Coronavirus: What questions do you have?

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cwbullet

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@cwbullet first I hope your test is negative. Second, is the downward trend you reported a few days ago continuing?
Yes, sort of. It is very gradual. I would say we are on a slowly decreasing plateau. 4220 today and the 8 day average is 4700-4900 in GA. We are seeing similar numbers across the south. I do not want to declare a "mission complete" moment, but I think this spike is trending down.

Also, my test is negative. The reason I worry is I do nto like ordering tests for admin reasons. The tests are too expensive and they do not rule out infections.
 

RobCamele

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How is monoclonal antibody treatment used at your facility? Who gets it? When? What are the current indications for its use? Has it had any effect on hospitalizations and/or deaths?
 

cwbullet

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How is monoclonal antibody treatment used at your facility? Who gets it? When? What are the current indications for its use? Has it had any effect on hospitalizations and/or deaths?
We have several trials proceeding in a few our facilities. It really depends on the drug and the facility. Some are testing outpatients to prevent admission and others are using them on admitted patients to prevent deaths.

One trial looked at Bamlanivimab plus etesevimab, which are neutralizing monoclonal antibodies. We stopped using them and the trial was stopped. The newer variants are not as susceptible to them. I would recommend against this treatment.

Another AB of interest is Casirivimab plus imdevimab. It binds to an inactivates the spike protein. It is not a magic gun but it does show a significant reduction in hospitalization and death. I think it was around 60-70% but varies with age.

The better treatment in my book will be sotrovimab. It has show to reduce hospitalization and death by over 80%.

All of these are under and EUA or investigational agreement. The indication vary by facility. Ours typically are:
  • Patient is high risk for developing severe COVID-19 and:
    • Have a positive COVID-19 test and have not yet been admitted to the hospital and
      • Are 12 years of age or older
      • Weight at least 88 pounds
      • Not fully vaccinated or vaccinated but immunocompromised
 

rocketsaway

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Just saw today that 30% of all Covid cases in the US right now are kids. Too many schools/states not taking appropriate steps to protect kids going back to school. Too many people are not thinking about the children.
Masks are "recommended" in my school district. School buses are packed, running double routes, because of a driver shortage.
We are not allowed to "enforce" mask wearing on the bus. 2020-2021 year we did.
Fortunately, I only have 5 students on my bus. The jewish kids take off their masks, while the catholic kids wear them.
From what I hear, none of the public school kids wear masks on the bus.
The catholic schools have very strict protocols.
Current county positivity rate is 7.5%
 

cwbullet

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This thread is for COVID question. Does anyone have a question? Reply to this post with our question.
 

Marc_G

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This thread is for COVID question. Does anyone have a question? Reply to this post with our question.
Chuck, two questions:

1. do you have much experience with the ECMO treatment described in this article? Thoughts on it as applies to Covid?


2. The article makes an unfortunate mathematical error in the graph comparing hospitalization percentages:

Screenshot_20210919-172555.jpg


It adds up to 102.5%

My question on this is: while the exact numbers above may be a bit off, the trend is pretty clear... But have you seen any trend data to suggest significant changes due to waning vaccination protection?
 

SharkWhisperer

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What are your thoughts on India's predicted third wave not occurring, at least not yet?

They continue vaccination efforts but as of today only report 15% fully vaccinated (202 million of a population of 1,353 million). Their Ministry of Health actively discourages masking ("Only wear a mask if you are ill with COVID-19 symptoms (especially coughing) or looking after someone who may have COVID-19."), though it's likely this is to preserve mask availability for healthcare workers.

This graph is from the WHO's India Situation Report #85, released Sept 15. Whoever made this graph for WHO and typed the official numbers at the Ministry of Health website apparently have difficulty with comma placement in large numbers...
1632089605600.png

 

cwbullet

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Chuck, two questions:

1. do you have much experience with the ECMO treatment described in this article? Thoughts on it as applies to Covid?


2. The article makes an unfortunate mathematical error in the graph comparing hospitalization percentages:

View attachment 482600

It adds up to 102.5%

My question on this is: while the exact numbers above may be a bit off, the trend is pretty clear... But have you seen any trend data to suggest significant changes due to waning vaccination protection?
  1. ECMO is not available in my hospitals. I have to refer patients. We have done it a few times with success. There is not enough ECMO in the US so it has to be used judiciously. It takes a very specialized team and there are not enough in the US for all fo COVID patients. It is also not really indicated for all.
  2. Concur with the math error. My OCD will not let me look past it.
  3. The Trend is a small increase in the waning of protection. Who knows when it will become significant. The vaccine still protects most against death and hospitalization.
 

