COVID-19 vaccines: medical concerns and recommendations

[bofe954]

I love the confidence. It's adorable. I met a patient who said literally the same thing when we sent him home after his endoscopy was canceled for testing COVID +. He came back to our service a week later in florid ARDS. We tubed him and proned him. last I heard general surgery was queuing him up for a trach and d/c to rehab. He got lucky.

Have you seen any data on what happens to the patients who are trach'd and sent to rehab? It is too early to really know for a lot of them I guess, but I always wonder how many actually will live on their own unassisted, or ever work again. I haven't decided if these people arer lucky or unlucky at this point.

[Totem Polar]

Those last two posts are sobering.


Question for the medical personnel/SMEs here: if this booster idea becomes an every 6 month, or every year thing, will you be getting shots bi-annually or yearly, as a matter of course?

[Clusterfrack]

Still jab free.

Just follow the Zelenko Protocol when you get the virus and you'll be fine.

If you're not already start taking a quality vitamin D.

I’m traveling for the holidays and missed this post. This thread has already discussed and dismissed quackery like HCQ, using peer reviewed science published in tier 1 journals and thanks to the significant knowledge base from medical experts who are P-F members.

[MickAK]

New York City is reporting a 4x increase in pediatric covid hospitalizations in December: https://health.ny.gov/press/releases...h_advisory.pdf

Looking at the increase in cases that doesn't seem to indicate that Omicron is any more dangerous to young children than previous variants. If anything significantly less.

[Nephrology]

Have you seen any data on what happens to the patients who are trach'd and sent to rehab? It is too early to really know for a lot of them I guess, but I always wonder how many actually will live on their own unassisted, or ever work again. I haven't decided if these people arer lucky or unlucky at this point.

Some short term outcomes. Haven't looked at long term success of pulm rehab. May be too early for that. That said my gestalt is that they are unlucky. Living with lungs scarred down to little nubs is not something I would want for myself if I was in such a position. Would prefer compassionate extubation with a generous pushes of morphine and midazolam

Here are a few articles:

Outcomes After Tracheostomy in COVID-19 Patients

Of the 53 patients who underwent tracheostomy, the average time from endotracheal intubation to tracheostomy was 19.7 days ± 6.9 days. The most common indication for tracheostomy was acute respiratory distress syndrome, followed by failure to wean ventilation and post-extracorporeal membrane oxygenation decannulation. Thirty patients (56.6%) were liberated from the ventilator, 16 (30.2%) have been discharged alive, 7 (13.2%) have been decannulated, and 6 (11.3%) died. The average time from tracheostomy to ventilator liberation was 11.8 days ± 6.9 days (range 2–32 days). Both open surgical and percutaneous dilational tracheostomy techniques were performed utilizing methods to mitigate aerosols. No healthcare worker transmissions resulted from performing the procedure.

Early Outcomes From Early Tracheostomy for Patients With COVID-19

Participants included 148 patients, 120 men and 28 women, with an overall mean (SD) age of 58.1 (15.8) years. Mean (SD; median) time from symptom onset to intubation was 10.57 (6.58; 9) days; from symptom onset to tracheostomy, 22.76 (8.84; 21) days; and from endotracheal intubation to tracheostomy, 12.23 (6.82; 12) days. The mean (SD; median) time to discontinuation of mechanical ventilation was 33.49 (18.82; 27) days; from tracheostomy to first downsize, 23.02 (13.76; 19) days; and from tracheostomy to decannulation, 30.16 (16.00; 26) days. The mean (SD; median) length of stay for all patients was 51.29 (23.66; 45) days. Timing of tracheostomy was significantly associated with length of stay: median length of stay was 40 days in those who underwent early tracheostomy (within 10 days of endotracheal intubation) and 49 days in those who underwent late tracheostomy (median difference, −8; 95% CI, −15 to −1). In a competing risks model with death as the competing risk, the late tracheostomy group was 16% less likely to discontinue mechanical ventilation (hazard ratio, 0.84; 95% CI, 0.55 to 1.28).

[David S.]

Do we like this guy? He seems to be providing a bunch of data.

[Nephrology]

Do we like this guy? He seems to be providing a bunch of data.

