Got my vaccine

[ACHiPo]

The incidence of shingles increases with age, but it is also a factor of immune competence. When I treated HIV patients, it was often one of the intial presenting symptoms in an otherwise healthy young individual. Immunity and the immune system is a complex issue, and having had exposure to HZV zoster does not provide prevention of a future recurrence, so it is the reason they recommend vaccination. The risk/incidence vs. cost are a factor in determining the age at which it is recommend. But there are recommendations for other vaccines much earlier such as HPV vaccine. In contrast, exposure to multiple proteins from a virus that may be bound to cells or fragments is more likely to result in autoimmunity and viruses are constantly mutating and finding ways to evade the immune system. The design and delivery of the vaccine, is an evolving science. In this case they seem to have achieved a very high efficacy, how this compares to individuals that have already had COVID remains to be seen. I agree that there is very little information on COVID reinfection, but there are documented cases. In HIV neither the immune system, nor any vaccines to date has been effective in minimizing the development/progression of infection. There is no simple answer.

In medicine there is nothing that is absolute, as I like to say just shades of grey. Ironically there are many treatments that have been approved, that years later the efficacy came into doubt, or long term ramifications were found. Between the Pfizer and Moderna vaccine, there is no clear superior candidate that I see from an efficacy point of view and the current data available, I prefer the latter because I do some consulting for them and feel their science is sound. The same (mRNA) vaccine has been used and is being developed for a numerous other indications, so this is not the first occurence of this technology.

Outstanding summary. Thanks!

 

[MontanaLon]

I wonder about this claim. How does your wife know that More than half of the providers have had the virus? Just curious.

It’s actually not that easy to know unless they were tested (PCR off a swab). Remember there is no usable antibody test. And if somebody were positive then they probably quarantine for two weeks or so if not sick, and then longer of course if sick. I struggle to understand how A tightly integrated system like a hospital doesn’t fall apart if more than half of its providers have to check out for at least two weeks over a span of 6 to 8 months. Something doesn’t make sense in this story.

Disclosure: I am myself a front line healthcare provider and have worked almost exclusively with covid pts in 2020. And yes i was vaccinated in Dec, going for part II in a few days.


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Well, it isn't rocket science. One of the jobs which falls under the wife's job is infection control and emergency operations. Since the beginning they have been monitoring closely the number of infections through testing. At first they only tested symptomatic cases but as the test became more available they went to testing everyone with pt contact twice a week regardless of symptoms or contact. Of course anyone who presents with symptoms can be tested at any time. And the result is that more than 50% of the providers have tested positive over the last 9 months. Of course the number of actual infections is likely higher as they certainly missed some at the start before the mandatory widespread testing who were asymptomatic.

Now, I don't know which hospital you work at but do they not give vacation time to the staff? Because virtually everyone at the hospital here can be expected to be off for 2 weeks every 6-8 months and there is no breakdown of care during any normal year. Now, this was far from a normal year and in fact from March to May there were more people furloughed from the hospital than have been sickened. That coincided with the peak of infections of HCP's so replacing a provider who was infected was as easy as picking up the phone and calling one who had been furloughed. There was never a time when patient care suffered because of the virus. Patient care did take a serious whack when the state suspended all elective procedures in March. And of course the patients themselves cancelled many needed appointments due to not wanting to go to the hospital and get covid.

What is odd is of all the statistics floating around about where people are being infected, hospitals and primary healthcare providers seem to be absent. Anyone can pull up the stats on the county website on what the contact tracing has shown and see that nursing homes, correctional facilities and home seem to be the places where the virus is most often transmitted to another person but healthcare other than nursing homes is left out of the picture.

 

[koenbro]

Well, it isn't rocket science. One of the jobs which falls under the wife's job is infection control and emergency operations. Since the beginning they have been monitoring closely the number of infections through testing. At first they only tested symptomatic cases but as the test became more available they went to testing everyone with pt contact twice a week regardless of symptoms or contact. Of course anyone who presents with symptoms can be tested at any time. And the result is that more than 50% of the providers have tested positive over the last 9 months. Of course the number of actual infections is likely higher as they certainly missed some at the start before the mandatory widespread testing who were asymptomatic.

Thanks for the extra details. It’s a very interesting data set and I hope they will publish it one day in a peer reviewed format.

