COVID-19 (Aka China Virus)

[LimaLowdown]

Hopefully it doesn't turn into something where you are put on a list for not taking a vaccine. It is completely rational to be weary of a brand new vaccine that has not been tested in any kind of long term environment.

[PitchTrimmer]

Cool, this has already got me thinking and looking up different things.

@Homestar - Infection rates is a known number, it looks like it's expressed as the basic reproduction number, R0. CDC has the current best estimate as 2.5. The wikipedia article has it as 2-6, but the sources are from papers in July, whereas the CDC's page was updated in September. For reference the common cold has an R0 of about 2-3 from the wikipedia page, and seasonal strains of influenza are listed as 0.9-2.1. As far as morbidity, the Swedish doctor I linked to before seems to have concluded that it's about on par with the flu. It seems to me that the tremendous effect on the country comes largely from our response to it. This is an area where I should do more research: the main group at risk of dying from COVID is also at risk from rhinoviruses such as the common cold. In a normal cold and flu season, how is this handled to keep elderly patients safe? And while I lack a linked source right now, from talking to people that I know that work in hospitals it is standard ops for the ICU to be around 80-90% capacity because anything else would not be profitable. Now obviously this gets difficult if you need to keep a separate "COVID ICU," but then again that is our response to the virus.

 

@N730 On the topic of reinfection, I have not seen too many things about that, and the CDC at least seems to think it's rare. I'd like to see more data on this (if you have some that'd be awesome), especially numbers. One of the things that I've noticed surrounding this whole thing is we are given a lot of large numbers with very little context. The town I'm in posts new cases daily and deaths daily on facebook. What if the same were to happen with the flu, or the cold, or even car accidents? Reinfection numbers would shed light on whether it's enough to make herd immunity unlikely.

 

@ThreeHoler on long term effects, again most sources say this is rare (but I haven't really seen numbers), and really the virus hasn't been around too long (someone I know had a bad bout of the flu in January and it took her until March-April to regain her lung capacity), so how much can we really know about this. Further, is it worth keeping a lot of people at home and unemployed? I do want to do more research on where the social distancing thing came from, but if you look into how far a sneeze can travel, I wonder how effective that really is. As far as masks, I'll link that Swedish doctor again (in that article he looks into pre-covid studies about decreasing the spread of raspatory infections), but people seem to regard them as a magical forcefield or something which they do not seem to be.

 

 

[N730]

 
[mention=79488]N730[/mention] On the topic of reinfection, I have not seen too many things about that, and the CDC at least seems to think it's rare. I'd like to see more data on this (if you have some that'd be awesome), especially numbers. One of the things that I've noticed surrounding this whole thing is we are given a lot of large numbers with very little context. The town I'm in posts new cases daily and deaths daily on facebook. What if the same were to happen with the flu, or the cold, or even car accidents? Reinfection numbers would shed light on whether it's enough to make herd immunity unlikely.

 

I wish I did, I don't know near enough about this stuff to speak with authority. I'm not smart enough to truly understand immunology. But anecdotally 3 people in my family have had COVID and 2 of them show no antibodies. From what I can find, reinfection isn't likely within a short amount of time. But as with everything else about this damn virus, there's a lot that's unknown.


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[FLEA]

I'm almost certain military members will have to get the vaccine. Forcing military members to take vaccines was upheld in court in the late 90s when several officers protested concerns about the anthrax vaccine that was still new. 

A big difference is the anthrax vaccine underwent long term testing so the extended side effects were known. In the case of COVID, it seems like scientist are taking a risk because they believe long term side effects are generally more rare than short term ones. That said, as a country, we have screwed up with rushing vaccines to market before, specifically Gerald Ford in the late 70s who killed several people with a swine flu (H3N2) vaccine that wasn't adequately tested. 

I live in Europe at the moment and generally they are more compliant with public health rules, meaning, if an authority makes a reccomendation they are likely to follow it. They have also accepted lock downs easier because their governments provide huge social benefits systems to people who are unemployed. That said they are starting to get massive protest to additional lockdowns as well. People are plainly getting tired. 

