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Corona Virus: Idiot things people are doing

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DrMetal

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Yeah it’s actually super awesome. There are currently labs working on HIV and better influenza mRNA vaccines.

I don't know that it's 'super awesome'. History goes against the utility of a mRNA vaccine. Let's be good stewards of basic science and guard out optimism.

If the mRNA particle is taken up by a cell, translated, relevant proteins expressed, resulting in a 'native' spike protein embedded in a cell membrane, which then serves as a more natural target for immune cells, then that's great. I get why they're doing it. Such a natural state of the spike protein is probably closer to that of the virus, thus the conferred immunity is more likely to be effective against the real deal.

But we've shown that you don't need such great accuracy . . . that a humoral response to an aqueous protein (in just plasma) may be enough . . . a la our proteinaceous vaccines.

There's a lot of unknowns here. And if SARS-Cov2 mutates like it's predecessors (a lot!), we're gonna need a new vaccine every year. Hard to do if it's mRNA based.

My money is on Moderna.
 
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JoaoMoutinho

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I don't know that it's 'super awesome'. History goes against the utility of a mRNA vaccine. Let's be good stewards of basic science and guard out optimism.

If the mRNA particle is taken up by a cell, translated, relevant proteins expressed, resulting in a 'native' spike protein embedded in a cell membrane, which then serves as a more natural target for immune cells, then that's great. I get why they're doing it. Such a natural state of the spike protein is probably closer to that of the virus, thus the conferred immunity is more likely to be effective against the real deal.

But we've shown that you don't need such great accuracy . . . that a humoral response to an aqueous protein (in just plasma) may be enough . . . a la our proteinaceous vaccines.

There's a lot of unknowns here. And if SARS-Cov2 mutates like it's predecessors (a lot!), we're gonna need a new vaccine every year. Hard to do if it's mRNA based.

My money is on Moderna.

Moderna is also an mRNA vaccine, so why are you more optimistic about it? Just because of the storage requirements?
 
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JoaoMoutinho

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It does make it substantially more convenient. Especially if we're talking about storing vaccines in clinics.
It definitely does, especially since the Pfizer one has more steps than "remove from fridge, attach needle, inject". The person I was replying to seemed to be saying that they preferred Moderna to an mRNA vaccine even though Moderna is also making an mRNA vaccine–just one that they seem to have found a better way to stabilize/distribute.
 
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Matthew9Thirtyfive

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I don't know that it's 'super awesome'. History goes against the utility of a mRNA vaccine. Let's be good stewards of basic science and guard out optimism.

If the mRNA particle is taken up by a cell, translated, relevant proteins expressed, resulting in a 'native' spike protein embedded in a cell membrane, which then serves as a more natural target for immune cells, then that's great. I get why they're doing it. Such a natural state of the spike protein is probably closer to that of the virus, thus the conferred immunity is more likely to be effective against the real deal.

But we've shown that you don't need such great accuracy . . . that a humoral response to an aqueous protein (in just plasma) may be enough . . . a la our proteinaceous vaccines.

There's a lot of unknowns here. And if SARS-Cov2 mutates like it's predecessors (a lot!), we're gonna need a new vaccine every year. Hard to do if it's mRNA based.

My money is on Moderna.

I guess I’m just confused because Moderna’s is also an mRNA vaccine. I’m also not sure what history you’re talking about.

If your issue with the Pfizer vaccine is the logistics, then I share your concerns at the clinic and pharmacy level, but I assume they will find ways around that. If Moderna’s vaccine has already made that moot, then I would bet money on theirs as well since it too showed ~95% efficacy so far.

My comment about it being awesome is the biochem behind an mRNA vaccine (which is what the post I quoted was about), not the logistics of putting it out into the community.
 
