COVID 19 Vaccination Discussion

[Will.iam]

Well government tracking via facial recognition is already here being applied today. I just did a cancun out and back from DFW on Thursday and when i came back through customs in DFW they didn’t ask for my passport or any filled out papers. I asked aren’t you going to look at my passport and the customs officer said only if the computer fails to recognize your face and you’re not in the system. It was minority report creepy. Also people vacationing in cancun are getting fleeced out of $110 for a covid test that you have to take within 3 days of travel back to the states with a negative result. This started Jan 26th for anyone thinking about going down there in the future FYI. 

[Bartman]

14 hours ago, N201MKTurbo said:

I had the rona. It ruined my endurance for a while. I skated 35 miles the week before I got it. I actually skated while I had it with a 101 fever (I was bored to tears). Don't worry it was on a week day and there was nobody on the path. I hit the wall after 7 miles. Making the last 4 miles home was a chore. I had to sit and catch my breath about every 1/2 mile. It took 2 months until I was back up to speed and could do 25 miles (the most I've done since).

Did you check your O2 saturation with your pulse oximeter ?

[N201MKTurbo]

21 minutes ago, Bartman said:

Did you check your O2 saturation with your pulse oximeter ?

No, it was at the airport. 
 

I did cough up a substantial amount of phlegm. I did feel much better the next day.

[KLRDMD]

9 hours ago, Nukemzzz said:

Interesting. I see several of you mentioned taking pain killers prior to the shot. Seems the latest on this is to avoid the pain killers until after. 

https://www.google.com/amp/s/www.cbsnews.com/amp/news/covid-19-vaccine-shot-painkillers-doctors/

That was published a week and a half after my last vaccination. Again, one of my reluctances to get the vaccine was the intermediate and long term side effects. Apparently analgesics decrease the efficacy. It would have been nice to have that published and told to those getting the vaccine six weeks ago. What else will we find out about this vaccine in the next month, year, decade?

Edited January 30, 2021 by KLRDMD

[KLRDMD]

8 hours ago, bradp said:

But now we have the South African variant community spreading in South Carolina.  And the Brazil variant has been identified in MN.

So is it OK to call the original variant the Chinese virus?

Edited January 30, 2021 by KLRDMD

[KLRDMD]

12 hours ago, bradp said:

More data needs to come quickly- but for now wear your masks (yes double up), continue to social distance, get the vaccine when your turn comes.

I'm on staff at two hospitals. One is NYU Langone. They sent the following E-Mail last week:

The Dangers of Double-Masking in the Workplace

You may have seen reports in the media this week advising the public to wear two masks to help protect against new variants of Covid-19.

However wearing two masks in the workplace is too much of a good thing. Official guidance from NYU Langone’s department of Environmental Health and Safety (EH&S) remains consistent—wear a face shield over your N95 or your surgical mask, if additional protection is required.

Wearing a surgical mask over an N95 respirator can interfere with the N95’s seal and actually make you less safe. N95s, worn correctly, provide you with excellent protection by themselves. They weren’t designed or tested to be worn with another mask over them.

When an N95 is not required, a single surgical mask provides the right amount of source control and protection in patient care environments. Cloth masks can be worn in non–patient care areas, but they should have at least two layers, cover your nose and chin, and have adjustable straps to ensure a good fit. Single-layer masks, bandannas, scarves, or gaiters are not allowed.

Edited January 30, 2021 by KLRDMD

[bradp]

19 minutes ago, KLRDMD said:

So is it OK to call the original variant the Chinese virus?

OG SARS-CoV-2 

[1964-M20E]

[bradp]

On 1/30/2021 at 9:36 AM, KLRDMD said:

I'm on staff at two hospitals. One is NYU Langone. They sent the following E-Mail last week:

The Dangers of Double-Masking in the Workplace

You may have seen reports in the media this week advising the public to wear two masks to help protect against new variants of Covid-19.

However wearing two masks in the workplace is too much of a good thing. Official guidance from NYU Langone’s department of Environmental Health and Safety (EH&S) remains consistent—wear a face shield over your N95 or your surgical mask, if additional protection is required.

Wearing a surgical mask over an N95 respirator can interfere with the N95’s seal and actually make you less safe. N95s, worn correctly, provide you with excellent protection by themselves. They weren’t designed or tested to be worn with another mask over them.

