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Everything posted by mattb65

  1. Things are still on track for a good summer. The decline in first doses of the vaccine has been a bit steeper than expected but the decline in cases has also been a bit earlier and steeper than expected.
  2. https://www.bbc.com/news/world-asia-india-56891016
  3. Exactly, what's the point in him posting those pictures? Is it to prove that the NY Post is a garbage news source and a glorified tabloid? You don't need to convince me... Is it to downplay the covid situation in India? Seems like everything in India regarding covid is as bad as one could imagine right now. https://www.statnews.com/2021/04/27/in-covid-grip-india-gasps-for-air-if-there-is-an-apocalypse-this-has-to-be-one/
  4. @Hoosier West Virginia is getting creative at trying to improve their vaccination numbers West Virginia Gov. Justice: State will use COVID-19 stimulus funds to give all residents 16-35 a $100 savings bond https://www.wvnews.com/news/wvnews/west-virginia-gov-justice-state-will-use-covid-19-stimulus-funds-to-give-all-residents/article_3464b366-a6af-11eb-8cef-a3be246c97ac.amp.html
  5. This is hard to measure, if you look at covidactnow.org you can sort by daily cases per 100k or current infection Rt. Louisiana and Alabama have among the top 5 Rt but their current daily cases per 100k is in the bottom 10 in states. Hard to declare winners and losers I don't think there's been enough time to show a negative correlation between vaccination rates and infection rates between different states. Maybe check back in 6 months to see if there's been a difference between cases per capita and deaths per capita between high vaccine and low vaccine states.
  6. A private school in Miami, citing false claims, bars vaccinated teachers from contact with students. https://www.nytimes.com/2021/04/26/us/florida-centner-academy-vaccine.html
  7. I thought this was a good and balanced take on the transition from the first phase of vaccination where there was a pent up demand and a supply scarcity to the current phase where supply had caught up and it's about outreach to those on the fence and those that aren't highly motivated. Efforts should be on making it as painless as possible to get vaccinated, public education about the facts with transparency about the risks and benefits, and reasonable incentives for example Hawaii is launching its vaccine exemption to avoid quarantine for interisland travel and hopefully will do the same for transpacific travel not to long afterwards. It sounds like the CDC is going to be providing more and more guidance that being vaccinated makes a lot more fun things safe. I'm still very optimistic about the way ahead, of course it would have been nice to keep the numbers averaging over 3 million per day vaccinated for a little longer but we knew that wasn't going to happen based on the large chunk of people that have decided against vaccines for their variety of reasons. I think most of their reasons are misguided but it's their life and their free will, as a provider I'll be happy to discuss this with my patients and provide facts to help then make their own decision.
  8. This is a really good article that goes into the data on the blood clots from this vaccine and explains the rationale that different members of the advisory committee used in making their decisions. They also discuss the risks and benefits of different courses of action. https://www.cnn.com/2021/04/23/health/johnson-vaccine-acip-recommendation/index.html They present a lot of numbers in the risks/benefits section. "For every million doses of vaccine given to women 18 to 49, 13 TTS cases can be expected, Oliver said. But 12 deaths from Covid-19 would be prevented and 127 ICU admissions would be prevented among those women if they had access to the Janssen vaccine."
  9. This is definitely interesting, if the rough math I did before is still close to accurate this would correlate to a roughly 1 in 100,000 risk of this serious adverse reaction in women under 50. I wonder if there are other commonalities besides gender like being on combined oral contraceptives as an additional risk factor. I agree either a warning or even an outright restriction on giving it to women under 50 would both be reasonable. Even though the risk is small, the consequences are devastating. If I were in the at risk demographic I would 100% choose Pfizer or Moderna.
  10. I've had my second dose of Pfizer since early January, no problems at all. Not sure why people are living their life in fear. Get out there, get the shot, be a patriot. We are at war with the virus, when you look back do you want to be a draft dodger/bone spur pansy or do you want to be a freedom loving american that did your part? Insert 1,000 american flag emojis.
