Corona Virus: It's a Marathon, Not a Sprint

[Smoove_B]

Since Isg likes data, have you seen what the #1 killer in TX has been since June of 2021?

[Isgrimnur]

Since Isg likes data, have you seen what the #1 killer in TX has been since June of 2021?

Rap concerts?

[LordMortis]

So I figure now is coming up on two weeks after Halloween weekend. So I also figure it's time to batten down the hatches. Naturally I have to go to the hospital to have blood drawn this weekend and my insurance provider are threatening to drop my health care system so I have to get all my on going care done before the end of the year, so as not to risk losing the continuity of that care. I guess if I'm trying to leave my job and have no idea how the ACA is going to work when I leave, it's probably not a bad thing to get all these visits done.

[Smoove_B]

Lil' update on the deer situation:

Now veterinarians at Pennsylvania State University have found active SARS-CoV-2 infections in at least 30% of deer tested across Iowa during 2020. Their study, published online last week, suggests that white-tailed deer could become what's known as a reservoir for SARS-CoV-2. That is, the animals could carry the virus indefinitely and spread it back to humans periodically.

If that's the case, it would essentially dash any hopes of eliminating or eradicating the virus in the U.S. — and therefore from the world — says veterinary virologist Suresh Kuchipudi at Penn State, who co-led the study.

"If the virus has opportunities to find an alternate host besides humans, which we would call a reservoir, that will create a safe haven where the virus can continue to circulate even if the entire human population becomes immune," he says. "And so it becomes more and more complicated to manage or even eradicate the virus."

But this right here?

From April to December of last year, about 30% of the deer that they tested were positive for SARS-CoV-2 by a PCR test. And then during the winter surge in Iowa, from Nov. 23, 2020, to Jan. 10 of this year, about 80% of the deer that they tested were infected. At the peak of the surge, Kapur says, the prevalence of the virus in deer was effectively about 50 to 100 times the prevalence in Iowa residents at the time.

During this time frame, the team also sequenced the genes of nearly 100 samples of the virus. They found the variants circulating in the deer matched the variants circulating in people.

Those genomic sequences suggest that during the pandemic, deer have caught the virus from people multiple times in Iowa alone, Kapur says. "The data are very consistent again with frequent spillover events from humans into deer and then transmission among the animals."

So basically SARS-CoV-2 is acting like influenza does with pigs. Birds give it to everyone and then pigs give it to us and we give it back to pigs, over and over again.

"Now the question is: Can the virus spill back from deer to humans? Or can deer transmit the virus effectively to grazing livestock? We don't know the answers to those questions yet, but if they are true, they're obviously concerning," she says.

Another concern, Saif says, is that SARS-CoV-2 could evolve inside the deer and create new strains of the virus. Researchers have already documented such a scenario with minks on farms in the Netherlands and Poland, she points out.

[Exodor]

An excellent piece in the Atlantic this morning about how going back to normal only works until you test positive:

Are all of the measures described in that article - the isolation, the quarantining the family and children, the endless tests - to protect the unvaccinated? The author's actual experience with the illness seems pretty mild:

The worst-case scenario that I’d imagined was that I’d get sick, mildly, as I did. I ended up taking one day off from work, and even that was more of a precaution. I felt pretty sick, like when you have a cold, but I’ve probably been sicker 15 times as an adult.

I ask because it seems since this summer those of us who observed the lockdowns, got the vaccine and wore masks have been jumping through hoops to try and protect the idiots who continued gathering all last year, refuse to wear masks and can't be bothered to get a safe vaccine. And I'm about at the end of my patience with doing so.

[Default]

Considering that hunters skew antivax, that has got to make for an interesting conversation.

[Smoove_B]

Are all of the measures described in that article - the isolation, the quarantining the family and children, the endless tests - to protect the unvaccinated? The author's actual experience with the illness seems pretty mild

I'm not sure. They didn't say their kids were unvaccinated, only that they believed their kids would get a mild case. That suggests to me that no, they weren't vaccinated and they were going with the risk analysis that (for them) they weren't worried.

I ask because it seems since this summer those of us who observed the lockdowns, got the vaccine and wore masks have been jumping through hoops to try and protect the idiots who continued gathering all last year, refuse to wear masks and can't be bothered to get a safe vaccine. And I'm about at the end of my patience with doing so.

Yes, by doing those things we were helping to stop the virus from circulating - especially after it became clear that vaccinated people could still (1) get and (2) spread the virus. I still believe (based on anecdotal evidence) that breakthrough cases were much higher than we acknowledged but it really wasn't the focus of news stories as the number of breakthrough deaths were still quite low. Unvaccinated people dying dominated the news. I am rather curious to see how the narrative changes now that it's only <5 year olds that are at risk.

