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I've read your posts in the hyponatremia thread, don't come in here telling us about medicine 101.
This is extremely vague. I presented a case and asked questions. My asking for opinions on a relatively complex anesthetic scenario is a sign of weakness? What should I do instead? Pretend I have all the answers like the people here? No thanks, I will continue to ask questions, if that to you is a sign of weakness, when I try to fill any defecits in my knowledge, then you know what? Go back into your echo chamber.I've read your posts in the hyponatremia thread, don't come in here telling us about medicine 101.
This is extremely vague. I presented a case and asked questions. My asking for opinions on a relatively complex anesthetic scenario is a sign of weakness? What should I do instead? Pretend I have all the answers like the people here? No thanks, I will continue to ask questions, if that to you is a sign of weakness, when I try to fill any defecits in my knowledge, then you know what? Go back into your echo chamber.
Of course. This has little to do with vaccines in general per se. It has to do with the fact the safety in this novel vaccine is unknown. The fact that prior vaccines for SARS has been not only ineffective but made people worse off in the long term.Just out of curiosity, you’re pro-vaccination for the ones that have decades of data like MMR, tdap, hep b, varicella, influenza, etc, right?
I am not abstaining from vaccination. I’m still not sold on the excess optimism that isn’t supported by the data but the risk benefit analysis didn’t look good for catching COVID either. My point is that this isn’t an all or nothing discussion here. There is room for caution without painting the cautious as tin foil hatters. Yes, some are excessive in their worry, but there IS room for some objective analysis too.
bt dubs you get vaccine safety data for COVID the same way you get it for any other vaccine- time and process. The anxiety for many is that we are shortchanging both. The question that I’m not smart enough to answer is- are our protocols and data robust enough, and is the situation dire enough, to pilot an abridged process right now?
Based on what? You have zero data to make this assertion. What data do you have to come to your conclusion? Absolutely none. Its frustrating the amount of people who comment with such determination and with such eagerness as if they are expert, and have absolutely nothing to back their assertions. These are the same people deriding others as tinfoil hat wearers. The amount of projection here is unbelievable.
This is extremely vague. I presented a case and asked questions. My asking for opinions on a relatively complex anesthetic scenario is a sign of weakness? What should I do instead? Pretend I have all the answers like the people here? No thanks, I will continue to ask questions, if that to you is a sign of weakness, when I try to fill any defecits in my knowledge, then you know what? Go back into your echo chamber.
I am not abstaining from vaccination. I’m still not sold on the excess optimism that isn’t supported by the data but the risk benefit analysis didn’t look good for catching COVID either. My point is that this isn’t an all or nothing discussion here. There is room for caution without painting the cautious as tin foil hatters. Yes, some are excessive in their worry, but there IS room for some objective analysis too.
bt dubs you get vaccine safety data for COVID the same way you get it for any other vaccine- time and process. The anxiety for many is that we are shortchanging both. The question that I’m not smart enough to answer is- are our protocols and data robust enough, and is the situation dire enough, to pilot an abridged process right now?
You’re misinterpreting what I’m saying. The place where there is a binary decision is to get vaccinated or not to get vaccinated. We don’t disagree on that. We agree even that the risk of unknowns from vaccine is likely less harmful from the consequences of COVID.Actually this is indeed an all or nothing decision. There exists a dichotomy. Your choices are 1) to get vaccinated or 2) to NOT get vaccinated. There is no such thing as a little vaccinated or "just a little bit" unvaccinated. We have several months of data on several hundred thousand people across the world at this point. At this point we are indeed cautiously optimistic.
The problem is that you are looking for 10 year data on this topic, but alas you will have to wait 10 years for that to come out. In the meantime asymptomatic carriers continue to spread this virus. Your request for "time and process" is the equivalent of recruiters looking for computer programmers with 5 years of experience in <insert new coding language here>. Only problem is that the language was only developed 1 year ago...
