Medical Discussion of Coronavirus

[StarTrekDoc]

It looks like there is agreement that people >65 who had the Pfizer vaccine should get another dose, also LTC patients..

it looks like there is disagreement whether healthy people in a high-risk occupations should get the third shot. Also Walensky has added another 50-64 tier which I don't remember seeing until now.

I think the conclusion has to be there is not a consensus on what to do with people under 65, and that the effect of the 3rd dose in healthy people under 65 is probably small.

The NNT (Numbers Needed to Treat) to avoid 1 hospitalization was quite compelling for >65. ~1 in 200. Also in underlying medical conditions. ~1 in 500 IIRC.

The numbers really started getting into the 1 in 2000-5000+ was it went lower age groups and risks. I don't even think they had enough data for HCWs. That is why the group had such a hard time deciding on the medical merits of vaccinating HCW based on hospitalization risk.

- CDC ultimately makes public policy decisions (aka not always only science [read politics if you wish]). This is what the CDC director did which I'm not surprised.

If people are clamoring vaccine mandates potential knock out 5% of workforce; for sure a spike in covid within the HCW ranks and that's what the CDC director must balance against.

[FunkDoc83]

I think they would decline the request. There are other qualifiers that I’m doubting they would require you to prove that would probably be a better strategy if you want to circumvent the recommendations.

If I get push back, I'll just point to my phone with the latest news report and say "But Walensky Said...."

[G]

Can you just walk into a Wallgreens, CVS, etc. today and ask for a vaccine due to occupational exposure? Will they say no?

If you schedule online at CVS, yiu click a button saying that you meet qualification; nobody asks after that.

Word on the street.

[Rando]

- CDC ultimately makes public policy decisions (aka not always only science [read politics if you wish]). This is what the CDC director did which I'm not surprised.

Thanks, your explanation is better than the CDC which is really the problem. I'm seeing a lot of pundits and physicians in the media today trying to explain Walensky's decision and the old saying in politics is if you're explaining, you're losing. The recommendations should be straightforward and the rationale for them should be apparent, not just to us but to lay people.

This is from the New York Times:

. “There’s a complexity here, because Dr. Walensky was part of the White House announcement” on boosters, noted Dr. Ashish Jha, dean of the Brown University School of Public Health.

As you probably recall,. the White House announced on August 18th they planned to offer boosters to everyone 18 or over starting Sept 20th. Walensky was a big part of that announcement and ironically presented the studies to support the announcement.

So it's a reasonable question to ask whether she kind of backed herself into a corner, or felt political pressure.

[SpacemanSpiff12]

If you schedule online at CVS, yiu click a button saying that you meet qualification; nobody asks after that.

Word on the street.

I know numerous docs who - weeks ago - walked into CVS, stated that they do not meet any of the criteria for a third shot, and were given one anyway.

[Tim]

Nope same committees.

FDA move then ACIP rec then CDC final.

FDA was yesterday
ACIP rarely goes contrary to FDA but they did today on HCW or other high risk exposures.

They had little data for NNT on it so there was quite a heated debate on following the lack of science available.

CDC final is up.tomorrow. they may ignore the ACIP recs today.....who knows.

Follow the science, which science?. The question is when you have a committee that votes, you need to remember by definition a vote is political.

[Tim]

So it's a reasonable question to ask whether she kind of backed herself into a corner, or felt political pressure.

Retaining her employment involves only a vote of one. Just saying. The swamp is alive and thriving with Covid. High impact and high stakes. I just hope the teacher's union was consulted. The CDC is in no way following science only. Scientific judgement would be perfectly fine. That is not how judgements are made in DC. No if's, and's or but's about it. Too bad she didn't speak out about other issues. CDC follows the rule of speak when you are spoken to. And it needs to be the desired answer.
Not the actually worker bees, just the top rungs.

[CordMcNally]

Andddddddd now, the director of the CDC has overruled the CDC panel and recommend a booster for all frontline workers, including teachers and healthcare workers. The CDC is still a ridiculously unfunny joke.

As much as I hate the SEC (the athletic conference), the CDC could really take a page out of their book with how they dealt with expansion. They can talk all they want behind closed doors and can even disagree but when the vote comes out publicly, it needs to be unanimous.

