mattb65

3 hours ago, Hoosier said:

I'd be curious to know how much less mask wearing is occurring in those states after the mandates were lifted.  If it's almost at the same level as before, then you wouldn't necessarily expect a big surge.  If it's much less than before, then perhaps a combo of vaccinations and changing seasons is helping them out.

Indiana will be an interesting test coming up to see what happens when you end the mask mandate in a northern state.

Be quiet with your logic here.

Fwiw, I didn't get the sense that people in this thread were feeding too much into the media hysteria about the mask mandate issue. So much of the ebbs and flows of this virus seem to be driven by seasonal factors, it's extremely hard to assign causality to the rise and fall in cases. Like you said it's a function of human behavior and the innumerable environmental factors that affect transmission.  At this point I'm not sure how much unenforceable mandates on mask wearing affects human behavior. 

Having said that there is very obvious and clear cause and effect data coming out of Israel,  Nursing Homes in the US and Healthcare workers in the US that validates how insanely effective the vaccine is at preventing infections. 

36 minutes ago, Hoosier said:

Got me thinking.  We focus on daily hospitalization numbers, but cumulatively, how many people in the US have been hospitalized with covid?  Gotta be around a million, plus or minus, right?  Over a half million dead but probably a non-negligible number died without ever being in the hospital.

Per CDC data, total of 1.9 million hospitalizations - https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions

Edit: this is from August 2020 to within the past week so not including the first waves of the virus. The total number would be significantly more. 

dta posted above that 95% don't require hospitalization,  that's 5% that do require hospitalization which is insanely high and appropriately covered by the media as a big deal.

For reference, according to CDC data approximately  1-1.5% of all influenza cases require hospitalization.  When you take the hospitalization rate in combination with how extraordinarily more transmissible covid is compared with influenza it is expected that almost all the news would be terrible about the virus.  2020 was a terrible year for so many reasons. 

The vaccine effect on deaths and hospitalizations diverging from cases is becoming more and more apparent especially now that cases are starting to level off our even tick back up slightly.  With the pace of vaccines providing protection to the vulnerable and slowing of transmission things should be generally open everywhere and restrictions lifted by the end of April or May at the latest imo. I agree with those that are saying that we aren't giving enough positive incentives and positive messages about the benefits of widespread vaccinations and how rapid we will be way low on deaths and hospitalizations. 

I think it's partially fear of a variant taking off and the difficulty to walk things back plus the political fall out if you over promise and under deliver.

I'm pretty sure people are paying enough attention to see where things are going with the pandemic end in sight.

1 hour ago, schoeppeya said:

Fair. I just don't specifically buy into "if someone doesn't get the vaccine it is because they are selfish/too dumb to understand risk/reward". And I don't think taking that stance promotes a healthy dialogue around the vaccine, which is something that could end up convincing somebody who actually needs the vaccine to get it. Actually,  I know for a fact that type of rhetoric stops people from getting it.  

That's fair too,  I would never talk to a patient like this either. If you go back a few pages I did go through in detail the risks and benefits which is how I'd discuss it on an individual level. Ultimately it's the individual's decision. 

3 hours ago, schoeppeya said:

You must be in a pretty successful position in life seeing as how you have all the answers to why strangers make the decisions they do.  

I'm a physician,  it's literally my job to review the medical information and assess the risks and benefits or a particular intervention to make a treatment recommendation. Ultimately it's the individual's decision to follow the advice or not. 

I think the @winterwx21 scenario is interesting.  Since he already had covid I would say putting off the vaccine is a reasonable decision considering all of his individual factors but once we know more about the durability of the immune response to infection it'll be important to consider making a different recommendation if vaccine boosters are needed. I'm a little curious why his medical recommendation changed from it coming from his cardiologist to now coming from his primary care.

4 hours ago, dta1984 said:

Ya not sure he quite understands the distrust of the african american community against vaccines.  The vaccine mistrust is for a good reason.  Stan van gundy had an excellent response in an interview about this a few days ago.  I'll see if I can find. ..

