On the Nature of Things | Forum

Mod note. This discussion thread is for those who do not care to base their public healthcare decisions on polarized parochial politics, tribalism, and/or histrionic mainstream and social media posts by charlatans and opportunists.

For those who do, please read and post on the

COVID-19 Pandemic | Anarchy in the USA

thread.

probably simpler for those of us that arent being genocided by our governments to chat here.

noddy wrote: ↑Fri Dec 31, 2021 1:22 am probably simpler for those of us that arent being genocided by our governments to chat here.

Good point. I should avoid the sunk-cost fallacy.

kmich wrote: ↑Thu Dec 30, 2021 2:55 pm Over the past year or so I have been doing my 3 days a week and on call once a week. Many unvaccinated patients show up in the ER, some go home and recover, some require hospitalization, and some require intubation and ventilation. Some die. Unlike early in the year which was dominated by the elderly population, far more middle aged and younger people are being admitted. While vaccinated patients do occasionally show up in the ER, the vast majority are managed at home with the assistance of their primary care physicians. Hospitalization or deaths of the vaccinated have been very rare, and the handful I have dealt with all had significant comorbidities and debilities.

Anyone who spends time as an ER physician regularly deals with hostile and combative patients and families. They are often very frightened and shocked by their course of events. If you have read that this has gotten worse, that has been my experience also. People come in insisting that they do not have COVID, demand treatments outside acceptable medical practice, and dream up various conspiracies including whether we are doing this just for the money, etc. Certainly don't need the money. My wife is concerned and encourages me to finally retire. The reason I keep on is my loyalty to my partners and staff, Many are burning out and some told me that if I retire they will leave also.

I have been doing this long enough to not personalize patient hostility. They are just scared. Projecting fear into anger and grievance is a way to feel some empowerment, as delusional as they may be. It is a pointless exercise to try to persuade people when they are locked into a conspiratorial frame. I just find it sad that people have become so spiritually impoverished that they lack the faith to face existential challenges without placing their faith on crackpots that reinforce their motivated reasoning.

We are heading into a rough patch with pandemic. If you remain not vaccinated and boosted, you are going to have a tough time ahead.

Thank you for your service, kmich.

On the quarantined USA COVID-19 anarchy thread, Denmark was mentioned.

NIH | How mRNA vaccines work


Note that no "gene editing technology" is involved. The mRNA does not enter nucleus and does not interact with the genes of the genome in any manner.

Rather, the mRNA is translated by the ribosomes residing in the cytoplasm into an amino acid chain which folds into the coded protein.

Is it appropriate to refer to this malady by this term?....'>.....

Miss_Faucie_Fishtits wrote: ↑Fri Dec 31, 2021 5:22 am Is it appropriate to refer to this malady by this term?....'>.....

Well, the COVID-19 virus is indifferent, so one may call it any name one pleases.

To me, the

"Wuhan Coof"

has an appealing ring to it.

By now it has been well established* that two comorbidities that significantly increase the probability of hospitalization, ICU admission, and death after infection with COVID-19 are

age and obesity.


*For example: https://pubmed.ncbi.nlm.nih.gov/32422233/


These are also confounding factors that should be taken into account in any analysis.

Canada's response to the COVID-19 pandemic is remarkable considering that it shares the world's longest international border with the USA.

NSW has shifted to a "let it rip" policy of no real restrictions or contract tracing now that everyone is vaccinated.

they are getting 20 thousand official cases a day, with probably that many again not recorded due to a collapse in the testing regime from overload.

only 80 in the ICU, and 900 in hospitals - leaving huge amounts of spare capacity, its seeming that waiting for the mass vaccination was the correct choice.

my state had a delta covid incursion but it seems to have died out, we are also highly vaccinated and are going to drop out border restrictions in february.

https://covidlive.com.au/

Omicron (or delta perhaps) is ripping through Connecticut and New York City right now.

Governor Lamont reported on Thursday that the positivity rate is around 21%



As it says in the tiny print above:

"Of the 1,151 patients currently hospitalized with laboratory-confirmed COVID-19, 819 (71.2%) are not fully vaccinated"

Spent most of the night in the ER.   On call and had to go in with lots of people showing up, although fewer end up being admitted than usual.  Due to a combination of high volumes and less acuity, time to use my trusty stethoscope and complete auscultation of the eight lung fields bilaterally for wheezes, crackles, and egophony.  Other than taking vitals such as determining if temperature is greater than 37.8 C, SpO2 is less than 95%, and a peripheral pulse rate is greater than 100 beats per minute, none of the imaging resources, which are already very strained, typically need to be utilized.  Maybe my experience reflects what I have been reading about the lower severity of the Omicron VOC - more likely to present with upper respiratory issues and less likely to set off COVID pneumonia.   I just don't think we really know enough yet. 

