Medical Discussion of Coronavirus

[triad]

Comparing waves between the South African population seems reasonable and so far it’s promising.

Regardless, less and less people are more inclined to not go out of their way as time goes on.

german data is looking pretty favorable as well. hospitalizations already declining and didn't get too high in the first place

https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=total_cases&Metric=Hospital+admissions&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=DEU~NLD

https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=total_cases&Metric=Confirmed+cases&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=DEU~NLD

[Tim]

Another conflicting signal from CDC. Approval of TTS policies for schools. Exposed to covid, no longer requires quarantine.

"Test-to-stay, according to experts, is another valuable tool in a layered prevention strategy that includes promoting vaccination of eligible students and staff, requiring everyone age 2 and older wear a mask inside schools and facilities, keeping at least 3 feet of distance between students, screening testing, ventilation, handwashing, and staying home when sick."

https://abc7ny.com/covid-schools-student-testing-home-quarantine-cdc/11352035/

It seems that school closures due to exposure and the quarantine requirement were too much for the population.

If memory is correct, one of the key items for schools was ventilation systems would need to be upgraded. I really wonder how schools used the funds. Additional staff, covid related improvements? I think that was the intent of some massive funding that was needed. I doubt a new football field or athletic facilities was the intent.

https://www.newsweek.com/education-department-cant-stop-schools-using-covid-funds-athletic-facilities-1636260

I seriously doubt that many schools upgraded the ventilation systems. I wonder what the teachers union influence was. Teachers, students and parents don't want to go back to the online learning for even 10 days. Pack em up and send them to class unless you can prove they are sick is the solution.

The planned Christmas Eve gathering is likely not going to happen. Four kids tested positive, two in laws had long serious illnesses. Vaccinated, boosted or not, the clan is in self preservation mode. Wife bought some BinaxNow test kits. Fauci said to check vaccine cards. The wife is now in the "take the test" mode if you want to enter the house. We are back in "isolation mode" for the 94 yr old MIL. And Omicron hasn't even ran it's cycle! This Covid thing is getting very old and I am tired of the political messaging and spending. I will follow my wife's mandates. I have never been tested for Covid. I might have to, on orders of my spouse, not the CDC or schools or employer. Gotta live some place. House rules (they change fast).

[StarTrekDoc]

Hatton too soon to tell. My eight ball says we're going to maintain the q6months for 2022. Whether we update the sequencing or not for 2022 tbd.

The data for omicron simply too soon to tell anything. Just not enough people and at risk folk being infected... thankfully.

If I were travelling, yes would get boosted q6months.

That means before our planned cruise in April will be right before six months and will determine if I hit it again before or not...or if we're even going as traveling with 92 yo inlaw ...he's determined to go!

[FIREshrink]

there isn't a lot of data available but it looks like antibody levels from the booster drops off pretty quickly (3-4 months). Tcell response may be adequate to prevent severe infection if you're not high risk.

Cellular immunity failure would be unexpected, wouldn't it, barring mutation?

[Tim]

People that are saying less severe? I don’t know. What I do know is I work in rural/college town Indiana at two hospitals. The one is critical access and we are willing to take 7 Covid patients.

I am flying one of those out every other day. The main hospital, we have roughly 142 beds and have 175 patients.

I am flying patients to ERs from inpatient because there is not beds in Indiana at all. My hospital is the only one where we hospitalists manage optiflow and Bipap w/o a pulm consult obligatory or outside icu proper

We use to have 8 Hospitalist teams of 15 now we have 11 with 14-16 patients each …

https://app.powerbi.com/view?r=eyJrI...UwOCIsImMiOjN9

I am sorry for your situation. I know I am guilty of drawing conclusions on “national” policies “ based on my personal observations.

• You in rural Indiana (and the state) are getting crushed.
• New York seems to be having a surge.
• Southeast Texas is not. See the above. Eight flip charts of data.
• My extended family had a surge in SE tx. (Low point in Covid but high point for us).

Much of this debate has been “what others should do or be required to do.” I don’t think we will beat Covid by “regulating.
I think vaccines and treatments are the solutions and people will choose based on their own personal situations.
The medical messaging of vulnerable populations (elder and conditions) has been the best guidance. I don’t want to isolate, but I need to take precautions for family reasons. Isolation as a duty for strangers will not work. Regardless of the variant.

From 20,000 feet, I don’t see much difference in controlling surges in Indiana, New York or Texas.They seem to follow its own path. That does not make logical sense. Your update added a valuable perspective.
Strong work.

[Hatton]

Hatton too soon to tell. My eight ball says we're going to maintain the q6months for 2022. Whether we update the sequencing or not for 2022 tbd.

The data for omicron simply too soon to tell anything. Just not enough people and at risk folk being infected... thankfully.

If I were travelling, yes would get boosted q6months.

That means before our planned cruise in April will be right before six months and will determine if I hit it again before or not...or if we're even going as traveling with 92 yo inlaw ...he's determined to go!

I was hoping you would weigh in. I will try to get boosted again a week or so before the flight unless some new data comes out. The travel is to the WCIcon in Phoenix.

[snowcanyon]

Hang in there and remember to give yourself a break as we're just beginning the winter surge with influenza and dual infections that we saw early on in March 2020 that will cause a lot more issues with LOS IMHO.

I truly hope omicron is less lethal as it theoretically should be as evolution of a virus over time that becomes endemic. While the breakthroughs are happening, the severity remains the same with delta for the most part so far...bit most in the healthy folk. The elderly is more import and majority out 9-10 months now if not boosted.

