Coronavirus: What questions do you have?

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boomtube-mk2

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Hopefully, it's not as deadly.
As our treatment options and success rates improve, and vaccination penetration increases (as well as the boosters), this will become an endemic source of a manageable disease. Larger spikes in infection will become seasonal, or new variant wave driven, "normal" occurrences. We'll just learn to stop freaking out about it.

Forget about achieving herd immunity - it ain't happening in the US, never mind in less medically capable parts of the world. In the entire modern history of the world, we've only managed to eradicate one and only one virus, smallpox, after decades of global vaccination efforts. There is zero political will to attempt anything of the kind with Covid-19.


One question we are going to have to answer and come to terms with is; what is an "Acceptable yearly death rate due to Covid19"?
The U.S. looses anywhere from 36,000 to as many as 60,000 a year from the flu.
Will we accept the same figure from Covid19?
What if after all acceptable measures we get an annual death rate of twice that of the flu?
What if it is much worse; say upwards of 250,000 a year, year after year after year.
Will we just learn to deal with it and move on?
Or will there be a concerted effort, along with some pretty draconian measures, implemented to get that quarter-million down to something we can "live with?
 

Bat-mite

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Hopefully, it's not as deadly.
As our treatment options and success rates improve, and vaccination penetration increases (as well as the boosters), this will become an endemic source of a manageable disease. Larger spikes in infection will become seasonal, or new variant wave driven, "normal" occurrences. We'll just learn to stop freaking out about it.

Forget about achieving herd immunity - it ain't happening in the US, never mind in less medically capable parts of the world. In the entire modern history of the world, we've only managed to eradicate one and only one virus, smallpox, after decades of global vaccination efforts. There is zero political will to attempt anything of the kind with Covid-19.


Interesting reads, thanks.
 

boatgeek

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One question we are going to have to answer and come to terms with is; what is an "Acceptable yearly death rate due to Covid19"?
The U.S. looses anywhere from 36,000 to as many as 60,000 a year from the flu.
Will we accept the same figure from Covid19?
What if after all acceptable measures we get an annual death rate of twice that of the flu?
What if it is much worse; say upwards of 250,000 a year, year after year after year.
Will we just learn to deal with it and move on?
Or will there be a concerted effort, along with some pretty draconian measures, implemented to get that quarter-million down to something we can "live with?
Well, in a way, we're finding out. The last 12 months were ~500K deaths from COVID. 200K of that was in the December 2020-March 2021 timeframe when vaccines weren't widely available. Another 100K was in March-June 2021. Finally, there were another 200K between June and December 2021 when vaccines were widely available, though uptake varied. In the best case scenario, we're looking at ~300-400K deaths/year. At this point, there are two basic paths in the road depending on who is in charge in your state/country:

(a) Nothing to see here, we're tired of lockdown, let's open everything up and to heck with the consequences!
(b) Let's get everybody vaccinated and exercise a little common sense maybe we can knock this down to a more reasonable level of risk.

I'm obviously biased here, but I don't think that I'm presenting either path unfairly (though (a) is obviously a little exaggerated). I don't think that there's much appetite for significant restrictions other than mask and vaccine mandates in most places. And to more directly answer your question, people get used to "a new normal." If we have 400K deaths/year over the next two years, despite vaccine and mask mandates, then everyone is going to pretty much get used to that level of risk, and it will be the new baseline.

I agree with @afadeev that we're never getting to herd immunity--this is endemic. Even New Zealand has given up on stamping it out.
 

cwbullet

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Hopefully, it's not as deadly.
As our treatment options and success rates improve, and vaccination penetration increases (as well as the boosters), this will become an endemic source of a manageable disease. Larger spikes in infection will become seasonal, or new variant wave driven, "normal" occurrences. We'll just learn to stop freaking out about it.

Forget about achieving herd immunity - it ain't happening in the US, never mind in less medically capable parts of the world. In the entire modern history of the world, we've only managed to eradicate one and only one virus, smallpox, after decades of global vaccination efforts. There is zero political will to attempt anything of the kind with Covid-19.


We might be experiencing that now. I am reading a lot about the potential wimplification of the virus through mutations that make it weaker. If it does become endemic, it will probably be less and different,
 

BABAR

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I think it is important on this thread to clearly define “spikes” of “what?”

Especially when cases are occurring in patients with previous natural or vaccinated exposure, it will be informative to look at the data in terms of deaths, hospitalizations, symptomatic but not hospitalized, and asymptotic pick up by random testing.

