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

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3342

Re: https://www.nejm.org/doi/full/10.1056/NEJMoa2109072

Among other things from that study of 39 breakthrough cases in health care workers in a large medical center in Israel (of which 11,453 were vaccinated):

“In all 37 case patients for whom data were available regarding the source of infection, the suspected source was an unvaccinated person; in 21 patients (57%), this person was a household member.”

“Of all the workers with breakthrough infection, 26 (67%) had mild symptoms at some stage, and none required hospitalization. The remaining 13 workers (33% of all cases) were asymptomatic during the duration of infection; of these workers, 6 were defined as borderline cases, since they had an N gene Ct value of more than 35 on repeat testing.”

“On follow-up questioning, 31% of all infected workers reported having residual symptoms 14 days after their diagnosis. At 6 weeks after their diagnosis, 19% reported having “long Covid-19” symptoms, which included a prolonged loss of smell, persistent cough, fatigue, weakness, dyspnea, or myalgia.”

“Of the 33 isolates that were tested for a variant of concern, 28 (85%) were identified as the B.1.1.7 variant, by either multiplex PCR assay or genomic sequencing. At the time of this study, the B.1.1.7 variant was the most widespread variant in Israel and accounted for up to 94.5% of SARS-CoV-2 isolates.”

“However, no secondary infections were traced back to any of the breakthrough cases, which supports the inference that these workers were less contagious than unvaccinated persons, as has been reported previously.”

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3343

Hopefully there will be similar studies published regarding breakthroughs and the delta variant.

The findings of long Covid were also a bit disheartening.

3344

Yes, although 19% after 6 weeks is less bad than the 25-30% after 6 months that a pre-vaccine study of long COVID-19 found.

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3345

Did the Provincetown cases involve transmission from vaccinated people ?

I am concerned by articles concerning possible development of variants that are resistant to vaccines, which could become dominant due to natural selection.

This would be the main reason for vaccinated folks to wear masks, but the general public is not going to understand the concept, or want to think about it.

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3346

I have been following the PTown outbreak and have yet to see answers to important questions like - did the vaccinated people catch it from unvaccinated or vaccinated people, how many younger (under 12) unvaccinated people were involved in the spread, what pattern is the contact tracing revealing (did people catch it in restaurants, clubs, or just shopping?), what percentage of the people were asymptomatic, etc.

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3347

Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021 | MMWR says that “Persons with COVID-19 reported attending densely packed indoor and outdoor events at venues that included bars, restaurants, guest houses, and rental homes.” It also suggests that the place was like a giant party, which is also suggested in other news reports. Note that 87% of the 469 infected people mentioned in the CDC page were male.

'The sky is not falling': Provincetown outbreak shows vaccines work, even against Delta says that “Of the 833 people in the Provincetown cluster as of Wednesday, only seven had been hospitalized. And zero had died.”

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3348

For those that are unfamiliar, Provincetown is a destination party location for gay men.

Oops - meant to reply to thread, not to you specifically.

3349

Provincetown had the highest rate of vaccination in the state. This outbreak of course involved many visitors.

I agree that it is heartening that only 7 were hospitalized and zero died. But the news that vaccinated people might transmit is concerning as is the potential for variants that evade the current vaccines.

ps I don’t see how gender or orientation is relevant

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3350

Gender would be solely because it could explain why most of those affected were men vs 50/50.

3351

Why does it matter?

3352

From my perspective, because it might give the impression to some, that men are more vulnerable than women to breakthrough infection. Similar to the information at the beginning of the pandemic that men seemed or perhaps ended up actually being more vulnerable to severe Covid than women (can’t remember where things ended up on that).

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3353

On average, amongst people who died of Covid, there were more men than women. Despite the facts that there are more women than men in the 65-plus age group category and that men and women are equally represented in Covid cases. This is data from my state to date.

And there are studies confirming this, for example:

https://www.nature.com/articles/s41467-020-19741-6

3354

Yes, I am aware.

3355

Because if men made of the bulk of the breakthrough infections it makes a difference whether the pool drawn from were mostly men or mostly women or roughly 50/50.

Sometimes gender matters and sometimes it doesn’t when it comes to medical issues.

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3356

Disagree that was a blunder. She was just following the science: those who are fully vaccinated are protected from bad health outcomes, even from Delta. (Yes, Delta can have bad outcomes in fully vaccinated persons, but those are extremely rare.) But what the science now indicates is that the fully vaccinated can transmit Delta to others. So, the fully-vaccinated masks go back on, to protect the un-vaccinated (which is more of a policy statement than science, as nearly all of the unvaccinated can easily protect themselves by getting a jab.)

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3357

Gender matters because 87% of the infections were in men. It helps to know that the visitors to town were predominantly male. It wasn’t like the visitor population was split 50/50 and only the men got sick. More men got sick because there were more men in town.

You are correct that orientation doesn’t matter except to maybe explain why the visitors were predominantly of one sex. I guess I could have said there was some type of event that especially appealed to only men and so the distribution was skewed, without bringing up orientation.

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3358

Worth a read:

3359

Let me clarify. While she was following science in one way, she should have known that masks would be shed by so many of the unvaccinated. That’s a different kind of science. And many of those people will NEVER put their masks back on. Their stance from lying by saying (while unvaxxed) “I’m vaccinated” will go back to “I have a medical condition” or outright refusal. They will not wear masks.

It’s not as if it’s always been only about the science in this pandemic. Recommendations have been changed throughout the pandemic to reflect political/administration pressure.

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3360

It may be common sense, but it is not science, which would have numbers behind it with peer-reveiwed studies. In other words, how many people will cheat nationally? How many in local communities? 1%, 10%, or 90%, or somewhere in between? Without numbers, its just a policy decision. (No different than the current policy recommendation that the vaccinated need to mask up to protect the vaccinated.)

3361

So much hairsplitting in CC today! There is peer-reviewed info re how likely people are to cheat/lie in different situations. However we word it, Walensky did a great disservice with her revision of CDC guidelines in mid-May.

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