NateB

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We do ECMO and can transport pts in ECMO on our ground unit. My personal experience with it is limited to stabilizing pts enough to survive transport to be placed on ECMO and dedicated team with specialized nurses and a perfusionist attend to the patient once they are placed on it. If they are cannulated and transported on our ambulance, the perfusionist and the ECMO specialist nurse joins our team for the trip.

I do know that it has been used successfully with Covid, but the time required on it is long which brings up other problems. The docs have strict criteria for who to attempt it on.
 

cwbullet

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What are your thoughts on India's predicted third wave not occurring, at least not yet?

They continue vaccination efforts but as of today only report 15% fully vaccinated (202 million of a population of 1,353 million). Their Ministry of Health actively discourages masking ("Only wear a mask if you are ill with COVID-19 symptoms (especially coughing) or looking after someone who may have COVID-19."), though it's likely this is to preserve mask availability for healthcare workers.

This graph is from the WHO's India Situation Report #85, released Sept 15. Whoever made this graph for WHO and typed the official numbers at the Ministry of Health website apparently have difficulty with comma placement in large numbers...
View attachment 482602
I think India's next wave is inevitable. I think we see a spike every 4-8 months. I am not sure why, but I suspect that people tend to become arrogant between spikes and start venturing out again. Also, the rise of mutations could play a part in the time line because it is variable. Since, the delta variant, we have not seen a new variant that become significant regionally to date. There are a couple possibilities but not significant yet.
 

Peartree

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Concur with the math error. My OCD will not let me look past it.
Two possibilities:

1) there was a math error that allows the options to add to greater than 100 percent,

or

2) the questions were structured in such a way that a small amount of overlap was allowed to exist between to categories (such as "vaccinated less than 14 days before positive test" and one of the two vaccinated statuses.
 

cwbullet

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Two possibilities:

1) there was a math error that allows the options to add to greater than 100 percent,

or

2) the questions were structured in such a way that a small amount of overlap was allowed to exist between to categories (such as "vaccinated less than 14 days before positive test" and one of the two vaccinated statuses.
Good points.
 

les

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I am eligible for a booster shot. Original vax was Pfizer. Assuming both Pfizer and Moderna shots are available locally, which would be better?
Pfizer to stay with the same?
Or since Moderna appears to more effective should I consider that?
 

cwbullet

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I am eligible for a booster shot. Original vax was Pfizer. Assuming both Pfizer and Moderna shots are available locally, which would be better?
Pfizer to stay with the same?
Or since Moderna appears to more effective should I consider that?
I would get Pfizer. Although we assume a Moderna booster will work in those immunized with Pfizer, it has not been tested.
 

afadeev

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I would get Pfizer. Although we assume a Moderna booster will work in those immunized with Pfizer, it has not been tested.
Chuck,
Is there any possible down side to "jumping the wagon" on vaccines, or double-vaccinating?

In other words, for someone who had been filly vaccinated with J&J or Pfizer, any reason not to re-start the process and go for 2 Moderna shots, now that Moderna has turned out to be providing a more enduring protection?

a
P.S.: Yes, I do realize that these are 1st world problems.
 

cwbullet

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Chuck,
Is there any possible down side to "jumping the wagon" on vaccines, or double-vaccinating?

In other words, for someone who had been filly vaccinated with J&J or Pfizer, any reason not to re-start the process and go for 2 Moderna shots, now that Moderna has turned out to be providing a more enduring protection?

a
P.S.: Yes, I do realize that these are 1st world problems.
This is a tough question. In theory, it with increase the immune response. The question would be when is this going to be too much of a response. I cannot answer that question. I am not saying that you are going to get a cytokines storm from the vaccine but it could be deleterious. There is just no research to back doing this. A booster shot is helpful but not needed at this stage, 2 shots?

I would like to assume it is safe, but we will not know until a couple hundred thousand of our friends step forward for 2 extra jabs and the research is correlated.
 
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Peartree

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I would like to assume it is safe, but we will not know until a couple hundred thousand of our friends step forward for 2 extra jabs and the research is correlated.
Does that mean that there *is* a clinical trial ongoing?
 

Marc_G

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Additive to what Chuck posted here is an article directly relevant to the discussion about boosters and mix-n-match:


The CDC guidance is currently clear to stick with same brand when boosting until/unless new data suggests otherwise, as Chuck said.

Note that all three shots cause us to generate the same protein, and form immune response against it, generating the same subset of antibodies. The apparent difference in effectiveness seems to based on the fact that the differences in vaccine method/dose cause a different profile of how much spike protein we produce over time, leading to some difference in our bodies' immune response.

