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

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3422

For a walk in the outdoor park and a brief encounter with one other person (1 minute is the shortest time frame, although a brief encounter is really only a few seconds, so probably only 1/20 of the exposure) at 3 feet, with no masks and no talking, the calculator at https://www.microcovid.org gives:

Your vaccine Other person microCOVIDs Risk
None Average person in CA ~0.1 Very low
None Average person in MO ~0.2 Very low
None Person with COVID-19 ~20 Low
J&J - Janssen Average person in CA ~0.05 Very low
J&J - Janssen Average person in MO ~0.08 Very low
J&J - Janssen Person with COVID-19 ~8 Low
Pfizer - BioNTech Average person in CA ~0.02 Very low
Pfizer - BioNTech Average person in MO ~0.04 Very low
Pfizer - BioNTech Person with COVID-19 ~4 Low

Note: ā€œAverage personā€ is with unknown vaccination and infection status, and risk is based on having a ā€œstandard caution budgetā€. Risk may be considered higher for those with a ā€œhigh caution budgetā€.

3423

I just got an advertisement for a flu shot.

I keep thinking we havenā€™t had much flu in ā€¦two years? It makes me think weā€™re due.

I also heard reports of RSV and Norovirus in kidsā€¦

3424

I have been getting my flu shot regularly for past 20+ years. As an added bonus itā€™s supposed to be somewhat protective vs bad covid. I plan to get mine as usual in September.

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3425

There is a small noro outbreak here in my neck of the woods. A restaurant is the alleged source.

3426

COVID-19 mitigation methods like social distancing and masks worked better against flu than against COVID-19, so the 2019-2020 flu season basically stopped around March 2020, and there was much less flu than usual during the 2020-2021 flu season. Note that flu season is winter, when people are more likely to gather indoors.

But with people in many areas no longer practicing COVID-19 mitigation methods, flu now gets more of a chance to come back. Getting a flu vaccine reduces the chance of getting flu-like symptoms from the actual flu, which can be quite unpleasant (and sometimes deadly). Non-egg flu vaccines are available if egg allergy is a concern.

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3427

Stay away from the ellume at home test unless you want to have a panic attack. I am flying later today domestically but seeing my mother, so CVS was out of the Binax Now tests. The Ellume test is much more expensive and you have to download an app. Image my surprise when it said positive. I did have an Binax that was I was waiting to use for kid before returning to college next week, but used it. Negative. Then I went to my Dr and had a rapid PCR test and it was negative. Went online and found that Ellume has more false positives then any of the other tests.
Note I should have made the Drā€™s appt first, but Dr not close. I could not get a rapid test anywhere today at CVS/Urgent cares, etc. I got lucky with getting the appointment.

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3428

COVID, stress, wearing a ponytail for the last year and a halfā€¦ :smile:

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3429

I have more of a question, wondering if anyone has seen reliable research on this.

Iā€™m interested in understanding how worrisome ā€œlong covidā€ is. So far, none of my close family has contracted covid, and that was important to me, mostly out of concern about long covid (well, and not spreading to others). As we move towards the greater likelihood that covid will be endemic, Iā€™m mostly getting ok with us getting infected (praying of course that none of us ends up with a severe case, though we are not at high risk of that happening as everyone is vaccinated and healthy). So that just leaves long covid for me to worry about on a personal level (of course I worry about the world at large)

To me, there are 2 buckets of long covid. One would be very long-lasting/lifetime-lasting damage that would permanently and significantly impair oneā€™s life. The other would be more minor changes, that resolve in less than a year. For me, Iā€™ve decided Iā€™m not going to worry about that 2nd bucket, no matter how annoying and unpleasant those things may be.

Hereā€™s an example of what Iā€™m trying to parse. Iā€™ve had pneumonia several times. Each time I vastly improved within a week or 2 due to antibiotics that helped. After that point, I was back to work, back to socializing, back to life and generally feeling good-ish. However, as I recall, I still was somewhat out of breath when I climbed stairs for up to 6 weeks or so, and I bet if I took a lung test, perhaps there was reduced performance for even longer. But I was basically ok within 2 weeks and felt absolutely fully recovered within 2 months. That kind of situation is fine with me (although not desired!), although Iā€™m sure I would have counted as ā€œlong-pneumoniaā€ if there was such a thing! But in the scheme of things, it was no big deal. I see that many of the surveys for long covid ask how people are feeling a mere 6 weeks out, and they seem to count as long covid even a very very minor situation like me feeling a tiny bit winded at the top of stairs, while my overall life was not impacted. Things like that would not worry me at all. I wish they werenā€™t counted as long covid.

I wish the reports separated what I would consider truly worrisome situation from what I would consider minor and/or temporary situations. Iā€™d love to get a sense when they say ā€œX% of people recovering from covid, even asymptomatic covid, experience long covidā€ā€¦Iā€™d like to know how many of those people are in the 1st serious bucket, and how many are in the 2nd minor/temporary bucket.

