Vaccines and Therapeutics 2.0 & 3.0 Merge

[Jersey Girl]

He has a point. : )

Yep. I only went unmasked for a short while. Masking up again. Same reason. I don't trust anyone. Idgaf what people think of me and I never did to start with. We have a pile of medical masks and I have 3 fabric masks with filters. One fabric mask is my clan tartan, waiting to be worn in Scotland. I hold out a hope for that.

Looks like some state governments are putting pressure on groups of people they can mandate--state employees, essential workers, teachers,etc. I'm hoping that other state gov'ts do the same and up the ante on the unvaccinated wherever possible. Why not mandate vaccinations for mass transit--including airline flights? That ought to force the hand of many.

The rate of new infections are on par with last summer. I fully expect to be in lock down again by fall if nothing serves to move the needle on vaccinations.

Vaccine passports or some darn thing like that needs to happen. So what if all hell breaks loose? We're already living in hell anyway. If I had to show shot records to get into Europe re: military, I don't see why we can't do that within the country.

In any case, the FDA needs to get it's ass in gear and approve the mRNA vaccines which is expected within a month to two months. Again...we'll be in lock down again if it takes that long and even then, some folks will refuse vaccination.

[Atlanticmike]

He has a point. : )

Yep. I only went unmasked for a short while. Masking up again. Same reason. I don't trust anyone. Idgaf what people think of me and I never did to start with. We have a pile of medical masks and I have 3 fabric masks with filters. One fabric mask is my clan tartan, waiting to be worn in Scotland. I hold out a hope for that.

Looks like some state governments are putting pressure on groups of people they can mandate--state employees, essential workers, teachers,etc. I'm hoping that other state gov'ts do the same and up the ante on the unvaccinated wherever possible. Why not mandate vaccinations for mass transit--including airline flights? That ought to force the hand of many.

The rate of new infections are on par with last summer. I fully expect to be in lock down again by fall if nothing serves to move the needle on vaccinations.

Vaccine passports or some darn thing like that needs to happen. So what if all hell breaks loose? We're already living in hell anyway. If I had to show shot records to get into Europe re: military, I don't see why we can't do that within the country.

In any case, the FDA needs to get it's ass in gear and approve the mRNA vaccines which is expected within a month to two months. Again...we'll be in lock down again if it takes that long and even then, some folks will refuse vaccination.

Nothing wrong with wearing a mask. But, if your going to wear a mask and you want it to work try to find some p100 mask. Kinda hard to breathe through, but more effective than n95 mask. They make p100 disposable mask with the exhaust port, that's best and if your vaccinated who cares if it has a vent hole. I wear a p100 mask to acid wash garage floors and around other harsh chemicals and they are great.

[Chap]

So far as I understand the situation in relation to masks and the protection of oneself and others, it is something like this:

1. If you are infected with the virus (something that can happen without you having any symptoms) , then each time you breathe out you will exhale many microdroplets of nasal, bronchial and lung secretions, all of which will carry a load of the virus. If people breathe in those microdroplets, they may in turn become infected. Putting pretty well any kind of fabric barrier in close contact with your face so that your exhalations have to pass through it will greatly reduce the number of microdroplets that get out into your surroundings (hence the inside of your mask may feel wet), and hence do a lot to protect those around you from infection.

2. On the other hand, if someone near you is spraying infected droplets into the atmosphere, or has recently done so, the effect of the mask in preventing you breathing in some of the very smallest of the droplets is limited, though not zero. (And in liquid evaporates from the droplets over time, making them smaller, so that the float around in the air fro a much longer time before hitting the floor)

Hence the common saying 'I wear a mask to protect others rather than to protect myself' . It's something we mostly do for our fellow-citizens (or just fellow human beings) rather than something we do for ourselves. If you do want to protect yourself from infection at a high level, you will need a higher quality mask than the kind that will simply protect others to a good extent.

Hence all that stuff about 'It's my decision whether I judge the risk of my getting COVID is great enough to make me wear a mask. It's MY body, isn't it?' is - shall we say politely - of limited value. Yeah, it's your body, but do you have a right to put other people's bodies at risk just so you can feel brave? Have you got the right to be brave on other people's behalf, and potentially at the expense of their life or health?

Early advice on the advisability of wearing masks was to say the least confused. But this was a completely novel virus whose mode of transmission was not initially well understood, quite apart from the political pressure to avoid a run on the small supply of masks, which at that time was insufficient to meet even the urgent needs of health workers.

