Coronavirus thread

[feudist]

I know some of the physicians in FCCC. Their ring leader, Paul Merik, is quickly becoming the Sidney Powell of critical care - someone who built up a remarkable career with minimal resources (EVMS is not a powerhouse medical institution like Harvard or Hopkins), but is losing credibility after recently latching on to medical voo doo. It started about 4 years ago when he published an observational case series of 47 patients with septic shock who he treated with a cocktail of vitamin C. He reported an absolute risk reduction in mortality of 20% which is unheard of in my field. Clear thinking doctors were wary of his too-good-to-be-true findings, but clear thinking is actually a minority in medicine (hence all the BLM pins on white coat lapels).

Needless to say, the subsequent randomized trials failed to support his cocktail, yet he and others persist despite the mounting evidence. He is no stranger to lay media where he uses terms like “revolutionary, remarkable, and game-changing” despite the fact that his recent ideas are, at best, hypothesis generating. Even more disturbing is the fact that a prestigious journal published his case series when it should have been relegated to preliminary data for a grant application.

Speaking of "too good to be true", does the vaccines advertised 90% plus success rate give you pause?

[Sensei]

Speaking of "too good to be true", does the vaccines advertised 90% plus success rate give you pause?

A couple thoughts. While obviously industry sponsored, this was a randomized control trial of 40,000 subjects which means it sits near the top of the evidence food chain. It was not a single-investigator, single-institution, retrospective or observational study of a handful of people. So, I’m encouraged by the some aspects of the study design.

On the other hand, we need to be careful that we are very specific in our terminology and how we define “success rate” so that we do not project benefits to this vaccine that are not reported in the study. That is to say, the vaccine was 95% effective at preventing significant symptoms of COVID-19 as study subjects were tested for COVID only if they developed pre-specified symptoms. We do not know how the vaccine performs in terms of preventing asymptomatic spread since the subjects did not undergo serial, weekly testing if they were asymptomatic. We also do not know how the vaccine performed in kids or immune compromised individuals, or those who’ve had COVID since they were not enrolled. Thus, it is very possible that this vaccine does not prevent asymptomatic spread or disease in kids which could mean that the virus could be hanging out with us for a while...

[Bio]

A couple thoughts. While obviously industry sponsored, this was a randomized control trial of 40,000 subjects which means it sits near the top of the evidence food chain. It was not a single-investigator, single-institution, retrospective or observational study of a handful of people. So, I’m encouraged by the some aspects of the study design.

On the other hand, we need to be careful that we are very specific in our terminology and how we define “success rate” so that we do not project benefits to this vaccine that are not reported in the study. That is to say, the vaccine was 95% effective at preventing significant symptoms of COVID-19 as study subjects were tested for COVID only if they developed pre-specified symptoms. We do not know how the vaccine performs in terms of preventing asymptomatic spread since the subjects did not undergo serial, weekly testing if they were asymptomatic. We also do not know how the vaccine performed in kids or immune compromised individuals, or those who’ve had COVID since they were not enrolled. Thus, it is very possible that this vaccine does not prevent asymptomatic spread or disease in kids which could mean that the virus could be hanging out with us for a while...

Am I paranoid or thinking that people getting the vaccine and then go back to loving their lives as they were before the pandemic significantly blunts its effectiveness? If, say, instead of staying mostly at home you go hang out at a bar (in contact with many people), you're counteracting the protection of the vaccine by increasing exposure. Am I understanding this correctly?

Obviously people that have no choice, front line health care workers, grocery store workers, peace officers, etc., get a straight benefit because they don't have a choice, but for regular folk, is it a smart play to get the vaccine, when available, then maintain distancing for some amount of time to let the concentration of virus in society drop?

