Just the Facts, the Crown virus.

[hacknchop]

Roxie same here except mine were girls and now that the older one is gone the younger one can't get over missing her big sister.

[Andries]

So, Yellowhammer, I'm thinking Martha is due an extra generous birthday present ?
"  My wife went to the Hospital clinic where they give these, and while they were doing the infusion, she talked to the Dr. there and they told her to have me come in, because yes, I was qualified.  "

[YellowHammer]

You bet.  She got the present she asked for.  She said "No Jewelry!" and instead asked for this battery operated chop saw.  So what she wants, she gets!  We use it every day.




BTW, I dropped my Doctor and have started going to hers.  

[doctorb]

Just finished the monoclonal antibody infusion. No problems.

The science here is still in its infancy.  Different cocktails of monoclonal antibodies have been studied versus the delta variant.  Three of the four emergently approved "MAB's" demonstrate some effective actions versus delta, but all are reduced in their "potency" when comparing older forms of Covid to the newer delta strain.

Having been vaccinated, the overwhelming data shows that I was...1. Not gonna die from this Covid infection and 2. I have a very very small chance of being hospitalized from it when compared to the unvaccinated population.  Did I need to get this treatment to improve on those outcomes?  Probably not.  The issue is that very small chance that around day 7-10 my immune system gets kicked into overdrive and inflammatory reactions start cascading through my body.  I agree with doc h that they advise getting this early in the course of your disease so that you prevent your immune system from turning into your mortal enemy.  We, at this point, have no way to identify which patients are at risk for  that immune system over-response.

[doctorb]

New info on the wedding Covid infections.  We may have found Typhoid Mary!

Turns out, one of the guests, a mother in law to the bride's sister, came to the wedding along with her sister, both coughing and hacking.  She is a nurse, but believes Covid is a hoax.  Her son did not attend the wedding because he caught Covid (they live far apart). Her son's wife, the sister of the bride (she's negative so far) missed her sister's wedding to quarantine as well.  But this Mother in Law and her sister, with all their symptoms, came anyway.

They were seated at the table with my daughters, who were horrified by their continual respiratory symptoms, lack of covering their coughs, and lack of masks.  They avoided her as much as possible.  Unfortunately, now eight people and counting have tested positive from the event.

The MIL, however, remains a stalwart conspiracy theorist.  This week, she finally got tested and -surprise- was positive.  She believes certain corners of the Internet more than any doctor or public health source, so she's taking Invermectin, which she bought online.  This is an antiparasite drug used on livestock (worms, etc) that has been discussed as a potential treatment for Covid, but is unproven at this time. My understanding is that she had been forced into retirement for her refusal to get vaccinated by her employer.  I don't know if that was pre or post wedding.

So, I am sure that everyone will say that it's easy to place blame, and that I do not accurately know that she was positive at the ceremony.  That's true.  I do know, however, according to my many family contacts who were there, she and her sister were the only people demonstrating any overt respiratory symptoms.  You can imagine the texts flying around our families about this!

It just angers me how irresponsible people can be.  Myself and my oldest daughter are positive and quarantined.  My wife and my other daughter are negative, but quarantined.  The bride and groom (+) are quarantined from each other, as are the mother (+) and father of the bride.  Two bridesmaids are positive and quarantined.  Nobody is going to die, I understand that.  But there comes a time when personal responsibility must have some weight in one's decisions.  I'm glad she's retired from nursing.  The last thing I would want is to look up from a hospital bed and see her responsible for my care.

As they live far away, I may never see her again.  That would be too soon.  This is the monster that blind, blanket mistrust coupled with exaggerated self-justification of "personal freedoms" can create.  When are we going to act like our fellow man matters?  

Finally, this thread has been pretty apolitical, and I like that.  I am not trying to send the conversation in that direction.  IMO, this scenario remains a good example of the philosophic and medical bind in which we now find ourselves.  Stay healthy, everyone, and treat those you don't know as you would your friends and family.

