The Politics of Covid 19, mask wearing and the vaccination process

[Smoove_B]

Somehow, this was a pass:

The U.S. Supreme Court rejected to hear an appeal relating to COVID-19 vaccine requirements in the workplace, dealing a blow to vaccine skeptics across the nation.

On Tuesday morning, the Supreme Court orders list showed that it was denying to hear any further arguments in the case Katie Sczesny, et al. v. Murphy, Gov. of New Jersey, et al. The case focused on four New Jersey nurses who filed a lawsuit against New Jersey's COVID-19 vaccine requirements in the workplace, citing religious freedom and health concerns.

The Supreme Court did not provide any further explanation for its refusal to hear the case, but the decision allows a ruling in the U.S. Court of Appeals for the Third Circuit to stand. The lower court ruled that the vaccine mandate challenged by the nurses did not violate their Constitutional freedoms and allowed an executive order from New Jersey Governor Phil Murphy to stay in place.

Commentary:

"We are disappointed the Supreme Court did not take up this issue now, but hope that it will take up this question soon, whether in this case after final judgment or another case. We need our highest Court to provide guidance on this important question of liberty before another pandemic and another emergency vaccine," Dana Wefer, a lawyer for the four nurses who filed the lawsuit, told Newsweek on Tuesday.

[Smoove_B]

I'm putting this here because its in direct response to the idea that Covid-19 was created in a lab

My amendment to end gain-of-function research funding passed tonight! It’s insane to use taxpayer dollars to create a blueprint for the next pandemic.

We're slipping backwards

[El Guapo]

You know, I suppose it would be crazy to spend taxpayer dollars to create a blueprint for the next pandemic.

[Smoove_B]

Here's where we are:

On May 11, 2023, the US federal government put an end to the COVID-19–related public health emergency. The US Centers for Disease Control and Prevention (CDC) no longer recommends routine universal masking in most health care settings. Many clinicians and staff at hospitals, clinics, and nursing homes around the country have stopped regularly wearing masks. A conflict might arise when patients who are immunocompromised or have other risk factors that increase their susceptibility to COVID-19 complications seek health care and encounter an unmasked clinician. Individuals who have such conditions are considered disabled under the Americans with Disabilities Act (ADA). Those disabled patients nowadays must embark on a “personal crusade for public health” to have their needs met.

In theory, the solution to the problem should be simple: patients who wear masks to protect themselves, as recommended by the CDC, can ask the staff and clinicians to wear a mask as well when seeing them, and the clinicians would oblige given the efficacy masks have shown in reducing the spread of respiratory illnesses. However, disabled patients report physicians and other clinical staff having refused to wear a mask when caring for them. Although it is hard to know how prevalent this phenomenon is, what recourse do patients have? How should health care systems approach clinicians and staff who refuse to mask when treating a disabled patient?

Important reminder:

Physicians have a history of antagonism to the idea that they themselves might present a health risk to their patients. Famously, when Hungarian physician Ignaz Semmelweis originally proposed handwashing as a measure to reduce purpureal fever, he was met with ridicule and ostracized from the profession.

Physicians were also historically reluctant to adopt new practices to protect not only patients but also physicians themselves against infection in the midst of the AIDS epidemic. In 1985, the CDC presented its guidance on workplace transmission, instructing physicians to provide care, “regardless of whether HCWs [health care workers] or patients are known to be infected with HTLV-III/LAV [human T-lymphotropic virus type III/lymphadenopathy-associated virus] or HBV [hepatitis B virus].” These CDC guidelines offered universal precautions, common-sense, nonstigmatizing, standardized methods to reduce infection. Yet, some physicians bristled at the idea that they need to take simple, universal public health steps to prevent transmission, even in cases in which infectivity is unknown, and instead advocated for a medicalized approach: testing or masking only in cases when a patient is known to be infected. Such an individualized medicalized approach fails to meet the public health needs of the moment.

What to do?

Relevant agencies of the federal government, such as the CDC (as it did during the HIV epidemic) and CMS, should also step in, promulgating guidelines to physicians and hospitals on the importance of disability accommodations. Such accommodations could be tied to reimbursement, as with other reportable errors in quality and safety. In particular, hospitals should partner with people with disabilities to help effect change and hear and respond to their concerns.

