Coronavirus: What questions do you have?

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Michael L said:
I was talking about your lung cancer post. :) I said maybe because I'm not prone to protecting myself from something that I'm not statistically likely to get, and yes... as I typed that I said "I hope I don't have to eat my words some day".

I wouldn't wish cancer on my worst enemy. It's already taken too much from me and if we can make a vaccine that protects people from getting COVID... oops... makes the symptoms milder if you take a booster... I mean take two boosters, maybe booster up for the rest of your life, they should have developed something for cancer a long time ago.

I don't take my vehicles to mechanics, one vehicle is fairly new and not likely to need anything and the other is a 2000 Landcruiser that I can work on, if I ever need to... anyway, if I had a mechanic that claimed that he fixed the loud squeak, then said he only made it quieter, then said bring it back again every six months and I'll make it quiet again, I wouldn't use that mechanic. Thankfully I don't need a mechanic.

If you're good with 6 months of trials for an all new type of vaccine developed for a virus of "questionable" origin I'm fine with that. I think it's sketchy at best. I've spent my lifetime not taking meds if I can help it. When I dislocated my shoulder in a motorcycle wreck the ambulance guy used up his morphine but it didn't work. Then when I finally got out of the ER 6 hours after getting there I didn't fill the pain med prescription. I simply didn't need it. I don't run to the doc every time my nose runs. That's not good, that's not bad, that's just me. I watch what I eat. I don't spend a lot of time in crowds. I've survived this doing the opposite of the majority and I've been fine.

We can't talk about the more current vaccination without inciting unfriendly comments from bystanders so I'm out of this topic at this point. Best wishes to all for a healthy, happy, and safe New Year. 73
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Best wishes to you for a healthy New Year as well. I’m of the opinion that anyone who doesn’t get vaccinated is almost guaranteed to get covid eventually. Of course, there’s a decent chance they won’t have a severe case or die, unless they are older or have other health issues, but it’s a gamble. That said, good luck!
 
Marc_G said:
Chuck,

I've got a question, let me start with the short version, then I'll add more detail for clarity about what I'm getting at.

Short version: So, my wife had the J&J one shot vaccine in early April, then the Moderna booster in Mid November. While it's probably too early for real data, I'm wondering based on your knowledge how her resistance to omicron is likely to be compared to a mRNA+booster (three shots) regimen. And, is there any reason to think folks like her might need a third shot anytime soon?

Longer ramblings:
Despite the different delivery methods between the adenovirus-based J&J versus mRNA-based Pfizer or Moderna shots, they largely do the same thing as far as I understand it: they coax the body into producing a bit of spike protein (the same one, among the three shots) over a period of hours to days, and the body then reacts to the spike protein and develops and immune response over a period of days to a month or so. The rate-over-time at which the body produces the spike protein and thus the various immune response components varies among the shots, based on nuances of the delivery mechanism. But, the data I've seen is that the two mRNA two-course regimens are broadly comparable in their effect, and the J&J single shot regimen produces less of a response, largely due to being a single shot regimen rather than due to the delivery mechanism. Again, because the body is complicated, nuances aren't trival; they actually have an impact at the end. So we see some statistically significant differences when we analyze immune components in cohorts of folks that have had different immunizations. But still, I'm working on an assumption that three mRNA shots over time likely gives a better immune response than one J&J shot plus one mRNA booster.
My wife works face to face with kids in a mental health setting, and televisits work poorly for what she does, and masks are impractical due to blocking so much nonverbal communication needed for her work, so she is "out there." I worry about her as her health is delicate.
Do you have any thoughts based on what we are hearing about omicron? The more immune response, the more effectiveness against the partially vaccine resistant omicron. So, since it seems to be a quantity play at the moment, I wonder about her getting a third shot sometime in the next month or two.
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I think you are protected. I am telling patients to keep listening to the news and to have an open dialog with the PCM. It is only a matter of time for the recommendations to change again. Your protection is probably not as good as modern, but it is probably adequate.
 
