January 9, 20214 yr 3 hours ago, NYEagle said: Ok.....day like 10'ish.....about 80% to 85% back to normal....still stuffy like having a cold, but aches gone, breathing fine, still slight tightness in chest.....but the one major thing I'm still fighting is fatigue....it hits me and I'm like yeah.....I can go to sleep right now. Of course when it's 1pm and I'm on a conference call that makes it tough!! Think though I'm through the majority of the crap though. Glad to hear you’re feeling better. Stay strong!
January 9, 20214 yr 13 hours ago, NYEagle said: Ok.....day like 10'ish.....about 80% to 85% back to normal....still stuffy like having a cold, but aches gone, breathing fine, still slight tightness in chest.....but the one major thing I'm still fighting is fatigue....it hits me and I'm like yeah.....I can go to sleep right now. Of course when it's 1pm and I'm on a conference call that makes it tough!! Think though I'm through the majority of the crap though. Stay with it. Some people take some weeks but they slowly get there. Sounds like that is your path.
January 9, 20214 yr 2 hours ago, DrPhilly said: Stay with it. Some people take some weeks but they slowly get there. Sounds like that is your path. Just did 25 minutes on the eliptical (Max Trainer).........want to start building back up, definitely was breathing heavier than normal but nothing too bad. Still feeling tired, still have that stuffy cold feeling in the head. Do not have severe headache and body aches which I had when this started. So here is a question, when is it safe to be around others in public. I do not want to give this to anyone but it's been 14 days. If I understand correctly, I am ok to go out in public? But of course, I would still wear a mask (which I always did except for f'ing Christmas with the family)....
January 10, 20214 yr Just found out My niece tested positive on Wednesday. She took a second test today to be sure and that was positive as well. I saw her for all of 5 minutes last Sunday. She was tested the Friday before I saw her and was negative. My brother and sister in law are negative. Nobody has any symptoms. I’m not overly concerned that I contracted it but will probably go get a rapid test tomorrow to be sure I didn’t bring it home. My dad was also around her and tested negative today. They aren’t sure where she got it but most likely at work.
January 10, 20214 yr Been behind on the updates: Here was last weeks 1/3/21 Update https://www.nothingbutthetruthmd.com/2021/01/1321-covid-19-update.html Distribution 1. phenomenal technology developments 2. brilliant hard working scientists 3. federal monetary support for research and development 4. manufacturing of millions of doses before final approval by the FDA 5. months of prodding by the federal government for the states to develop their own distribution based on their own perceived needs and priorities Steps one through four, phenomenally successful, step five, not so much. Beginning January 21st, the new administration plans to administer 100 million doses in one hundred days. Where will they obtain the 100 million doses from? Sounds great though. Press reports talk of the need for increased federal funds to help distribution efforts. In Pennsylvania, I know of no county volunteer medical reserve corp that has been asked to participate in vaccinations. We frequently train to give out medications to masses of the public. They are offering to "train" nurses to give vaccinations????? Seriously, what nurse has to be trained to give a shot. Giving or getting this vaccination is no different than any other shot or vaccination. The Pennsylvania Public Health department spent lots of money and wasted weeks of time preparing the Liacouras center to take care of overflow covid patients in the early summer. Nurses were paid to sit around with nothing to do. If they took care of 20 patients that would be a lot. (they had the capacity to care for as many as 200 patients at a time) Confusion and lack of communication were the orders of the day. (much as we are witnessing today) Lots of funds were spent preparing other centers that never saw even a single patient. What was the plan? Was prioritizing vaccination of addicts part of the New York State plan or did the governor just make that up on the fly? Did long term health care residents suddenly become hard to find? Did the Public Health Department not know the exact numbers and locations of these folks? What was the plan? Where is the accountability? Why does it seem like vaccinating long term care residents did not occur simultaneously with vaccinating healthcare workers? Two different work forces are being utilized for the vaccinations, neither dependent on the other. The incompetence at the state level makes anything at the Federal level look amateurish!! I cannot tell you accurately how many doses of vaccine the US actually has or when they might get more. Currently the federal government has allotted 12 million doses to the states. The allotment to each state represents about 2.7% to as high as 5% of each states total population. The federal government forwards doses to the states as they request them. Currently, states have drawn anywhere from 27% to as high as 50% of their allotments. I do believe that the decision to allow the states to make their own plans and prioritize distribution in their own way was the correct decision. Each state health department should know better, the needs of their citizens, and the impact of disease burden in