This virus has thrown us one curveball after another.  This is not the time for complacency.   Lockdowns and travel restrictions during another surge are politically impossible and just don't work well enough to justify the high cost/low benefit ratio, although a soft "lockdown" during this surge of people less likely to go out due to infection concerns remains likely.   Encouraging vaccination and the use of quality masks (N95 and KN95) is probably our best approach for now.

Science is an evolving process in addressing a new pathogen, so it is inevitable that mistakes will be made, learned from, and corrected by following reliable research.  People who point out these errors as an example of the failure of science do not understand how science works.   In historical retrospect, the rapid development of testing and effective vaccines to address SARS-CoV-2 within a year will likely go down as a singular milestone and achievement in medical science. 

Still, we are not out of the woods on this virus, and we are likely to end up with SARS-CoV-2 being an endemic pathogen with periodic surges of infection due to the development of VOC.   As long as significant numbers of people have not attained a measure of immunity through vaccines or natural infection, there are plenty of people in whom the virus can infect, breeding frequent mutations (SARS-CoV-2 is a positive-stranded RNA virus having mutation rates on the order of 10^-6 and 10^−4  substitutions per nucleotide site per cell infection).    VOC will are likely to periodically reappear as long as this remains the case and the virus circulates in the world population.

Time to try to get some sleep.  Hope I stop having that weird dream of people who have died in my care standing around my bed looking down at me.  Creepy.

Anyway, Happy New Year all...

Mrs. Hilaire works in an ER and they are swamped with people who want Covid tests. No concern about the ER being the easiest place to catch the bug.

No real reason to get a test tbh. If they are not in respiratory distress they get a test and sent home no matter what the result. Mostly a lot of unnecessary busywork and an exposure festival.

I don’t know if this is true for your ER, kmitch, but here the triage team and physicians are not allowed to ask about Covid immunization hx. Do you put your patient’s cv immunization hx on their record?

US CDC | Characteristics and Clinical Outcomes of Children and Adolescents Aged <18 Years Hospitalized with COVID-19 — Six Hospitals, United States, July–August 2021

Summary
What is already known about this topic?

Pediatric COVID-19–related hospitalization rates increased when the highly transmissible SARS-CoV-2 B.1.617.2 (Delta) variant became the predominant circulating strain.

What is added by this report?

Among children and adolescents with SARS-CoV-2 infection admitted to six hospitals during July–August 2021, 77.9% were hospitalized for acute COVID-19. Among these patients, approximately one third aged <5 years had a viral coinfection (approximately two thirds of which were respiratory syncytial virus) and approximately two thirds of those aged 12–17 years had obesity; only 0.4% of age-eligible patients were fully vaccinated.

What are the implications for public health practice?

COVID-19 vaccination and other prevention strategies are important to protect children from COVID-19, particularly children with obesity and other underlying health conditions.

Reason | CDC: 61% of Teenagers Hospitalized for COVID-19 Had Severe Obesity

why does every thread need to be a twitter conspiracy thread?

noddy wrote: ↑Wed Jan 05, 2022 1:07 am why does every thread need to be a twitter conspiracy thread?

Good question.

Especially as rather than censoring these type of mainstream and social media posts,
this mod has left a thread open and uncensored dedicated to such posts.

Typhoon wrote: ↑Wed Jan 05, 2022 2:01 am

noddy wrote: ↑Wed Jan 05, 2022 1:07 am why does every thread need to be a twitter conspiracy thread?

Good question.

Especially as rather than censoring these type of mainstream and social media posts,
this mod has left a thread open and uncensored dedicated to such posts.

So what do you call heartfelt response to someone else's post being redirected to another thread? "science"?

Doc wrote: ↑Wed Jan 05, 2022 7:32 am

Typhoon wrote: ↑Wed Jan 05, 2022 2:01 am

noddy wrote: ↑Wed Jan 05, 2022 1:07 am why does every thread need to be a twitter conspiracy thread?

Good question.

Especially as rather than censoring these type of mainstream and social media posts,
this mod has left a thread open and uncensored dedicated to such posts.

So what do you call heartfelt response to someone else's post being redirected to another thread? "science"?