But yes, I'm also out of patience. I still genuinely feel for those that are hesitant, have access issues or can't afford to take off (or miss a day of work) if they have a reaction. But people that have the ability to vaccinate and are absolutely refusing? I'm done.

[Zaxxon]

Hopefully the under-5 approval comes reasonably quickly. What's the guesstimate--January?

[Smoove_B]

Yes, last I'd seen the first wave of data from Pfizer would be released late 2021 or early 2022. Not really sure what to expect in terms of approvals though. It would be great it they could start shortly after the new year, but I'm guessing that's a stretch.

[LordMortis]

As few people as are in my office at any time, I am amazed at the volume of notifications I get that "some was in the office on such and such day and has been in contact with someone with COVID. This is a courtesy notification. Nothing is required of you at this time."

I wonder if it's the same one or two people. I need to start paying attention to who is in the office and then not in the office cause right now as much as I live in isolation, I'm beginning to believe that working may eventually put me on a course for not seeing my parents. The only thing that prevents me from thinking that now is that I work in a private room in a secluded area of the building and rarely poke my head out of the door since I cam back to the office in... July? of 2020.

[Smoove_B]

Something, something, something, foreshadowing.

https://twitter.com/DrAliSKhan/status/1 ... 0583151616

Maine hits record #COVID10 hospitalizations & ICU patients - despite 72% fully vaccinated. Still short of our my 85% suggested target. If you are unvaccinated, #SARSCoV2 will find you - kind like the Royal Canadian Mounties.

[Isgrimnur]

Why is the RCMP looking for people in Maine?

[Smoove_B]

Trying to give back Americans that are escaping into Canada?

Back to where this all started:

https://twitter.com/EricTopol/status/14 ... 5935676416

Today in the USA, over 132,000 new cases, 7-day average back up to ~80,000
Over 2,100 deaths
Test positivity >5% for the first time in a month
Fasten your seat belts

[YellowKing]

Meanwhile, our county just rolled back its public mask mandate, setting us up for another surge which will lead to another mask mandate....sing along if you've heard this one before.

[Alefroth]

Meanwhile, our county just rolled back its public mask mandate, setting us up for another surge which will lead to another mask mandate....sing along if you've heard this one before.

Maybe this time it will be different and they'll skip the mask mandate.

[Daehawk]

2nd verse same as the first.

[Kraken]

Howzabout a success story for a change?

MIT's students, staff, and faculty are 99% vaccinated. The Institute has a universal indoor mask requirement, weekly testing, and aggressive contact tracing. Nobody gets into any building without either a Vax Pass or a Tim Ticket (for visitors). So far, there have been 18 cases during the fall semester among their population of roughly 20,000. All of those were traced to social gatherings off campus.

There's at least one community in America that's doing it right.

[Daehawk]

Ive lost my vax card. I didn't realize it until they asked for it Thursday. I couldn't figure out how anyone lost that item...well now I know. its here someplace. Just need to find the place.

Also arm is barely noticeable as sore today after 3rd shot Thursday. So either it doesn't phase me or my immune system sucks.....which it doesn't as Im hardly ever sick in my life....until I say that Im hardly ever sick in my life.

[msteelers]

My vac card is too big to fit in my wallet. Luckily(unfortunately) I live in a state that has banned vaccine passports, so the only people I have to show it to are the people giving me a vaccine.

[Blackhawk]

Yeah, it's a terrible format for carrying around. I have mine in the files, although I photographed everyone's.

I have yet to ever have a need for it.

[Kurth]

Howzabout a success story for a change?

MIT's students, staff, and faculty are 99% vaccinated. The Institute has a universal indoor mask requirement, weekly testing, and aggressive contact tracing. Nobody gets into any building without either a Vax Pass or a Tim Ticket (for visitors). So far, there have been 18 cases during the fall semester among their population of roughly 20,000. All of those were traced to social gatherings off campus.

There's at least one community in America that's doing it right.

That is good news! And personally, I’m happy to hear this since my family is heading back to Boston next week to visit for Thanksgiving and also so my son can tour MIT and the media lab. He’s a senior this year, and this will be his first actual college tour. Glad to know we’re not likely to get COVID taking him there!

[Daehawk]

I love how Maine used the same color for two different demographics.

[Smoove_B]

There's at least one community in America that's doing it right.

I remember reading something about MIT back in August and the insane amount of money they were spending to try and set up this program. It can absolutely work (clearly), but I always question at what cost and what is realistic for all. It's definitely impressive - in the same way the NBA and NFL (well, maybe) has managed to keep things under control. But scaling that out to everyone? I just don't know.

In other news

https://twitter.com/kylegriffin1/status ... 4456765442

NBC News: The U.S. has exceeded 47 million COVID cases since the start of the pandemic.

