Herd Immunity and Belgium

[The Knife & Gun Club]

For a small anesthesia group that takes call 24 hours at a time, working postcall is a real pain.

Didn’t realize you weren’t EM, makes more sense if you’re taking call.

I would also be bummed.

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[GeneralVeers]

Improved knowledge of the start and extent of the spread might help to some degree. Might also improve model data.

Coronavirus Was In U.S. Weeks Earlier Than Previously Known, Study Says

"These findings also highlight the value of blood donations as a source for conducting SARS-CoV-2 surveillance studies," they said.

Serologic testing of U.S. blood donations to identify SARS-CoV-2-reactive antibodies: December 2019-January 2020

I wonder how many cases we saw in the later part of 2019 that went undiagnosed.

It's sad because we will never know exactly when this hit. Considering China's cover-up and continuation of direct flights from Wuhan to several U.S. cities, December/January arrival date is not far-fetched.

That's why I think total deaths is an excellent way to extrapolate total cases as we have a reasonable estimate of the morality rate now. Thankfully it's way less than the 3% mortality that led to the ridiculous nonsense that we all have to deal with.

 

[GeneralVeers]

Total deaths is perhaps the only (mostly) accurate number we have. We know the mortality rate based upon CFR. We know the rough percentages of how many will remain asymptomatic or only experience mild infection. I feel like we still don’t have a great sense though of how many undiagnosed asymptomatic exposures/infections and mild infections already occurred from December 2019-2020. The number of severe cases also might be underreported given we didn’t have a test a year ago. The true IFR is a mystery still given we don’t know the denominator.

I supposed the simplest way to figure it out would be to do a random sampling of 10,000 adults for Positive COVID results (regardless of symptoms) and then see how many die.

 

[turkeyjerky]

I highly doubt there were enough cases here last winter to make any appreciable difference in terms of population immunity or overall IFR. These studies are interesting though, in that they pretty much establish that the cat was out of the bag in terms of containment before we even knew it existed.

 

[bravotwozero]

any of you guys seeing influenza these days? We're well into flu season and I have yet to see a single case.

 

[GeneralVeers]

any of you guys seeing influenza these days? We're well into flu season and I have yet to see a single case.

I haven't really been testing for it. Certainly the younger crowd we tested like crazy last year aren't getting flu tests this year. Everyone is only worried about the 'Rona

 

[WilcoWorld]

any of you guys seeing influenza these days? We're well into flu season and I have yet to see a single case.

Flu's on the respiratory viral panel that all our Peds admissions with respiratory symptoms are required to get if they're to be admitted - not seeing an uptick yet.

 

[GeneralVeers]

Flu's on the respiratory viral panel that all our Peds admissions with respiratory symptoms are required to get if they're to be admitted - not seeing an uptick yet.

Are the kids in school where you are? If not then that could explain the lack of flu circulating. I don't see a lot of kids, but ours aren't in school for reasons.

 

[GeneralVeers]

No, I haven't seen a case yet and was also surprised. I looked at the CDC's flu surveillance site and noted though how it looks like it really upticks around December each year. I've always remembered diagnosing some cases in October-November, but maybe I'm just thinking it comes earlier than it does. It seems like I also barely see any kids in the ED these days as they (their parents) are staying away. That also might be contributing. For likely outpatient dispositions from the ED, we recently switched from a VRP for testing to a quick antigen test as our supplies are getting low. We might be missing a few cases as our focus is heavily on COVID-19. Perhaps masks, social distancing and schools closing are more effective for the flu than COVID-19.

View attachment 324296
CDC - Weekly U.S. Influenza Surveillance Report

Well we know that kids transmit influenza to each other and to adults. Not so for COVID-19. Wouldn't it be interesting if school closures reduced influenza this year while likely not making a dent in COVID spread? Makes the case for shutting schools every flu season. Maybe have kids go to school in Summer instead.

 

[WilcoWorld]

Are the kids in school where you are? If not then that could explain the lack of flu circulating. I don't see a lot of kids, but ours aren't in school for reasons.

