PlagueWatch 2020-23 - Coronavirus

[devil84]

So, is your thought that the big shift for your family will be when your kids are eligible for the vaccine and get fully vaccinated? The challenge with all this is that COVID is likely to be endemic, and I don't want my children living in fear forever. So, at some point, there HAS to be a shift to "normal." I have been fairly cautious, but have loosened the strings a bit lately. I will take my kids into Target or a museum (masked). They go to daycare 9+ hours a day (masked indoors and outdoors, including my two year old, which is unusual as most states don't require it that young -- I frankly wish they didn't require it for that age or at least not outdoors.) Everybody needs to decide what is right for them and their family. It's hard to have a mindset shift I've determined once you've been doing something for so long though.

Yes, the shift for my family will be when my grandkids are fully vaccinated AND many of my daughter's medically fragile pediatric patients (most can and will be vaccinated ASAP, per their parents). My grandchildren have day care here in my house -- grandma has always been their daycare, even pre-pandemic, so we made the decision early to treat our two separate houses as one unit, even buying our groceries together. Because we've been able to stare at another set of four walls and interact with one of our adult children and her family, we didn't suffer from isolation too much. Perhaps more of too much togetherness at times!

We're willing to continue because of the infant, the just barely 3 year old, and the medically fragile pediatric patients my daughter sees with communication and swallowing disorders. Some of these children have other factors, such as autism or being wheelchair-bound, that really complicate their lives. These special children are likely on Medicare which requires that the therapy be given in the patient's home. The patients' parents are willing to let her in their home because she is being just as cautious as these families have been. My daughter has indicated that they have volunteered to her that anyone in the household who is eligible has been vaccinated and they are (im)patiently waiting for their children to be eligible. A few are immunocompromised and may not respond well to the vaccine. My daughter is still on a very reduced case load because she is not comfortable going into other people's homes where it's unknown how concerned they are about Covid. Any return to normalcy for her came to a halt last fall when a patient's parent called while she was en route to their house and wanted to mention that people in the household had mild but active cases, but she could see the patient in the dining room instead of the living room where the sick people were. Like many therapists, my daughter is not salaried, so she's paid by the visit. She really doesn't like to get to the patient's house (or have left her house) and find out she wasted her time.

We might have a different outlook if she had a different career, where what we do with her kids doesn't also affect a number of other extremely medically fragile children. We might have a different outlook if people did not expect her to come into their house with active cases in the house. We might have a different outlook if my grandmother hadn't carried the guilt of bringing home the pandemic disease that killed her sister, the young mother of an infant. We might have a different outlook had I not taken so many courses in the history of medicine at Duke and found out that, collectively as a nation, we really aren't behaving that differently than the 1918 flu pandemic, the cholera pandemics beginning in 1817, or the Bubonic plague in 1346, despite the existence of modern medicine and public health, nearly all of which hadn't been discovered by the end of Spanish Flu pandemic in 1920.

We're hoping that there's a vaccine by the end of the year approved for children. We're content to wait another year if we need to. We kinda all like working from home, having the little ones around and eating lunch with them and playing with them on breaks. We're seeing other vaccinated people, like my other son and his girlfriend, and we even braved going to his indoor hooding ceremony at the Greensboro Coliseum -- fully vaxxed, 2 guest per graduate, 80 graduates, plus maybe another 80 faculty. There were several hundred masked people in stadium that seats over 23,000, so we felt safe. Other people have different levels of feeling safe. I don't expect anyone to be as careful as we are (I couldn't live with myself if our family got somebody else's medically fragile child extremely sick or worse). Our outlook is that this is a challenge that we'll get through, but we aren't in control of the timetable. What we are in control of is how we look at this. We're in a pandemic -- I studied these with great interest! And we're determined to do what we need to for ourselves and our community. If we keep ourselves out of circulation, that's six fewer bodies that can possibly harbor the virus and help it mutate. We are making the best of this family time. We want to keep my grandsons, Nolan and Grayson, as safe as we can as well as those wonderful pediatric patients that my daughter sees who are the apple of their family's eyes. Besides, not taking the kids into stores has a benefit: they have no idea that there are toy aisles, that there are other snack/cereal/cookie options that they aren't getting, or that there's candy at the checkout counter! We're looking for the silver linings.