No. Vitamin supplements have never, ever been shown to effectively treat any disease process except vitamin deficiency.

You can wax poetic about B and T cells but basic science concepts mean nothing at all to sick patients if they don't make them better.

Those last two posts are sobering.


Question for the medical personnel/SMEs here: if this booster idea becomes an every 6 month, or every year thing, will you be getting shots bi-annually or yearly, as a matter of course?

Lord knows. I think this will depend a lot on the ecology of COVID strains and also their evolving relationship with the human host. Indication for vaccine is driven by prevalence of the disease (among other factors of course)- we have a vaccine for smallpox, for example, but unless you join the military you will not be getting it as the odds of encountering smallpox in the USA is 0%.

I do not have the expertise to predict what the natural evolution of this bug will be, just buckled up for the ride like everyone else

[MVS]

No. Vitamin supplements have never, ever been shown to effectively treat any disease process except vitamin deficiency.

You can wax poetic about B and T cells but basic science concepts mean nothing at all to sick patients if they don't make them better.

Purely anecdotal but we have a number of people in our church who subscribe to this theory because they are ate up with politics. It isn't working out real well. With about 200 members we have a large number sick, some hospitalized, and one on deaths door right now. Of the members who have been vaccinated some have been positive with mild symptoms but so far none hospitalized. The same pretty much holds true for my immediate family of about 40 people. As a matter of fact at a party 0n Oct. 31 all of the people there who were unvaccinated subsequently came down positive and sick to some degree with one (the guy who brought it) being hospitalized. Those of us who were vaccinated got nothing. If I paid no attention to the science this alone would be enough for me, but politics don't rule my life.

[bofe954]

Those last two posts are sobering.

Question for the medical personnel/SMEs here: if this booster idea becomes an every 6 month, or every year thing, will you be getting shots bi-annually or yearly, as a matter of course?

I'm medical but I wouldn't call myself SME. I get a flu shot every year at work. Usually 50% effective on a good year. Haven't ever had any kind of ill effect from a vaccine, so I probably wouldn't care.

I am still optimistic about covid. I think Paxlovid will change things quite a bit when it becomes easy to acquire and home test kits are readily available.

My understanding of basic virology is that viruses tend to become less lethal over time, and cause less symptoms. I assume this will occur with covid (and omicron might be the start).

Total speculation, but I doubt the boosters will last long, I wouldn't be surprised to get another one, though.

[Nephrology]

Purely anecdotal but we have a number of people in our church who subscribe to this theory because they are ate up with politics. It isn't working out real well. With about 200 members we have a large number sick, some hospitalized, and one on deaths door right now. Of the members who have been vaccinated some have been positive with mild symptoms but so far none hospitalized. The same pretty much holds true for my immediate family of about 40 people. As a matter of fact at a party 0n Oct. 31 all of the people there who were unvaccinated subsequently came down positive and sick to some degree with one (the guy who brought it) being hospitalized. Those of us who were vaccinated got nothing. If I paid no attention to the science this alone would be enough for me, but politics don't rule my life.

Thanks for sharing. I'm sorry COVID has affected your family and community so heavily. It is a very unfair disease. Vaccination definitely helps quite a bit but like everything it is not perfect.

It is very unfortunate the influence that politics have had on the thinking of Americans about this virus, and I mean that truly in both directions. It is quite odd as there are no such feelings about every other medical problem encountered in the hospital.

I just recently read an article about a woman denied liver transplantation at our institution because she refused to be vaccinated. The article spun things in a way that suggested this was an injustice. However our institution's experience with transplantation before the vaccine was available was that quite frankly those who got COVID early post-tpx died like dogs. One person, COVID + but asymptomatic, got a liver that immediately clotted off in the OR. They died on the table.

The liver that woman would have gotten undoubtedly will go much farther in someone who has the protection of the vaccine especially if administered pre-transplant before immunosuppression. Livers do not grow on trees and the sad fact of the matter is we have to decide who gets them and who does not on the basis of how many years we can expect out of the graft. I have sympathy for that woman but Americans have a right to make bad decisions. There is no entitlement to surgery, however.