Recognizing ethical duties and legal rights is an important first step in developing a framework that accommodates patients with disabilities now that universal masking is no longer the norm in many clinical settings, and in particular, as COVID-19 cases are again on the rise.

[ImLawBoy]

We've had a mixed reaction from medical folks. For a while when we took my oldest to appointments and they saw us wearing masks, they would ask us if we want them to wear masks (but not always). That's less common now, though. When my wife went to an oncology appointment the other week, the oncologist was not wearing a mask and did not ask my wife about it. Now, she's in remission, so I'm not sure what the protocol would have been if she were still in chemo, but I was a bit surprised to hear that.

[Smoove_B]

Oh look, from the Texas Attorney General:

I am suing Pfizer for misrepresenting Covid-19 vaccine efficacy and conspiring to censor public discourse.

[Max Peck]

Who could have predicted that it would come to this...

Most Ottawa COVID-19 signals are very high

The city's COVID-19 numbers to watch are mostly very high, and they are either stable or rising in this week's Ottawa Public Health (OPH) updates.

The latest numbers show a high amount of respiratory syncytial virus (RSV) activity, while flu trends are mostly low.

OPH says the city's health-care institutions remain at a high risk from respiratory illnesses, as they have been since early September.

The city is about to enter the traditional respiratory season — December through February — with more coronavirus signal in its wastewater than at this point over the past three years, less flu signal than last year at this time, and roughly the same amount of RSV.

Experts recommend people cover coughs and sneezes, wear masks, keep their hands and often-touched surfaces clean, stay home when sick and keep up to date with COVID and flu vaccines to help protect themselves and vulnerable people.

Wastewater

Data from the research team shows, as of Nov. 23, the average coronavirus wastewater level is again rising to its highest point since mid-January 2023. OPH considers this very high.

Hospitals

In the past week, the average number of Ottawa residents in local hospitals for COVID-19 has risen to 79, including two patients in an ICU.

A separate count — which includes patients who either tested positive for COVID after being admitted for other reasons, were admitted for lingering COVID complications or were transferred from other health units — drops after two weeks of significant increases.

There were 54 new patients in the previous week. OPH sees this as a high number of new hospitalizations.

Tests, outbreaks and deaths

The city's weekly average test positivity rate sits at about 20 per cent. It has stayed between 15 and 20 per cent this month. OPH categorizes this as very high, up from high the last few weeks.

There are 38 active COVID outbreaks — almost all are in either retirement homes or hospitals. The total remains stable but there is a very high number of new outbreaks.

The health unit reported 292 more COVID cases in the last week and four more COVID deaths.

It also said it added 25 more deaths to its count after the province changed what it considers a COVID death. The new total sits at 1,171 reported resident COVID deaths, including 154 so far this year.

OPH's next COVID vaccination update is expected next week.

It is perhaps noteworthy that "with more coronavirus signal in its wastewater than at this point over the past three years" pretty much means that it's the highest it's ever been at this time of the year. Testing for SARS-CoV-2 in wastewater wasn't really a thing in 2019.

[Punisher]

Can someone explain what a relative risk reduction is and why it's misleading?

[Smoove_B]

Can someone explain what a relative risk reduction is and why it's misleading?

Relative risk is an epidemiological measurement where we compare what happens when we look at a single factor affecting one group vs that factor missing in another (the control). As an example, let's give baby aspirin to a population of people above the age of 65 that experienced a stroke to see if reduces the chances of having a second stroke. Or let's compare rates of cancer between groups of smokers and non-smokers.

Relative risk is reported as a percentage.

"People that received 5mg of baby aspirin daily experienced a 37% relative risk reduction for experiencing a second stroke in comparison to a similar cohort that did not."

"Smokers have a 37% higher relative risk of experiencing a cancer diagnosis than non-smokers."

Relative risk reduction (RRR) is a specific type of relative risk calculation (ratio) focused on the application of some kind of medical treatment or intervention. The reason it's potentially misleading is because you're only looking act the impact of the intervention as a function of the group that didn't.

Instead, studies will usually report an Absolute Risk Reduction (ARR) which mathematically accounts for this by not turning the calculation into a ratio (like hte RRR) and instead just compares the actual risk reduction between the experimental and control groups.