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Redpancreas

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1.) Patient has respiratory failure with an infiltrate? COVID negative x3. Is it COVID? Is it COVID? Is it COVID? Its become the new diagnosis of exclusion. All the other medical conditions must be on vacation. Seriously though, we have to take precautions so I somewhat get it.
2.) There was a point where leadership thought bringing back in person lectures after the first surge promoted wellness. If I had it my way, lectures would be via Zoom moving forward regardless.
 
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DrMetal

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I guess I’m just confused because Moderna’s is also an mRNA vaccine. I’m also not sure what history you’re talking about.

If your issue with the Pfizer vaccine is the logistics, then I share your concerns at the clinic and pharmacy level, but I assume they will find ways around that. If Moderna’s vaccine has already made that moot, then I would bet money on theirs as well since it too showed ~95% efficacy so far.

My comment about it being awesome is the biochem behind an mRNA vaccine (which is what the post I quoted was about), not the logistics of putting it out into the community.
Modern a is a mrna vaccine: https://www.nejm.org/doi/full/10.1056/nejmoa2022483

But it seems to be more stable in case in the lipid nanoparticle.

It's not foolproof either, and when mutations occur, I think it'll be hard to reproduce on a regular basis, but we'll see. Were in uncharted territory here
 

Matthew9Thirtyfive

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gutonc

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    Modern a is a mrna vaccine: https://www.nejm.org/doi/full/10.1056/nejmoa2022483

    But it seems to be more stable in case in the lipid nanoparticle.

    It's not foolproof either, and when mutations occur, I think it'll be hard to reproduce on a regular basis, but we'll see. Were in uncharted territory here
    What makes you think an mRNA vaccine with GCT at codon 172 will be harder to reproduce than one with GCA at codon 172?

    And obviously we're in uncharted territory. But would you suggest proceeding ahead half speed with a spotter in the crows nest, or scuttling the ship because some fog has rolled in.
     
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    DrMetal

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    What makes you think an mRNA vaccine with GCT at codon 172 will be harder to reproduce than one with GCA at codon 172?

    And obviously we're in uncharted territory. But would you suggest proceeding ahead half speed with a spotter in the crows nest, or scuttling the ship because some fog has rolled in.

    No, I do suggest pushing ahead, with the Moderna one. If I'm reading the methods section of the above NEWJM article right---that they're delivering it in a lipid nanoparticle, to protect it from denaturing---that's very clever. And with less handling/refrigeration restrictions, it would be much easier to deploy. If a single codon mutation is all we need to worry about, that'd be great, easy fix. If we have two dozen different strains by next winter, that's a problem.

    And there's no T (thymine) in mRNA, I think you meant U (uracil). :)
     
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    thehundredthone

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    1.) Patient has respiratory failure with an infiltrate? COVID negative x3. Is it COVID? Is it COVID? Is it COVID? Its become the new diagnosis of exclusion. All the other medical conditions must be on vacation. Seriously though, we have to take precautions so I somewhat get it.
    2.) There was a point where leadership thought bringing back in person lectures after the first surge promoted wellness. If I had it my way, lectures would be via Zoom moving forward regardless.
    It does matter that the question be asked over and over, given that the prevalence in the community and hence the pre-test probability is only going up. The other medical conditions can co-exist with COVID in some cases, or it really might be COVID. And it matters specifically because of the risk of contagion in a hospital full of other sick patients who may have worse outcomes if you add COVID to the mix, and full of staff that are already stretched thin who then may be pulled out of the labor pool.
     
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    InvestingDoc

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    How much do they have to pay for these covid swabs? Presumably the insurance is not going to cover 50 tests. If they are taking advantage of free testing, then that's the problem. A cost is the only way to disincentivize these ppl from wasting resources and getting tested indiscriminately.
    Free with insurance.
     

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    Epi Geek
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    Is it accurate that it has to be injected within minutes of coming out of a freezer? Is it IV or IM?