Too early to tell on pact of elderly as tended to run later on the surge


That's going to start showing up in hospitalizations from omicron probably three weeks from our modeling with the winter surge.
..right around new years

I can find no evidence of this "viruses become less lethal" theory. Can someone provide a link?

[Zaphod]

Just pointing out that there is no guarantee that viruses evolve only in less lethal or less severe direction over time. Sometimes that happens. Many of the diseases we immunize against remain as pathogenic as always. What this wave will do is add to population immunity due to infections, which could move us in the direction of herd immunity eventually. It will probably be a combination of vaccines and infection-based immunity that gets us there in the long run. We will be lucky if viral mutation helps also.

Theres frankly no reason to even consider it until after the evidence shows us its true. Makes no sense from any way you look at it. Your bayesian prior should be its similar.

Everyone is now quoting a bunch of things that is actually different about the human population, ie, vulnerable are dead, others vaxxed/prior infection and doing terrible math, ie, the faster it grows the less accurate your initial estimates of severity are and larger the biasing is.

It would be shocking if the same people havent been wrong at every stage here but its still disappointing.

[Kamban]

The question I have is it a mRNA booster q6months now? I am flying in Feb which will 6 months since my first booster. I will be in the Atlanta airport. Should I get a second booster. Thoughts?

A lot of unknowns

1. What is the dominant strain at that time. Is it Omicron, delta or something else?
2. We think Omicron is less lethal but more infectious But that is in a younger South African population. What it will do to an older unvaccinated US population is not known.
3. Immunity is less with standard 2 dose MRNA against Omicron but much better with booster. But no one know how much and how long will the effect of that booster last.
4. Even if you don't take any booster in Feb you are protected against any serious complication or death against any Coronavirus. But that is not the same as not getting a mild or asymptomatic case of Omicron which can sometimes impact travel plans if new restrictions are in place.

If I were you I would wait till 2 weeks before the flight and reassess. If I had no reaction to the 1st booster I would take the 2nd booster and hopefully that will protect me against even a mild case of Omicron.

[G]

It's really tough for businesses to mandate something that will likely make more of their already short staff quit. While I agree that those in healthcare should do what they can to protect themselves and their patients, hospitals also need all the people they can to come into work to care for patients.

Word on the street (highway) is that the snowplow drivers are shorthanded due to vaccine refusal/mandates. I find the whole "I'm quitting because The Gov can't tell me what to do" thing very fascinating. One would assume that no job means no spending money and no health insurance...presumably these arent the folks in the FI one more year camp...so how does this turn out?

[Tim]

Word on the street (highway) is that the snowplow drivers are shorthanded due to vaccine refusal/mandates. I find the whole "I'm quitting because The Gov can't tell me what to do" thing very fascinating. One would assume that no job means no spending money and no health insurance...presumably these arent the folks in the FI one more year camp...so how does this turn out?

So far the courts have ruled against the government. One can support the requirement that a solitary snow plow driver at 4am is the route cause of Covid surges in the winter. Many times, government workers get awarded backpay if they were inappropriately prevented from working..
I doubt the Supreme Court will be unanimous. Different opinions. No sense in voting, until the lawyers finish arguing.
After that, people will vote and politics will start all over.Again and again. Individual liberties are a never ending debate.No clue how next month’s bills get paid.
Hey, CDC caved on the required quarantine for school kids, if plowing snow needs drivers, drivers will get “exemptions”.

[CordMcNally]

Word on the street (highway) is that the snowplow drivers are shorthanded due to vaccine refusal/mandates. I find the whole "I'm quitting because The Gov can't tell me what to do" thing very fascinating. One would assume that no job means no spending money and no health insurance...presumably these arent the folks in the FI one more year camp...so how does this turn out?

It's honestly a little weird. My guess is that people in general are just kind of fed up with the government and this was the one thing that kind of pushed everyone over the edge. When there's support from a fairly large number of people then I think it's easier to do drastic things such as quit your job. We tried to get takeout from two different places last night and neither were answering their phone or allowing online orders.

My best prediction is that the federal vaccine mandate gets blocked by the Supreme Court. Some areas try to continue with various masking and other COVID policies. We'll likely see some companies relocate to less restrictive areas. The appetite for additional vaccine booster doses is going to wane by those already vaccinated. The hospitals will continue to be on the brink of disaster because of staffing issues for 12-18 months. Finally, they'll have to come up with a new naming system of naming variants.

[Brains428]

CordMcNally The culture of my town isn't going to change- so the 2 hospitals in town are just going to operate understaffed for whatever amount of time. In the meantime, there are people who are vaccinated who have quit because of feeling overworked/underappreciated. So, we're going to have to relax the vaccine mandate at some point. Do I think people should just get the vaccine? Yes.

Who knows- maybe if you let the "freedom of choice" side win, then it won't be such a mental hurdle to just get the thing.

[CordMcNally]

CordMcNally The culture of my town isn't going to change- so the 2 hospitals in town are just going to operate understaffed for whatever amount of time. In the meantime, there are people who are vaccinated who have quit because of feeling overworked/underappreciated. So, we're going to have to relax the vaccine mandate at some point. Do I think people should just get the vaccine? Yes.

Who knows- maybe if you let the "freedom of choice" side win, then it won't be such a mental hurdle to just get the thing.

Doubtful but not having any mandates/restrictions would certainly help things from an economy standpoint but we can all agree would worsen other areas.

[StarTrekDoc]

I can find no evidence of this "viruses become less lethal" theory. Can someone provide a link?

A nice general overview of coronaviruses and pathology - and from a reputable source -- nicely written.

https://www.smithsonianmag.com/science-nature/how-viruses-evolve-180975343/