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wathe

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Posts posted by wathe

  1. 47 minutes ago, Not_a_Number said:

    And that's honestly the question I was mostly asking. WHEN would you start dialing back activities? WHEN would you put the masks back on in playgrounds? WHEN would you start seriously thinking about staying home for a few weeks/months except for outdoor masked playdates outside playgrounds? 

    Right now, our positivity just jumped up from 0.3% to more than 1.1% percent. And I'm MUCH less happy with the slope of this jump than I am with the absolute numbers. 

    Honestly, I was fine with a positivity of 1% and dropping. I feel freaked out about a positivity of 1.1% and rapidly rising 😕 . It's still small, but it's making me ask hard questions. 

     

    I think it's very reasonable for you to be concerned.  I don't like Delta. 

    We're at a positivity rate of 0.9% here and holding steady.  68%/78% of the total population/eligible population have had at least one dose, 47%/53% have had both doses.  Both of my kids have had their first dose, and the older one has had both doses.  

    We're still only doing outdoor activities, and avoiding crowds.  No indoor kid stuff.   I won't be comfortable with indoor kid activities until we see how delta pans out, and until most kids under 12 are vaxxed, I don't think.  We have stopped masking outdoors - but we are meeting in very small groups of like-minded, risk-averse people.  I think we'd still be masking if we went to crowded playgrounds.  (This pandemic isn't over until the whole world is vaxxed.  Until then, it's global whack-a-mole)

     

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  2. 1 hour ago, KSera said:

    As is common, I think the headline and story over states what she actually said. Here’s her full quote:

    “There are people who are thinking about mixing and matching. We receive a lot of queries from people who say they have taken one [dose] and are planning to take another one (doses). It’s a little bit of a dangerous trend here. We are in a data-free, evidence-free zone as far as mix and match,” Swaminathan said in an online briefing earlier in the day.

    “There is limited data on mix and match. There are studies going on, we need to wait for that. Maybe it will be a very good approach. But, at the moment we only have data on the Oxford-AstraZeneca vaccine, followed by Pfizer. It will be a chaotic situation in countries if citizens start deciding when and who will be taking a second, a third and a fourth dose,” she said.

    I saw that.  Most people don't read beyond the headline, unfortunately.  

    This WHO announcement is going to increase vaccine hesitancy here, and undermine public confidence.  Mixed dosing was already a tough sell, and this will make it ever so much worse.  More people are going to decline their second dose* and hold out for their preferred vaccine.  We can't afford delays in getting the population fully vaccinated ('cause Delta), and this is going to contribute to delays.

    *Background on the Canadian situation for those who don't know:  We've had no end of supply difficulties.  Public health wanted to get as many people a first dose as quickly as possible (which made very good public health sense in vaccine-scarce conditions), so the dosing interval was extended to 16 weeks second doses weren't held back - the entire supply was administered for first doses as soon as possible.  We've had mostly Pfizer available since January (sources from Europe), and very little Moderna (sourced from USA, who had export bans), and lots of Pfizer in April and May when eligibility really opened up, so most people got Pfizer for their first dose.  Now we have a shortage of Pfizer, but plentiful Moderna.  And with delta breathing down our necks, public health has shortened the dosing interval back down to 4 weeks and endorsed a mixed-dosing regiment for mRNA vaccines, which also makes very good sense from a public health/population point of view.  So most people who got Pfizer for their first dose are now being provided with Moderna for their second dose.  And many of them are not happy about it.  Most accept it, but a small number decline and walk out.  I do about 60 - 80 shots per shift.  On Moderna days, I get grumbling/eye-roll/sigh from about half, and between 1 and 5 who decline and walk out.

    There is also a weird anti-Moderna bias here, even for first doses, that defies logic.  Pfizer was the only one we had for a long time, so it's what people are used to hearing about and have somehow internalized that it's the original and the best, and that Moderna is some sort of knock-off brand.  Which makes no sense, of course. 

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  3. It's also going to make my mass vax clinic shift this week very not fun.  We'll likely have Moderna for second doses (because that's what there's lots of in the country right now), and patients are likely to have had Pfizer for first doses (because that's what there was lots of at the time).  There's already anti-Moderna bias here to start with.  This will make it even worse.