their own borders. ANTIBODY STATUS AND INCIDENCE OF SARS-CoV-2 INFECTION IN HEALTHCARE WORKERS S. Lumley NEJM, 12-23-20 Evidence of post-infection immunity is emerging. With 76 million people having been infected worldwide and on going transmission, reported reinfection has been very rare, occurring mostly in cases where the primary infection was mild or asymptomatic. In a prospective study of healthcare workers was performed to assess the relative incidence of subsequent positive SARS-CoV-2 PCR tests and symptomatic infection in individuals who were seropositive and seronegative for SARS-CoV-2 at the initiation of the study. Healthcare workers at the Oxford University Hospital system were tested between the dates of 4/23/20 and 11/30/20. An ELISA platform was used for antibody testing against the spike IgG antibody and the antinucleoplamid IgG antibody. Both antibody positive and antibody negative patients were followed. During the follow up period a PCR test was considered positive only if 60 days had elapsed since a previous positive PCR had been obtained. This precaution, to rule out the possibility of a positive test from remnant circulating RNA protein as opposed to current viral infection. Of the 12,541 healthcare workers followed, 11,364 were antibody negative at the time of enrollment into the study (90.6%), 1177 were antibody positive. (9.4%) Of the seronegative group, 24 patients had had prior positive PCR tests. This means they either failed to seroconvert or their antibody levels became undetectable in the interim from infection until entry into the study. In the United Kingdom 3.7% of the population has tested positive for SARS-CoV-2. Given the observation that a percentage of known infections never produce antibodies, we can assume that a higher percentage than 9.4% of the healthcare workers tested for antibody had actually been infected. Of this group, 68% had symptomatic infections. Healthcare workers in the United Kingdom appear to have been infected at a much higher rate than the population at large. This does not seem to have been the case in the US. This might be explained by the initial approach to SARS-CoV-2 in the United Kingdom which was to avoid mitigation and accomplish herd immunity. Since healthcare workers were more frequently exposed to covid positive individuals it stands to reason that without PPE they became infected more frequently. During the study 88 healthcare workers who had been seronegative became seropositive. Of the patients who were seropositive on entry into the study,, two developed positive PCR tests during follow-up, which represents true reinfection. The time from initial seropositivity to new positive PCR tests ranged from 160 to 199 days. This study suggests that previous infection with seroconversion is associated with protection from reinfection for the vast majority of people for at least six months. QUARANTINE TIME AFTER EXPOSUTRE TO AN INDEX PATIENT Recently the CDC suggested a revision in the quarantine time after exposure to an index patient in the family household, from 14 days down to seven days. In an investigation recently reported by the CDC, among household members who were exposed to an index patient living in the house, who were asymptomatic for seven days and had negative PCR tests at day seven, 17% went on to experience symptoms or tested positive in the second week. NUMBERS DEATHS - 350,215, an increase of 18,140 in the last seven days, the previous seven days had an increase of 15,551 CASE FATALITY RATE - remains unchanged NEW WEEKLY CASES - up 7.5% for the week, same as the week prior HOSPITAL BED UTILIZATION - 123,614, up from 117,344 Some hospitals in California have run out of traditional beds and are using tents in parking lots, cafeterias, and conference rooms to house patients. I am hoping that 2021 will be new and improved. I dislike complaining, things could always be worse, but this was a challenging year for many. There may be challenges to meet in the coming year but hopefully Covid 19 will diminish in importance as the year goes on and increasing numbers of vaccinations are administered. If you made a wish for the New Year I hope it comes true for you. Live safer Be Well
January 10, 20214 yr And today's update: 1/10/21 DISTRIBUTION Much of the critique on the progress, or lack thereof, for getting vaccine into the arms of people is pure conjecture. Some better informed than others. It is irrelevant whether the US is doing better than most countries in getting vaccines administered if we are not meeting our own expectations. Were our expectations realistic? I read repeatedly of a goal to get 20 million "vaccinated" by the beginning of January. Come and gone. Did that mean 20 million shots or 20 million people "vaccinated". If we are talking about 20 million "vaccinated", with vaccinated being two doses per person, I don't believe that the US is in possession of 40 million doses currently. As of Wednesday January sixth, according to the Bloomberg Vaccine tracker, 5.46 million individuals had received a shot. (representing 1/3 of the worlds total distribution of vaccines) As of January, people started receiving their second shot. Between the fifth and the sixth, about 400,000 people were "vaccinated". Between the sixth and the seventh, 760,000 were vaccinated. Between the seventh and eight, 800,00 were vaccinated. On the ninth 680,000 doses were given shots. It is encouraging to see that we are making progress in increasing the numbers getting shots. According to the Bloomberg tracker, the US currently has distributed 22.2 doses to the states. That will "vaccinate" 11.1 million people. The US has made arrangements to purchase 1 billion doses of vaccine by the end of 2021. 