IM DOc pt 18

[temporaryreality]

 Anecdote from alert reader pq:

Thanks! Per recent NC link, I’m in the highest reaction group, but three days since Moderna #2, and still no reaction (arm still a little sore). A friend told me her father had no reaction to Moderna 2 and theorized it was because he hyper-hydrated starting the day before. I tend not to drink enough water so started guzzling Thursday for Saturday jab. While checking into the VA clinic yesterday for PT, I remarked to the admin that I was surprised I was feeling well enough to make the appointment. Without prompting, she replied, ‘The key is hydration.’ On my way out, I asked her for a source on that info. She didn’t know where the recommendation originated, but said she was working the COVID vax operation at the regional VA medical center, and that’s what they were telling everyone. They’d told me that at the clinic, too, but I took it as the standard advice for cold and flu in case of flu-like reaction, i.e., rest, take ibuprofen, drink lots of fluids, etc. She said that was also recommended, but said specifically that her group was telling people to make sure they stayed hydrated before and after being vaccinated.

IM DocMay 5, 2021 at 3:01 pm

I have looked at both the Pfizer and the Moderna vaccine handouts and physician information. I am seeing nothing about hydration on the Pfizer documentation. On the Moderna documents, there is a comment encouraging patients to be fully hydrated before their vaccination.

I will look into this later today with colleagues. If I am able to find anything more, I will certainly share. I have not heard anything about this before. Other than, in general, it would seem to be common sense to approach any medical intervention fully hydrated.

Seychelles, World’s Most Vaccinated Country, Hit by Covid Surge….Including Among the Vaccinated

Posted on May 6, 2021 by Yves Smith

The Seychelles is a tiny country, with a population of less than 100,000 people. It is nevertheless providing a cautionary tale in what happens if you relax Covid protections and rely over-much on vaccinations as your Covid firewall. It’s in the midst of a Covid outbreak so severe that it has had to reimpose lockdown-type measures like closing bars and schools, despite having over 60% of its adults fully vaccinated.

The trigger appears to have been reopening the archipelago for tourism. From Bloomberg:

Seychelles, which has fully vaccinated more of its population against COVID-19 than any other country, has closed schools and canceled sporting activities for two weeks as infections surge…

To date 62.2% of its eligible population is fully vaccinated, according to the Bloomberg Vaccine Tracker. That compares with 55.9% for Israel, the next most vaccinated nation.

Colonel Smithers added via e-mail:

The BBC article [cited below] did not mention that a few weeks ago Seychelles and Maldives opened their borders to tourism, somewhat to the envy of their competitor for tourist hard currency Mauritius.

The big Mauritian hotel operators have hotels in Seychelles and Maldives and have been lobbying for Mauritius to open, too, and cited the example of the pair.

This included getting a doctor heiress to a hotel fortune, amongst other sources of income, to write about the need to open in the island’s largest circulation newspaper. She quoted that 60% vaccination figure as conferring herd immunity, which dad challenged in a BTL comment.

Seychelles and Maldives reported that a few thousand visitors had arrived within the first week of opening and Emirates and Turkish Airlines, with their spokes and hub models centred on Dubai and İstanbul, had been the first airlines to return and to some fanfare.

Seychelles and Maldives have been advertising that they are open for business in the likes of the FT and Guardian and on CNN in the past fortnight. Not just tourism, but people able to and wishing to work from home or just sit out the pandemic for a while in the tropics, not necessarily those with any connections to the archipelagos.

One wonders if variants from around the world which render the current vaccines ineffective have caused this.

It is hard to blame vaccine choice. Seychelles used Sinopharm, which according to the BBC, has performed well, and AstraZeneca. And as you can see from the chart below, these vaccines don’t require as much special handling as the mRNA alternatives, meaning the odds of spoilage would be lower. From the BBC (hat tip vlade):

The Seychelles, which has fully vaccinated over 60% of its population against Covid-19, is bringing back restrictions amid a rise in cases.

The archipelago of nearly 100,000 people recorded close to 500 new cases in the three days to 1 May and has about 1,000 active cases.

A third of the active cases involved people who had had two vaccine doses, the country’s news agency said….

More than four-fifths of the active cases were among Seychellois people, with the remainder made up of foreigners.

We don’t have more granular data as to whether the bad outcomes occurred heavily among citizens who weren’t far enough past their second shot to have received full immunity. But this is still not a good look. Again from BBC:

By mid-April about 60% of the vaccine doses administered in the country were Sinopharm, with the rest Indian-made AstraZeneca vaccine doses, Bloomberg reported….

Trials in China and the United Arab Emirates have put Sinopharm vaccine efficacy at 79% and 86% respectively.

I have been concerned that the odds of the new variants escaping the current vaccines has been underestimated. Note that experts outside the US have argued that an inactivated virus vaccine should offer better protection against variants than the mRNA vaccines, so the use of an “old technology” vaccine does not seem likely to be the cause of these results. For instance, from LiveMint in March:

India’s mass covid-19 vaccination drive, which began on 16 January, entered its second phase on Monday to include senior citizens and those over 45 years with comorbidities. The programme includes two vaccines. Covishield, developed by AstraZeneca-Oxford University, is based on a recombinant chimpanzee adenovirus vector that encodes the spike protein. Covaxin, developed by Bharat Biotech in collaboration with National Institute of Virology, is an “inactivated” vaccine that uses killed SARS-CoV-2 virus, eliciting an immune response targeting more than just the spike protein. In an interview with Mint, Dr Shekhar Mande, secretary, department of scientific and industrial research and director general, Council of Scientific and Industrial Research, spoke on how the antibody response by a killed virus vaccine is likely to offer greater protection against mutated variants of covid-19, than vaccines generating antibodies against spike proteins….

Interestingly, the breadth of antibody response generated by a killed virus vaccine is likely to offer greater protection against mutated viruses, than vaccines that generate antibodies against the spike protein.

Note that a more technically-oriented article concedes the efficacy versus variants issue while still defending the mRNA approach. From Clinical Trials Arena:

Despite the theoretical potential of inactivated virus vaccines to offer a lead over other Covid-19 vaccine technologies against variants of concern, experts said they are unlikely to be a long-term solution. While it is logical that these vaccines could have better efficacy against variants that have mutations in the spike protein, they come with existing baggage such as relatively lower efficacy versus other Covid-19 vaccines, they noted. And though inactivated virus vaccines have an edge in initiating a T-cell response, the overall value of this mechanism is still unclear in the context of Covid-19 vaccine development, some added.

Hopefully the surge in Seychelles will focus some minds and lead to more caution about reopening. But given animal spirits and business clamoring for income, probably not.
 

cocomaanMay 6, 2021 at 8:35 am

What a big pile of garbage from The Atlantic. A lot like the NYT “travel to the hinterlands” except lazier.

What are they thinking, these vaccine-hesitant, vaccine-resistant, and COVID-apathetic? I wanted to know. So I posted an invitation on Twitter for anybody who wasn’t planning to get vaccinated to email me and explain why. In the past few days, I spoke or corresponded with more than a dozen such people. I told them that I was staunchly pro-vaccine, but this wouldn’t be a takedown piece. I wanted to produce an ethnography of a position I didn’t really understand.