    I can see how they would need to have vaccination centers like maybe one or 2 per state depending on the size/population where they have specially trained staff who literally just administer this preposterous vaccine all day long 7 days a week if it is indeed that onerous. Outside of that I don't foresee this working since there are too many opportunities for error.

    No it’s not minutes. The Pfizer vaccine actually can be refrigerated for several days after thawing. It requires a diluent and after that’s mixed in I believe it’s stable refrigerated for 6 hours. There are 5 doses per vial.

    Good overview https://www.washingtonpost.com/health/2020/11/17/covid-vaccines-what-you-need-to-know/?arc404=true
     
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    Epi Geek
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    Back on the topic of the thread, people keep lying and exposing my staff and admins keep making dumb choices and I keep getting to derail my personal life to clean up messes that were predicted and preventable.
     

    Kaustikos

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    Don't know if this was brought up:


    Bamlanivimab is new treatment for COVID. I know vaccines are generally better. But what's not to like about a antibody treatment for COVID. Other than the possibly of bringing on the zombie apocalypse.
     

    Kaustikos

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    No it’s not minutes. The Pfizer vaccine actually can be refrigerated for several days after thawing. It requires a diluent and after that’s mixed in I believe it’s stable refrigerated for 6 hours. There are 5 doses per vial.

    Good overview https://www.washingtonpost.com/health/2020/11/17/covid-vaccines-what-you-need-to-know/?arc404=true

    So is it similar to similar compounds where the drug doesn't have an expiration date until it's diluted? I want to say no because a liquid formulation and not powder like other drugs where compound is stable until it's diluted in saline.
     

    gutonc

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    Don't know if this was brought up:


    Bamlanivimab is new treatment for COVID. I know vaccines are generally better. But what's not to like about a antibody treatment for COVID. Other than the possibly of bringing on the zombie apocalypse.
    You just think the logistics of the mRNA vaccines are complicated, this one is ridiculous.

    It's an infusion, approved for mildly to moderately symptomatic C-19+ patients who do NOT require hospitalization. But they do require an infusion center. And I don't know how familiar you are with infusion centers (I'm the medical director for 7 of them), but they tend to be filled with people getting chemo and immunosuppresive drugs like infliximab and IVIG. Ain't nobody want a bunch of COVID+ patients strolling in there for their Bamlanivimab.

    There's also a pretty limited supply of the drug so unclear how it's going to be distributed.
     
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    Kaustikos

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    You just think the logistics of the mRNA vaccines are complicated, this one is ridiculous.

    It's an infusion, approved for mildly to moderately symptomatic C-19+ patients who do NOT require hospitalization. But they do require an infusion center. And I don't know how familiar you are with infusion centers (I'm the medical director for 7 of them), but they tend to be filled with people getting chemo and immunosuppresive drugs like infliximab and IVIG. Ain't nobody want a bunch of COVID+ patients strolling in there for their Bamlanivimab.

    There's also a pretty limited supply of the drug so unclear how it's going to be distributed.
    Oh, I understand. It's not that practical and, as you said, the requirement for infusion center makes it more difficult.
    But I guess I wonder if it could work that a home health aid goes to patients place to infuse the medication. I know they do it for antibiotics. Or, better yet, short term rehab for administration.
    Just a thought. Not an expert in infusion. Just familiar with long term antibiotics.
     

    chessknt

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    You just think the logistics of the mRNA vaccines are complicated, this one is ridiculous.

    It's an infusion, approved for mildly to moderately symptomatic C-19+ patients who do NOT require hospitalization. But they do require an infusion center. And I don't know how familiar you are with infusion centers (I'm the medical director for 7 of them), but they tend to be filled with people getting chemo and immunosuppresive drugs like infliximab and IVIG. Ain't nobody want a bunch of COVID+ patients strolling in there for their Bamlanivimab.

