2020

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
alphaholic06

alphaholic06

Doctor, Who? Me?
Verified Member
Physician
15+ Year Member
Joined
Jan 14, 2004
Messages
962
Reaction score
126
Members don't see this ad.
If only this year had a bougie.
Screenshot_20201028-010244.jpeg
 
I’m glad I graduate residency in 2023. May be slave wages, but I’ve got a guaranteed income at least for 2.5 years.

Have a few friends in finance and law who’ve been raking in $200+ for a few years now, but spending it all on the affiliated lifestyle, who came crashing back to reality this year.

Medicine may be f’d but the rest of the high-earner economy is doing too hot either.
 
I'm curious. It seems like in my state, and several others, we are letting the 'rona run rampant. With no precautions of any kind- masking is suggested, not enforced, everything is open 100%. We are on a verrryy steep growth curve, and there isn't much political will or ability to do anything. I can't think of a country that has completely, 100% just let Covid just run wild, which is what we are doing.

Has anywhere actually done that (even Sweden limited some things). What happens if we just let it run wild? Has anywhere truly done that, or do we get to be the first? Where will this land us in a month?
 
miacomet said:
I'm curious. It seems like in my state, and several others, we are letting the 'rona run rampant. With no precautions of any kind- masking is suggested, not enforced, everything is open 100%. We are on a verrryy steep growth curve, and there isn't much political will or ability to do anything. I can't think of a country that has completely, 100% just let Covid just run wild, which is what we are doing.

Has anywhere actually done that (even Sweden limited some things). What happens if we just let it run wild? Has anywhere truly done that, or do we get to be the first? Where will this land us in a month?
Click to expand...

It will be an interesting experiment. I'm anxious to see the results. Hopefully it debunks the stupid mask mandates once and for all.
 
No one knows. What is interesting is the idea of another lock down. The first one did a great job at reducing the numbers. However, it also cratered our economy. This virus has shown that it is not going away. Maybe we have no real choice? Maybe nature takes it course and we do the best we can with what we have? I honestly do not know the answer. Nor does anyone else.

Option 1 - fight the virus and lock down, crater economy again (likely much worse than before)

Option 2 - No national lock down and just fight the virus the best we can with social distancing and masks and restricting large events

Option 3 - ignore the virus and realize some people are going to die

It seems like we are trying all 3 options.
 
I guess I should clarify- many places have opened only to basically have to shut down again when cases spiked. None has had the fortitude or ability to stay open.

Belgium is running out of police and teachers, not just healthcare workers, because they all have Covid.

The Czech Republic really, really tried not to lock down again, and stated they would keep everything open no matter what, concerned about their economy. They are noted libertines and libertarians (they didn't ban smoking in bars until 2019) and have decent health system (not as robust as, say Houston, but pretty good). They opened everything, including schools (without masking because they thought it would traumatize the children), bars, gyms, pools etc.

I'm not saying we will follow suit since the societies differ in many, many ways, but they are now locked down indefinitely, begging for international aid that is just not coming. Their army built a hospital in three days, and they are recruiting teenagers to help staff it.

Has anywhere had a crazy spike and avoided further restrictions?
 
Last edited:
Porfirio said:
No one knows. What is interesting is the idea of another lock down. The first one did a great job at reducing the numbers. However, it also cratered our economy. This virus has shown that it is not going away. Maybe we have no real choice? Maybe nature takes it course and we do the best we can with what we have? I honestly do not know the answer. Nor does anyone else.

Option 1 - fight the virus and lock down, crater economy again (likely much worse than before)

Option 2 - No national lock down and just fight the virus the best we can with social distancing and masks and restricting large events

Option 3 - ignore the virus and realize some people are going to die

It seems like we are trying all 3 options.
Click to expand...

Agree completely. Before any more lock downs (already started in IL) the goal needs to be clear and realistic. Herd immunity is looking more and more like the only way out. Knowing that you can't prevent infections but push them into the future should guide policy.