Unfortunately not. Hope we can get them back to school soon> I'd much prefer to see schools open than bars, but no one asked for my input.

 

[WilcoWorld]

Well we know that kids transmit influenza to each other and to adults. Not so for COVID-19. Wouldn't it be interesting if school closures reduced influenza this year while likely not making a dent in COVID spread? Makes the case for shutting schools every flu season. Maybe have kids go to school in Summer instead.

The old rationale of letting 'em out in summer to bring in the harvest largely doesn't apply any more...

 

[GeneralVeers]

The old rationale of letting 'em out in summer to bring in the harvest largely doesn't apply any more...

It actually makes more sense to have them out of school during Flu pandemic season. There's no reason to to cluster kids inside densely during the annual peak of the flu pandemic that's actually more dangerous to kids and young adults than COVID. While we are at it, let's switch the whole country to daylight savings time permanently. Archaic traditions need to go.

 

[bravotwozero]

While we are at it, let's switch the whole country to daylight savings time permanently. Archaic traditions need to go.

It's amazing nobody in office has addressed this. Completely nonpartisan issue with most of the country wanting to get rid of it, and no special interest groups getting in the way. Would be a easy win for anyone wanting to scrap DST.

 

[BAM!]

Well we know that kids transmit influenza to each other and to adults. Not so for COVID-19. Wouldn't it be interesting if school closures reduced influenza this year while likely not making a dent in COVID spread? Makes the case for shutting schools every flu season. Maybe have kids go to school in Summer instead.

Are you suggesting kids don't transmit covid? smh

 

[GeneralVeers]

Are you suggesting kids don't transmit covid? smh

Not that they don't, but rates are far lower than adult ---> child or adult--->adult. Low enough that the risk of opening schools is minimal.

 

[VA Hopeful Dr]

It actually makes more sense to have them out of school during Flu pandemic season. There's no reason to to cluster kids inside densely during the annual peak of the flu pandemic that's actually more dangerous to kids and young adults than COVID. While we are at it, let's switch the whole country to daylight savings time permanently. Archaic traditions need to go.

If we didn't have a flu vaccine I would 100% agree with you.

Well that and we'd kill summer camp as a thing.

 

[GeneralVeers]

If we didn't have a flu vaccine I would 100% agree with you.

Well that and we'd kill summer camp as a thing.

Fine with that. Those of us who are childless would appreciate year-round schooling as everything would be quieter.....

 

[thegenius]

any of you guys seeing influenza these days? We're well into flu season and I have yet to see a single case.

One case that I know of. But I'm not even testing for it. Very low prevalence right now

 

[bravotwozero]

One case that I know of. But I'm not even testing for it. Very low prevalence right now

we're doing RPPs plus covid on our patients who are symptomatic. it's either covid, or rhinovirus.

 

[AMEHigh]

It seems like the US is trying to reach herd immunity.

On Wednesday we had the highest number of daily deaths since the pandemic started.

The next couple of months are going to suck.

 

[miacomet]

Plenty of countries have done better than us- NZ, Australia, Korea, Singapore, Hong Kong, Taiwan. Sure, island advantage, but the US has only two borders, both of which have been closed since winter. Places with fewer restrictions have done worse (looking at the Dakotas). But the US in general seems more than happy to let the virus run its course, for better or for worse, and seem happy to accept a high number of deaths.

 

[miacomet]

Yes I understand this. But the person I quoted said it’d be a waste to vaccinate their approximation of 40% of people who’ve had Covid.

I’m trying to figure out why it’d be a waste to vaccinate people who had Covid in March or April 2019 for example and it’ll be almost a year later when vaccine roll out starts. Thosea people are still at risk of getting and spreading Covid to my understanding, but that’s why I asked if I were missing some new info.

Is immunity lifelong?

 

[AMEHigh]

Is immunity lifelong?

No. People have been getting reinfected.