As an American here it's pretty miserable. Still go to work, but nothing to do in your off time. Base closed to social activities and social gatherings; it feels rather isolating. Families are having a hard time. Many want to go visit home for the holidays but are being advised not to because their spouse will be quarantined when the family returns. (Current rules require all members of a household to quarantine even if the member didn't travel). 

The lack of concern for people (and their mental health) in this whole debacle has pushed me 100% ready to get out. I have 1.5 years left and it couldn't come faster. 

 

[brabus]

10 hours ago, Homestar said:

, but that is not relevant to the failed leadership the USA has demonstrated on the issue in our own country. 

I get your point, but it is relevant when people throw out stats like this as supporting points for their argument that our response was subpar. Totally in agreement we’ve had, and continue to see, horrific leadership failures. A large portion of them being at the state level (governors). 

[pawnman]

8 hours ago, N730 said:

 

 

 

I wish I did, I don't know near enough about this stuff to speak with authority. I'm not smart enough to truly understand immunology. But anecdotally 3 people in my family have had COVID and 2 of them show no antibodies. From what I can find, reinfection isn't likely within a short amount of time. But as with everything else about this damn virus, there's a lot that's unknown.


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So if you can be reinfected, and getting the disease doesn't create antibodies... How would a vaccine work?

[PitchTrimmer]

8 hours ago, N730 said:

 

 

 

I wish I did, I don't know near enough about this stuff to speak with authority. I'm not smart enough to truly understand immunology. But anecdotally 3 people in my family have had COVID and 2 of them show no antibodies. From what I can find, reinfection isn't likely within a short amount of time. But as with everything else about this damn virus, there's a lot that's unknown.


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You can have immunity without antibodies. The antibodies themselves will go away after a certain amount of time without the virus present, but the T cells will still retain the memory and can make them again.

[ViperMan]

15 hours ago, ThreeHoler said:

The long-term effects of this thing are quite nasty in many cases. I wouldn’t want to risk my flying career over something stupid like not wearing a mask and maintaining distance. I also wouldn’t want to risk it over purposely getting infected when there is very little data to support effective herd immunity from this virus.
 

To be fair, I don't think we know what the "long term" effects of this are since it's been around < 1 year. What we "know" is speculation.

[Alpharatz]

I've been wondering about how (if) Gamma Globulin might fit in...I've had it two..maybe three times as a preventative for nasty third world bugz.  Any medics want to opine on it as a preventative for Covid?

[N730]

So if you can be reinfected, and getting the disease doesn't create antibodies... How would a vaccine work?

From the little I do know (and that's very little), it does create antibodies. What seems to be variable is how long they last.

As for a vaccine, I don't understand how most of that magic works hahaha.

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[N730]

You can have immunity without antibodies. The antibodies themselves will go away after a certain amount of time without the virus present, but the T cells will still retain the memory and can make them again.

Ok, that's good to know. So are the antibody tests just bullshit or is there any benefit to them?

This stuff is way over my head, but definitely still interesting to learn about.

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[17D_guy]

21 hours ago, PitchTrimmer said:

Cool, this has already got me thinking and looking up different things.

@Homestar - Infection rates is a known number, it looks like it's expressed as the basic reproduction number, R0. CDC has the current best estimate as 2.5. The wikipedia article has it as 2-6, but the sources are from papers in July, whereas the CDC's page was updated in September. For reference the common cold has an R0 of about 2-3 from the wikipedia page, and seasonal strains of influenza are listed as 0.9-2.1. As far as morbidity, the Swedish doctor I linked to before seems to have concluded that it's about on par with the flu. It seems to me that the tremendous effect on the country comes largely from our response to it. This is an area where I should do more research: the main group at risk of dying from COVID is also at risk from rhinoviruses such as the common cold. In a normal cold and flu season, how is this handled to keep elderly patients safe? And while I lack a linked source right now, from talking to people that I know that work in hospitals it is standard ops for the ICU to be around 80-90% capacity because anything else would not be profitable. Now obviously this gets difficult if you need to keep a separate "COVID ICU," but then again that is our response to the virus.