With the caveat that regarding “Long Covid”, we have no accepted definition so we have no good data, am I crazy in thinking that a potential variant that is more infectious but far less malignant in terms of death and hospitalizations (particularly in previously infected or vaccinated people) may not be such a bad thing, particularly if it outcompetes Delta or more malicious strains?

There is of course the risk of mutations of an initially less malevolent strain reverting to something more dangerous, and I am not proposing we change our stance on promoting masks and vaccinations, but just maybe the Spanish Flu maturation phase( (into something less malignant) may be the norm.

In any case, reports of deaths and hospitalization rates I think are more relevant when comparing new to previous variants.
 

boatgeek

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I think it is important on this thread to clearly define “spikes” of “what?”

Especially when cases are occurring in patients with previous natural or vaccinated exposure, it will be informative to look at the data in terms of deaths, hospitalizations, symptomatic but not hospitalized, and asymptotic pick up by random testing.

With the caveat that regarding “Long Covid”, we have no accepted definition so we have no good data, am I crazy in thinking that a potential variant that is more infectious but far less malignant in terms of death and hospitalizations (particularly in previously infected or vaccinated people) may not be such a bad thing, particularly if it outcompetes Delta or more malicious strains?

There is of course the risk of mutations of an initially less malevolent strain reverting to something more dangerous, and I am not proposing we change our stance on promoting masks and vaccinations, but just maybe the Spanish Flu maturation phase( (into something less malignant) may be the norm.

In any case, reports of deaths and hospitalization rates I think are more relevant when comparing new to previous variants.
I think this is a good point. It's the combo pack of contagious and lethal that makes COVID different. If it develops into a strain that is somewhere on the order of the flu in terms of lethality, then we basically go back to normal. That depends on delta dying out, though.
 

blackwing94

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News from New Hampshire: "COVID-19 hospitalizations reached a new high Tuesday in New Hampshire as 13 more deaths were reported. State health officials said there are 441 Granite Staters hospitalized for COVID-19, the most at any point of the pandemic. Hospitalizations have been rising steadily since the beginning of November."

News from Maine: "Hospitalizations broke another record Tuesday, with 367 hospitalized, including 110 in intensive care, and 59 patients on ventilators."

Is New England the tail end of the last spike, or the beginning of the next spike?
 

speed

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Our local hospital had 23 beds out of 80 filled. 7 are vaccinated. ICU has 5 patients, all on ventilators, 3 have been vaccinated. Population here is approximately 475,000. I am curious though, im seeing in the news that all those that have gotten the latest version, all seem to be vaccinated, can that be true?
 

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Our local hospital had 23 beds out of 80 filled. 7 are vaccinated. ICU has 5 patients, all on ventilators, 3 have been vaccinated. Population here is approximately 475,000. I am curious though, im seeing in the news that all those that have gotten the latest version, all seem to be vaccinated, can that be true?
All? Not true.
 

cwbullet

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News from New Hampshire: "COVID-19 hospitalizations reached a new high Tuesday in New Hampshire as 13 more deaths were reported. State health officials said there are 441 Granite Staters hospitalized for COVID-19, the most at any point of the pandemic. Hospitalizations have been rising steadily since the beginning of November."

News from Maine: "Hospitalizations broke another record Tuesday, with 367 hospitalized, including 110 in intensive care, and 59 patients on ventilators."

Is New England the tail end of the last spike, or the beginning of the next spike?
Great question. I think it depends on the variant. I think this is a continuation of the summer wave from the south.
 

NateB

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I am curious though, im seeing in the news that all those that have gotten the latest version, all seem to be vaccinated, can that be true?
Most of the Covid patients I still treat are unvaccinated.

I don't think I can share the numbers, but one of the ICU nurses today said a significant portion (almost all) of her unit's beds were full of intubated, covid cases. That was 1 ICU in our hospital and not counting the progressive care unit and the other ICUs.
 

cwbullet

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The numbers I am seeing are still around 70-80% are unvaccinated. Since most are vaccinated, this should speak even louder.
 