 

[AMEHigh]

Plenty of countries have done better than us- NZ, Australia, Korea, Singapore, Hong Kong, Taiwan. Sure, island advantage, but the US has only two borders, both of which have been closed since winter. Places with fewer restrictions have done worse (looking at the Dakotas). But the US in general seems more than happy to let the virus run its course, for better or for worse, and seem happy to accept a high number of deaths.

Yes it’s pretty bad here and it doesn’t seem like enough people care.
We have more cases and deaths than India.

As a Black person I certainly understand mistrust of the medical system due to a history of experiments on us but I’m going to be pissed if people don’t get vaccinated and continue to run around like we’re not in a pandemic and we’re stuck in this hell even longer than we need to be.

 

[miacomet]

Yes it’s pretty bad here and it doesn’t seem like enough people care.
We have more cases and deaths than India.

As a Black person I certainly understand mistrust of the medical system due to a history of experiments on us but I’m going to be pissed if people don’t get vaccinated and continue to run around like we’re not in a pandemic and we’re stuck in this hell even longer than we need to be.

I worry the vaccine situation with Covid has been so politicized that it's going to be a problem. I've seen physicians, including Black physicians, expressing a lot of skepticism on line, publicly, while not citing any data. I hope we find a solution to the pandemic. No one liked masks. They may not like vaccines.

 

[turkeyjerky]

I worry the vaccine situation with Covid has been so politicized that it's going to be a problem. I've seen physicians, including Black physicians, expressing a lot of skepticism on line, publicly, while not citing any data. I hope we find a solution to the pandemic. No one liked masks. They may not like vaccines.

Yeah, vaccination uptake is poised to be one more thing I'm wrong about. A few months ago I thought it would be near 100%....

I don't really get the comparison to masks though. Only one has data and offers minimal inconvenience.

 

[GeneralVeers]

Yeah, vaccination uptake is poised to be one more thing I'm wrong about. A few months ago I thought it would be near 100%....

I don't really get the comparison to masks though. Only one has data and offers minimal inconvenience.

Which one? People often quote overwhelming data on mask effectiveness, as I'm sure the vaccine makers have as well.

 

[turkeyjerky]

Which one? People often quote overwhelming data on mask effectiveness, as I'm sure the vaccine makers have as well.

Sorry, was referring to vaccines (at least if the press releases are accurate). I'm still not aware of any actual strong evidence on the reliability of masking, it all seems to be circular logic.

Media messaging went from "Test, Test, Test!" to "Mask, Mask, Mask!" and it's gotten us to this point.

 

[Rekt]

I worry the vaccine situation with Covid has been so politicized that it's going to be a problem. I've seen physicians, including Black physicians, expressing a lot of skepticism on line, publicly, while not citing any data. I hope we find a solution to the pandemic. No one liked masks. They may not like vaccines.

I think some skepticism is healthy and should be allowed/expected. Essentially a new mechanism for vaccine use that was extremely rushed to development with very measly numbers supporting it's efficacy. In the eyes of someone that's not even thirty yet, runs >5miles a day, eats well, etc. There's plenty of docs/residents that are really healthy. It's going to be a hard sell. Sure, there's no evidence, but there's the risk of becoming that evidence . With that said, if my parents asked me to get it, I'd tell them to get it immediately when possible.

 

[GeneralVeers]

Sorry, was referring to vaccines (at least if the press releases are accurate). I'm still not aware of any actual strong evidence on the reliability of masking, it all seems to be circular logic.

Media messaging went from "Test, Test, Test!" to "Mask, Mask, Mask!" and it's gotten us to this point.

Agreed. It's almost to the point of religious fervor. Mask compliance is up past 80% but cases keep going up...

 

[AMEHigh]

I think some skepticism is healthy and should be allowed/expected. Essentially a new mechanism for vaccine use that was extremely rushed to development with very measly numbers supporting it's efficacy. In the eyes of someone that's not even thirty yet, runs >5miles a day, eats well, etc. There's plenty of docs/residents that are really healthy. It's going to be a hard sell. Sure, there's no evidence, but there's the risk of becoming that evidence . With that said, if my parents asked me to get it, I'd tell them to get it immediately when possible.

