Delta Breakthrough: 100% my household vaccinated, 50% COVID +

[Birdstrike]

All in my household had Pfizer x 2 (range, 2-8 mos ago).

50% are currently COVID-19 positive and symptomatic, currently mild/moderate; nothing severe.

I’m pretty sure it was the obnoxious, coughing, sneezing, drunks in the row behind, on the plane. All 20-something, likely anti-vax superspreaders, with high viral load.

Delta will break through.

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[sloh]

Any loss of smell? This is my main "mild" covid concern.

 

[Birdstrike]

Any loss of smell? This is my main "mild" covid concern.

Partial.

"I can taste and smell. But I noticed my coffee tasted weird this morning. Bitter, even though I put sweetened creamer in it."

 

[RustedFox]

"I can taste and smell. But I noticed my coffee tasted weird this morning. Bitter, even though I put sweetened creamer in it."

That's my fault. I'm sorry.

 

[Birdstrike]

Go get a booster, everyone. Preferably Moderna.

"US study: Moderna vaccine far better than Pfizer at preventing Delta infection"

 

[Old_Mil]

All in my household had Pfizer x 2 (range, 2-8 mos ago).

50% are currently COVID-19 positive and symptomatic, currently mild/moderate; nothing severe.

I’m pretty sure it was the obnoxious, coughing, sneezing, drunks in the row behind, on the plane. All 20-something, likely anti-vax superspreaders, with high viral load.

Delta will break through.

Had Covid a year ago. Antibody positive, vaccine negative.

I'll lick a petri dish full of Delta variant for $5000 if anyone wants to set up a go fund me.

 

[Cinclus]

Go get a booster, everyone. Preferably Moderna.

"US study: Moderna vaccine far better than Pfizer at preventing Delta infection"

Is getting a booster an official "thing" yet? Because I would take one.

 

[GeneralVeers]

So if the vaccine doesn't protect against getting COVID and spreading COVID, what's the reason for the push behind not-at-risk school-aged children and young healthy adults to get the vaccine? Seems to me there's potential for more harm than good.

 

[dchristismi]

I don't know about you, but our hospitals here in Central Florida are overrun. 10+ hour waits, pretty much all of Tampa was on diversion a couple of days ago.

It's like the whole "protect the medical system from crashing" thing when we were talking about "flattening the curve"... except now the medical system IS crashing and "not-at-risk" children and young adults are ending up hospitalized. And it appears to be a crapshoot about who gets sick, who doesn't get sick, who gets REALLY sick. You pays your money and you takes your chances. But right now around here, there are no ICU beds, even if you aren't a covid patient. Hope you don't have a STEMI this week or need a balloon pump...

 

[MechEDoc]

All in my household had Pfizer x 2 (range, 2-8 mos ago).

50% are currently COVID-19 positive and symptomatic, currently mild/moderate; nothing severe.

I’m pretty sure it was the obnoxious, coughing, sneezing, drunks in the row behind, on the plane. All 20-something, likely anti-vax superspreaders, with high viral load.

Delta will break through.

What kind of mask did you use and how good was your self discipline on the flight? Eat? Drink? Cloth mask? Chin-diaper? N95?

 

[GeneralVeers]

What kind of mask did you use and how good was your self discipline on the flight? Eat? Drink? Cloth mask? Chin-diaper? N95?

unless N-95 it probably doesn't matter.

 

[Birdstrike]

Is getting a booster an official "thing" yet? Because I would take one.

It’s not “officially” a thing yet in this country. But 1 million people have already gotten them.

COVID booster: More than 1 million Americans have gotten them | Fortune

More than 1 million Americans who got the Pfizer or Moderna COVID vaccines have already gotten booster shots despite a lack of government authorization.

www.google.com

 

[Birdstrike]

What kind of mask did you use and how good was your self discipline on the flight? Eat? Drink? Cloth mask? Chin-diaper? N95?

The “two vaccinated, COVID-positive household members” wore regular surgical masks (not N95) but didn’t eat or drink.

 

[namethatsmell]

So if the vaccine doesn't protect against getting COVID and spreading COVID, what's the reason for the push behind not-at-risk school-aged children and young healthy adults to get the vaccine? Seems to me there's potential for more harm than good.

Swing and a miss

 

[GeneralVeers]

Swing and a miss

I'd say touchdown... Or whatever sports metaphor you want to use. The changing vaccine narrative is impressive.