When an N95 is not required, a single surgical mask provides the right amount of source control and protection in patient care environments. Cloth masks can be worn in non–patient care areas, but they should have at least two layers, cover your nose and chin, and have adjustable straps to ensure a good fit. Single-layer masks, bandannas, scarves, or gaiters are not allowed.

Ken that’s really interesting. Our hospital is asking us to wear ear loop face masks over N95s to aid in reuse.  They use them 4x with H2O2 sanitization between uses.  It makes sense to put a cheap disposable mask that in no practicable way will interfere with a seal.  We also have goggles galore but fewer full length face shields as these are going to Covid units mostly. If you don’t have to reuse n95 or have everyone wearing face shields instead of goggles, it makes no empiric sense to put another paper mask over it.  Face shields will provide sufficient splatter protection.
 

Two of my colleagues had exposures last week because they had prolonged (>hr) conversations with a parent in an enclosed space wearing only a ear loop mask.  That parent both refused to wear a mask and hid that she was symptomatic and was later found to be positive.  I’ve started wearing my reusable/recycled n95/googles in all patient encounters because so many either don’t remember or still refuse to wear masks and I simply don’t trust their judgement all the time.  Many of the nurses have started wearing a cloth face mask with a paper one over it.  This is what I’m now doing going to the grocery store etc.  Fortunately most of my colleagues are so imprinted with PPE use that nobody has yet let their guard down, even after being vaccinated.  That is a smart move. 
 

My caveat emptor with a lot of the circular hospital PPE guidance even a year into the pandemic is that the guidance is mostly decided by non-clinical hospital administrators who are trying their best, but lack expertise and are always trying to balance resource utilization with availability and, yes, cost.  The massaging and manipulating of public health guidance/science regarding masks from the CDC because of lack of resource availability was the thing that got us into this mask mess in the first place. The message should have been from the beginning masks work, but we don’t have enough for everyone and the hospitals need them more.  Sorry.  We’ll that message got a bit corporatized and politicized and ended up nowhere good or useful.   

 

For the general public outside of health care settings there is growing consensus that it is a reasonable approach to increase filtration efficiency by either using two layers of multiple layer (3x “paper” or 2x cloth) face masks -or- a single N95/KN95 in the context of more transmissible variants arriving.
 

The following is not applicable to Covid particularly but an anecdote to help understand filtration efficiency of the cheap paper masks compared to others.  With different random respiratory viruses (not covid) I’ve found that two cheap ear loop masks were about as effective as a single actual OR (3M or equivalent) tie back face mask when I would be manipulating airways of virally infected kids with respiratory failure.  These ear loop masks which are the mainstay of PPE are typically *not* allowed in the OR environment because they lack filtration efficiency.  Single cheap ear loop mask + eye shield plus gown/gloves -> pretty consistent me getting URI 3-4 days later.  Double up or use the higher quality masks -> me not sick. But that’s for breathing about 6 in away from a kid with RSV or some such, again not Covid. Ear loop masks achieve maybe 40% vs 70% for surgical tie back masks.  

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772936

Ok here’s the COVID application: it makes empiric sense that there is growing consensus to double up ear loop masks or combination with a cloth face mask, or use a KN95 when out and about.  

[steingar]

I have strong doubts that any stain variant is going to escape vaccine mediated immune surveillance.  COVID19 has one secret weapon that makes it very infectious among humans.  It has a coat protein that binds very very tightly to a ubiquitous human protein.  All the vaccines are directed against that coat protein.  The virus can change lots of other things. It can evolve in its ecosystem (us) to be more efficient.  But I think if it ginks that coat protein enough to avoid immune detection it will no longer bind the ACE2 protein tightly, and will therefore be less infective.

[bradp]

1 hour ago, steingar said:

I have strong doubts that any stain variant is going to escape vaccine mediated immune surveillance.  COVID19 has one secret weapon that makes it very infectious among humans.  It has a coat protein that binds very very tightly to a ubiquitous human protein.  All the vaccines are directed against that coat protein.  The virus can change lots of other things. It can evolve in its ecosystem (us) to be more efficient.  But I think if it ginks that coat protein enough to avoid immune detection it will no longer bind the ACE2 protein tightly, and will therefore be less infective.

The hypothesis is that eventually this coronavirus will evolve into a common cold.  The question is of course how long that process of cycles or selection pressure and mutation rate will take.  That’s well out of my area of expertise and involves variables like the error rates of RNA replicase, the Ro number, infectious time course, the relative probabilities of incorporation of silent, nonsense or advantageous mutations etc etc. This is one of the first examples of a zoonotic emerging disease of this scale that I’m aware of, and certainly there hasn’t been this degree of technological availability to measure the mutation rate.  Influenza is not a fair comparison. In all likelihood the other coronaviridiae all started like this, but happened long long ago, or as in MERS or SARS1, fizzles.  However, It won’t be a year or two before CoV-2 it less of a tiger and more of a kitten. Likely much much longer. 