Is Twitter representative of the population? Is it a good place to run an ethnography? Give me a break. Author is using twitter because he doesn’t want to leave his home office. And then:

After many conversations and email exchanges

Many is twelve?

1. Try something like “DoorDash for vaccines.”

Someone kill me now. The cringe is too strong.

 

1. IM DocMay 6, 2021 at 9:05 am

   I will say again – I have just as many blue liberal professional patients balking as I do MAGA folks. This clearly is a take down of the Neanderthals.

   But he gave away his game in striking fashion. “I am rooting for the vaccines.”

   Let me ask a simple question. Are journalists supposed to be rooting for their covered subjects?

   At least he admitted it. He is forever banned to the trash in my mind.

   Somewhere Edward R Murrow is doing RPMs. The profession of journalism is clearly as compromised morally as my own medicine, maybe more so.

   Lord Have Mercy.

CanChemistMay 10, 2021 at 10:37 am

Today in Canada, our equivalent of Fauci (Dr. Tam) was explicit:

CTV: Tam warns that full vaccination does not equal full protection from COVID-19
https://www.ctvnews.ca/health/coronavirus/tam-warns-that-full-vaccination-does-not-equal-full-protection-from-covid-19-1.5419843

“Canada’s chief public health officer reminded Canadians on Saturday that even those who are fully vaccinated remain susceptible to COVID-19. …’But it’s not absolute. There’s reduction in your risk of transmission, but it doesn’t necessarily eliminate your risk of transmission’.” More discussion in the article.

A few more points,
-Breakthrough is to be expected because we know efficacy isn’t 100%, particularly so for newer variants. Provincial modelers here have estimated 60% in their models. I agree that it makes no sense for CDC not to track this. I have also seen in Ontario an unwillingness to discuss these implications publicly – I would agree with Greg’s guess above.

-We knew it was likely to go endemic early on, and it has. We will likely need boosters 1-2x year to account for variants as well as waning immunity. We already do this on influenza vaccination and I don’t see how this will be any different. I’ve seen estimates that it will take 5-10 years to reach an equilibrium in the population, so I think in the near to medium term, yes, there will be a lot of booster shots.

1. IM DocMay 10, 2021 at 11:54 am

   We already do this on influenza vaccination and I don’t see how this will be any different.

   This approach may absolutely be required in the future – I agree.

   I would completely disagree with the idea that we already “do” this with the flu shots. I have been fighting for years for people to get flu shots. 30 years of trying every way imaginable to get older people to do it. My EHR at this very moment in time – is telling me that only 18% of my 1327 Medicare patients have been vaccinated for the flu shot in either 2019 or 2020. It is undoubtedly a bit higher, because we do not capture all of them from outside pharmacies – but even that is no longer much of an excuse – the computers do talk to one another much better than they did just 5 years ago.

   At best that number is 33%. I would be confident to state that yearly or every 6 month COVID vaccines would be about the same if not much lower. You will be dealing with a much younger population.

Health Care

Scripps Health CEO Confirms to Staff That Information Systems Damaged By Malware NBC San Diego. Epic fail?
 

IM DocMay 11, 2021 at 7:15 am

With regard to the Scripps Clinic EMR ransomware disaster.

It is Epic. It is clearly involving patient care issues such as scheduling and portal messaging and medical records. So, this is not just “internal servers”.

I cannot tell you how many times I have set through Epic meetings with their employees bragging that their systems and software are impervious to hacks.

Smaller non-epic hospitals have been hit before. This is the first Epic whale.

I have known this day was coming for a long time. These systems are a disaster.

Americans, when your Doc is putting your private medical info into a computer, as of today, he may as well be putting it online for the world to see. You have been warned.

And I am certain the CEO’s hesitation to talk is because of his EPIC contract. It is boilerplate in all of them. No matter what happens, even if Epic’s fault, you can say or do nothing.

 

1. MiltonMay 11, 2021 at 9:52 am

   I’m with Scripps Health and have received no direct notification of any of this, though it may be because the entire system is crippled. My portal entry is down as are the billing sites. Those large rooms with volumes of patient records in color-coded file tabs are looking better and better.

    
2. CNuMay 11, 2021 at 11:54 am

   IM Doc,

   No dog in this hunt, but in the interest of clarity, the article and embedded t.v. news stories don’t give any indication that Epic platforms/applications were attacked. Rather, it is stated that the email system and portal integrations were hit by malware. This would be consistent with every other ransomware attack with which I’m familiar.

   Further, most cyber-insurers implement a complete information clampdown in the event of such incidents. My guess is that industry-standard low per capita spend on IT at Scripps left Windows based systems – with which Epic is integrated – vulnerable to attack. Further, no telling how long or how extensively that email system (Exchange?) was compromised and Scripps systems surveilled – prior to the actual ransomware attack.

   Going after Linux backend systems would be highly atypical, inclusive of Epic’s database and application servers.

    
   1. Yves SmithMay 11, 2021 at 11:24 pm

      All of IM Doc’s patients with appointments through June have had them cancelled. That is not the behavior you would see with the level of attack you describe. Scrips is not being truthful.

      Via e-mail:

      All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.

BittercupMay 13, 2021 at 7:26 pm

“Across the country, health clinics said that many patients were uniquely excited about the one-shot regimen—due to either skepticism about mRNA technology or fear of needles. Some of that enthusiasm evaporated after the pause, doctors told The Wall Street Journal.”

Also in J&J news, CDC upped their blood clot count to 28, new doses won’t be coming anytime soon per WaPo, and Norway is considering dropping it along with AZ. Is it conspiracy-brained to wonder if it’s being squeezed off the market in favor of the mRNA vaccines? Is the safety profile for the J&J seriously that much worse than for Pfizer/Moderna that it deserves this special treatment? What is Sputnik V doing differently with the same adenovirus vector as J&J? Be nice if J&J took them up on that purification technology offer and looked at it to see if that would work better.

 

1. Yves SmithMay 13, 2021 at 8:37 pm

   To your answer, our IM Doc says the VAERS database shows enough heart/stroke incidents with Pfizer/Moderna, which if you make conservative assumptions about how many were clotting induced or related, suggests that they have similar problem. This was indirectly confirmed when he described a horrific clotting case with a middle aged very healthy man who after his first Moderna shot, had a blood ox plunge in hours, tested positive, and experienced clotting that got much worse on the administration of Heparin (clotting so bad that his platelet count plunged, meaning a lot were tied up in the clots). Led to a pulmonary embolism. This was about a week BEFORE the J&J clotting story broke. Same pattern, different drug.

IM DocMay 14, 2021 at 8:51 am

Dr Walensky on Tuesday

I will not let my vaccinated son go to summer camp without a mask.

Dr Walensky on Thursday 48 hours later

Anyone who is vaccinated can get rid of their mask and no more social distancing. We’re all good.

Americans – what has changed in the scientific data between that 48 hours?

Young Americans – believe it or not, the CDC was once the envy of this entire planet.

Now it is being run by someone who is a liar, a charlatan, or a political numbskull – pick your poison.

We were so much better than this in the past. I just simply cannot believe what has happened to our public health infrastructure.

I do despair for the young of this country. They will never understand the concept of competence with leadership like this.