As far as being selfish..... it's just weird to me that so many (non at risk) people are rushing to take the vaccine.  Vaccines have a typical 10yr trial period. You are now participating in a vaccine trial.    https://www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation

So we all of a sudden develop a vaccine for a coronavirus that we have never vaccinated against in record time using a new method?  Hmm, just seems like being cautious about it should be the common sense thing to do.  Not being "selfish.".  

I understand that there has been a narrative about vaccine hesitancy in the black community which is why I found the survey results that I posted interesting.  It turns out that only 25% of black people in the poll linked above don't intend to get vaccinated vs 30% of white people.

This would support the primary issue being an access problem rather than a hesitancy  problem.

Back to the discussion of why people that have access to the vaccine choose not to. It's one of fear, selfishness or poor comprehension of risk vs benefit calculation which goes back to fear. And I suppose there's a handful of people deep in conspiracy land. 

@winterwx21 can you link to the JAMA article that you referenced about the anaphylaxis rates.

26 minutes ago, dta1984 said:

Weird, maybe I missed it, but the 1200 person survey you linked just lists republican men as the top (not just white).

It is well publicized that there is a high percentage of ;  healthcare, nursing home, prison, military and other front line workers are refusing. 

African Americans; https://www.webmd.com/vaccines/covid-19-vaccine/news/20210202/black-vaccine-hesitancy-rooted-in-mistrust-doubts

"New CDC figures show that of those who have received at least the first dose of a vaccine, 5.4% are Black people, compared to 60% who are white people. According to recent Kaiser Family Foundation poll, about 35% of Black Americans said they don’t plan to get the vaccine, citing fears about safety and concerns that the vaccines are so new."

You are correct, I am in the anti COVID (china virus) vaccine at this moment, thanks. 

Black people not getting the vaccine appears that it may be more of an access problem rather than interst in getting vaccinated, hopefully the state, local and federal programs will improve this problem. 

I am all for appealing to selfish people by making enjoyable things like traveling by plane internationally contingent on being vaccinated.

My mistake, re: the republican white men, I fixed it

1 hour ago, dta1984 said:

Ouch, quite the reference to African Americans, Latinos, health care workers, military, police and those who chose not to.

You've got your groups wrong, top people rejecting the vaccine:

1. Republican men

2. Trump 2020 supporters

3. White men without college degrees

4. White evangelical christians

5. Under 45

6. Latino

7. Rural

8. Independent men

9. White

10. Black 

In fact 30 % of all people are saying no but only 25% of black people.

Source - https://www.tomfriedenpublichealth.net/tom-frieden-blog#it-aint-over-til-its-over-3-13-21

My point still stands it's frustrating that something like vaccinations that should be apolitical is now yet another partisan thing. You fit right into the core anti covid vaccine demographic. 

Fwiw I'm all for using whatever carrots or sticks are needed to get the necessary numbers of people vaccinated to crush this virus. 

3 hours ago, dta1984 said:

Fear mongering.  The fact that you have to be scared into taking the vaccine or promised "freedoms" should tell you all you need to know.  

Yup, tells us a lot about the segment of the population that needs to be given these carrots or beaten with these sticks to take something obviously beneficial on both an individual and societal level. 

Says something about those people not about the scientists doing the science and presenting the information. 

To me it has been very encouraging to continue to see the weekly decline in cases, hospitalizations and deaths even as the variants are becoming the dominant strain in more and more locations. We all know that we're getting close to a critical mass of people vaccinated and/or immune from prior infections but not quite there yet. 

I think what may be working in our favor is that the people who were most careful and least likely to get covid are first in line to get vaccinated and the plandemic types have already been infected and are already part of the herd. I know this is an over generalization and lots of people who were careful also got infected but I bet this is part of what's helping to keep numbers down. 

6 minutes ago, Hoosier said:

Should a family be allowed to write something like this in a public obituary when autopsy results aren't in?

https://www.legacy.com/us/obituaries/name/kassidi-kurill-obituary?pid=197924552

 

Here's the story behind it:

https://kutv.com/amp/news/local/utah-woman-39-dies-4-days-after-2nd-does-of-covid-19-vaccine-autopsy-ordered

Sometimes attribution of the cause of death can help families in their grieving process. I think the article provides a balanced accounting of the facts known so far. It's possible that the vaccine caused her to go into liver failure but lots of other things can cause acute liver failure. With over 300 million doses worldwide,  there hasn't been any other widespread cases reported so even if this one is determined to be linked to the vaccine it would appear to be vanishingly rare. 