Personally just generally concerned about the abridged process, less so the route of delivery. I’m actually pretty excited about mRNA vaccines in genera, sounds like a pretty cool way to go about vaccine developmentShouldn't we all be hesitant about any treatment that has very little evidence short or long term to support its mass use? This is medicine 101.
Again vague. You are being petty for the sake or being petty. You obviously have a lot riding on your image.
I asked what would be peoples anesthetic preference in the setting of an urgent c section in a patient with profound hyponatremia.
Go for it, give me your petty reasons as to why this was a poor case.
Again being vague. A scholar such as yourself that can make accusations such as this "The case you presented and the questions you asked undermine your education as a physician if that’s in fact what you are.", should be able to lay out your case. So why don't you lay out your case instead of scurrying away? Referencing someone else's statement shouldn't suffice. Layout your specific reasoning to claim that the questions I asked undermine my education as a physician. Come on Aristotle, lets hear your evidence.Sounds like I'm being petty about the petty of my pettiness. Is that overly petty? You're right, I have a lot riding here on my online anonymous image.
I found myself thinking what @SaltyDog posted in that thread, FWIW.
As far as this thread goes, it's looking more and more dumpster fireish. So I'll not contribute my part to it any longer.
Actually this is indeed an all or nothing decision. There exists a dichotomy. Your choices are 1) to get vaccinated or 2) to NOT get vaccinated. There is no such thing as a little vaccinated or "just a little bit" unvaccinated. We have several months of data on several hundred thousand people across the world at this point. At this point we are indeed cautiously optimistic.
The problem is that you are looking for 10 year data on this topic, but alas you will have to wait 10 years for that to come out. In the meantime asymptomatic carriers continue to spread this virus. Your request for "time and process" is the equivalent of recruiters looking for computer programmers with 5 years of experience in <insert new coding language here>. Only problem is that the language was only developed 1 year ago...
I will be the direct one, I am not concerned with making an example of anyone.Sounds like I'm being petty about the petty of my pettiness. Is that overly petty? You're right, I have a lot riding here on my online anonymous image.
I found myself thinking what @SaltyDog posted in that thread, FWIW.
As far as this thread goes, it's looking more and more dumpster fireish. So I'll not contribute my part to it any longer.
Oof. Been there. The first year with my twins was the only time I’ve ever drank daily.
the risk of my dying or being severely ill is less than 0.009%, and that is for all comers in my age group, which includes obese and people suffering concomitant illnesses. I am exceptionally healthy therefore my risk is significantly lower than 0.009%
Out of curiosity, how are you calculating this 0.009%? You mean if you contact covid19, or are you somehow multiplying in your population risk of getting it times risk of morbidity?
Everything (reputable) I’ve read shows higher rates of morbidity/morality, except maybe children.
Please link source. Because while there are certainly unknowns about the vaccines, even a risk of even 0.3% is a much different decision than than 0.009% (you are saying your risk of any serious outcome after contracting covid19 is less than 1 in 10,000)
Out of curiosity, how are you calculating this 0.009%? You mean if you contact covid19, or are you somehow multiplying in your population risk of getting it times risk of morbidity?
Everything (reputable) I’ve read shows higher rates of morbidity/morality, except maybe children.
Please link source. Because while there are certainly unknowns about the vaccines, even a risk of even 0.3% is a much different decision than than 0.009% (you are saying your risk of any serious outcome after contracting covid19 is less than 1 in 10,000)
Shouldn't we all be hesitant about any treatment that has very little evidence short or long term to support its mass use? This is medicine 101.
Personally just generally concerned about the abridged process, less so the route of delivery. I’m actually pretty excited about mRNA vaccines in genera, sounds like a pretty cool way to go about vaccine development
Actually, you have this backwards. We have data on how covid will affect populations. We have a very reasoned answer to outcomes based on age and comorbidities. Of course one never knows how one will react in the course of any illness but we do have meaningful data based on age and comorbidity.I was asking a genuine question because a lot of people in general have been focusing on mrna, so I was wondering if it was specific to mrna concerns or were people ok with the other vaccines?