Now we know a lot better, and have the supply of masks needed for everybody to be able to wear one. And that's what we should do in any environment where we share the same space with significant numbers of other people. I'm fully vaccinated, but I know I can still carry infection. Hence I still wear a mask when appropriate - I mean, what kind of normal person can't put up with the very slight discomfort and inconvenience involved?

[Chap]

This is an interesting scientific review of mask wearing from the Proceedings of the National Academy of Sciences; that is probably a more reliable source than ... well, anybody who has not actually reviewed the evidence on a careful scientific basis.

The article is of course based on the situation in late 2020, since when medical masks have become plentifully available.

An evidence review of face masks against COVID-19

PNAS January 26, 2021 118 (4) e2014564118; https://doi.org/10.1073/pnas.2014564118

By the way, the odour of tobacco is not primarily transmitted by exhaled microdroplets. Nor is the smell of (to refer to one particularly stupid comparison I have seen made) the smell of bowel gas. The COVID-19 virus is transmitted that way. That's why fabric masks are effective against it.

ABSTRACT

The science around the use of masks by the public to impede COVID-19 transmission is advancing rapidly. In this narrative review, we develop an analytical framework to examine mask usage, synthesizing the relevant literature to inform multiple areas: population impact, transmission characteristics, source control, wearer protection, sociological considerations, and implementation considerations. A primary route of transmission of COVID-19 is via respiratory particles, and it is known to be transmissible from presymptomatic, paucisymptomatic, and asymptomatic individuals. Reducing disease spread requires two things: limiting contacts of infected individuals via physical distancing and other measures and reducing the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. Given the current shortages of medical masks, we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory particles become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask wearing by infectious people (“source control”) with benefits at the population level, rather than only mask wearing by susceptible people, such as health care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.

The rest of the article gives details of the supporting research. Basically mask wearing is a good thing we can do for other people, and a useful precaution for ourselves.

[canpakes]

The rest of the article gives details of the supporting research. Basically mask wearing is a good thing we can do for other people, and a useful precaution for ourselves.

Studies seem consistent in this regard.

From: https://www.cureus.com/articles/38957-e ... ing-review

Cloth masks have limited inward protection in healthcare settings where viral exposure is high but may be beneficial for outward protection in low-risk settings and use by the general public where no other alternatives to medical masks are available.

[canpakes]

Chap, on your neck of the woods, there still seems to be guidance to use masks to mitigate spread:

The UK’s Scientific Advisory Group for Emergencies (SAGE) is considering this. In a recent paper that focused on physical distancing and face coverings in light of the UK variant B.1.1.7, SAGE said “using face coverings in a wider range of settings where people could be asymptomatic and may be in close proximity (less than 2 m)” should now be considered.

https://www.bmj.com/content/372/bmj.n432

I get that masks are a bit of a pain, but it strikes me as odd how some folks seem so unable to deal with them. Gawd help ‘em should they have to deal with any actual inconvenience.

[Chap]

It's interesting to follow this aspect of the pandemic:

In Utah, hospitals swell with unvaccinated COVID-19 patients

Reuters, 27 July


A key point:

Of 247 deaths in Salt Lake County from the beginning of this year through July 9, 99% were among unvaccinated people, said Ilene Risk, the county's top epidemiologist. Transmission in the county is particularly high in zip codes where fewer people are vaccinated.

Of course Utah may be an exception? Maybe Mormons react differently. But somehow I doubt it.

July 27 (Reuters) - The COVID-19 intensive care unit where nurse Janine Roberts works in a Salt Lake City suburb is once again full, with patients who are mostly young, mostly unvaccinated and very ill.

They arrive in the unit at Intermountain Medical Center in Murray, Utah, already intubated and unconscious, in many cases stricken by the Delta variant of the coronavirus blazing through unvaccinated communities across the United States.

"We have people in their 20s, 30s, even 40s who are so desperately sick, and we're seeing all patients who are unvaccinated," Roberts said. "It's this new terrain."

Healthcare providers like Roberts had expected the rollout of COVID-19 vaccines to curb hospitalizations. But just 45% of Utah residents are fully vaccinated against COVID-19, and their vulnerability is fueling a surge in the virus, state data shows.

Utah's intensive care units were 84% full on July 22, and COVID patients made up about a quarter of the population. By comparison, the units were 59% full on April 19, and only 11% of those patients had COVID, state data shows.

The quick rise in coronavirus transmission and hospitalization in Utah and many other states serves as a reminder that the country is still in the throes of a deadly disease, even as signs of pre-pandemic life have returned with people flocking back to restaurants, concerts and summer camps.

