Covid = back.

[calvnandhobbs68]

New York, California and New Jersey don’t count. They were hit in the very beginning when we were all clueless and intubating everyone. It’s where we learned what NOT to do. We all know or should know this.
Pick some other blue states to try and prove your point.

People that try to do things like argue numbers like this in a vacuum are either just 1) willfully being ignorant and argumentative on purpose or 2) actually so dumb that they don’t understand the complexities of, for instance, large dense population centers which were hit quickly and early with a new highly infectious disease having high per population case counts despite trying to implement public health measures that by their very nature were lagging since they didn’t know what to do until covid was ripping through the population likely undetected.

also the whole “least fatal pandemic” schtick is also just purposefully (?) ignorant of advances in medical technology. O2 (just straight up concentrated/liquid o2) literally just started to come into practice as an actual therapeutic in the late 1910s. The case fatality rate would be quite a bit higher if we had the medical technology we had in 1918 (or the Middle Ages….) to work with.

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[doctalaughs]

As I've said repeatedly we need to learn to live with this virus and let the majority of the population resume normal lives.

I would agree —- IF you change the word majority to “vaccinated.” The vaccinated should return to normal life at the expense of the unvaccinated, and we should accept the small risk of “living” with covid for these people.

Vaccine passports strictly enforced to participate in society is the way to go. Choose not to vaccinate? Fine- don’t go to restaurants, stadiums, airplanes, trains, school or work. You may be “low risk” but grandma sitting next to you isn’t.

 

[dadaddadaBATMAN]

I know it’s the same thing that frustrates everyone else but the thing that drives me the most crazy is how close we came to actually getting rid of this thing.

we were down to 4000 cases in the country on off days, and under 10,000 on the bad days.

If even half the people who refused vaccines had gotten them it would probably be gone.

 

[STLINI]

I know it’s the same thing that frustrates everyone else but the thing that drives me the most crazy is how close we came to actually getting rid of this thing.

we were down to 4000 cases in the country on off days, and under 10,000 on the bad days.

If even half the people who refused vaccines had gotten them it would probably be gone.

I don't mean to be inflammatory but I feel compelled to push back on this. We can hate the anti-vaxxers all we want but this virus isn't ever going away even if we have the military go door to door and forcibly vaccinate people. We see highly vaccinated countries all over the world having Delta spikes. Hell Gibraltar is basically 100% vaccinated and an island and they recently had one of the highest per capita case rates in the world. I think its time to move on from the idea of ever eliminating COVID and come to terms with the fact that we're living with COVID forever. If we as physicians can't even accept this reality how is the general public supposed to?

 

[Dr Mantis Toboggan]

I don't mean to be inflammatory but I feel compelled to push back on this. We can hate the anti-vaxxers all we want but this virus isn't ever going away even if we have the military go door to door and forcibly vaccinate people. We see highly vaccinated countries all over the world having Delta spikes. Hell Gibraltar is basically 100% vaccinated and an island and they recently had one of the highest per capita case rates in the world. I think its time to move on from the idea of ever eliminating COVID and come to terms with the fact that we're living with COVID forever. If we as physicians can't even accept this reality how is the general public supposed to?

Israel got a bunch too right? They’re about as vaccinated as it gets.

 

[dadaddadaBATMAN]

I don't mean to be inflammatory but I feel compelled to push back on this. We can hate the anti-vaxxers all we want but this virus isn't ever going away even if we have the military go door to door and forcibly vaccinate people. We see highly vaccinated countries all over the world having Delta spikes. Hell Gibraltar is basically 100% vaccinated and an island and they recently had one of the highest per capita case rates in the world. I think its time to move on from the idea of ever eliminating COVID and come to terms with the fact that we're living with COVID forever. If we as physicians can't even accept this reality how is the general public supposed to?

It’s not inflammatory, it’s correct, and I am wrong.

I was under the mistaken impression that Israel was still in the 5-10 case per day range, which is not remotely accurate. It had been several weeks since I looked at anything. Been workin a lot.

strangely that makes me feel much better, even though the “why” is meaningless.

 

[Arcan57]

Government can't mitigate it.

I gain nothing but grief from the 90% who disagree with me. One should always be skeptical of public policy measures. As I've said repeatedly we need to learn to live with this virus and let the majority of the population resume normal lives.