CanChemistMay 17, 2021 at 7:47 am

Compare and contrast with Canada – our reopening guidelines were just released by federal public health on Friday.
https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/awareness-resources/vaccinated-against-covid-19.html

I was… very pleasantly surprised. This strikes me as quite conservative and appropriate based on what we know so far especially regarding vaccines and variants. No starting reopening until 70%single / 20% double and no serious reopening until 75% double, and all with low cases. Reinforcement of mask wearing. Right now we are at about 50% single in Canada with low double.

I suspect the timing was not a coincidence, but an attempt to 1. get out ahead of this US nonsense and 2. get out ahead of provincial nonsense that’s starting to brew (since Ontario in particular just can’t seem to stop winging it about parameters for reopening, which led to our current stay at home order).

The CDC statements quite frankly amaze me. The US will certainly converge to herd immunity the old fashioned way since covid is so contagious that one’s choices appear to amount to either getting a vaccine or getting covid. But the idea that you’d just throw in the towel at this stage without even trying to mitigate things anymore, in a way that can likely never be reversed, is appalling.

 

1. ambritMay 17, 2021 at 9:05 am

   The problem with the “herd immunity” argument is that there is evidence that one can both ‘get vaccinated’ and ‘get Covid.’
   This is looking more and more like a sub-conscious decision to implement Social Darwinism.

    
   1. CanChemistMay 17, 2021 at 9:12 am

      Regarding herd immunity, yes, breakthrough cases are expected, because no vaccine is 100% regardless, plus the issue of the variants. There will most certainly be some fully vaccinated people who also get covid, the question is whether it will still disable / kill them. Evidence so far is that death at least is greatly reduced. Exposure to covid after vaccination is still enormously preferable to without.

       
      1. ambritMay 17, 2021 at 11:05 am

         I ‘get’ the herd immunity theory, but note that this pathogen might end up like the flu viruses, with yearly ‘booster shots’ tailored to the latest estimated ‘major’ varieties. The various health authorities have a spotty record with the effectiveness of the yearly flu shot’s efficacies.
         I’m really worried about, first, the long term effects of the mRNA vaccines, and, second, the effects of “long covid” on the population. the second effect is what motivated my social darwinism comment.
         We are still in very early days with this pathogen.

          
         1. CanChemistMay 17, 2021 at 11:42 am

            Yes, I fully believe it will be like flu shots, as I’ve stated elsewhere. Sterilizing immunity with a coronavirus vaccine was never really in the cards. In that sense, ‘herd immunity’ will be a dynamic thing, relative to most people antibody status vs circulating strains. I’ve heard from pandemic experts that it could be 5-10 years to reach some sort of equilibrium in the general population.

            I would actually agree that there are a lot of unknowns about these newer vaccines, but right now with the data we have, vaccination still appears to be the lesser of the evils by far. People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data. It’s not a great situation. Personally I’m choosing to vaccinate.

             
            1. JasonMay 17, 2021 at 12:06 pm

               People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data.

               People I respect and know in both the medical and scientific community (not many, admittedly – these aren’t my circles) poo-pooed Ivermectin and continue to flippantly dismiss those in their own ranks with differing views on vaccination and how it should be used in relation to what are very different viruses. Polio is not the flu is not coronavirus is not human papillomavirus. Etc.

               The vaccine for human papillomavirus is one of the only vaccines that provides complete sterilizing immunity. The polio vaccine doesn’t. The flu and coronavirus vaccines never will. Obviously.

               Max Planck, where are you?

                
      2. IM DocMay 17, 2021 at 11:42 am

         Unfortunately – the concept of “herd immunity” applies to some viral infections and not to others.

         The fact that this “herd immunity” concept for coronaviruses is being whipped around in our media and spoken from the rooftops by our medical leaders is just sinful. The misinformation is causing people to make all kinds of false assumptions about their own health and the health of our communities and thereby do things that are at best counterproductive. It really is quite startling.

         Measles is an example of a virus that read the chapter about herd immunity, influenza clearly has not. To wit, having a profoundly infectious virus like influenza kill millions a year and require yearly vaccinations is NOT an example of herd immunity.

         Respiratory viruses as a rule do not follow that credo. Coronaviruses most certainly do not.

         We have 4 others in wide endemic circulation in humanity that sicken billions every year.

         The “flu” pandemic of the 1890s – the Great Russian Flu – was almost assuredly caused by Coronavirus OC43 – one of those 4. And yet – now 120 years after its release into the landscape – it kills 2000-10000 people globally every year – and is responsible for all degrees of flu and cold like illness for billions. This is NOT an example of herd immunity. You do not hear similar case studies about infections like measles.

         What happens is these viral infections are birthed when just the right mutations cause them to be able to jump to humanity. They almost all start with a pandemic. Some of them abort immediately or after a season for at times inexplicable reasons at times very obvious reasons ( MERS and SARS1 are examples). If still viable (and COVID19 appears to be winning the viability test) , the viral genome and our own immune systems do a years long “hot war” and then we settle in for a “cold war” for eternity. It has all happened before many times – and it will all happen again. There is simply no other way. It is the price of admission on this planet. It happens to humans and animals alike.

         How the vaccines will play in this “hot war” is absolutely an open question at this time. This type of vaccine intervention has never been attempted in all of human history during the “hot war” phase of the process.

         The fact that our media and our global medical leaders have not communicated these basic medical facts to the populace in any kind of appropriate and understandable way is a disgrace for the ages. These simple facts were known to us for a very long time – this was taught to me in medical school decades ago – and nothing has changed except our own hubris and ridiculous expectations.

         I would love to be able to read the exposes and head-shaking reports about this era that will be available to my children when they are 70. I am certain it will be quite entertaining.

          
         1. JasonMay 17, 2021 at 12:12 pm

            Thank you IM Doc, You help me keep my sanity!

             
         2. curlydanMay 17, 2021 at 1:44 pm

            thanks, IM Doc for your detailed perspective. I was just thinking yesterday that it’s not a case of not getting COVID-19, but more of a case of when I get COVID-19, how well will my immune system be prepared for it. Right now, since I’ve vaccinated recently, I’m guessing I’m fairly prepared. In 6 months, who knows? Can my immune system’s memory be good enough to make up for lack of antibodies?

            I think asymptomatic infections are way under-reported (or not reported at all thanks to the CDC), and knocking the masks off everyone will cause the virus to pop up asymptomatically more and more.

             
         3. DariusMay 17, 2021 at 3:56 pm

            This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

             
            1. IM DocMay 17, 2021 at 5:07 pm

               I would like you to direct me to any information from any source regarding any global pandemic contagion in the history of mankind that has been “solvable” in the manner in which you are suggesting.

               There is but one solution – learn and understand how it is transmitted and educate the populace in methods to mitigate their risk as best they can. You never know, tools may in the future be determined that can help – the vaccines may be one such tool – but we are way too early to even begin to know that. Other than that – the war between the virus and our communal immune system must play itself out.

               Unfortunately, that is the only way. That has been a rule of living on this planet from time immemorial. I know that we feel we are indispensable – and we can figure any and everything out. Unfortunately that is just not the way this process works.