Moderation.

I'm probably the wrong person when it comes to terms such as "heartfelt respone" given that the nickname my colleagues in the US came up with was "Spock-san".

Typhoon wrote: ↑Thu Jan 06, 2022 1:06 am

Doc wrote: ↑Wed Jan 05, 2022 7:32 am

Typhoon wrote: ↑Wed Jan 05, 2022 2:01 am

noddy wrote: ↑Wed Jan 05, 2022 1:07 am why does every thread need to be a twitter conspiracy thread?

Good question.

Especially as rather than censoring these type of mainstream and social media posts,
this mod has left a thread open and uncensored dedicated to such posts.

So what do you call heartfelt response to someone else's post being redirected to another thread? "science"?

Moderation.

I'm probably the wrong person when it comes to terms such as "heartfelt response" given that the nickname my colleagues in the US came up with was "Spock-san".

Highly logical.....'>......

Typhoon wrote: ↑Thu Jan 06, 2022 1:06 am))

Doc wrote: ↑Wed Jan 05, 2022 7:32 am

Typhoon wrote: ↑Wed Jan 05, 2022 2:01 am

noddy wrote: ↑Wed Jan 05, 2022 1:07 am why does every thread need to be a twitter conspiracy thread?

Good question.

Especially as rather than censoring these type of mainstream and social media posts,
this mod has left a thread open and uncensored dedicated to such posts.

So what do you call heartfelt response to someone else's post being redirected to another thread? "science"?

Moderation.

I'm probably the wrong person when it comes to terms such as "heartfelt respone" given that the nickname my colleagues in the US came up with was "Spock-san".

[Mod note. This thread is not for polemics about the scientific method.]

Cherry picked stat

North America comes in third in the total number of COVID deaths worldwide

Behind Europe
Behind Asia (excluding China)
ANd just ahead of South America
Next will it be a claim that the US has one of the highest infant mortality rates in the world?

. . .


I have yet to see any government science based suggestions in the US. For the first year people that tested positive for COVID were sent home and told nothing as to what they should be doing other than isolate and wear a mask. Where are the ads telling people to take vitamin D? Where are all the government health officials ?

https://pubmed.ncbi.nlm.nih.gov/33447107/

Abstract

Introduction: Vitamin D status is related to risks of influenza and respiratory tract infections. Vitamin D has direct antiviral effects primarily against enveloped viruses, and coronavirus is an enveloped virus. The 2019 coronavirus disease had a high mortality rate and impacted the whole population of the planet, with severe acute respiratory syndrome the principal cause of death. Vitamin D can adequately modulate and regulate the immune and oxidative response to infection with COVID-19. The goal of this systematic review was thus to summarize and decide if there were a link between vitamin D status and COVID-19 infection and prognosis.

Methods: The protocol of this study is documented in the Prospero database and can be accessed with the protocol number CRD42020201283. PubMed and Google Scholar were used for a literature search from August 2020 to September 2020. We restricted the year of publication of reviewed articles to 2019-2020, and the selected language was English. Studies that used secondary data, feedback, or analysis of reviews were removed. To assess the standard of studies included, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method was used.

Results: Of the nine studies reviewed, seven (77.8%) showed that COVID-19 infection, prognosis, and mortality were correlated with vitamin D status.

Conclusion: Most of the articles reviewed showed that blood vitamin D status can determine the risk of being infected with COVID-19, seriousness of COVID-19, and mortality from COVID-19. Therefore, maintaining appropriate levels of Vitamin D through supplementation or natural methods, eg, sunlight on the skin, is recommended for the public to be able to cope with the pandemic.

If you go to the link they list study after study that Vitamin D is a good treatment for COVID-19

I have heard little to nothing from US government officials on this. IE they are not telling people to make sure they get enough vitamin D.

This once.

Doc wrote: ↑Thu Jan 06, 2022 5:52 am

Typhoon wrote: ↑Thu Jan 06, 2022 1:06 am

Doc wrote: ↑Wed Jan 05, 2022 7:32 am

Typhoon wrote: ↑Wed Jan 05, 2022 2:01 am

noddy wrote: ↑Wed Jan 05, 2022 1:07 am why does every thread need to be a twitter conspiracy thread?

Good question.

Especially as rather than censoring these type of mainstream and social media posts,
this mod has left a thread open and uncensored dedicated to such posts.

So what do you call heartfelt response to someone else's post being redirected to another thread? "science"?

Moderation.