BABAR

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That depends on delta dying out, though.
I am curious if the spread of Omicron impies it is more infectious than Delta (Therefore more ”successful” and likely to dethrone/supplant Delta.) It remains to be seen however if acquired immunity from Omicron is protective against Delta.

i believe it was the Pfizer CEO who stated that one of the reasons they HAVEN’T released new updated vaccines is that the current vaccines are still to some extent effective against current variants, including Delta, specifically in terms of hospitalization and death.

edit: my source was a post from @ThirstyBarbarian excerpt as follows
**************begin
I saw an interview with the head of Pfizer, and he said that when they get the genetic sequence for a new variant, they can design a variant-specific vaccine almost immediately. He said they have already designed an omicron-specific vaccine, and if it is deemed necessary, they could take it through testing, approval, manufacturing, and distribution in about 100 days. But they would only do it if current vaccines are found to not be effective enough. He said they did the same for delta, but it was never deployed, because current vaccines were considered good enough.
**************end

it’s important to remember that viruses don’t think, they randomly mutate with most mutations being neutral or even lethal to the VIRUS progeny. Severity of disease and particularly lethality of disease are not generally advantageous to the virus (if you are a bug, you’d rather infect someone, make him infect others, let him recover, than infect him again. OTOH, killing him or hospitalizing him takes him out of circulation, neither is a propagation advantage for the VIRUS.)

were it not for the unknowns of “Long Covid”, you can make an argument that variants with very very low lethality and hospitalization rates may be a positive for HUMANS, especially if the acquired immunity from such is still effective against the more lethal variants. Emphasize that neither the lethality nor hospitalization rates for Omicron are established, and may vary with whether the patient has NEVER been exposed to Covid previously, has HAD previous Covid (and then does it matter which strain?), or has been previously vaccinated, or BOTH previously infected AND vaccinated.

I wonder if in 20 years or so we will really understand what happened, and perhaps more importantly, how we can prepare for the next superbug.
 
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Peartree

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I wonder if in 20 years or so we will really understand what happened, and perhaps more importantly, how we can prepare for the next superbug.
Since there still seems to be a lot of discussion/argument/guessing about what happened with the Spanish Flu epidemic a hundred years ago, my guess is that humans will still be arguing about this pandemic 20 years from now and still long after all of us are dead.
 

cwbullet

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I am curious if the spread of Omicron impies it is more infectious than Delta (Therefore more ”successful” and likely to dethrone/supplant Delta.) It remains to be seen however if acquired immunity from Omicron is protective against Delta.

i believe it was the Pfizer CEO who stated that one of the reasons they HAVEN’T released new updated vaccines is that the current vaccines are still to some extent effective against current variants, including Delta, specifically in terms of hospitalization and death.

edit: my source was a post from @ThirstyBarbarian excerpt as follows
**************begin
I saw an interview with the head of Pfizer, and he said that when they get the genetic sequence for a new variant, they can design a variant-specific vaccine almost immediately. He said they have already designed an omicron-specific vaccine, and if it is deemed necessary, they could take it through testing, approval, manufacturing, and distribution in about 100 days. But they would only do it if current vaccines are found to not be effective enough. He said they did the same for delta, but it was never deployed, because current vaccines were considered good enough.
**************end

it’s important to remember that viruses don’t think, they randomly mutate with most mutations being neutral or even lethal to the VIRUS progeny. Severity of disease and particularly lethality of disease are not generally advantageous to the virus (if you are a bug, you’d rather infect someone, make him infect others, let him recover, than infect him again. OTOH, killing him or hospitalizing him takes him out of circulation, neither is a propagation advantage for the VIRUS.)

were it not for the unknowns of “Long Covid”, you can make an argument that variants with very very low lethality and hospitalization rates may be a positive for HUMANS, especially if the acquired immunity from such is still effective against the more lethal variants. Emphasize that neither the lethality nor hospitalization rates for Omicron are established, and may vary with whether the patient has NEVER been exposed to Covid previously, has HAD previous Covid (and then does it matter which strain?), or has been previously vaccinated, or BOTH previously infected AND vaccinated.

I wonder if in 20 years or so we will really understand what happened, and perhaps more importantly, how we can prepare for the next superbug.
I am far more worried about the Long Covid Syndrome than I am of the vaccine.
 

cwbullet

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Since there still seems to be a lot of discussion/argument/guessing about what happened with the Spanish Flu epidemic a hundred years ago, my guess is that humans will still be arguing about this pandemic 20 years from now and still long after all of us are dead.
It will give the talking heads on TV something to talk about. I would rather hear that than why Coumo was fired or about Britney Spears.
 

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A local hospital where my brother works has reported steady declines in Covid related cases over the past 7 months with less than 1% of their beds taken by Covid patients. They have had no deaths related Covid since Oct. 2021 and no one currently in ICU for Covid related symptoms.

One thing I did find interesting is that the numbers of hospitalizations were pretty much split down the middle 51/49 for vaccinated vs unvaccinated.