In practice, this will usually mean a high RRR (37%) will have an ARR of something like 3.1 or 2.7 instead - which is why RRRs are potentially misleading.

Textbook definitions:

Relative risk is the ratio of the probability of an event occurring with an exposure versus the probability of the event occurring without the exposure.

Absolute risk is the actual risk of some event happening given the current exposure.

I wasn't expecting this question here or on a Thursday night.

[Punisher]

Thanks. I brought it up because that lawsuit mentions it so im trying to find out if its a legit suit or a bunch of crazy talk.

[Smoove_B]

Ah, that makes more sense.

I can't even begin to imagine how the legal world is going to parse epidemiological practice. Interesting times.

[Max Peck]

It's interesting that they are specifically going after Pfizer. IIRC, Pfizer released its initial trial results a few days after the 2020 election, and Trump accused them of holding back the announcement in order to damage his electoral chances. To be MAGA is to never forget a grudge.

[GreenGoo]

Who could have predicted that it would come to this...

3 of my 5 person family tested positive this week. We think it came home from school. Not as rough as the first time, but no picnic either.

[Smoove_B]

A month later... mask mandates return to NYC public hospitals:

A mask mandate has resumed for all 11 of the city's public hospitals after an increase in coronavirus, flu and respiratory syncytial virus cases.

The mask requirement also applies for all health clinics and nursing homes run by NYC Health + Hospitals.

Health Commissioner Dr. Ashwin Vasan said Wednesday the requirement is for areas of the hospital where patients are being treated.

He said it is also partially to protect the staff from incoming sickness as the numbers of patient cases rise. He said city hospitals are currently handling patient levels well and none are overwhelmed.

[coopasonic]

Masks... you damn yanks. Masks are for robbing banks not healthcare! Oh, I think I get it. You have to rob a bank to afford healthcare so just wear a mask the whole time.

[Max Peck]

It looks like "DNA integration" is going to be the MAGA buzz word of the week.

Florida surgeon general calls for halt on mRNA covid vaccines, citing debunked claim

Florida’s top health official called for a halt to using mRNA coronavirus vaccines on Wednesday, contending that the shots could contaminate patients’ DNA — a claim that has been roundly debunked by public health experts, federal officials and the vaccine companies.

Florida Surgeon General Joseph A. Ladapo’s announcement, released as a state bulletin, comes after months of back-and-forth with federal regulators who have repeatedly rebuked his rhetoric around vaccines. Public health experts warn of the dangers of casting doubt on proven lifesaving measures as respiratory viruses surge this winter.

“We’ve seen this pattern from Dr. Ladapo that every few months he raises some new concern and it quickly gets debunked,” said Ashish Jha, dean of Brown University’s public health school who led the White House’s national coronavirus response before stepping down last year. “This idea of DNA fragments — it’s scientific nonsense. People who understand how these vaccines are made and administered understand that there is no risk here.”

Ladapo issued the bulletin as Florida Gov. Ron DeSantis (R), his political patron, fights to stay alive in the Republican presidential primary, in which he trails former president Donald Trump by more than 40 percentage points in head-to-head polls. The Iowa caucuses, the first nominating contest, are slated to be held Jan. 15.

“Providers concerned about patient health risks associated with COVID-19 should prioritize patient access to non-mRNA COVID-19 vaccines and treatment,” Ladapo wrote.

[Victoria Raverna]

Is Ladapo a real medical doctor? If so where did he study medicine? Maybe the university can take back his medical degree since apparently he is not qualified to be a medical doctor?

[LordMortis]

Nothing about treatments or vaccines, but I was happy to see this in mainstream news today:

“There is some early evidence starting to show that if you had COVID-19, there can be all sorts of problems after getting infected” and reinfected, says Dr. Robert Murphy, professor of medicine and executive director of the Havey Institute for Global Health at Northwestern’s Feinberg School of Medicine. “We are just at the beginning of learning about them.”

...

Underlying health conditions that people may not necessarily be aware of—like prediabetes or increased inflammation—could also put them at higher risk after each infection. “For somebody who is already on the edge of developing diabetes and then gets COVID-19, that could damage the pancreas and the endocrine system enough to change things,” Smith says. Similarly, having high rates of inflammation before COVID-19 could raise the risk of heart events such as stroke or a heart attack after an infection.