Australia and Melbourne just successfully suppressed the virus for a second time, at the cost of obliterating thr economy of Melbourne. The problem is that they have a huge reservoir of non-immune people and they are set up for a massive spike once international travel resumes in the future.
 
@GeneralVeers - most coronaviridae only confer 12 or so months of immunity; how does this play into your scenario?

If we just let things run wild, do we just recruit the military to give comfort care and cart off the bodies? How does that affect our economy? We have a loooong way to go with only 9 million infections (or even 18 million) thus far.
 
miacomet said:
@GeneralVeers - most coronaviridae only confer 12 or so months of immunity; how does this play into your scenario?

If we just let things run wild, do we just recruit the military to give comfort care and cart off the bodies? How does that affect our economy? We have a loooong way to go with only 9 million infections (or even 18 million) thus far.
Click to expand...

Well you've explained my fear. If this behaves like other similar viruses and gives ~12 months of immunity, that is the length of time to either eradicate the virus, or get to immunity. The first is not going to happen. January/February may be the time we start to see significant re-infection numbers, and at that point I'm not sure what will happen. Officials are also saying now that a vaccine may not be available until January at the earliest.

We have a lot of bad options, but unfotunately "Carting off the bodies" may be the only one feasible in the 3-4 months we have left.

If we lock down and suppress the virus again, we will be pushing the infections into the future.....one in which people may be able to get re-infected.
 
La Cumbre Lines said:
I wouldn’t be surprised if it is actually closer to 90ish million infected in this country so far. Remember that a huge percentage are asymptomatic and likely not tested. Many more are only mildly symptomatic, also not likely to be tested in high numbers. Anecdotally this summer it seemed like only 1 out of 10 patients tested positive, despite all with clear viral symptoms and a completely negative VRP without another explanation for their symptoms.

Let’s please not let this thread also devolve into lockdown and mask debates ultimately resulting in it be locked.
Click to expand...

That was my estimate too. In NV we have had 90K infections, so I think it's more like 900K which gets us to about ~30% immunity. If we had two more months of 1000 infections per day, we'd likely get to 50% immunity and close to the threshold we'd need to get R < 1.
 
GeneralVeers said:
That was my estimate too. In NV we have had 90K infections, so I think it's more like 900K which gets us to about ~30% immunity. If we had two more months of 1000 infections per day, we'd likely get to 50% immunity and close to the threshold we'd need to get R < 1.
Click to expand...

Antibody tests (I realize they are not perfect) have not shown that high a prevalence of infection, excepting Chicago and certain parts of NY; I'm curious why you would think immunity would be so high?

We did extensive antibody testing in my state, and very few had them despite being an early hot spot. Looking at Italy, France, and Spain, all of which had bigger outbreaks this spring, there are obviously plenty of non-immune people.

I'm not entirely sure letting the virus run wild would necessarily heal the economy.
 
La Cumbre Lines said:
No doubt (on the first part). The worst is likely yet to come judging by history of other viral pandemics where the winter after the pandemic began saw the worst spike in cases. As I said before, it is far from over with this pandemic likely continuing into next year and even 2022. However, I choose to see the light at the end of the tunnel with hope that the roaring 20s are not just the roar of winter and death, but of something much better over the latter half of the decade like the feel of that bougie rubbing against tracheal cartilaginous rings.
Click to expand...

A few weeks ago it struck me that the 2nd "spike" we had over the summer was actually a seasonally mitigated rate of infection. It's starting to look like this might be the case.

miacomet said:
I'm curious. It seems like in my state, and several others, we are letting the 'rona run rampant. With no precautions of any kind- masking is suggested, not enforced, everything is open 100%. We are on a verrryy steep growth curve, and there isn't much political will or ability to do anything. I can't think of a country that has completely, 100% just let Covid just run wild, which is what we are doing.

Has anywhere actually done that (even Sweden limited some things). What happens if we just let it run wild? Has anywhere truly done that, or do we get to be the first? Where will this land us in a month?
Click to expand...
Wuhan before the lockdown. I dunno, maybe Brazil?
 
I think we are boxed in a corner with this virus. We have no choice but to proceed with things as we are.