No plague or pandemic has lasted forever, and neither will this one. Many seem to last a few years or so, so it shouldn't be that much longer. We, collectively, can also behave like humanity has in every other pandemic and get tired of it too soon and have yet another wave worse than before. Thankfully, we have effective vaccines for this one and Americans are pretty well vaccinated compared to the rest of the world. But, the longer we have continued epidemic/pandemic levels of cases worldwide, there's a chance that there's a mutation that could get around the vaccine and we're back to square one. I'd rather have mask wearing and reduced indoor capacities for another 6-12 months than to have another protracted lockdown this fall/winter with a surge in some horrible variant, or even just a surge in today's variants that affects mostly the unvaxxed, which can still overwhelm our health care system.

[budwom]

I am on a business trip this week and flights/airports are PACKED. At least there, everyone (largely) is masked. I think we're almost at prepandemic levels now and that's with a tremendous drop in business travel so pleasure travel is probably up in comparison to June 2019.

did you get a rental car? I'm fascinated as to how long it may take to sort that situation out...what are usually $30 rentals going to $240, and some friends simply unable to get a car at all for a Western trip this summer...

[Bluedog]

did you get a rental car? I'm fascinated as to how long it may take to sort that situation out...what are usually $30 rentals going to $240, and some friends simply unable to get a car at all for a Western trip this summer...

In a major city, so no rental car. I rode a Lyft for the first time since pandemic started. But the security at the airport this afternoon is truly insane. I'm pretty surprised to be honest. Flights are overbooked everywhere and offering vouchers.

[budwom]

In a major city, so no rental car. I rode a Lyft for the first time since pandemic started. But the security at the airport this afternoon is truly insane. I'm pretty surprised to be honest. Flights are overbooked everywhere and offering vouchers.

I saw the other day that American had to cancel 400 flights that day alone...they just can't ramp things up fast enough, pilots need to be recertified, the whole process takes a lot of time. Glad I'm sitting this summer out.

[CrazyNotCrazie]

In a major city, so no rental car. I rode a Lyft for the first time since pandemic started. But the security at the airport this afternoon is truly insane. I'm pretty surprised to be honest. Flights are overbooked everywhere and offering vouchers.

I'm flying for the first time this weekend. Two hour flight so not too bad. As of earlier today both of my flights look half full, which is good. I cannot get to the airport until about an hour ahead of time so I'm hoping that is OK - I am leaving a major family event near home early as it is to take a flight to another major family event. I sometimes get a nervous cough tic so I'm hoping that doesn't happen on the plane or I will likely have a lot of enemies. Fortunately I do not need a rental car.

I have been taking a cab at least once a week and had no issues - I normally don't like the windows open so just remind myself to leave them open for circulation. I also have been taking public transportation at least once a week since September. It is getting more crowded but people all continue to wear masks and try their best to keep their distance. I don't wear a mask much outside but do so indoors as my wife remains high risk and I have two kids who are not vaccinated. I also "read the room" - if the person I am with seems anxious and is keeping the mask on, I also do to be respectful.

[Bluedog]

I also "read the room" - if the person I am with seems anxious and is keeping the mask on, I also do to be respectful.

Yeah, I "read the room" this week too where 0% of people wore masks in all conference rooms (literally nobody -- only masked people were office building cleaning staff). I honestly felt somewhat uncomfortable...it just felt strange. I kinda knew what was coming though...Social norms/cues are a powerful thing. I tried to keep as much distance as I could and hoped for good air circulation and left room when I could. I was in a purplish state in a blue city for a red industry client. It seemed like I was the only person that felt this way though. Everyone else was operating as no pandemic.