Update: Most of the US is in or starting to enter another spike. The numbers are increasing and the rise is exponential in many areas. We have 3700 cases today across GA. The admission rate is low and serious infections are even lower. That being said, the US had its first death with Omicron. The patient is from Texas and was unvaccinated. RIP.
 
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boatgeek said:
I have a question about dominant strains. I can see how a more infectious strain can become the one with the highest percentage of cases (delta then, omicron now), but I'm having trouble seeing how a less dominant strain dies out. I started down the line with this thought experiment...

* Assume an arbitrary population of 5-10 million. Some are vaccinated, some aren't; some people have had the virus already and some haven't. This is roughly the size of Washington State, and the case numbers below are reasonably representative of WA.
* The population is large enough and the dominant variant has been circulating long enough that it's settled into a pretty predictable pattern of about 1000 new infections per day. This is basically where the US was in April and November 2021, though at a higher daily case rate because of a higher population.
* The new kid shows up, and due to less vaccination resistance, less prior infection resistance, and more infectivity, it rapidly reaches 5000 new cases per day in our hypothetical population.

The new variant now has 83% of new infections. But given relatively steady state, wouldn't the old variant still keep on trucking with 1000 new cases/day? You wouldn't get to herd immunity for a year or two at least with that infection rate. Are there other mechanisms that would reduce the old variant's case counts?
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In your scenario, the old variant has an effective reproductive number r_eff of 1 and the new one has an r_eff greater than 1. This can work in the short term, but it is not sustainable. At a certain point, the new variant will generate so many new cases that they will be overwhelming. So something must change to get the situation back under control. This might be more or better vaccinations, more social distancing, more folks developing some natural immunity or a combination thereof. This will drive r_eff down for both variants, which means a value below 1 for the old variant, leading to a steady decay of that variant.

The same happened with the flu, before the COVID vaccines became available. Until this point, we only had non pharmaceutical interventions that also affected influenza which spreads slower than COVID. Anything that keeps COVID at least barely in check will drive the flu numbers down. Now that we rely more on the COVID specific vaccines and less on more generic non pharmaceutical interventions, the situation allows for a comeback of the flu.

Reinhard
 
Reinhard said:
In your scenario, the old variant has an effective reproductive number r_eff of 1 and the new one has an r_eff greater than 1. This can work in the short term, but it is not sustainable. At a certain point, the new variant will generate so many new cases that they will be overwhelming. So something must change to get the situation back under control. This might be more or better vaccinations, more social distancing, more folks developing some natural immunity or a combination thereof. This will drive r_eff down for both variants, which means a value below 1 for the old variant, leading to a steady decay of that variant.

The same happened with the flu, before the COVID vaccines became available. Until this point, we only had non pharmaceutical interventions that also affected influenza which spreads slower than COVID. Anything that keeps COVID at least barely in check will drive the flu numbers down. Now that we rely more on the COVID specific vaccines and less on more generic non pharmaceutical interventions, the situation allows for a comeback of the flu.

Reinhard
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Concur, but we need to keep using these preventive measures for a little longer.
 
I'm seeing stories in the news about the Army getting ready to announce a vaccine again "all?" coronaviruses. Can you tell us anything?
 
Update:

Computational models reveal that the Omicron variant has 30+ changes to the spike protein that result in the virus having a higher affinity to the ace receptor (stronger electrostatic bond) and less strong bond to the antibodies. Hence, it is more infectious and antibodies provide less protection. The models also show that natural infection provides 19% prevention in infection versus 20% with a one-shot vaccine. Moderna and Pfizer clearly provide superior protection. I have no data on AZ. Boosters appear to provide 40-60% protection against infections.

Symptoms: So far, there are fewer serious infections, but only 70% of the infections are Omicron alone. Live infections do provide protection against serious infections but it is believed to be shorter in duration. The reason to get vaccinated and continue protective protocols (masking and distancing) is to help prevent the impact on our workforce. Remember, if you test positive, it is important to quarantine and that impact could be devastating on a business or A hospital.
 