400 million mRNA vaccines and 300 million vector vaccines. (and others yet approved) The question of when these doses will be delivered remains unanswered. I read that Pfizer (their statement) has contracted to deliver 70 million doses by June 1, 2021, and 30 million more by July 1, 2021. Pfizer has contracted to deliver 200 million doses to the US during 2021. Moderna, a similar amount. Moderna had to destroy 400,000 doses for improper storage. Could we have done better? Should we have done better? Ford has been building cars for over 116 years, can they build a better one? If we have only 23 million doses of vaccine available currently (and no more until March) does it really matter whether we distribute these by today or next week? CUTTING THE DOSE - DELAYING A SECOND SHOT There is increasing talk from some in the medical community (and now the President elect) of delaying the second shot to get more people vaccinated. I offer some questions to those who are proposing this. 1. Where is the science to support this? Two Presidents in a row seem to have a proclivity for making their own science. 2. We know the efficacy of two shots is 95%. What is the efficacy of a single shot? (would the FDA have approved a single shot of mRNA vaccine) 3. What is the duration of immunity with only a single shot of the vaccine? Surely it will be shorter than that provided by two shots. The half life of the antibodies will be the same but data released by both companies shows that antibody titers are much lower after a single injection than after the second, booster shot, thus shorter duration of immunity. 4. Will we need to "re-dose" these single shoters? If so, when? Where will the vaccine supply come from? Who will do the studies? 5. An altered vaccination schedule (one shot) will result in exposing circulating virus to lower levels of antibody which could lead to evolutionary selection of variants able to bypass these antibodies. (more about viral evolution in the presentation by Dr. Lauring - see below) 6.. The President elect talks about ramping up production. Both companies (Moderna/Pfizer) have previously stated (on multiple occasions) that they are working at maximum production for 2021. I know of two physicians who contracted Covid after vaccination. One at four days after his first shot and he got pretty sick, one at seven days after his first shot and he was very symptomatic. Did they contract the new strain? There have been over 6 million people who have been vaccinated and had a three week interval waiting for their second shot. How many of them contracted Covid during that interval? How many of the Covid infections were the new strain? In the last three weeks about 1.4% of the adult population in the US has contracted Covid. Based on those numbers, out of a cohort of 6 million people (the number who received their first shot) we would have expected 84,000 new cases of Covid. How many did we actually get? How many of the new infections were the new strain? THESE ARE QUESTIONS THAT MUST BE ANSWERED BEFORE WE START ALTERING THE SCIENCE OF VACCINATION!! NOW, WHEN WE MAY NEED OUR MOST ROBUST ANTIBODY RESPONSE TO DEAL WITH A NEW STRAIN, IS NOT THE TIME TO DECREASE OUR ANTIBODY RESPONSE BY GIVING ONLY ONE SHOT. IMMUNOLOGIC MEMORY TO SARS-CoV-2 ASSESSED FOR UP TO 8 MONTHS AFTER INFECTION Science, 1-6-21 J.M. Dan, et al In response to SARS-CoV-2 infection humans manufacture specific antibodies , CD4T cells, CD8T cells and memory B cells. Cellular immunity functions in primary control of infection where as neutralizing antibodies seem to be associated with protection against secondary infection. Primary transfer of antibody in advance of inoculation effectively limits respiratory infection and symptomatic disease in animals. Passive transfer after inoculation demonstrates decreased efficiency in combating infection and probably explains the lack of efficacy of antiviral treatments that were initiated after day 10 in humans. Understanding immune memory necessitates evaluation of the components of the immune response both cellular and humoral. In this study 188 patients from the US were investigated who had recovered from Covid-19 infection and were subsequently followed up for 8 months. Clinical presentation ranged from asymptomatic to severe disease. 97% were symptomatic (this is high compared to the general public), 93% were never hospitalized. 43 samples were studied beyond 6 months post symptomatic onset (PSO) 51 patients provided multiple samples. An ELISA platform was utilized for assay. Seroconversion occurred in 90% of the patients IgG spike, nucleocapsid and receptor binding (RBD) were measured IgG spike titers ere relatively stable with apparent 1/2 life of 140 days IgG nucleocapsid had apparent 1/2 life of 68 days IgG RBD had apparent half life of 83 days Spike specific memory B cells had no apparent 1/2 life, consistent with life long immunity RBD memory B cells showed similar kinetics CD8T cells had apparent 1/2 life of between 125 to 225 days CD4T cells had apparent 1/2 life between 93 and 153 days Antibodies are the only component of the immune memory response active against a respiratory challenge of viral load. Titer levels of 200 and 3400 are effective in high and very high viral loads in non-human