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  4. 3 hours ago, KSera said:

    Since this is the only current mask thread, I’ll drop this here. It’s a good, long discussion of some current research and of why the calculus on masks has been from the wrong starting point, and shows how much of a difference in population level transmission even a small effect can have:

    https://threadreaderapp.com/thread/1414294003479089154.html

    Quoting from the part about decreasing transmission on a population scale:

    “More fundamentally, we’re not just interested in whether my mask protects either me or you from catching Covid during a short intervention period (say, one month). We’re interested in how masking impacts on the *exponential spread* of an accelerating pandemic. 
    24/

    Take the number 1 and double it, and keep going. 1 becomes 2, then 4, etc. After 10 doubles, you get 512. After 10 more doubles, you get 262144. Now instead of doubling, multiply by 1.9 instead of 2 (a tiny reduction in growth rate). After 20 cycles, the total is only 104127. 
    25/
    => if masks reduce transmission by a TINY bit (too tiny to be statistically significant in a short RCT), population benefits are still HUGE. UK Covid-19 rates are doubling every 9 days. If they increased by 1.9 every 9 days, after 180 days cases would be down by 60%. 
    26/
    These two issues—the near-impossibility of using RCTs to test hypotheses about source control and over-reliance on “statistically significant effects” within a short-term intervention period—is why a RCT of masks is *highly likely to mislead us*”

    Thanks, that's a great thread.  There are some fabulous links embedded in there too.

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  5. 3 minutes ago, KSera said:

    As always with these outdoor transmission events, I wish there was more in formation. Were these six people inside together at some point? How closely did they interact? These are answers I really wish we had. because if the six of them went out for drinks before the wedding, that’s an entirely different thing than the level of concern I would have if they were six people who didn’t know each other and only shared the same outdoor air space.

    I agree that we need more information to make personal risk decisions based on this.  Outside often doesn't really mean outside.  Could mean in a tent, could mean shared indoor washrooms where people went to get out of the heat etc.  

    It is useful from a public health point of view  though - lots of outside activities were banned during lockdown here because public health knows that these sorts of activities tend to not be strictly outdoors, and that they do lead to some transmission for all the reasons KSera listed above.

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  6. I probably would have unvaxxed kids mask at a busy, crowded playground.  Kids are gross and in each other's faces, and they cluster tightly on play structures.

    I probably wouldn't bother with masking on the walk to or from, or when seated at a picnic table/park bench with the family, but while playing on the playground, probably yes.

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  7. 1 hour ago, BaseballandHockey said:

    Thanks, to be clear, he’s going.  He needs a gentle transition back to group things before school.  The question is whether we still see my nieces and the baby.  

    What masks are people using for indoor things?  

    My kids are using regular disposable pleated ear-loop masks in most instances, with the ear loops knotted to the right length to get a good fit.  In higher risk situations (ie medical office visits), they are wearing the same pleated mask under well-fitting home-made cloth masks.  The pleated disposable masks are melt-blown polypro with good filtration, and the cloth masks improve the fit.  

    My thought process:  Hospital HCW here have been wearing disposable pleated procedure masks for covid care here all along (except for AGMP, where n95's are worn) and it really seems to work.  If it's good enough for me at work to protect me when caring for covid patients, then it's good enough for my kids in the community IYKWIM.  The pleated masks are comfy enough to wear all day.

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  8. 2 hours ago, BaseballandHockey said:

    Can I ask opinions on something related to the vaccinated people transmitting?

    My SIL has a 7 day old baby and is understandably very worried about the virus.  When I agreed to provide childcare for her kids we agreed that the unvaccinated kids would only do outdoor activities, and would wear masks  unless they were in the pool.

    But at that point, it seemed like vaccinated people weren’t transmitting, so I signed my oldest up for a four week long in person musical theater camp that starts on the 19th.  The camp seems pretty cautious with masking and distancing, but it’s got singing and dancing (and thus heavy breathing).  

    How risky is it if he keeps seeing his unvaccinated cousins (sisters to newborn), and his 90 year old vaccinated Great grandfather?  He can mask around them. 