I think the bolded is a false narrative that we as physician need to stop spreading.
I don't have time to find all the conversations that show it wasn't rushed. The timeline was fast because the world decided to put money behind this and cooperate together. The backbone of much dna sequencing was already there from other coronaviruses, so once china shared the dna secquence of specifically covid-19 (which worldwide sharing is typically unheard of), it made it easy to get things rolling on production and trialing the vaccines. Most governments don't put money behind vaccine production for a very long time. There were no science or safety shortcuts.

 

[AMEHigh]

Agreed. It's almost to the point of religious fervor. Mask compliance is up past 80% but cases keep going up...

In my area where we have decent testing and contact tracing, approximately 70% of infections have been found to be spread within small indoor family/friend type gatherings. Masks typically aren't worn in such gatherings. So the fact that cases are going up isn't proof that masks don't work at all. But if you want to work with potential covid patients without a mask on because it doesn't do anything, then go right ahead, but I hope you're isolating yourself outside of work and not spreading it to others.

 

[GeneralVeers]

In my area where we have decent testing and contact tracing, approximately 70% of infections have been found to be spread within small indoor family/friend type gatherings. Masks typically aren't worn in such gatherings. So the fact that cases are going up isn't proof that masks don't work at all. But if you want to work with potential covid patients without a mask on because it doesn't do anything, then go right ahead, but I hope you're isolating yourself outside of work and not spreading it to others.

Once again you are ascribing thoughts and actions to me that aren't in evidence.

 

[BAM!]

I worry the vaccine situation with Covid has been so politicized that it's going to be a problem. I've seen physicians, including Black physicians, expressing a lot of skepticism on line, publicly, while not citing any data. I hope we find a solution to the pandemic. No one liked masks. They may not like vaccines.

The problem is there is no data to cite! the only available data is an interim analysis of 90 patients. Therein lies the skepticism, or perhaps caution.

 

[BAM!]

I think the bolded is a false narrative that we as physician need to stop spreading.
I don't have time to find all the conversations that show it wasn't rushed. The timeline was fast because the world decided to put money behind this and cooperate together. The backbone of much dna sequencing was already there from other coronaviruses, so once china shared the dna secquence of specifically covid-19 (which worldwide sharing is typically unheard of), it made it easy to get things rolling on production and trialing the vaccines. Most governments don't put money behind vaccine production for a very long time. There were no science or safety shortcuts.

It was rushed to development. Vaccines typically take 10+ years to develop. The fastest ever in the US prior to these ones was the mumps vaccine which took 4 years.

The COVID19 vaccines were developed so quickly for 3 reasons:
1. $$$, in the case of moderna --> "Operation Warp Speed."
2. Jumping the line for approvals at governmental agencies.
3. High prevalence of disease. We have millions of cases, so the clinical tries have lots of positives to bolster the data. This is not true for meningococcal disease...

Rushed --> yes.
Shortcuts --> the experts are saying, "No." I suppose we have to believe them based on their reputations.

From a health policy standpoint I completely understand the message of "No shortcuts taken. The science is sound."
However I can also understand healthy skepticism for a new technology that was rushed into practice.

 

[turkeyjerky]

In my area where we have decent testing and contact tracing, approximately 70% of infections have been found to be spread within small indoor family/friend type gatherings. Masks typically aren't worn in such gatherings. So the fact that cases are going up isn't proof that masks don't work at all. But if you want to work with potential covid patients without a mask on because it doesn't do anything, then go right ahead, but I hope you're isolating yourself outside of work and not spreading it to others.

Were the transmission patterns substantially different in the spring before universal masking?

 

[BAM!]

AMEHigh said:
In my area where we have decent testing and contact tracing, approximately 70% of infections have been found to be spread within small indoor family/friend type gatherings. Masks typically aren't worn in such gatherings. So the fact that cases are going up isn't proof that masks don't work at all. But if you want to work with potential covid patients without a mask on because it doesn't do anything, then go right ahead, but I hope you're isolating yourself outside of work and not spreading it to others.

Once again you are ascribing thoughts and actions to me that aren't in evidence.

