Medical Discussion of Coronavirus

[White.Beard.Doc]

Here is a better graph from WaPo. The one in the NY Times is "percentages compared to the last time". The NYT graph is very misleading.

[snowcanyon]

snowcanyon - 80%+ vaccinated; 30% boosted last figures; haven't really looked since Dec so imagine it's higher now.

@jagen - Lots of what I call 'glancing blows' of boosted over the holidays. Family dinner; someone brought asx omicron to the party - everyone gets the sniffles Dec ~28 and done by New Years. Then those New Years surge folk brought to Urgent care and sheer loads eventually blew through UC precautions and sidelined essentially entire UC staff last week. Mainly float staff now manning the UC end of last week and next week. -- we're using 5 day; test negative +Mask to get mainline staff back

That's a much better protocol (hope you are using N-95s) than most.

[snowcanyon]

Saw some twitter account of a NYC ER doc

Least symptomatic - 2 dose and booster. Often asymptomatic.

Next is 2 dose mRNA , no booster

Quite symptomatic but not dying - one dose J & J

The most sick, ICU and dying - unvaccinated.

Was there anything new that we already did not know or predicted?

The problem is not what we know, but what can we do. More masking and lockdowns won't do any good.

Why wouldn't masking help? Because it's all social spread, not work/public?

[snowcanyon]

You didn’t ask me but quit alienating those who may make decisions we don’t agree with. Batten down the hatches and deal with things as best we can. It’s clear that the “pandemic of the unvaccinated” is becoming less so every day and alienating people with the current messaging is not helping and is likely hurting.

This seems...unnecessarily alienating, too. And scolding. Which is unhelpful, too.
Agreed that we need to realize that many vaccinated people are getting sick, too, and address that. The "pandemic of the unvaccinated" was never a useful strategy.
What kind of "batten down" do you think might help?

[Tim]

StarTrekDoc
”Omicron hitting lots of the vaccinated and doing more wiping out staffing than anything this past week. We're on contingency mode for next 2 weeks anticipated.”
So if I understand, the staffing problem is extreme for a vaccinated staff. 5 days to 2 weeks. Relatively mild healthcare symptoms and an extremely low rate of reinfection. So the lowering of the curve as impacts healthcare workers is an extremely short duration without significant risk to the individuals.

The cause of this is that vaccines reduce the severity, but are relatively ineffective for prevention.
The unvaccinated have much higher health risks. The cause was personal choice.
San Diego healthcare will be fully (if they started) in 2 weeks. Smooth sailing and the two week staffing issues will have passed. So unvaccinated are not causing permanent damage to anyone but themselves.
Is that the short version of Omicron?
Substantially different than last year because of vaccines.
What I am seeing is that ICU’s and beds are up but not pushing capacity except for the 5 to 2 weeks for the staffing problems. That should clear up as well.
With Omicron, it will run it’s course regardless in the next 2 weeks.
Please feel free to correct. Tough 2 weeks ahead.

[CordMcNally]

This seems...unnecessarily alienating, too. And scolding. Which is unhelpful, too.
Agreed that we need to realize that many vaccinated people are getting sick, too, and address that. The "pandemic of the unvaccinated" was never a useful strategy.
What kind of "batten down" do you think might help?

Recommending people to not alienate other people is in no way alienating or scolding. Batten down the hatches basically means that we deal with whatever comes our way. It’s just another day in the ED. There’s nothing that is going to stop what is going to happen over the next several weeks. People want to live normal lives and I respect that. That means some people aren’t going to get the care they deserve or need. We’re already seeing that now. Might as well take a direct hit rather than spreading it out over the rest of the year.

[snowcanyon]

Recommending people to not alienate other people is in no way alienating or scolding. Batten down the hatches basically means that we deal with whatever comes our way. It’s just another day in the ED. There’s nothing that is going to stop what is going to happen over the next several weeks. People want to live normal lives and I respect that. That means some people aren’t going to get the care they deserve or need. We’re already seeing that now. Might as well take a direct hit rather than spreading it out over the rest of the year.

I don't see much that's normal about our lives right now- it seems hard to be normal with so many issues like the airlines not being able to staff etc.
Agreed we are in for a surge no matter what, sadly for those who will miss cancer surgeries, contract Covid in the hospitals etc.
How do you know that a big surge now means we get relief for the rest of the year? Wasn't that supposed to happen after delta, and now we have omicron? I admit I'm confused on the science/evidence for this.

[Kamban]

What's your solution?

I am not anti mask but wearing cloth and surgical masks is not making a major dent in the number of cases. But I wear it indoors now, in shopping areas.

The solution in ideal world would be 2 dose mRNA with booster to reduce hospitalizations and deaths. But I am not holding my breath.

While that will/might lead to future milder or asymptomatic infections of the vaccinated it can still put you off work and cause work disruptions and worker shortages. That will be the bigger issue

[CordMcNally]

I don't see much that's normal about our lives right now- it seems hard to be normal with so many issues like the airlines not being able to staff etc.
Agreed we are in for a surge no matter what, sadly for those who will miss cancer surgeries, contract Covid in the hospitals etc.
How do you know that a big surge now means we get relief for the rest of the year? Wasn't that supposed to happen after delta, and now we have omicron? I admit I'm confused on the science/evidence for this.

There are lots of people living normal lives. Maybe not where you’re at but there’s entire states going on like normal.