[MooneyMitch]

[daytonabch04]

I got voluntold to join Operation Warp Speed being a US Army Logistics Officer.  I know nothing about vaccines, but here for the distribution and ensuring supplies are needed at the right place at the right time.  My job everyday is an LNO to watch the Moderna and soon to be Janssen vaccines being filled into vials, inspected, and packaged for shipment.  I'm no MD, but been involved in many meetings with senior leaders and do not feel any shortcuts have come about this process.  Has there been challenges...of course, but the approval process and decision making has been based on science.  Everyday, we're filling about 2M Moderna doses to be distributed to the American public.  

It's been a rewarding experience to say the least.  I get my second shot next week and look forward to it.  

[MooneyMitch]

3 minutes ago, daytonabch04 said:

I got voluntold to join Operation Warp Speed being a US Army Logistics Officer.  I know nothing about vaccines, but here for the distribution and ensuring supplies are needed at the right place at the right time.  My job everyday is an LNO to watch the Moderna and soon to be Janssen vaccines being filled into vials, inspected, and packaged for shipment.  I'm no MD, but been involved in many meetings with senior leaders and do not feel any shortcuts have come about this process.  Has there been challenges...of course, but the approval process and decision making has been based on science.  Everyday, we're filling about 2M Moderna doses to be distributed to the American public.  

It's been a rewarding experience to say the least.  I get my second shot next week and look forward to it.  

Thank you for this unique perspective. 

[Immelman]

On 1/30/2021 at 6:32 AM, KLRDMD said:

So is it OK to call the original variant the Chinese virus?

OK with me, but to be fair, gotta call that 1918 pandemic the Kansas flu.

... As for me: Sign me up for the shot! But at age 40, it will be a while. "Essential" (transportation) job.... sounds like that stuff may be brushed aside in favor of going by age, which is probably better.

Edited February 1, 2021 by Immelman

[jaylw314]

On 1/30/2021 at 6:36 AM, KLRDMD said:

I'm on staff at two hospitals. One is NYU Langone. They sent the following E-Mail last week:

The Dangers of Double-Masking in the Workplace

You may have seen reports in the media this week advising the public to wear two masks to help protect against new variants of Covid-19.

However wearing two masks in the workplace is too much of a good thing. Official guidance from NYU Langone’s department of Environmental Health and Safety (EH&S) remains consistent—wear a face shield over your N95 or your surgical mask, if additional protection is required.

Wearing a surgical mask over an N95 respirator can interfere with the N95’s seal and actually make you less safe. N95s, worn correctly, provide you with excellent protection by themselves. They weren’t designed or tested to be worn with another mask over them.

When an N95 is not required, a single surgical mask provides the right amount of source control and protection in patient care environments. Cloth masks can be worn in non–patient care areas, but they should have at least two layers, cover your nose and chin, and have adjustable straps to ensure a good fit. Single-layer masks, bandannas, scarves, or gaiters are not allowed.

Good point, although I think the talk of double-masking was for people who did NOT have an N95 mask, e.g. two cloth masks.

[Bartman]

As a Hospitalist I have worn my N95 for every single patient encounter since the beginning of the pandemic. I cannot tell you how many times I have seen someone who was thought to be low risk for COVID or came to the hospital for another symptom and then found to be positive. 
 

I did fly with an instructor back in the summer for an Instrument Proficiency Check. I wore my N95 in the cockpit and even provided a new N95 for him, but the instructor chose not to wear it. 

[ilovecornfields]

58 minutes ago, Bartman said:

As a Hospitalist I have worn my N95 for every single patient encounter since the beginning of the pandemic. I cannot tell you how many times I have seen someone who was thought to be low risk for COVID or came to the hospital for another symptom and then found to be positive. 
 

I did fly with an instructor back in the summer for an Instrument Proficiency Check. I wore my N95 in the cockpit and even provided a new N95 for him, but the instructor chose not to wear it. 

This. After half a dozen “you may have been exposed” notices I just started assuming that every patient or family member has COVID and I wear the appropriate PPE. You can’t tell if someone is infectious by looking at them and, unfortunately, people lie.