Are your own words not meaningful?

Angry Birds said:
Did you get COVID from work or from not using a mask or social distancing?

Probably a mix of all three. I didn't care because I realize given my exposure at work I'd probably get it, as most of our population will get it and recover before this is over.

 

[VA Hopeful Dr]

Agreed. It's almost to the point of religious fervor. Mask compliance is up past 80% but cases keep going up...

In SC it absolutely is not. Maybe where you live is a haven of compliance, especially nose covering, but not where I am.

 

[VA Hopeful Dr]

It was rushed to development. Vaccines typically take 10+ years to develop. The fastest ever in the US prior to these ones was the mumps vaccine which took 4 years.

The COVID19 vaccines were developed so quickly for 3 reasons:
1. $$$, in the case of moderna --> "Operation Warp Speed."
2. Jumping the line for approvals at governmental agencies.
3. High prevalence of disease. We have millions of cases, so the clinical tries have lots of positives to bolster the data. This is not true for meningococcal disease...

Rushed --> yes.
Shortcuts --> the experts are saying, "No." I suppose we have to believe them based on their reputations.

From a health policy standpoint I completely understand the message of "No shortcuts taken. The science is sound."
However I can also understand healthy skepticism for a new technology that was rushed into practice.

Have you looked into why vaccines take so long normally?

Its a combination of money (vaccines are not huge money makers), participants (it can take years to get enough volunteers), and basic science research. The first 2 we had in overwhelming abundance with COVID. The 3rd one was addressed already by a previous post.

 

[GeneralVeers]

Are your own words not meaningful?

I wear a mask with every patient interaction. It's the rule at work and I want to keep my job. I have never advocated for not doing that at work.

What we do in our private lives is different.

 

[miacomet]

I wear a mask with every patient interaction. It's the rule at work and I want to keep my job. I have never advocated for not doing that at work.

What we do in our private lives is different.

Masks work in the hospital, but not outside of it? I confess I'm confused by this.

 

[AMEHigh]

It was rushed to development. Vaccines typically take 10+ years to develop. The fastest ever in the US prior to these ones was the mumps vaccine which took 4 years.

The COVID19 vaccines were developed so quickly for 3 reasons:
1. $$$, in the case of moderna --> "Operation Warp Speed."
2. Jumping the line for approvals at governmental agencies.
3. High prevalence of disease. We have millions of cases, so the clinical tries have lots of positives to bolster the data. This is not true for meningococcal disease...

Rushed --> yes.
Shortcuts --> the experts are saying, "No." I suppose we have to believe them based on their reputations.

From a health policy standpoint I completely understand the message of "No shortcuts taken. The science is sound."
However I can also understand healthy skepticism for a new technology that was rushed into practice.

As physicians we can certainly discuss the wording nuances between rushed and shortcuts etc.
All I'm saying is that for a public health standpoint we shouldn't go about spreading the rumor that it was rushed.
To the general public rushed means things like not paying attention, taking safety short cuts, etc.
And I personally hated the phrase "operation warp speed"
I realize the person I quoted said "rushed" here on these message boards among other physicians so hopefully they aren't telling their patients that the vaccine was rushed, but I still wanted to point out this important difference.

 

[GeneralVeers]

Masks work in the hospital, but not outside of it? I confess I'm confused by this.

I follow the rule in hospital. When I go to a casino, hotel or restaurant I have to wear a mask to get service. I don't wear a mask when there are no rules forcing me to comply, such as in my car, on a public street, or walking outside. I'm not sure why this is controversial.....

 

[AMEHigh]

Were the transmission patterns substantially different in the spring before universal masking?

Where are you speaking of that has universal masking?
Are you talking about within the US or outside of the US?

But yes I live in the epicenter of the pandemic in the US. Obviously in Jan and Feb we didn't know we should be masking as cases were slowly spreading. Now that people are wearing masks on the subway, in the hospital and at stores, yes less people seem to be getting covid and dying. I believe there is a correlation between lower viral load and symptoms as well. So masks don't prevent all spread, but does block some spread.
Unfortunately, since testing was so ****ty in the spring we'll never know for sure how many people actually had covid, but since the hospitals were overrun and a TON of people died at home as well, I think it seems fair to say that there were a lot of covid cases.
As I said above, based on contract tracing here approximately 70% of cases are spreading in small gatherings, so that also points towards that masks are helping in public settings.