But anyway to answer your question, we’re in a pandemic that’s killing a lot of people daily. Yes in an ideal situation we wouldn’t be in a pandemic, we would’ve seen this coming and could’ve magically been testing the vaccine on people 5 years ago and have robust data now. But that’s not our reality.
But since we don’t and With the evidence we have now, covid itself seems like a bigger immediate threat to our population and well-being, vaccinate away. I’m actually in a vaccine trial myself so yes I decided that the science seemed ok enough to me to take a small risk to help advance science for others.
Of course I understand if people have questions but all the data we have now says the vaccine is safe (safer than Covid because no one can predict exactly how Covid will affect someone) and during a pandemic that is killing millions of people it’s not practical to wait 5 years for longer term data.
Medicine 101 (ok maybe 201 once you start actually treating people) is mostly about weighing risks vs benefits, and this is just another example of that.
Maybe I missed it, but when and who made that claim?Actually, you have this backwards. We have data on how covid will affect populations. We have a very reasoned answer to outcomes based on age and comorbidities. Of course one never knows how one will react in the course of any illness but we do have meaningful data based on age and comorbidity.
Again we did see this coming. There were vaccine trials in 2005 for the first SARS-COV and there were issues in developing that vaccine. You state all the data we have now regarding the vaccine is not concerning. The data we have now is extremely limited. The risks and outcomes surrounding this vaccine are an unknown. I am not sure why people insist on repeating the same untruths over and over in this discussion, as if those untruths will somehow make it more real. We don’t have any long term data. Zero. To claim we know this vaccine is safe long term is an absolute fallacy.
Actually, you have this backwards. We have data on how covid will affect populations. We have a very reasoned answer to outcomes based on age and comorbidities. Of course one never knows how one will react in the course of any illness but we do have meaningful data based on age and comorbidity.
Again we did see this coming. There were vaccine trials in 2005 for the first SARS-COV and there were issues in developing that vaccine. You state all the data we have now regarding the vaccine is not concerning. The data we have now is extremely limited. The risks and outcomes surrounding this vaccine are an unknown. I am not sure why people insist on repeating the same untruths over and over in this discussion, as if those untruths will somehow make it more real. We don’t have any long term data. Zero. To claim we know this vaccine is safe long term is an absolute fallacy.
There have been a number of posts claiming that the risk benefit ratio tilts heavily in favor of benefit for the vaccineMaybe I missed it, but when and who made that claim?
There have been a number of posts claiming that the risk benefit ratio tilts heavily in favor of benefit for the vaccine
There have been a number of posts claiming that the risk benefit ratio tilts heavily in favor of benefit for the vaccine
Like I’ve said before, there is absolutely zero evidence to suggest that receiving the vaccine is in any way beneficial in preventing transmission.How about the tie the 2G pp stimulus to the vaccine? Anyone who voluntarily wants the vaccine can get 2G for it. People who don't want it don't have to get it. Numbers will probably reach herd immunity levels.
Check the post right below you. The poster is claiming for the population as a whole the benefits outweigh the risks. That is an impossible claim to make at this point.
I'm pro vaccination but i can agree with a lot of the points raised here.Exactly my point. This is the type of thinking that is dangerous. "You need to get the vaccine, because youre killing your patients" Based on what evidence? You make a lot of assumptions based on zero evidence. I am not killing anyone by not being vaccinated, and you have zero idea the long term effects of this drug, let alone the short term effects, if this drug prevents asymptomatic spread in those who take the drug, and how long this drug protects the person who takes it. You make a lot of assumptions and pontificate as if you are the holder of these truths. You aren't. You are in no better position than any of us. We are all wading through this, and for you to stand up and pretend like you know better than anyone else is not based at all in fact or in you knowing that this drug is the cure all.