[cato]

I appreciate tbe anecdotes from other vaccinated folks like myself who are still being cautious. I am still eager to hear from healthcare professionals who have a bigger picture understanding of how we can best continue to protect ourselves.

Thanks!

At this point, with the lessons learned since last Jan/Feb, I think public health officials are the ones to listen to. Unvaccinated people can resume life without masks. I now only wear a mask when picking up my kid from pre-school, because those are the school rules.

Unvaccinated people shouldn’t change their behavior. I’ve got young kids, so they still have to wear masks, eat outside, etc.

We just scuttled plans to go to Florida to visit my mom. We really want to visit my mom (she hasn’t seen her grandkids in years, which is pretty meaningful at their age), but are not going to take our unvaccinated kids into a crowded airport and onto a plan with a bunch of maskless, unvaccinated folks running around.

[mpj96]

Do you realize how condescending this post is?

My tone was in every way commensurate with your own.

[PackMan97]

So, Packman, if you see masked people roaming around the southwest area of Wake County, it could be me and my family. We're feeling like some of the only people who still mask.

We live off Penny, so I guess that's mostly SW Wake...we head to Crossroads/Walnut/Kildaire for most of our shopping. We find masking in Cary is SIGNIFICANTLY higher than Fuquay, though your mileage may vary.

[Dr. Rosenrosen]

These are only estimates, but I don’t like this bit from Israel where they seem to be saying 30-50% of new cases are among people who are fully vaccinated. And the delta variant seems to be the driver. Thankfully, they are saying the symptoms are less severe for those who were fully vaccinated. But still. Ugh.

https://www.businessinsider.com/isra...-severe-2021-6

[YmoBeThere]

These are only estimates, but I don’t like this bit from Israel where they seem to be saying 30-50% of new cases are among people who are fully vaccinated. And the delta variant seems to be the driver. Thankfully, they are saying the symptoms are less severe for those who were fully vaccinated. But still. Ugh.

https://www.businessinsider.com/isra...-severe-2021-6

It said this in the article, "It wasn't clear whether those people had been fully or partially vaccinated." But looking at their numbers they claim 82% with at least one shot and 78% fully vaccinated so it may not be a substantial distinction. The new cases there are averaging about 75 per day:

Screenshot 2021-06-24 195852.jpg

[cato]

It said this in the article, "It wasn't clear whether those people had been fully or partially vaccinated." But looking at their numbers they claim 82% with at least one shot and 78% fully vaccinated so it may not be a substantial distinction. The new cases there are averaging about 75 per day:

Screenshot 2021-06-24 195852.jpg

Did they discuss which vaccines?

[YmoBeThere]

Did they discuss which vaccines?

My understanding is that they are mostly Pfizer with some Moderna. The article does cite lower efficacy against the Delta variant.

[Skydog]

These are only estimates, but I don’t like this bit from Israel where they seem to be saying 30-50% of new cases are among people who are fully vaccinated. And the delta variant seems to be the driver. Thankfully, they are saying the symptoms are less severe for those who were fully vaccinated. But still. Ugh.

https://www.businessinsider.com/isra...-severe-2021-6

Thats depressing.

[sagegrouse]

These are only estimates, but I don’t like this bit from Israel where they seem to be saying 30-50% of new cases are among people who are fully vaccinated. And the delta variant seems to be the driver. Thankfully, they are saying the symptoms are less severe for those who were fully vaccinated. But still. Ugh.

https://www.businessinsider.com/isra...-severe-2021-6

Thats depressing.

Israel has at least partial vaccination for 61 percent of its population (57 pct. full). It is probably much higher among adults. Moreover, from the article Dr. Rosenrosen cited, the number of new cases is a tiny, tiny fraction of the peak level in February 2021.

[devil84]

We live off Penny, so I guess that's mostly SW Wake...we head to Crossroads/Walnut/Kildaire for most of our shopping. We find masking in Cary is SIGNIFICANTLY higher than Fuquay, though your mileage may vary.