No political leader is going to lock down the economy, force isolation, and force strict measures.

Let’s just get over that option. There is just no way for this option to ever work in this country.

Best thing to do is reduce the impact of the virus, reduce spread, buy time for the potential benefits of a vaccine or antiviral treatments, and build up the infrastructure needed to deal with the effects of the virus (hospital capacity, etc).
 
miacomet said:
I guess I should clarify- many places have opened only to basically have to shut down again when cases spiked. None has had the fortitude or ability to stay open.

Belgium is running out of police and teachers, not just healthcare workers, because they all have Covid.

The Czech Republic really, really tried not to lock down again, and stated they would keep everything open no matter what, concerned about their economy. They are noted libertines and libertarians (they didn't ban smoking in bars until 2019) and have decent health system (not as robust as, say Houston, but pretty good). They opened everything, including schools (without masking because they thought it would traumatize the children), bars, gyms, pools etc.

I'm not saying we will follow suit since the societies differ in many, many ways, but they are now locked down indefinitely, begging for international aid that is just not coming. Their army built a hospital in three days, and they are recruiting teenagers to help staff it.

Has anywhere had a crazy spike and avoided further restrictions?
Click to expand...

Some asian countries.
Singapore, Taiwan, China
Sorry doesn't directly answer your question...those places never really had a big spike, and if they did they got it once they didn't get a spike a second time.

It's really kind of sad there are so many things we can do and carry on with our lives without kissing and hugging people and throwing parties. Throw a 75 person party and you'll infect 50 people and a few will end up hospitalized.

I stand far away from people unless I need to be close to them. I wash my hands and wear a mask. If we all did that we could save a lot of lives and have a stronger economy too. Why don't people want a stronger economy and save some lives while their at it? All for wearing a mask in public? It's such an easy, effective, intervention.

All we have to do, for a country our size, is maybe have 10-20K infections / day. Spread out over 50 states...that would be so easy to manage. We can play the NHL (virtually nobody got the virus there), there are tons of things we can do. It's not ideal but what else is there to do? We have to change our life until we come out with a vaccine.

Well, I predict this thread will be closed in another 10-20 responses, just like the others.
 
miacomet said:
Antibody tests (I realize they are not perfect) have not shown that high a prevalence of infection, excepting Chicago and certain parts of NY; I'm curious why you would think immunity would be so high?

We did extensive antibody testing in my state, and very few had them despite being an early hot spot. Looking at Italy, France, and Spain, all of which had bigger outbreaks this spring, there are obviously plenty of non-immune people.

I'm not entirely sure letting the virus run wild would necessarily heal the economy.
Click to expand...

In the beginning there were probably 10-20x the number of people infected because we weren't testing that many people.
Sometime in the summer that multiple reduced to probably 10x.
Now given that we test all the time, I think it's well less than 10x. Maybe 5x.


miacomet said:
I'm not entirely sure letting the virus run wild would necessarily heal the economy.
Click to expand...

Of course not. Having it run wild is stupid. But those who live in 'Merica don't really care all that much.

There are so many advantages to delaying infections. The principle one is it gives us time to come up with better therapies for COVID-19.
 
La Cumbre Lines said:
Places that didn’t have big spikes probably didn’t have diets as reliant on fast food and sedentary lifestyles. There probably won’t be an effective therapy. There probably won’t be an effective vaccine. Most people will eventually be exposed to this virus. I suppose we can try to delay the inevitable, but the end may end up the same. I do the things that are minor inconveniences as I don’t think it’s the hill to die on, but can think for myself and think that is important as long as I don’t become one that thinks too much or only for oneself.
Click to expand...

While I'm sure there are multiple factors explaining why Singapore, Taiwan, China, etc, don't have near the number of infections that other countries do, the principle one is that they wear masks and social distance much more effectively than others. Taiwan is a tiny little island that has a population density > 10x USA, and they seem to have it under control quite well.