I have a hunch that the truly devastating long covid cases are quite exceedingly rare, and Iā€™d love to see stats on that. Because if thatā€™s true, Iā€™m going to start getting more comfortable thinking about loved ones getting exposed to covid. Anecdotes can be scary, so Iā€™m more interested in numbers. But if the majority of the long covid cases truly are going to entail lifelong suffering, then Iā€™m going to stay focused on being hyper vigilant (by the way, I donā€™t think Iā€™m hypervigilant, really, as we socialize and go to restaurants, etc, but I am always mindful of local conditions and other risk factors, and as cases begin to rise in my Northeast area this fall, Iā€™m wondering to what extent I should start reigning things in again).

I wish I could have designed the surveys. I would not have included anything that resolves in less than 6 months, and/or that doesnā€™t really impair ones ability to enjoy life and function normally, etc.

Anyway, sorry for the long-winded post, but if anyone has info that can shine a light on this, Iā€™d really appreciate it.

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3430

The researchers behind the REACT-1 study also found that the prevalence of SARS-CoV-2 was nine times higher in people aged 13ā€“17 years compared with the previous round.

Furthermore, people aged 5ā€“24 years made up 50% of the positive results, despite this age group only accounting for 25% of people over the age of 5 years in England.

The results for the effectiveness of the vaccines were mixed. On the one hand, the vaccines are still making a significant difference in protecting people from the virus. In fact, unvaccinated people are three times more likely to contract the virus than vaccinated people.

However, after adjusting for a range of variables, the researchers found that vaccine effectiveness was 49%. This is a reduction from the previous round of analysis, which found the vaccines to be 64% effective.

The vaccines are more effective at protecting against symptomatic COVID-19, at 59% effectiveness. However, this is still a drop from the previous roundā€™s 83% effectiveness.

3431

The problem is that ā€œlong COVID-19ā€ appears to be relatively neglected in research. There have been few studies on the matter. One found that the prevalence of symptoms 6 months after was about 30% in the pre-vaccine time. A more recent one found that 19% of breakthrough cases had symptoms 6 weeks after. There was also a study that found that most with ā€œlong COVID-19ā€ from the pre-vaccine time got better after vaccination, but some got worse.

Certainly, there are lots and lots of anecdotes about ā€œlong COVID-19ā€ from the pre-vaccine time, enough that it cannot be ignored in frequency and seriousness, but the lack of research means that assessing oneā€™s risk means guessing some unknowns, and many people will probably guess either wildly optimistically or wildly pessimistically.

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3432

The NIH is funding lots of research in ā€œlong COVIDā€ but it will take time for the studies to produce results. NIH Plans Research on ā€œLong COVIDā€ | NIH COVID-19 Research.
A colleague enrolled in one of these studies, and received a very thorough evaluation. Fortunately her symptoms have improved over time.

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3433

To understand what long covid might be like for some people, I suggest reading about Postural Orthostatic Tachycardia Syndrome, not just the rapid heart rate upon standing but everything that goes along with the syndrome, especially the fatigue and dysautonomia. When I read about the symptoms of long covid, I immediately thought it sounded just like what living with POTS is like for many people.

There are probably ups and downs, with flares from overdoing it or following illness which can last for weeks or even months. Most people can probably live their lives a lot of the time as long as they take it easy, and other times where they just have to lie down.

Thatā€™s just my impression of what it might be like based on having lived with POTS.

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3434

https://www.reuters.com/business/healthcare-pharmaceuticals/delta-infections-among-vaccinated-likely-contagious-lambda-variant-shows-vaccine-2021-08-02/

Third mRNA dose may boost antibody quantity, but not quality

Among fully vaccinated people who never had COVID-19, getting a third dose of an mRNA vaccine from Pfizer (PFE.N)/BioNTech or Moderna (MRNA.O) would likely increase levels of antibodies, but not antibodies that are better able to neutralize new virus variants, Rockefeller University researchers reported on Thursday on bioRxiv ahead of peer review.

They note that in COVID-19 survivors, the immune systemā€™s antibodies evolve during the first year, becoming more potent and better able to resist new variants. In 32 volunteers who never had COVID-19, they found that antibodies induced by mRNA vaccines did evolve between the first and second shots.

But five months later, vaccine-induced antibodies were ā€œequivalentā€ to those seen after the second dose, with ā€œlittle measurable improvementā€ in the antibodiesā€™ ability to neutralize a broad variety of new variants, said coauthor Michel Nussenzweig. Therefore, he said, giving those individuals a third dose of the same vaccine would likely result in higher levels of antibodies that remain less effective against variants.

3435

What is the status of readily available treatments to for people with Covid at early stages of disease (antivirals similar to Tamiflu)? Starting to look like we will be playing catch up with vaccines targeted to new variants and would be helpful to have more treatment options. Iā€™m not hearing much about that right now. Does anyone know whatā€™s in the pipeline in terms of treatment options?