Editorials
Asymptomatic transmission of covid-19
BMJ 2020; 371 doi: Asymptomatic transmission of covid-19 (Published 21 December 2020)Cite this as: BMJ 2020;371:m4851
What we know, and what we don’t
- Allyson M Pollock, professor of public health1,
- James Lancaster, independent researcher2
- Author affiliations
- Correspondence to: A M Pollock [email protected]
The UK’s £100bn “Operation Moonshot” to roll out mass testing for covid-19 to cities and universities around the country raises two key questions. How infectious are people who test positive but have no symptoms? And, what is their contribution to transmission of live virus?
Unusually in disease management, a positive test result is the sole criterion for a covid-19 case. Normally, a test is a support for clinical diagnosis, not a substitute. This lack of clinical oversight means we know very little about the proportions of people with positive results who are truly asymptomatic throughout the course of their infection and the proportions who are paucisymptomatic (subclinical), presymptomatic (go on to develop symptoms later), or post-infection (with viral RNA fragments still detectable from an earlier infection).
Earlier estimates that 80% of infections are asymptomatic were too high and have since been revised down to between 17% and 20% of people with infections.12 Studies estimating this proportion are limited by heterogeneity in case definitions, incomplete symptom assessment, and inadequate retrospective and prospective follow-up of symptoms, however.3 Around 49% of people initially defined as asymptomatic go on to develop symptoms.45
It’s also unclear to what extent people with no symptoms transmit SARS-CoV-2. The only test for live virus is viral culture. PCR and lateral flow tests do not distinguish live virus. No test of infection or infectiousness is currently available for routine use.678 As things stand, a person who tests positive with any kind of test may or may not have an active infection with live virus, and may or may not be infectious.9
The relations between viral load, viral shedding, infection, infectiousness, and duration of infectiousness are not well understood. In a recent systematic review, no study was able to culture live virus from symptomatic participants after the ninth day of illness, despite persistently high viral loads in quantitative PCR diagnostic tests. However, cycle threshold (Ct) values from PCR tests are not direct measures of viral load and are subject to error.10
While viral load seems to be similar in people with and without symptoms, the presence of RNA does not necessarily represent transmissible live virus. The duration of viral RNA shedding (interval between first and last positive PCR result for any sample) is shorter in people who remain asymptomatic, so they are probably less infectious than people who develop symptoms.11
Viral culture studies suggest that people with SARS-CoV-2 can become infectious one to two days before the onset of symptoms and continue to be infectious up to seven days thereafter; viable virus is relatively short lived.7Symptomatic and presymptomatic transmission have a greater role in the spread of SARS-CoV-2 than truly asymptomatic transmission.121213
The transmission rates to contacts within a specific group (secondary attack rate) may be 3-25 times lower for people who are asymptomatic than for those with symptoms.1121415 A city-wide prevalence study of almost 10 million people in Wuhan found no evidence of asymptomatic transmission.16 Coughing, which is a prominent symptom of covid-19, may result in far more viral particles being shed than talking and breathing, so people with symptomatic infections are more contagious, irrespective of close contact.17 On the other hand, asymptomatic and presymptomatic people may have more contacts than symptomatic people (who are isolating), underlining the importance of hand washing and social distancing measures for everyone.
Missed opportunity
By failing to integrate testing into clinical care, we have missed an important opportunity to better understand the role of asymptomatic infection in transmission. Given the variation in prevalence and testing strategies by region, the proportions of people with positive and negative test results should be published alongside the purpose of the testing strategy and the population tested (screening healthy populations in schools, universities, and health and social care, or testing people with symptoms). Government regulations on recording the age, ethnicity, sex, and place of residence of people with positive results must also be followed.18
Searching for people who are asymptomatic yet infectious is like searching for needles that appear and reappear transiently in haystacks, particularly when rates are falling.19 Mass testing risks the harmful diversion of scarce resources. A further concern is the use of inadequately evaluated tests as screening tools in healthy populations.20
The UK’s testing strategy needs to be reset in line with the Scientific Advisory Group for Emergencies’ recommendation that “Prioritising rapid testing of symptomatic people is likely to have a greater impact on identifying positive cases and reducing transmission than frequent testing of asymptomatic people in an outbreak area.”21
Testing should be reintegrated into clinical care with clinical and public health oversight and case definitions based on clinical diagnosis. Carefully designed prospective studies of cases and contacts are needed to estimate transmission rates by people with and without symptoms. These should include careful investigations of outbreaks—for example, testing all contacts of people with a clear history of exposure, especially in high risk environments such as nursing homes, prisons, and other institutional settings.