Yep that's the SW Wake I was referring to! We live right at Crossroads (Tryon/Cary Pkwy), so we shop at the same places. Masking in Cary/Apex is significantly higher than surrounding areas, though a couple of necessary trips to Lowe's Home Improvement recently indicated that "significantly higher" is still considerably less than the percentage of the unvaxxed population. The number of families with unmasked children squarely in the school-age but under 12 was astounding to me.

Last night at the neighborhood food truck, which was outdoors and people were very spread out, there wasn't a single mask, not even the guy serving in the food truck. (The Big Easy Rouler does have excellent shrimp po'boys, though -- hand breaded and fried and ready in a flash. The gumbo was good and the alligator was, well, tasted like chicken, haha.)

[budwom]

Interesting article from the Atlantic touting Novavax as the best vaccine currently available...though obviously the earlier availability of the mRNA vaccines put it behind the eight ball..https://www.theatlantic.com/health/a...accine/619276/

[summerwind03]

Yes, the shift for my family will be when my grandkids are fully vaccinated AND many of my daughter's medically fragile pediatric patients (most can and will be vaccinated ASAP, per their parents). My grandchildren have day care here in my house -- grandma has always been their daycare, even pre-pandemic, so we made the decision early to treat our two separate houses as one unit, even buying our groceries together. Because we've been able to stare at another set of four walls and interact with one of our adult children and her family, we didn't suffer from isolation too much. Perhaps more of too much togetherness at times!

We're willing to continue because of the infant, the just barely 3 year old, and the medically fragile pediatric patients my daughter sees with communication and swallowing disorders. Some of these children have other factors, such as autism or being wheelchair-bound, that really complicate their lives. These special children are likely on Medicare which requires that the therapy be given in the patient's home. The patients' parents are willing to let her in their home because she is being just as cautious as these families have been. My daughter has indicated that they have volunteered to her that anyone in the household who is eligible has been vaccinated and they are (im)patiently waiting for their children to be eligible. A few are immunocompromised and may not respond well to the vaccine. My daughter is still on a very reduced case load because she is not comfortable going into other people's homes where it's unknown how concerned they are about Covid. Any return to normalcy for her came to a halt last fall when a patient's parent called while she was en route to their house and wanted to mention that people in the household had mild but active cases, but she could see the patient in the dining room instead of the living room where the sick people were. Like many therapists, my daughter is not salaried, so she's paid by the visit. She really doesn't like to get to the patient's house (or have left her house) and find out she wasted her time.

We might have a different outlook if she had a different career, where what we do with her kids doesn't also affect a number of other extremely medically fragile children. We might have a different outlook if people did not expect her to come into their house with active cases in the house. We might have a different outlook if my grandmother hadn't carried the guilt of bringing home the pandemic disease that killed her sister, the young mother of an infant. We might have a different outlook had I not taken so many courses in the history of medicine at Duke and found out that, collectively as a nation, we really aren't behaving that differently than the 1918 flu pandemic, the cholera pandemics beginning in 1817, or the Bubonic plague in 1346, despite the existence of modern medicine and public health, nearly all of which hadn't been discovered by the end of Spanish Flu pandemic in 1920.

We're hoping that there's a vaccine by the end of the year approved for children. We're content to wait another year if we need to. We kinda all like working from home, having the little ones around and eating lunch with them and playing with them on breaks. We're seeing other vaccinated people, like my other son and his girlfriend, and we even braved going to his indoor hooding ceremony at the Greensboro Coliseum -- fully vaxxed, 2 guest per graduate, 80 graduates, plus maybe another 80 faculty. There were several hundred masked people in stadium that seats over 23,000, so we felt safe. Other people have different levels of feeling safe. I don't expect anyone to be as careful as we are (I couldn't live with myself if our family got somebody else's medically fragile child extremely sick or worse). Our outlook is that this is a challenge that we'll get through, but we aren't in control of the timetable. What we are in control of is how we look at this. We're in a pandemic -- I studied these with great interest! And we're determined to do what we need to for ourselves and our community. If we keep ourselves out of circulation, that's six fewer bodies that can possibly harbor the virus and help it mutate. We are making the best of this family time. We want to keep my grandsons, Nolan and Grayson, as safe as we can as well as those wonderful pediatric patients that my daughter sees who are the apple of their family's eyes. Besides, not taking the kids into stores has a benefit: they have no idea that there are toy aisles, that there are other snack/cereal/cookie options that they aren't getting, or that there's candy at the checkout counter! We're looking for the silver linings.