What about how it affects your immune system?

At this point, many people view COVID-19 as relatively benign. But even if you've already recovered from a mild case, there's no guarantee that next time will go as smoothly. "Just because you did okay with it last year doesn’t mean you’ll do okay with it this year,” Smith says.

“There is a mischaracterization in the public understanding that you can get an acute infection with fever, cough, malaise, and fatigue, get over it after a few days or a week or so, then bounce back, and it’s gone,” says Al-Aly. “The data are showing that [some] people still display increased risk of problems even two years after an infection.”

That’s what he found in his study. People who had multiple infections were three times more likely to be hospitalized for their infection up to six months later than those who only got COVID-19 once, and were also more likely to have problems with clotting, gastrointestinal disorders, kidney, and mental-health symptoms. The risks appeared to increase the more infections people experienced.

More importantly:

But there is also growing evidence that in some people, getting COVID-19 the first time may compromise the immune response in a way that makes the body less likely to respond effectively the next time it sees the virus. That could leave certain organs and body systems, such as the brain, weaker for months after infection—and subsequent ones. “It’s the balance of these two opposing forces—the immune system learning from the past and knowing how to deal with a virus and do a better job the second and third time around, and the idea that a first encounter with a virus might alter the immune system in some way that it becomes less efficient—that could explain why some people get Long COVID,” says Al-Aly.

Data also continue to show that even vaccinated people can get Long COVID—although the risk may be lower—since the protection provided by vaccines wanes over time, just as it does from infections. Vaccines are therefore a strong but not absolute barrier to the virus.

Say it again:

In the meantime, Smith says it’s important for people to understand that they still need to do everything they can to avoid getting COVID-19. That means staying up to date with vaccinations and taking some basic precautions, such as wearing high-quality masks indoors when cases are high, especially in crowded places and on public transportation.

“I wish we lived in a world where getting repeat infections doesn’t matter," says Al-Aly, "but the reality is that‘s not the case."

I don't see anything about gain of function, so he must be talking state over reach.

[Smoove_B]

Clearly.

For those that like pictures (who doesn't?), here's a story of COVID-19, as told through wastewater:



Note how the 2023/24 curve is currently the 2nd worst of the last 5 years. After all the vaccinations, repeated cases and half-asssed public health efforts, it's the worst it's been since 2021.

Regardless, given the shapes of the curves and when we've seen a rises in cases, I am not gonna lie - I'm kinda curious to see what happens over the next ~8 months. Will we have a curve that once again looks like last year (relatively low through the summer with a rise in September) or will it look more like 2022/23 where we had a rise in July/August?

All things being equal, I'm guessing it looks more like 21/22 curve, but with variants, its all a guess.

What's weird is that I can't figure out how the data for 20/21 is so low - before we had the vaccine. I wonder what we were doing back in 2020 that stopped the virus from spreading? I guess it will forever be a mystery.

[malchior]

What's weird is that I can't figure out how the data for 20/21 is so low - before we had the vaccine. I wonder what we were doing back in 2020 that stopped the virus from spreading? I guess it will forever be a mystery.

I agree lock downs helped bu I'm also curious about data availability/completeness for 20-21. In essence, if I were to assume 2021-2022 onward has some level of coverage (call it 100%), what does 2020-2021 look like as a dataset? Maybe 50% coverage? I don't have a real background on what was happening then but it'd be a question I'd ask if I were reviewing it with the creator of the infographic.

[Smoove_B]

"Lockdowns" are a misnomer. Don't kid yourself, very few places in America experienced anything resembling an actual "lockdown" despite what some news affiliates would like you to believe.

In truth our masking requirements - as shoddy and as half-assed as they were - made a huge difference. But that vocal ~30% that refused to comply mixed with the CEOs that testified how bad masking and testing were for business changed everything. So now we collectively live in their world - the world of f you, I got mine.

[stessier]

It's nice that our current curve might be peaking.

[LordMortis]

"Lockdowns" are a misnomer. Don't kid yourself, very few places in America experienced anything resembling an actual "lockdown" despite what some news affiliates would like you to believe.