[barbender]

That really chaps me, doctorb. I don't care if you think it's a hoax, sick is sick. They shouldn't have went if even if it turned out to be a common cold! I've missed plenty of gatherings over the years (and this is pre-covid) because I came down with something. It is just lacking common decency to go to a wedding, funeral, etc. when you are sick. 

[thecfarm]

I think I posted about a couple that came into the store wearing masks when all this started. They too thought it was a hoax, as they told me.  Than they both had it!! Mask for them.

[Nebraska]

I have read a little regarding the ivermectin usage and the dose I calculated to achieve what the author was claiming was above what I would consider safe to use in a person. Just an fyi.

Sorry Drb you can pick your nose, and your friends but alas not your relatives. The exercise of personal freedom also needs to be linked with common sense. They were wrong to go, and I hope they realize the error of their ways.

[Don P]

You're not dealing with enough mental horsepower to acknowledge that they are causing a problem.

[hacknchop]

Sorry Drb you can pick your nose, and your friends but alas not your relatives. The exercise of personal freedom also needs to be linked with common sense. They were wrong to go, and I hope they realize the error of their ways.

In case you already don't know the difference between in laws and outlaws , outlaws are WANTED.

[Paul_H]

What is involved in determining whether the virus is regular covid 19 or Delta or Lamda? Is it a single swab and many tests for each of the variants?  DrB which one did you catch? Was it further transmitted by those vaccinated or was it only Typhoid Mary that spread it to everybody?
I agree that nobody that is feeling ill should be going out in public these days but like others here have stated it was what most of us did at one time. The oldtimers would say "keep working, you'll sweat it out"

[doctorb]

Paul-

My infection was never specifically ID'ed.  That's because I knew that others already had been diagnosed, and the timing with the event was too perfect.  My diagnosis confirmation came from a home antigen test.   People with symptoms who test positive with such tests are over 99% sure to have the disease.  I do not know the process whereas one variant is identified versus another.  I will have to investigate that.

As the delta variant is by far the most widely reported infecting agent for Covid in the US right now, and it's easier to catch than previous subtypes, I have made the assumption that I am infected with the delta variant.  I am not planning any further tests to verify that specifically.  I will get a PCR test in a week or three as I need a negative PCR to get to Canada.

[Claybraker]

I have read a little regarding the ivermectin usage and the dose I calculated to achieve what the author was claiming was above what I would consider safe to use in a person. Just an fyi.

Sorry Drb you can pick your nose, and your friends but alas not your relatives. The exercise of personal freedom also needs to be linked with common sense. They were wrong to go, and I hope they realize the error of their ways.

I've used Ivermectin, the vet printed the dosage and told me to come back when the bottle was empty with a fresh stool sample from the pup. Same stuff?

[doctorb]

I assume so.  I've never heard of it used on people before, but maybe it is prescribed in countries where they have unsanitary water supplies and a high rate of intestinal parasites.

[Claybraker]

Just found out a cousin has been intubated and in ICU. I assume it's a breakthrough infection, she works in a 911 center would have been among the first eligible. Her hubby has tested negative, he's vaxxed, smart enough to do what his wife tells him after 30 years of marriage. She's being given heparin. Just when we thought it was safe to go into the water.

[YellowHammer]

What is involved in determining whether the virus is regular covid 19 or Delta or Lamda?

My daughter is an ICU nurse and moonlighted at the local Covid Testing and Vaccination lab, which was one of the first in Huntsville to identify a breakthrough Covid D infection of a previously infected Covid 19 patient.

The patient had already tested positive with Covid 19 a couple months previous by this lab, had gotten better, tested negative, and then had returned months later with a similar infection, tested again, and this came back positive.  At that point, after a positive repeat infection, the sample was sent off for "genetic testing" at Birmingham, Al, where it was subsequently identified as Covid D.

