Inside Medicine. What Are You Seeing? [COVID-19 medical news]

No one is suggesting getting together if someone has covid. Just questioning the effectiveness of nasal lavage.

Sorry for your lossā€¦
As far as mrsa in a gym usually through skin exposure.

https://cultureofsafety.thesilverlining.com/fitness/mrsa-infections/

The article I read on lavage was protective for me, not others. Gargling with Listerine, however, was described as possibly protecting others. I would not rely on either.

The latest news is that an SSRI, fluvoxamine, prevents deterioration if given during early COVID. I wonder if this is true for any other SSRIā€™s. Apparently fluvoxamine addresses inflammation.

https://www.thenewstribune.com/news/coronavirus/article247177899.html

Luvox (fluvoxamine) had lot of risks (side effects, dangerous interactions, etc) so its great if its helpful for COVID treatment, but it has not been a first line choice for other issues. It was used for treatment of OCD a long time ago, but it was taken off the market and then reformulated and reintroduced.

Question about how contagious is a lingering covid cough? Employee #1 is due back on Tuesday I think. Nobody talks about how he is doing. But I do know that employee #2 talked to him last Monday and he was very congested and had a cough at that point. He also had a fever and sore throat the previous Friday.

If he is still coughing and allowed to work unmasked in my office after his 10 day quarantine, how bad is that for me? I am seriously thinking about pitching a fit and demanding to let me work from home. But I will burn a lot of good will built up over 23 years if I do so, so Iā€™m not sure if I want to do that if itā€™s not that big of a deal. I know HR will not be in my corner.

I did Google some but it was very vague, especially about coughing. Does anyone know more?

Healthcare worker here: @ClassicMom98 , the policy for the healthcare system I work in is that people have to quarantine for 2 weeks and should not have a fever at the end to break quarantine. I donā€™t know about congestion, but theyā€™ve said that the cough could last for > 1 month and that that should not preclude patients from getting care. (In other words, a cough alone after the quarantine period was ok. With that said, every patient I see has to be masked, as do I. Being unmasked indoors isnā€™t ok in my setting.)

Why is anyone allowed to work unmasked at your workplace?

^because if the HR director thinks itā€™s fine to sit and eat food from a buffet table in an 1:30 workplace meeting sitting 4 feet from other unmasked people, then I donā€™t see our policy of only wearing a mask ā€œif you want toā€ being changed anytime soon. Technically you must wear one of youā€™ll be closer than 6 feet for 15 min, but obviously they are not enforcing that.

And I donā€™t know if employee #1 still has a cough, so this may be for nothing. I just want to be prepared. Coughing is like nails on a chalkboard to me even during normal times.

My sonā€™s coughing lasted long after his other symptoms. Data point of one and it was prior to widespread testing to know when he would have been negative, so take it for what itā€™s worth.

What area do you live in, @ClassicMom98? Are the hospitals there overrun yet? They soon will be if theyā€™re not already, with the attitude your co-workers are exhibiting.

I worked at a covid surge SNF facility. In the beginning, patients needed two consecutive negative Covid tests to go home. One patient was there for weeks with positive tests. Later the rule changed to 14 days after the first positive test they were no longer thought to be contagious. I am not sure if a fever, cough or other symptoms changes the rules or not.

Modernaā€™s vaccine interim reporting 94.5% effectiveness!!! Right in line with Pfizerā€™s ā€œOver 90%ā€. Hooray!!

(Sounds like they will have less productive capacity in the immediate months, but every bit helps!).

From NYTImes: StĆ©phane Bancel, the chief executive of Moderna, said in a statement that the results had provided ā€œthe first clinical validation that our vaccine can prevent Covid-19 disease, including severe disease.ā€

More from NY Times: In Modernaā€™s study, 95 people contracted the coronavirus: five who were vaccinated, and 90 who received placebo shots of saltwater. Statistically, the difference between the two groups was highly significant. And of the 95 cases, 11 were severe ā€” all in the placebo group.

From me: I also think with 94.5% effectiveness and the fact that they had so many older adults including elderly in the study and people of various ethnicities, etc, itā€™s pretty hard now to worry too much that this does not dramatically help the older/elderly or other specific demographic groups. Hip, hip, hooray!!

@EmptyNestSoon2 thanks for sharing that! I had a rough weekend with work issues, so I need some good news. :slight_smile:

So Elon Musk was just tested by 4 rapid tests. 2 positive and 2 negativeā€¦ Aghā€¦

We use the 14 day rule in my medical office. Plus some negative test before going back to work. It also depends on the situation at hand.

As far as the companies coming out with vaccines will be interesting. I forgot but are these all free and paid by the government? Why would I want a 90 % vaccine when one is slightly better?? How will it be distributed? People in the south get X and people in the north get Y?

Personally, the more data the better. I would still wear a mask even after having both vaccines. We still donā€™t know what happens 6 months down the road when someone with covid coughs on you. People have to understand itā€™s not like get a vaccine and then everything is fine. This is just step one. If people go back to normal life right away, this will be for not.