               Really and truly – if you can find a single case where mankind has “solved” a global pandemic in the way you are suggesting – I will be all ears.

               There will likely be some time when we have achieved the ability to “solve” this problem – and this may be the time – but at this point – there is absolutely no way to know that and so far things are not looking so rosy.

                
            2. Lambert StretherMay 18, 2021 at 5:15 am

               > This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

               I think you and IM Doc are talking at cross purposes re: “Solvable.”

               Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

               The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

               (Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

1. antidlcMay 17, 2021 at 3:21 pm

   As readers have likely heard, the CDC issued new guidelines on Thursday which amount to declaring victory against Covid, with only 35% of Americans fully vaccinated and it not known whether “breakthrough” asymptomatic cases can spread the disease.
   …
   We have no basis for thinking that asymptomatic cases among the vaccinated operate any differently until we have evidence.

   In case anyone missed it:
   https://www.cbsnews.com/news/transcript-dr-anthony-fauci-face-the-nation-05-16-2021/?ftag=YHF4eb9d17
   ———————-

   DR. FAUCI: Well, what’s happened, there’s been an accumulation of data on showing in the real-world effectiveness of the vaccines. It is even better than in the clinical trials, well over 90% protecting you against disease, number one. Number two, a number of papers have come out in the past couple of weeks showing that the vaccine protects even against the variants that are circulating. And thirdly, we’re seeing that it is very unlikely that a vaccinated person, even if there’s a breakthrough infection, would transmit it to someone else. So, the accumulation of all of those scientific facts, information and evidence brought the CDC to make that decision to say now when you’re vaccinated, you don’t need to wear a mask, not only outdoors, but you don’t need to wear it indoors.

   JOHN DICKERSON: So, on that third point, let me ask you this. If I have no symptoms and I have been vaccinated, but I- but I am infected, what’s the difference between that? And if I have no symptoms and I’m infected but have not been vaccinated?

   DR. FAUCI: Good question, JOHN. And what the- what the issue is, is that the level of virus in your nasal pharynx, which is correlated with whether or not you were going to transmit it to someone else, is considerably lower. So even though there are breakthrough infections with vaccinated people, almost always the people are asymptomatic, and the level of virus is so low, it makes it extremely unlikely, not impossible, but very, very low likelihood that they are going to transmit it. Whereas when people who are getting infected, who were without symptoms, who are not vaccinated, generally the titer or the level of virus, relatively speaking, is higher than in the vaccinated individuals.
   —————

   Where is his proof for these statements?

    
   1. Yves SmithMay 17, 2021 at 7:04 pm

      See my reply to Jeff W. It is impossible for them to have gathered relevant data. It would require very frequent testing of the vaccinated (more frequent than weekly, which is generally the gold standard in medical orgs), which we are not doing. Among other things, we wouldn’t want to spook the horses by suggesting the vaccines might not be perfect.

       
   2. IM DocMay 17, 2021 at 9:29 pm

      This is the same guy who just 6 months ago was stating emphatically that remdesevir was a game changer.

      A silver bullet.

      Please refer to this week’s Annals of Internal Medicine to see how that all turned out. Cliffs Notes version – not a silver bullet. No effect on mortality whatsoever and minimal change in length of stay. And all for 10000 bucks a whack.

      Oh by the way who owns the patents for remdesevir? Why of course the NIH.

And, off topic but relevant, some talk about Medicare:

gnattMay 18, 2021 at 3:28 pm

The Metropolitan Labor Council (150 unions) is selling out all New York City retirees as we speak, switching from Medicare to a Medicare disAdvantage plan to save the city 600 million a year by reducing care and adding expenses for 250,000 elderly people.
The union bosses get reelected year after year. They don’t sit down with the people they’re supposed to represent but with the politicians and CEO’s they’ve become more comfortable with.
We’re all gig workers now.

 

1. IM DocMay 18, 2021 at 6:32 pm

   I could write a novel about Medicare Advantage plans – as in all the tragedies I have seen.

   They hook the seniors with a big steak dinner for the pitch – and then gym memberships that they never use etc.

   But in essence they have literally signed their lives and their benefits away.

   These companies haggle over every little thing in the doctor’s office. The patients have literally no choice in their medications – and often the worst possible 1970s technology drugs are the only choice.

   Need a referral to the rheumatologist – forget about it.

   But the worst of all is what happens in the hospital. They simply do not pay for any kind of post hospital rehab care – NONE. So your grandma is in the hospital after a massive stroke – and has been deconditioned by 21 days in the hospital. This is after the Medicare HMO has told the case managers that they are only going to pay for 3 days. Grandma cannot walk – grandma cannot do her daily activites – she can do nothing – but GET HER THE HELL OUT OF THE HOSPITAL NOW. By the way, everyone else – including those still on traditional Medicare get to go to a rehab unit. BUT NOT GRANDMA. They do not pay for them. Here is the thing – if your grandma’s doc is a chump like me – and OK with getting all kinds of demerits from the hospital – grandma may be lucky to sit it out in the hospital for 2 weeks while having her Medicare changed back to traditional so she can go to rehab. If not – she is DCd home – and then starts a merry go round of ER visit hell until she gives up and dies.

   Folks – this is the way it is. They have to be able to afford the 10s of millions in salaries for their executives somehow. And I have never understood the whole system. Many of these patients are transferred back to traditional Medicare during these crises. The Advantage plans get all the benefits of the “cost savings” and traditional Medicare gets stuck with the gigantic bills. The taxpayers are getting hammered.

   The city workers of New York likely have no idea what they are getting signed up for. This is all such a tragic mess. I just cannot believe my country anymore.

    
   1. antidlcMay 18, 2021 at 7:47 pm

      Many of these patients are transferred back to traditional Medicare during these crises.

      How do they go back to traditional Medicare? To switch from Medicare Advantage to Medigap part B, you usually have to go through underwriting. Or do they just drop the Medicare Advantage, stick with Part A, and just go without a part B plan?

      I’m confused.

       
      1. Yves SmithMay 19, 2021 at 12:35 am

         You can’t be denied Medicare Part B. You are heavily penalized if you don’t take Medicare B when you enroll in A and change your mind later. To be in Medicare Advantage, you’ve enrolled in Medicare B. You just need to switch out of Medicare Advantage:

         You must have Medicare Part A and Part B to join a Medicare Advantage Plan.

         https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf

         Medigap plans are not Medicare B.

Comments

I have looked at both the Pfizer and the Moderna vaccine handouts and physician information. I am seeing nothing about hydration on the Pfizer documentation. On the Moderna documents, there is a comment encouraging patients to be fully hydrated before their vaccination.

I will look into this later today with colleagues. If I am able to find anything more, I will certainly share. I have not heard anything about this before. Other than, in general, it would seem to be common sense to approach any medical intervention fully hydrated.

What a big pile of garbage from The Atlantic. A lot like the NYT “travel to the hinterlands” except lazier.

What are they thinking, these vaccine-hesitant, vaccine-resistant, and COVID-apathetic? I wanted to know. So I posted an invitation on Twitter for anybody who wasn’t planning to get vaccinated to email me and explain why. In the past few days, I spoke or corresponded with more than a dozen such people. I told them that I was staunchly pro-vaccine, but this wouldn’t be a takedown piece. I wanted to produce an ethnography of a position I didn’t really understand.