 

[Angry Birds]

So if the vaccine doesn't protect against getting COVID and spreading COVID, what's the reason for the push behind not-at-risk school-aged children and young healthy adults to get the vaccine? Seems to me there's potential for more harm than good.

You're a doctor, right?
I don't know how many times this needs to be repeated:

1) Getting the vaccine does not prevent the possibility of getting COVId, but it significantly lowers the chances of getting it.
2) The viral load is likely less in someone who is vaccinated as opposed to who is not.
3) Even if you get COVID after being fully vaccinated, usually you are less sick and are less likely to require a bed or die.
4) School-aged children and young adults may be less at risk but we are seeing an uptick in cases with them (including hospitalizations, which ties up beds and also indicates a sicker patient). So, obviously, they should also be vaccinated.
5) Sending unvaccinated children to public schools is a disastrous idea. Kids usually have, you know, parents and grandparents at home.

What part of all of this is confusing you, Joe (Rogan)?

 

[Angry Birds]

I'd say touchdown... Or whatever sports metaphor you want to use. The changing vaccine narrative is impressive.

Medical narratives should be constructed based on scientific data, not on political ideology; therefore, they are, indeed, wont to change as new data comes in and new events unfold.

 

[namethatsmell]

I'd say touchdown... Or whatever sports metaphor you want to use. The changing vaccine narrative is impressive.

Sure, if you're calling the adjustment of one's thinking and behavior in response to shifting conditions and new information to be a changing narrative...than yeah I agree it's impressive and we should all be thankful for changing narratives.

What about deuce? I'm not a big tennis guy, but it always brightens my day to hear "DEUCE" announced on TV.

 

[PTPoeny]

The vaccine reduces the risk of getting COVID and at least in stores reduces the risk dramatically of severe disease. Kids are lower risk, not not-at-risk. When all (or nearly all) the PICU beds in several states are full in August clearly that is showing that kids are getting sick. It isn't all COVID but instead added on top of the RSV and paraflu going around this summer. And there is no reason to think Delta won't cause MISC, so there will only be more sick kids in a few weeks.

So if the vaccine doesn't protect against getting COVID and spreading COVID, what's the reason for the push behind not-at-risk school-aged children and young healthy adults to get the vaccine? Seems to me there's potential for more harm than good.

 

[RustedFox]

The vaccine reduces the risk of getting COVID and at least in stores reduces the risk dramatically of severe disease. Kids are lower risk, not not-at-risk. When all (or nearly all) the PICU beds in several states are full in August clearly that is showing that kids are getting sick. It isn't all COVID but instead added on top of the RSV and paraflu going around this summer. And there is no reason to think Delta won't cause MISC, so there will only be more sick kids in a few weeks.

I'm sorry, what's MISC?
I'm bad at following this thread.

 

[Arcan57]

I'm sorry, what's MISC?
I'm bad at following this thread.

Multi-inflammatory syndrome - Children. Delta definitely causes MISC. Source: wife who just got off a week of in-patient peds. Also, RSV is crushing it.

 

[RustedFox]

Multi-inflammatory syndrome - Children. Delta definitely causes MISC. Source: wife who just got off a week of in-patient peds. Also, RSV is crushing it.

Thanks.
I don't pretend like I know these abbreviations.
Do you mean to say that the disease burden from RSV is outweighing the burden from COVID in kids?
Asking, not telling.

 

[Arcan57]

Thanks.
I don't pretend like I know these abbreviations.
Do you mean to say that the disease burden from RSV is outweighing the burden from COVID in kids?
Asking, not telling.

Depends on age group but there are more sick RSV kids in the hospital right now , at least in my neck of the woods. COVID tends to be screwing over an older population of kids than RSV does. The scary thing is this isn’t RSV season. I think it may have something to do with the lockdowns changing exposure patterns last winter (like with flu) and therefore having 2 cohorts of kids that are seeing RSV for the first time.

 

[BAM!]

Thanks.
I don't pretend like I know these abbreviations.
Do you mean to say that the disease burden from RSV is outweighing the burden from COVID in kids?
Asking, not telling.

No offense, man, but you gotta know this stuff. I get that you've been out of residency for a while, but you're still an Emergency Doc.

 

[Mount Asclepius]

And it appears to be a crapshoot about who gets sick, who doesn't get sick, who gets REALLY sick.

Vast majority of my admitted COVID-19 patients have been obese. Most of the rest are usually older and/or have chronic lung disease. I can’t say I’m usually terribly surprised by those that are really sick.

