CMM and my good friend who had a heart transplant and his wife got their Covid vaccines today - yay!
My optimism about us all getting vaccinated though is tempered by the data on these new Covid strains. The Brazilian one and the South African one may not be as sensitive to antibodies from the current vaccines or from previous infections - and are likely to spread like wildfire. (In South Africa, 90% of new infections are the new strain already.) So I caution all of you, even once you're vaccinated, do not let your guard down.
This is exactly what happened during the Spanish Flu pandemic, btw - a first wave in the spring, then the next winter a much more deadly wave. When a new virus infects that many millions of people, there are just too many opportunities for it to mutate, and the more contagious strains win out. Please be safe and get vaccinated when you can.
Off-label drugs may still have some promise for outpatient Covid cases, although the research is not as good as we would like yet. Ivermectin is being studied, an old antidepressant used for OCD called Fluvox is in a trial, and the American Journal of Medicine (the prestigious "Green Journal") just published an algorithm that restores a role for hydroxychloroquine in outpatient cases. In my limited experience, hydroxychloroquine did seem to improve breathing problems, although it didn't shorten the duration or stop the long term complications. Fluvox, on the other hand, was reported to result in NO symptoms after two weeks in an uncontrolled open trial - that would be highly unusual if true. I'll be following the research - it makes me a little nervous because the dose of Fluvox they are using is the maximum dose, and anti-depressants can trigger suicidality or mania in some people. But if it works as well as it appeared to it would be a real game changer.
Meanwhile my patient's 52 year old healthy husband has been on a ventilator and ECMO for a week. Take this seriously.
Thank you KML for keeping us updated. So glad that CMM and your friends got their vaccines. Not sure about what vaccines are available in the States. We have two up here...Pfizer and Moderna. I had heard that Pfizer was not recommended for people who are immunocompromised but that Moderna was okay. Is that the case or did I hear it wrong?
Pfizer and Moderna are what we have now too. Johnson and Johnson is being considered next week for an EUA.
Neither Pfizer or Moderna are a problem for immune compromised people - they do not contain any live virus and are almost identical, both mRNA vaccines with only minor differences. In fact, if you had to get Pfizer for your first shot and Moderna for the second, or vice versa, it would probably work just fine.
Astra Zeneca and Johnson and Johnson vaccines are based on modified adenoviruses and that might theoretically be more of a concern for severely immune compromised patients.
Last edited by job; 01/29/2102:33 PM. Reason: corrected the spelling of "Ofizer" to "Pfizer"
Looks like at least the Johnson and Johnson vaccine shouldn't be a problem for immunocompromised people either, although I don't know what the package insert will say. It IS an adenovirus based vaccine but the virus is altered so that while it can infect your cells and deliver its payload of Covid spike protein, it cannot replicate in your body. The main problem for immunocompromised people is vaccines that use a live, weakened virus like measles and polio vaccines.
(How do they grow this virus then? They give it a mutation such that it can only grow in the laboratory with the addition of something that it would not find in your body. I don't know the specifics yet with this vaccine, but a friend of mine does research on mosquitoes that will only reproduce in the presence of doxycycline, so they can release them into the community without having them reproduce there.)
I would like to clear up here some of the many misconceptions about the vaccines that I keep having to debunk on FB.
No, the vaccine cannot change your DNA. mRNA vaccines like Pfizer and Moderna especially cannot do this. They don't even enter the nucleus where your DNA resides, and RNA does not turn into DNA. And even if you believe like some troll I encountered online that somehow the mere presence of the mRNA in your cytoplasm would change your DNA expression - what do you think would do that more? Having a few molecules of mRNA in your arm muscle for a short time, or having all the cells in your body infected with Covid making multiple different viral mRNA copies in your cells for days at a time???