Is Twitter representative of the population? Is it a good place to run an ethnography? Give me a break. Author is using twitter because he doesn’t want to leave his home office. And then:

After many conversations and email exchanges

Many is twelve?

1. Try something like “DoorDash for vaccines.”

Someone kill me now. The cringe is too strong.

What a big pile of garbage from The Atlantic. A lot like the NYT “travel to the hinterlands” except lazier.

What are they thinking, these vaccine-hesitant, vaccine-resistant, and COVID-apathetic? I wanted to know. So I posted an invitation on Twitter for anybody who wasn’t planning to get vaccinated to email me and explain why. In the past few days, I spoke or corresponded with more than a dozen such people. I told them that I was staunchly pro-vaccine, but this wouldn’t be a takedown piece. I wanted to produce an ethnography of a position I didn’t really understand.

Is Twitter representative of the population? Is it a good place to run an ethnography? Give me a break. Author is using twitter because he doesn’t want to leave his home office. And then:

After many conversations and email exchanges

Many is twelve?

1. Try something like “DoorDash for vaccines.”

Someone kill me now. The cringe is too strong.

I will say again – I have just as many blue liberal professional patients balking as I do MAGA folks. This clearly is a take down of the Neanderthals.

But he gave away his game in striking fashion. “I am rooting for the vaccines.”

Let me ask a simple question. Are journalists supposed to be rooting for their covered subjects?

At least he admitted it. He is forever banned to the trash in my mind.

Somewhere Edward R Murrow is doing RPMs. The profession of journalism is clearly as compromised morally as my own medicine, maybe more so.

Lord Have Mercy.

I will say again – I have just as many blue liberal professional patients balking as I do MAGA folks. This clearly is a take down of the Neanderthals.

But he gave away his game in striking fashion. “I am rooting for the vaccines.”

Let me ask a simple question. Are journalists supposed to be rooting for their covered subjects?

At least he admitted it. He is forever banned to the trash in my mind.

Somewhere Edward R Murrow is doing RPMs. The profession of journalism is clearly as compromised morally as my own medicine, maybe more so.

Lord Have Mercy.

I will say again – I have just as many blue liberal professional patients balking as I do MAGA folks. This clearly is a take down of the Neanderthals.

But he gave away his game in striking fashion. “I am rooting for the vaccines.”

Let me ask a simple question. Are journalists supposed to be rooting for their covered subjects?

At least he admitted it. He is forever banned to the trash in my mind.

Somewhere Edward R Murrow is doing RPMs. The profession of journalism is clearly as compromised morally as my own medicine, maybe more so.

Lord Have Mercy.

We already do this on influenza vaccination and I don’t see how this will be any different.

This approach may absolutely be required in the future – I agree.

I would completely disagree with the idea that we already “do” this with the flu shots. I have been fighting for years for people to get flu shots. 30 years of trying every way imaginable to get older people to do it. My EHR at this very moment in time – is telling me that only 18% of my 1327 Medicare patients have been vaccinated for the flu shot in either 2019 or 2020. It is undoubtedly a bit higher, because we do not capture all of them from outside pharmacies – but even that is no longer much of an excuse – the computers do talk to one another much better than they did just 5 years ago.

At best that number is 33%. I would be confident to state that yearly or every 6 month COVID vaccines would be about the same if not much lower. You will be dealing with a much younger population.

We already do this on influenza vaccination and I don’t see how this will be any different.

This approach may absolutely be required in the future – I agree.

I would completely disagree with the idea that we already “do” this with the flu shots. I have been fighting for years for people to get flu shots. 30 years of trying every way imaginable to get older people to do it. My EHR at this very moment in time – is telling me that only 18% of my 1327 Medicare patients have been vaccinated for the flu shot in either 2019 or 2020. It is undoubtedly a bit higher, because we do not capture all of them from outside pharmacies – but even that is no longer much of an excuse – the computers do talk to one another much better than they did just 5 years ago.

At best that number is 33%. I would be confident to state that yearly or every 6 month COVID vaccines would be about the same if not much lower. You will be dealing with a much younger population.

We already do this on influenza vaccination and I don’t see how this will be any different.

This approach may absolutely be required in the future – I agree.

I would completely disagree with the idea that we already “do” this with the flu shots. I have been fighting for years for people to get flu shots. 30 years of trying every way imaginable to get older people to do it. My EHR at this very moment in time – is telling me that only 18% of my 1327 Medicare patients have been vaccinated for the flu shot in either 2019 or 2020. It is undoubtedly a bit higher, because we do not capture all of them from outside pharmacies – but even that is no longer much of an excuse – the computers do talk to one another much better than they did just 5 years ago.

At best that number is 33%. I would be confident to state that yearly or every 6 month COVID vaccines would be about the same if not much lower. You will be dealing with a much younger population.

We already do this on influenza vaccination and I don’t see how this will be any different.

This approach may absolutely be required in the future – I agree.

I would completely disagree with the idea that we already “do” this with the flu shots. I have been fighting for years for people to get flu shots. 30 years of trying every way imaginable to get older people to do it. My EHR at this very moment in time – is telling me that only 18% of my 1327 Medicare patients have been vaccinated for the flu shot in either 2019 or 2020. It is undoubtedly a bit higher, because we do not capture all of them from outside pharmacies – but even that is no longer much of an excuse – the computers do talk to one another much better than they did just 5 years ago.

At best that number is 33%. I would be confident to state that yearly or every 6 month COVID vaccines would be about the same if not much lower. You will be dealing with a much younger population.

With regard to the Scripps Clinic EMR ransomware disaster.

It is Epic. It is clearly involving patient care issues such as scheduling and portal messaging and medical records. So, this is not just “internal servers”.

I cannot tell you how many times I have set through Epic meetings with their employees bragging that their systems and software are impervious to hacks.

Smaller non-epic hospitals have been hit before. This is the first Epic whale.

I have known this day was coming for a long time. These systems are a disaster.

Americans, when your Doc is putting your private medical info into a computer, as of today, he may as well be putting it online for the world to see. You have been warned.

And I am certain the CEO’s hesitation to talk is because of his EPIC contract. It is boilerplate in all of them. No matter what happens, even if Epic’s fault, you can say or do nothing.

With regard to the Scripps Clinic EMR ransomware disaster.

It is Epic. It is clearly involving patient care issues such as scheduling and portal messaging and medical records. So, this is not just “internal servers”.

I cannot tell you how many times I have set through Epic meetings with their employees bragging that their systems and software are impervious to hacks.

Smaller non-epic hospitals have been hit before. This is the first Epic whale.

I have known this day was coming for a long time. These systems are a disaster.

Americans, when your Doc is putting your private medical info into a computer, as of today, he may as well be putting it online for the world to see. You have been warned.

And I am certain the CEO’s hesitation to talk is because of his EPIC contract. It is boilerplate in all of them. No matter what happens, even if Epic’s fault, you can say or do nothing.

I’m with Scripps Health and have received no direct notification of any of this, though it may be because the entire system is crippled. My portal entry is down as are the billing sites. Those large rooms with volumes of patient records in color-coded file tabs are looking better and better.