  11. Edit: misread your post the first time... By the end of June, total 62% of the total population immune 32% from vaccine alone, (45% of the total american population vaccinated aka 149 million people) 13% from vaccine plus infection, 17% from infection alone. By January 2022 the breakdown is 64% total protection, 38% vaccine, 16% vaccine plus infection, 10% infection alone. Link - https://covid19-projections.com/path-to-herd-immunity/ He posts all of the assumptions in his model in terms of rate of waning natural immunity, effectiveness of vaccines, etc. According to the CDC we are already at 41% of the population that has received at least the first shot. The model estimates 60-70% total will get the vaccine by the end of the year. As we know the protection isn't 100% from the vaccine in terms of preventing transmission, the model estimates an 85% vaccine efficacy rate which is why the total immune from vaccination stays below that number.
  12. It's the start of the dip, we are definitely past the immunization peak. I too wish we had maintained the pace a bit longer but it's dropping as predicted, and the drop is likely to accelerate in the next few weeks. I'm anticipating media hysteria on the drop off in vaccination rates over the next couple weeks. I posted before that the vaccine projection by youyanggu from months ago on vaccination rates appears to be remarkably spot on. On the plus side the expected collapse in cases also appears to be happening right on schedule also. *fingers crossed*
  13. This data scientist projected the vaccination rates and infection rates back in December with adjustments made up until early March. What's impressive to me is that he correctly projected when cases would start to plateau and slowly increase through the last 6 weeks and appears to correctly have predicted the peak in cases to within a week. Let's hope he's accurate with how fast and how far cases drop over the next two months. https://covid19-projections.com/path-to-herd-immunity/ He is also the only site that I've seen where the vaccination rates were projected out in time. He predicted ahead of time that new vaccinations would rise and peak about 1 week ago and then fall sharply over the next month and remain at a relatively low level until the fall when presumably younger people will be approved to get vaccinated. He made this apparently accurate projection without any knowledge of the J&J clotting issue. This is a long way of saying that though vaccine rates are likely to drop over the next few weeks, try not to get discouraged, we probably have enough people vaccinated to get cases through the summer to an extremely low level, even "well below 10,000" . If things go as expected and no crazy escape variant emerges then the next stress test will be in the fall. I'm curious once we get cases really low if we'll be able to utilize rapid testing and tracing more effectively to try and contain localized outbreaks. It seems like NZ and Australia have shown that this is possible but only when the virus isn't widespread.
  14. Below 10k isn't vague at all, either you're above the number or below it. How is that vague?
  15. I respect Dr. Fauci quite a bit and really don't like the way some law makers have behaved and been disrespectful toward him like what happened with Jim Jordan. There does need to be a better articulated end game. I think setting a goal to some low level of infections before we recommend easing up should be the message right now. They've done this on a local level here. "Well below 10,000" is too vague. Gun to head, Dr. Fauci said 10,000 even if he qualified it with "well below".
  16. The 7 day average of reported cases will probably get below 10k well before the end of June, want to make a friendly wager? If 7 day average of cases are below 10k before July 1st, you don't post in this thread for all of July and August, if it never gets below that level I will do the same.
  17. The last paragraph that you highlighted and underlined should be qualified further. Experts estimate 70-85% of people need to become immune to the virus through infection or vaccination to prevent spread without any mitigation measures. Again we are already seeing the beginning of a downturn but are nowhere near the 70-85% number. If you take that paragraph literally then there's no way we would have any of the downturns that we've seen. I feel very confident that the downturn over the next 3 months driven by seasonal changes and vaccination rates will be the largest we've seen thus far. Dr. Fauci suggests that we can lift all restrictions if the national cases get to below 10,000 cases per day, I bet we get there by the end of June.
  18. There's been no better cause and effect relationship in this pandemic than vaccine uptake in a population group and subsequent declines in cases, hospitalizations and deaths. There's a difference between herd immunity in a population acting like it did before the pandemic and the current herd immunity threshold in a population acting like it is now and with the other environmental factors that affect transmission. We can and will overcome the herd immunity threshold and cases will start to decline in the coming weeks/months, I have a lot of confidence that this will happen because it's happened in comparable countries. I also think the current prevalence of the virus and hospitalizations should be some of the main metrics used to inform policy and messaging on how cautious people need to be at a particular time and that there can be different rules for people that are vaccinated and people that are not vaccinated. The herd immunity threshold will be different in the summer than it will be in the fall and winter but the rate of cases will reflect the current amount of immunity and caution needed to keep things contained.