No plague or pandemic has lasted forever, and neither will this one. Many seem to last a few years or so, so it shouldn't be that much longer. We, collectively, can also behave like humanity has in every other pandemic and get tired of it too soon and have yet another wave worse than before. Thankfully, we have effective vaccines for this one and Americans are pretty well vaccinated compared to the rest of the world. But, the longer we have continued epidemic/pandemic levels of cases worldwide, there's a chance that there's a mutation that could get around the vaccine and we're back to square one. I'd rather have mask wearing and reduced indoor capacities for another 6-12 months than to have another protracted lockdown this fall/winter with a surge in some horrible variant, or even just a surge in today's variants that affects mostly the unvaxxed, which can still overwhelm our health care system.

Grandsons Grayson and Nolan!!! That is awesome.

[Skydog]

Israel has at least partial vaccination for 61 percent of its population (57 pct. full). It is probably much higher among adults. Moreover, from the article Dr. Rosenrosen cited, the number of new cases is a tiny, tiny fraction of the peak level in February 2021.

I realize its dangerous to look at “30%-50% of cases are from vaccinated patients” and making sense of it without knowing a lot more detail. Like you point out absolute rates matter. Article mentions 100 new cases/day, highest since May. Now that is tiny compared to their peak of 8000/day. But 50 or so fully vaccinated Israelis per day getting Covid isn’t nothing.

A lot depends on how sick the vaccinated are getting. Article says “no severe cases” in Israel. But article also says that in the UK “26 of 73 deaths were fully vaccinated. Those are very different stories. Maybe UK deaths weren’t Pfizer or Moderna, supposedly more effective vs Delta variant?

Another note - knowing that “50% of new covid cases are in vaccinated people” tells us little about the general effectiveness of the vaccine. We also need to know the comparative amount of exposures as well as pre-vaccine susceptibilities of the two groups. Also matters how cases are being identified. Are we doing randomized testing, finding cases from people who contact a physician, or just comparing rates within a hospitalized population? Those approaches will yield very different results.

Say for example that pre-vaccine 90% of hospitalizations are of people 65yo+, 80% of people 65+ are now vaccinated versus only 25% of those under 65. This would mean that being vaccinated is highly correlated with being old and vulnerable and not being vaccinated is highly correlated with being young and low risk in the first place. In this scenario even if a vaccine cut hospitalizations by 90%, we might still see more vaccinated than unvaccinated people being hospitalized.

So my questions now are: 1. Why are there no severe vaccinated cases in Israel but a third of UK deaths coming from the vaccinated group? 2. How bad are the Israei vaccinated cases? Are long hauler cases happening for the vaccinated? 3. How do these findings affect predictions about the virus evolving fast enough to require constant boosters of updated vaccines?

[rsvman]

Interesting article from the Atlantic touting Novavax as the best vaccine currently available...though obviously the earlier availability of the mRNA vaccines put it behind the eight ball..https://www.theatlantic.com/health/a...accine/619276/

I have just been placed on an advisory committee for this vaccine,so in a few weeks I will have a lot of information about it.
For now what I know is that it is a subunit vaccine, which is a vaccine type that we (humankind) have a lot of experience with. They use a baculovirus to get genetic material that encodes the spike protein into moth cells. The moth cells make the spike protein. The scientists then collect spike proteins and attach them to a tiny carrier cylinder. They use an adjuvant derived from a tree (i don't know a lot about this aspect of the vaccine just yet, but I probably will within a few weeks).

I am excited to be included in this small group that will help the company think through all things about testing and marketing this vaccine.