3436

This is an NIH site and itā€™s very interesting. I actually just love to read through the different sections. :nerd_face:

It includes standard therapies as well as potential therapies that are currently being investigated. It provides explanations of the mechanisms behind why a therapy might work, makes a statement on recommendation, and then gives its rationale. Warnings are also included.

For example, hydroxychloroquine received attention early on. It describes why it might work, states that itā€™s not recommended, and then gives evidence from studies on why it came to that conclusion.

Two other medication that are currently getting attention are also included. One is ivermectin, under antivirals as it is a anti-parasitic with anti-viral properties. Another is fluvoximine, under immunomodulators. In both of these cases, there is no clear statement for it against, and information from studies is presented supporting their lack of position for or against. Of note: There is mention of the FDA warning about using ivermectin that is intended for animals. And there is a warning about not using fluvoximine if one is already taking an SSRI, for example.

On a side note, very recently, a group of icu doctors that advocated for ivermectin use are now saying they are not seeing the same benefit from ivermectin in icu patients with delta as they did before, probably because delta has a higher viral load and a shorter incubation so by the time people see doctors, the virus has already done a lot of damage. They are now recommending dosing at more frequent intervals for prevention, as well as increased higher doses for when people get sick with a strong emphasis on early treatment, at first sign of symptoms, which is interesting since I think studies have shown greater evidence on prevention rather than treatment on patients who are already really sick even before Delta.

Fluvoximine is just interesting because itā€™s an SSRI and should work in the brain, right?

Itā€™s so cool whoever comes up with these ideas to try pre-existing drugs against covid.

On the list is also colchicine, which my friend, who had pericarditis after the vaccine, is prescribed. But it is not recommended for patients with covid.

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3437

Writer tries to analyze the limited information about long COVID-19 in the context of vaccination and the Delta variant.

One small (but boldfaced) part of what the writer writes is that ā€œBased on all the above evidence, Iā€™m making a very rough guess that mRNA vaccination cuts the risk of a Delta COVID infection developing into long COVID in half, independent of vaccinationā€™s reduction of the risk of catching Delta at all.ā€

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3438

Iā€™ve been reading some alarmist takes on the pandemicā€”how delta is a whole new ballgame, even vaccinated people are very vulnerable, and Covid itself is a uniquely bad disease. I disagree with these takes, and Iā€™m very optimistic about life for vaccinated people in highly vaccinated homes, workplaces and communities. Here are some of my reasons for this optimism:

  1. Delta is a variant, not a new virus. It spreads faster than the other variants, but we have no evidence that it is making people sicker, or that it has developed an ability to infect past six feet, outside, or in passing.

  2. Vaccines and masks absolutely work. DH has treated thousands of Covid patients. He spends hours in close contact with poor ventilation. Patients are coughing, vomiting, crying, and getting intubated (an aerosolizing procedure). Yet, DH has never tested positive for Covid. He credits his careful use of N95 masks, and since February, his vaccinated status.

  3. Covid is not unique among viruses. There are many viruses that cause inflammation, pneumonia, hypoxemia, clotting, and autoimmune effects (especially in the medically vulnerable). Asymptomatic infection and transmission are also common in viruses, and extended post viral symptoms like long Covid are well known (although not well understood).

Whatā€™s different about Covid is:
A. It was new to the human immune system, so we had no memory of it.
B. Very large numbers of people are getting infected (due to 1, and lack of vaccine).

  1. I am extremely grateful that multiple safe, effective vaccines were developed so quickly for this virus, and vaccine rates are rising. We also have a highly effective monoclonal antibody treatment for the minority of cases where vaccinated people get infected.

We are living through a pandemic, which is by nature tragic and deeply harmful, yet I think we are much luckier than the headlines and social media would generally suggest.

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3439

Maybe this belongs in another thread.

Iā€™m stunned at the number of medical professionals Iā€™ve seen since the vaccine became available and how few asked if I had had the vaccine.

(Ophthalmologist, Dermatologist, Internist, Orthopedic, Dentist, Physical Therapist, GYN, etc.) Yes, Iā€™ve had the vaccine but it seems to be a missed opportunity if they are not asking every single patient.

Research Iā€™ve read says that patients are most convinced by their doctorā€™s recommendations.

Thoughts on this?

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3440

I live in a highly vaxxed county. I have only had 2 doctor appts during COVID, but both (dermatologist and optometrist) have asked if I am fully vaccinated and they shared that their office was fully vaccinated as well.

The dermatologist said that all of her patients except one was vaccinated and she got on that unvaccinated one to get vaccinated.

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3441

School has not yet begun where you are? The reopening of schools may change your situation.
There is no such thing as a highly vaccinated County for school age children; less than a quarter of 12-15 years olds nationwide are vaxxed.

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