[Health] The Infectious Diseases Thread

[LordMortis]

I was in the store this morning and I saw some guy walking around without a mask. I was thinking bad thoughts about him until I remembered.........there is no state wide (or city wide) mandate anymore.

Was there a store mandate? I don't want to shop anywhere that doesn't have one. Assuming there was, then the question is, is the mandate lip service or is the guy an ass. I was super impressed with Costco a year ago. I will likely let my membership lapse this July. My Costco clearly has policy in place as a legacy from last April but they absolutely do not care and it shows. As a result, I go about once every other month now. That leaves two more shopping trips until my membership expires unless my mind changes (quite frankly based on my own feeling about fully vaccinated for two months by then)

All that said, not matter what that person's feeling is on personal freedom, I'd hold that disdain. That's me. That person has no regard for their fellow shoppers nor the employees providing that service.

[FishPants]

This afternoon the premier of Ontario is expected to lay down more lockdown restrictions such as prohibiting any curb side pickup of non-essential goods, maybe a curfew (apparently Covid only spreads at night), and not allowing get togethers even outside with anyone not living at that address. Modelling shows we can expect 18,000 cases per day by the end of May without intervention -- and 10,000 cases per day WITH intervention (For reference we just broke through our all time record with 4700 cases per day, of which 60-70% are variants).

We have finally laid in the bed we made, by allowing our airports to remain open and unfettered we pretty much have every fucking strain raging across the country. I had to have a PCR test because of a close contact which thankfully was negative however the doctor doing the swab said this is a whole new disease, and isn't like COVID from last year. Young healthy people are getting it in record time, and ending up in the ICU in record time - no longer are co-morbidities a "thing" with Covid 2.0 flying around here. He also explained how OG Covid was a risk indoors of being exposed inside of 6 feet for 15+ minutes -- now it's 15 seconds within 3-4 feet and you're pretty much infected.

The testing centre I had to go to looked like something from a post apocalyptic movie, and I care to not experience that again -- my anxiety was through the roof waiting for my test and GTFO. I continue to track to a first jab sometime in the late summer based on current vaccination rates and supply unless something changes (for good or bad); in the meantime I wait and try to stay safe and keep my wife and kids safe.

[Kraken]

The Boston Globe asked "a group of experts" for their opinions on what's safe behavior for fully vaccinated people. The gist is that gathering indoors with small groups other vaccinated people, such as a family gathering, is fine. Outdoor dining is fine. Opinions are mixed on air travel, and indoor dining is right out. “There are still some things I am not doing. Eating indoors at restaurants is one. Although these vaccines are amazing, they are not 100 percent. To be somewhere indoors with the current rate of COVID what it is and being there without a mask on — it’s just not worth it.”

[Lorini]

I know I'm fully vaccinated and would not eat indoors in a restaurant. Maybe never, who knows.

[Kraken]

I know I'm fully vaccinated and would not eat indoors in a restaurant. Maybe never, who knows.

I look forward to doing that again someday when the level of virus transmission fades into background noise. Maybe by next fall/winter if we're diligent and lucky. Meanwhile, outdoor dining will become desirable again in a month, just about the same time we gain immunity, so I'm good through the summer.

[dbt1949]

My wife and I passed our two week mark after having had our second shots. Still wearing masks and feeling like nothing has changed.

[Blackhawk]

I was in the store this morning and I saw some guy walking around without a mask. I was thinking bad thoughts about him until I remembered.........there is no state wide (or city wide) mandate anymore.

Was there a store mandate? I don't want to shop anywhere that doesn't have one. Assuming there was, then the question is, is the mandate lip service or is the guy an ass.

I don't know about Canadia, but down here it was established early on in the pandemic that all store mandates are lip service, as there is no reasonable way for stores to enforce them. Every store I go into around here has a mask mandate. Every store I go into around here also has about a third of the people unmasked. The police can't patrol the aisles and enforce it if they take them off once they're inside. They can't have Phil the Greeter refuse to let people in. The manager can't stand by the door and personally eject every one of them, and what's he going to do when they start saying no and coming in anyway? Hell, I've been a prison guard in a maximum security prison and nightclub bouncer and even I wouldn't accept that job.

So, yeah. With no force of law, there are no masks.

[LordMortis]

I know I'm fully vaccinated and would not eat indoors in a restaurant. Maybe never, who knows.

The reason to go a restaurant and east indoors is to have a relaxing meal with my parents. Mom is still choosing not to get vaccinated, so restaurants are out.