I remain unconvinced about hospitals being some big source of danger. In fact I think they are some of the safer places you can be due to all the policies and procedures in place. Don’t think people catch covid in hospitals.


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[MontanaLon]

Thanks for the extra details. It’s a very interesting data set and I hope they will publish it one day in a peer reviewed format.

I remain unconvinced about hospitals being some big source of danger. In fact I think they are some of the safer places you can be due to all the policies and procedures in place. Don’t think people catch covid in hospitals.


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Odd, I don't ever recall "policies and procedures" being on the list of things that prevent infections in hospitals. If that were the case then we wouldn't have 1 in 10 patients in hospital settings getting an infection of some sort during care in a hospital. Hospitals are where sick people go. Sick people, and those not sick are the ones spreading infections and that is in spite of a multi-layered policy and procedure set which is approved and mandated by the CDC.

It is great you don't think people catch covid in hospitals, the media has succeeded in propagating a myth in at least 1 case.

If people aren't getting covid infections in hospitals then why have they locked hospitals down to the point that you cannot even visit a loved on who is dying from something other than covid? Seriously, that doesn't even pass the most basic sniff test.

 

[koenbro]

I am not sure how to respond.

I have been an attending physician for almost 20 years, and every day I reach out for to advice to my peers about various questions, and they solicit my advice in the same way. In that sense we "get schooled" and "school" each other (to use the forum vernacular) many times daily, as part of normal decision-making. In that culture, one is not losing face for being wrong, and there is no gratuitous defensiveness in those conversations. Quite the opposite, the humility inherent in asking for advice and be willing to be proven wrong is the currency of trust in these professional exchanges. Needless to say, we seamlessly defer to each other's niche expertise.

Against this background, I come to this forum to learn as a home hobbyist, welder, fabricator and aspiring machinist. Not here to do CME, journal clubs, or M&Ms, so I am a bit baffled by what we are trying to achieve.

It is great you don't think people catch covid in hospitals, the media has succeeded in propagating a myth in at least 1 case.

I promise you, I am not learning about my own field of expertise from the local ABC affiliate or some cable talking head.

If people aren't getting covid infections in hospitals then why have they locked hospitals down to the point that you cannot even visit a loved on who is dying from something other than covid? Seriously, that doesn't even pass the most basic sniff test.

The public is not catching covid from hospitals precisely because of restricted visitation. I think you are confusing cause and effect here.

Odd, I don't ever recall "policies and procedures" being on the list of things that prevent infections in hospitals. If that were the case then we wouldn't have 1 in 10 patients in hospital settings getting an infection of some sort during care in a hospital. Hospitals are where sick people go. Sick people, and those not sick are the ones spreading infections and that is in spite of a multi-layered policy and procedure set which is approved and mandated by the CDC.

What does it mean you don't "recall"? Did you once know lots of stuff about nosocomial infections and they lapsed from your memory? My experience suggests that policies and procedures and the institutional culture they build and sustain are the reason why nurses, respiratory therapists, dialysis, EKG and radiology technicians, and others who deal with covid in person have not been dying en masse from it. OTOH nosocomial infections are a very complicated topic, and I do not have either the deep expertise or the willingness to discuss it here.

 

[Tozguy]

If people aren't getting covid infections in hospitals then why have they locked hospitals down to the point that you cannot even visit a loved on who is dying from something other than covid?

I am not a doctor or health care worker but can easily see the lack of logic in that statement.

 

[rwm]

NC is in the thick of it now. Our hospital has 120 Covid inpatients out of 450 beds! They have cancelled elective procedures that might require admission overnight. There are no ICU beds. Not sure what they are going to do about trauma.
Robert

 

[NCjeeper]

 

[Aaron_W]

Well I just got the Pfizer vaccine, the one that has to stay very cold. Same one my wife got a few weeks ago.

She went in for her second dose, and I guess they had a no show, so they had an extra dose that had to get used up. There is only a short shelf life once it is out of the freezer. Since I was just out in the car, and am a firefighter (so high on the list of people to get it) she offered me up as an arm to put it in. Hopefully I don't have the response my wife had, but it is sounding like that is not too common.

 

[Larry$]

Interesting. I had no idea people could be affected that way by PEG. I used to use PEG 1000 to treat wet wood to prevent cracking.