    And of course, the other question is if I am worried about a vaccinated kid at camp with 30 kids, what am I thinking sending my unvaccinated 11 year old to a public school of a thousand kids in he fall?

    Re camp:  as long as masking means actually masking properly*, then you are probably OK.  Masks work very well.  Masked plus vaxxed is as good as it gets.

    It's going to be hard to transition out of pandemic mode. To be constantly risk-analyzing every decision is really a burden, particularly when that analysis has to be based imperfect information in constantly evolving circumstances.  (I'm agonizing over kid plans for summer and fall here too.)

    *Well-fitting mask worn over both mouth and nose at all times while indoors.  I know you know this, but your camp might not...  

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  9. 1 hour ago, Carol in Cal. said:

    I think so.  Victorious/righteous vs. defeated/pardoned.  Yup.

    That depends on your perspective, I think.  Not victorious everywhere.  Revolutionary war rebel forces were defeated in what's now Canada.  The Loyalists were "victorious" here, and the rebel forces really were the traitors, despite being victorious in what's now south of the border.  

    I can't agree with righteous either.  Particularly from a First Nations perspective.  As I understand it, FN mostly sided with the British, for reasons having to do with British law requiring negotiation of treaties by the Crown vs 13 Colonies appropriating land without negotiation or treaty.  (obviously, neither was good  for FN, but rather a forced choice between less bad and more bad)

     

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  10. 2 hours ago, Melissa Louise said:

    Vaccine Q for my mum. 

    She's 4 weeks out from her second AZ shot. So she's 8 weeks from her first.

    We are in the middle of a Delta outbreak. Should I encourage her to get her second dose early? 

    Thankfully my dad has his second dose in a few days. 

    8 weeks between shots is the current protocol for AZ here.

    it’s a choice between pretty good immunity sooner (8 weeks between shots) vs maybe better immunity later (12 weeks between shots).  

    Given your national situation, I think I would opt for pretty good immunity sooner.

     

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  11. 2 hours ago, TCB said:

    A town just 90 miles from us is now stretched to the absolute limits due to the delta variant. Last week they ran out of ventilators and had to bring more in from other parts of the state. I just read a quote from the fire chief describing it as a mass casualty event in slow motion. Our hospital is stretching at the seams. They are expecting large increases still in the next 3 weeks.

    There are absolutely no non-pharmaceutical interventions taking place. We have never had a mask mandate, and since the CDC proclaimed no masks required for vaccinated people, virtually no one wears a mask anywhere, other than healthcare sites. The problem is, only just over 35% have had the first vaccine dose, I’m not sure what the figure is for both doses.

    There just are no words to describe this. I have written a number of sentences but then deleted them because I just don’t know what to say. How much longer do we have to do this?

     

    I'm so sorry.

    The burden on front-line health care staff has been just so very heavy.  It's very hard.

    Lack of compliance with public health measures, or in your case, even worse, no public health measures at all, really feels personal, and makes HCW feel unvalued.  Especially now - we know that public health measures work. A lot of us are really angry.  The moral injury we have suffered is real.

    HCW are burning out (burn out is an over-used phrase, but this is the real thing).  Non-trivial numbers are quitting or retiring early or leaving frontline work for other, less stressful work. There's going to be an after-covid HCW staffing crisis (in my department there already is).  And it's going to be very hard to fix.

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  12. 3 hours ago, popmom said:

     

    My husband had J&J back in April. He would like to boost that with the Pfizer. Has anyone done this? Or heard whether its even allowed? I'm wondering if our insurance would reject it. 

    In light of the article about Germany shared above....if one does follow up the AZ or J&J with a mRNA vaccine, would one just get one dose or two?

    The protocol here (Canada) in my province AZ first dose is  followed by mRNA single dose only at 8 weeks.  If, down the line, data suggest that a second mRNA dose is required, then the protocol will likely be adjusted, but so far the plan is for a single mRNA dose only.  

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  13. 6 hours ago, frogger said:

    I am curious what has happened in health care capacity since this has started and if local circumstances are representative of what is going on nationwide.