 

2 Questions on this:

What's the source/logic behind having the ICU at 80-90% all time, when now the hospital administrators, state health director and doctors across my whole state (UT) are stating utilization rates have exceeded staffing capacity (85%+), and the drive in the early months was to flatten the curve from CDC/Health Dudes?

I've seen the videos on our "less impactful" (can't think of better words) Flu season last year "burning off" the chaff that didn't die.  (I've also followed a swedish doctor who won a Nobel prize for...something data science related, going on about the need for herd immunity, and it only really needing to be around 20%.  I wonder if it was the same as your guy.) However, I believe the current us excess deaths does not account for the normal die off from the prior flu season + extra flu season.  Thoughts on that?

[waveshaper]

23 minutes ago, 17D_guy said:

 I believe the current us excess deaths does not account for the normal die off from the prior flu season + extra flu season.  Thoughts on that?

Another angle to help understand the impact of COVID when it comes to death rates is to look at the potential adjustment to the 2020 US life expectancy due to COVID-19. These life expectancy downward adjustments may be heavily localized - "see NYC as an example". Here's some data on this subject:
- "Using data reported by the New York City Health Department through May 14, 2020, we estimated that the excess deaths to date due to COVID-19 caused a drop in life expectancy of 5 years (95% CI: 4.8 – 5.2 years)."

- "Reductions in 2020 US life expectancy due to COVID-19 and the disproportionate impact on the Black and Latino populations": (Source - NIH/long/complicated/etc).   "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523145/

  

[Snuggie]

On 11/16/2020 at 6:42 PM, Danger41 said:

On this topic, what’s everyone’s opinion on the vaccine? I’d 100% not take this vaccine and just get exposed if that were an option. I have no issues with vaccines, but rushing something out with those earlier referenced fatality numbers seems like a cut off the nose to spite the face thing. 

I'm going to do it. After I left AD earlier this year I started working at a hospital and have been involved in COVID surge planning since the beginning. I would have been hesitant to get it if only political leaders gave it a thumbs up but with multiple sets of experts giving the go ahead getting it I feel ok about it. I expect my health system to receive one of the first rounds of the vaccine and my family will be authorized to get it then. 

I'm with @ThreeHoler in wanting to reduce my risk to COVID. Though the death rate for 35 year old healthy-ish men is low the randomness of the long term impacts and deaths concern me. 538, through their Podcast "PODCAST-19", did a great job explaining what we know about long COVID. Basically 20% of people who got SARS in 2013 still weren't at 100% two years later. We don't know if the same will hold for COVID but I really don't want to personally find out. 

My family has also canceled Thanksgiving. We moved across the country post AD to be closer to family but with my in-laws comorbidities and age if one of us has COVID they will probably catch it and die. It doesn't help that in Nebraska right now if you put 10 people in a room there is a 40% chance somebody has an active case of COVID. I feel comfortable managing risk but this juice doesn't seem worth the squeeze. 

 

 

[ClearedHot]

On 11/16/2020 at 6:42 PM, Danger41 said:

On this topic, what’s everyone’s opinion on the vaccine? I’d 100% not take this vaccine and just get exposed if that were an option. I have no issues with vaccines, but rushing something out with those earlier referenced fatality numbers seems like a cut off the nose to spite the face thing. 

Understand your concern but that math doesn't follow your logic.I read an interesting study yesterday...short version = of the 238,000 U.S. deaths 9300 were normal healthy people that had no underlying health issues. 

The two most common causes of death due to a flu shot are anaphylaxis and Guillain-Barre Syndrome, and from the information given by the CDC (Centers for Disease Control and Prevention) it is possible to work out an approximate number.

The CDC reports 1.31 cases of anaphylaxis per million flu shots given, so that would be about 183 cases per year in the US (on average, around 140 million Americans a year receive a flu shot). Anaphylaxis has a fatality rate of between 0.25% and 0.33%, so on average that would be one death every two or three years.

