Medical Discussion of Coronavirus

[StarTrekDoc]

True. The data is a bit lacking. Earlier a page or two it was discussed on an Israeli preprint that natural + immunization outperforms everyone for Delta.
Can use that as reason for vaccinating prior natural infections.

I know we're not actively tracking this either. It does take a bit of effort as need to draw nucleoside Ab at the point of PCR+ diagnosis to really capture true prior infection status and track the differences from there. Takes a bit of logistics which we simply don't have at this time.

[StarTrekDoc]

I know, but for people thinking that having covid once already and surviving is enough clearly aren’t correct. I’m pretty sure there are studies showing the highest antibody levels in patients who had covid, got better, then had the vaccine. We obviously don’t know what the magic number is for antibody level yet, but I would guess more is better.

The more trained sentinels and types of sentinels standing guard to defend against an upgraded offensive Delta/Mu/Lambda/Zeta vs untrained militia

That's the analogy I use for my patients to visualize the concept.

[pulmdoc]

I am really hoping for guidance at some point in the near future regarding antibody levels (either immunized or infected) vs risk of future severe infections. I have had a lot of previously infected patients who aren't antivax, but who reasonably want guidance re:vaccination, whether it's necessary and timing. The CDC guidance on antibody testing hasn't been updated since March. My current advice is for previously infected to get vaccinated 3-9 months after infection, but it's a pretty soft recommendation and I would love to be able to say with confidence "let's test your antibody levels and then we'll know what to do." It would also dramatically help sort through those who were unvaccinated, caught delta recently, and now face an employer mandate to be vaccinated. It doesn't make a lot of sense to vaccinate someone 3 weeks after infection, but I also have lots of doubt that immunity is lifelong. I have had several hospitalized patients during the current wave who were infected last year so skipped vaccination; all were mild cases, but numbers too small to know whether that's a correlation or just an effect of "most first cases are mild and dead people don't get re-infected, therefore most second cases will have had mild infection to start." Definitely something to look forward to.

[StarTrekDoc]

pulmdoc - it's a very good question and one we tackle daily especially with the heavy data academic types we see. That is why the titer is important tool we have but as pointed out, we don't have any cutoffs to say - x is good; y is intermediate; z is bad. And not only that, Delta moves the goalposts as will future variants as this isn't stable Hep B to make these demarkations.

It's the same question that's coming up for Covid #3 shots. The vast majority patients are willing it do their part, but they do want to know when/if question on #3. How much booster, will this affect mod/severe disease or simply prevent spread and 'doing my bit' against the unknown of repeated jabs over the next x years as we await covid to become endemic

My practice - draw the spike antibody titer - if lowish -- ammunition to vaccinate; if highish - feel a little better. It's kind of like CT Calcium scoring.

[Hatton]

On my wish list would be a panel that would check antibody titers to all currently available vaccines to really help people make decisions.

[CordMcNally]

My advice to patients with hx of prior COVID is to get the vaccine anyway as it seems logical, but I feel like I don't have a lot of evidence to back that up.

I don't have any raw data to back this up but I think if you've had COVID in the last several months (i.e. the delta variant) then I think you're probably covered fairly well as opposed to getting COVID previously from a different variant but I blanket recommend anyone who has not gotten the vaccine to get it, regardless of previous infection, unless they've been told by a reputable physician (not a naturopath lecturing at a school board meeting) to not get it.

[pulmdoc]

The number of people who have legitimate permanent medical reasons to not get vaccinated is extremely small. A patient would have to have prior anaphylaxis to ingredients in all 3 vaccines. CDC is suggesting a history of Guillen-Barre syndrome as a possible contraindication, but without any evidence. Other types of allergies, allergies to different vaccines, pregnancy etc are not contraindications.

[Rando]

The number of people who have legitimate permanent medical reasons to not get vaccinated is extremely small. A patient would have to have prior anaphylaxis to ingredients in all 3 vaccines. CDC is suggesting a history of Guillen-Barre syndrome as a possible contraindication, but without any evidence. Other types of allergies, allergies to different vaccines, pregnancy etc are not contraindications.

I think we might be seeing a question with kids who have had MIS-C and are now eligible for the vaccine. if I had kids in that situation I doubt I would give them the vaccine at this point.

[FIREshrink]

I don't have any raw data to back this up but I think if you've had COVID in the last several months (i.e. the delta variant) then I think you're probably covered fairly well as opposed to getting COVID previously from a different variant but I blanket recommend anyone who has not gotten the vaccine to get it, regardless of previous infection, unless they've been told by a reputable physician (not a naturopath lecturing at a school board meeting) to not get it.

Yes at least 90 days based on antibodies . We had family visit in January after they had had COVID in December, but we wouldn't let them visit in April.

[artemis]

Yes, 1918 had several large peaks and fortunately mutated to a less aggressive form and believed to be 1 of the 4 common circulating human coronaviruses. With COvid19 follow this path? Perhaps.

Minor nit. The 1918 pandemic was caused by H1N1 influenza A, not a coronavirus. But there was a pandemic in the late 1890s dubbed the "Russian Flu" that epidemiologists now think may have been due to Coronavirus OC-43 (which is now an endemic human coronavirus). Of course, no one can be 100% sure exactly what pathogen caused the "Russian Flu" today.

[artemis]

I try to be respectful and often learn from other's differing views but this is unbelievable. In addition to the devastating losses of life, the sheer volume of ignorance that has been exposed during this pandemic has been both shocking and disheartening.

Worse, some of it is coming from supposedly well-educated medical professionals. It's unbelievable to me that 20% of nurses won't get vaccinated.

[artemis]

I think we might be seeing a question with kids who have had MIS-C and are now eligible for the vaccine. if I had kids in that situation I doubt I would give them the vaccine at this point.

Fortunately not many kids end up with MIS-C, but I agree that that group warrants caution when it comes to COVID vaccinations. The last thing they need is myocarditis on top of their already-existing problems!

[CordMcNally]

Worse, some of it is coming from supposedly well-educated medical professionals. It's unbelievable to me that 20% of nurses won't get vaccinated.

There is a lot of crazy out there in the general public. That level of crazy tends to carry over into similar percentages of many professions.

[Shant]

That's true but one does wonder how they survive the cognitive dissonance of going to work each day and doing the opposite of what they profess to believe. I mean do they lie awake at 2 am wondering if they are Nurse Evil for doing their day job well?

[G]

do they lie awake at 2 am wondering if they are Nurse Evil for doing their day job well?

No.