Unfortunately more data that refutes the widely held belief that the virus will mutate to become less lethal over time. With the UK strain, the evidence is pretty compelling that in this instance the opposite is true. 

Fortunately the UK infection and mortality curves show that we can still win against variants by attacking them with aggressive vaccinations and public health measures. 

1 hour ago, dta1984 said:

O look, some "freedoms" are being returned...

A rare time where I agree with you,  pretty dumb headline by CNN, the CDC isn't doing anything with "freedoms". They are providing expert advice and guidance...

23 minutes ago, OSUmetstud said:

The cdc guidance if anything has been late to the party. Other scientists have been suggesting that there should be "benefits" to vaccination. The data is becoming more clear that the vaccine not only imparts good immunity but also reduces onward transmission. 

You dont want to construct this reality where you get a vaccine but then still have to do all the same shit you've been doing for the last year. If anything, that would increase vaccine hesitancy. 

I'm pretty sure it's just looking at your scenario as a low risk activity. 

I completely agree with this,  I think they are underselling how much protecting one is afforded by vaccination and agree that the CDC should give the green light safe sign to a lot more regular activities.

Things like going out to dinner is safe,  traveling on a plane with a mask on is safe,  going to a movie among others. There is convincing evidence of both significantly reduced risk of getting infected and lower viral load meaning if you get infected then you're not as infectious. 

I understand the hesitation in giving the green light for people to let down their guards too quickly but I think the bigger risk in the near future will be a vaccine demand problem in part due to the underselling of the vaccine benefits. 

1 hour ago, BuffaloWeather said:

It seems those numbers are high as well CDC numbers are more accurate as posted above. Hospitalizations are now at 33k

https://covid.cdc.gov/covid-data-tracker/#hospitalizations

 

They do indicate that the most recent 5 days are subject to errors and adjustments so I'm not sure the 33k will stay low.  I'm not used to seeing how the CDC data changes day by day.

Today is the last day that the covid tracking project is publishing their data which is unfortunate.  

The CDC is where I'll be looking as the definitive source for data going forward,  there are slight discrepancies between the two datasets for example CDC has current hospitalizations at 33,834 and 7 day average at 40,546 and the covid tracking project at 41,401 currently hospitalized with the 7 day average also substantially higher than the CDC. 

https://covid.cdc.gov/covid-data-tracker/#hospitalizations

1 hour ago, winterwx21 said:

And you post a lot of great information. We all appreciate it. Obviously a lot of debates here as many disagree about different things about this virus, but obviously we all want this pandemic to end very soon. Getting most people vaccinated should do that. Hopefully this horrific pandemic will be over by the Summer. In the meantime, masking up continues to be extremely important. Hopefully everyone will continue to do that until the pandemic is over.

I appreciate the debate and understand the differences in opinion and hope continued discussion of the nuances in the data and how it applies to different individuals will help people see that recieving the vaccine is the correct choice.

I also read that Pfizer is planning to submit for full FDA approval,  not just EUA in April.  I'm not sure how long that approval process takes but I actually think full FDA approval would further erode a lot of lingering skepticism in the wait and see crowd. 

There will always be a small subset of individuals who are too deep in conspiracy theories to reach.  Full FDA approval would mean that there are more vaccine mandates - ie military will probably make it mandatory,  same with colleges.

Fine anecdote time again,  if Tatum had been vaccinated the Celtics probably wouldn't be at risk of missing the playoffs. 

https://www.si.com/nba/raptors/news/toronto-raptors-covid19-jayson-tatum-return-to-normal

Like I said you've made up your mind, we agree young and healthy athletes have an extremely low but non zero risk of severe covid.

I've provided the best evidence out there that also shows that the individual benefits of vaccination to eliminate this risk far outweigh the risks associated with vaccination.

There's also large societal benefit to getting young healthy people vaccinated because they tend to be drivers in asymptomatic transmission because they rationally are willing to accept more risk of exposure. 