Modernaā€™s also has the positive aspect of not needing to be kept so cold.

Thereā€™s a bit positive news coming out lately. Hopefully it will help some folks have a little more stamina for trying to stay safe between now and when Covid can be combatted. Itā€™d be really sad to needlessly lose someone in the homestretch.

Listening to the CEO on CNBC interview, of the 95 people who got covid, 15 were over 65 and 20 were from people of color. So there is clear evidence that this is working in 65+ and range of ethnicities. And most importantly, of the 5 people in the vaccine arm who did get covid, none of them had severe disease (while 11 in placebo arm had severe disease). So we can be excited for our elderly!!

Also, Moderna had slowed their recruitment to make sure they had ample participants who were 65+, had diabetes, obesity, high blood pressure, etc.

Moderna had planned to report interim results when they had 57 cases, but because of the surge of the virus, they ended up with the 95 cases. The CEO in this morningā€™s interview said they expect to get to their full data set (approximately 150 cases) in a few days.

Like Pfizer, they should be ready to request FDA emergency approval in late November (they need half of their 30,000 participants to have safety data over 2 months).

Unlike Pfizer, they have not yet started testing below age 18, but CEO said they will be starting 12-18 within a month, and moving to younger kids after that. Younger kids will possibly get a one shot vaccine, or at least lower dose, etc so there is more testing required.

They have 2 production lines, one for USA and one for rest of world. It sounds like they expect 20 million doses in 2020 (vs Pfizer 50 million), and 500 million -1 billion in 2021 (Pfizer 1.3 billion). 2 doses per person. Iā€™ve had a hard time understanding what portion is for USA vs ROW, but weā€™ll see! Also, the CEO did indicate that they will work to increase that capacity, he expects there are opportunities, partnering with governments, so it may end up being higher.

He spoke about how they will test for whether it actually prevents infection going forward, I couldnā€™t completely understand the process, but they do not currently have that information but will be measuring it somehow going forward. But at 94.5% efficacy, I have a hard time thinking that is nearly as important as it would be if it was a less effective vaccine. Is that wrong?

When we get the final data sets from Moderna and Pfizer (and the others), I really hope they all are very close to the same level of effectiveness. Right now with Pfizer OVER 90 and Moderna 94.5%, it sounds like they are basically the same. We will need all of their production from all companies in 2021, so it would be a shame if some people feel like they are getting the ā€œlesserā€ vaccine. But thankfully it appears that wonā€™t be an issue.

Creek land, its true, itā€™s awesome that the Moderna one is easier to handle, and also has 12 hour shelf life at room temp and 30 days at regular refrigeration. Much easier to handle! Also something about not needing to be diluted. But fortunately, Pfizer and Operation Warp Speed have already designed the special cases and the supply chain to work for their more difficult vaccine, so although it is more of a pain/trickier, it is ā€œdo-ableā€. But Iā€™m guessing the facilities doing the vaccinating will have their favorites.

Ok, bring on the skeptical questions!

Good question about distribution. I thought each state had to develop their own vaccination distribution plan (so each state could prioritize its distribution)? Maybe each state is designated a certain number of dosages by population?

I am still hoping the Johnson & Johnson vaccine will come through, because it has the huge advantage of only requiring ONE dose.

No skeptical questions here, but I plan to still watch the data as we get it - same as before. Itā€™s preliminary. There hasnā€™t been enough time to see full results. Thatā€™s all one has to go on in an emergency.

Any good news is welcome. Press on! Sure beats bad news.

A potential way to distribute would be to keep Pfizerā€™s in areas that can more easily handle it and send Modernaā€™s to places that canā€™t.

Not sure itā€™s wise to have each state come up with their own plan. Maybe a national plan that states mimic. Like to take politics out of this. Build a McDonaldā€™s and follow that success in every stateā€¦ Heh, thatā€™s been doneā€¦ Lolā€¦

I agree, we donā€™t know about the duration of immunity yet. BUT, shouldnā€™t we know about the relevant duration when itā€™s relevant to us?

What I mean is, say ā€œweā€ average Joes get the vaccine in March 2021. There will be all these study participants who got the vaccine back in July 2020, who are 8 months ahead of us. So the trials will be watching those participants, and we will learn about the length of immunity. If, for example, it looks like it only lasts for them for 6 months, we will start to know that by late winter/early spring. Then ā€œweā€ can get boosters after we hit 6 months.

I also agree itā€™s not a bad idea to wear masks as long as we can tolerate them after mass-vaccination occurs. Especially in higher-risk situations. But we will have the data to guide usā€”presumably once the vaccines start getting adopted, we will see numbers drop and our collective concerns will also drop accordingly. If our hospitals are empty and people arenā€™t really dying in numbers higher than diseases such as flu, I think a good portion of people will move on from mask-wearing or other precautions.