The Delta variant is far more contagious than earlier versions of the coronavirus, enabling it to pass quickly among unvaccinated people, many of whom are young adults. Its fast spread has quickly overwhelmed health systems in the United States, which in previous surges led to less effective care and more deaths.

To make room for COVID-19 patients, the University of Utah Hospital in Salt Lake City has begun postponing non-essential surgeries, said Dr. Kencee Graves, its associate chief medical officer.

The hospital's total COVID case load is lower than last winter, she said, but tight staffing and an influx of non-COVID cases have left it just as strained.

The unwillingness of so many people to get vaccinated adds to the frustration, she said.

"Caring for someone during the first surge, when this was not a wholly preventable illness was one thing," Graves said. "Now this is totally preventable. It's demoralizing."

STATE LIMITS RESTRICTIONS

Of 247 deaths in Salt Lake County from the beginning of this year through July 9, 99% were among unvaccinated people, said Ilene Risk, the county's top epidemiologist. Transmission in the county is particularly high in zip codes where fewer people are vaccinated.

Utah's Republican-controlled legislature has banned local jurisdictions from imposing COVID-19-related restrictions, leaving public health officials no way to slow the spread of infection, said Dr. Todd Vento, an infectious disease specialist with Intermountain Healthcare, a large healthcare provider.

Local school districts are also banned from requiring children and teachers to wear masks.

"You're just watching it like a train crash in slow motion," he said.

Vento said one of his patients who refused to get vaccinated died from the virus, leaving behind a spouse and young children.

Hospital admissions among children have jumped in recent weeks, said Dr. Andrew Pavia, a pediatrician in the Salt Lake City area. Unlike prior surges, many do not have underlying conditions to make them more vulnerable to COVID, he said.

While speaking with a reporter late last week, Pavia's cellphone beeped with a text message from colleagues telling him that an 11-month-old infant in a part of the state with low vaccination rates had been admitted and put on oxygen.

Nancy Foster, vice president of the American Hospital Association, said wards throughout the country are crowded with COVID-19 patients as well as people who put off care during the pandemic. Doctors and nurses have left hospital jobs for other work, and providers who might have been willing to travel to help out in hard-hit areas are needed at home, she said.

"After 18 months of COVID, health care workers who have given so much of themselves to care for people are exhausted," she said. "They are burned out."

The Utah Nurses Association is developing online stress management classes to help caregivers cope, said Executive Director Liz Close.

At Intermountain Medical Center, Roberts said she and some of her team think about quitting daily.

"I’ve had so many people coming to me saying, 'This is so, so hard,'" she said.

The nice gestures people did for healthcare providers early in the pandemic - help with laundry or a free meal - have stopped. Some patient's relatives, particularly those whose political beliefs have led them to reject COVID vaccines and doubt the medical establishment, can be unkind, she said.

Too late, some people have come to the realization that they or their family members should have gotten vaccinated. Roberts said the hospital received one letter from a COVID-19 patient who eventually recovered enough to be sent home.

In it, the patient wrote: "I wish I could take back everything I believed and everything I said about this."

Oh, and that Wachter guy?

https://Twitter.com/Bob_Wachter/status/ ... 7926133761

Bob Wachter
@Bob_Wachter
Replying to
@Bob_Wachter
I don’t have the vaccinated/unvaxxed breakdown for today's census, but it’s been running >90% unvaxxed in recent wks. When we do see vaccinated patients in the hospital, many are immunocompromised (a group in which vaccine’s effect is attenuated – we need a new approach). (6/20)
6:30 am · 26 Jul 2021·Twitter Web App

Bob Wachter
@Bob_Wachter
Replying to
@Bob_Wachter
In April, I wrote
@washingtonpost
that “this is the most dangerous moment to be unvaccinated.” https://washingtonpost.com/opinions/202 ... accinated/….
I was wrong – now is even MORE dangerous since Delta has taken over, caution's been thrown to the wind, and there’s far more virus around. (8/20)

Opinion | This is the most dangerous moment to be unvaccinated
Now is not the time to let our guard down.
washingtonpost.com
6:30 am · 26 Jul 2021·Twitter Web App

[Doctor Steuss]

Masks didn't work. They do not work. Go get one of those fake Cuban cigars and blow smoke through any of the masks you all think are working. Let me know if you puke into the mask because the smoke could not escape. I will be here waiting.