After two days of computer modeling, I feel comfortable that Omicron will spike quickly and burn itself out. I think it will spike differently in each state and then drop as quickly as it had risen. I think it will spike near when it did in the last two spikes. For GA, that is 10K per day. It is hard to predict US numbers because each state is going to spike at a different time. GA and SC will be at the same time. I cannot predict dates for the North and West at this time. I think they will be delayed, but with travel, all bets are out the door.
 
cwbullet said:
After two days of computer modeling, I feel comfortable that Omicron will spike quickly and burn itself out. I think it will spike differently in each state and then drop as quickly as it had risen. I think it will spike near when it did in the last two spikes. For GA, that is 10K per day. It is hard to predict US numbers because each state is going to spike at a different time. GA and SC will be at the same time. I cannot predict dates for the North and West at this time. I think they will be delayed, but with travel, all bets are out the door.
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Ohio now has a seven day average higher than last year's peak. Over 15,000 new cases yesterday. Deaths are increasing as well but, so far, not nearly as high as last year.
 
Peartree said:
Ohio now has a seven day average higher than last year's peak. Over 15,000 new cases yesterday. Deaths are increasing as well but, so far, not nearly as high as last year.
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I could be wrong, but I am not expecting as many deaths.
 
There's usually about a 2-4 week lag on deaths following the new cases trend. People linger on the vents a while before they pass.
 
Cnorm said:
Definitely good news.
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It is. I track the admission at over 30 facilities in the Southeast. Covid is less than 10% of admission at this time. Unfortunately, most facilities are near capacity with non-Covid admission. My biggest concern is loss of staff due to COVID infections. The plus is the CDC is allowing us to test HC workers at day 7 and if they are negative, they can return to work as long they are negative and asymptomatic.
 
cwbullet said:
It is. I track the admission at over 30 facilities in the Southeast. Covid is less than 10% of admission at this time. Unfortunately, most facilities are near capacity with non-Covid admission. My biggest concern is loss of staff due to COVID infections. The plus is the CDC is allowing us to test HC workers at day 7 and if they are negative, they can return to work as long they are negative and asymptomatic.
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What's driving the non covid admissions?
 
cwbullet said:
That seems high but I will believe you. I suspect that is 90% of all COVID admissions are unvaccinated.
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I thought that's how the newspaper quoted it, but I agree with you. That sounds much more likely/reasonable.
 
cwbullet said:
A lot of things: Poor diabetes control, sedentary lifestyle, poor medical follow-up for 18 months and general delay in care. I am sure we can find more.
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Ignoring covid, are you noticing anything unusual with these admissions or any increase from other years? It always seems the hospital is more full or overflowing this time of year even without covid.
 
NateB said:
Ignoring covid, are you noticing anything unusual with these admissions or any increase from other years? It always seems the hospital is more full or overflowing this time of year even without covid.
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Increase over prior years? No. Admissions are down in 2021. People have avoided the ER and their physicians. We are seeing a higher number of Influenza admission from the prior 2 years. I will pull the stats but I am pretty sure everything else is lower.

One thing is certain, we do have fewer beds available because we are only able to staff a lower number due to staff shortages.
 
When I got my booster shot They remembered me , it was still the same group of national guard doing the shots at the health dept. I asked what this one was, she looked at the label, and said, "you've already had the distemper and rabies shot, so this one is feline aids I guess" I quickly said, "Hey, I love my kitty, but it ain't like that! So we were cracking up as we left, and my sis was looking at me strange, lol. I was joking around with them when I got my original shots; I was amazed they remembered me.
 
Will there be a variant shot for Omicron?
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That is the question of the hour. It will be in human trials soon. If the variant lasts long enough and becomes endemic, then we will see a booster or shot for Omicron.
 
I notice that in NY the Gov says that over 90% are vax’d, with over 70% fully vax’d. Worldometer reports that the new case rate for NY is over double any of the previous daily peaks. So vaxing doesn’t seem to affect the case rate. If this season repeats last year’s pattern the the peak will spread to most other states within a couple months. Main difference this year seems to be that hospital admissions are a much lower % of total daily case rate, so there’s hope for much lower deaths than last year.
I’m fully vaxed but high risk so I haven’t been out other than grocery shopping. Thank goodness for internet shopping and big rocket pile.
 
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