Announcement

Collapse
No announcement yet.

Medical Discussion of Coronavirus

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Originally posted by StarTrekDoc View Post
    There's about as much information and informed consent as there can be.

    ​​​​​​What haven't you heard over the past two years that makes you think there is something known but not disclosed?

    I've suggested this to my patients who have the same hesitancy that you voice....suggest that you go to your local hospital and take a look at any ICU. Ask the nurse coming off duty if they think covid is the cause of the patient being in the ICU and recent spike of additional deaths over the past year is normal. Ask if there is a difference between vaccinated patients or not. That will provide a very informed and truth at face value to you.
    ​​​​​​​​
    I appreciate your sincere replies. Rhetorically, most discussions about "herd immunity" are a two factor discussion. Vaccine + the natural immunity. There are legitimate questions about natural immunity possibly providing a better protection against "variants" because of the "targeting specific variants of the vaccines". I am vaccinated, but I still have that question. Why is natural infection not a factor in vaccines being mandated?

    The "evidence" you cite is probably in the "more likely than not" category rather than "beyond a reasonable doubt". Not sure, everyone is dealing with the same standards for making decisions. For sure, pro vaccine takes the position of "why does it matter". I don't think natural immunity is even mentioned or considered in vaccine mandates. But is definitely was in all discussions of "heard immunity". No idea where it went. I would appreciate an explanation why it is no longer is a factor.

    Probably because it is an unknown.
    https://cap-press.com/pdf/33733.pdf
    https://www.lawinsider.com/dictionar...1%20Sample%202

    More of a decision making theory question. The messaging has completely ignored "natural immunity" and the statistics as well. Vaccinate, un vaccinated and natural immunity are the three factors I see.

    https://www.news-medical.net/news/20...nic-study.aspx

    I have not heard of the Cleveland Clinic being accused of disinformation.



    Comment


    • Originally posted by Rando View Post

      Thanks Max but ultimately this is anecdotal. After poking around the CDC site there have been fully vaccinated patients that have died of COVID, the number looked to be around 1500 in the US as of last month. In order for me to properly counsel a patient with documented history of COVID ideally I want to compare that number to COVID deaths among those with prior infection, and I'm disappointed that I can't. And really with the advent of Delta in the past few months I'm not sure how helpful older data would be even if I had it.

      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 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.

      Comment


      • 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.

        Comment


        • Originally posted by MaxPower View Post

          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.

          Comment


          • 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.

            Comment


            • 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.

              Comment


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

                Comment


                • Originally posted by Rando View Post
                  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.

                  Comment


                  • 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.

                    Comment


                    • Originally posted by pulmdoc View Post
                      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.

                      Comment


                      • Originally posted by CordMcNally View Post

                        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.

                        Comment


                        • Originally posted by StarTrekDoc View Post
                          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.

                          Comment


                          • Originally posted by StateOfMyHead View Post
                            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.

                            Comment


                            • Originally posted by Rando View Post

                              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!

                              Comment


                              • Originally posted by artemis View Post

                                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.

                                Comment

                                Working...
                                X