[Eric_L]

I'll be 65 in July, my wife is 69 with a compromised immune system. I'd take the vaccine in a heart beat. Here's the thing. I'm just a Security Officer working for a private contractor. Not so much considered a "critical" worker. Except:
I work at a 24hr Emergency Center. We are just about the only place in town that does COVID testing. My post is in the foyer, first contact with patients. I have to distinguish between patients and visitors/family. So, I usually ask, "Are you here to see a doctor." In slightly more that half of the cases, I'll start getting medical history.
These folks are scared and there for help. I suppose the fact that I obviously work there makes them think I'm in some way qualified to make some judgement on what they are telling me. Being a smart-ass won't help and is unnecessary. I wait for the first opening, then explain that I just need to take their temperature, record visitors in my log. The lady (not misogyny, just the way it is at the moment.) behind the counter will help them. I'll get somewhere between 15 to 20 people per day who will volunteer on their way out, "I was positive. (For COVID.)
So likely double that including COVID cases that didn't volunteer that info.
Here's the thing. I'm the first person who contacts those infected people as they enter the clinic. I have to stand within arms length to hold the IR scanner to their forehead, then get them to sign the visitor's log and direct them to the desk. Often, I'm helping them into wheelchairs.
I know that clinic workers will be offered early doses. I'm shocked at the number of staff who don't want the vaccine. I'm not sure it will be offered to the "Non-first workers" acting as security.
Any of you SOBs don't want your shots, send em my way.

Talk to the administrator or chief nurse/charge nurse about your concerns, you have a legitimate need to be vaccinated.

[ccmdfd]

Our first vaccine shipment is arriving today.

Still waiting for word of who gets it and in what order.

From what I've seen so far, launching an ICBM, or getting a bill through both houses of Congress is going to be easier.

Have to register with several different agencies, none of which are prepared for the #'s involved.

Jeez

[Balisong]

Our first vaccine shipment is arriving today.

Still waiting for word of who gets it and in what order.

From what I've seen so far, launching an ICBM, or getting a bill through both houses of Congress is going to be easier.

Have to register with several different agencies, none of which are prepared for the #'s involved.

Jeez

I'm sorry to hear that. But to be fair, they've only had like 7 months to prepare for this

I'm pretty annoyed that my city has apparently received it and has started immunizing today. But out of the 5 initial points of distribution, only 2 are running until Monday. That's kind of pissing me off. Emailed the CEO of my hospital company, and he said he doesn't understand the delay either and doesn't know the answer to why that's happening.

[Nephrology]

Our first vaccine shipment is arriving today.

Still waiting for word of who gets it and in what order.

From what I've seen so far, launching an ICBM, or getting a bill through both houses of Congress is going to be easier.

Have to register with several different agencies, none of which are prepared for the #'s involved.

Jeez

Not sure if I've posted this yet but it's utter chaos here. Apparently someone in the SOM Dept of Psychiatry objected to ED/MICU providers being up first for the vaxx because "[they] see COVID patients too," so now its by clinical site lottery system supposedly. Or, it was last I heard; with how our operations tend to go this very well may have changed 5 times in the last 48 hrs

[41magfan]

A few random observations:

- Vaccines (of all types) that offer viral protection don't work very well on metabolically unhealthy people. The people that are having the most difficulty with this virus are metabolically unhealthy people.

- It's my understanding the AstraZenaka/Oxford vax trials tested their participants DAILY and their efficacy is on the order of 90% or so. One would think that a vax that mitigates infections would me more more useful than a vaccine that just mitigates symptoms.

- A local Pharmacist made the statement earlier this week that he has yet to fill a Rx for Tamiflu so far this flu season.

[ccmdfd]

Not sure if I've posted this yet but it's utter chaos here. Apparently someone in the SOM Dept of Psychiatry objected to ED/MICU providers being up first for the vaxx because "[they] see COVID patients too," so now its by clinical site lottery system supposedly. Or, it was last I heard; with how our operations tend to go this very well may have changed 5 times in the last 48 hrs

Good Lord! I guess I should be happy with my system!?

That sounds like something a psychiatrist would do.

My opinion he should be fired on the spot. Yes everybody is exposed to the virus but please have him explain which would be more deleterious to the community's health. A psychiatrist getting the virus and being out of work versus in ICU, critical care physician?

Maybe you all should make him pull a shift or two in the covid icu.

[pangloss]

Not sure if I've posted this yet but it's utter chaos here. Apparently someone in the SOM Dept of Psychiatry objected to ED/MICU providers being up first for the vaxx because "[they] see COVID patients too," so now its by clinical site lottery system supposedly. Or, it was last I heard; with how our operations tend to go this very well may have changed 5 times in the last 48 hrs

That's really ridiculous. How it's being done here was not open to any discussion at all. The administration made the decision and that's it. Period. Fortunately, they/we seem to be following the common sense plan. No complaints from my little windowless office.

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