new Covid wave

[yesmaster]

“Whenever the number or proportion of COVID-19 deaths at age < 70 years was not provided in the paper, I retrieved the proportion of these deaths from situation reports of the relevant location. If I could not find this information for the specific location, I used a larger geographic area.”

Highest quality data? Okay, buddy.

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[Burt Radnolds]

“Whenever the number or proportion of COVID-19 deaths at age < 70 years was not provided in the paper, I retrieved the proportion of these deaths from situation reports of the relevant location. If I could not find this information for the specific location, I used a larger geographic area.”

Highest quality data? Okay, buddy.

Highest quality available is different than high quality. The second paper only allowed data with full age info available btw.

This is worldwide data and the US is not a particularly healthy country in regards to some of the known risk factors for mortality. We are a diabetic, obese, atherosclerotic bunch in general.

COVID can be a disaster and not particularly fatal to the young healthy individual at the same time. It doesn't mean the young healthy individual should overlook the affects of their actions on those around them. I'm a masker and a vaxxer and COVID is depressing as hell. I've had close family members and patients die, as I'm sure most of us have. I've made it very clear that I respect the virus and will do all in my power to mitigate it.

 

[radOresident]

COVID can be a disaster and not particularly fatal to the young healthy individual at the same time. It doesn't mean the young healthy individual should overlook the affects of their actions on those around them.

This is the point that I believe so often gets overlooked by the anti-mask, anti-vaxx crowd. I, as a healthy young person, can probably dine at restaurants indoors and go to parties with no social distancing and no masks and in all likelihood will not die from covid. But every patient I see after doing that is now at a higher risk than if I'd just done the right thing and taken mitigating measures. My family is at higher risk. The people who have to keep working in settings like restaurants despite the health hazards are at higher risk.

Death may be an unlikely outcome, but fatality rate is not the only endpoint that matters. Longer term side effects can be troublesome at any age range.

 

[yesmaster]

In the setting of many unknown's, my preference is to assume and act on the worst-case scenario, and hope for the best-case scenario.

With these studies of IFR (infection fatality rate) varying from 0.00% (smh) to 0.5% to 1.3%, there are so many unknowns.

• How reliable is data collection in USA vs. OECD vs. ex-OECD countries?
• How reliable are serologic tests for prior SARS-CoV-2 infection?
• Does serologic test positivity wane over time? Does serologic test positivity confer protection against future COVID-19 infection? Does serologic test positivity prevent future asymptomatic transmission of SARS-CoV-2?
• How much protection does the Pfizer or Moderna vaccine provide, compared to asymptomatic vs. symptomatic COVID-19 infection?

I would much rather overestimate the dangers of COVID-19, and be extra cautious (social distancing, masking, vaccination), than underestimate the dangers of COVID-19 and put myself and others at risk.

For radiation oncologists and anyone with face-to-face contact with cancer patients, my opinion is that vaccination should be mandated (assuming an infinite supply of vaccine), unless you have uncontrolled HIV, or you're an organ transplant recipient, or you were otherwise excluded from the phase 3 vaccine trials. For young healthcare workers (ages 20's-40's), the primary rationale is protection of patients, maintenance of the healthcare workforce (i.e. absenteeism due to quarantine), and public health messaging.

Since vaccine supplies aren't infinite, and if a fraction of healthcare workers are vaccine hesitant, it may be equally beneficial to just quickly move on to vaccinating older adults and medically high-risk people, like radiation oncology clinic patients.

 

[medgator]

.

Death may be an unlikely outcome, but fatality rate is not the only endpoint that matters. Longer term side effects can be troublesome at any age range.

The longer term side effects are only beginning to be known over the last year and amazes me how so many downplay it.

This is not just a mortality issue, but a morbidity one as well. Coronavirus causes coagulopathy in organs in some people with long term ramifications

 

[communitydoc13]

For young healthcare workers (ages 20's-40's), the primary rationale is protection of patients, maintenance of the healthcare workforce (i.e. absenteeism due to quarantine), and public health messaging.

This is spot on. The absolute benefit to self is minimal in low risk populations but the potential community benefit is huge. I'm taking it when available and I'll let my patient's and staff know.

A couple of numbers that help me with order of magnitude arguments.

1. NJ already has aggregate COVID mortality over 0.2%. I think it is unlikely that over 50% of the vulnerable population of NJ has already been infected. Those super low case mortality numbers get hard to believe when considering this (and many other municipalities data).

2. How old is your average prostate patient in radonc? Average patient in general? Unless you are at MSKCC or a very high end urban center, it is pushing 70. Hard to say risk profile of your 60 y/o woman s/p AC/Taxol is really in that super low category. It is very reasonable to think that your patients may have a case mortality rate well in excess of 1%. I have had patients die of COVID in a community clinic not in a present hot spot.

3. While I agree that it is not proven, I think that it is likely that the vaccine has a significant impact on communicability. Even if the vaccine does not provide permanent or long term immunity, there are scenarios where if a large fraction of the population becomes temporarily immune, you can functionally eradicate the virus.

As an aside. I think that it is interesting that COVID is apparently a fairly easy virus to vaccinate against. (The population based data regarding possible effectiveness of non-specific vaccines like the flu vaccine is telling in my opinion.) I suspect that nearly all the vaccines out there will be significantly effective. I think China and Russia may have been effectively vaccinating people for some time. The U.S. should definitely not be self congratulatory about where we are right now.

 

[scarbrtj]

I think China and Russia may have been effectively vaccinating people for some time. The U.S. should definitely not be self congratulatory about where we are right now.

yes and yes

We Had the Vaccine the Whole Time​

...it’s worth noting, as early as July the MIT Technology Review reported that a group of 70 scientists in the orbit of Harvard and MIT, including “celebrity geneticist” George Church, were taking a totally DIY nasal-spray vaccine, never even intended to be tested, and developed by a personal genomics entrepreneur named Preston Estep (also the author of a self-help-slash-life-extension book called The Mindspan Diet). China began administering a vaccine to its military in June. Russia approved its version in August...

 

[Ray D. Ayshun]

Is anybody doing whole lung rt regularly/at all?