I'm probably the wrong person when it comes to terms such as "heartfelt respone" given that the nickname my colleagues in the US came up with was "Spock-san".

[Mod note. This thread is not for polemics about science and the scientific method. Please use the other thread.]

Cherry picked stat

North America comes in third in the total number of COVID deaths worldwide

Behind Europe
Behind Asia (excluding China)
And just ahead of South America

world covig deaths.jpg

This is like adding adding mariachi performers, NASCAR drivers, and hockey players together and believing that the the sum has some significant meaning with regards to the percentage that die due to accidents in the home.

The three N Am nations of Mexico, the USA, and Canada are distinct with regards to culture. economy, and government.
How each nation has responded to the COVID-19 pandemic is also different.


That Mexico and the USA correlate to some degree in per capita deaths due to COVID-19 does not indicate that their public health measures and citizens responses are necessarily similar - correlation may or may not be due to causation.

Note also, that over half of the N Am population [57%] is American.

Grouping Europe together also makes no sense given the probably even wider disparities between nations such as Denmark and Albania.
Same for Asia.

Doc wrote: ↑Thu Jan 06, 2022 5:52 am Next will it be a claim that the US has one of the highest infant mortality rates in the world?

No. The highest among developed nations.

Mod note. Same applies to polemics and the US govt and public officials. Please use the other thread.

Doc wrote: ↑Thu Jan 06, 2022 5:52 am I have yet to see any government science based suggestions in the US. For the first year people that tested positive for COVID were sent home and told nothing as to what they should be doing other than isolate and wear a mask. Where are the ads telling people to take vitamin D? Where are all the government health officials ?

https://pubmed.ncbi.nlm.nih.gov/33447107/

Abstract

Introduction: Vitamin D status is related to risks of influenza and respiratory tract infections. Vitamin D has direct antiviral effects primarily against enveloped viruses, and coronavirus is an enveloped virus. The 2019 coronavirus disease had a high mortality rate and impacted the whole population of the planet, with severe acute respiratory syndrome the principal cause of death. Vitamin D can adequately modulate and regulate the immune and oxidative response to infection with COVID-19. The goal of this systematic review was thus to summarize and decide if there were a link between vitamin D status and COVID-19 infection and prognosis.

. . .

Conclusion: Most of the articles reviewed showed that blood vitamin D status can determine the risk of being infected with COVID-19, seriousness of COVID-19, and mortality from COVID-19. Therefore, maintaining appropriate levels of Vitamin D through supplementation or natural methods, eg, sunlight on the skin, is recommended for the public to be able to cope with the pandemic.

If you go to the link they list study after study that Vitamin D is a good treatment for COVID-19

I have heard little to nothing from US government officials on this. IE they are not telling people to make sure they get enough vitamin D.

US CDC | COVID-19 Treatment Guidelines: Vitamin D

Well, one should ensure that one has a sufficient vitamin D intake for general health reasons.

However, the role of vitamin D in preventing COVID-19 infection or reducing the symptoms of infection, if any, is far from clear.

Various meta-analyses draw different and opposite conclusions:

Metabolism | Myths and facts on vitamin D amidst the COVID-19 pandemic

What this suggests is that many of the underlying trials are flawed: either poorly designed and/or executed or even bogus.

Note that Retraction Watch lists 7 papers about COVID-19 and vitamin D as retracted.

My thanks to Typhoon for addressing misinformation here. Moderation is never perfect and is likely a thankless job.

As far as the Vitamin D-Covid issue, I particularly enjoyed the study done at McGill which employed Mendelian randomization. A bit technical, but a method which is less likely to be affected by confounding or reverse causation than conventional observational studies. While vitamin D has long been known to support your immune system, its use as an antiviral or as a Covid-19 prophylactic is currently not supported.

Hospital is a mess.   Staffing shortages are rapidly growing as staff get sick and the ER is as crowded as it would be during a mass casualty drill.  And no, we do not test in the ER, you will need to find a testing site or a home test, if you can find them.  

The recent CDC guidelines sound like a product of an academic committee and are confusing and not helpful.  I would keep it simple.  If you feel sick, stay home,  Testing is of limited availability and usefulness in the current situation.  You could test negative one day, and suddenly become ill the next.  After you feel better, go out only wearing a quality mask (N95, KN95).    If you are sick and experience increased work of breathing, that is the time to call your doctor or if you are in acute distress, come to the ER.

Talked into an extra day of work, so I am doing 4 instead of three now.  On call an extra day.    Don't know how long I can keep this up.