No, it's not okay for you to just choose to get infected and "get it over with". The whole reason we see more dangerous strains evolving is because so many people have gotten the virus, and most outbreaks start with someone's carelessness. When millions of people get infected the opportunity for new strains arise - the more infected people, the more selection pressure on the virus to become more contagious. Getting everyone vaccinated and breaking the train of transmission is the way to stop this from happening. "Herd immunity" from everyone getting infected does not work, as the city of Manaus in Brazil has shown us. So far we are just LUCKY that the new strains are more transmissible but not apparently severely more damaging (The British strain might be 30-40% more deadly). Imagine if a new strain arose that was ten times more deadly? The way to prevent this is to prevent infections, by mask wearing, social distancing and vaccination.
Adverse events triggered by the vaccine are WAY WAY less common than death and disability from the virus itself. Just because you know a handful of people who got the virus and had a mild course does not change the fact that 10-20% of outpatient cases have some long term consequences and 2/3 of hospitalized patients have long term damage. And these are just the things we currently know about. For instance, Covid can trigger orchitis (inflammation of the testicles). This can lead to infertility or low testosterone. The testes are rich in the ACE2 receptors that Covid attaches to. Full blown orchitis seems to be a rare complication (although I have a case) - but how many men may have had a low grade case and may end up with testosterone deficiency in the future? No one knows because we aren't following that kind of thing, and it might show up ten years later. Same for heart disease - will the people who recover from cardiac inflammation with the virus become a surge of heart disease patients ten years later due to scarring of their hearts? We don't know.
No, "at risk" people can't all just stay home so you can go out maskless. Many do, but they have to interact with family members who live in the same household, they have to go to the doctor's. We ALL have a role to play in protecting the vulnerable people in our population, and that means mask wearing, social distancing, and getting vaccinated so we can break the transmission of the virus. I'm so tired of selfish trolls saying "well you just stay home then if you're afraid of the virus". Essential workers can't do that. Plus, you can't be sure you're not "at risk". My niece the ECMO nurse watched a 32 year old die yesterday of Covid. She's had a 19 year old die. My patient's husband on ventilator and ECMO is probably going to die - he's only 52 and previously healthy with just a mild asthma history.
Yes, masks work. In the current environment with these more transmissible strains starting to spread, you need a better level of mask protection than you had. Double mask, or wear a N95 or KN94 mask. The more contagious the virus, the smaller viral load it takes to get sick, so be extra strict with your precautions. Wear a mask, save someone's life.
Once you're vaccinated you still need to wear your mask and socially distance until the pandemic has calmed down. The vaccines are very effective but NOT 100%, and effectiveness may decrease as new strains appear (we may need a booster in the future to give us better immunity against the South African and Brazilian strains, for instance). Some immunity is still better than none. Getting vaccinated AND continuing to wear masks and socially distance should bring the virus under control.
My niece has been an ICU nurse for three years, and has spent the last year as an ECMO nurse treating almost exclusively end-stage Covid patients. She works incredibly long hours and is suffering from PTSD from all the death and destruction she has seen. If you won't do it for yourself, do it for her and the many other healthcare workers on the front lines like her.
And btw, there's no fetal cells, no heavy metals, and no microchips in these vaccines! Honestly, the crazy stuff people read on the internet and believe with no basis in fact is astounding. A friend of mine who is a hospital nurse is eager to get his mom vaccinated - she won't get it because she's afraid of "evil Bill Gates" microchipping her!
Lord have mercy but people are loons! If I had a nickel for every person I heard say "they ain't forcing me to get it so they can track me" while they were talking on a blasted cell phone which is, spoiler alert, TRACKING THEM, I could quit my job and lie on a beach drinking margaritas all day every day for the rest of my life. People are just strange. And, to those I say, sit the heck down and let those of us who are not crazy conspiracy theorists get ours.
Me 52, H53 Bomb drop 9/29/2014 Divorce from XH final 12/17/2014 Marriage #2 12/31/2019 5 adult (step)daughters (3 from XH's first marriage, 2 from current H's previous relationships) 6 grandkids
I already know that trying to argue with you or change your mind is fruitless, but for the other readers I add a few comments just for perspective. I base these mostly on my home states very well documented and verified stats.