     

    Our hospitals do not have an extremely high number of people in them but in talking to a nurse, locally at least, it seems there are fewer employees. Many were just tired. Some retired earlier than they might have. She works a lot of overtime already  and vaccine hesitancy is high so I imagine winter will be worse. We have plenty of vaccine for everyone. The problem is people don't want it and that is a much more complicated problem to solve and the healthcare workers are tired of bearing the brunt all alone. 

     

    True here.

    1) HCWs are burnt out.  Many are transitioning out of hospital work - either retiring or transitioning to work that's not frontline.  A significant proportion are on leave - medical or "stress".  Hospitals are having trouble filling shifts in emergency departments, so departments are working short-staffed, which makes working conditions worse for those who are left, which increases the burnout rate.  It's a vicious cycle that will be hard to remedy.

    2) Hospital capacity is better, but still not great.  We still have 226 in ICU because of covid in the province, (down from the third-wave April peak of 900 that nearly broke us).  For perspective, the threshold for calling a lockdown pre-third wave here was 150 in the ICU province-wide.  So 226 is better than terrible, but still not  good.  We cannot sustain another wave.

    On the plus side, our vaccination rates are really good - 78% of eligible (12+) have had at least one dose, and 47% have had two doses, with the second dose rate climbing very quickly as our vaccine supply woes resolve, and the first dose rate climbing steadily.  Our re-opening has been slow and steady and appropriately cautious (our powers-that-be really seem to understand just how close we came to total health system collapse in wave 3), so I am hopeful that we will avoid a disastrous 4th wave.

     

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  14. Perhaps not quite what your looking for, but an idea and resources that worked for us:

    My kids are involved in scouting (Canada).  We studied world and Canadian scouting history, which is really tightly linked with British colonialism in India and Africa (and also the rest of the former British Empire, but especially India and Africa).  We read some of Baden Powell's writings, including the original Scouting for Boys (which has not aged well, it is appallingly racist and imperialist), and some of Kipling's works that are tied tightly to scouting, including The Jungle Books, Kim, the Just So Stories, and  his poems The White Man's Burden and If.  British colonialism and imperialism are inextricably woven throughout and became a main theme of our studies.  The kids came out with some really interesting insights.  (Including forming an opinion that basing the current cub program theme on Rudyard Kipling's The Jungle Book is racist and contrary to the organization's current diversity and inclusion policy.... and writing Scouts Canada a letter to tell them so.)

    Canadian history is also largely a British colonial story - my kids were already very familiar with this bit. 

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  15. 1 hour ago, melmichigan said:

    I think that there is very much a "pick and choose" amongst data points from various scientists, one only has to look at the Canadian vaccine file on Pfizer's effectiveness studies to see that in play.  I don't think we will have adequate, reliable, real world numbers for some time. 

    Can you point me to this please?  Is this referring to efficacy after first dose?

    Canada definitely has adopted a certain amount of make-it-up-as-we-go-along (in a calculated and well-reasoned fashion, I think) with respect to delayed first dose and miseducating dose regimens, because of poor/unreliable supply.

  16. 33 minutes ago, SKL said:

    I still don't see what's wrong with acknowledging / appreciating two different sexes/genders.

     

     

    21 minutes ago, regentrude said:

    As several of us explained, it causes women to be viewed and treated differently in situations where sex/gender is irrelevant. You don't think it's wrong that a female doctor has to fight to be taken seriously?

    And take home less pay.  Social gender differences make pay equity impossible in a fee for service system that rewards numbers and is, in theory, "gender-blind".

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  17. 14 hours ago, regentrude said:

    I am not petite and never had trouble being accepted while in college, grad school, or postdoc in a very male dominated field , but definitely had issues as a young professor at an engineering school. My (80% male) students did not take me seriously and thought I was the TA. I had to dress up and wear suits and heels to get them to accept that I am actually the professor and not some student helper (while my male colleagues get away with jeans). I am so relieved that I am now in my fifties and no longer have to go to great efforts to play the adult academic.
    I am, however, still the only faculty who gets emails addressed by first name or Mrs Lastname; my male colleagues are almost always addressed as Dr. Lastname.