I know this is one hospital but we're in a major metro area. The interesting thing is that the numbers being reported are a stark contrast from what you are hearing on main stream media. I can't believe that this hospital is doing anything differently than the others in the area. How are their numbers so far off from what is being reported?
 

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A local hospital where my brother works has reported steady declines in Covid related cases over the past 7 months with less than 1% of their beds taken by Covid patients. They have had no deaths related Covid since Oct. 2021 and no one currently in ICU for Covid related symptoms.

One thing I did find interesting is that the numbers of hospitalizations were pretty much split down the middle 51/49 for vaccinated vs unvaccinated.

I know this is one hospital but we're in a major metro area. The interesting thing is that the numbers being reported are a stark contrast from what you are hearing on main stream media. I can't believe that this hospital is doing anything differently than the others in the area. How are their numbers so far off from what is being reported?
In a major metro area (as opposed to rural), most people in the local population are vaccinated. So, a disproportionate number of the cases will be among the vaccinated.

For example, if 80% of the people around are vaccinated, and chance of being hospitalized (per 100k people) for vaccinated people is a quarter that of the unvaccinated cohort, you will get similar absolute numbers of cases between vaccinated and unvaccinated.
 

NateB

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A local hospital where my brother works has reported steady declines in Covid related cases over the past 7 months with less than 1% of their beds taken by Covid patients. They have had no deaths related Covid since Oct. 2021 and no one currently in ICU for Covid related symptoms.

One thing I did find interesting is that the numbers of hospitalizations were pretty much split down the middle 51/49 for vaccinated vs unvaccinated.
We had a steady decline in Covid cases through October. In October there were few and it was really looking like it was finally winding down. Cases spiked up again in November. We did admit several from out of state (also pretty normal for us, but some were outside our normal referral patterns.) Now we are full again, many are Covid cases and about 90% of 1 ICU is full of intubated, covid cases. We again have beds in hallways, conference rooms, and other places they have turned into makeshift units. The smaller outlying hospitals report not being able to find beds to transfer people to for days on end. Even when beds are available, crews to transfer patients might not be for several hours.

Yes, as vaccinations increase, the number of admitted people who are vaccinated have increased as well. From personal experience, there is a marked increase in the severity of cases between the unvaccinated and the vaccinated. I have treated 1 person who was vaccinated who required intubation and that person had very serious underlying lung problems. Most of the vaccinated I have treated have needed BiPAP or Airvo treatment while the unvaccinated have needed intubation and ECMO.
 

Back_at_it

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In a major metro area (as opposed to rural), most people in the local population are vaccinated. So, a disproportionate number of the cases will be among the vaccinated.

For example, if 80% of the people around are vaccinated, and chance of being hospitalized (per 100k people) for vaccinated people is a quarter that of the unvaccinated cohort, you will get similar absolute numbers of cases between vaccinated and unvaccinated.

Very true. The part that I was questioning was how this hospital has shown a steady decline in cases and no deaths in more than 5 weeks while everyone else is claiming increased cases, increased deaths, increased "record" numbers in the hospitals.
 

boatgeek

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Very true. The part that I was questioning was how this hospital has shown a steady decline in cases and no deaths in more than 5 weeks while everyone else is claiming increased cases, increased deaths, increased "record" numbers in the hospitals.
What metro area are you in? There are a lot of differences between states, especially if they're in warmer or cooler climates.
 

Marc_G

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Very true. The part that I was questioning was how this hospital has shown a steady decline in cases and no deaths in more than 5 weeks while everyone else is claiming increased cases, increased deaths, increased "record" numbers in the hospitals.
Good point.

The pandemic remains very local I. Terms of which area is spiking at which time. What state are you in? I think a current trend is that more northerly areas are spiking more due to cold weather and more inside activities, compared with the south, bit there are exceptions to this trend as well .
 

NateB

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The pandemic remains very local I. Terms of which area is spiking at which time.
I'd say regional, at least by what I see moving patients around to different major hospitals. I'm routinely in and out of hospitals in Fort Wayne, Indianapolis, Toledo, Cleveland, Columbus, Chicago and Ann Arbor and see a similar pattern at all of them.
 