I’m with Scripps Health and have received no direct notification of any of this, though it may be because the entire system is crippled. My portal entry is down as are the billing sites. Those large rooms with volumes of patient records in color-coded file tabs are looking better and better.

I’m with Scripps Health and have received no direct notification of any of this, though it may be because the entire system is crippled. My portal entry is down as are the billing sites. Those large rooms with volumes of patient records in color-coded file tabs are looking better and better.

All of IM Doc’s patients with appointments through June have had them cancelled. That is not the behavior you would see with the level of attack you describe. Scrips is not being truthful.

Via e-mail:

All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.

IM Doc,

No dog in this hunt, but in the interest of clarity, the article and embedded t.v. news stories don’t give any indication that Epic platforms/applications were attacked. Rather, it is stated that the email system and portal integrations were hit by malware. This would be consistent with every other ransomware attack with which I’m familiar.

Further, most cyber-insurers implement a complete information clampdown in the event of such incidents. My guess is that industry-standard low per capita spend on IT at Scripps left Windows based systems – with which Epic is integrated – vulnerable to attack. Further, no telling how long or how extensively that email system (Exchange?) was compromised and Scripps systems surveilled – prior to the actual ransomware attack.

Going after Linux backend systems would be highly atypical, inclusive of Epic’s database and application servers.

IM Doc,

No dog in this hunt, but in the interest of clarity, the article and embedded t.v. news stories don’t give any indication that Epic platforms/applications were attacked. Rather, it is stated that the email system and portal integrations were hit by malware. This would be consistent with every other ransomware attack with which I’m familiar.

Further, most cyber-insurers implement a complete information clampdown in the event of such incidents. My guess is that industry-standard low per capita spend on IT at Scripps left Windows based systems – with which Epic is integrated – vulnerable to attack. Further, no telling how long or how extensively that email system (Exchange?) was compromised and Scripps systems surveilled – prior to the actual ransomware attack.

Going after Linux backend systems would be highly atypical, inclusive of Epic’s database and application servers.

All of IM Doc’s patients with appointments through June have had them cancelled. That is not the behavior you would see with the level of attack you describe. Scrips is not being truthful.

Via e-mail:

All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.

All of IM Doc’s patients with appointments through June have had them cancelled. That is not the behavior you would see with the level of attack you describe. Scrips is not being truthful.

Via e-mail:

All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.

All of IM Doc’s patients with appointments through June have had them cancelled. That is not the behavior you would see with the level of attack you describe. Scrips is not being truthful.

Via e-mail:

All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.

“Across the country, health clinics said that many patients were uniquely excited about the one-shot regimen—due to either skepticism about mRNA technology or fear of needles. Some of that enthusiasm evaporated after the pause, doctors told The Wall Street Journal.”

Also in J&J news, CDC upped their blood clot count to 28, new doses won’t be coming anytime soon per WaPo, and Norway is considering dropping it along with AZ. Is it conspiracy-brained to wonder if it’s being squeezed off the market in favor of the mRNA vaccines? Is the safety profile for the J&J seriously that much worse than for Pfizer/Moderna that it deserves this special treatment? What is Sputnik V doing differently with the same adenovirus vector as J&J? Be nice if J&J took them up on that purification technology offer and looked at it to see if that would work better.

“Across the country, health clinics said that many patients were uniquely excited about the one-shot regimen—due to either skepticism about mRNA technology or fear of needles. Some of that enthusiasm evaporated after the pause, doctors told The Wall Street Journal.”

Also in J&J news, CDC upped their blood clot count to 28, new doses won’t be coming anytime soon per WaPo, and Norway is considering dropping it along with AZ. Is it conspiracy-brained to wonder if it’s being squeezed off the market in favor of the mRNA vaccines? Is the safety profile for the J&J seriously that much worse than for Pfizer/Moderna that it deserves this special treatment? What is Sputnik V doing differently with the same adenovirus vector as J&J? Be nice if J&J took them up on that purification technology offer and looked at it to see if that would work better.

To your answer, our IM Doc says the VAERS database shows enough heart/stroke incidents with Pfizer/Moderna, which if you make conservative assumptions about how many were clotting induced or related, suggests that they have similar problem. This was indirectly confirmed when he described a horrific clotting case with a middle aged very healthy man who after his first Moderna shot, had a blood ox plunge in hours, tested positive, and experienced clotting that got much worse on the administration of Heparin (clotting so bad that his platelet count plunged, meaning a lot were tied up in the clots). Led to a pulmonary embolism. This was about a week BEFORE the J&J clotting story broke. Same pattern, different drug.

To your answer, our IM Doc says the VAERS database shows enough heart/stroke incidents with Pfizer/Moderna, which if you make conservative assumptions about how many were clotting induced or related, suggests that they have similar problem. This was indirectly confirmed when he described a horrific clotting case with a middle aged very healthy man who after his first Moderna shot, had a blood ox plunge in hours, tested positive, and experienced clotting that got much worse on the administration of Heparin (clotting so bad that his platelet count plunged, meaning a lot were tied up in the clots). Led to a pulmonary embolism. This was about a week BEFORE the J&J clotting story broke. Same pattern, different drug.

To your answer, our IM Doc says the VAERS database shows enough heart/stroke incidents with Pfizer/Moderna, which if you make conservative assumptions about how many were clotting induced or related, suggests that they have similar problem. This was indirectly confirmed when he described a horrific clotting case with a middle aged very healthy man who after his first Moderna shot, had a blood ox plunge in hours, tested positive, and experienced clotting that got much worse on the administration of Heparin (clotting so bad that his platelet count plunged, meaning a lot were tied up in the clots). Led to a pulmonary embolism. This was about a week BEFORE the J&J clotting story broke. Same pattern, different drug.

Dr Walensky on Tuesday

I will not let my vaccinated son go to summer camp without a mask.

Dr Walensky on Thursday 48 hours later

Anyone who is vaccinated can get rid of their mask and no more social distancing. We’re all good.

Americans – what has changed in the scientific data between that 48 hours?

Young Americans – believe it or not, the CDC was once the envy of this entire planet.

Now it is being run by someone who is a liar, a charlatan, or a political numbskull – pick your poison.

We were so much better than this in the past. I just simply cannot believe what has happened to our public health infrastructure.

I do despair for the young of this country. They will never understand the concept of competence with leadership like this.

Compare and contrast with Canada – our reopening guidelines were just released by federal public health on Friday.
https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/awareness-resources/vaccinated-against-covid-19.html

I was… very pleasantly surprised. This strikes me as quite conservative and appropriate based on what we know so far especially regarding vaccines and variants. No starting reopening until 70%single / 20% double and no serious reopening until 75% double, and all with low cases. Reinforcement of mask wearing. Right now we are at about 50% single in Canada with low double.

I suspect the timing was not a coincidence, but an attempt to 1. get out ahead of this US nonsense and 2. get out ahead of provincial nonsense that’s starting to brew (since Ontario in particular just can’t seem to stop winging it about parameters for reopening, which led to our current stay at home order).

The CDC statements quite frankly amaze me. The US will certainly converge to herd immunity the old fashioned way since covid is so contagious that one’s choices appear to amount to either getting a vaccine or getting covid. But the idea that you’d just throw in the towel at this stage without even trying to mitigate things anymore, in a way that can likely never be reversed, is appalling.

