Medical Discussion of Coronavirus

[Tim]

The emphasis on covid statistics is changing as the messaging will no longer be positive for the number of infections or percentage of positive tests. With the much higher rate of spread, this would be too much for anyone to claim success. Delta and now Omicron have mutated. The messaging will mutate as well.
The focus and all the data used will now be on hospitalizations as a secondary and the deaths as the primary. Rate of spread and severity. Will the progress made in therapeutics and population vaccinated, positive outcomes will be the focus.

The reality is our efforts in preventing spread have been largely unsuccessful. Vaccines (and boosters) will be the primary hard sell because it has been shown to prevent and limit the severity. Therapeutics limit the severity as well. Present as positive of a picture as possible given the circumstances.
Masking, social distancing and plexiglass will fade.
Additionally, vaccinating the "world" will become a talking point. Limits future variants, one less battle to fight. That actually aligns government policies with effective measures in lowering the damages caused by the cost benefit choices in society. Testing positive will cease to be used for messaging.

Not sure how cherry picking the metrics will work out. PR for hospitalizations or deaths for vaccinated (booster) would be counter productive to people getting vaccinated which is the best choice. I would think some PR gurus would figure out that you can't convince someone to vaccinate if the majority of the populatin is vaccinated and still end up hospitalized or dead. Drop the split out. Promote the benefits. How much better results are if you are vaccinated. Positive messaging will get results, more vaccinations and boosters.

[StarTrekDoc]

Agree about that feeling after reading here and seeing some of the national news...but hard to fit into the narrative here as we are routinely at only double digit new cases and have a positivity rate of 7%. I personally haven't admitted a covid patient in a month. RSV seems to be hurting us pretty bad....

This is the concern we have-- coinfection. It did us pretty bad last time in mar apr 2020.

I'm hoping our Friday county report is a blip. We jumped from 600s to just over 1000 cases. We're doing surveillance sequencing deletion and about 10% and rising quickly for omicron. This is lagging about 24-48 hours.

[CordMcNally]

This is the concern we have-- coinfection. It did us pretty bad last time in mar apr 2020.

I'm hoping our Friday county report is a blip. We jumped from 600s to just over 1000 cases. We're doing surveillance sequencing deletion and about 10% and rising quickly for omicron. This is lagging about 24-48 hours.

It doesn't seem like a matter of if but when we see the cases. Our best hope is that omicron is mild like it appears to be in other countries.

[StarTrekDoc]

It doesn't seem like a matter of if but when we see the cases. Our best hope is that omicron is mild like it appears to be in other countries.

We're better equipped and knowledge base better now for covid. Our management experience for coinfection is a bit more limited though since last winter we were lucky not to have much rsv or flu. That's certainly not going to be the case this year as we already see a good bit of flu and rsv and not even Jan .

It's weird that I wrote first Rx of tamiflu last week in any recent memory.

[Lordosis]

We're better equipped and knowledge base better now for covid. Our management experience for coinfection is a bit more limited though since last winter we were lucky not to have much rsv or flu. That's certainly not going to be the case this year as we already see a good bit of flu and rsv and not even Jan .

It's weird that I wrote first Rx of tamiflu last week in any recent memory.

We have had quite a bit of RSV as well. But luckily it's all been very mild cases. Mostly found just when we are testing for the sniffles because they need a negative covid test to go back to school or daycare.

[PedsCCM]

There is an assumption that the CDC, hospital,county, county, and state were reporting the daily data all off of this one document. Separate reporting systems were cobbled together for the speed needed. Correct me if I am wrong. The actual death certificate takes much longer. Please explain to me how CDC gets daily totals. The daily totals in some cases were backlogged. It takes 'weeks" for the official process to be tabulated and balanced to the CDC daily reports. All states do not report the same. Some don't release even county and there were inconsistencies. I did not mean the death certificate was incorrect.
Personal experience: Man dead sitting on a porch. EMT calls the cops. Cop calls the coroners office. No MD no physician present. Clearance given and cause of death ascertained via COP and phone and cause of death indicated. Body released to the funeral home. CDC has a fast track data collection system, not necessarily based on the death certificate. That is not Covid denier, that is the fast track system was not based on the actual death certificate. And then you get into the autopsy needed or not. The vital records system is and was separate from the fast track data system.

Our miscommunication is not with the vital records process based on the death certificates.. It is that the numbers reported were not based on that process but a separate fast track system that had more errors and could be subject to classifications that differ from the official record, which occurs later. Totals are reported to the CDC. Feel free to correct me. Two systems, one fast and one official. There was no requirement to reconcile. Docs were not involved in this. Makes zero sense to accuse them. I think the health care reporting was over matched in the early stages. The same way vaccine appointments, wait lists and vaccine availability was over the heads. The mass vaccination sites had to be developed and the fast track reporting systems had to be developed and implemented.
I also do not blame the "admin staff" that was doing the best they could do for a new reporting system. I can guarantee Johns Hopkins was not working off death certificates. All the daily numbers actually had notes for "adjustments" that states had made and the quality of the reporting.
I think it is misleading to point any blame on physicians or the vital records process.