Guillain-Barre Syndrome is a reaction of the central nervous system to bacterial or viral infection, most commonly food poisoning. It causes paralysis, usually temporary, and may result in a hospital stay of up to six weeks. A small number of people are permanently impaired, and approximately 3% -5% die. According to the CDC, only one or two people in a million will develop GBS as a result of the flu shot. That gives a range of between 4 (140 x 3%) and 14 (280 x 5%) deaths a year from flu-shot related GBS.

Based on these calculations, the number of people dying from the flu shot in the US each year would be between 4 and 15, so probably an average of about 9, out of 140 million vaccines given, while anywhere from 12,000 to 56,000 die as a result of catching the flu, and the vast majority of flu-related deaths occur in people who are not vaccinated (CDC figures from 2010–11 through 2013–14).  Compare that against a known 9300 COVID-19 deaths from a healthy population using social distancing, masks and lockdowns....seems like easy math even for a knucklehead gunship dude like me.

Given all this I will 100% get it, especially the Moderna version that just finished Phase III Trials.  As others have noted vaccination is not just about preventing you from getting the disease, it is also about protecting the herd.  The U.S. government does have a specious record when it comes to experimenting on unknowing Americas but given the engagement by the entire scientific community on this problem, I seriously doubt anything nefarious has happened.  Like a dork I read the Phase III report on the Monsanto vaccine and there were no fatalities or serious side effects in the 30,000 recipients.  I believe there were 5 fatalities and 1 other serious illness in the test subjects, but all deaths were among people that received the placebo. 

Just my .02

[Danger41]

2 good posts. Thanks for the info.

[Day Man]

47 minutes ago, ClearedHot said:

good post...

...but i think you mean 'Moderna', not Monsanto

[jazzdude]

What's the source/logic behind having the ICU at 80-90% all time, when now the hospital administrators, state health director and doctors across my whole state (UT) are stating utilization rates have exceeded staffing capacity (85%+), and the drive in the early months was to flatten the curve from CDC/Health Dudes?

Pretty sure this is driven by business decisions. Hospitals don't want to be way overstaffed, or purchase (expensive) equipment they won't use. This goes for for-profit and non-profit hospitals. So they forecast out demand, and staff and purchase equipment according to the capability they plan to provide.

It doesn't make business sense to operate an ICU at only 10-20% capacity routinely. Who pays for the extra staff and unused equipment sitting on a shelf? To do that, you'd have to either pass on the costs to subsidize the unused ICU capacity elsewhere, like routine appointments/procedures, get subsidized from outside the hospital (local/state/federal taxes?), or charge crazy amounts for emergency care based on demand at time of service (insurance companies probably would negotiate an upper limit here, but if you're uninsured, sucks to be you).

Operating at 80-ish% probably gives you a reasonable buffer to absorb spikes in demand while getting a good return on the investment on staff and equipment, and allow for vacations, training, etc. It's like a line flying squadron, if the squadron was manned exactly for the mission demand (100% utilization of crews for missions), you wouldn't have time for leave or upgrades; you need slack in the taskings to take care of your people (leave, dnif, etc) and organization (upgrades, training/development, schools).

But when hospitals have a spike that keeps going upward (like a pandemic), they start having to surge, and potentially offload patients to other hospitals that have excess capacity.

Flattening the curve was to help keep the demand for beds below the number of beds available (locally or regionally), especially for a virus that had a lot of unknowns with it while meeting routine demands, and given a long lead time to increase capacity (medical staff, equipment, physical space). Though those routine demands may change given COVID mitigations (for example, I'm guessing there have been less car accidents requiring ICU care since lockdowns and telework have gone into effect, freeing up some capacity at hospitals to deal with COVID). We're also probably better now at triaging COVID patients and meeting their needs as well. All this leads to a moving picture on demand and capacity, but with a long tail to significantly increase capacity if needed.

Hospitals can surge (do more with less... sound familiar?), but who knows for how long. They are accepting more risk (more patients per provider/nurse than typical, longer days, having COVID positive but asymptomatic healthcare workers continue working until they physically can't). Just like the AF and the pilot shortage, there's been a shortage of doctors and nurses, and both have a long lead time to add to the workforce, and their management probably isn't much better than ours. So it'll be interesting to see how this plays out.

