wathe
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Posts posted by wathe
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I had my second Pfizer dose today. 33 days after my first dose - we've had shortages.
I got a weird taste in my mouth about 5 min after both doses, and a bit of a sore arm after the first. So far, so good after dose 2.
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My local public health unit is quoting very reassuring numbers regarding efficacy after just the first dose of the Pfizer vaccine:
Up to 92% fourteen days after the first dose.
Based on data from England and Quebec.
They go on to argue that the 52% efficacy quoted in the original NEJM paper is too low, because they counted all cases of covid post first dose of vaccine starting immediately - so cases acquired within hours or days of vaccination were counted, even though it is not reasonable to expect that vaccine would provide protection so quickly. Also, some of those early cases may have been acquired pre-vaccination, but not detected until post vaccination.
So that's some good news.
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Getting Started With French is great for solidifying grammar. It's a very gentle, very grammar focused approach. It uses limited vocabulary, so it wouldn't be enough on it's own for you , I don't think.
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Oooh, I like the looks of that.
This board costs me a lot of $$$ 🙂
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7 hours ago, Laura Corin said:
Yes. His family is at the hospital with him, which in the current circumstances is unfortunately not good news. He may have an advance directive about what treatment he wants. He is not in the ICU.
Ftr, he was not raising money for the NHS, which is tax funded. It was for an associated charity that offers wellbeing support to staff and patients.
He has died.
https://www.cbc.ca/news/world/captain-tom-moore-obit-1.5897602
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34 minutes ago, TCB said:
It is a really difficult thing to negotiate and I can see that there are many things you need to take into account in your situation.
The biggest thing I do to protect my family is be as careful as I possibly can to not catch Covid. I am meticulous with PPE at work. I always wear my surgical mask the entire shift, except very short periods of eating and drinking. I haven’t eaten in the break room since March. I stand up at the counter in the galley kitchen area which is open on both sides to eat quickly, and I make sure there isn’t anyone else there. I change into and out of my “covid” shoes before going in from my car, and leave them in my car. I shower as soon as I get home from work and wash all clothes straight away. I was more cautious at first, but it isn’t sustainable, as Wathe said, and I don’t think necessary.
Agreed. My mask is on my face at all times. Breakrooms are dangerous, IME. I have adapted to working up to 10 hours without eating or drinking. (If I must eat or drink, I use a room that's empty, and shut the door. And scarf food and chug water as quickly as possible. Not healthy, I know.)
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Just now, Not_a_Number said:
Well, he's not unmasked. Other people are.
I misunderstood, then. That changes the risk assessment.
I still think that working face-to-face with unmasked members of the public, even while vaccinated, is likely risker that staying at home unvaccinated. But the risk is less. If masked properly (real medical mask) and wearing eye-protection, then probably acceptable level of risk. But still riskier than staying at home unvaccinated.
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17 minutes ago, BaseballandHockey said:
To be clear. It's not that I think that vaccinated is a greater threat than unvaccinated in your situation. I think that DH vaccinated and working face to face with unmasked members of the public, might be a great risk than unvaccinated DH who isn't working and hasn't gone anywhere in months.
Absolutely yes. During current conditions where community spread is rampant, yes, working face-to-face with the public while unmasked is risky, even when vaccinated, I think. I don't think I would do that. And short of sending DH to live somewhere else and have no contact with family, I don't think that there is any home mitigation strategy that will really work.
I'm curious to know what sort of job would require unmasked exposure to the public. No need to answer that.
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6 minutes ago, BaseballandHockey said:
So, we pod my in laws, which includes four high risk people. One of those people, my GFIL would be particularly hard to stop seeing, but he is also not going to want to stop seeing the other high risk people, two of whom won't be vaccinated for quite a while.
If DH goes back to work, the chances he'll be exposed are high. Maybe higher than if he worked in a medical setting, just because he's got so much less control. We can stop DH from seeing the high risk people directly, but stopping my kids from seeing them would be very very hard. My GFIL is really struggling with grief, and my kids are huge comfort to him. He eats better if they sit and eat with them, for example, and if we isolate from them, then my kids aren't seeing any adults who aren't completely messed up by grief. That doesn't seem healthy. So, I'm just trying to sort it out.