 

[RustedFox]

No offense, man, but you gotta know this stuff. I get that you've been out of residency for a while, but you're still an Emergency Doc.

No offense taken. That's why I ask; to make sure that I don't miss something that somehow swims on by me.

"MISC" escaped me, yeah. That's not one that you hear every day like ROSC or CHADS score.
It doesn't help that I have seen zero pediatric patients in one year.

The RSV/COVID comparison that I was asking him to make was asking about his specific observations.

 

[skougess]

Is MISC even an actionable, discrete entity? I always thought of it as something academicians created to pat themselves on the back. “Look at all these inflammatory markers when a kid has a severe infection! It must be a new condition!”
Do we do anything different when we see it? It’s like when people order a dimer on Covid patients. Now you’re stuck with a positive dimer on someone with a viral infection.

 

[sylvanthus]

Meh I had to google MISC, guess im a bad doc.

 

[Birdstrike]

"MISC" escaped me, yeah.

Is MISC even an actionable, discrete entity?

Meh I had to google MISC, guess im a bad doc.

Just learn these six words, "MISC is the Kawasaki of COVID," and you're 90% there.

They're not exactly the same, but close enough that knowing those six words allows you join the group that turns, scoffs and says, "SHAME...SHAME....SHAME..." at those who don't know those six words.

 

[Arcan57]

Is MISC even an actionable, discrete entity? I always thought of it as something academicians created to pat themselves on the back. “Look at all these inflammatory markers when a kid has a severe infection! It must be a new condition!”
Do we do anything different when we see it? It’s like when people order a dimer on Covid patients. Now you’re stuck with a positive dimer on someone with a viral infection.

We get echoes and stuff...

Most viral infections screw kids up through the lungs or through hypovolemia/electrolyte derangements from GI losses. If a MISC kid has dilated cardiac vessels they get ASA and/or IVIG which isn't standard therapy. MISC minus dilated vessels doesn't change treatment from regular COVID.

I think in adults currently there seems to be little point in getting a dimer on COVID (our hospitalists have stopped asking for inflammatory markers) because everybody that's admitted is getting anticoagulation, steroids, and remdesivir.

 

[PTPoeny]

I do think it is a discrete actionable entity. The kids generally are PCR negative and antibody positive and the peak of MISC was over a month after the peak of acute COVID for our last peak locally.

My experience has been kids with MISC look and feel like crap and then go from looking like crap but all their vitals are fine to needing two pressors in just a few hours. IVIG and high dose steroids seem to keep kids off ECMO. But they get better quickly, they don't act like the kids that get overwhelming acute influenza or other viral infections.

 

[skougess]

Good to know, thanks guys

 

[BoardingDoc]

“Look at all these inflammatory markers when a kid has a severe infection! It must be a new condition!”

It is. MISC kids don't even look like covid kids. The last one I treated was 16 but essentially had Kawasaki, except that, you know, 16 yr olds don't generally get Kawasaki. Diffuse rash, injected conjunctiva, cracked lips, mucosal lesions, tachy to 150 and hypotensive requiring 2 pressors. She ultimately got intubated after being transferred to the local children's hospital but is doing well now and has been discharged thankfully.

 

[cyanide12345678]

So since most of us got vaccinated pretty early around December/January. What's the prevailing thought amongst you guys/gals regarding a booster dose?

I'm seeing 2-3 covids a day and am engaging in international travel around the world soon, kinda thinking about walking into a cvs/Walgreens and getting a booster. Really don't want to be positive and be stuck internationally. Thoughts?

 

[MechEDoc]

So since most of us got vaccinated pretty early around December/January. What's the prevailing thought amongst you guys/gals regarding a booster dose?

I'm seeing 2-3 covids a day and am engaging in international travel around the world soon, kinda thinking about walking into a cvs/Walgreens and getting a booster. Really don't want to be positive and be stuck internationally. Thoughts?

It's up to you and your conscience, but some docs that I *know* have terrible memory and went to a walk in for their "first" shot and later realized that it was their third.

 

[Birdstrike]

So since most of us got vaccinated pretty early around December/January. What's the prevailing thought amongst you guys/gals regarding a booster dose?

I'm seeing 2-3 covids a day and am engaging in international travel around the world soon, kinda thinking about walking into a cvs/Walgreens and getting a booster. Really don't want to be positive and be stuck internationally. Thoughts?