I used to think there will be no effective therapies...but now I'm beginning to think we just might come up with some. It won't happen over the next few months, but in 1-2 years we very well could have something much much better than Tamiflu for Flu, or azithromycin for bronchitis. I'm more confident we will develop good treatment vs an effective vaccine.
 
La Cumbre Lines said:
Do you think in 1-2 years that there will be anyone left who hasn’t been exposed? I don’t. By that point any therapy we create won’t be that important. We’ve been fighting influenza for forever and still haven’t created an overly effective therapy. We create semi-effective therapies a lot of the time and hope that is enough. A lot of times though semi-effective just doesn’t cut it under increased scrutiny and societal expectations. I don’t know that I believe much in a lot of medicine any more. I think the human body is much more adaptive and creative in fighting off disease than even our incredible ingenuity.
Click to expand...

The most powerful therapy we have against influenza is the fact that most get vaccinated every single year. For decades. It's our cumulative-generated immunity over generations that is a great fighter against influenza.

We have no (or just few) drug manufacturers making antibody cocktails for the flu. Plus it's 10x less dangerous.
On the contrary with COVID-19, we have dozens upon dozens of companies, maybe more than 50, that are trying to get something out to help reduce the death rate and severe morbidity.

The two just don't compare.

I definitely agree with your last sentence.

I mean look at our death rate with COVID...it's probably gone down by a factor of 10 (from 2 to 0.2%...and I'm just simply guessing with these numbers) by doing a number of different things, less tubing, more proning, better fluid balance, remdesivir, dexamethasone, drinking clorox, convalescent plasma, etc.
 
Porfirio said:
Option 1 - fight the virus and lock down, crater economy again (likely much worse than before)

Option 2 - No national lock down and just fight the virus the best we can with social distancing and masks and restricting large events

Option 3 - ignore the virus and realize some people are going to die

It seems like we are trying all 3 options.
Click to expand...

Which ensures maximum side effects with minimum benefit.
 
thegenius said:
I mean look at our death rate with COVID...it's probably gone down by a factor of 10 (from 2 to 0.2%...and I'm just simply guessing with these numbers) by doing a number of different things, less tubing, more proning, better fluid balance, remdesivir, dexamethasone, drinking clorox, convalescent plasma, etc.
Click to expand...
La Cumbre Lines said:
You almost slipped it past me. Well done. 🤣
Click to expand...

I think clorox is only approved for parenteral use.
 
miacomet said:
The Czech Republic really, really tried not to lock down again, and stated they would keep everything open no matter what, concerned about their economy. They are noted libertines and libertarians (they didn't ban smoking in bars until 2019) and have decent health system (not as robust as, say Houston, but pretty good). They opened everything, including schools (without masking because they thought it would traumatize the children), bars, gyms, pools etc.
Click to expand...
They were doing very well too. Then they opened the borders in August and everyone left the country for break then everyone came back with covid in September and now they're locked down again. When they did lock down, everyone was very good abt distancing and masking and it worked. I have little worry they won't be able to do it again.
 
I 100% understand the frustrations with business lockdowns, curfews, online schooling, etc. I don't know what the right balance is regarding the effects on the economy of those actions vs. the direct (and indirect) health/economic effects of the pandemic itself.

However, I have never understood why wearing a mask and socially-distancing is such a big deal. Is it just a reactionary "you can't tell me what to do"? Is it just a supposed slippery slope of "first they tell us to wear masks, then they steal our kidneys"?

On the topic of herd immunity: honest question here (I could not find an answer after a quick search)--which diseases have we attained herd immunity against without mass vaccination?
 
There's no coordinated national lockdown but multiple cities have their own partial lockdowns.

Boston is planning on having a nightly curfew and will close all non essential businesses.
 
Ok, so a vaccine in the pipeline that's gotten to phase III with 90% efficacy? Why aren't we all giddy with optimism and discussing this already?

Thoughts?
 
bravotwozero said:
Ok, so a vaccine in the pipeline that's gotten to phase III with 90% efficacy? Why aren't we all giddy with optimism and discussing this already?

Thoughts?
Click to expand...
I'm pretty psyched about it. But I'm not a fan of medicine by press release.