Your niece must have the worst luck ever, or her patients do. I’m staying clear. . Of over one half million of confirmed cases in my state, we’ve had exactly TWO (2) die under the age of 20. TWO!!!!!! One of those was confirmed to have leukemia as well. Not sure about the other. That puts our death rate for a 19 year old at .000374%. Tragic for that person and their family but about the chance of getting struck by lightening. OTOH if you are 90 or above in my state you have more than a 1 in 5 chance of dying from covid. If 80 to 89 it’s greater than 1 in 10. That’s where the problems are - not in the extremely unlucky, and very likely already very sick, 19 year old.
I honestly think masks might possibly help a little bit. To think they are any significant answer to our problems is very naive. They are not even in the same ballpark as a vaccine. We had a statewide mask mandate go into place in August when there were about 400 people hospitalized. Since after the mask mandate numbers have never been as low as they were for months prior to it. They peaked at near 2,400 people hospitalized a few weeks before thanksgiving and months after the mandate. So in other words after a mask mandate the numbers infected increased by over 6 times! A cynical response might be that masks have caused the increase of covid by 6 times. That’s simply not true either but the evidence shows the outcome has done nothing. You can’t do something to refuse the number of infected, see that number increase 6 fold, and still claim it’s working.
For sure covid needs to be taken seriously. Just not more seriously than life itself. It’s but one component of life even though it’s clearly become an obsession for some. Education has greatly suffered. The least at risk, our children, have suffered the most. Businesses wiped out. Depression, suicide, drug overdose and abuse through the roof. By all means we need to safely vaccinate. We need to continue reasonable precautions. Masks are not a suit of armor. I constantly see people tell someone to out on a mask - before hugging them!!!! That’s insane. We are about to see if any of this worked as even California is about to start opening things. The super bowl will have 20,000 plus in the stands. Let’s see what happens after. I’m sure it will be the same as after the elections and thanksgiving and Christmas and school openings and state openings we we were told these things would cause numbers to surge and soar. Instead they stayed the same or went down
Balance. Hopefully that’s some balance.
DonH Midwest Me 56 WAW-EXW 55 Met 11/95 / Married 5/00 Bomb 6/20/05 / She Filed on 6/2/06 / Divorced on 10/9/06 4 who'd qualify as GF since D & dated about 25 women since D
Just because people are stupid and don’t wear their masks properly doesn’t mean masks don’t work, it means people are dumb.
Numbers are increasing because we’ve let so many people contract this virus that new mutations have arisen that are more contagious. That’s why the new recommendation is to double mask or wear an N95 mask. With more contagious strains, you can become ill with a lower viral inoculation.
My niece sees the patients who are on their last legs, as ECMO is the very last treatment they can offer. 2/3 of patients on ventilators and ECMO die. She doesn’t even see elderly patients anymore because they don’t waste limited ECMO on them. She sees the younger patients that might have a chance of surviving.
And again, people like to diminish this virus by only talking about the deaths, but the long term morbidity is shocking as well. Young people may survive but they are not immune to the other complications.
Vaccines are the ultimate answer but we can’t get there without continued mask wearing and social distancing too - the combination can cut the chain of transmission.
Remind me to never get kml wound up about something she is passionate about - LOL.
So .... How's the 1000 mile challenge going? Got that furniture re-upholstered? Been able to move your instruments and get some practicing in?
On BD H52, W50 T27, M26 S21, D23 BD-9-Mar-16 D-15-Jan-18 Final-19-Apr-18 I am a storyteller. The story may do you no good. But a story is never for the listener. It is always for the one who tells
. Of over one half million of confirmed cases in my state, we’ve had exactly TWO (2) die under the age of 20. TWO!!!!!! One of those was confirmed to have leukemia as well. Not sure about the other. That puts our death rate for a 19 year old at .000374%. Tragic for that person and their family but about the chance of getting struck by lightening. OTOH if you are 90 or above in my state you have more than a 1 in 5 chance of dying from covid. If 80 to 89 it’s greater than 1 in 10. That’s where the problems are - not in the extremely unlucky, and very likely already very sick, 19 year old. 