39 minutes ago, winterwx21 said:

But what about healthy young people that get themselves into athlete level shape from exercise? There have been thousands of positive test results in college and pro sports, and you almost never hear of an athlete in the hospital with their life on the line. It seems if you get yourself into great shape (super strong heart, lungs and immune system from intense exercise), the chance of developing severe Covid is pretty much zero. There are a lot of people that are young with no underlying conditions, but are not fit because they don't exercise. I can see how they can be at slightly higher risk, because this virus can take advantage of any weakness. But if you get into tremendous shape, there's very little chance the virus can do anything serious to you. I was talking with my cardiologist about this, and this is exactly what he said. So since I have gotten myself into althlete level shape and am at close to 0% severe Covid risk but also have lots of allergies, I don't feel it's worth it taking the chance with a vaccine that's having some severe allergic reactions.

It's not almost zero, read the post above it's about 1 in 10,000 or higher if you do the math.  

Edit:

1 in 200k to 1 in 500k get anaphylaxis. Anaphylaxis is easily treated.  

You're twisting yourself into a logical pretzel to justify the decision you've already made.  That's okay. But it's not rationale or based on the facts. 

Also why are you seeing a cardiologist of you are athlete level healthy?

46 minutes ago, Hoosier said:

Not exactly true.  In the trials, the vaccines are near 100% in preventing hospitalizations/deaths, but there have been some "severe" covid cases in those vaccinated people.  Of course I would think a severe covid case would require some hospital time, so I'm not sure how they are classifying that.

I totally get not wanting to get a vaccine back in December/January, since rare side effects can slip by in the trials (which we saw to some extent with the anaphylaxis reactions that didn't really show up in trials) but I think the fear of the "unknowns" about the vaccines becomes a harder position to stand by with the passage of time.  That being said, I do think it should still be a personal choice to get one, with a strong public education campaign to try to get as many as possible to take it.

Here you go "severe" covid in the pfizer trial - not hospitalized, did not require any treatment, only classified as a severe illness based on oxygen saturation.

Quote

The vaccine recipient who had severe COVID-19 disease met the severe case definition because oxygen saturation at the COVID-19 illness visit was 93% on room air. The subject was not hospitalized, did not seek further medical care, and did not have risk factors for severe disease. The three placebo recipients who had severe COVID-19 disease met the severe case definition for the following reasons: one subject had an oxygen saturation of 92% on room air without other severe disease criteria, one subject was hospitalized for noninvasive positive pressure ventilation with bilateral pneumonia, and one subject had an oxygen saturation of 92% and ICU admission for heart block. One of these placebo recipients with severe disease also had a body mass index > 30 kg/m2 as a risk factor, while the other two participants did not have any risk factors for severe disease.

Emphasis mine

Source - https://www.fda.gov/media/144245/download

1 hour ago, winterwx21 said:

Did you read the kutv.com article that was posted on the last page? We're seeing more severe anaphylaxis reactions with the Covid vaccines than we've seen with other vaccines from the past, and it's more than what we saw in the rushed Covid trials. Here is the quote from Dr. Tamara Sheffield...

"In terms of what is higher than we would see in other vaccines, anaphylaxis is moderately higher," Sheffield said.

And some of the stories of what happened to people are downright frightening. Look, I'm not against the Covid vaccine. As I said, I think it's extremely important for all vulnerable groups to get vaccinated. People that have any kind of underlying condition  (even very common things like high blood pressure or being overweight)  are at much higher risk of developing severe Covid, so it 100% makes sense for them to get the vaccine. I'm just saying for younger to middle aged people that have no underlying conditions at all, it's not as important to get vaccinated because they're super low risk of developing Covid complications. That hockey player is an incredibly rare case, but even he was not in the hospital fighting for his life. He's just fine now. You posted the deaths in younger age groups, but how many of those have underlying conditions? Probably most of them. The statistics show that most young Covid deaths are people with underlying conditions. I'm saying all people with underlying conditions, even the young, should get vaccinated. This vaccine is critical.