Compare and contrast with Canada – our reopening guidelines were just released by federal public health on Friday.
https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/awareness-resources/vaccinated-against-covid-19.html

I was… very pleasantly surprised. This strikes me as quite conservative and appropriate based on what we know so far especially regarding vaccines and variants. No starting reopening until 70%single / 20% double and no serious reopening until 75% double, and all with low cases. Reinforcement of mask wearing. Right now we are at about 50% single in Canada with low double.

I suspect the timing was not a coincidence, but an attempt to 1. get out ahead of this US nonsense and 2. get out ahead of provincial nonsense that’s starting to brew (since Ontario in particular just can’t seem to stop winging it about parameters for reopening, which led to our current stay at home order).

The CDC statements quite frankly amaze me. The US will certainly converge to herd immunity the old fashioned way since covid is so contagious that one’s choices appear to amount to either getting a vaccine or getting covid. But the idea that you’d just throw in the towel at this stage without even trying to mitigate things anymore, in a way that can likely never be reversed, is appalling.

> This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I think you and IM Doc are talking at cross purposes re: “Solvable.”

Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

(Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

The problem with the “herd immunity” argument is that there is evidence that one can both ‘get vaccinated’ and ‘get Covid.’
This is looking more and more like a sub-conscious decision to implement Social Darwinism.

The problem with the “herd immunity” argument is that there is evidence that one can both ‘get vaccinated’ and ‘get Covid.’
This is looking more and more like a sub-conscious decision to implement Social Darwinism.

> This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I think you and IM Doc are talking at cross purposes re: “Solvable.”

Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

(Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

Regarding herd immunity, yes, breakthrough cases are expected, because no vaccine is 100% regardless, plus the issue of the variants. There will most certainly be some fully vaccinated people who also get covid, the question is whether it will still disable / kill them. Evidence so far is that death at least is greatly reduced. Exposure to covid after vaccination is still enormously preferable to without.

Regarding herd immunity, yes, breakthrough cases are expected, because no vaccine is 100% regardless, plus the issue of the variants. There will most certainly be some fully vaccinated people who also get covid, the question is whether it will still disable / kill them. Evidence so far is that death at least is greatly reduced. Exposure to covid after vaccination is still enormously preferable to without.

People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data.

People I respect and know in both the medical and scientific community (not many, admittedly – these aren’t my circles) poo-pooed Ivermectin and continue to flippantly dismiss those in their own ranks with differing views on vaccination and how it should be used in relation to what are very different viruses. Polio is not the flu is not coronavirus is not human papillomavirus. Etc.

The vaccine for human papillomavirus is one of the only vaccines that provides complete sterilizing immunity. The polio vaccine doesn’t. The flu and coronavirus vaccines never will. Obviously.

Max Planck, where are you?

I ‘get’ the herd immunity theory, but note that this pathogen might end up like the flu viruses, with yearly ‘booster shots’ tailored to the latest estimated ‘major’ varieties. The various health authorities have a spotty record with the effectiveness of the yearly flu shot’s efficacies.
I’m really worried about, first, the long term effects of the mRNA vaccines, and, second, the effects of “long covid” on the population. the second effect is what motivated my social darwinism comment.
We are still in very early days with this pathogen.

I ‘get’ the herd immunity theory, but note that this pathogen might end up like the flu viruses, with yearly ‘booster shots’ tailored to the latest estimated ‘major’ varieties. The various health authorities have a spotty record with the effectiveness of the yearly flu shot’s efficacies.
I’m really worried about, first, the long term effects of the mRNA vaccines, and, second, the effects of “long covid” on the population. the second effect is what motivated my social darwinism comment.
We are still in very early days with this pathogen.

People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data.

People I respect and know in both the medical and scientific community (not many, admittedly – these aren’t my circles) poo-pooed Ivermectin and continue to flippantly dismiss those in their own ranks with differing views on vaccination and how it should be used in relation to what are very different viruses. Polio is not the flu is not coronavirus is not human papillomavirus. Etc.

The vaccine for human papillomavirus is one of the only vaccines that provides complete sterilizing immunity. The polio vaccine doesn’t. The flu and coronavirus vaccines never will. Obviously.

Max Planck, where are you?

Yes, I fully believe it will be like flu shots, as I’ve stated elsewhere. Sterilizing immunity with a coronavirus vaccine was never really in the cards. In that sense, ‘herd immunity’ will be a dynamic thing, relative to most people antibody status vs circulating strains. I’ve heard from pandemic experts that it could be 5-10 years to reach some sort of equilibrium in the general population.

I would actually agree that there are a lot of unknowns about these newer vaccines, but right now with the data we have, vaccination still appears to be the lesser of the evils by far. People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data. It’s not a great situation. Personally I’m choosing to vaccinate.

Yes, I fully believe it will be like flu shots, as I’ve stated elsewhere. Sterilizing immunity with a coronavirus vaccine was never really in the cards. In that sense, ‘herd immunity’ will be a dynamic thing, relative to most people antibody status vs circulating strains. I’ve heard from pandemic experts that it could be 5-10 years to reach some sort of equilibrium in the general population.

I would actually agree that there are a lot of unknowns about these newer vaccines, but right now with the data we have, vaccination still appears to be the lesser of the evils by far. People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data. It’s not a great situation. Personally I’m choosing to vaccinate.

People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data.

People I respect and know in both the medical and scientific community (not many, admittedly – these aren’t my circles) poo-pooed Ivermectin and continue to flippantly dismiss those in their own ranks with differing views on vaccination and how it should be used in relation to what are very different viruses. Polio is not the flu is not coronavirus is not human papillomavirus. Etc.

The vaccine for human papillomavirus is one of the only vaccines that provides complete sterilizing immunity. The polio vaccine doesn’t. The flu and coronavirus vaccines never will. Obviously.

Max Planck, where are you?

People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data.

People I respect and know in both the medical and scientific community (not many, admittedly – these aren’t my circles) poo-pooed Ivermectin and continue to flippantly dismiss those in their own ranks with differing views on vaccination and how it should be used in relation to what are very different viruses. Polio is not the flu is not coronavirus is not human papillomavirus. Etc.

The vaccine for human papillomavirus is one of the only vaccines that provides complete sterilizing immunity. The polio vaccine doesn’t. The flu and coronavirus vaccines never will. Obviously.

Max Planck, where are you?

People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data.

People I respect and know in both the medical and scientific community (not many, admittedly – these aren’t my circles) poo-pooed Ivermectin and continue to flippantly dismiss those in their own ranks with differing views on vaccination and how it should be used in relation to what are very different viruses. Polio is not the flu is not coronavirus is not human papillomavirus. Etc.

The vaccine for human papillomavirus is one of the only vaccines that provides complete sterilizing immunity. The polio vaccine doesn’t. The flu and coronavirus vaccines never will. Obviously.

Max Planck, where are you?

> This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I think you and IM Doc are talking at cross purposes re: “Solvable.”

Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

(Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

Unfortunately – the concept of “herd immunity” applies to some viral infections and not to others.