Even though Huntsville has several comprehensive testing facilities, the strain identification could not be done locally at the time, the sample had to be sent away.  That was several months ago, I don't know if they have a more rapid or local test at this time.  

It turns out that was only the second Covid D breakthrough in Huntsville, and it was only coincidence that it was identified immediately because it was in a person who already had been tested and eventually cleared of Covid 19 by that very same testing facility, and they had his previous test on file.

[Ianab]

I assume so.  I've never heard of it used on people before, but maybe it is prescribed in countries where they have unsanitary water supplies and a high rate of intestinal parasites.

Ivermectin is used on humans for the same issues as you give it to dogs. As a parasite treatment. Works on scabies and headlice and other weird tropical infestations. 

Ivermectin is available as a generic prescription drug in the U.S. in a 3 mg tablet formulation. It is also sold under the brand names Heartgard, Sklice and Stromectol in the United States,

I'm guessing it's given a different name so patients don't realise their Doc has given them a script for cattle drench  :D
Figuring out what variant the virus is needs genetic testing. It's pretty much routine now, but it takes longer than the screening tests. They do the genetic test on every positive case here to help with tracking infections. In an outbreak, if a case appears with a significantly different genetic sequence, then there is another cluster of cases to find and isolate. 

[doc henderson]

our lab sent swabs to the state after they tested +.  I am told now they are not doing that as they are all delta.

[gspren]

I've used lots of ivermectin in/on goats as a wormer/anti parasitic. I find it strange that people that don't trust the vaccines because they aren't totally approved would then use something that wasn't even intended for that purpose.

[Paul_H]

Sure beats dragging your butt across the lawn

[LeeB]

Sure beats dragging your butt across the lawn

Especially if you have sticker burs in the lawn. 

[doctorb]

The humor regarding relatives earlier in this thread reminded me of an interchange between myself and one of my patients in the preop area a few years ago.  I saw her in her cubicle, and she was all checked in and ready to go.  We went over the procedure again, and I asked if there was anyone with her at the hospital today.  She said "nope."  I then asked, "Any family members you wish me to contact after we're finished?"  She looked up at me with a straight face and said, "Family....the other f-word."  I laughed and took that as a "no". :D

[Old Greenhorn]

  She looked up at me with a straight face and said, "Family....the other f-word."  I laughed and took that as a "no". :D

Patients say the darndest things. ;D ;D
 I once had a geriatric patient in my ambulance on the way to the E/D for eval after a syncope episode and a fall. As I was running through the standard questions I asked here if she knew what day today is? She looked me square in the eye and said "Honey, I've been retired for 25 years, I don't give a [dang] what day it is!". "Ok", I said, 'can you tell me who the President is?' and she perked up a bit more and said "Oh sure, you mean that lying, cheating, weasel that wouldn't know an honest day's work if he tripped over it?'
 I just put the abbreviation for 'alert and oriented x 3' on my PCR report and moved on. She was a funny gal.

[scsmith42]

Doc and Doc,

For a layman, I found the article below to be refreshingly understandable regarding why vaccinated folks are still contacting Covid, can spread it, yet be protected by the vaccine all at the same time.

From what I can discern, the author is legit. 

Thoughts?

***************************************


I am in a unique position to report on what is going on with COVID-19, particularly the delta variant and why it's so dangerous, and how it interacts with the vaccines. I'm the Special Assistant to the National Director of Pathology and Lab Medicine for the entire Veterans Affairs system, with a specific role in advising on elements of COVID testing for the system.

RELATED: Florida's COVID battle in four charts
As such, I have a front row seat to all of the latest data since we use that information to make our national-policy decisions. So, here are a few important points that help explain why you should get vaccinated and wear a mask. I'll do my best to stitch this all together so it makes sense:


[img width= height=]https://www.tampabay.com/resizer/flFDhpJOHIJL1yC_EbPyyaIGd1Q=/620x0/filters:focal(112x104:122x94)/cloudfront-us-east-1.images.arcpublishing.com/tbt/RQ3WQ4DMAFBWPMJ3CZZTXNSPIQ.png[/img]

Dr. J. Stacey Klutts [ Provided ]

1. Like Gorilla Glue. The delta variant (lineage B.1.617.2) has a particular collection of mutations in the spike protein (that knob-like projection you see in renderings of the virus) that make it extremely effective in attaching to human cells and gaining entry. If the original COVID strains were covered in syrup, this variant is covered in ultrafast-drying Gorilla Super Glue (industrial strength).

