Just the Facts, the Crown virus.

[Ianab]

I have been seeing some reports the current surge in pediatric hospitalizations may be confused with RSV cases which also has respiratory symptoms.

We have been seeing an "outbreak" of RSV here in NZ as well, and although the symptoms might appear similar, once the swab tests are done the Dr then knows what they are dealing with. I suspect there ins't really an "outbreak", just more cases being detected. I think part of the issue is that hospitals only have x% spare capacity, and "x" is quite a small number, in Dr H's current situation, it's 0. They don't need 5 more RSV AND 10 more Covid patients showing up tomorrow. 

Thing is RSV is more like the Common Cold, and it would probably be mistaken for it 95% of the time. Ministry of Health web page suggests most kids here will have had it before they are 2 years old, but resistance to the virus wears off and they can catch it multiple times over the years.  But unless there are complications, it's one of those things that the Family Dr will say "It's a virus, take some paracetamol and keep up the fluids". It can be dangerous to premature or very young babies, and some do end up in hospital. I'm sure from the symptoms our kids will have had it, taken a couple of days off school, and quickly recovered. 

With the Corona virus still spreading though, kids are being tested in case it's Covid, and the tests are confirming the "Mystery Virus" is RSV. 

[doctorb]

It looks like it is.  we will follow for a bit to see the data.  It looks like everyone will get the infection or the vaccine.

Or both!
Just attended a family wedding at Mt. Hood, Oregon.   Now the mother of the bride has Covid, my daughter, who officiated the service, has symptoms and has tested positive, and I have a "cold".  I'll get tested and have quarantined.  Have no idea how many others are showing signs and symptoms of Covid.  All three of us were fully vaccinated.  All symptoms are relatively mild.  Cough, runny nose, sore throat, and headache.  Never thought I would say that I just attended a super spreader event!  Jenny and I have been so careful....and now this.

[doc henderson]

we are seeing RSV, and para influenza.  croup in kids, and laryngitis in adults.  just saw a few kids with throwing up and diarrhea, one is adenovirus.

[Roxie]

Oh doctorb!  I'm so sorry!  

[doc henderson]

get some sleep @doctorb , if you are not working.  I am up all night (working), and a trauma meeting at 7 am.

[Ianab]

All symptoms are relatively mild.

Here's hoping the vaccine at least worked well enough to keep things that way. 

[doctorb]

Hunkered down.  Have a PCR drive through test tomorrow.  May get an antigen (immediate) test today if I can find one. Went to 2 pharmacies yesterday and they were sold out.  

I actually feel fine, except like I have a cold.  In my working days, I would have gone to work with the degree of symptoms I currently have.  Heck, many of us worked through colds all the time.  

It is interesting that all 3 people mentioned in my post with post-wedding illness had the Pfizer vaccine.  My wife had Moderna, as had my other daughter who also attended the ceremony.   They have shown no signs of infection. The father of the bride also had Moderna and is symptom free.  I read that Moderna has better coverage of the Delta variant, but I think that needs corroboration.

Was planning to head to our cabin in Canada for the first time since October 2019 next week.  Kinda threw a monkey wrench in those plans.

[Shotgun]

Good luck Dr. B. Probably you'll come through with flying colors. Keep us informed.

[doctorb]

Thanks, Shotgun!  That's the plan!

Given the timing of this wedding and the onset of my symptoms, it's no surprise to me that my instant (antigen) Covid test was positive today.  So it's 10 days of quarantine from the beginning of my illness.  No need for a PCR test tomorrow.  While not as accurate as the PCR test, the sequence of events and the positive antigen test confirm for me all I need to know.  

[scsmith42]

Dr B, I hope that you have a complete and full recovery.

There was an article out yesterday about the long term effectiveness of the Pfizer versus Moderna vaccines. According to the study the Pfizer lost about half of its effectiveness after 6 months, versus only 25% or so for the Moderna.

The study was conducted by the Mayo Clinic and another party.

https://news.yahoo.com/data-suggests-pfizer-modernas-vaccines-090012364.html

[SwampDonkey]

I heard Moderna themselves say 6 months effectiveness for theirs, announced 2 weeks ago.

That was recently updated a week ago when they told Time that the vaccine was still 93% effective at 6 months.

Pfizer said 84% after 6 months.

I believe they are talking the old viral strain, not Delta.

And that linked report above states:

'There has been no data so far that has found either vaccine's protection against severe disease and death is significantly less against Delta, and the study notes that there doesn't appear to be much of a difference in complications stemming from breakthrough infections based on which vaccine someone got.'

I'm pretty much sure, there is going to be a booster needed no matter which one was given. There's been talk of it for weeks.

[Claybraker]

When I got Pfizered in April they told us in the waiting area all 3 manufacturers were looking at a booster. At least they've got most of the kinks ironed out in the delivery infrastructure so it's not like they have to train a bunch of new people on new procedures. 