We don’t know that but previous surges showed cases falling off for a while after. With likely 1M infected per day (including those who have positive tests at home), I think it’s clear we’re going to have way more people than ever vaccinated, with previous infection, or both. I don’t think I ever heard any rumblings of it petering out after delta. A more contagious/less severe variant is about as good of a scenario as we could ask for. We don’t have a lot of the information from previous large scale pandemics like we do from this one so we’re flying blind in those regards.

[snowcanyon]

There are lots of people living normal lives. Maybe not where you’re at but there’s entire states going on like normal.

We don’t know that but previous surges showed cases falling off for a while after. With likely 1M infected per day (including those who have positive tests at home), I think it’s clear we’re going to have way more people than ever vaccinated, with previous infection, or both. I don’t think I ever heard any rumblings of it petering out after delta. A more contagious/less severe variant is about as good of a scenario as we could ask for. We don’t have a lot of the information from previous large scale pandemics like we do from this one so we’re flying blind in those regards.

Interesting. I'm glad some places are doing so well.

I live in a state with no restrictions at all, but I wouldn't say things are normal. Schools can't staff because many are sick, hospitals are short-staffed so surgeries are being cancelled and nosocomial spread is increasing, jobs can't hire because no one wants to deal with customers (I live in a state with a ton of tourism), events had to be canceled because of lack of staffing, and the hospital has some significant, if not overwhelming, supply chain shortages, and life is certainly not normal for the elderly or immunocompromised.

I'm glad some places are doing better- it's good to hear. I hope you are right on immunity, but we will see- covid seems to mutate quickly, and the vaccines seem to both wane over time and become less effective with each variant. This may be the new normal, but I have to say I'm not a huge fan and I hope things improve and that you are right.

[Kamban]

Another anecdotal thing I have noticed during this surge, so far in 3+ families.

The young teenagers who had the 2 dose mRNA and were lucky enough to be boosted were not even COVID test positive, even with close contact. Some have become caregivers!.

The slightly older (30-45 years) in the same situation tested positive but did not even realize they were positive for the virus. They only got tested because someone else in close contact got it.

The 50-65 year olds in the same situation had mild sniffles, headaches and body aches.

If this was not a COVID pandemic but the winter flu the first and 2nd groups would never have been tested for anything and the third group would have taken a Tylenol and rested overnight and gone to work the next morning. Instead all are being tested and the second and third group put out of work for 5 days.

[CordMcNally]

If this was not a COVID pandemic but the winter flu the first and 2nd groups would never have been tested for anything and the third group would have taken a Tylenol and rested overnight and gone to work the next morning. Instead all are being tested and the second and third group put out of work for 5 days.

It’ll be interesting to see what changes in the future because up until this pandemic everybody in healthcare has gone to work with an infectious disease and likely did it multiple times per year.

[Jaqen Haghar MD]

Here is a better graph from WaPo. The one in the NY Times is "percentages compared to the last time". The NYT graph is very misleading.

That graph looks like what we are seeing here. Tons of flu like illness. Some admits, but not a lot.

Life in this area goes on normally and has for a long time through multiple waves, except hospital staff gets a spanking every few months for 6 weeks. Nothing is closed, nothing is restricted since the first wave in 2020. In the community some people wear masks out…. But not a lot.

The politicians and famous from the lock-down states come here to go out and party with no masks.

We may reach the point soon, where as a nation, we ask what we are really doing with all this. Especially with what Omicron looks like.

Get vaccinated, be careful if you are high risk. Give the hospitals a lot of resources. It’s been 2 years.

Armageddon never came, with minimal precautions over 18+ months here.


“Keep your ear to the grindstone.”



We’ve had hard periods in the hospital, but made it through each time. The price we pay the keep things going in the outside world…..

[snowcanyon]

It’ll be interesting to see what changes in the future because up until this pandemic everybody in healthcare has gone to work with an infectious disease and likely did it multiple times per year.

Right? And I frequently wore a mask when I did, but I'm pretty sure I was one of the only ones, and I didn't always. I have a ton of not so great feelings about that now.

I dunno ya'll, I consider a million dead and one of the highest death rates in the world at least a mini-Armageddon, but maybe I just knew more people who died, I dunno.

[StarTrekDoc]

Tim - yes, 2 weeks then anticipate able to return to regular covid programming. Some areas being impacted with shifting flex staff -- mainly outpatient services that can't pivot to video visits.

Kamban - yes, new normal is mask wearing for those who are at risk or who don't want to risk exposure to those at risk (mainly within households).

snowcanyon - your state is in a pickle because infrastructure simply isn't there to handle a surge AND normal operations with the current level of vaccination. That'll change with 2022 as natural immunity eventually catches up (hopefully). With larger urban areas, infrastructure for admissions/ICU isn't being overwhelmed this round like in Jan 2021. Sure, there's an uptick in hospitalizations; but for the most part the majority aren't actively dying. A subset of the unvaccinated still are and most are predictable when they hit the door. There still are the really unfortunate <50 yo healthy ones with Omicron, but less so .

This is the overall hope as CordMcNally alludes to for 2022. People realizing what COVID is and the reality that vaccines do work in saving lives but won't prevent mild disease from happening. People at the edges of reason will hopefully get off their soapboxes (or at least their bullhorns taken away) and acceptance that we will manage this like seasonal flu (probably with greater frequency).

To this, I still believe q6m-yearly covid shots will be the norm as is annual flu shots to maintain a level of protection for those that need it --- high risk 65+ and HCP. -- especially if SC goes the way I anticipate it; 65+ and HCP will be the new normal.