[snowcanyon]

I know numerous docs who - weeks ago - walked into CVS, stated that they do not meet any of the criteria for a third shot, and were given one anyway.

Not here. CVS and Walgreens are like a police state. It's impossible. I think they have actually dissuaded many of our undocumented because they are so strict. It's a big problem.

[Dusn]

Pfizer recognized that they can just amp up the media and public pressure to get their booster shots passed rather than providing actual data.

Honestly, I’m not sure what the fda or cdc was supposed to do. I know many healthcare workers who would have been really pissed at the regulatory agencies if they were not allowed to get a booster. And maybe a booster really is needed? No one will know because Pfizer just bypassed getting real data.

The studies that they’re doing for kids look pathetically small for a vaccine study as well. Why bother spending money on a real study when public pressure will get it approved regardless.

[pulmdoc]

I was surprised at the CDC director adding HCW/high risk occupations to the booster pool, but not that much (my predictions of strong recommendations for 65+ and immunocompromised and weak for others held up). Ultimately, there's a judgment call involved in regards to what NNT is considered appropriate for a booster. Anything >1 involves judgment which is why there was disagreement.

Transparency vs closed doors+unanimity. I fear no matter which approach the FDA/CDC took, they would be roasted by those who had decided beforehand to oppose their decisions. I personally prefer the transparency so that I can better counsel my patients regarding recommendations and know where to bend and where to hold firm.

[snowcanyon]

I was surprised at the CDC director adding HCW/high risk occupations to the booster pool, but not that much (my predictions of strong recommendations for 65+ and immunocompromised and weak for others held up). Ultimately, there's a judgment call involved in regards to what NNT is considered appropriate for a booster. Anything >1 involves judgment which is why there was disagreement.

Transparency vs closed doors+unanimity. I fear no matter which approach the FDA/CDC took, they would be roasted by those who had decided beforehand to oppose their decisions. I personally prefer the transparency so that I can better counsel my patients regarding recommendations and know where to bend and where to hold firm.

My only surprise was that it wasn't 60.
Great analysis, though

[StarTrekDoc]

I was surprised at the CDC director adding HCW/high risk occupations to the booster pool, but not that much (my predictions of strong recommendations for 65+ and immunocompromised and weak for others held up). Ultimately, there's a judgment call involved in regards to what NNT is considered appropriate for a booster. Anything >1 involves judgment which is why there was disagreement.

Transparency vs closed doors+unanimity. I fear no matter which approach the FDA/CDC took, they would be roasted by those who had decided beforehand to oppose their decisions. I personally prefer the transparency so that I can better counsel my patients regarding recommendations and know where to bend and where to hold firm.

Exactly. Each committee/level has their job and scoand. I appreciate that it's done. Watching ACIP panel go at it was fun academic entertainment
ultimately it's a judgement call on public policy for the CDC. Can it be political? Sure. Was this one? Not really...compared to other CDC calls in recent memory.

[Kamban]

Can you just walk into a Wallgreens, CVS, etc. today and ask for a vaccine due to occupational exposure? Will they say no?

Not sure. Depends on their corporate policy.

Most don't care what you check off. If you really want it you can check immunocompromised and they will give it to you

[Tim]

Looks like NYC city healthcare should be fine with the mask mandates. The schools appear to be exempted (at least temporarily). New York outside of NYC might be a different question.

https://www.usnews.com/news/top-news/articles/2021-09-27/new-york-hospitals-face-staff-shortages-as-vaccine-mandate-kicks-in

https://www.usnews.com/news/education-news/articles/2021-09-27/federal-judge-delays-vaccine-mandate-for-new-york-city-teachers?rec-type=sailthru

What is lost in the shuffle is some of these were praised last year (hopefully heathcare heroes) and now they are terminated as (as mandate violators) that have previously had Covid and question the consideration of prior infection. With a 15% unvaccinated rate, something does not sit right with denying them unemployment benefits with the generous approach for benefits for Covid issues that are not related to vaccines. PPE was a problem that some marched through. Maybe Lordosis can give an eyewitness assessment of the cost of this benefit. Canning 15% of healthcare workers seems to require calling out the national guard again. No idea how soon the terminations will happen. I wonder why teachers were able to avoid the pain. Well funded legal representatives would be my guess.