Coronavirus

[thrill]

I got my moderna booster and flu shot in one sitting. Rocking bandaids on both shoulders. Nothing can stop me now.

[AWvsCBsteeeerike3]

@GeddyWrox It'll be interesting to see what unfolds. When looking at new variants, there are always 3 big questions to answer. 1. Is it more transmissible? 2. Is it more severe/lead to more severe cases? 3. Does it evade the immune response (either vax or natural)?

I think wrt 1, you can probably say yes even at this early time. Given the prevalence of delta, any variant that is being seen en masse such as omicron is almost assuredly more transmissible than delta. Though, i reserve the right to change this as more data become available

Regarding 2, I've seen accounts from other S Africa doctors saying they're seeing more 20 and 30 year olds end up in the ICU. Dr. Coetzee seems to be the authoritative voice at this point, but, again without more data, it's tough to make a judgement.

Regarding 3, there are a lot of mutations to the spike protein, so...who knows. Certainly too early to make a judgement still.

Only time will tell.

All that said, it does seem, and I still think, the end result is a virus that circulates continuously, like the flu or other common colds, and we establish enough immunity that even with the spread of the virus, the severity of infections reduces and the number of deaths tail off. Of course, what that number is is still wildly variable. It could be similar to the flu, or the common cold, or better, or worse.

[G. Keenan]

So we have another new variant of concern now. UGH.

This things is testing humanity something fierce! Will it ever end?

No

It will end in the sense that we psychologically accept Sars Cov 2 as just another of the gazillion things floating around out there that can make you sick or kill you. The virus will become endemic, always mutating as viruses do, and every year there will be a new Covid shot tailored as best we can to that year's predominant strains. This, combined with improved post-infection therapies, will turn it into another seasonal flu killing a similar amount of people every year. We stop thinking about it just like we don't think about the odds of a car accident every time we run an errand.

If it weren't for the stress it puts on healthcare workers, I'd say just stop with the testing and tracing and masking and travel bans. What's the point? None of that is going to eliminate the virus. The vaccines will save your life for all but the weakest in the herd, like always. If you have access to them but don't want them because you're a "free thinker," that's your choice. Good luck to you. (not you, AW, just people in general).

But we aren't quite there yet since the pool of unvaccinated/uninfected is still large enough to allow new infections to quickly overwhelm hospitals and the whole healthcare system . . . so still we mask and go through these performative travel bans that let politicians look like they are doing something helpful, even though the horses are long out of the barn. "I closed that barn door as soon as I heard the horses had run away! Kudos to me."

[AWvsCBsteeeerike3]

@GeddyWrox It'll be interesting to see what unfolds. When looking at new variants, there are always 3 big questions to answer. 1. Is it more transmissible? 2. Is it more severe/lead to more severe cases? 3. Does it evade the immune response (either vax or natural)?

I think wrt 1, you can probably say yes even at this early time. Given the prevalence of delta, any variant that is being seen en masse such as omicron is almost assuredly more transmissible than delta. Though, i reserve the right to change this as more data become available

Regarding 2, I've seen accounts from other S Africa doctors saying they're seeing more 20 and 30 year olds end up in the ICU. Dr. Coetzee seems to be the authoritative voice at this point, but, again without more data, it's tough to make a judgement.

Regarding 3, there are a lot of mutations to the spike protein, so...who knows. Certainly too early to make a judgement still.

I'll just go ahead and quote myself since it's basically the tl;dw. Here's a more in depth look at the answers to those 3 questions above. The short answers are 1) almost certainly, 2) still need data, not likely a variant would become a lot more deadly but need more data, and 3) need more data, but shouldn't rely only on antibodies because can't ignore t-cells and natural killer cells. Antibody efficacy will be decreased by some amount but the t-cells/nk cells could still prevent the worst case scenarios even if a decline in antibody efficacy. Antibody neutralizing ability should be known in a couple weeks or so.

[AWvsCBsteeeerike3]

So we have another new variant of concern now. UGH.

This things is testing humanity something fierce! Will it ever end?

No

It will end in the sense that we psychologically accept Sars Cov 2 as just another of the gazillion things floating around out there that can make you sick or kill you. The virus will become endemic, always mutating as viruses do, and every year there will be a new Covid shot tailored as best we can to that year's predominant strains. This, combined with improved post-infection therapies, will turn it into another seasonal flu killing a similar amount of people every year. We stop thinking about it just like we don't think about the odds of a car accident every time we run an errand.

If it weren't for the stress it puts on healthcare workers, I'd say just stop with the testing and tracing and masking and travel bans. What's the point? None of that is going to eliminate the virus. The vaccines will save your life for all but the weakest in the herd, like always. If you have access to them but don't want them because you're a "free thinker," that's your choice. Good luck to you. (not you, AW, just people in general).

But we aren't quite there yet since the pool of unvaccinated/uninfected is still large enough to allow new infections to quickly overwhelm hospitals and the whole healthcare system . . . so still we mask and go through these performative travel bans that let politicians look like they are doing something helpful, even though the horses are long out of the barn. "I closed that barn door as soon as I heard the horses had run away! Kudos to me."