[LordMortis]

I don't know about Canadia, but down here it was established early on in the pandemic that all store mandates are lip service, as there is no reasonable way for stores to enforce them. Every store I go into around here has a mask mandate. Every store I go into around here also has about a third of the people unmasked. The police can't patrol the aisles and enforce it if they take them off once they're inside. They can't have Phil the Greeter refuse to let people in. The manager can't stand by the door and personally eject every one of them, and what's he going to do when they start saying no and coming in anyway? Hell, I've been a prison guard in a maximum security prison and nightclub bouncer and even I wouldn't accept that job.

So, yeah. With no force of law, there are no masks.

Some stores will engage non mask wearers. Some don't want to create waves. I get the hesitancy to engage because there are so many nuts but I can see where I feel like the it's posted but 0 consideration is given. Home Depot is low near my house. My closest Costco. Where they initially were most serious of all, gives no fucks.

[Blackhawk]

I have seen enforcement at privately owned local shops where they primarily serve the local community, but I've never seen it at any store led by a corporate body.

[ImLawBoy]

FWIW, mask compliance is still at 100% in my experience here in Chicago. I saw someone walk into my regular grocery store without a mask on a couple of weeks ago, and he got a panicked look on his face when he realized what he did and quickly pulled a mask out of his pocket and put it on. My work from home office is on the second floor (in our bedroom) overlooking the street. Probably 75% of the people out walking are wearing masks, even if they're on their own.

[Sudy]

Even people I generally trust and agree with are starting to post stupid shit on Facebook. We may yet avoid a physical Armageddon, but the apocalypse of rational discourse is upon us. I find the thought of all the reasonable people being mentally and emotionally exhausted at the same time to be a disturbing one.

[dbt1949]

Went to the store this morning and saw a sign that basically said "We strongly encourage you to wear a mask".

[Lorini]

Masks are mandated in CA and even when we 'fully open up' on June 15 (tentative) they will still be mandated. I haven't seen anyone in a store without a mask on. I'm sure it's happened somewhere because Target has a giant sign that basically says 'your ass will be masked or don't come in' but I haven't seen it. I plan on wearing mine forever in places where I don't know the people.

[FishPants]

Even people I generally trust and agree with are starting to post stupid shit on Facebook. We may yet avoid a physical Armageddon, but the apocalypse of rational discourse is upon us. I find the thought of all the reasonable people being mentally and emotionally exhausted at the same time to be a disturbing one.

Ya I'm one of the exhausted ones; full shut down happened way too late with the variants ripping through our population and young people getting aced/disabled -- meanwhile Pearson airport is open with daily flights in from hotspots around the world. Justin has really screwed the pooch on this, followed right behind by druggie doug.

I find it amazing that anyone in this country thinks Trudeau is handling this well, but at least the general consensus in Ontario is that Doug is a fucking tool.

[Blackhawk]

Michelle discovered today that she's an MMR vaccine nonresponder (to the measles component.) As she works in a hospital, this makes me want to punch anti-vaxxers just a little bit more.

[Sudy]

I'd been putting off going to the dentist since they cancelled my cleaning last June. They called me in July but I didn't re-schedule. Mrs. Nym needed urgent work and they suggested having me come in as well. I gave in as I'd let my hygiene slip earlier in the pandemic and had been experiencing a lot of sensitivity lately. 4 cavities, about what I expected. The covid screening and safety procedures seem well implemented, but it still seems upside-down considering we're in the middle of Ontario's worst outbreak of the entire pandemic and it's business as usual, while they were completely shut down except for dental emergencies at this time last year.

I stopped by the nextdoor grocery store afterward since I was already out. It's our main store, but I haven't been there in months since we began getting our groceries delivered (which suits me anyway, since I don't have a car and it sucks bringing drinks and cat litter home). I was stunned that people are just as sloppy with masks and distancing as they were earlier in the pandemic. You're going to have to pass people in the aisles; I don't think the "arrows on the floor" traffic routing is practical or easily enforceable. But the number of people who pass or linger near you unnecessarily is disgusting. Everyone's just as impatient as always, I saw a lot of poorly fitting masks, and no one was double-masking at all. (Which I know isn't mandatory anywhere that I'm aware of, but I'm surprised no one is encouraging it.)

[Jeff V]

Most of the stores here removed the floor arrows some time ago, nobody was paying them much attention anyway. All of the people are masked, but some still don't know how to wear them and somehow think the virus shoots out of their chin and not their schnozz.