When it comes to limiting virion spread from upper respiratory shedding, they are actually really effective at infection mitigation. By no means 100% effective (or even 90% for that matter), but the efficacy is high enough to warrant their use. This is a basic tenet of infection control in hospital settings. Outside of an N95, you are most definitely not going to do much good against preventing being infected by a bioaerosol. And even with an appropriate mask, it has to be specifically fitted to your face.** The key is to mitigate transmission prior to droplet evaporation. The verifiable goal is to prevent virion-containing droplets from evaporating.

If you walk the corridors of a hospital, you're likely to see color-coded "flags" or cards outside of rooms. These act as a warning to hospital staff of various protocols for that particular patient (most common are allergen and infection control). Almost all patients on immunosuppressive therapies will require others to wear a mask when entering their room.

Many things we encounter in the world are "safety theater" (TSA, anyone?). Masks and their prevention of certain virion that have transmission dependent on droplet load is one of those things that isn't safety theater.

There has only been a small amount of research so far on size distribution of virus laden droplets when it comes to SARS-CoV-2, but there has been quite a bit on influenza over the past few decades. While the actual virion load per um is still not exactly ironed out, what has been fairly well studied, and would apply across all icky-ickies that depend on droplets for transmission -- the bigger the droplet, the larger the virion load. Incidentally, the bigger the droplet, the more likely it is to be trapped by a mask. It only takes a few seconds for a virion containing droplet to lose about 50% of its size. Using the influenza models, when it comes to droplets that are 60 um or less, you’re looking at a 99.9% probability that there are no nasties in there.

All that being said, a higher thread-count, and multiple layers are preferable. An 80 TPI single-layer mask is going to have downwards of 5% efficacy at stopping the iddy-biddies. Now 5% is better than 0%, and the 80 TPI single-layer mask is still going to stop some of the largest droplets, but it’s best to go with as tight a knit, and as many layers, as you can comfortably tolerate.

To use a kind of counter-example of blowing smoke through a cloth mask, that someone can try at home: Sneeze on a window screen.

** The mask fitting test by infection control coordinators for new hospital medical staff is pretty cool (and tasty). The person being fitted puts on a mask, and then has a big plastic hood put over their noggin'. A fine mist of sucrose is then sprayed into the hood. If the person can taste the sugary goodness, then they have to try a different mask size and/or brand until one is found the keeps them from getting the nom-noms. Doing these delicious fittings for newly hired doctors and nurses is one of the things I miss about my old profession.

[Doctor Steuss]

Bob Wachter
@Bob_Wachter
Replying to
@Bob_Wachter
Given this vax rate, it shouldn’t surprise that 83% (77/93) of our July cases are in vaccinated folks. This DOESN’T mean vax isn't working – calculated efficacy from these data is 82%. We’d expect 422 cases in our vaccinated population, not 77, if the vaccine didn’t work. (14/20)

It's worth noting that the only 3% of the population group that Dr. Wacther is referencing are unvaccinated (in other words, 3% of the population makes up 17% of cases).

ETA. Hopefully we will see more effective vaccines down the road... or at the very least, more effective at preventing serious illness and hospitalization.

[Chap]

Here's the thread.

It's about cases in a highly vaccinated population of employees and students - 32,550 vaccinated, 1,234 not.

So surprise - there are vaccinated people who get ill! But as he says, many fewer than there would have been if those people had not been vaccinated. This is NOT the general US population. Amongst them, it appears that the sick are still overwhelmingly unvaccinated. Surprise!

https://Twitter.com/Bob_Wachter/status/ ... 1515670531

Bob Wachter
@Bob_Wachter
Replying to
@Bob_Wachter
My interpretation: the risk of getting Covid is related to your vax status, whether you're taking steps to lower risk (masking, etc), & whether you’re exposed to the virus. Even in highly vaccinated SF, the odds of being exposed have gone up ~ 20-fold since June 1. (12/20)



Bob Wachter
@Bob_Wachter
Replying to
@Bob_Wachter
The point's been made that, if everybody’s vaccinated, all infections will be in vaccinated people (even if vax efficacy stays high). Among
@UCSF
students/employees, we’re not at 100% but we’re close: 32,550 of our 35,018 people (93%) are vaccinated. (Mandate starts 9/1.) (13/20)
6:30 am · 26 Jul 2021·Twitter Web App



Bob Wachter
@Bob_Wachter
Replying to
@Bob_Wachter
Given this vax rate, it shouldn’t surprise that 83% (77/93) of our July cases are in vaccinated folks. This DOESN’T mean vax isn't working – calculated efficacy from these data is 82%. We’d expect 422 cases in our vaccinated population, not 77, if the vaccine didn’t work. (14/20)
Image
6:30 am · 26 Jul 2021·Twitter Web App