[doctorb]

My doc weighed in today.  Because of my age (70), he is suggesting both the antiviral medication Remdezivir and the monoclonal antibodies.  I'm not going to go against his recommendations, but I feel like I just have a cold.  He says that, when Covid turns bad, it's about day 7-10.  There is no data on the use of these meds in vaccinated people who get a breakthrough infections because breakthrough infections are so new.

[gspren]

Well @doctorb I'm just a youngster compared to you, wont be 70 for another 4 months :D, but I tend to take my doctors advice, if I didn't trust her I'd change doctors. Best wishes from here.

[YellowHammer]

My wife and I both had the monoclonal antibody infusion as we became symptomatic between Moderna vaccinations.  20 minutes or so of IV, 45 minutes of waiting around watching TV to see if we had a reaction.  Pretty much a non event.

I wasn't feeling too bad with Covid, my wife was doing significantly worse, and I started feeling improved the next day, and both of us were feeling improvements by day two.  When the hospital did a followup, they said most people reported decrease in symptoms by day two, which was also our timeframe.  

[doc henderson]

if a study came out that said it was good for 3 years, you would have to ask yourself, how was a study done looking at a 3 year history when the vaccine has only been used for 1.5 years.  early on, they were following the antibody titers produced, but most protection for viral stuff is from cellular immunity, not antibodies.

[doctorb]

Been doing some snooping with my Infectious Disease friends.  The Remdezivir may not be indicated, as it's usually reserved for hospitalized patients who are trending toward requiring a ventilator.  The monoclonal antibodies (MAB) may be a good idea.  Waiting to talk to the people in charge of making that decision at the Univ. Of MD.

[doc henderson]

I would move fast on the mono clonal antibody, as it will stop the replication attaching to the spike proteins.  I have thought for a while that the viral medication should be started sooner, as we wait until people are very sick.  that should change as this in no longer in short in supply.  the only consideration in not using the mono clonal antibody, may be to develop a stronger protection in the future, but if you get very sick, it will be too late.  

[Roxie]

Aren't both those treatments the protocol given to Trump?  I like knowing our doctorb is getting Presidential treatment. 

[doc henderson]

It has been strange how we are told to use these, based on the fact they are still experimental and were in short supply.  docs often use medications "off label" but you have to be careful if it is under an emergency use authorization.  I do not remember for sure what all trump got.  

[YellowHammer]

From what we were told by the medical staff on the monoclonal antibodies, its best given before things get bad, be given early in the disease, and from the nurses at the hospital, the followup they did, and from our own experience, very effective.  We didn't take any other treatment and what was odd was that when I notified my physician of my positive test, they prescribed antibiotics, steroids, etc.  Kind of a shotgun thing.  I wasn't impressed.  I didn't take any of them.  I figured I'd just work through it.

However, my wife was coughing, clearly getting worse, I wasn't too bad, and she telemed her doctor.  We were both in the den when she made the call and her Dr. said they could get her in for monoclonal treatment because of a previous condition, and in real time they made her appointment at the hospital and said go on down.  I'm sitting there , thinking "What the heck??"  So I called my Dr. and asked for the same treatment based on one of my conditions.  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.  So literally as I'm walking out the door with my truck keys in my hand, my Dr. office calls me back and says they can't get me in, I don't know why.  What a swing and a miss.  So I drive there, I fill out the forms, they check me out, I get accepted, they hit me up, and a couple days later I'm feeling improved.  The nurse there said their feedback had been overwhelmingly positive, but they were seeing people waiting too long to come in for this particular treatment, as once they gets to the point where someone has to be admitted to the hospital, other more drastic treatments were required.  She herself was 26 years old, had Covid, let it get too far, stopped breathing, was revived with an Epipen at the hospital emergency room, and said she almost died right there at the hospital.  Quite an eye opener for me.

From what they told me, they had plenty of these monoclonal treatments, and the biggest issue was getting the word out.  They had literally dozens of infusion stations set up, some occupied, some not.  Very professional and organized.  I was most impressed.  During that time and for weeks later, the local news networks were broadcasting that they had plenty of doses.

These were given by the Huntsville Hospital, Fever and Flu Clinic.  This is just my experience.        

[doc henderson]

It is like the monitoring for termites, and killing them before they can get all over your house.  shuts it down and cannot spread cell to cell.  after it is all throughout your body, no longer helps to stop cell to cell transfer.  The antiviral however should work early, and was withheld unless in the hospital.  I hope we can start using more common sense soon.

[Roxie]

We're Americans. We'll figure it out. 

[Dan_Shade]

Especially if we can stop fighting about everything....

[Roxie]

My sons are exactly four years apart and my pediatrician told me that was ideal spacing to prevent sibling rivalry. He was fresh out of med school at the time. Wasn't long before I had to disillusion him with the fact that all it accomplished was to make the fights uneven. 

Those two boys were at it constantly. I even came home to find a perfect imprint of my ten year old in the living room drywall. However, let a neighbor kid touch one or the other, and the wrath of God was rained down upon the interloper. The school kids and several men that mommy tried to date, called them the Anderson mafia. 

We're just like those children. We'll work it out.