Coronavirus infection surveys by the Office for National Statistics22 and the REACT survey23 could be expanded to include clinical follow-up of participants combined with tests of viral load and viral cultures. The absence of strong evidence that asymptomatic people are a driver of transmission is another good reason for pausing the roll out of mass testing in schools, universities, and communities.
What do we know? Not a lot. So you claiming to know what is happening and how to react and shaming me or anyone else who chooses to not take this drug that is a complete unknown is completely unwarranted and reckless on your behalf.
I'm pro vaccination but i can agree with a lot of the points raised here.
Overall i believe (but yes it's just a belief) that injecting a little bit of chopped up protein is very benign when you consider all the crap we submit our bodies to.
Hygiene vaccination and penicilline have saved a hell of a lot more lives that an Miller 2 or a Mac 3.
I think something is completely off with this person. Like something is missing. The elevator/lift does not go all the way to the penthouse/top floor.It’s fine to question the vaccine. It’s just difficult believe someone has been face to face with bad Covid (that our icus are full of right now), then look at the vaccine data for prevention and transmission, and think that for the entire population the vaccine is more dangerous than the disease. Matter of fact it’s unscientific.
How will we obtain long term data on vaccination? By tracking the disease and how the population responds to covid post-vaccination. There’s no other way.
Let me reiterate for the majority of the population the risk benefit is simply not been proven.
We don't know the long term risk, the vaccine could affect a much broader population in an adverse way. Therefore it would be prudent to vaccinate those at highest risk.
The risk of the virus is not just about you or me catching it and dying.Let me reiterate, the majority of deaths have been in subpopulations.
Let me reiterate for the majority of the population the risk benefit is simply not been proven. Sure if you are in a higher risk population, such as elderly, obese etc, then it could tilt in favor of the vaccine. But to claim that we understand the risk of the vaccine to be less than the risk of covid is simply untrue. Science is a materialist philosophy that relies on observation. The only observation available is the past. The past attempts at a vaccine have been wrought with failure for SARS. That is what I am saying. It isn’t a controversial stance.
I think Blade pushed harder for hcq than the pharm industry.I saw how they pushed hydroxychloroquine
I think Blade pushed harder for hcq than the pharm industry.
There are threads for all four of these subjects on the first page of the forum, right now.SDN in 2010:
- How to be PP Slick
- AANA is Crazy
- How do I pick fellowship?
- Is this a good PP contract?
In 2010 we had physicians acting crazy about Obama and there wasn't a swine flu vaccine to deny.SDN in 2020:
- Physicians acting crazy about Trump
- Physicians fervently denying a vaccine
Wtf happened to some of you? Were you always crazy and now feel safe to let it out post 2016?
Like I’ve said before, there is absolutely zero evidence to suggest that receiving the vaccine is in any way beneficial in preventing transmission.
“
- The World Health Organization's chief scientist, Dr. Soumya Swaminathan, has urged people to be cautious with their behavior even after receiving a COVID-19 vaccine.
- Swaminathan told a Monday briefing there was not yet enough evidence from vaccine trials "to be confident that it's going to prevent people from actually getting the infection and therefore being able to pass it on."
- She added that at least for now, even people who had received the vaccine should still quarantine when traveling to countries with lower coronavirus transmission rates.
- Vaccine researchers in the US are trying to determine whether vaccines can stop the virus from spreading or are effective only at preventing symptomatic cases of COVID-19.”
That sucks really.But that vaccine....