[Sudy]

I wish there were a magical computer that could spit out an irconclad simulation that would tell people, "If you do just a little better with covid precautious, you'll get to return to normal life [x] weeks sooner, and [x] fewer people will die". I feel like that would bring a lot (but not all) of people in line.

[malchior]

I wish there were a magical computer that could spit out an irconclad simulation that would tell people, "If you do just a little better with covid precautious, you'll get to return to normal life [x] weeks sooner, and [x] fewer people will die". I feel like that would bring a lot (but not all) of people in line.

+1. People are terrible at risk. Making something concrete would help so much.

[noxiousdog]

The Boston Globe asked "a group of experts" for their opinions on what's safe behavior for fully vaccinated people. The gist is that gathering indoors with small groups other vaccinated people, such as a family gathering, is fine. Outdoor dining is fine. Opinions are mixed on air travel, and indoor dining is right out. “There are still some things I am not doing. Eating indoors at restaurants is one. Although these vaccines are amazing, they are not 100 percent. To be somewhere indoors with the current rate of COVID what it is and being there without a mask on — it’s just not worth it.”

This makes no sense to me.

COVID-19 isn't crazy contagious in most situations (there are exceptions.. I thought this MIT study was useful tl/dr: singing and yelling is bad). In completely uncontrolled situations and no social distancing it has an estimated r0 of 3-4. With social distancing it drops to 1.2. It's contagious to populations, but not nearly as so to individuals.

In Boston, the 7 day moving average infection rate peaked early in April at 35/100,000. Let's assume two weeks of infectiousness, and that none of them stayed home or wound up in the hospital, so roughly 490/100000 were infected.

Your chance of encountering someone with covid at the early April peak - worst case - is 10% in a room with 20 people. That isn't transmission, mind you, it's just encountering.

It seems possible that COVID is going to be around forever and that we will need boosters. For the above recommendation of no indoor dining to be reasonable, that means we should just close them all now as nothing is going to change. There's always going to be infection and this person believes vaccinated people are at risk.

That quote is fear mongering... though it might be good public policy for reducing transmission in the populace. If vaccinated people are less likely to go out, then it helps keep un-vaccinated people at home too.... maybe.

Sudy, if you're -fully vaccinated (meaning two weeks post 2nd dose)- you're as good as you're going to get.

There is a simulation. When 65%-70% of the population gets vaccinated, we can return to "normal" as the infection rate will drop accordingly. This assumes vaccine efficacy of 90%.

[Jeff V]

Because my wife is depressed from overwork and pandemic fatigue, we are actually going to a restaurant Saturday for our 10 year anniversary. The weather is supposed to be too shitty for outdoor dining, but we are going at 4:30 pm, so maybe the crowds won't be at their peak. She was vaccinated in January and has low risk, I'm not getting my 2nd Moderna shot until Monday and won't be immortal for a couple of weeks after that.

She understands this could kill me, and she's okay with that.

[Sudy]

So... the Ontario government just introduced a temporary paid sick day program that will permit up to three paid sick days. (Good thing the recommended isolation period for possible covid contact is only three days. And that the average duration of the illness should you contract it is the same! It was for Trump, anyway.) But I mean, earnest "yay!" It's something. They know the pandemic has been around over a year now though, right? The federal government has been providing a special benefit since early last year, but it didn't help those living hand-to-mouth make the decision to take time off voluntarily due to the length of the approval process. However, critics of the new provincial plan are saying that it's still too slow.

The big joke, of course, is that this conservative government scrapped the limited paid sick leave plan we already had when they took power in 2018.

[FishPants]

So... the Ontario government just introduced a temporary paid sick day program that will permit up to three paid sick days. (Good thing the recommended isolation period for possible covid contact is only three days. And that the average duration of the illness should you contract it is the same! It was for Trump, anyway.) But I mean, earnest "yay!" It's something. They know the pandemic has been around over a year now though, right? The federal government has been providing a special benefit since early last year, but it didn't help those living hand-to-mouth make the decision to take time off voluntarily due to the length of the approval process. However, critics of the new provincial plan are saying that it's still too slow.

The big joke, of course, is that this conservative government scrapped the limited paid sick leave plan we already had when they took power in 2018.