Not 100% sure what you're saying, but here's the info on how the CDC counts data but I feel like we're moving the argument a bit. I admitted up front that there is opportunity for error. My argument is purely that there is no simple opportunity for widespread over-reporting outside of a pervasive, nationwide fraud committed by physicians with seemingly zero personal gain. Yes, absolute and immediate accuracy depends on state-level reporting systems. Some of those work better or worse at the quick snapshot. The second link listed below for "provisional COVID-19 death counts" links to the data from death certificates - around 801k COVID deaths to date. It is delayed but probably not as much as you would guess since most states have relatively short death certificate cert requirements (5-10 days most places). I don't really understand your point about the police. Some states (like Texas) allow judges or folks in other atypical professions to certify death certificates. But that is true for deaths reported for any cause. I find very few people arguing that cardiovascular or oncology deaths are wildly over-counted. We're using the same system for COVID.

https://www.cdc.gov/coronavirus/2019...veillance.html

"The count on the Cases, Deaths, and Testing page includes deaths reported by state, local, and territorial health departments. Reporting frequency might vary by jurisdiction. This reflects the most up-to-date information received by CDC based on preliminary reporting.
In contrast, provisional COVID-19 death counts from the National Center for Health Statistics (NCHS) are updated with information from death certificates. This offers the most accurate death counts, but there is a reporting lag time of one to two weeks on average. Death counts are continually updated as new death certificate data are received. For these reasons, provisional COVID-19 death counts might differ from those on other published sources."

[Tim]

Not 100% sure what you're saying, but here's the info on how the CDC counts data but I feel like we're moving the argument a bit. I admitted up front that there is opportunity for error. My argument is purely that there is no simple opportunity for widespread over-reporting outside of a pervasive, nationwide fraud committed by physicians with seemingly zero personal gain. Yes, absolute and immediate accuracy depends on state-level reporting systems. Some of those work better or worse at the quick snapshot. The second link listed below for "provisional COVID-19 death counts" links to the data from death certificates - around 801k COVID deaths to date. It is delayed but probably not as much as you would guess since most states have relatively short death certificate cert requirements (5-10 days most places). I don't really understand your point about the police. Some states (like Texas) allow judges or folks in other atypical professions to certify death certificates. But that is true for deaths reported for any cause. I find very few people arguing that cardiovascular or oncology deaths are wildly over-counted. We're using the same system for COVID.

https://www.cdc.gov/coronavirus/2019...veillance.html

"The count on the Cases, Deaths, and Testing page includes deaths reported by state, local, and territorial health departments. Reporting frequency might vary by jurisdiction. This reflects the most up-to-date information received by CDC based on preliminary reporting.
In contrast, provisional COVID-19 death counts from the National Center for Health Statistics (NCHS) are updated with information from death certificates. This offers the most accurate death counts, but there is a reporting lag time of one to two weeks on average. Death counts are continually updated as new death certificate data are received. For these reasons, provisional COVID-19 death counts might differ from those on other published sources."

There are two systems. The vital records system and the flash reporting. The flash reporting system was where the problem was. That is the process everyone still uses for all the stuff that gets published. The CDC final database takes weeks. That is why originally, CDC didn't have any data. It takes time for the vital records process.
You can trash it and call it "deniers", but the global reporting that most rely on is the JHU database. CDC was and is slow. That is the reason originally the vaccine allocations CDC deferred to the states. No data and no testing capabilities. Vastly under prepared. That is not a criticism, that is how two systems came to exist.

[FIREshrink]

Evidence that omicron is substantially less virulent is tenuous and some reports from Europe not encouraging. If it's 2-3 times as contagious and 2 shots don't block infection or transmission, could be an ugly ugly winter.

[Lordosis]

I do not really understand this notion that a booster shot is required to block the newest variant. Shortly after getting your initial series you should be at peak antibody level now if that was 8 10 months ago I can understand why I booster is necessary to reboost your immunity but if it was 2 months ago shouldn't you be just as protected as somebody who had a booster 2 months ago? The way it sounds is that unless you got the original shot back in the spring and got your booster this fall like a good little boy you are not going to be protected. I think I might be missing something?

[Tim]

I do not really understand this notion that a booster shot is required to block the newest variant. Shortly after getting your initial series you should be at peak antibody level now if that was 8 10 months ago I can understand why I booster is necessary to reboost your immunity but if it was 2 months ago shouldn't you be just as protected as somebody who had a booster 2 months ago? The way it sounds is that unless you got the original shot back in the spring and got your booster this fall like a good little boy you are not going to be protected. I think I might be missing something?

Fr

In jest only, follow the frigging guidelines.
https://www.cdc.gov/coronavirus/2019...ster-shot.html
You have to wait at least 6 months for Pfizer and Moderna and 2 months wait for J&J.
Wait for it .......................................... No official recommendation of actually when you need to get one. ONLY you CAN and the recommended minimum wait.

My understanding is the debate of for the booster need expansion actually focused on the US hoarding vaccine supply, so they compromised with the wording "CAN" was agreed and the supply issue was probably what prevented a statement about "When you SHOULD".