The only people that seem to have natural strong protection from this horrible virus are younger fit people with no underlying conditions. I can understand people in that group not wanting to take any chance with a vaccine like this one because they're already at such low risk. I happen to be in that group. Normal body weight with no underlying conditions and athlete level fitness due to a lot of exercise. But I also happen to have very bad allergies. I'm allergic to tons of things, including some food allergies. So since I'm at such low Covid risk (in fact I had Covid last Spring and had hardly any symptoms at all) I would be terribly worried about getting a reaction to the vaccine since I have so many allergies and we're hearing that this vaccine is causing more anaphylaxis reactions than other types of vaccines from the past. So I don't feel it's worth the risk for me since I'm already at such low Covid risk. I'm sure you can understand that.

TL;DR: If you do the math for young healthy people - covid vaccine - essentially eliminates all risk of infection or death from the infection and introduces a 1 in 200,000 to 1 in 500,000 risk of a treatable anaphylactic reaction. Covid infection has a ~0.5 to 2% hospitalization rate for people 18-39, and of those who get hospitalized with no underlying conditions 1-2% die and ~6-8% require mechanical ventilation. There's a subset of young healthy people that suffer months of chronic debilitating symptoms - as a Neurologist, I've treated a handful of these. I have no idea the rate of this syndrome but it can be significantly debilitating. This syndrome to my knowledge has not been described in those vaccinated. Proportionally speaking, despite what the anecdotes say, there is no question that the risks from the covid infection to the young and healthy are orders of magnitude higher than the risk of anaphylaxis or other serious negative effects from the vaccine. The benefits of receiving the vaccine, preventing serious illness or infection far outweigh the miniscule risks of an anaphylactic reaction that is usually easily treatable.

See below for detailed discussion and sources

I apologize that this is a ridiculously long post but I've did the research on this when I made my own decision to choose whether to receive the vaccine and felt it would be worthwhile to share. I am 37 and am fit enough to easily run a 5k and have no underlying health conditions. This analysis also doesn't even consider the public health benefits of a young/healthy person getting vaccinated and thus much much less likely to continue a chain of infection transmission or serve as a super spreader.

I read the article, it's a terrible adverse reaction that the individual suffered. I could find many anecdotes of young healthy people who contracted covid and had as bad or much worse experiences than the anecdotes about the negative vaccine effects. I could also find thousands of anecdotes from people that had mild covid and thousands of anecdotes from people that had little to no negative effects from the vaccine.

As a medical provider using anecdotes to give medical device is a fools errand. As an individual (not as a provider) using anecdotes to make an individual decision on what health decision to make is normal and common. If your friend got the vaccine and ended up in the hospital you are going to be afraid and probably not trust the experts saying this vaccine is extremely safe and effective. Similarly where you consume information and what your pre-existing biases are will inform which stories your read and absorb and which stories you ignore or discount.

This is why double blind placebo controlled trials are so incredibly powerful. I want to disavow people of the notion that the Moderna, Pfizer or J&J phase 3 trials were rushed in any way. They were done with the rigor of all the best clinical trial studies we use to make medical recommendations for other illnesses. The regulatory process was expedited - in normal circumstances phase 1 and 2 take longer, the FDA review process takes longer. All of the red tape was done away with - phase 1/2 were done in paralell, phase 3 was started immediately after phase 1/2 were successful. Even though the vaccine was highly effective they still said wait lets monitor for at least 3 months and as OSUMetstud said above the negative effects tend to happen in the first 6 weeks. Furthermore we now have real world data from hundreds of millions of doses worldwide that is largely consistent with the clinical trial findings.

Looking specifically at the relative risk for people as you describe - normal body weight, young, no underlying conditions and otherwise healthy. The FDA reviewed the clinical trial data and gave EUA for this group because the benefits of vaccine far outweigh the risks.

Covid vaccine - no deaths in the clinical trials, all the deaths that occur in close relationship to the vaccine have been investigated and none have been found to be caused by the vaccine

Source - CDC - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html

Quote

Over 76 million doses of COVID-19 vaccines were administered in the United States from December 14, 2020, through March 1, 2021. During this time, VAERS received 1,381 reports of death (0.0018%) among people who received a COVID-19 vaccine. CDC and FDA physicians review each case report of death as soon as notified and CDC requests medical records to further assess reports. A review of available clinical information including death certificates, autopsy, and medical records revealed no evidence that vaccination contributed to patient deaths. CDC and FDA will continue to investigate reports of adverse events, including deaths, reported to VAERS.