In truth our masking requirements - as shoddy and as half-assed as they were - made a huge difference. But that vocal ~30% that refused to comply mixed with the CEOs that testified how bad masking and testing were for business changed everything. So now we collectively live in their world - the world of f you, I got mine.

We were technically in a lock down with "stay at home order" going on for months but it wasn't enforced for the most part, except for business owners. I want say it went from Late March until September where they started to open up the concept of essential workers and that became more and more open until the following September when schools opened again. In that time all kinds of crap came up including the governor ignoring her own orders and underground gyms and salons appearing everywhere.

[Smoove_B]

It's nice that our current curve might be peaking.

It is, yes. Risk is still elevated, but the hope would be that over the next few weeks we're back down to more reasonable levels. Not sure exactly when that would be (end of this month? early Feb?) but I'll be watching wastewater...because that's my life now.

[LordMortis]

It's nice that our current curve might be peaking.

It is, yes. Risk is still elevated, but the hope would be that over the next few weeks we're back down to more reasonable levels. Not sure exactly when that would be (end of this month? early Feb?) but I'll be watching wastewater...because that's my life now.

March... Right before it ticks up again in early April because everyone heads out for St Patty's day and think it's springs before huddling inside freezing cold and slobbering drunk. I'm sure it will be different on our 5th try this year.

[Alefroth]

What pandemic?

https://www.kron4.com/news/bay-area/oak ... ource=t.co

In a turnaround from 2020’s strict stay-at-home protocols, students can now go to class even if they test positive for the virus, according to a message from the OUSD COVID Response Team.

COVID-positive students no longer have to stay home, as long as they do not have any symptoms, according to district officials. Asymptomatic, COVID-positive students should wear a mask at school while indoors, the response team added.

“The updated guidance moves towards a more symptom-based approach to COVID-19, similar to guidance for other illnesses. Most important to note, the new guidance removes the recommendation for a 5-day isolation period following a COVID-19 positive test,” the team wrote.

[The Meal]

Those have been my work's guidance for at least a year. All symptoms-based, no reason for testing.

[Smoove_B]

Yeah, I mean who cares about asymptomatic spread anymore:

It is now well established that asymptomatic individuals can transmit SARS-CoV-2 infections (6–10), but asymptomatic cases are increasingly shaped by prior immunity (whether through infection, vaccination, or both).

...

In this manuscript, we explore the effects of asymptomatic infection and transmission on disease severity at the population level. In doing so, we assume that symptomatic individuals reduce their transmission, reflecting changes in behavior (e.g., self-isolation after symptom onset) and/or nonpharmaceutical intervention measures. Under this assumption, we show that a high proportion of asymptomatic infections could paradoxically make population-level outcomes worse than if SARS-CoV-2 was more dangerous at the individual level.

[Zarathud]

Businesses are going for plausible deniability. If you catch it from an asymptomatic carrier, you are unlikely to prove workplace disability or compensation.

[Smoove_B]

Senator Sanders is spear-heading a hearing on Long Covid, currently underway. I'm just waiting for some links...

You can watch it live here, but I'll post summaries and highlights when it's over, once I see them

[Zaxxon]

My attempt at a psychic prediction of how it'll go:

Experts: This is a thing. It's a documented, real thing. And it's scary, and it could be a medium thing or a Very Bad Thing long-term.
Democrats: Wow, this thing is a thing we should take seriously (but not too seriously).
Experts: Yes, we definitely should, and dare I say that taking this thing too seriously would not be a serious problem.
Republicans: GAIN OF FUNCTION! FAUCI!!!!!111!!! BUT YOU SAID THE VACCINE WOULD PREVENT ALL DISEASE AND INFECTION AND DELIVER A HEALTHY PUPPY TO EVERY HOME! LOLJUSTACOLD
Experts: What does this even me...
Republicans: LIBERAL COASTAL ELITE PROPAGANDA COMMON COLD ETC ETC TRUMP!
Democrats: We'll vote to fund this thing at 10% of what you experts would like.
Experts: *collective sigh*
Republicans: *block any action on the thing*

[Smoove_B]

It's in the Senate, so based on what I've seen in the last hour, it hasn't been insane. Of course Rand Paul and Tommy Tuberville are on the committee, so I guess anything is possible.