Governments can and have mitigated it.
Your solution is fanciful. We can’t live with the virus given current vaccination rates and going back to 2019 behaviors.

I don't mean to be inflammatory but I feel compelled to push back on this. We can hate the anti-vaxxers all we want but this virus isn't ever going away even if we have the military go door to door and forcibly vaccinate people. We see highly vaccinated countries all over the world having Delta spikes. Hell Gibraltar is basically 100% vaccinated and an island and they recently had one of the highest per capita case rates in the world. I think its time to move on from the idea of ever eliminating COVID and come to terms with the fact that we're living with COVID forever. If we as physicians can't even accept this reality how is the general public supposed to?

So there's a strong chance we could have had significantly fewer COVID cases if we had gotten vaxxed completely, and if we had required vaccine passports (which I understand wouldn't be 100% effective but we're talking mitigation). COVID has mutated into a form that is partially vaccine resistant. That happened because it had enough human hosts in which to replicate. It had enough human hosts to replicate and mutate in because we took our foot off the gas the first moment is seemed reasonable to do so. We took one of the greatest innovations in human history and used it to buy a couple of months of normalcy while pretending like raging outbreaks in India or Latin America wouldn't affect us.

That being said, vaccination radically shifts the mortality curve. While Delta makes it less of a panacea, not having thousands of moms and dads leave behind orphaned middle schoolers is probably a good thing. And pretending like it's ok to stop urging vaccinations through any reasonable means feels way too much like surrendering, right now.

 

[rokshana]

Government can't mitigate it.

I gain nothing but grief from the 90% who disagree with me. One should always be skeptical of public policy measures. As I've said repeatedly we need to learn to live with this virus and let the majority of the population resume normal lives.

Well maybe normal now will be masks and social distancing…maybe this IS the way life will be.

 

[GeneralVeers]

Well maybe normal now will be masks and social distancing…maybe this IS the way life will be.

I can't accept that. Won't.

 

[FutureInternist]

I can't accept that. Won't.

Why not?

Asian countries mask up every flu season, since its for the greater good.

 

[d2305]

The pandemic has exposed the political hacks at the CDC and NIH.

 

[sylvanthus]

2 more covid patients died overnight….

 

[Birdstrike]

Governments can and have mitigated it.
Your solution is fanciful. We can’t live with the virus given current vaccination rates and going back to 2019 behaviors.

So there's a strong chance we could have had significantly fewer COVID cases if we had gotten vaxxed completely, and if we had required vaccine passports (which I understand wouldn't be 100% effective but we're talking mitigation). COVID has mutated into a form that is partially vaccine resistant. That happened because it had enough human hosts in which to replicate. It had enough human hosts to replicate and mutate in because we took our foot off the gas the first moment is seemed reasonable to do so. We took one of the greatest innovations in human history and used it to buy a couple of months of normalcy while pretending like raging outbreaks in India or Latin America wouldn't affect us.

That being said, vaccination radically shifts the mortality curve. While Delta makes it less of a panacea, not having thousands of moms and dads leave behind orphaned middle schoolers is probably a good thing. And pretending like it's ok to stop urging vaccinations through any reasonable means feels way too much like surrendering, right now.

Delta has been shown to breakthrough with cases (see Israel, UK). But it seems to be holding strong against deaths and severe COVID, which I think is what you’re saying here. I hope that holds, at least long enough for a booster that keeps us ahead of the mutations.

 

[chocomorsel]

It’s not inflammatory, it’s correct, and I am wrong.

I was under the mistaken impression that Israel was still in the 5-10 case per day range, which is not remotely accurate. It had been several weeks since I looked at anything. Been workin a lot.

strangely that makes me feel much better, even though the “why” is meaningless.

However, from what I am seeing as an ICU doc, the vaccinated ones are not doing poorly. Only one is on the vent and he’s a kidney transplant.
From what I am reading as well the vaccinated ones are fairing much better with the delta variant. I am ok with living with this thing as we all should be. But we should try to minimize it and it’s symptoms as much as possible by vaccinating.
Thr governments honestly needs to mandate this in my opinion. That’s not gonna happen in this “me, me, me,” country that is America though.