[ClearedHot]

1 hour ago, Day Man said:

...but i think you mean 'Moderna', not Monsanto

100% correct...oddly I was just talking to my bud who is a VP at Monsanto...I guess my brain is old.

 

[herkbier]

4 hours ago, ClearedHot said:

Understand your concern but that math doesn't follow you logic.I read an interesting study yesterday...short version = of the 238,000 U.S. deaths 9300 were normal healthy people that had no underlying health issues. 

Do you happen to have a link to the 9300 healthy people deaths article or source? Not that I disagree with you, it just seems high. 

[Snuggie]

3 hours ago, jazzdude said:

Pretty sure this is driven by business decisions. Hospitals don't want to be way overstaffed, or purchase (expensive) equipment they won't use. This goes for for-profit and non-profit hospitals. So they forecast out demand, and staff and purchase equipment according to the capability they plan to provide.

Hospitals can surge (do more with less... sound familiar?), but who knows for how long. They are accepting more risk (more patients per provider/nurse than typical, longer days, having COVID positive but asymptomatic healthcare workers continue working until they physically can't). Just like the AF and the pilot shortage, there's been a shortage of doctors and nurses, and both have a long lead time to add to the workforce, and their management probably isn't much better than ours. So it'll be interesting to see how this plays out.

 

This checks with what I have seen. I've learned that hospitals will typically run 80-90% full in November and December due to people taking care of issues (i.e. surgeries)  before their deductible resets. But a bunch of knee replacements is a different patient population than a bunch of COVID positive patients. 

The hospital I work at has a solid surge plan, and contingencies on top of contingencies, but if individuals don't change their behaviors we will be overrun. Much like AF leadership assuming there will be a pilot in the seat when needed, the public assumes there will be a bed for them if they get sick. It's true right this minute but it's might not be true in a few weeks. 

[ClearedHot]

10 hours ago, herkbier said:

Do you happen to have a link to the 9300 healthy people deaths article or source? Not that I disagree with you, it just seems high. 

I think it was NY Times and I am out of free views...I certainly won't support that paper.  I do have an older story from the NY Times saying the same thing (https://www.nytimes.com/2020/04/23/health/coronavirus-patients-risk.html)

[VMFA187]

22 hours ago, ClearedHot said:

9300 were normal healthy people that had no underlying health issues. 

The two most common causes of death due to a flu shot are anaphylaxis and Guillain-Barre Syndrome, and from the information given by the CDC (Centers for Disease Control and Prevention) it is possible to work out an approximate number.

 

Interestingly enough, whenever I see stories that have pictures of "healthy" people dying from Covid, they are all massively obese. Maybe that goes along with the whole "large is beautiful" movement, but I digress.

Sure, the probability of death from a vaccine are low, but what of other potential effects that we have absolutely zero knowledge of?

[17D_guy]

15 hours ago, ClearedHot said:

I think it was NY Times and I am out of free views...I certainly won't support that paper.  I do have an older story from the NY Times saying the same thing (https://www.nytimes.com/2020/04/23/health/coronavirus-patients-risk.html)

IF you're on a normal browser you can use "private" or "incognito" mode and get some more free views.

That's your cyber tip for the day!

[17D_guy]

5 hours ago, VMFA187 said:

Interestingly enough, whenever I see stories that have pictures of "healthy" people dying from Covid, they are all massively obese. Maybe that goes along with the whole "large is beautiful" movement, but I digress.

Sure, the probability of death from a vaccine are low, but what of other potential effects that we have absolutely zero knowledge of?

Well, obesity is a co-morbidity.  Just because someone has a co-morbidity doesn't mean they couldn't have had a much longer life.  I have a quite a few, some I'm working on, some I got cursed genetics on.  My line generally survives until about 70 without medical intervention, with it..Dad's probably going to get into his mid-80's.  To hand wave a possible COVID death off for me with "co-morbidity" isn't a honest way to look at it.  I think that's the same for a lot of the folks out there. 

What I've read more was pregnant women late in term having miscarriages, and at least here in UT there's some strange syndrome hitting some of the kids that get it.