And the biggest issue I can see going forward is that it's an RNA based vaccine and the cold chain to administer this is going to be complicated at best.

But sign my a** up for this one. And the next one that gets approved. And the one after that. I'll take 'em all!
 
bravotwozero said:
Ok, so a vaccine in the pipeline that's gotten to phase III with 90% efficacy? Why aren't we all giddy with optimism and discussing this already?

Thoughts?
Click to expand...

By the time it is here (shipped, etc) how many total infections will we have? Current rate is 100,000+ a day. Will it matter?
 
Porfirio said:
By the time it is here (shipped, etc) how many total infections will we have? Current rate is 100,000+ a day. Will it matter?
Click to expand...

If you're implying that by the time the vaccine is available, COVID will be so widespread that we will effectively have herd immunity, I would have to disagree. At the current rate of infection, we would reach herd immunity (70% of the total population infected) in about 5 years time. I also highly doubt that this rate of new covid infections is going to continue at the same pace or increase.
 
half of infected people are asymptomatic? Where did you get that from?
 
We're still only diagnosing probably 20-50% of the total number of cases.

That means that right now we're probably having 200K-500K new cases.
 
Well if it's 500k new cases per day then we'll have herd immunity in just over a year and a half. Woo hoo!
 
I just got COVID. Full Monty - pleuritic chest pain, shaking chills, cyclical fever spikes, drenching sweats, the whole thing.

Luckily I’m pretty young and so far my pulse ox has stayed above 94, so I should be ok.

But damn if it isn’t a very impressive virus.

Thanks a lot 2020.
 
The Knife & Gun Club said:
I just got COVID. Full Monty - pleuritic chest pain, shaking chills, cyclical fever spikes, drenching sweats, the whole thing.

Luckily I’m pretty young and so far my pulse ox has stayed above 94, so I should be ok.

But damn if it isn’t a very impressive virus.

Thanks a lot 2020.
Click to expand...

Wow man, I'm sorry to hear that. Hang in there. Really hope you get better soon!
 
It was almost inevitable with the rise in case numbers but we are back to coronavirus lockdowns.
 
Lockdown as a goal to any sort of true control is a lost cause. Prn regional lockdowns to avoid hospital overload should continue. I'm not sure what the trends are looking like in other states, but our trend has been vertical. We currently have a reasonable amount of ICU and inpatient reserve for my hospital system, but really feel we need to lockdown or we're going to get ****ed sometime in the next few weeks
 
Moderna's vaccine is 94.5% effective, in phase III trials! Also an mRNA vaccine. The nice thing is there's a lot of clinical trials using mRNA vaccines, so if one is effective, others will likely have the same result.
 
bravotwozero said:
Moderna's vaccine is 94.5% effective, in phase III trials! Also an mRNA vaccine. The nice thing is there's a lot of clinical trials using mRNA vaccines, so if one is effective, others will likely have the same result.
Click to expand...

Effective being generating antibodies. Does that translate into preventing disease?
 
Siggy said:
Um... that's not what the news Moderna press release is saying.
Click to expand...

Yea, you're right. They tracked them for illness.

Still, I'm reticent to get a vaccine with such limited data on its side effects. Nothing immediate seems to come of it, but most vaccines require 2 years of side effect data before being approved by the FDA. Obviously COVID vaccines are getting exceptions to this.
 
You must log in or register to reply here.

Similar threads

snapjack
EM residency reviews/rank order thread (2019-2020) sorted by program
Replies
6
Views
11K
RustedFox
RustedFox
W
cyberattack 2020
Replies
12
Views
2K
WheezyBaby
WheezyBaby
E
ABEM Written Board Scores 2020
2
Replies
73
Views
21K
KGflyboy
KGflyboy
JohnnyBlaze2020
ITE 2020
Replies
12
Views
2K
CliveStaples
CliveStaples
AlmostAnMD
Punished by ABEM for not doing orals in 2020?
Replies
12
Views
3K
AlmostAnMD
AlmostAnMD
Top