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wathe

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Posts posted by wathe

  1. 24 minutes ago, Ausmumof3 said:

    65 for NSW today so moving in the right direction

    10 for Vic

    3 for QLD

    had my first Pfizer so far so good!  Arm is a little dead.

    Congrats on your vax!

    • Like 1
    • Thanks 1
  2. 4 minutes ago, Not_a_Number said:

    Thanks for the recommendation! I always like hearing about people who are worth listening to. Sometimes all the opinions get overwhelming... 

    They are the group our provincial government is supposed to listen to for advice......

    • Like 1
  3. I don't generally review primary data myself, unless it is a topic of particular interest (I looked at the mRNA vaccine trial data quite closely, for example) because it is absolutely impossible to read the primary data on everything and still have time to practice.

    I rely on professional medical reviewers who are vetted, and who cite primary sources (so I can check up on them from time to time) .  For covid, UpToDate is one of my favourites. It's a professional reference resource that is $$$$ to subscribe to, but has made its covid pages free to all during the pandemic. The Ontario Covid-19 Science Advisory Table is my favourite local covid resource. These types of resources look at data through an individual patient lens and also a public health/systems lens. They know what they are doing with respect to critical appraisal of evidence.  For what it's worth,  both recommend against Ivermectin*.

    ETA I know some of the Ontario Science table people IRL.  They've earned my trust - they are Very Smart People who Know What They Are Doing.

    *ETA again except in very specific circumstances of covid, immune compromise and strongyloides co-infection - but in that case the ivermectin is to treat the parasite, not the covid.

    • Like 3
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  4. 3 hours ago, Danae said:

    Don’t project your PCP’s ridiculousness onto the rest of the US.  Practices here are seeing people as normal.  Many have a separate waiting area for people with respiratory symptoms, or ask you to wait in your car until called, but people are being seen and treated.

    She might mean this (PCP's declining to see patient with URI symptoms), 'cause that's definitely still happening in some communities, but I think she instead means that PCP's aren't treating respiratory symptoms with the treatments that she believes are indicated, which might include non-mainstream treatments, or treatments outside standard practice guidelines.  I think that interpretation fits better with the theme of the posts leading up to this one.  

    Perhaps @Halftime Hopewill clarify.

     

     

    • Like 2
  5. 42 minutes ago, Terabith said:

    Our doctors will not see anyone with anything remotely upper respiratory, or gastrointestinal.  They tell everyone to go to urgent care.  I could get a tele-health appointment with my doctor for a sinus infection, but when I thought I had an ear infection, they said I had to go to urgent care, because ear infection might have been caused by something respiratory, and they aren't seeing people who are sick with potentially contagious ailments.  Which is kind of a nice gig for doctors, but kinda sucky for the urgent care folks.  

    We have this problem here now.  some family practices still aren't seeing patients in person, or are declining to see respiratory illness.  So we end up seeing these people in our over-crowded, understaffed emergency department.  For complaints that really should go to primary care.  The patients wait a long time to have their non-emergencies seen (because, of course, in an emergency department, they get bumped by emergency cases) and then get upset because their "doctor called ahead" and somehow this gives people the idea that I am waiting for them with nothing else to do......

    Emerg staff are so very tired.

    • Sad 13
  6. 32 minutes ago, Corraleno said:

    https://www.tennessean.com/story/news/health/2021/07/13/tennessee-halts-all-vaccine-outreach-minors-not-just-covid-19/7928701002/

    Excerpt:

    The Tennessee Department of Health will halt all adolescent vaccine outreach – not just for coronavirus, but all diseases – amid pressure from Republican state lawmakers, according to an internal report and agency emails obtained by the Tennessean. If the health department must issue any information about vaccines, staff are instructed to strip the agency logo off the documents.

    The health department will also stop all COVID-19 vaccine events on school property, despite holding at least one such event this month. The decisions to end vaccine outreach and school events come directly from Health Commissioner Dr. Lisa Piercey, the internal report states.