 

[Birdstrike]

Thr governments honestly needs to mandate this in my opinion.

For such a proposal to work there needs be consequences for non-compliance. What consequences would you propose for those who refuse a government mandated vaccine?

 

[GassYous]

I think people need to be realistic.
The vaccines don’t appear to limit transmission. They don’t prevent symptomatic disease much with the new variants. 30%-40% of the population is strongly against to at least apprehensive about the vaccines. The Current administration will get their ass handed to them in the midterm elections if they try and mandate vaccinations.

We are all getting COVID. Just a matter of when, and if we are vaccinated. Going to be a rough few months, then back to ”normal” with the odd spike of COVID every now and again to add to our list of endemic viruses.

???
Completely wrong about vaccine efficacy. Also we have been having several rough few months for almost two years and people are still getting sick. Obviously herd immunity from everyone getting covid isn't a valid strategy

 

[chocomorsel]

For such a proposal to work there needs be consequences for non-compliance. What consequences would you propose for those who refuse a government mandated vaccine?

Internment camp.

 

[chocomorsel]

2 more covid patients died overnight….

If they weren’t vaccinated I don’t feel bad. That’s on them.

 

[doctalaughs]

For such a proposal to work there needs be consequences for non-compliance. What consequences would you propose for those who refuse a government mandated vaccine?

As I said— consequence is you can’t get into a restaurant, school or your workplace. People will change their minds pretty quickly except for a few whackos living off grid in the middle of no where.

 

[chocomorsel]

As I said— consequence is you can’t get into a restaurant, school or your workplace. People will change their minds pretty quickly except for a few whackos living off grid in the middle of no where.

I like it. I like it a lot.

 

[STLINI]

Two months ago I think I would have agreed with widespread vaccine mandates. But it seems more data comes out every day that the vaccines are not preventing transmission. Israel says Pfizer's only 39% effective at preventing transmission and even less so if you were vaccinated early in their drive. I have a hard time getting on board with mandating that...

I also think we need to take a serious look at why this is happening. I don't think the data really supports that Delta is evading the vaccine. In vitro antibodies still show high levels of neutralization against Delta. I fear we're seeing 3 effects:
1) we oversold the initial efficacy in preventing transmission. We rolled these out as the winter wave was collapsing and some people tried to attribute this solely to vaccines which was fanciful thinking
2)waning immunity. Pfizer's own data shows something like a 6% decrement every 2 months
3) a somewhat more transmissible variant

We also need to take a critical look at why vaccine mediated immunity appears to be SIGNIFICANTLY INFERIOR to convalescent immunity in Israel. 50% of their cases are in fully vaccinated vs ~1% in previously infected. We need to figure out why this is ASAP. My hunch has to do with Tcells. Evidently the majority of the convalescent Tcell response is directed against the nucleocapsid protein and little against the spike protein. There is little selection pressure against the nucleocapsid protein and it has changed very little. I think future versions of the vaccine may need to include other viral targets.

 

[VA Hopeful Dr]

Two months ago I think I would have agreed with widespread vaccine mandates. But it seems more data comes out every day that the vaccines are not preventing transmission. Israel says Pfizer's only 39% effective at preventing transmission and even less so if you were vaccinated early in their drive. I have a hard time getting on board with mandating that...

I also think we need to take a serious look at why this is happening. I don't think the data really supports that Delta is evading the vaccine. In vitro antibodies still show high levels of neutralization against Delta. I fear we're seeing 3 effects:
1) we oversold the initial efficacy in preventing transmission. We rolled these out as the winter wave was collapsing and some people tried to attribute this solely to vaccines which was fanciful thinking
2)waning immunity. Pfizer's own data shows something like a 6% decrement every 2 months
3) a somewhat more transmissible variant

We also need to take a critical look at why vaccine mediated immunity appears to be SIGNIFICANTLY INFERIOR to convalescent immunity in Israel. 50% of their cases are in fully vaccinated vs ~1% in previously infected. We need to figure out why this is ASAP. My hunch has to do with Tcells. Evidently the majority of the convalescent Tcell response is directed against the nucleocapsid protein and little against the spike protein. There is little selection pressure against the nucleocapsid protein and it has changed very little. I think future versions of the vaccine may need to include other viral targets.