It could be data, but who knows. Every physician and eligible person has zero guidance as to "When or SHOULD". CDC should focus on the science of the recommended vaccines for best practices in its recommendations. I have no problem with global vaccine allocations being a separate decision. So much confusion and people standing in line for "testing" rather than having a recommendation about "When or SHOULD".

It would be nice if Lordosis could get the answer from CDC. This is how the public starts "filling in the blanks".
It is not "required" nor "when" nor "should" from the official CDC position. Everything else is messaging, subject to change for whatever reason.

[CordMcNally]

I do not really understand this notion that a booster shot is required to block the newest variant. Shortly after getting your initial series you should be at peak antibody level now if that was 8 10 months ago I can understand why I booster is necessary to reboost your immunity but if it was 2 months ago shouldn't you be just as protected as somebody who had a booster 2 months ago? The way it sounds is that unless you got the original shot back in the spring and got your booster this fall like a good little boy you are not going to be protected. I think I might be missing something?

It's a legit question. The difficult part of this process is that pretty much everybody involved has some kind of bias with this whether they realize it or not. Will Pfizer/Moderna ever come out and say they don't recommend a booster shot? I would find that hard to believe given the enormous amounts of money on the line for them. Is a booster shot completely necessary? That's still something that not everyone agrees on and caused some resignations at the FDA.

[Lordosis]

It's a legit question. The difficult part of this process is that pretty much everybody involved has some kind of bias with this whether they realize it or not. Will Pfizer/Moderna ever come out and say they don't recommend a booster shot? I would find that hard to believe given the enormous amounts of money on the line for them. Is a booster shot completely necessary? That's still something that not everyone agrees on and caused some resignations at the FDA.

My understanding of the booster is it gives you more temporary immunity for a few months. And if you happen to catch covid later you probably have a lighter illness then if you did not have it. But the real benefit is in the initial series. After that you get less bang for your buck but now that the vaccine is so available and does not cause much trouble you might as well get the booster.

I work seeing sick people all the time so I got the booster. Anybody who's older has any medical problems I strongly recommend they get the booster. I'm having a hard time with the young healthy people who are honestly asking me if it's a good idea for them to get it. They were good enough to go out and get the initial shots even though the chance of them falling gravely ill is quite low. And they're wondering if they should continue to get these. I explained it the best I can and do make it more encouraging than discouraging but I'm not nearly as forceful as I am with my greater than 50 or medical problem people.

[FIREshrink]

My understanding of the booster is it gives you more temporary immunity for a few months. And if you happen to catch covid later you probably have a lighter illness then if you did not have it. But the real benefit is in the initial series. After that you get less bang for your buck but now that the vaccine is so available and does not cause much trouble you might as well get the booster.

I work seeing sick people all the time so I got the booster. Anybody who's older has any medical problems I strongly recommend they get the booster. I'm having a hard time with the young healthy people who are honestly asking me if it's a good idea for them to get it. They were good enough to go out and get the initial shots even though the chance of them falling gravely ill is quite low. And they're wondering if they should continue to get these. I explained it the best I can and do make it more encouraging than discouraging but I'm not nearly as forceful as I am with my greater than 50 or medical problem people.

Yes the antibody boost we've seen might be temporary. But it's not as simple as that, look at the childhood series of vaccines and their spacing. Could we be in the same boat in six months, maybe. But could a third shot six months later be qualitatively different than a second shot three weeks later? That's possible, too.

[triad]

My understanding of the booster is it gives you more temporary immunity for a few months. And if you happen to catch covid later you probably have a lighter illness then if you did not have it. But the real benefit is in the initial series. After that you get less bang for your buck but now that the vaccine is so available and does not cause much trouble you might as well get the booster.

I work seeing sick people all the time so I got the booster. Anybody who's older has any medical problems I strongly recommend they get the booster. I'm having a hard time with the young healthy people who are honestly asking me if it's a good idea for them to get it. They were good enough to go out and get the initial shots even though the chance of them falling gravely ill is quite low. And they're wondering if they should continue to get these. I explained it the best I can and do make it more encouraging than discouraging but I'm not nearly as forceful as I am with my greater than 50 or medical problem people.

if the healthcare system isn't close to collapsing I would agree with this philosophy. from what i read here the system can't handle a huge wave right now and if the boosters can slow that down it would be in all our interests for as many as possible get boosted

[StarTrekDoc]

I do not really understand this notion that a booster shot is required to block the newest variant. Shortly after getting your initial series you should be at peak antibody level now if that was 8 10 months ago I can understand why I booster is necessary to reboost your immunity but if it was 2 months ago shouldn't you be just as protected as somebody who had a booster 2 months ago? The way it sounds is that unless you got the original shot back in the spring and got your booster this fall like a good little boy you are not going to be protected. I think I might be missing something?

The thought is incomplete series response. Just like Hep B series. 3rd shot make the immunity longer lasting even though initial response is 90%+ after 2nd shot. Same theory.

The issue is coronavirus mutations can cause evasion a la influenza vaccine issues; so updates probably needed in the near term to help the immune system get a leg up on this.