    Much the same experience here, in a male dominated medical specialty.  Same issue with email   and having to work to be taken seriously.  And having to work to establish that I am the doctor, not the nurse.  And  I'm  dealing with the public, so I also get darling'd and dearie'd and sweetheart'd too, on a daily basis.  It's infuriating.

    I put up with all kinds of gendered social crap at work, and because of it, I earn less than my male colleagues:  We are fee for service.  Gender bias means that women see fewer patients per shift than men, and therefore earn less. (we have more interruptions, spend time establishing credibility, our time is not respected in the same way as them men, by patients and staff, we are expected to take on a nurturing role that our male colleagues are not, we get requests to see certain types of patients that are almost always more time consuming "requests female physician", and on and on.  All of this has been well-studied and well-documented.)

    ETA:  The worst part is that the men (many of them anyway) can't seem to see It, and don't really believe it.  They just think that we don't work as hard as they do.  It's enraging.

    Sorry @Mercy, that turned into a slightly off-topic rant!

    Edited to correct;  kinds not kids.  I  really like kids! I don't just "put up" with them 🙂

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  18. 1 hour ago, Ellie said:

    I don't understand why you would wear a mask if you are "vaxed." A vaccine is supposed to protect from the disease. That's why we vaccinate our children with MMR and DPT and everything, yes? So why would you still need to wear a mask?

    Because though vaccination reduces risk (by quite a lot) it does not eliminate risk.  Mask plus vax reduces risk even further.

    The pandemic isn't over.  Covid is still circulating.  New, more transmissible variants are infiltrating our communities. Community vaccination rates are still low in many places.

    Masking is not a hardship for me, and I am used to it.  For me, the more salient question is," why wouldn't I mask?"

     

     

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  19. 24 minutes ago, PeterPan said:

    Almost no one is wearing them.

    You mean you put masks on your kids? Even though they have very little likelihood of transmitting it if they are positive and even though they aren't positive? Or to protect them? Since their masks won't protect them (unless they're happy masks or something similar) and since the data is now showing that kid masks are germ factories, it would seem much safer to remove the masks on your kids.

    To me, a better question is whether you're queing and chumming up like normal and doing the sardine thing. Personally, I give people space and I see that a lot. With no marks on the floor, nothing, people are just giving others space. I think this is good.

    Where is this information coming from?

    My understanding is that kids absolutely can (and do) transmit covid, and that masks both protect the wearer and protect others from the wearer.  

    I have not seen anything to suggest that masks are dangerous for kids over 2. 

    All other things being equal, masking during a pandemic is safer than not masking, even for kids.

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  20. 6 minutes ago, whitestavern said:

    I would be uncomfortable with this. Those people are essentially guinea pigs as there has been no testing of that regimen. 

    In my circle, everyone thinks Pfizer is better. Most people I know waited to be vaccinated until they could choose. 

    You are right about testing, but we are stuck with imperfect due to supply limitations.

    We've, as a country, been forced to make difficult decisions with imperfect data.  We've had such limited supply.  We elected to delay second doses to get as many people a first dose as possible, even though delayed second dosing hadn't been tested.   Which was the only ethical choice from a public health point of view, really, during our horrific third wave that came a hair's breadth away from causing total health care system collapse; pretty good immunity with one dose in twice as many people would save many more lives than full immunity in half as many.  So we didn't save product-matched second doses; we couldn't ethically hold back vaccine.  Now we are in a position, with the delta variant breathing down our necks, where we really, really want to accelerate second doses.  But we don't have the supply of matched product to  do that.  Mixed-dose regimens now will save more lives than delaying second doses for a matched-dose regimen.  Again, from a public health point of view, it's a very ethical choice.  

    Unfortunately, the regimen change wasn't as well advertised as it should have been and people felt blind-sided.

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  21. Just now, vonfirmath said:

    Woah? Why do they think Moderna is worse? I've thought the two were virtually interchangeable?

    I know, it's weird.  But it's definitely a thing.  And it doesn't make any logical sense.

    Pfizer was the first to be approved here, and was the one we had the most supply of for quite a long time.  It's got brand recognition.

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