  19. Have you reviewed the infection and immunization curves in Israel and the United Kingdom. Once they had over 40% of their populations with some level of immunity from vaccination,, their infection curves showed exponential decay. We are getting close to those same levels of immunity in the US even with a large segment of people not eligible to get vaccinated yet. That segment obviously doesn't tend to get bad outcomes from this virus which is important to consider. The more the better obviously but I think there is compelling data that people will be able to resume most normal activities very soon. I think the July 4th date proposed by Pres Biden or maybe sooner is realistic. I don't think we'll have a herd immunity level of immunization by that point in time and I don't think it will matter. A critical enough mass will be vaccinated, anyone who wants to be vaccinated that has a significant level of risk will have had a chance to be vaccinated by that time period. Edit: you said there isn't data on this, only conjecture, that's wrong, see paragraph 1.
  20. Nearly 50% of all eligible adults have already initiated their vaccination. Many colleges are requiring vaccinations to attend which will cover a large portion of the 18-22 group. I understand the concern over vaccine hesitancy but the data we already have on how many people have been vaccinated and continue to be vaccinated - 3.3 million shots per day and still climbing - is really encouraging. I think saying half of all Americans may not get it which includes all those under 16 that aren't eligible is the wrong measure to evaluate. It should be how many of the 16+ or 18+ are getting the vaccine. So far those numbers still look great.
  21. Yes, though that probably would have also caused some chaos with people canceling appointments. My back of napkin math - looking at the data we have from cdc unfortunately doesn't break down vaccines individually by age or gender but does provide the breakdown of all vaccine doses by age and gender. If I assume a similar proportion of J&J is given based on age/gender of all vaccines - is 35% of vaccines to those under 50, and 55% to women. So of the 6.8 million J&J doses administered, approximately 1.3 million have gone to women under 50. This gives a cerebral venous sinus thrombosis rate of approximately 1 in 200,000 to 1 in 250,000 for this group. There my be additional cases identified due to more awareness as well as cases from doses given within the last 14 days that haven't developed or been diagnosed yet. For all of these reasons a pause is reasonable from a medical perspective imo. Maybe people will have more confidence in the RNA based vaccines that have been given for a longer time without any big safety problems aside from rare anaphylaxis. As I had mentioned when those first reports came out, anaphylaxis is not fun but is very treatable. CVST is much more difficult to treat and much more likely to cause potentially permanent disability or death.
  22. One thing regarding the J&J vaccine that's missing in the public discussion is a more nuanced view of the blood clot risk. Everyone is putting out the less than 1 in 1,000,000 rate of this adverse effect. What I've read is that it's only affected women under 50 so instead the discussion should be the risk in women under 50 is 1 in x and so far this adverse effect has not been seen in any males or women over 50. My guess is eventually they will resume vaccinations with J&J except for the high risk population. They should be communicating the specific facts. Transparency will be the best way to build trust in my opinion.
  23. As a Neurologist, I'm very familiar with cerebral venous thrombosis and can affirm that they are very scary, can be difficult to treat and can be deadly or very disabling. It's one of the reasons why I support them doing due diligence to define and mitigate this risk as much as possible. I'll never forget the woman I saw as a medical student who was teaching a class as a professor and went down and was found to have a massive CVT and became brain dead 48 hrs later even with maximal treatment. I've had plenty that were identified and got anti coagulation and did fine too. I agree with those that note since we have alternative and safer vaccines, maybe we should restrict J&J if we identify that young women are the ones getting this complication.
  24. People will assume they can avoid covid or assume that even if they get unlucky and catch itthat they'll probably be fine. On the other hand they have to actively choose to get a vaccine that they've now heard May cause blood clots. Even though the risk of blood clots appears to be extremely low, I can easily see the thought process behind someone saying nope to choosing J&J or AstraZeneca because it is now a known risk that is within their control. Catching covid and the risks of infection is a much more nebulous risk. Tough position for the FDA/CDC if they said nothing it seems like they may be hiding something, if they do what they've done, the media and everyone freaks out.
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