So just to tie off this discussion, even if I were to be tested for covid T-Cells that came back as a true positive, it's still an unknown how long that T-Cell memory will last... which I assume would be the same for the vaccine as well?
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I believe the R0 estimate for covid-19 to be falsely low as it was based on symptomatic patients and misses asymptomatic carriers. The true R0 is probably a bit higher if one based it on testing everyone exposed rather than clinical disease. Some of the modelers at one of the national labs put the R0 range at 3-5.
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Bob Noel
if true (missing so many asymptomatic carriers), then the true CFR is going to be much lower than some people fear.... just the way the math works.
Matthew Rogers
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So if that is correct, then COVID is about twice as contagious as swine flu. So not the nicest virus, but a far cry from the terror that is a virus that can spread like measles.
The infection fatality ratio (IFR) is lower than the case fatality ratio (CFR). The CFR in turn is going to be lower than the 'symptomatic case fatality ratio. Symptomatic CFR is just that, the CFR in those who are diagnosed with the clinical syndrome and confirmed to have the disease.
The relation between the IFR and CFR depends on the multiplier between known cases and actual cases in the community. From antibody studies done after the early wave in the northeast, we know that at the time that factor was greater than 10. So for every 'case' that the NYS dept of health recorded, there were actually 10 people who had gone through the disease. That is not to say that those 9 'dark' cases were asymptomatic, just that they never got caught by the testing regime. At the time, the supply for testing was very constrained so outside of hospitalized patients, relatively few people got picked up by testing.
To be clear, the idea that that the R0 number is probably higher is something I personally believe to be the case based on the fact that those R0 numbers were published when the definition of 'case' heavily relied on the development of symptoms and not on testing.
Testing is now much more available and I dont believe that 10x factor we saw in NYC in the spring is still applicable.
Back in April/May during the first wave, we were still being 'suprised' by patients who showed up at the hospital and had covid. Now in the second wave, the story is near universally 'got tested on x/x/xxxx after an exposure at _________ now presents with shortness of breath / chest pain / nausea'.
For anyone who presents to the hospital with a positive test in hand, there are others who test positive but remain in the community. The majority of 'cases' are thankfully low symptomatic or even asymptomatic. However, all these positive tests count as 'cases' for the health department reporting system. This does two things:
- 'case' numbers can take off in a rather impressive manner
- case fatality ratio appears to be lower than during the first wave.
Yes, we have gotten better at treating this. The ICU docs got better with deciding who needs mechanical ventilation, the use of steroids at the correct time reduces severity and we stopped dicking around with things that were proven to not work. Still, if you catch covid and you show up at the ER door, your odds of making it back out of the hospital are not the 99.x% that some expert on youtube told you it is.
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Lindberg
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I'm sure you can point out where I said any such thing.
PlasticCigar
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This is an interesting perspective on a new ICU nurse’s experience.
https://www.cnn.com/videos/health/2...its-going-coronavirus-pandemic-nr-bts-vpx.cnn
There are definitely few things more frustrating than watching someone die and not being able to do anything about it. Sadly, it seems like the public’s high regard and concern for healthcare workers wore off a long time ago. I hope she survives this experience without too much long term damage.
For those of use who have worked in the ER for decades, this has been a challenging time. Can’t even begin to imagine what it’s like for a new grad in their 20’s to be dumped into this.
https://www.cnn.com/videos/health/2...its-going-coronavirus-pandemic-nr-bts-vpx.cnn
There are definitely few things more frustrating than watching someone die and not being able to do anything about it. Sadly, it seems like the public’s high regard and concern for healthcare workers wore off a long time ago. I hope she survives this experience without too much long term damage.
For those of use who have worked in the ER for decades, this has been a challenging time. Can’t even begin to imagine what it’s like for a new grad in their 20’s to be dumped into this.
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Bob Noel
I do understand the difference between IFR, CFR, symptomatic CFR, etc... and the math relationships.
I'm in maskachusetts and I watch every single one of Gov Baker's media briefings regarding covid. Recently he's been saying that the recent increase in the number (%) of positive tests is not as serious as it was in the spring... precisely because of the reasoning you stated in your post above. He says his medical experts are telling him that maybe 1 in 4 cases are being detected now versus 1 in 10 (or 1 in 20) in the spring (note that in maskachusetts more than 100,000 tests are being administered each day... or thereabouts). Don't get me wrong... he is not going all la-dee-dah about it (and neither am I).
"if you catch covid and you show up at the ER door," is a subset of "if you catch covid".