Ford must know now he fucked this entire pandemic response up and doesn't have a hope in hell of recovering for the next election, the OPCs will never get my vote ever again (to be fair it had been a very long time since I had considered their platform anyways) - putting dollars before lives, brutal. At least some of the regions have enacted their own legislation to get shit sorted out - I'm LOVING the new Peel and Toronto laws around workplace covid infections, if 5+ employees test positive in the past 14 days you are shut down for 10 days and named in the paper. Helps put a name to the piece of shit companies putting people in the line of fire a year into a pandemic.

[Sudy]

My employer is one of them. Smallish call center, but 80% of staff are still expected to report to site. Every other cubicle is left vacant, but we didn't even bother cordoning them off. Laughable. Alarm monitoring is an essential service, but this volume of staff don't need to be on site. Last time it came up in conversation with a manager, the excuse seemed to be chip shortages making it difficult to acquire the mini-routers we needed to get staff set up at home. I still pray every day that someone doesn't get sick, because if an entire shift were to get infected (that being the foremost tragedy in itself), I'm not sure if we could function as a company in the meantime. Or at least, it would be a living hell for those providing coverage, myself included. We're already significantly short-staffed on a standard operating day.

Like much of the populace, it's like we just packed it in early on decided to bury our heads in the sand and hope for the best till it's all over.

[Isgrimnur]

Time to get the CV up to date.

[LordMortis]

we are going at 4:30 pm, so maybe the crowds won't be at their peak.

You're so pretty.

I was on the drive home at 17:00 on a Wednesday (yesterday) and had to pick up new glasses. Every restaurant I drove by had a completely full parking lot between the 17:00 and 17:30 window it took me to get to the optometrist. Weekend? First one in May? Not being as packed as guidance will allow them? Any time of day? HAHAHAHA!!!!

[Jeff V]

Ended up not going, after pining for the place for months, wife decided she'd rather sleep so I had to cancel the reservation at the last minute.

[Sudy]

Time to get the CV up to date.

Lol... while I do need and appreciate the encouragement, it was time to do that about five years ago. I'm too comfy. I'm going to ride out covid though.

[Smoove_B]

I'm really looking forward to posting non-COVID related stuff in this thread. Case in point:

https://twitter.com/CleverTitleTK/statu ... 9910854659

Wow. Flu cases down from 38 million in 2019-20 to 2038.

2038.

Not a typo.

[stessier]

They really nailed the formulation on the flu shot last year!

[Anonymous Bosch]

Well, this sounds right up Smoove's alley…

A rare black fungus is infecting many of India's COVID-19 patients—why?

On May 9, Ananyaa Mazumdar received a call that left her stumped. Her panic-stricken cousin explained that her 48-year-old aunt, who had recently recovered from a COVID-19 infection, had lost most of her vision in both eyes.

The emergency room doctors at the Max Super Speciality Hospital in Ghaziabad, a satellite city outside India’s capital New Delhi, suggested that because the infection was so advanced, she needed immediate surgery to remove her eyes. Aghast at first, the family soon realized that they had no other option.

“It’s all that could be done—and had to be done,” Mazumdar said. “It’s like we were sitting on a ticking time bomb.”

Her diabetic aunt was diagnosed with an extremely rare fungal infection called mucormycosis that’s on the rise among recovering and recovered-but-vulnerable COVID-19 patients in India. Colloquially referred to as “black fungus” due to its dark pigmentation, this potentially fatal infection starts in the nose and spreads to the eyes and then the brain.

Public health experts are blaming the indiscriminate use of steroids to treat COVID-19 as the likely cause. Steroids reduce inflammation in the lungs. But overuse of these drugs in COVID-19 patients can result in lowered immunity and raised blood sugar levels. These conditions leave some patients, particularly those with uncontrolled diabetes, susceptible to such infections.

As India—the diabetes capital of the world—continues to battle a devastating second wave of COVID-19, ear, nose and throat physicians are expecting to see more mucormycosis cases come their way in the next few weeks.

In Delhi, for instance, Manish Munjal, an ENT surgeon at Sir Ganga Ram Hospital, has been treating nearly 15 new cases every day since last week. According to him, the city has recorded about 250 mucormycosis cases since April.

“That’s a huge number,” he says, comparing it to a case or two he’d treat every month in pre-pandemic times.

In the western Indian state of Maharashtra, which has been hit hardest by COVID-19, state health minister Rajesh Tope said there could be more than 2,000 mucormycosis patients. In the neighboring state of Gujarat, some 300 cases have been reported from four cities.

“The concern is that this is just the start,” Munjal says. “The infection typically begins to hit the body two to three weeks into the steroid therapy, and we might see the case numbers jump in the coming weeks.”