The vaccine trial shows the well published 94/95% reduction in symptomatic cases for the RNA vaccines but there was also nearly 100% reduction in severe illness and there was a 100% reduction in hospitalization rate for the virus

In terms of the risk for anaphylaxis that his been discussed in this thread and likely was the cause of the anecdotal story from the article. 2 to 5 per million (baseline vaccination rate is 1 per million) - so relatively higher but still very rare. Of those that get anaphylaxis usually it is treated with a dose of epinephrine with no further negative reactions and usually a brief admission to the hospital for observation. of the 2 to 5 per million a much smaller number will have a more serious anaphylactic reaction that leads to cardiac arrest or require more invasive treatments.

Quote

Anaphylaxis after COVID-19 vaccination is rare. If this occurs, vaccination providers can effectively and immediately treat the reaction.

CDC and FDA scientists have evaluated reports from people who experienced a type of severe allergic reaction—anaphylaxis—after getting a COVID-19 vaccine. Anaphylaxis after COVID-19 vaccination is rare and occurred in approximately 2 to 5 people per million vaccinated in the United States based on events reported to VAERS. This kind of allergic reaction almost always occurs within 30 minutes after vaccination. Fortunately, vaccination providers have medicines available to effectively and immediately treat patients who experience anaphylaxis following vaccination. 

Source CDC - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html

Hopefully that adds some proportionality on the relative risks from the covid vaccine.

How about the risks for the covid infection to the otherwise young and healthy? The data is hard to find the death rate for this cohort.

This study which clearly shows the harms of obesity/hypertension in covid is also informative as the control group is people without those conditions. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2770542 

From that article - over 5% of hospitalized young adults with no risk factors require mechanical ventilation and 1-2% died.

I'm familiar with the age based data in Hawaii in terms of risk of hospitalization/death from the infection 2% of 18-29 year old positive cases required hospitalization and 5% of 30-39 year old cases required hospitalization. If I assume that there are also 50% of asymptomatic cases never identified then those numbers would go down to 1% and 2.5% respectively. In those groups there were 5 deaths in the 18-29 and the 30-39 group. I don't have data on the rate of underlying conditions but the JAMA article above is a useful reference looking at this question on all hospitalized young adults. Hawaii is a good example because we've never had any major hospitalization or testing shortages except for testing shortages in the very beginning of the pandemic https://health.hawaii.gov/coronavirusdisease2019/what-you-should-know/current-situation-in-hawaii/

1 hour ago, dta1984 said:

There is plenty that question the effectiveness of the vaccine. 

You said there is literature aka scientific studies. Link?

I'll even settle for non scientific  opinions, link?

37 minutes ago, dta1984 said:

Definitely an odd response.  I simply said there's plenty of literature that goes against your literature regarding masks and the covid vaccine (not vaccines in general).  

 

What literature goes against the vaccines?

Link?

There are studies that question the effectiveness of masks and real world data that questions the efficacy of mask mandates but literature questioning the covid vaccines? What?

3 hours ago, BuffaloWeather said:

That was written before J&J got approved too. I just don't see it with the current trajectory. Even without vaccines last summer saw a huge reduction in cases as with most viruses they have a seasonality to them. 

You might be right and obviously I hope you are that we do continue to just trend lower in cases from here on out.  To me though the rate of decline even accounting for some data irregularities from presidents day and the big freeze,  the cases appear to be leveling off.

I also think there are some complexities to seasonality,  we all thought it would just rage out of control with the cold weather but in reality there was a sweet spot in the fall first in the Midwest and then spreading South over time. It's reasonable to think that maybe the transition from the coldest part of winter to early spring may be a second time where seasonality kicks in and increases spread of the virus. 

The vaccine is obviously the trump card plus the high degree of natural immunity in a lot of places. 

To me,  I think the messaging coming from the cdc director is because the data scientists are seeing some signs of a possible last spring wave until this thing is finally behind us. 

This pretty accurate forecast is projecting cases to nadir this week and then rise through much of march/april to almost double their current level and then crash down to negligible levels from June onward. https://covid19-projections.com/path-to-herd-immunity/

If this happens, I hope we see the vaccine effect exert continued downward push on hospitalizations and deaths.