     

    https://www.tennessean.com/story/news/health/2021/07/12/covid-19-tennessee-fired-vaccine-official-michelle-fiscus-fears-state/7945291002/

    Excerpt from a statement by TN's top vaccine official, who was fired yesterday:

    "It is the mission of the Tennessee Department of Health to “protect, promote and improve the health and prosperity of the people of Tennessee” and protecting them against the deadliest infectious disease event in more than 100 years IS our job. It’s the most important job we’ve had in recent history. Specifically, it was MY job to provide evidence-based education and vaccine access so that Tennesseans could protect themselves against COVID-19. I have now been terminated for doing exactly that.
    ...
    What's more is that the leadership of the Tennessee Department of Health has reacted to the sabre rattling from the Government Operations Committee by halting ALL vaccination outreach for children. Not just COVID-19 vaccine outreach for teens, but ALL communications around vaccines of any kind. No back-to-school messaging to the more than 30,000 parents who did not get their children measles vaccines last year due to the pandemic.  No messaging around human papilloma virus vaccine to the residents of the state with one of the highest HPV cancer rates in the country. No observation of National Immunization Awareness Month in August. No reminders to the parents of teens who are late in receiving their second COVID-19 vaccine. THIS is a failure of public health to protect the people of Tennessee and THAT is what is “reprehensible”. When the people elected and appointed to lead this state put their political gains ahead of the public good, they have betrayed the people who have trusted them with their lives.
    ...
    I have been terminated for doing my job because some of our politicians have bought into the anti-vaccine misinformation campaign rather than taking the time to speak with the medical experts. They believe what they choose to believe rather than what is factual and evidence-based. And it is the people of Tennessee who will suffer the consequences of the actions of the very people they put into power."

     

    I saw the NYT version of the story.  It beggars belief.

    “Nobody else in this state needs to die from Covid-19 because we have effective vaccines,” she said. “And the fact that we have elected and appointed officials that are putting barriers up to protecting those Tennesseans is, I think, it’s unforgivable.”  

    • Like 8
  7. 6 hours ago, regentrude said:

    Several folks mentioned using positivity rates as a measure. Why? Wouldn't the positivity rate entirely depend on how many and how sick people test? If there's a ton of testing, like mandated on schedule,  rate will be much smaller than if there's only a few sick folks testing and noone else.

    It's correlated well here with hospitalizations and deaths, but percent positivity rises earlier, while hospitalizations and deaths lag behind.

    Lots of people are getting covid tests who don't have symptoms here:  Nursing home staff are all tested weekly, every hospital inpatient gets a covid test at the time of admission, no matter what the reason for admission (including obstetrics, orthopaedics, etc), all patients  getting discharged to a nursing home get another test before discharge, all patients having surgery for any reason get a covid test etc.  

    • Like 3
  8. 1 minute ago, wathe said:

    Provincial.  My health unit rate is slightly lower (0.5%), but we are close to Toronto (0.7%) and adjacent to another health unit with a positivity of 1.4%.  We are also an area that attracts a lot of seasonal travellers.

    Quoting myself to say that I pick whichever one is worse, local vs provincial.  

    • Like 1
  9. 7 minutes ago, mommyoffive said:

    What positivity rates are you guys using?  Your state's or county's? 

    Provincial.  My health unit rate is slightly lower (0.5%), but we are close to Toronto (0.7%) and adjacent to another health unit with a positivity of 1.4%.  We are also an area that attracts a lot of seasonal travellers.

    • Like 1
  10. 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)

     

    • Like 6
  11. 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. 

    • Like 1
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  12. 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.

    • Confused 1
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  13. 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.

    • Like 1
  14. 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.

    • Like 4
  15. 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.

    • Like 9
  16. 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.

    • Like 4
  17. 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...  

    • Like 2
    • Thanks 1
  18. 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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