What is the black fungus?
Mucormycosis is an invasive infection caused by a class of molds called mucormycetes. These fungi are ubiquitous, naturally occurring in our environment, most commonly in soil. Humans get the infection by inhaling the fungal spores floating around in the air and in dust. These spores get lodged in the nasal passages and sinuses and cause disease at that site.

But not everyone exposed to the spores will get the infection. “For most part, if you have a normal immune system, it’s an asymptomatic, silent encounter,” says Tobias Hohl, chief of infectious disease service at New York’s Memorial Sloan Kettering Cancer Center. But developing the invasive disease depends on a person’s health condition.

People with compromised immune systems, for example, those with blood cancer undergoing chemotherapy or bone-marrow transplant patients who can’t form neutrophils—a type of white blood cell that defends against infections—in the initial weeks, may fall victim to mucormycosis.

Similarly, during COVID-19, patients prescribed heavy and prolonged steroid doses can have weakened immune systems. “We’ve seen people go crazy with steroid prescriptions,” says Lancelot Pinto, a pulmonologist at Mumbai’s P.D. Hinduja Hospital and Medical Research Center. “There’s a misperception among doctors that more severe the [COVID-19] case, higher the dose of steroids needed, which isn’t supported by any trial so far.”

Steroids can cause blood sugar levels to spike, which can be especially challenging for patients with uncontrolled diabetes. Higher blood sugar levels and more acidic blood creates a fertile environment for Mucorales fungi to thrive.

In such vulnerable patients, the spores germinate to form long tubular filaments that can grow into the sinuses, into the bone, and the blood stream. The symptoms of mucormycosis and progression of the infection can vary from person to person; they include a throbbing headache, fever, facial and nasal pain, blackish nasal discharge, loss of vision, toothache, loosening of teeth, swelling in the upper jaw, and sometimes face paralysis.

“This is a horrific infection, and can be disfiguring,” Hohl says. “Unless treated, the infection can cross into the central nervous system, and that’s more dangerous.” The chances of dying exceeds 50 percent if the infection reaches the brain.

Early diagnosis can be lifesaving. But the infections can be extremely challenging to treat, even at an early stage.

Treating mucormycosis
Patients are prescribed antifungal treatments such as liposomal amphotericin B injections for at least 10 days to several weeks after diagnosis. But these essential drugs have the potential to induce substantial side-effects, including kidney damage.

Often, a surgical intervention is also needed. In less severe cases doctors insert an endoscope through the nasal cavity and remove any diseased tissue. If the infection has spread further, the surgeons may need to remove the eyes or the jaw bone.

[Smoove_B]

Yeah, it's gnarly stuff. I don't know the environmental connection - if's it a more common type of fungal infection in parts of India just based on their local conditions. Interesting theory on the steroids too.

Here in the U.S. we have more cases of Coccidioidomycosis, which is the same idea but caused by a different fungal source and completely unrelated to COVID-19, though there was a study published earlier this month looking at risk factors for co-infection.

Not something we're worried about here in Jerz, but definitely an issue for the West and SW portions of the country.

[Daehawk]

Sounds like The Last of Us .

I remember when I was a kid that my brother was living in Denver and him telling me he had gotten some kind of fungal growth in one of his lungs that basically made that one useless. My imagination pictured mushrooms and moss growing in there.

[Isgrimnur]

If you want to image search for Mucormycosis, be my guest.

[Daehawk]

tempting

[Smoove_B]

Add thrush to your list. Maybe get something to eat first.

[Jaymann]

I'm really looking forward to posting non-COVID related stuff in this thread. Case in point:

https://twitter.com/CleverTitleTK/statu ... 9910854659

Wow. Flu cases down from 38 million in 2019-20 to 2038.

2038.

Not a typo.

This is why I continue wearing a mask in public even though I am vaccinated. It is working.

[Alefroth]

I'm really looking forward to posting non-COVID related stuff in this thread. Case in point:

https://twitter.com/CleverTitleTK/statu ... 9910854659

Wow. Flu cases down from 38 million in 2019-20 to 2038.

2038.

Not a typo.

That's mind boggling. I assume masking and distancing are the primary drivers. Are there any others at work?

[LordMortis]

That's mind boggling. I assume masking and distancing are the primary drivers. Are there any others at work?

Isolation. Specifically I would say school from home style isolation. Coworkers with kids getting sick and coming to work while they themselves were sick were always the vectors of spread at my work.