    There's also a pretty limited supply of the drug so unclear how it's going to be distributed.
    I mean it is pretty obvious the hope is that they get to ramp up supply and push this drug out to hospitals and then watch as it gets used on everyone as an uncontrolled phase IV trial like remdesivir which (despite evidence to the contrary) is STILL being used in the severely ill population as the 'standard of care.'
     
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    Kaustikos

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    Are any other hospitals now using hand scanners at the front for temperature eval? They used to have the temperature scanners but now using hand scanners/whatever. On vacation so I haven't used it but I can't be surprised if this causes a major burden for employees to get inside. We'll see.
     

    chessknt

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    Are any other hospitals now using hand scanners at the front for temperature eval? They used to have the temperature scanners but now using hand scanners/whatever. On vacation so I haven't used it but I can't be surprised if this causes a major burden for employees to get inside. We'll see.
    I have wondered what the point of screening employees is. Have they actually ever screened anyone positive?
     
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    Kaustikos

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    I have wondered what the point of screening employees is. Have they actually ever screened anyone positive?

    Not to my knowledge. Though our screening devices are so ****ty I've been "hypothermic" on several occasions and they're just like "you're good". Yeah, thanks. Let's recheck that. :lame:
     
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    WheezyBaby

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    I sure hope you're right, because we are down to using LTV vents at one site (and at ~75% of all vents including Trilogy and travel vents), and just ran out of PB840s today at the other.

    Cringing at the thought of having to manage sick ARDS on an LTV. Puke

    The "Heroes Work Here" banners, posters, whatnot, being planted across the hospitals. Stop it, it's patronizing. It doesn't make anyone feel better after working a 12-hour shift with minimal PPE. Give us good PPE, good diagnostic tests, etc, that's what we care about (not being called a hero).

    Our health system has honestly taken pretty good care of us through COVID, but yes, these signs and the general pandering for Healthcare heroes messages without meaningful action has been nauseating. Still hate walking by these signs daily

    1.) Patient has respiratory failure with an infiltrate? COVID negative x3. Is it COVID? Is it COVID? Is it COVID? Its become the new diagnosis of exclusion. All the other medical conditions must be on vacation. Seriously though, we have to take precautions so I somewhat get it.
    2.) There was a point where leadership thought bringing back in person lectures after the first surge promoted wellness. If I had it my way, lectures would be via Zoom moving forward regardless.

    I agree that anchoring is a problem but epidemiologically it's a likely etiology to illness particularly if other labs are suggestive. I've had more than 1 patient negative on repeat OP/NP swabs only to turn positive on bronch. If the clinical picture is consistent they get treated as COVID while working up alternative etiologies

    I have wondered what the point of screening employees is. Have they actually ever screened anyone positive?

    Such a waste of time. Oh **** yeah thanks for asking, completely forgot I shouldn't be here with my rigors cough and dyspnea. Just ends up with long lines of employees waiting in lines to go through screening
     
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    Kaustikos

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    Cringing at the thought of having to manage sick ARDS on an LTV. Puke



    Our health system has honestly taken pretty good care of us through COVID, but yes, these signs and the general pandering for Healthcare heroes messages without meaningful action has been nauseating. Still hate walking by these signs daily



    I agree that anchoring is a problem but epidemiologically it's a likely etiology to illness particularly if other labs are suggestive. I've had more than 1 patient negative on repeat OP/NP swabs only to turn positive on bronch. If the clinical picture is consistent they get treated as COVID while working up alternative etiologies



    Such a waste of time. Oh **** yeah thanks for asking, completely forgot I shouldn't be here with my rigors cough and dyspnea. Just ends up with long lines of employees waiting in lines to go through screening

    We resorted to LTV and BIPAP machines converted to PRVC.... this was in March/April. Not to mention our ICU patients were basically managed on floors and in the ED. 1/3 of the ED was ICU patients. Fun times.
     
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    Epi Geek
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    You just think the logistics of the mRNA vaccines are complicated, this one is ridiculous.