I know that there are health care providers who take precautions to prevent them from passing the virus to their families. I'm wondering what those precautions are, and how well they work. We took a lot of precautions when we were going back and forth to PICU, but the risk benefit calculations were different then.
Short of living somewhere else and not seeing your family (which is not sustainable for years for most of us), I don't think is is much you can do. If you are sharing a home, and interacting with your family, they are going to be exposed. If I get covid, then they will be likely to get it too.
I put my energy into not catching it in the first place.
(Well, common-sense things like hand-washing are obvious. I wear scrubs that stay at work, so I'm not bringing home on my clothes. I've stopped showering after work, and just wash face and hands instead (everything else, including hair, is under clothing or PPE while working)
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24 minutes ago, BaseballandHockey said:
Thank you! That article is helpful, although not reassuring.
For example, for AZ it says that there was a 59% reduction in asymptomatic covid, but that means there's still a 41% chance of getting it asymptomatically? For someone in a high exposure job that seems like a high risk to me.
How are health care workers thinking about the risk to their families. @wathe and @TCB any thoughts?
I'm still not fully vaccinated. We've have a national supply failure, and my second dose remains in limbo.
That said, I haven't changed my behaviour at work, home, or in the community, and I still won't change my behaviour once fully vaccinated. At work I'm wrapped up tight in PPE and diligent about IPAC process. At home, I don't do anything special - separating myself from my family is not sustainable, and the harms of longterm separation outweigh the risks, I think. as for community, I am locked-down as tightly as anyone else; Groceries twice a month and necessary medical appointments, and walks in the neighbourhood.
I don't think I will change my behaviour until community transmission is negligible. And that won't be for a long time.
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Double post, sorry.
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1 hour ago, mlktwins said:
I am trying to catch up on all of this, but haven't been in a hurry since DH and I are not eligible yet. My dad and my in-laws were eligible, but then our county ran out of vaccines. Hard to keep track of what is going on anymore, but maybe they can get signed up soon.
But...and I am honestly not trying to make waves, I just have no one else really to talk to about this...is anyone concerned at all about getting the vaccine (either of the 2 being offered at the moment)? How fast they came out, that people getting them now are really just a big trial, that Pfizer and Moderna will not be held labile for things that happen to people getting the shots, how long immunity really lasts, the new variants? I have a relative, who works at a hospital, that is concerned about the new mRNA technology?
Again, I really am not trying to stir the pot. But...these are concerns of mine and I am overweight and probably would not do well if I got the virus. I'm not anti-vax by any means as we (my teenage boys too) are all up to date on our shots and we get flu shot every year.
I think it helps to frame it as choosing between risks of the vaccine and risks of the virus. Because it's only a matter of time before we are all exposed - lockdown forever isn't sustainable. The current state of evidence suggests that the vaccine is much less risky than the virus.
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On 1/29/2021 at 4:17 PM, SKL said:
2) I hope you are right that they won't bring the vax to market (for kids) if it has worse side effects than Covid, but I have my doubts. The chickenpox vax is not only available, schools require it for entry into KG, even though chickenpox is a mild disease in kids under 10. The fact that (despite documented side effects) it's forced on kids, for a pretty mild illness, makes me wonder about what policy will be applied to a Covid vax. I've already seen some headlines suggesting Covid vax mandates for school attendance. I just don't feel a lot of scientific objectivity on that topic.
A mild illness for most. A non-trivial proportion get very sick, and some of those die.
Canadian hospitalizations for chickenpox have decreased 10-fold from the pre-varicella-vaccine era to the publicly-funded-varicella vaccine era, from 1500 per year to just over 100 per year. Hospitalizations and deaths have decreased by similar proportions in the US, "Since 1996, when the varicella vaccination program was implemented, hospitalizations and deaths from varicella have declined in the United States 93% and 94%, respectively."
I started my medical training in the years before the varicella vaccine was licensed here. I've seen chickenpox-associated necrotizing fasciitis. I am so glad that I will likely never see another case again. Nor will I ever likely see a case of chicken-pox encephalitis, or chicken-pox pneumonia.