primates The immune response could be completely sterilizing preventing infection or could result in reduced entry resulting in symptoms consistent with a common cold. The likelihood of T and B cells entering the battle is closely tied to the kinetics of infection. Memory T and B cells require 3 to 5 days to respond successfully to infection. Fortunately Covid-19 has a relatively slow onset of severe disease in humans with a median time of 19 days in fatal cases. At the the present time we do not know what the minimum antibody level for sterilization or protection needs to be. Determining this level will be hugely important because it will allow us to predict immunity based on known antibody kinetics (1/2 lives) It does appear that the cellular immune response will be relatively prolonged suggesting that severe disease after immunization or after primary infection will be uncommon. This study is small but it adds to other small studies that suggest that humoral immunity will last at least six months. UNDERSTANDING SARS-CoV-2 GENETIC VARIATION JAMA LEARNING NETWORK Adam Lauring, MD, PhD University of Michigan Division of Infectious Disease and Departments of Microbiology and Immunology If you haven't had your coffee yet, now would be a good time!! Coronavirus is an RNA virus. Most RNA virus have genomes of 10,000 to 15,000 bases, but Coronavirus has up to 30,000 bases. In general, they have a lower mutation rate and there are four or five coronavirus that cause only common cold like symptoms. Viral Fitness is an especially important concept when it comes to mutation (has nothing to do with cardio-workouts) There are three components to viral fitness: 1. how well the virus exists in a host 2. how well the virus spreads between hosts 3. how well the virus does between hosts Mutation refers to a single change in a genetic sequence, or a single amino acid change which can change coding potential Variant - refers to a virus that has several or multiple mutations Strain - refers to a variant with a phenotypic difference, that is, it performs one of the three components different than the ancestral virus. These differences could lead to increased transmissibility, virulence or survivability (ability to avoid antibody) There have been several mutations already of the ancestral SARS-CoV-2 virus. We know that it probably entered the US back in October and caused minimal if any symptoms. What we are seeing is not unlike the 1918 Pandemic that had several strains resulting in greater virulence and then ultimately lesser virulence. The most recent new strains were recognized in the UK in September and now are recognized in multiple countries. In the UK B117 now accounts for the majority of their new cases of Covid. N501Y - which is rapidly spreading in South Africa These two strains are doing something differently in one or more of the components of viral fitness resulting in enhanced transmission. They may be multiplying faster in the host making the host more contagious. They may be adhering to the H2 receptor better (or maybe a new receptor) gaining entrance to the host better. They may be existing outside the host better remaining in the air or on objects longer. The UK has a very robust sequencing program, about 10% of their samples are sequenced which probably allowed them to recognize this new strain earlier than the US which sequences only about 0.5% of its samples. It is possible that this new strain has been here for some time and partially accounts for the tremendous increase in cases since September. So far these changes have only resulted in increased transmission as opposed to increased virulence. The author is optimistic (but does not know) that these changes will not change the effectiveness of the vaccines. It is hard for a virus to figure out how to get around a polyclonal (our immune system makes multiple different antibodies), multifaceted response across multiple individuals (who each have a unique response) who are going to target the spike protein in different ways which makes it harder for the virus without compromising what it likes to do, and that is target the spike protein and bind to the H2 receptor and trigger a rearrangement of protein in the cell. Also, the platform used to produce the mRNA vaccine allows for more rapid manipulation of the vaccine than ever before if it becomes necessary. Dr. Lauring stresses that until such time as more are vaccinated, in the face of a potentially more transmissible virus, physical distancing and masks are even more important. Unfortunately that has not been our strong point. "The test of a society is whether it can submerge its differences in the pursuit of common objectives, and whether it can keep in mind that society thrives on their reconciliations, not on their conflicts." (Kissinger 1994) We are not doing so well on this test. NUMBERS CASE FATALITY RATE - no change DEATHS -372,152 (21,937 in the last seven days) NEW WEEKLY CASES - increased 8.3% up from 7.5% for the past two weeks (1,673,641 new cases in the last week) HOSPITAL BED UTILIZATION - 130,777 ( up from 123,614 a week ago) Live safer Be well
January 10, 20214 yr I know of two physicians who contracted Covid after vaccination. One at four days after his first shot and he got pretty sick, one at seven days after his first shot and he was very symptomatic. Did they contract the new strain? Doesn’t it take time for vaccines to build antibodies ? Also vaccines won’t stop you from getting COVID just reduce symptoms ?