    It's an infusion, approved for mildly to moderately symptomatic C-19+ patients who do NOT require hospitalization. But they do require an infusion center. And I don't know how familiar you are with infusion centers (I'm the medical director for 7 of them), but they tend to be filled with people getting chemo and immunosuppresive drugs like infliximab and IVIG. Ain't nobody want a bunch of COVID+ patients strolling in there for their Bamlanivimab.

    There's also a pretty limited supply of the drug so unclear how it's going to be distributed.


    And back on the topic of idiot things people do, our town’s outpatient NP run clinic thinks they’re going to offer this.

    They are currently making bank on covid. A curbside “visit” with covid and flu test is like $500 and they’re doing like 40 people a day 5 days a week.
     
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    WheezyBaby

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    You just think the logistics of the mRNA vaccines are complicated, this one is ridiculous.

    It's an infusion, approved for mildly to moderately symptomatic C-19+ patients who do NOT require hospitalization. But they do require an infusion center. And I don't know how familiar you are with infusion centers (I'm the medical director for 7 of them), but they tend to be filled with people getting chemo and immunosuppresive drugs like infliximab and IVIG. Ain't nobody want a bunch of COVID+ patients strolling in there for their Bamlanivimab.

    There's also a pretty limited supply of the drug so unclear how it's going to be distributed.

    We actually have a tiny amount and were just sent our use guidelines. Elderly and/or obese + at least one of a variety of chronic health conditions (in addition to the EUA guidelines). I'm under the impression one of our infusion centers is going to be dedicated to exclusively bam infusions, though that wasn't stated explicitly. I'm a skeptic. I guess we'll see
     

    Crayola227

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    I don't know that it's 'super awesome'. History goes against the utility of a mRNA vaccine. Let's be good stewards of basic science and guard out optimism.

    If the mRNA particle is taken up by a cell, translated, relevant proteins expressed, resulting in a 'native' spike protein embedded in a cell membrane, which then serves as a more natural target for immune cells, then that's great. I get why they're doing it. Such a natural state of the spike protein is probably closer to that of the virus, thus the conferred immunity is more likely to be effective against the real deal.

    But we've shown that you don't need such great accuracy . . . that a humoral response to an aqueous protein (in just plasma) may be enough . . . a la our proteinaceous vaccines.

    There's a lot of unknowns here. And if SARS-Cov2 mutates like it's predecessors (a lot!), we're gonna need a new vaccine every year. Hard to do if it's mRNA based.

    My money is on Moderna.
    Why is it hard to do because it's mRNA based? To make the vaccine? To make it on industrial scale? Or the cold storage?
     
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    VA Hopeful Dr

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    And back on the topic of idiot things people do, our town’s outpatient NP run clinic thinks they’re going to offer this.

    They are currently making bank on covid. A curbside “visit” with covid and flu test is like $500 and they’re doing like 40 people a day 5 days a week.
    There are days I really wish I didn't have a sense of morality or professional ethics
     
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    DrMetal

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    We need to increase public awareness

    Post in: 'We Choose NPs'
    We Choose NPs

    The public is plenty aware. And they do choose the NP. The public doesn't listen to the physician anymore. They won't listen when we tell them that they really don't need a COVID test (having been asymptomatic and not reasonably exposed). Nor will they listen when we explain to them that it's not ethical to get tested for the sake of attending a social gathering. What the public will do then, is find a NP/PA who will administer them the test, in the same way that they find that NP to order their MRI for a light ankle sprain (because they 'want it').

    COVID has not revealed anything new. It has just highlighted where we are in healthcare in the 21st Century. Nobody cares about the opinion of (nor listens to their) physicians any more. People basically do whatever the F they want.

    I don't have the stomach to read the above thread, but it matters not b/c that discussion is being had on a predominantly physician forum. Meanwhile, the NP lobby is passing laws in states allowing them to practice independently. What's more legit: discussion on a forum OR political action that results in the passage of a f-in law! Clearly the latter.