One million new cases in 13 days.

[Kraken]

Howzabout a success story for a change?

MIT's students, staff, and faculty are 99% vaccinated. The Institute has a universal indoor mask requirement, weekly testing, and aggressive contact tracing. Nobody gets into any building without either a Vax Pass or a Tim Ticket (for visitors). So far, there have been 18 cases during the fall semester among their population of roughly 20,000. All of those were traced to social gatherings off campus.

There's at least one community in America that's doing it right.

That is good news! And personally, I’m happy to hear this since my family is heading back to Boston next week to visit for Thanksgiving and also so my son can tour MIT and the media lab. He’s a senior this year, and this will be his first actual college tour. Glad to know we’re not likely to get COVID taking him there!

It might be the safest place in America. Or at least, the safest urban place.

I remember reading something about MIT back in August and the insane amount of money they were spending to try and set up this program. It can absolutely work (clearly), but I always question at what cost and what is realistic for all. It's definitely impressive - in the same way the NBA and NFL (well, maybe) has managed to keep things under control. But scaling that out to everyone? I just don't know.

These are some of the smartest people in the world, coming together with a shared sense of community and purpose. They're a privileged elite, and they know it. Especially after enduring a year of virtual education, it's not surprising that they're working hard to keep the classrooms, dorms, and labs safe. It can scale as large as you can assemble a group that's motivated to cooperate.

[LawBeefaroni]

My vac card is too big to fit in my wallet. Luckily(unfortunately) I live in a state that has banned vaccine passports, so the only people I have to show it to are the people giving me a vaccine.

I folded it in half and stick it in my wallet on day one. After the second dose I stuck clear packaging tape on either side of the fold to keep it from falling apart. Been fine since.

[malchior]

I use the Docket app and I've had no issues using it as proof of vaccination in NY, NJ, PA, and CA. Probably good enough for my limited travel needs.

[gbasden]

I use the Docket app and I've had no issues using it as proof of vaccination in NY, NJ, PA, and CA. Probably good enough for my limited travel needs.

Yeah, the State of CA has an app that links up with your statewide vaccine record and gives you a nice proof of vaccination screen complete with QR code. I haven't needed my paper copy since that came out.

[ImLawBoy]

Ive lost my vax card. I didn't realize it until they asked for it Thursday. I couldn't figure out how anyone lost that item...well now I know. its here someplace. Just need to find the place.

Also arm is barely noticeable as sore today after 3rd shot Thursday. So either it doesn't phase me or my immune system sucks.....which it doesn't as Im hardly ever sick in my life....until I say that Im hardly ever sick in my life.

I lost mine shortly after my second dose (I'm guessing in the parking lot on my way out as I was juggling keys and phone trying to get on a work call). I reached out to the place where I had the shots done and they sent me an electronic record containing all the relevant information. So far it's worked fine for my employer and when I got my booster (they did give me a card for my booster, but it just has the first two doses lined through).

[Zaxxon]

Prepare thyselves.

https://twitter.com/edyong209/status/14 ... t3-Bw&s=19

[Smoove_B]

I had one of my Tweets liked by Ed Yong a few weeks ago, so we're basically best friends now. I am really looking forward to what he's going to drop - always amazing, always razor-sharp.

[Zaxxon]

And here it is:

I think I'm done.

[Smoove_B]

I can only imagine as we head into 2022, it's going to continue to get worse for them

The U.S. Bureau of Labor Statistics estimates that the health-care sector has lost nearly half a million workers since February 2020. Morning Consult, a survey research company, says that 18 percent of health-care workers have quit since the pandemic began, while 12 percent have been laid off.

I know I've said it before, but I have quite a few friends in public health that have told me they would quit tomorrow if they could afford to do so. Not health care and not on the scale that you're seeing here, but you're talking about people that have 20+ years in the field that are ready to just walk away. It was one thing when they were the only thing keeping people alive, but now that there's a vaccine and people are still overwhelming the hospitals? I don't know how the health care community is doing it.

Add to that all the other people that have delayed care for other issues over fear of being in hospitals that are getting crushed with COVID and I'm confident that we're still going to be talking about the impacts of the pandemic as we head into the 2030s.

And I like switching to moral distress instead of using burnout. That alone is worth the entire article and it exactly describes what my peers have communicated - an inability to do their jobs.

[LawBeefaroni]

I think you'll see even more stratification as the quality labor pool shrinks.

Expect more telehealth and self-service clinics.

[Smoove_B]

Expect more telehealth and self-service clinics.

Funny you should mention that because our NJ governor decided to gut telehealth options last week.