January 10, 20214 yr 28 minutes ago, Talkingbirds said: I know of two physicians who contracted Covid after vaccination. One at four days after his first shot and he got pretty sick, one at seven days after his first shot and he was very symptomatic. Did they contract the new strain? Doesn’t it take time for vaccines to build antibodies ? Also vaccines won’t stop you from getting COVID just reduce symptoms ? Quote It typically takes a few weeks for the body to build immunity after vaccination. That means it's possible a person could be infected with the virus that causes COVID-19 just before or just after vaccination and get sick. This is because the vaccine has not had enough time to provide protection. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fvaccines%2Fvaccine-benefits%2Ffacts.html #Facts
January 10, 20214 yr 7 hours ago, Talkingbirds said: I know of two physicians who contracted Covid after vaccination. One at four days after his first shot and he got pretty sick, one at seven days after his first shot and he was very symptomatic. Did they contract the new strain? Doesn’t it take time for vaccines to build antibodies ? Also vaccines won’t stop you from getting COVID just reduce symptoms ? Yes it takes time to build up antibody protection. I think he was just asking the question rhetorically. We don’t know yet if the vaccines prevent infection in addition to preventing illness. we should have data on that relatively soon. It would make sense that the vaccines result in at least SOME reduced chance of infection.
January 10, 20214 yr Still a bit fatigued/tired at points in the day, still am really stuffy in the mornings (head), still slight tightness in upper back area....but again, did 30 minutes on the Elliptical today but definitely would like to get back to 100%. I'd still say I'm at like 85%......more annoying at this point......
January 10, 20214 yr 10 hours ago, Talkingbirds said: Doesn’t it take time for vaccines to build antibodies ? Yep. The "95% effectiveness" mark comes 2 weeks after a the second shot. Efficacy between then isn't fully known but it's certainly a lot less, and physicians are at high risk of exposure. The vaccine uses your body's own immune system to build memory cells against COVID and that takes time. 10 hours ago, Talkingbirds said: Also vaccines won’t stop you from getting COVID just reduce symptoms ? Very unlikely. This gets brought up from time to time because it hasn't been studied yet so they can't say "no" definitively. However in order to catch then be able to spread COVID it needs to enter your body and replicate to make a sufficient number virus copies in your body (aka "viral load"). Viral load also correlates with symptoms usually. The vaccine makes it so your body recognizes and kills off the virus quickly because it already has cellular "memory" of the virus. So it would be very unlikely to be able to catch and spread COVID still without symptoms. Now that's not 100% obviously, but with enough people immunized it makes the risk much much lower.
January 11, 20214 yr New Zealand is covid free folks. This is what a plan looks like and how it works when people care about others and not just themselves. https://www-bbc-com.cdn.ampproject.org/c/s/www.bbc.com/news/amp/world-asia-52961539
January 11, 20214 yr 34 minutes ago, DBW said: New Zealand is covid free folks. This is what a plan looks like and how it works when people care about others and not just themselves. https://www-bbc-com.cdn.ampproject.org/c/s/www.bbc.com/news/amp/world-asia-52961539 That article is from June.
January 11, 20214 yr 2 hours ago, DBW said: New Zealand is covid free folks. This is what a plan looks like and how it works when people care about others and not just themselves. https://www-bbc-com.cdn.ampproject.org/c/s/www.bbc.com/news/amp/world-asia-52961539 2 hours ago, mikemack8 said: That article is from June.
January 11, 20214 yr 6 minutes ago, SNOORDA said: Are they still covid free? Free? No But very, very low. Yesterday was their worst day since the initial spike at 31 new cases https://www.worldometers.info/coronavirus/country/new-zealand/ Also note, it's summer there.
January 11, 20214 yr 5 minutes ago, SNOORDA said: Are they still covid free? No - I mean they only have like 2200 cases but they just reported a few new ones either yesterday or today.
January 11, 20214 yr 12 minutes ago, paco said: Oops 😂 2 hours ago, mikemack8 said: That article is from June. Ah crap I missed that. I popped up on LinkedIn like it was a new thing
January 11, 20214 yr 2 minutes ago, DBW said: Oops 😂 Ah crap I missed that. I popped up on LinkedIn like it was a new thing Not a big deal - they've still done an amazing job with it. Granted - their population is less than NYC on a much larger area
January 11, 20214 yr 1 hour ago, DEagle7 said: Second dose done. Wife was totally wiped the day after hers so we'll see. Wishing her well!! She’s a trooper!!
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