I know two docs that just went and got Moderna boosters. Showed up at pharmacies they never went to and filed no insurance. Done.

 

[Dral]

They're apparently recommending a third vaccine for immunocompromised folks. It was really unclear to me what the process is though. It seems it's supposed to be given with the first two, so I don't know what is supposed to happen to the folks who were vaccinated a few months ago and are immunocompromised.

Coronavirus (COVID-19) Update: FDA Authorizes Additional Vaccine Dose for Certain Immunocompromised Individuals

The FDA authorized the use of an additional dose of the Pfizer-BioNTech or Moderna COVID-19 Vaccines in certain immunocompromised individuals.

www.fda.gov

 

[Birdstrike]

...so I don't know what is supposed to happen to the folks who were vaccinated a few months ago and are immunocompromised.

Coronavirus (COVID-19) Update: FDA Authorizes Additional Vaccine Dose for Certain Immunocompromised Individuals

The FDA authorized the use of an additional dose of the Pfizer-BioNTech or Moderna COVID-19 Vaccines in certain immunocompromised individuals.

www.fda.gov

My interpretation is that they're supposed to go get a booster, right now, as opposed to, "Other fully vaccinated individuals do not need an additional vaccine dose right now," from the subtitle of your link.

 

[ER BlueBlood]

All in my household had Pfizer x 2 (range, 2-8 mos ago).

50% are currently COVID-19 positive and symptomatic, currently mild/moderate; nothing severe.

I’m pretty sure it was the obnoxious, coughing, sneezing, drunks in the row behind, on the plane. All 20-something, likely anti-vax superspreaders, with high viral load.

Delta will break through.

Hope you guys are ok. How are your symptoms currently?

 

[Birdstrike]

No one has anything worse that moderate cold/mild flu symptoms, right now.

 

[turkeyjerky]

No one has anything worse that moderate cold/mild flu symptoms, right now.

The horror!

 

[Dred Pirate]

Depends on age group but there are more sick RSV kids in the hospital right now , at least in my neck of the woods. COVID tends to be screwing over an older population of kids than RSV does. The scary thing is this isn’t RSV season. I think it may have something to do with the lockdowns changing exposure patterns last winter (like with flu) and therefore having 2 cohorts of kids that are seeing RSV for the first time.

My child is in a hospital day care and we are having a major RSV outbreak in the center (ironically we have only had one COVID case this entire time. Also have seen an uptick in RSV at our hospital (we only have a super tiny peds unit so this is purely anecdotal)

 

[bravotwozero]

My child is in a hospital day care and we are having a major RSV outbreak in the center (ironically we have only had one COVID case this entire time. Also have seen an uptick in RSV at our hospital (we only have a super tiny peds unit so this is purely anecdotal)

I think that might be from the whole viral interference thing. Hopefully RSV in your area predominates to the point it prevents the delta from skyrocketing.

 

[Dred Pirate]

I think that might be from the whole viral interference thing. Hopefully RSV in your area predominates to the point it prevents the delta from skyrocketing.

I don't claim to be any sort of expert in viral interference, but we had an interesting case - a young child (maybe 3 or so) who tested positive for RSV, one of the non-covid coronviruses, and parainfluenza all at the same time - to me that seemed rather suprising, not sure how often that occurred back before we seemed to do more comprehensive respiratory panels on everybody.

Unfortunately the delta variant is skyrocketing in my area - just have been lucky that my particular daycare has seemed to be able to avoid it for whatever reason (the balance of having healthcare workers who take smart precautions/getting vaccinated outweighs those fact the healthcare workers are more likely to be exposed due to the nature of the job?)

 

[Dr Mantis Toboggan]

I don't claim to be any sort of expert in viral interference, but we had an interesting case - a young child (maybe 3 or so) who tested positive for RSV, one of the non-covid coronviruses, and parainfluenza all at the same time - to me that seemed rather suprising, not sure how often that occurred back before we seemed to do more comprehensive respiratory panels on everybody.

Unfortunately the delta variant is skyrocketing in my area - just have been lucky that my particular daycare has seemed to be able to avoid it for whatever reason (the balance of having healthcare workers who take smart precautions/getting vaccinated outweighs those fact the healthcare workers are more likely to be exposed due to the nature of the job?)

Eh if you do these resp panels multiple positives happen all the time. Not sure if they are true coinfections or if one of them is a false positive. They are most useful to me in the well appearing infant (>28 days old obviously) the pediatrician (from their home of course) wants me to do a full septic work up on.