Medical Discussion of Coronavirus

[fatlittlepig]

We got the Bivalent Vaccine when it rolled out. I encourage everyone to get it. I am very pro vaccine. But....

Does it work? I have been seeing a ton of people with covid 2-4 weeks after getting the vaccine. I ask people their vaccine status and about 25% of the covid cases I have been seeing lately have had a recent vaccine. All mild courses which is good but I was hoping that this would cut down transmission some.

Is there any efficacy data? Could be already be dealing with a new strain? What have you guys seen in your areas?

Thanks for sharing. This is very interesting. My thinking is that the boosters provide very good albeit transient protection against infection, so if you are saying that you are seeing a lot of symptomatic covid 2-4 weeks after boosting (which should be the peak period of protection) that would be very interesting.

[NumberWhizMD]

We got the Bivalent Vaccine when it rolled out. I encourage everyone to get it. I am very pro vaccine. But....

Does it work? I have been seeing a ton of people with covid 2-4 weeks after getting the vaccine. I ask people their vaccine status and about 25% of the covid cases I have been seeing lately have had a recent vaccine. All mild courses which is good but I was hoping that this would cut down transmission some.

Is there any efficacy data? Could be already be dealing with a new strain? What have you guys seen in your areas?

I haven't personally seen this where I'm at. However, our COVID cases at least in office have been much lower in my area recently. We've been seeing a lot more flu A than COVID when I've been testing patients. Granted, I think we had our big COVID hit about a month ago. Me and my family just got our COVID boosters on Saturday ahead of a Thanksgiving trip...so now I'm a little anxious. I was hoping it would at least give us some good immunity for the trip!

[Jaqen Haghar MD]

I haven't personally seen this where I'm at. However, our COVID cases at least in office have been much lower in my area recently. We've been seeing a lot more flu A than COVID when I've been testing patients. Granted, I think we had our big COVID hit about a month ago. Me and my family just got our COVID boosters on Saturday ahead of a Thanksgiving trip...so now I'm a little anxious. I was hoping it would at least give us some good immunity for the trip!

Much lower? Were you seeing a lot of COVID recently? I might see a case every week or two. Nobody is being hospitalized for it here, or has been for a very, very long time. We still do PCR testing on everybody getting a work up in the ED. This is a panel that includes Flu. I’ve had days recently where I’ve seen 3 Flus in a shift.

During the big surges of past years, I could see 30+ COVID cases per shift day after day after day. Now, no one worries about it. Everyone has had COVID once or trice now, both in the hospital and community.

The major hospital systems here have gone totally maskless now. We are still doing mask theater at our place though, probably for not much longer.

I noticed during the latest round of provider vaccinations, that no physician in line opted to get the COVID booster. We all got the flu shot though, as that is required.

My sister is up in NY. Her husband had to have emergency open heart surgery last week. They are still following strict COVID precautions like it was 2 years ago. No visitors. Super-strict everything. The hospital had to stop all elective procedures due to lack of nurses to staff beds. It seems like a disaster zone, unrelated to any COVID though. 24 hr waits in the ED due to inpatient holds.

….Oh, and he tested positive for COVID just before, so no specialist would see him for a bit and no office would allow him in. Turns out his undiagnosed strep endocarditis got a lot worse due to the delays. Almost checked out. Survived sepsis and emergent valve replacement, though a little worse for the wear now.

COVID paranoia.

[NumberWhizMD]

Much lower? We’re you seeing a lot of COVID recently? I might see a case every week or two. Nobody is being hospitalized for it here, or has been for a very, very long time. We still do PCR testing on everybody getting a work up in the ED. This is a panel that includes Flu. I’ve had days recently where I’ve seen 3 Flus in a shift.

During the big surges of past years, I could see 30+ COVID cases per shift day after day after day. Now, no one worries about it. Everyone has had COVID once or trice now, both in the hospital and community.

The major hospital systems here have gone totally maskless now. We are still doing mask theater at our place though, probably for not much longer.

I noticed during the latest round of provider vaccinations, that no physician in line opted to get the COVID booster. We all got the flu shot though, as that is required.

My sister is up in NY. Her husband had to have emergency open heart surgery last week. They are still following strict COVID precautions like it was 2 years ago. No visitors. Super-strict everything. The hospital had to stop all elective procedures due to lack of nurses to staff beds. It seems like a disaster zone, unrelated to any COVID though. 24 hr waits in the ED due to inpatient holds.

….Oh, and he tested positive for COVID just before, so no specialist would see him for a bit and no office would allow him in. Turns out his undiagnosed strep endocarditis got a lot worse due to the delays. Almost checked out. Survived sepsis and emergent valve replacement, though a little worse for the wear now.

COVID paranoia.

Much lower meaning my tests I'm running in office are mostly negative. I definitely was contacted by patients more around August/September about positive tests, but none hospitalized as a result. I work outpatient FM, and just not seeing much COVID at all. I would get probably at least 5-10 calls/emails from patients around the spike, but still nothing like what it was last year or even before that. I guess it's more relative to the recent spike. I am seeing way more flu, RSV, and other URI-type illnesses than COVID right now.

We definitely live in a place where no one cares. Hardly any masks, people living their lives. I really went for the booster as we have a vacation coming up, otherwise I don't know that I would be that pressed to get one. I was just hoping to buy some immunity to maybe avoid getting sick, knowing that I could still get it. My last booster I got because I was pregnant and didn't want to worry about serious complications from waning immunity.