Agreed. At some point, probably about now, most people will stop caring enough to take any preventative measures like masking and distancing and what not. But, the virus, and all the mutations that are yet to come, are here for the long haul.

I do wonder what the longterm implications are for the healthcare system. On the one hand, covid is a +1 so you could think well [expletive] every covid hospitalization is an additional hospitalization on the system that wouldn't have been there without covid. And, that's true to an extent. Covid doesn't really decrease car accidents or workplace injuries or [expletive] like that. But it will, almost assuredly year in and year out, prematurely end some peoples' lives, especially in the elderly population, that have comorbidities like heart disease, uncontrolled diabetes, obesity, cancer, etc. If this thing is just going to circulate in perpetuity, which it will, and neither boosters nor natural infections will provide sterilizing immunity, at what point does it thin the herd so to speak that hospitalizations are down overall to the point even an increase in covid hospitalizations is still below the infrastructure threshold. I don't know the answer, just started thinking about it over the weekend. It's a pretty morbid thought, really.

[Arthur Dent]

so still we mask and go through these performative travel bans that let politicians look like they are doing something helpful, even though the horses are long out of the barn. "I closed that barn door as soon as I heard the horses had run away! Kudos to me."

Continuing to pretend we should take measures that everyone hates but on the other hand also don’t work to pretend like we’re doing something while also spreading the conflict over this stuff to the one measure that does work really well is just an awful record all around. We joke about the “I’m doing my own research” crowd, but we’re all doing that because it is in fact totally rational to dismiss a ton of the bad public health communication that has too often substituted bogus ideas about how to manipulate behavior over honest information and remains way too often incredibly technically shoddy. I guess this is what happens when your incentives point to rewarding for mere appearances.

My latest gripe on this front is Austin’s COVID risk stage guidelines. These were based on the rate of new hospital admissions, a totally sensible criteria. But after our Delta wave faded away, it shows near the lowest risk levels recorded, which according to the stage guidelines was supposed to mean relaxed guidance. But the instant it was clear this is where the data pointed, they just added another criteria, so they could say they had a reason not to loosen the guidance, quite obviously because they feel their only real risk is from looking bad by telling people they can let their guard down which could possibly look bad whenever it goes up again. Result: guidance is basically ignored except in totally theatrical and useless ways, and even the local politicians that are supposedly managing this don’t even bother to pretend to follow the rules for their photo ops anymore. Public health advice who’s only purpose is political cover your ass means whatever actually useful content we may want to give out in the future will not be heard by many. And this is supposed to be the good liberal approach to the pandemic.

I guess I still don’t really think this will happen, but my fears are growing that some places will continue to do these annoying and ineffective pandemic theater measures essentially forever like what’s happened with airport security.

[heyzeus]

I was gonna say, AD, we are still taking off our shoes at the airport over a decade after some guy tried and failed to take down a plane with shoe explosives. We're in this for the long haul.

[AWvsCBsteeeerike3]

Some new info from South Africa, viral loads in wastewater is going up, cases are not following suit, as can mostly be seen in the noisy data/graphs in this article:

https://www.dailymaverick.co.za/article ... signposts/

IDK how to post pics anymore, so whatever, just click the link and scroll down. Pay attention the Guateng - Tshwane graphs in particular.

Medcram did a video on this, I halfway paid attention, you can find him on youtube if you want, same channel as the last video I posted.

Anyway, to me and I think the Dr in the video, it's one of a couple scenarios. Actually, hold up, let's talk about wastewater sampling for a second. Not sure how familiar everyone is with sanitary sewer (wastewater aka where your toilets go when you flush it along with shower, sink, dishwasher, washing machine, etc that goes down the drain). This all goes from your house/business through a service line (on your property that you're responsible for, generally speaking) to a main line (in the public Right of Way that the wastewater authority in your region is responsible for, generally speaking) that collects multiple service lines. Mains inevitably intersect and are combined as the vast majority of wastewater is reliant on gravity (has to go downhill) to discharge. So two 8" mains intersect and then become a 12". Two 12" intersect and become an 18". Etc etc etc. All these mains end up in one form or another of a treatment plant before being released. As you can imagine, it's not economical to have multiple treatment plants, so they try to minimize the plants and increase the amount of wastewater treated at each plant.

Okay, that's out of the way. In South Africa - home of omicron- they sample the wastewater (presumably coming into the plant before treatment) and can test for the Sars-Cov-2 viral RNA because people that are infected poop it out. More viral RNA corresponds to more infected people. This of course isn't a perfect method for a multitude of reasons, but it is a decent way to track the amount of virus in a given area. And, in one area in particular (Guateng - Tshwane) they're seeing a significant increase of virus in the wastewater but not necessarily a significant increase in cases. So, either 1) people are getting infected and sick but not tested. 2) people are getting infected but not sick and therefore not tested. or 3) there are anomalies in the data.