    So why don't physicians get a good lobby going and make some laws? B/c we don't care all that much. We're too stuck up in our ivory towers training--yipee, I'm the PGY7+ in a Sleep Fellowship (because it takes 7 years of training to read sleep studies), or doing MOC (that Sleep physician has fours BCs to maintain!), or we're just tired and burned out.
     
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    DrMetal

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    I think the flu shot should be a prerequisite for the COVID vaccine.

    I admire the anti-vaxxers who are refusing the COVID vaccine (and previously refused all other shots). At least they're consistent in their idiocy.

    But what I don't like is the traditional anti-vaxxers who are now in favor of getting the COVID vaccine. Eff them.
     

    Kaustikos

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    I think the flu shot should be a prerequisite for the COVID vaccine.

    I admire the anti-vaxxers who are refusing the COVID vaccine (and previously refused all other shots). At least they're consistent in their idiocy.

    But what I don't like is the traditional anti-vaxxers who are now in favor of getting the COVID vaccine. Eff them.
    I get your idea, but it should just be that politics are avoided for this one. Healthcare workers get it first. I get why they want NH/AH patients next....

    I'm still baffled at the antivaxxers supporting this one.
     
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    Kaustikos

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    Also this. Boy it's a man's world!

    I stopped reading after the tweet below. How can anyone be as astronomically stupid as make a statement that they "can't find a link between restaurants and covid"?
     

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    DrMetal

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    I stopped reading after the tweet below. How can anyone be as astronomically stupid as make a statement that they "can't find a link between restaurants and covid"?

    You could potentially make somewhat of an argument, for opening things, based on the latest CDC data which demonstrates . . . .

    Ah hell, never mind. I just want a lap dance.
     
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    Kaustikos

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    You could potentially make somewhat of an argument, for opening things, based on the latest CDC data which demonstrates . . . .

    Ah hell, never mind. I just want a lap dance.
    You could make an argument, sure, but I could....*looks at florida, midwest, south*....gestures vaguely
    Even NY is going back to shutting down.
    In any case - can you actually get lap dances? or do you need a mandatory covid swab and wait 4 hours before doing it?
     

    DrMetal

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    Got the first shot of the vaccine (Pfizer) about 5 days ago. So asymptomatic am I, that I'm a little concerned that the vaccine didn't take. I was hoping to have a little fever or something.

    Does anybody know (or has anybody heard of) any plans to draw titers on us (those received the first round, first batch), to make sure we developed antibodies? Would make sense, right? Brand new mRNA vaccine with a treacherous cold supply chain . . .it would be nice to know that I didn't just get a shot of water.
     
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    chessknt

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    Got the first shot of the vaccine (Pfizer) about 5 days ago. So asymptomatic am I, that I'm a little concerned that the vaccine didn't take. I was hoping to have a little fever or something.

    Does anybody know (or has anybody heard of) any plans to draw titers on us (those received the first round, first batch), to make sure we developed antibodies? Would make sense, right? Brand new mRNA vaccine with a treacherous cold supply chain . . .it would be nice to know that I didn't just get a shot of water.

    Wait for the second shot in a few weeks that is the one that is supposed to really trigger a response. Of everyone I know who got it it was just arm soreness for a few days and that was it.
     
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    aafisahar

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    Don't know if this was brought up:


    Bamlanivimab is new treatment for COVID. I know vaccines are generally better. But what's not to like about a antibody treatment for COVID. Other than the possibly of bringing on the zombie apocalypse.
    Bamlanivimab is 30,000 dollar Tamiflu that's given hospital adjacent.

    Bamlanivimab is more impressive in its money making scheme than medicine.
     
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    rokshana

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    This can go horribly wrong:

    terminator GIF
    It’s not that new...I’ve seen robots that deliver meds from the pharmacy to the floors...can’t be much different...they just have faces
     
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