Today my wife and I gave about 100 COVID vaccines. It was a wonderful experience. 

[RobertGary1]

33 minutes ago, ilovecornfields said:

This. After half a dozen “you may have been exposed” notices I just started assuming that every patient or family member has COVID and I wear the appropriate PPE. You can’t tell if someone is infectious by looking at them and, unfortunately, people lie.

Today my wife and I gave about 100 COVID vaccines. It was a wonderful experience. 

For those in the low risk group, do you think its worth waiting for the next generation of vaccine? These are 1.0 versions; maybe 2.0 will cover more strains?

 

-Robert

[RobertGary1]

1 hour ago, Bartman said:

As a Hospitalist I have worn my N95 for every single patient encounter since the beginning of the pandemic. I cannot tell you how many times I have seen someone who was thought to be low risk for COVID or came to the hospital for another symptom and then found to be positive. 
 

I did fly with an instructor back in the summer for an Instrument Proficiency Check. I wore my N95 in the cockpit and even provided a new N95 for him, but the instructor chose not to wear it. 

In CAP we're wearing masks. I've given a lot of annual checkrides to pilots and we are wearing masks the entire time. Not easy with the mic, etc but you get used to it. Some say you're already stuck in a small place with the person so a mask may not help but we actually do have a lot of airflow in GA planes.

-Robert

[Bartman]

26 minutes ago, RobertGary1 said:

For those in the low risk group, do you think its worth waiting for the next generation of vaccine? These are 1.0 versions; maybe 2.0 will cover more strains?

 

-Robert

We are in uncharted territory... Novel virus. Novel vaccine platforms. Novel side effects and intensity from both the virus and the vaccine. 
 

As I wrote a few days ago, I have seen more people die this year than in the past previous 15 years combined. That includes young people too and most who have severe disease have the well defined risk factors, but not all. Unfortunately it’s a lot like Russian roulette and I recommend my family not take the chance. 

[carusoam]

Lie, don’t lie...

People often don’t know they are infected... while spreading for days...

 

wait, don’t wait...

Of the available vaccines... they all have very high affectiveness...

small side affect percentages...

Doesn’t get much better than that...

Do you prefer coke or Pepsi?

 

 

Priority, no priority...

Not getting sick would be my priority...

Not accidentally spreading the virus to people I know, or don’t know... would be my next priority...

 

A typical priority for me...  doing the best I  can...

Is it best to wait, or go now...

 

I decided go now... signed up...now I wait...   

That’s the best I can do...

Do the best you can do...  

PP thoughts only, not a vaccine expert...

Best regards,

-a-

 

 

 

[RobertGary1]

I guess it’s not a big choice for me. It will probably be summer before I qualify to get it. 

[ilovecornfields]

3 hours ago, RobertGary1 said:

For those in the low risk group, do you think its worth waiting for the next generation of vaccine? These are 1.0 versions; maybe 2.0 will cover more strains?

 

-Robert

I would personally recommend you get the vaccine as soon as you’re able. Those Pfizer and Moderna vaccines pretty much knocked it out of the park with the first swing. It’s going to be hard to beat 95% efficacy and minimal side effects.

Those of us in medicine are used to dealing with uncertainty and having to make decisions despite this uncertainty. Usually the pathologist can figure out what’s wrong with someone on autopsy but by then it’s too late, so the rest of us deal with incomplete information and make the best choices we can at the time.

For the vaccine to be anywhere near as bad as COVID it would have to be the worst vaccine in the history of vaccines by far. Keep in mind “low risk” for COVID complications isn’t “no risk” and if you remember the FAA’s “risk matrix” something low risk with a catastrophic outcome still warrants mitigation. I’ve sent plenty of “low risk” people to the ICU this year so that doesn’t really reassure me as much as it seems to reassure others.

I would argue you are “ridiculously low risk” of suffering an adverse effect of the vaccine so the smart move would be to get the vaccine instead of rolling the dice with COVID.

I will freely admit I am biased. I’ve also been traumatized by what I’ve seen in the last 12 months. I signed up for the vaccine the second it was available and was one of the first to get it. I got my wife vaccinated as soon as I could. As soon as my son is eligible I’ll get him a shot.

Go ahead and sign up when you can. Some places have been moving through their Tiers with impressive speed and I believe at least a dozen Moonryspacers have already been vaccinated.

[flyboy0681]

I was hoping to avoid a reaction but woke up today with 101 and achy from yesterdays second dose.