It's interesting to look at world-o-meter (https://www.worldometers.info/coronavirus/). It shows worldwide active cases and the percentage of those that are serious/critical. Over the course of this pandemic, the percentage of active cases that are serious/critical has been dropping and is now showing less than 1%. Note that I'm saying world-o-meter is an authoritative source... just noting it.
denverpilot
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Actually the numbers at the ER door are really good. Because tons who show up at the ER door are sent home to self-quarantine.
You’ll have to change that to admitted to make that slightly more accurate, and we know two now who were admitted, O2 administered, and O2 levels monitored for less than 12 hours and kicked to the curb.
Karen’s place has mostly been tossing people back to their houses since April. That’s been one of the “better care” things few mention — they figured out in a month that time-of-exposure really mattered a lot, and started bouncing everyone they could. If you don’t have critical vital signs, you aren’t staying... not even for observation unless you have a fairly high risk factor.
One of those we know has severe asthma. That was not a high enough risk factor to stay. Various drugs to mellow her respiratory distress, four hours on O2 until sats were rising and above 80, and a call to her contact person to get her the hell out of the Covid ward. Sister network hospital to Karen’s.
The correlation between time-under-the-curve for virus exposure and worse outcomes, continues to generally be true and they won’t add that risk to even a medium-distressed patient. Haven’t for months now. The ER doc who bounces between there and Karen’s clinic says, “If we can get them out, if there’s any debate, and no medical reason to keep them, they’re out.”
Side-effect: A bunch infect family at home adding to “cases” but their family symptoms are generally low and rarely severe. Anecdotal evidence that families at least attempt some level of isolation inside their dwellings which limits that time-under-the-curve exposure thing, but Doc says it’s extremely hard to measure that one other than lengthy interviews — which really nobody is doing.
Essentially the hospital network and their Docs have been trading off better outcomes for more “community spread” thru shared housing. The numbers just work out better that way.
GaryM
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I follow the science, professionally, and the stats as released from various organizations that collect the data.
The one thing I don't do anymore is listen to media briefings from ANY governor (or mayor, or president, or president-elect), regardless of where they sit on the political spectrum. Waaaayyy too much spin, in one direction or the other, to support their particular worldview.
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chemgeek
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Correct. We have no long-term data, and cannot until individuals who have achieve immunity naturally or through vaccines have extended out in time. No one has ever had this disease more than a year ago. That's the extent of our long-term knowledge. We cannot know what we cannot measure yet. And a "positive" result is not informative. What titer constitutes a "positive"?
chemgeek
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Remember, R0 is exponential. So twice the R0 is a very large change in transmissibility. As in half the doubling time. In the early days of the pandemic in NY, the doubling time for infection was 3-4 days. Even with all the knowledge we have now, and substantial mitigation efforts, the nationwide apparent doubling time currently is STILL around 50 days or less, and has been stable or decreasing for the last 2-4 weeks. That is an unusually transmissible virus. The "terror" is that a disturbing fraction of those infected (around 5 in a 1000, for those who test positive, about 1-3 in 100 depending on how you calculate it) will not just get sick, but die a horrible death and a much larger fraction will have long-term morbidity. The older you are, the more "above average" that mortality and morbidity risk becomes. If you are 65 or older, it is (if I recall correctly) around 8 times higher. Most common viral diseases don't leave that kind of permanent mark. The most maddening part is that while most individuals will survive infection, many relatively unscathed, an unpredictable few have very bad outcomes. It's the Dirty Harry of viruses: "Are you feeling lucky...?"
FWIW, self-consistent, recency-weighted calculation of the CFR (case fatality rate) based actual confirmed case and death data, regressing for the CFR and lag time shows about a 3% CFR with a 42 day lag time. (The numbers change slightly, but not a lot depending how much you weight the most recent data to get a "current" CFR estimate.) Most outlets estimate CFR by taking the current deaths and dividing by current cases, but of course individuals don't die instantly from COVID. There is a lag of 2-8 weeks between presenting symptoms sufficient to test positive and eventual death. Calculating CFR without accounting for lag during a growth period will significantly underestimate the CFR. The CFR has significantly decreased since the beginning of the pandemic for sure, likely due to a shift in the demographics of the infected population, and small improvements in treating patients who are hospitalized.
PlasticCigar
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You seem like a very wise man. Throughout this whole burning dumpster fire of a year I haven’t been able to wrap my head around why people trust politicians up for election (or re-election) more than their health professionals.
If I needed my appendix out, I wouldn’t go to the local mayor, I’d see a surgeon. Why anyone would take what a politician says at face value and make medical decisions based on that tripe is completely unfathomable to me.
PaulS
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It always amazes me that people look to politicians to fix problems they are total unqualified to fix. And the politicians seem more than eager to offer solutions that have no chance of succeeding.
Appreciate the explanation.
I will have no issues getting one of the COVID vaccines. The ones currently in the running are reported to be very effective. I don't get the influenza vaccine as it is generally not very effective; I plan on getting as I get older and more susceptible to it.