BABAR

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Full and accurate reporting seems hard to come by.

from CDC site


we have vaccinated fully vaccinated of the over 65 population, and 48.1% have had boosters
Fully vaccinated 71.6 % of the over 18 population, and 36.9% have had boosters

the continuously decreasing unvaccinated population remains at most risk. When we get reports of case rates between vaccinated and unvacinated populations, without more information the data interpretation can be misleading.

as the unvaccinated populations declines (some of the hold outs are finally voluntarily or coerced By their employers to get vaccinated), the virus has fewer “virgin” targets.

we know the vaccination isn’t perfect, so even early after vaccination some people STILL get Covid, although most but not all cases in this group tend to be milder and possibly the incidence of Long Covid may be less frequent to less severe in this group. We also know that both acquired and vaccinated immunity weakens over time since infection and vaccination.

what is RARELY reported is, among the unvaccinated cases, how many are RECURRENT victims, i.e., how many of the unvaccinated cases are breakthrough ”acquired immunity failures.”

also not reported is among the breakthrough “vaccinated immunity failures” how far out are they from vaccination and did they get boosters.

simply comparing current incidence of cases between vaccinated and unvaccinated is misleading, taken at face value we are seeing and will continue to see the ratio of vaccinated to unvaccinated increase. This is EXPECTED, as the pool of unvaccinated shrinks AND as we know vaccinated immunity wanes over time. Boosters seem to help although we can anticipate and likely ARE seeing some new strains resistant to vaccines, but we don’t have good data on the DEGREE of resistance (Died, hospitalized but recovered, sick but recovered at home, minimally or completely asymptomatic.)

data I really want to see

death and hospitalization rates for new variants broken down by age, vaccination and booster vaccination status, and previous Covid infection status. Particularly interesting would be death and hospitalization relative to vaccinated vs acquired immunity (possibly both.). That data is hard to come by and will take time to accrue. And its accuracy may be questionable.

but until we have that, especially when not broken down by hospitalization and death rates, simple infection rates vaccinated vs unvaccinated are close to meaningless. Saving ”Long Covid” for another day, the vaccines’ goals are to reduce deaths and hospitalizations. Anything above that is gravy.
 

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What metro area are you in? There are a lot of differences between states, especially if they're in warmer or cooler climates.
Chicago. Now you understand my confusion. We're being told by some that hospitals are at capacity while the people that work in some of these hospitals are wondering what everyone is talking about. I'm having dinner with a buddy tonight whos wife is an ICU nurse at one of the major hospitals in Chicago. I typically don't ask questions about covid as it almost always turns the conversation political but I'm curious to see what she is experiencing and her opinion as someone that is on the front lines of this thing.
 

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Chicago. Now you understand my confusion. We're being told by some that hospitals are at capacity while the people that work in some of these hospitals are wondering what everyone is talking about. I'm having dinner with a buddy tonight whos wife is an ICU nurse at one of the major hospitals in Chicago. I typically don't ask questions about covid as it almost always turns the conversation political but I'm curious to see what she is experiencing and her opinion as someone that is on the front lines of this thing.
Are the "hospitals are at capacity!" news stories you're seeing on the local news or are they national? I'm not seeing much of that kind of story, but we don't seem to be maxed out over here and I don't watch commercial national news. If it's local news, it seems like it's probably cherry picking (maybe one hospital specializes in COVID patients so more patients get sent there and it's pretty full?) or really stretching the truth. If it's national, it's probably focused on one particular state/region rather than a national trend.

In the Seattle metro, we never maxed out hospital capacity in the fall spike even when Idaho and Alaska were shipping lots of patients across the borders because they were full. Some of the Eastern Washington hospitals full enough to delay "elective" cancer surgeries because they didn't have enough ICU beds available.
 

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It's definitely local and regional. Areas like Maine and generally new England, Milwaukee, parts of Pennsylvania are struggling. Do a search for "Covid hospitals at capacity" and you will come up with lots of links to local news sources talking about the challenges those areas are facing.

Here in Indiana it's getting worse on average but the urban places like Indianapolis and well vaxxed northerly suburbs are doing ok, while rural places are swamped.
 

NateB

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Here in Indiana it's getting worse on average but the urban places like Indianapolis and well vaxxed northerly suburbs are doing ok, while rural places are swamped.
It is important to remember that not all hospitals and not all ICUs are equal. Rural hospitals often lack the staff, specialists, and equipment necessary to treat these patients. Someone might start off in a community hospital and end up in a large regional or university affiliated hospital which can offer the specialty care (any type of specialty care, not just Covid) the patient needs. These hospitals fill up from people within the city and people being referred from hundreds of miles away. The backlog then affects everyone as people get held in the smaller hospitals while they are waiting for beds to open up.
 
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