom” was a radical concept. Long haired hippies and the Vietnam War were symbols, not the actual values of freedom of choice. It was a move towards independence.
My misguided interpretation is that perception is that the institutions and government have adapted and are actually thought to be counterattacking and taking back control. Each step is viewed as a threat of more control.

The perception is that government forcing results rather than opportunities has no other possible result than taking away from one group and giving to another. No choice. And extending this to every aspect of life for you and future generations. Government and institutions decide “wildcards”, winners and losers.
The political appeal is “free stuff” and preference based on for lack of a better word your “draft status”. Or identify, or vaccination status or driving an EV. The fear is incentives are being replaced by government directives, driven by ideological bureaucrats. Immediate resistance when PR reduces the President to using a note card to call for questions that are specifically ordered who to call upon and in what order. Everything else that follows is disregarded. The message is classified as another battle.
Loyal political opposition has been eliminated.
Everything is viewed as another step to control outcomes for things that have not yet occurred.
The perception is, what the individual wants or chooses, doesn’t matter.

This is only a perception of what has changed.
Polio vaccine, no problem. Vaccine booster, why? Another press conference with reporters in the exact order by name and prescreened questions.
Don’t bother to reply. I would only “circle back”. I have no clue what the rest of the population thinks. Lordosis would need a poll for that.

[jacoavlu]

I suppose if you want the personal freedom to not get vaccinated, you should have to deal with all that the choice entails as well since " it only affects [you]" and no one else. So don't come to the hospital expecting treatment when you can't breathe.

let’s stop treating drunks and drug addicts too. or MVA victims ejected bc they weren’t wearing seatbelts. or gang bangers that get shot. or type 2 diabetics that end up with renal failure and necrotic toes

shameful statement from a physician

[jacoavlu]

Yes, but you could help with that messaging. You could encourage vaccination rather than confuse people by telling them ______.

I don’t want to put words in your mouth but you clearly don’t think it is very important for young people and healthcare workers to be encouraged to get vaccinated

You could help here. You are free. Free to help encourage or free to discourage and create mistrust of a very safe very effective FDA approved vaccine that millions all over the world have had.

don’t conflate anti mandate with anti vaccine