Maybe, but I'd bet population size plays into it as well. Israel has had 875k COVID cases while having 5.6 million people vaccinated.

I agree with your point 2, I think the waning immunity from the vaccine is likely a thing. Us healthcare workers are almost 8 months out from vaccination. We know flu shots don't last that long, not surprising that this one might not either.

 

[Dr Mantis Toboggan]

Pfizer wants to boost us. The feds say it’s not needed. Who do we trust?

Maybe, but I'd bet population size plays into it as well. Israel has had 875k COVID cases while having 5.6 million people vaccinated.

I agree with your point 2, I think the waning immunity from the vaccine is likely a thing. Us healthcare workers are almost 8 months out from vaccination. We know flu shots don't last that long, not surprising that this one might not either.

 

[turkeyjerky]

Pfizer wants to boost us. The feds say it’s not needed. Who do we trust?

Yeah, I’m sure Pfizer is pushing this stuff out of the goodness of its heart…what vested interest does the govt have?

this stuff about the vaccines not preventing infections is horse-****. You guys are misinterpreting the cdc announcements. According to the CDC, there’s still a 2-3x lower risk of getting infected w/ delta if youve been vaccinated. This is in line w/ the data from the original efficacy trials.

 

[calvnandhobbs68]

For such a proposal to work there needs be consequences for non-compliance. What consequences would you propose for those who refuse a government mandated vaccine?

Participation in social activities or government sponsored activities. For instance, being a member of the military/government jobs/government contractors. Going to school. Going to government funded institutions/events/etc.

These all have prior precendent with prior vaccines and tended to work pretty well for those.

 

[calvnandhobbs68]

Pfizer wants to boost us. The feds say it’s not needed. Who do we trust?

I wouldn’t necessarily boost with the current vaccine formulations but that’s just my way of thinking about it. We of course have to remember that Pfizer has a vested financial interest in administering as many shots as possible. I imagine this may end up being like influenza where specific targets are crafted every year against the most concerning variants.

 

[VA Hopeful Dr]

Yeah, I’m sure Pfizer is pushing this stuff out of the goodness of its heart…what vested interest does the govt have?

this stuff about the vaccines not preventing infections is horse-****. You guys are misinterpreting the cdc announcements. According to the CDC, there’s still a 2-3x lower risk of getting infected w/ delta if youve been vaccinated. This is in line w/ the data from the original efficacy trials.

Not paying for another 160 million doses of vaccine?

 

[Dr Mantis Toboggan]

Yeah, I’m sure Pfizer is pushing this stuff out of the goodness of its heart…what vested interest does the govt have?

The government’s interest would be in making sure there is enough vaccine to hit everyone before starting up round 2 for healthcare workers etc. Plus news that a booster is needed would likely be more ammo to the anti-vaccine crowd.

 

[GassYous]

I'm pretty sure there is enough demand worldwide for vaccines without companies having to invent unnecessary dosing

 

[calvnandhobbs68]

I'm pretty sure there is enough demand worldwide for vaccines without companies having to invent unnecessary dosing

Not for the same pricing and guaranteed volumes the US government offers. I’m not a conspiracy theorist saying the evil drug companies are trying to just push ineffective vaccines on us or anything of the sort but I think we all do have to appreciate that pharmaceutical companies have a significant financial interest in encouraging people to continue to use (and subsequently pay for) their products. There’s enough uncertainty about the need for “booster” vaccinations that you could spin the data multiple different ways right now.

 

[pawprint]

Seeing a surge in my area, but vaccination status doesn’t seem to be playing a big roll. We had more vaccinated people come back positive than unvaccinated people in the past week, which I’m sure will even out with time since my area is about 50% vaccinated but still disheartening to say the least. Our 48 year old healthy ophthalmologist just died from Covid as well, and he was fully vaccinated.

I’m hoping that vaccinated folks continue to have less severe disease but I’m definitely seeing disturbing trends. I’m just one area, but I can’t imagine we are alone.

Im not certain that a booster will help either. I don’t think it’s an issue of antibodies not being able to respond to new mutations, i think these newer strains are just producing so many viral particles so quickly that it doesn’t matter how good your immune system is, if you get exposed to enough virus it’s going to infect you. the virus seems to be taking the old world war 2 Soviet Union approach: doesn’t matter if the German soldiers are better trained, if you throw enough bodies at the eastern front, you’ll eventually take Berlin.