Wayne
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I'll take it a step further and say that im amazed they even have the means/authority to offer solutions to most problems to begin with. Big government doing what it does best.
PlasticCigar
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Can you cite your reference for that?
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Bob Noel
it's my understanding that if you live/work with elderly (e.g., someone is susceptible to it), the recommendation is to get the influenza vaccine
(please forgive the awkward sentence... I haven't had any coffee this morning...)
chemgeek
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Everyone is susceptible to influenza, not just the old. For some strains, younger individuals may actually be more susceptible than older ones. The influenza vaccine is typically very effective against the strains included in the annual formulation. The lower "effectiveness" of the influenza vaccine stems from how well epidemiologists estimated which strains are likely to circulate in the upcoming flu season. At the very least, the annual influenza vaccine will provide excellent protection against 3 or 4 common strains of virus (depending on which vaccine you get), and partial immunity to closely related strains. But there is no guarantee that a "surprise" strain may get to you during a particular season. Unlike coronaviruses, measles, chickenpox, etc., influenza viruses mutate wildly, presenting a moving target each year. Nevertheless, it is very worthwhile to get an influenza vaccination each year. There is no reason to needlessly suffer from an influenza strain you could be protected against, or to avoid reducing the intensity and shortening the duration of disease from closely related strains, and most health plans cover vaccinations in full. People do die from influenza, maybe 1 in 10,000. On a personal note, one of my aunts, in otherwise perfect health and in her mid-40s, suddenly died of complications from influenza in the 1970s.
PlasticCigar
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Good advice. None of the people I have seen die from influenza were vaccinated. Zero. Doesn’t mean it’s 100% effective, but if you do get it there’s a pretty good chance you won’t get as sick as you otherwise would.
I had H1N1 in 2009 and it’s the sickest I’ve even been in my life (I got it before the vaccine came out). I’d like to not repeat that experience with COVID.
I had H1N1 in 2009 and it’s the sickest I’ve even been in my life (I got it before the vaccine came out). I’d like to not repeat that experience with COVID.
Pfizer reportedly UAL is chartering UAL planes to distribute vaccine.
https://thepointsguy.com/news/united-charter-flights-pfizer-vaccine-distribution/
https://thepointsguy.com/news/united-charter-flights-pfizer-vaccine-distribution/
A co-worker got it in January. He was down hard for a week, then worked from home for another week. Lost 15+ pounds. He had the vaccine in the fall prior to that.
I also got it in January. It hardly slowed me down. I thought it was allergies, or maybe a sinus issue; sinuses congested in the mornings. Nope, Type A influenza. Loaded a truck up for the dump that evening (after the test) then took it to the dump in the morning and unloaded it. No vaccine.
Yeah, yeah, small sample set.
This is the first year my mother has gotten the flu vaccine; 78 years old. She’s never gotten the flu.
denverpilot
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Unless you’re the unlucky bastard to catch Influenza-A the year they didn’t put anything for A in the cocktail. That was fun.
Be interesting to see what variants and mutations of the current thing do. Going to tick a lot of people off if it does a bunch of that and hangs around in various potencies forever.
Which it’s likely to do, and always has been, strictly by the numbers.
danhagan
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Not a fun year for sure ... my younger new grads would say "uncle" if they could ...
steingar
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I don't know that many people who've had the 'rona. Of the handful I do know two have ongoing life altering disease symptoms. Do what you want, I'll sit this one out if I can. I just had to call my dentist and tell him I'm not coming untilI get a vaccine. I like my dentist, and I know he's doing the right thing. But I'm still not going. No doctors, no optometrist, nothing. Not until and unless I get the vaccine.
Like I said, do what you want. The 'rona could easily kill Mrs. Steingar. I'll sit this one out thank you.
Like I said, do what you want. The 'rona could easily kill Mrs. Steingar. I'll sit this one out thank you.
Matthew Rogers
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I am sitting it out too, because my dad who lives in an attached house, has pancreatic cancer. But being a young, not high risk person, I have to wait until the end of the line to get the vaccine. That part sucks. Good thing I don’t mind wearing my industrial shop PPE into the grocery store. N95, no way....full face P100 respirator for me.
Can I sit with you? Oh wait...you want to be alone.....Ok, I can take a hint.
woodchucker
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Talked to my half-brother who is currently applying for residency positions and he had the same opinion. Brand new stuff and no knowledge of long-term effects. At some point we need a vaccine that people are comfortable taking. Hopefully sooner than later.
PlasticCigar
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I’m not sure I would go to a medical student to get advice on what vaccines to get for a brand new disease with brand new vaccines, but if it works for you, go ahead...(full disclosure: I am a faculty member at an ER residency program and work with med students and residents on a daily basis).