Moving forward, not sure how frequently I'll be doing this. My kids are in school/daycare, we are living our lives, and we are fortunate to be low-risk already. I figure at this point, I've done all I can do.

[Lithium]

We got the Bivalent Vaccine when it rolled out. I encourage everyone to get it. I am very pro vaccine. But....

Does it work? I have been seeing a ton of people with covid 2-4 weeks after getting the vaccine. I ask people their vaccine status and about 25% of the covid cases I have been seeing lately have had a recent vaccine. All mild courses which is good but I was hoping that this would cut down transmission some.

Is there any efficacy data? Could be already be dealing with a new strain? What have you guys seen in your areas?

I was one of these cases, also with mild symptoms. Granted it came after a conference when I was in close proximity to hundreds of people every day.

[Hatton]

I have had 2 boosters and got Covid about 4 months after the second booster. I took paxlovid and did fine. In fact the boosters caused me more "illness" than taking paxlovid. If I get it again I plan to get paxlovid. I did just get a flu shot. Since I am 65 there was problem getting the med.

[StarTrekDoc]

It's interesting to see how our system changing with going into flu season. And much of decisions are driven by staffing (or lack thereof). Acute respiratory illness coming back into the regular clinics as our Urgent care clinics simply don't have the capacity to handle all of it. RSV+Flu are main culprits right now.

I'm interested to see how co-infections will impact severity. I suspect a lot of the Mar/Apr 2020 deaths had a lot of coinfections. Even though BA5 is nothing compared to Delta, the coinfection makes me wonder how we're going screen and treat these folk: Combo: paxlovid/medrol/tamiflu? A lot of Side Effects potential.

Weekly US Map: Influenza Summary Update | CDC
RSV State Trends - NREVSS | CDC

[Tim]

It's interesting to see how our system changing with going into flu season. And much of decisions are driven by staffing (or lack thereof). Acute respiratory illness coming back into the regular clinics as our Urgent care clinics simply don't have the capacity to handle all of it. RSV+Flu are main culprits right now.

I'm interested to see how co-infections will impact severity. I suspect a lot of the Mar/Apr 2020 deaths had a lot of coinfections. Even though BA5 is nothing compared to Delta, the coinfection makes me wonder how we're going screen and treat these folk: Combo: paxlovid/medrol/tamiflu? A lot of Side Effects potential.

Weekly US Map: Influenza Summary Update | CDC
RSV State Trends - NREVSS | CDC

(covid/flu) common testing nowaxlovid/tamiflu if it is caught early enough. The age/immune compromised guidance was not a factor in Texas or Illinois.

It won't do any good now, vaccine and 1 booster. Wife won't consider CDC recommendations now. She is a "rule follower" and is of the opinion that CDC broke the trust. Honestly, the director's statements directly conflicted with her own eyes and experience. Trust lost.

[nephron]

I haven't been following the data carefully, but my understanding is that there is only evidence of antibody response to the new vaccine, they haven't published data showing evidence of clinical efficacy. The phase 2/3 of the bivalent moderna vaccine showed a higher binding antibody response, but if you read what they have thus far for people getting infected, 11/437 (2.5%) patients who received the bivalent vaccine got infected vs 9/377 (2.3%) who received a second booster of the original vaccine. That wasn't the outcome they were looking at yet, but it is interesting.

https://www.nejm.org/doi/full/10.1056/NEJMoa2208343

There are some pre-publication news suggesting that the new boosters may not be superior to the old boosters in antibody response as well:
https://www.cnbc.com/2022/10/27/new-...dies-find.html

I don't remember where I read it, but I was reading some new article about how some doctor thought that the cdc had messed up on the strategy of making the new strain specific booster because it may not have the same immune memory benefits as just using the old booster? I didn't really read the article very carefully so I don't know if that's what he actually meant.

I think they should have just allowed everyone to get a 2nd booster shot months ago after they showed efficacy of getting a second booster in healthcare workers. I think that it would have prevented a lot of symptomatic infections if they just let everyone get it earlier this year. At this point, I'm fairly convinced that most people have gotten infected at least once. I think that they need to do more trials looking at what to do in people who were both vaccinated and previously infected. They seem to ignore previous infections in most of the vaccine trials, but I would imagine that previous infections would play a large role in the reported efficacy of any vaccine. They probably just need to have people self report prior infections in studies though as I don't think that there is any way reliable way to tell if someone has been infected previously, particularly with everyone getting vaccinated.

[CordMcNally]

I'm interested to see how co-infections will impact severity. I suspect a lot of the Mar/Apr 2020 deaths had a lot of coinfections. Even though BA5 is nothing compared to Delta, the coinfection makes me wonder how we're going screen and treat these folk: Combo: paxlovid/medrol/tamiflu? A lot of Side Effects potential.

Weekly US Map: Influenza Summary Update | CDC
RSV State Trends - NREVSS | CDC

Since none of those really have much true benefit and have risks associated with their side effects then the number of people who should be on them should be low. Healthy people certainly don’t need Paxlovid or Tamiflu.

[Lordosis]

Since none of those really have much true benefit and have risks associated with their side effects then the number of people who should be on them should be low. Healthy people certainly don’t need Paxlovid or Tamiflu.

I agree with you but most people think they do need them. Just like they need that antibiotic for 24hours of sinus congestion. Unfortunately this is another thing where doing the right thing and going over the risks and benefits with the patient and prescribing appropriately tends to hurt your "satisfaction scores"