 

[FutureInternist]

As I said— consequence is you can’t get into a restaurant, school or your workplace. People will change their minds pretty quickly except for a few whackos living off grid in the middle of no where.

Except you have governors stating mandates are not allowed, holding funds from schools that even think about it….if they want to kill their kids, that’s on them.

 

[Birdstrike]

As I said— consequence is you can’t get into a restaurant, school or your workplace.

Participation in social activities or government sponsored activities. For instance, being a member of the military/government jobs/government contractors. Going to school. Going to government funded institutions/events/etc.

These all have prior precendent with prior vaccines and tended to work pretty well for those.

All of these ideas are good and it's the approach I support. But I'm not sure those qualify as vaccine "mandates" with the full force of the federal government. They're all pretty soft, optional and give vaccine skeptics and easy out, if the only consequence of non-compliance is that you can't do something or go somewhere. It's give people lots of ways to evade and adapt.

However, a true government mandate, i.e. required by federal law, is what I was asking about. How would you enforce that? And what punishment would you suggest for those refusing?

 

[thegenius]

For such a proposal to work there needs be consequences for non-compliance. What consequences would you propose for those who refuse a government mandated vaccine?

Bilateral orchiectomy or oophorectomy, depending on sex.

 

[thegenius]

For such a proposal to work there needs be consequences for non-compliance. What consequences would you propose for those who refuse a government mandated vaccine?

For real though, I would just deny insurance payments by CMS (Medicaid / Medicare) and private insurers if you get COVID and are not vaccinated. That is simple enough. People have to pay their bills. If they can't pay, then collections will come in and take their money. This will affect all except those who are in poverty and/or homeless

 

[southerndoc]

Seeing a surge in my area, but vaccination status doesn’t seem to be playing a big roll. We had more vaccinated people come back positive than unvaccinated people in the past week, which I’m sure will even out with time since my area is about 50% vaccinated but still disheartening to say the least. Our 48 year old healthy ophthalmologist just died from Covid as well, and he was fully vaccinated.

Supposedly the fatality rate for vaccinated individuals has been 0.001%. The hospitalization rate is 0.003%. The only vaccinated individual I've had to admit was a lady with MS who was on Ocrevus infusions. I suspect it prevented her from mounting an immune response to the vaccine.

However, I've heard that the 48-year-old ophthalmologist that you reference was actually not fully vaccinated.

 

[namethatsmell]

However, I've heard that the 48-year-old ophthalmologist that you reference was actually not fully vaccinated.

Yup. Was just about to write this.

 

[pawprint]

Supposedly the fatality rate for vaccinated individuals has been 0.001%. The hospitalization rate is 0.003%. The only vaccinated individual I've had to admit was a lady with MS who was on Ocrevus infusions. I suspect it prevented her from mounting an immune response to the vaccine.

However, I've heard that the 48-year-old ophthalmologist that you reference was actually not fully vaccinated.

Those statistics are just not true from what I'm seeing play out in real life at my own hospital. I get it, my hospital is just one of the thousands in the US, but I am sure there are others just like mine. I'm all about people getting vaccinated, I wish the military would mandate it, but I think we also need to be very open about what we are seeing. This virus is spreading among vaccinated people and making them sick too, some of them very sick. Way more than just 0.003%.

And the ophthalmologist was vaccinated, I worked with him and know for a fact he was. The news articles online say "an unnamed navy official said he was unvaccinated"....which is total bogus. Can't even really refute the claim because the official is unnamed, it was probably someone just making that up because they didnt have the information. Our provider vaccination rate is 100%.

 

[turkeyjerky]

Supposedly the fatality rate for vaccinated individuals has been 0.001%. The hospitalization rate is 0.003%. The only vaccinated individual I've had to admit was a lady with MS who was on Ocrevus infusions. I suspect it prevented her from mounting an immune response to the vaccine.

However, I've heard that the 48-year-old ophthalmologist that you reference was actually not fully vaccinated.

Are those numbers real? That’s an order of magnitude below the flu.

 

[southerndoc]

Are those numbers real? That’s an order of magnitude below the flu.