However, as I said it before, that if in 5 years we find out that masks do absolutely nothing for covid, I still won't regret that I wore a mask during the pandemic. We don't have much to help us right now other than distancing, washing hands and masking...none of which are overly burdensome to me in the grand scheme of things and have the potential to help keep people safe, so I have no problem complying.

 

[Rekt]

In SC it absolutely is not. Maybe where you live is a haven of compliance, especially nose covering, but not where I am.

I'm sorry, but are you actively walking around stores/business/etc and counting how compliant people are? People wearing it poorly is still mask compliance. That's an education issue. Most of the time it's completely subconscious that they're wearing it incorrectly.
I'm somewhere without statewide mask mandate and masking is still likely >90%.
I think some of you guys get so absorbed in your CNN stories about anti-maskers you think it's reality.
You guys have probably never seen the behind the scenes behind those street interview type deals where they actually interview 40-50 normal people to find the one dumb ass to put on air.

 

[WilcoWorld]

I follow the rule in hospital. When I go to a casino, hotel or restaurant I have to wear a mask to get service. I don't wear a mask when there are no rules forcing me to comply, such as in my car, on a public street, or walking outside. I'm not sure why this is controversial.....

I don't think what you're saying here is controversial - But I think that your previous posts allow for multiple interpretations that are controversial.

 

[VA Hopeful Dr]

I'm sorry, but are you actively walking around stores/business/etc and counting how compliant people are? People wearing it poorly is still mask compliance. That's an education issue. Most of the time it's completely subconscious that they're wearing it incorrectly.
I'm somewhere without statewide mask mandate and masking is still likely >90%.
I think some of you guys get so absorbed in your CNN stories about anti-maskers you think it's reality.
You guys have probably never seen the behind the scenes behind those street interview type deals where they actually interview 40-50 normal people to find the one dumb ass to put on air.

I went to Cabelas 3 weeks ago. In the roughly hour I was there, I counted 4 mask-wearing customers including me. I didn't plan to but when almost everyone wasn't wearing one, those who were really stuck out.

Its location dependent. My city has an ordinance, my county does not. The 2 grocery stores I use in the city are easily >90%. The one in the county I frequent is probably right at 50%. I don't count but roughly half the people have masks and roughly half don't.

And your incorrect assumptions are adorable. I hate CNN intensely. Just because my experiences don't jive with yours doesn't mean I'm getting all of my information from a biased source.

 

[AMEHigh]

Do we think it’s simply luck of the draw how some young and healthy people do ok and others have long term symptoms or die? I’ve briefly seen headlines about something specific with some people’s immune system, but nothing concrete.

I just saw a young and healthy ED physician post his pic on cpap and said he cried to his nurse because he was so hypoxic he was scared.

I know most people on here say it’s no big deal because they’ll likely survive, which is true, but at the same time what is causing some healthy people to go down so hard? And why are kids still doing so well in general? I’m not walking around afraid, but I’m also following public health recs because I don’t want to get covid so I am just wondering if we’ll ever figure out if there is a scientific cause.

 

[BAM!]

Have you looked into why vaccines take so long normally?

Its a combination of money (vaccines are not huge money makers), participants (it can take years to get enough volunteers), and basic science research. The first 2 we had in overwhelming abundance with COVID. The 3rd one was addressed already by a previous post.

...same as what I said. In other words, it was rushed through, expedited, prioritized. However you want to say it. Not sure what your point is.

 

[thegenius]

Once again you are ascribing thoughts and actions to me that aren't in evidence.

My county shares contact tracing results and I've heard very similar results too. A weekend BBQ, family gathering, etc. Often no more than 5-10 people. And once it gets into a family house, everyone seems to get it within a few weeks.