I feel sorry for the people applying for residency this year. It used to be a really exciting few months where you would fly around the country and meet a bunch of people who would tell you how awesome you are and why you should pick them for “the match” but now it’s a whole bunch of zoom meetings (did 12 interviews back-to-back last week) and the applicants don’t really get a good way to get a feel for the programs.
Best of luck to your half-brother on the match.
I feel sorry for the people applying for residency this year. It used to be a really exciting few months where you would fly around the country and meet a bunch of people who would tell you how awesome you are and why you should pick them for “the match” but now it’s a whole bunch of zoom meetings (did 12 interviews back-to-back last week) and the applicants don’t really get a good way to get a feel for the programs.
Best of luck to your half-brother on the match.
woodchucker
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Not necessarily taking advice just sharing a conversation. At the same time vaccines have a relatively short testing period and the long term effects are not known until ... long term happens. As a teacher I will likely be required to take whatever vaccine is available over the summer. Guess I’ll be a test person also.
woodchucker
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yes he did also mention all the zoom interviews. More difficult to get an understanding of candidates probably.
Next week, my wife is going to spend 3 days on the other end of those zoom calls. Yes, its going to be really difficult. All of these folks applying are incredibly bright and have great credentials, its going to be like forming an NBA team based college statistics alone.
steingar
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I"m getting the COVID vaccine as soon as I can. I"m not waiting around to get a disease that has a decent chance of ending my or my spouse's life. If the FAA doesn't like they can pound sand. I've never wanted to be a scofflaw, but I'm not going to risk my life to follow an enormously ill advised rule.
chemgeek
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And I'm not aware of any regulation that prohibits pilots from receiving vaccines. As for any medication or treatment, FAA advice is to wait for transient side effects to pass before resuming pilot privileges. The last thing the FAA needs to be doing is discouraging the pilot community from getting preventive medicine.
steingar
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There has been some reasonably cogent talk about the FAA looking dimly on "experimental" vaccines. This was backed up by Bruce Chien his own self. His is the last word on these sorts of things as far as I'm concerned. Whether the mRNA vaccines, which are on the cusp of emergency authorization, will be considered experimental is another story. Don't really care, I'm getting vaccinated at my earliest opportunity. you should too. Just don't get the Astra Zeneca vaccine.
The question in my mind is "how does the FAA feel about a vaccine that is approved under an Emergency Use Authorization?"
gsengle
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Exactly. It’s not an “approved” vaccine, it’s I believe still considered experimental when allowed to be given under “emergency use”. Approval comes later. No idea how much later... I’ve written to the FAA med branch to urge guidance, no reply. Hope others will reach out too.
Sent from my iPhone using Tapatalk
PlasticCigar
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One of the recurring themes that gets people killed in both aviation and medicine is failing to recognize (and mitigate) the current life threat. Another way of looking at it is focusing on the wrong problem which isn’t likely to hurt you and missing the one that’s much more likely to kill you.
I remember as a resident having to justify my antibiotic choice on a septic patient with a multi drug resistant organism because the chosen antibiotic had a rare but serious side effect. I asked him “so you want me to inadequately treat his life-threatening infection that we KNOW he has because there’s an extremely rare possibility that he MIGHT have a side effect from the treatment?” He asked me to call ID. They agreed with me.
It looks like I’m first in line for the vaccine. Whether it’s the Moderna or Pfizer product, I really don’t care. I’ll ground myself for a week after each dose. I have both basicmed and a 2nd class medical, so if the FAA doesn’t like my choice they can kiss my a..
I’m not going to risk my health (and my families health) for some theoretical FAA technicality but I can almost guarantee that when you try to renew your medical they will look at a serious COVID case much more unfavorably than they will a vaccine FDA authorized under EUA.
Let’s use some common sense here, folks.
I remember as a resident having to justify my antibiotic choice on a septic patient with a multi drug resistant organism because the chosen antibiotic had a rare but serious side effect. I asked him “so you want me to inadequately treat his life-threatening infection that we KNOW he has because there’s an extremely rare possibility that he MIGHT have a side effect from the treatment?” He asked me to call ID. They agreed with me.
It looks like I’m first in line for the vaccine. Whether it’s the Moderna or Pfizer product, I really don’t care. I’ll ground myself for a week after each dose. I have both basicmed and a 2nd class medical, so if the FAA doesn’t like my choice they can kiss my a..
I’m not going to risk my health (and my families health) for some theoretical FAA technicality but I can almost guarantee that when you try to renew your medical they will look at a serious COVID case much more unfavorably than they will a vaccine FDA authorized under EUA.
Let’s use some common sense here, folks.
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