2. 1,000 times higher. There are two recent publications which demonstrate that the viral loads in the back of the throats of infected patients are 1,000 times higher with the delta than with previous variants. I can tell you from data in my own labs, that is absolutely true. We are seeing viral signals we never saw last year using the exact same assays.

3. Much more infectious. This much higher load plus the ultra "stickiness" of the delta strains for adhering to human cells makes it remarkably more infectious than previous strains. You may have heard of R0 (Pronounced R naught) which is, in a nutshell, the number of people to which an infected person would be expected to transmit the virus. Early versions of the virus had a 2 to 2.5 R0 value. So one infected person would infect two or so people on average. Delta has an R0 of about eight! In the infectious disease world, that's almost unheard of. Chickenpox and measles are about all we have ever seen that spread that efficiently from human to human. This changes the story line completely from earlier in the pandemic and makes this surge, in many ways, like a completely different pandemic event.


4. Five days. There is another recent publication out of Singapore with data that confirms something we suspected. I will explain more about the "why" on this below when I talk about vaccines, but the gist is this: The viral loads in the throats of vaccinated persons who become infected with delta rises at identical rates as in unvaccinated persons, but only for the first few days. After five days or so, the viral loads in the vaccinated person start to quickly drop whereas those in the unvaccinated person persist. This key set of observations is important for several reasons relating to vaccinated persons serving as vectors for spread (see below).

5. Young people. This pandemic, Round 2, is primarily being observed in younger patients than in Round 1. Our children's hospitals are even already filling up or full. Because of the delta viral dynamics, it is much more capable of causing severe disease in a larger swath of the population. You spew enough of any human pathogen on someone without immunity, and it's not going to end well. This sets up very poorly for the beginning of the school year — which has already started in Florida — and it scares me. Check that. It is actually terrifying. I sure hope we have vaccines for the 5- to 11-year-olds soon.

6. Vaccines work! Speaking of vaccines. Are they working? Yes! They are absolutely doing their expected job. We know a lot about vaccines for upper respiratory viruses, as we have been giving the population one every year for decades (influenza). To explain all of this, I need to provide some biological context. When you get a vaccine as a "shot," the "antigen" in the vaccine leads to formation of an antibody response. You probably knew that. What's important, though, is that it primarily leads to a specific Immunoglobulin G (IgG) response. That's the antibody type that circulates around in really high numbers in the blood, is located some in tissues and is more easily detectable by blood tests, etc.

What that shot does not do is produce an Immunoglobulin A (IgA) antibody response to the virus at the surface of the throat mucosa. That's the antibody type that could prevent the virus from ever binding in the first place. As such, in a vaccinated person, the virus can still attach like it's about to break into the house, but it doesn't realize that there is an armed homeowner on the other side of the door. When that virus is detected, the IgG beats it up and clears it before the person gets very ill (or ill at all). (Sidebar: Anyone ever had their kid — or themselves — get the "Flumist" vaccine as their annual flu booster? The idea there is to introduce the antigens at the surface of the throat mucosa leading to that IgA response that will prevent infection from happening at all. Sounds good and still has a place, but it isn't quite as effective overall as the shot.)