By the time we get to a third shot, probably any re-introduction of spike protein is likely to be largely equivalent in revving up our existing response. However, it's appropriate that we wait for the data, for both efficacy and safety.
 

Antares JS

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Hi Chuck, a relative of mine is claiming her husband died recently of myocarditis because of the vaccine. Can you comment on how likely this is? I can't find numbers, I can only find that this happened to one person in New Zealand a few weeks ago.
 
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Bat-mite

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Hi Chuck, a relative of mine is claiming her husband died recently of myocarditis because of the vaccine. Can you comment on how likely this is? I can't find numbers, I can only find that this happened to one person in New Zealand a few weeks ago.
You might be able to request data from VAERS.

Chuck will give you the "official" response. But the CDC says this.

It is a known side-effect for a small number of people, mostly young and male. Since one cannot know whether or not he will experience any side effect to any medication, there is always an associated risk to taking any medication. The question that one needs to evaluate is: which risk is bigger? The potential side effects or the illness itself?

In the case of COVID, the risk is mathematically far higher for going unvaccinated than for the potential side effects of getting vaccinated. Sadly, however, for the person who draws the red marble out of the bag with 9999 white marbles, the math doesn't help. Very sorry for your relative. :(
 

Marc_G

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It's also important to know that myocarditis is not unusual in men so it's not something that can be pinned on the vaccine. I have a good friend who had a bad case years ago, not associated with vaccinations. Hospitalized for days; recovered ok.
 

Bat-mite

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It's also important to know that myocarditis is not unusual in men so it's not something that can be pinned on the vaccine. I have a good friend who had a bad case years ago, not associated with vaccinations. Hospitalized for days; recovered ok.
There is linkage to immune response, but you can also get it from your body's natural response to fighting COVID. My wife knows of a young boy who got COVD and then myocarditis. So, there is a likelihood that if you got myo from the vaccine, you would also have gotten it from COVID if you didn't vaccinate.

Again, all these what ifs and maybes and who knows aren't any comfort to those dealing with a loss. The natural grief response when dealing with a loss is to seek something/one to blame it on. The vaccine is an easy target.
 

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It's also important to know that myocarditis is not unusual in men so it's not something that can be pinned on the vaccine. I have a good friend who had a bad case years ago, not associated with vaccinations. Hospitalized for days; recovered ok.
It is actually more common with the virus than the vaccine.
 

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FDA approved Gout drug may be a drug of the future to treat COVID. Probenecid appears to stop viral replication. There might be EUA coming but I wouldn't take it yet or hoard.

 
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cwbullet

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Will there be another spike?
That is the million dollar question. I think there will be smaller spikes as long as people avoid vaccination. We are on a 1-2 week decline. The deaths are up 40% in 2 weeks. The relative infection rate is still high. We are not out of this yet. The R.1 variant in Japan and KY is very concerning.
 

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My only question is does this thing warrant the hype? I mean, should people, be concerned past a basic level of hygiene?
Does what warrant the hype? Covid - heck yes. If you speaking of something else, let me know.
 

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Hospitals here (Northeast Ohio) are officially reporting that they are "slightly reducing" elective surgeries, but we have a local man, a brother of a church member, who came down with pneumonia (not COVID related as far as we know) and the only hospital with an available bed was/is over a hundred miles away. There is an anecdotal story circulating of a young man who died from a burst appendix while he was waiting for an available hospital bed. This is not a good situation. I am urging everyone I know to drive carefully, care of themselves and those around you, and try not to get sick because all of our hospitals are understaffed and overworked even if "officially" they are only "slightly" changing their regular procedures.
 

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Hospitals here (Northeast Ohio) are officially reporting that they are "slightly reducing" elective surgeries, but we have a local man, a brother of a church member, who came down with pneumonia (not COVID related as far as we know) and the only hospital with an available bed was/is over a hundred miles away. There is an anecdotal story circulating of a young man who died from a burst appendix while he was waiting for an available hospital bed. This is not a good situation. I am urging everyone I know to drive carefully, care of themselves and those around you, and try not to get sick because all of our hospitals are understaffed and overworked even if "officially" they are only "slightly" changing their regular procedures.
I turned down going to a rocket launch in part because of hospital census numbers in the area. We had a lot going on, but the final nail was that there weren't hospital beds available within 50 miles of the launch site. I know that serious injuries in rocketry are rare, but I've seen one happen (person didn't look up when LCO called a heads up on a ballistic rocket) and if it happens to me, I want to be able to get seen.
 
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