Chart: Less than 0.1% of vaccinated Americans have tested positive for COVID-19

Data: CDC and state Covid dashboards via NBC. Dani Alberti/Axios Of the 164 million vaccinated Americans, around 125,000 people have tested positive for breakthrough infections and 0.001% have died, according to state data compiled from state dashboards by NBC and data from the Centers for...

www.yahoo.com

 

[southerndoc]

Those statistics are just not true from what I'm seeing play out in real life at my own hospital. I get it, my hospital is just one of the thousands in the US, but I am sure there are others just like mine. I'm all about people getting vaccinated, I wish the military would mandate it, but I think we also need to be very open about what we are seeing. This virus is spreading among vaccinated people and making them sick too, some of them very sick. Way more than just 0.003%.

And the ophthalmologist was vaccinated, I worked with him and know for a fact he was. The news articles online say "an unnamed navy official said he was unvaccinated"....which is total bogus. Can't even really refute the claim because the official is unnamed, it was probably someone just making that up because they didnt have the information. Our provider vaccination rate is 100%.

I never intended to imply that vaccinated individuals don't get COVID. I'm simply stating that severity requiring hospitalization or leading to death is not common.

 

[Siggy]

I never intended to imply that vaccinated individuals don't get COVID. I'm simply stating that severity requiring hospitalization or leading to death is not common.

Unfortunately that doesn't matter to the antivax crowd. To them getting COVID is all that matters. Death and morbidity is a meaningless metric to the conspiracy nuts.

 

[turkeyjerky]

Chart: Less than 0.1% of vaccinated Americans have tested positive for COVID-19

Data: CDC and state Covid dashboards via NBC. Dani Alberti/Axios Of the 164 million vaccinated Americans, around 125,000 people have tested positive for breakthrough infections and 0.001% have died, according to state data compiled from state dashboards by NBC and data from the Centers for...

www.yahoo.com

That’s a poor way to present the data. A better way would be the case hospitalization and fatality rates. (I agree with the underlying premise though. It’s not been my experience that there are many severe breakthrough cases at all. Although I also thought that the risk of severe covid in younger, healthier patients was always overblown as well.)

 

[Birdstrike]

Unfortunately that doesn't matter to the antivax crowd. To them getting COVID is all that matters. Death and morbidity is a meaningless metric to the conspiracy nuts.

Let them get COVID if they don't want the shot. Good for them.

 

[bravotwozero]

Have not had to admit a single vaccinated covid positive patient so far. Even sent a 85yo vaccinated covid+ home the other, because he had mild symptoms and looked too good to benefit from a hospital stay.

 

[Goro]

Government can't mitigate it.

I gain nothing but grief from the 90% who disagree with me. One should always be skeptical of public policy measures. As I've said repeatedly we need to learn to live with this virus and let the majority of the population resume normal lives.

Learning to live with this virus means another 600,000 dead over the next year, another 10 to 30% of all covid patients, even mild ones, suffering from long covid syndrome, and our health care system blown out.

I really don't like seeing my clinical colleagues will have to work with covid patients suffering from battle fatigue. Literal combat fatigue.

 

[chocomorsel]

Pfizer wants to boost us. The feds say it’s not needed. Who do we trust?

Pfizer. Even thought they have a monetary vested interest. The damn government is too lax with these damn antivaxxers.

 

[chocomorsel]

I never intended to imply that vaccinated individuals don't get COVID. I'm simply stating that severity requiring hospitalization or leading to death is not common.

This still sucks a lot. Sucks really badly that we have to treat these patients. I am a healthy 40 something year old ICU anesthesiologist. Who is Vit D deficient.
This really sucks. The fact that we have to expose ourselves mostly due to all these non vaxxers.

 

[chocomorsel]

Let them get COVID if they don't want the shot. Good for them.

Except they are probably the ones driving these damn mutations and continuing to let this thing brew longer than is necessary.
And infecting us already vaccinated front line workers who have to intubate these jerks. This needs to stop. Selfishness at its best.

 

[chocomorsel]

Have not had to admit a single vaccinated covid positive patient so far. Even sent a 85yo vaccinated covid+ home the other, because he had mild symptoms and looked too good to benefit from a hospital stay.

Lucky you. We have a tubed one. Transplant.