It's actually been rather comprehensive - focus on marginalized populations, diagnostic ability, pandemic preparedness, and they just covered building codes and indoor air improvements.

It's actually nice to hear people in Congress actually talking about it.

EDIT: Ok, maybe I'll dial that back a bit as Sen Cassidy is rambling on about randomized trials, because he's an epidemiologist (apparently)

[malchior]

They talk about a lot of things...endlessly...unfortunately Zaxxon has hit the nail on the head.

[Smoove_B]

I've not heard anyone in Congress talking about Covid in any capacity in a formal setting (especially as it relates to funding) in years.

[LordMortis]

My attempt at a psychic prediction of how it'll go:

Experts: This is a thing. It's a documented, real thing. And it's scary, and it could be a medium thing or a Very Bad Thing long-term.
Democrats: Wow, this thing is a thing we should take seriously (but not too seriously).
Experts: Yes, we definitely should, and dare I say that taking this thing too seriously would not be a serious problem.
Republicans: GAIN OF FUNCTION! FAUCI!!!!!111!!! BUT YOU SAID THE VACCINE WOULD PREVENT ALL DISEASE AND INFECTION AND DELIVER A HEALTHY PUPPY TO EVERY HOME! LOLJUSTACOLD
Experts: What does this even me...
Republicans: LIBERAL COASTAL ELITE PROPAGANDA COMMON COLD ETC ETC TRUMP!
Democrats: We'll vote to fund this thing at 10% of what you experts would like.
Experts: *collective sigh*
Republicans: *block any action on the thing*

You forgot CHINA VIRUS!, so I don't trust your assessment even as you admit GAIN OF FUNCTION.

[Pyperkub]

Some somewhat surprising news

The genetic sequence of SARS-CoV-2, the virus that causes Covid-19, was submitted to a National Institutes of Health database two weeks before its release by the Chinese government, according to documents that were shared with US lawmakers and released Wednesday.

The sequence doesn’t indicate the origin of the coronavirus but undermines the Chinese government’s claims about its knowledge of the information, one expert told CNN – and could have cost critical weeks in the development of a vaccine against the virus.

I expect the conspiracy theorists to have a field day with this, even tho Covid cases were already rumored (confirmed? I think so if memory serves, but I didn't research to verify) for (over?) a month before the upload.

[Zaxxon]

My attempt at a psychic prediction of how it'll go:

Experts: This is a thing. It's a documented, real thing. And it's scary, and it could be a medium thing or a Very Bad Thing long-term.
Democrats: Wow, this thing is a thing we should take seriously (but not too seriously).
Experts: Yes, we definitely should, and dare I say that taking this thing too seriously would not be a serious problem.
Republicans: GAIN OF FUNCTION! FAUCI!!!!!111!!! BUT YOU SAID THE VACCINE WOULD PREVENT ALL DISEASE AND INFECTION AND DELIVER A HEALTHY PUPPY TO EVERY HOME! LOLJUSTACOLD
Experts: What does this even me...
Republicans: LIBERAL COASTAL ELITE PROPAGANDA COMMON COLD ETC ETC TRUMP!
Democrats: We'll vote to fund this thing at 10% of what you experts would like.
Experts: *collective sigh*
Republicans: *block any action on the thing*

You forgot CHINA VIRUS!, so I don't trust your assessment even as you admit GAIN OF FUNCTION.

Excuse me... It's spelled 'CHHYYNA.'

[Punisher]

Some clarification needed.
From my quick Google search, gain of function means someone taking an animal virus and mutating it so that it can affect humans.
If this is correct then it sounds like a recipe or disaster and other than trying to weaponize it doesn't sound likea a legit thing to do.
That being said and understanding my complete lack of knowledge and existing brain damage IS thete a legit reason to do this?

[Isgrimnur]

What is Gain-of-Function Research?

GOFR aims to inform public health and preparedness efforts, as well as support the development of medical countermeasures (MCM) when conducted by responsible scientists.

Although some scientists argue that GOFR poses an unjustified risk to public health, this research has contributed indefinitely to the development of MCM, including vaccines like the yellow fever vaccine.

[Max Peck]

I'm not sure that the phrase "contributed indefinitely" really means what they seem to want it to mean.