Throwing out 3 because there's no indication anything is amiss and two separate collection points and throwing out 1 because it just seems unlikely at this point there are widespread issues with getting tested when sick compared to previous waves in the same location, it leaves option 2. People are infected but not sick. Purely speculative, but also just deductive reason.

Then the question becomes...Why? South Africa has a vaccination rate of about 25%. They have a natural infection rate about average with the world (5% population with confirmed cases) and about 1/3 of America. I don't know what the specific numbers for Guateng -Tshwane are. It would be helpful to have this information. Regardless, you can probably play with numbers and come to a multitude of conclusions. But, it sure seems as if, based on this very preliminary data, omicron isn't making people sick like previous variants did.

This is of course speculative. Wastewater sampling doesn't tell what variant of the virus is detected. So, there's no proof the virus is omicron. It's possible the population in Tshwane is highly vaxxed, the vax prevents symptoms but not infection. Possible, but doesn't seem very likely given the overall vax rate is at 25% in the country. Also possible the population in Tshwane has large numbers of previous infections that are providing protection against symptomatic infections. Again, possible, but certainly not found anywhere in any data that I could find.

All that said, no definitive proof and very prelim data suggests omicron = what @GeddyWrox suggested a couple days ago that omicron doesn't make people as sick.

Should also be noted, I came to a completely different conclusion than the paper did which is a 4th wave of covid is coming and they should enact preventative measures now to minimize it. There are other points of wastewater sampling besides Tshwane which are just starting to see the uptick in viral loads which is why they come to that conclusion. Which makes sense as well. I'm just focused on the one specific area where the viral loads are already at/near previous record highs.

[AWvsCBsteeeerike3]

so still we mask and go through these performative travel bans that let politicians look like they are doing something helpful, even though the horses are long out of the barn. "I closed that barn door as soon as I heard the horses had run away! Kudos to me."

Continuing to pretend we should take measures that everyone hates but on the other hand also don’t work to pretend like we’re doing something while also spreading the conflict over this stuff to the one measure that does work really well is just an awful record all around. We joke about the “I’m doing my own research” crowd, but we’re all doing that because it is in fact totally rational to dismiss a ton of the bad public health communication that has too often substituted bogus ideas about how to manipulate behavior over honest information and remains way too often incredibly technically shoddy. I guess this is what happens when your incentives point to rewarding for mere appearances.

My latest gripe on this front is Austin’s COVID risk stage guidelines. These were based on the rate of new hospital admissions, a totally sensible criteria. But after our Delta wave faded away, it shows near the lowest risk levels recorded, which according to the stage guidelines was supposed to mean relaxed guidance. But the instant it was clear this is where the data pointed, they just added another criteria, so they could say they had a reason not to loosen the guidance, quite obviously because they feel their only real risk is from looking bad by telling people they can let their guard down which could possibly look bad whenever it goes up again. Result: guidance is basically ignored except in totally theatrical and useless ways, and even the local politicians that are supposedly managing this don’t even bother to pretend to follow the rules for their photo ops anymore. Public health advice who’s only purpose is political cover your ass means whatever actually useful content we may want to give out in the future will not be heard by many. And this is supposed to be the good liberal approach to the pandemic.

I guess I still don’t really think this will happen, but my fears are growing that some places will continue to do these annoying and ineffective pandemic theater measures essentially forever like what’s happened with airport security.

It's very annoying to see data manipulated to further political agendas or even good public policy. The Arkansas governor has been banging the 'get vaxxed' drum for almost a year now. Rightfully so. The message is fine. But, as cases go up, the message is 'get vaccinated to protect yourself/others'. When cases go down, the message is 'see vaccines are working, go get yours'. As cases go back up, the message switches back to 'get vaccinated to protect yourself/others'. Rinse. Wash. Repeat. Just seems disingenuous when it's presented like that especially since the rise/fall is an epidemiological certainty when new variants such as delta present themselves.

If it weren't for variants, I'd be all for abandoning most public policies preventing spread of the virus. But...variants are real and I don't get the feeling anyone has a great grasp on what the future holds. That begs the question though, if incessantly worried about future variants that may/may not arise, is there a path forward without the annoying measures? It almost takes a level of apathy about the virus in general that may not ever exist for a certain sector of the population.

[AWvsCBsteeeerike3]

Also, lastly, travel bans need to stop.

The latest travel bans are going to, again, prove that they don't work at preventing spread and only harm countries that are forthright with findings. As you could have guessed last week, omicron was going to make its way to America, and it has with the first community spread case already being found. This has been in europe for weeks already and likely been in America for weeks as well. Not allowing people from South Africa to travel to america is a prime example of hurting people for no real reason. Impose additional requirements if need be, require people to quarantine when arriving if need be. But, banning travel from a handful of certain areas is full stop one of the least effective ways to prevent the spread of the virus. It didn't work with China at the beginning, it hasn't worked throughout the pandemic with italy or spain or france or the uk or whomever and it won't work with South Africa.