The societal costs of pre-vaccine varicella were also non-trivial, " The total medical and societal costs of varicella in Canada were estimated in a multicentre study to be $122.4 million yearly or $353.00 per individual case. Eighty-one percent of this amount went toward personal expenses and productivity costs, 9% toward the cost of ambulatory medical care and 10% toward hospital-based medical care".
Not to mention the stress faced by non-immune women who worked with children - congential varicella sysdrome is tragic. And we just don't see it anymore.
Covid vaccines won't be approved for children until the data show that they are safe. But, knowing what we do about vaccines, and what we know about covid outcomes for children right now, if I could ethically source doses for my 11 and 13-year-olds right now (which I obviously can't, so moot point) I would get them vaccinated. Because I think the risk of covid between now and when vaccines are approved for children is greater than the potential risks of the vaccine.
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See, I wouldn't consider a <40F rating to be warm for playing in the snow - that's well above freezing.
(I also think that most garment and sleeping bag temperature "ratings" are bunk. I have never, ever in my life used a winter garment or sleeping bag that lived up to its temperature rating. Like, ever.)
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I don't think there is such a thing. IME, warm necessarily means bulky. Though I suppose it depends what you mean by warm (we were at -20C here yesterday)
I think comes down to the laws of physics/thermodynamics: Insulation works by trapping warm air. Thinner materials physically don't have space to trap warm air, so they just can't insulate well. (Obviously, some materials insulate better than others for the same thickness, but no really thin material can provide excellent insulation).
That said, for playing in the snow, dry is probably more important than insulation.
My kids like Gordini mitts, Kombi mitts, and MEC brand (like REI, I think). They all get wet eventually. They will swap for a fresh pair of dry ones as needed. They dry relatively quickly on a mitten dryer that fits over a forced air vent (this is much faster than the clothes dryer).
Also, IME mittens are definitely warmer than gloves.
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Is the workbook necessary for the program, or is it meant as an option for extra practice?
From what I can tell, it looks like more of the same types of problems that are in the text.
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1 hour ago, Halftime Hope said:
Just as one should not confound the data an chloroquine with hydroxychloroquine.
You are right, they are different drugs, but closely related drugs. With similar toxicity profiles. I will amend my statement: Neither chloroquine nor Hydroxychloroquine are not benign drugs. One should not prescribe any drug with known toxicity in the absence of evidence of clear benefit. The evidence is not there. Prescribing either of theses drugs for covid is , given the current state of the evidence, likely to do more harm than good.
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15 minutes ago, mommyoffive said:
Wathe~ Oh gosh that is so scary with the new strain. And so many sick. I am so sad for the nursing home residents. Did they already have the vaccine there? And the staff?
Vaccine was too little, too late. Nursing home staff were offered vaccine late December, uptake rate was lower than hoped for, and most wouldn't have had their second dose. Residents not until much more recently (there were concerns about transporting the Pfizer vaccine) and I think most hadn't been vaccinated in time or at all.
ETA As per the health unit, "As of Jan. 16, all residents of long-term care homes in <snip> have been offered their first dose of immunization against COVID-19". The outbreak started Jan 9. Too little, too late.
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2 minutes ago, TCB said:
I think I was a bit heated in my response on this thread last night. I broke my rule of not posting right after a 12 hour shift at work.
For me it seems that these claims are often coupled with the suggestion that any dr, who doesn’t immediately leap in and start using them, is automatically assumed to be part of a huge conspiracy to withhold the true cure. That is just so unjust. Everyone I work with is trying, and has been trying for months, to do everything we can to help. The insinuation that people in healthcare are deliberately keeping a “wonder drug” away from patients cuts to the quick.I’m trying to look at recent stuff about Ivermectin but finding it a bit difficult to sort through. Does anyone have a link to a recent Medcram about it?
You had the nerve to say what many of us are screaming in our heads.
HCP try very hard to keep the professional veneer intact. I think it's probably a good thing for the general public to get a peek behind the curtain sometimes. We're people. (And we're all going to have a certain amount of PTSD/burnout once this is over.)