Gov. Phil Murphy has rejected a bill that would have reimbursed doctors and other medical providers in New Jersey the same rate for telehealth services as they charge for in-person appointments, saying the cost may be too steep for taxpayers and may limit opportunities for patients who prefer office visits.

The Democratic governor on Monday conditionally vetoed the legislation, which means he won’t support it unless the lawmakers adopt his recommended changes. Murphy called for maintaining higher reimbursement rates until 2023, after the state Health Department has studied its usage and determined patients are getting the kind of care they need and costs are reasonable.

Additional information:

“While I wholeheartedly support expanding telehealth and telemedicine access and believe that New Jersey should be a national leader in innovative health care policy, I have reservations about making permanent a measure that was intended as a stopgap to preserve public health during an unprecedented emergency,” Murphy wrote.

“Approving this bill would amount to a very heavy thumb on the scale in favor of providers,” he added. “Moreover, the cost to carriers — which would be felt both by those paying premiums and taxpayers alike — could be substantial.”

“I am concerned that in the long term, pay parity could over-incentivize telehealth, further limiting in-person options. This could be especially detrimental for those in underserved communities,” Murphy continued.

To me it feels very much like the revelations of corporate America - where suddenly workers all over were able to work remotely. But we can't have that long term, that would be too "dangerous".

[YellowKing]

In one small silver lining, our county (which I posted recently lifted their mask mandate), has decided to keep the mask mandate in place for public schools. Nice slap in the face for the Proud Boys who showed up to the meeting to speak out in support of removing the mandate.

Fuck these people for supporting endangering my kids.

[LawBeefaroni]

Expect more telehealth and self-service clinics.

Funny you should mention that because our NJ governor decided to gut telehealth options last week.

Gov. Phil Murphy has rejected a bill that would have reimbursed doctors and other medical providers in New Jersey the same rate for telehealth services as they charge for in-person appointments, saying the cost may be too steep for taxpayers and may limit opportunities for patients who prefer office visits.

The Democratic governor on Monday conditionally vetoed the legislation, which means he won’t support it unless the lawmakers adopt his recommended changes. Murphy called for maintaining higher reimbursement rates until 2023, after the state Health Department has studied its usage and determined patients are getting the kind of care they need and costs are reasonable.

Additional information:

“While I wholeheartedly support expanding telehealth and telemedicine access and believe that New Jersey should be a national leader in innovative health care policy, I have reservations about making permanent a measure that was intended as a stopgap to preserve public health during an unprecedented emergency,” Murphy wrote.

“Approving this bill would amount to a very heavy thumb on the scale in favor of providers,” he added. “Moreover, the cost to carriers — which would be felt both by those paying premiums and taxpayers alike — could be substantial.”

“I am concerned that in the long term, pay parity could over-incentivize telehealth, further limiting in-person options. This could be especially detrimental for those in underserved communities,” Murphy continued.

To me it feels very much like the revelations of corporate America - where suddenly workers all over were able to work remotely. But we can't have that long term, that would be too "dangerous".

Well, pay parity doesn't make sense. It may have been a good emergency stop gap but kind of hard to rationalize paying the same amount for an in-person office visit as a telehealth visit permanently. I'm sure the hospital/physician lobby wants it and I'd love to have it here but I wouldn't call denying parity "gutting" telehealth.

[Smoove_B]

I guess my take on this is that they're going to cap charges and telehealth options will disappear because providers aren't going to invest in a service that doesn't have a good ROI - completely undermining access to health long after this pandemic ends (in 2025).

[Isgrimnur]

In one small silver lining, our county (which I posted recently lifted their mask mandate), has decided to keep the mask mandate in place for public schools. Nice slap in the face for the Proud Boys who showed up to the meeting to speak out in support of removing the mandate.

Fuck these people for supporting endangering my kids.

If you can't use the dump without showing proof of residence, why do you not have to do the same for speaking at a governmental meeting?

[LawBeefaroni]

I guess my take on this is that they're going to cap charges and telehealth options will disappear because providers aren't going to invest in a service that doesn't have a good ROI - completely undermining access to health long after this pandemic ends (in 2025).

It's not a cap on charges. They're just rejecting a mandate that in person and telehealth have to have the exact same reimbursement.

Systems and groups will continue to invest in telehealth. It brings patients to the system and it is much easier to manage shifts and personnel with telehealth. ROI is fine, it's cheaper to run after startup/tech are paid. The bean counters actually love it. The only risk is national competition running at scale but for a big enough system it's not a huge issue.

[Smoove_B]

I hope you're right. We used telehealth (well, my wife did) quite a few times over the last (checks watch) 20 months, so it's definitely been a welcome change.

Unrelated, I also just saw that Chicago just started a program (today?) that allows anyone over the age of 5 to be vaccinated at home via mobile vaccinators. That's good stuff.