7. Preventing disease and death. The COVID-19 vaccines are designed to prevent disease/death through that IgG response (though it does also reduce infections somewhat). How good are the vaccines at doing all of this with delta? The Centers for Disease Control and Prevention has just released data addressing that very question. Punchline: They're remarkably good! The vaccine shows an 8-fold reduction in the development of any symptomatic disease secondary to delta. For hospitalization, it is a 25-fold reduction. That's 25 times! Remarkable. For death, it is also 25 times! This is a very effective pharmaceutical class when looking at overall efficacy toward the intended/expected purpose. When looking at the very tiny side effect profile, I'd personally consider it one of the best overall pharmaceuticals on the market in any class of drugs.

8. So, you're vaccinated? First of all, a sincere, heart-felt thank you! But you may now ask, so why do I again need to wear a mask? We talked about disease, hospitalizations and death above, but what about infections themselves? The vaccines are now estimated to provide a 3-times reduction in infection. For reasons that I tried to make clear above, it isn't surprising that the vaccine is less effective at preventing infection vs. preventing disease. We are indeed seeing detectable virus, at high levels, in asymptomatic, vaccinated persons when we test them prior to procedures, etc. We have a few that are mildly symptomatic, too.

While we now understand that the virus fades from the back of the throat pretty quickly in a vaccinated person, we also know that an infected, vaccinated person can transmit this very infectious virus to others for at least a couple of days. So, as before, you are being asked to wear a mask to primarily protect others.

We need you again to interrupt the transmission cycle of the virus, as you don't know when you might be infectious. The vaccine alone cannot interrupt this cycle when there is a lot of virus in the community within unprotected persons.

9. What's next? I live and practice in Iowa, and I see the tsunami wave on the horizon. It's typical for respiratory viruses to begin in the southern United States (where it is hot and everyone clusters indoors in the air conditioning to escape the heat) and then creep north to affect those areas when it gets colder (and people go inside because it's getting colder). If you live in the north and are not vaccinated, it is not too late, but it's getting *DanG close. It's also time to start wearing masks in public again (ugh...I hate it, too).

Those of you in the south, particularly in Florida, know that the tsunami is already on your shores. If you weren't already off the beach, you might be in trouble. However, if you are there and haven't yet been affected, run like hell to metaphorical higher ground — get vaccinated, wear a mask.

I beg of you, watch that wave and don't ignore it. I have zero political agenda (I hate politics). I'm just a nerdy scientist and physician who loves you all, and I certainly don't want to see a mass of my friends grieving — or dead — because I didn't yell loud enough to get you and your families off that beach. So, run! (to your pharmacy ... driving is allowed). You don't want any part of this thing without vaccine on board.

Dr. J. Stacey Klutts is a clinical associate professor of pathology and clinical microbiology at the University of Iowa and is the chief of the Pathology and Laboratory Service for the Central Iowa VA Health Care System. He is the past president of the Academy of Clinical Laboratory Physicians and Scientists (ACLPS) and chairs the National VA Clinical Microbiology Council in addition to his national roles referenced above. This is adapted from a Facebook post with permission of the author.


https://medicine.uiowa.edu/pathology/content/dr-j-stacey-klutts-elected-president-academy-clinical-laboratory-physicians-and-scientists

https://www.researchgate.net/scientific-contributions/J-Stacey-Klutts-2030552875

[Ianab]

From what I can discern, the author is legit.  Thoughts?

Sounds about right. 

What's really needed is MORE actual information like that to be put out. It explains in a bit more detail what we have been told about the Delta strain. 

In other news, the Delta strain is now lose in NZ, one case so far. Having watched Australia struggle to control this, the Govt isn't taking any chances. Level 4 lock down for the whole country. 7 days for Auckland and Coromandel regions, and 3 days for the rest of us (so far). The worry is that the patient doesn't have any direct link to the border, so probably caught it from someone else (unknown), and that makes it likely there are other cases out there. 

We have watched the Australian cases go up from zero to ~500 a day over the past 6 weeks, in spite of gradually increasing restrictions. So the decision is to go hard and try and eliminate it again. The vaccine program is underway here, but behind many other countries, so too many unprotected people out there still. 

I think we were up to 169 days without a case in the community, but it's time to rest the counter....