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Evidence summaries for hydroxychloroquine from UpToDate:
In particular, hydroxychloroquine has received considerable attention as an agent with possible antiviral activity, but trials have not suggested a clinical benefit for patients with COVID-19, including those managed in the outpatient setting [82,83]. Although some observational and unpublished anecdotal reports have suggested a clinical benefit of hydroxychloroquine, those are subject to a number of potential confounders [84], and randomized trials offer higher-quality evidence that hydroxychloroquine has no proven role for COVID-19. As an example, in an open-label trial including 293 patients with mild COVID-19 who did not warrant hospitalization, hydroxychloroquine administered within five days of symptom onset did not reduce viral levels at day 3 or 7 compared with no treatment [82]. In addition, there was no statistically significant reduction in hospitalization rates or time to symptom resolution. The rate of adverse effects, primarily gastrointestinal symptoms, were greater with hydroxychloroquine. (See "Coronavirus disease 2019 (COVID-19): Management in hospitalized adults", section on 'Hydroxychloroquine/chloroquine'.)
Hydroxychloroquine/chloroquine — We suggest not using hydroxychloroquine or chloroquine in hospitalized patients given the lack of clear benefit and potential for toxicity. In June 2020, the US FDA revoked its emergency use authorization for these agents in patients with severe COVID-19, noting that the known and potential benefits no longer outweighed the known and potential risks [87].
Both chloroquine and hydroxychloroquine may inhibit SARS-CoV-2 in vitro [88]. However, accumulating data from controlled trials suggest that they do not provide a clinical benefit for patients with COVID-19 [89-94]. In a randomized, blinded, placebo-controlled trial of 479 hospitalized patients with COVID-19, hydroxychloroquine did not improve 14-day clinical status or 28-day mortality (10.4 versus 10.6 percent; adjusted OR 1.07, 95% CI 0.54-2.09) compared with placebo; the trial was terminated early because of this lack of benefit [94]. Other large, open-label trials comparing various potential therapies with standard of care also terminated the hydroxychloroquine arms after failing to detect a mortality benefit or reduction in hospital stay [49,89]. In another open-label trial of hospitalized patients who required no or only low-flow oxygen supplementation (≤4 L/min), hydroxychloroquine (with or without azithromycin) did not improve clinical status at 15-day follow-up compared with standard of care [93]. Observational data are somewhat mixed and have methodologic limitations, but overall also suggest no benefit with hydroxychloroquine or chloroquine [95-100].
Studies have highlighted the potential toxicity of hydroxychloroquine or chloroquine [99,101]. One trial comparing two doses of chloroquine for COVID-19 was stopped early because of a higher mortality rate in the high-dose group [101]. QTc prolongation, arrhythmias, and other adverse effects associated with hydroxychloroquine and chloroquine are discussed in detail elsewhere. (See "Coronavirus disease 2019 (COVID-19): Arrhythmias and conduction system disease", section on 'Patients receiving QT-prolonging treatments' and "Antimalarial drugs in the treatment of rheumatic disease", section on 'Adverse effects' and "Methemoglobinemia", section on 'Dapsone and some antimalarials'.)
Bolding mine. Hydroxychloroquine is not a benign drug. One should not prescribe a drug with known toxicity in the absence of evidence of clear benefit. The evidence is not there. Prescribing this drug for covid is , given the current state of the evidence, likely to do more harm than good.
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NIH on hydroxychloroquine:
There is good evidence to show that it is not effective in hospitalized patients.
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This Bernie Sanders dolly pattern (Etsy) made me smile (I don't crochet. Maybe I should learn)
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NIH most recent statement on Ivermectin.
The COVID-19 Treatment Guidelines Panel (the Panel) has determined that currently there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19.
and
However, most of the studies reported to date had incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias.
The quality of the data regarding ivermectin is very poor.
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The Vaccine Thread
in The Chat Board
Posted
I think only time will tell.
General vaccine history suggests that a booster dose will be neccessary to achieve full and lasting immunity.
Several juristdictions are stretching the interval between the first and second dose (mine included), so that they can get more first doses into arms, stat. And not setting aside dose two - so the timing of a second dose depends on vaccine supply at the time your second dose is due.