The fact that this “herd immunity” concept for coronaviruses is being whipped around in our media and spoken from the rooftops by our medical leaders is just sinful. The misinformation is causing people to make all kinds of false assumptions about their own health and the health of our communities and thereby do things that are at best counterproductive. It really is quite startling.

Measles is an example of a virus that read the chapter about herd immunity, influenza clearly has not. To wit, having a profoundly infectious virus like influenza kill millions a year and require yearly vaccinations is NOT an example of herd immunity.

Respiratory viruses as a rule do not follow that credo. Coronaviruses most certainly do not.

We have 4 others in wide endemic circulation in humanity that sicken billions every year.

The “flu” pandemic of the 1890s – the Great Russian Flu – was almost assuredly caused by Coronavirus OC43 – one of those 4. And yet – now 120 years after its release into the landscape – it kills 2000-10000 people globally every year – and is responsible for all degrees of flu and cold like illness for billions. This is NOT an example of herd immunity. You do not hear similar case studies about infections like measles.

What happens is these viral infections are birthed when just the right mutations cause them to be able to jump to humanity. They almost all start with a pandemic. Some of them abort immediately or after a season for at times inexplicable reasons at times very obvious reasons ( MERS and SARS1 are examples). If still viable (and COVID19 appears to be winning the viability test) , the viral genome and our own immune systems do a years long “hot war” and then we settle in for a “cold war” for eternity. It has all happened before many times – and it will all happen again. There is simply no other way. It is the price of admission on this planet. It happens to humans and animals alike.

How the vaccines will play in this “hot war” is absolutely an open question at this time. This type of vaccine intervention has never been attempted in all of human history during the “hot war” phase of the process.

The fact that our media and our global medical leaders have not communicated these basic medical facts to the populace in any kind of appropriate and understandable way is a disgrace for the ages. These simple facts were known to us for a very long time – this was taught to me in medical school decades ago – and nothing has changed except our own hubris and ridiculous expectations.

I would love to be able to read the exposes and head-shaking reports about this era that will be available to my children when they are 70. I am certain it will be quite entertaining.

Unfortunately – the concept of “herd immunity” applies to some viral infections and not to others.

The fact that this “herd immunity” concept for coronaviruses is being whipped around in our media and spoken from the rooftops by our medical leaders is just sinful. The misinformation is causing people to make all kinds of false assumptions about their own health and the health of our communities and thereby do things that are at best counterproductive. It really is quite startling.

Measles is an example of a virus that read the chapter about herd immunity, influenza clearly has not. To wit, having a profoundly infectious virus like influenza kill millions a year and require yearly vaccinations is NOT an example of herd immunity.

Respiratory viruses as a rule do not follow that credo. Coronaviruses most certainly do not.

We have 4 others in wide endemic circulation in humanity that sicken billions every year.

The “flu” pandemic of the 1890s – the Great Russian Flu – was almost assuredly caused by Coronavirus OC43 – one of those 4. And yet – now 120 years after its release into the landscape – it kills 2000-10000 people globally every year – and is responsible for all degrees of flu and cold like illness for billions. This is NOT an example of herd immunity. You do not hear similar case studies about infections like measles.

What happens is these viral infections are birthed when just the right mutations cause them to be able to jump to humanity. They almost all start with a pandemic. Some of them abort immediately or after a season for at times inexplicable reasons at times very obvious reasons ( MERS and SARS1 are examples). If still viable (and COVID19 appears to be winning the viability test) , the viral genome and our own immune systems do a years long “hot war” and then we settle in for a “cold war” for eternity. It has all happened before many times – and it will all happen again. There is simply no other way. It is the price of admission on this planet. It happens to humans and animals alike.

How the vaccines will play in this “hot war” is absolutely an open question at this time. This type of vaccine intervention has never been attempted in all of human history during the “hot war” phase of the process.

The fact that our media and our global medical leaders have not communicated these basic medical facts to the populace in any kind of appropriate and understandable way is a disgrace for the ages. These simple facts were known to us for a very long time – this was taught to me in medical school decades ago – and nothing has changed except our own hubris and ridiculous expectations.

I would love to be able to read the exposes and head-shaking reports about this era that will be available to my children when they are 70. I am certain it will be quite entertaining.

Thank you IM Doc, You help me keep my sanity!

Thank you IM Doc, You help me keep my sanity!

Thank you IM Doc, You help me keep my sanity!

thanks, IM Doc for your detailed perspective. I was just thinking yesterday that it’s not a case of not getting COVID-19, but more of a case of when I get COVID-19, how well will my immune system be prepared for it. Right now, since I’ve vaccinated recently, I’m guessing I’m fairly prepared. In 6 months, who knows? Can my immune system’s memory be good enough to make up for lack of antibodies?

I think asymptomatic infections are way under-reported (or not reported at all thanks to the CDC), and knocking the masks off everyone will cause the virus to pop up asymptomatically more and more.

thanks, IM Doc for your detailed perspective. I was just thinking yesterday that it’s not a case of not getting COVID-19, but more of a case of when I get COVID-19, how well will my immune system be prepared for it. Right now, since I’ve vaccinated recently, I’m guessing I’m fairly prepared. In 6 months, who knows? Can my immune system’s memory be good enough to make up for lack of antibodies?

I think asymptomatic infections are way under-reported (or not reported at all thanks to the CDC), and knocking the masks off everyone will cause the virus to pop up asymptomatically more and more.

thanks, IM Doc for your detailed perspective. I was just thinking yesterday that it’s not a case of not getting COVID-19, but more of a case of when I get COVID-19, how well will my immune system be prepared for it. Right now, since I’ve vaccinated recently, I’m guessing I’m fairly prepared. In 6 months, who knows? Can my immune system’s memory be good enough to make up for lack of antibodies?

I think asymptomatic infections are way under-reported (or not reported at all thanks to the CDC), and knocking the masks off everyone will cause the virus to pop up asymptomatically more and more.

> This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I think you and IM Doc are talking at cross purposes re: “Solvable.”

Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

(Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I would like you to direct me to any information from any source regarding any global pandemic contagion in the history of mankind that has been “solvable” in the manner in which you are suggesting.

There is but one solution – learn and understand how it is transmitted and educate the populace in methods to mitigate their risk as best they can. You never know, tools may in the future be determined that can help – the vaccines may be one such tool – but we are way too early to even begin to know that. Other than that – the war between the virus and our communal immune system must play itself out.

Unfortunately, that is the only way. That has been a rule of living on this planet from time immemorial. I know that we feel we are indispensable – and we can figure any and everything out. Unfortunately that is just not the way this process works.

Really and truly – if you can find a single case where mankind has “solved” a global pandemic in the way you are suggesting – I will be all ears.

There will likely be some time when we have achieved the ability to “solve” this problem – and this may be the time – but at this point – there is absolutely no way to know that and so far things are not looking so rosy.

I would like you to direct me to any information from any source regarding any global pandemic contagion in the history of mankind that has been “solvable” in the manner in which you are suggesting.

There is but one solution – learn and understand how it is transmitted and educate the populace in methods to mitigate their risk as best they can. You never know, tools may in the future be determined that can help – the vaccines may be one such tool – but we are way too early to even begin to know that. Other than that – the war between the virus and our communal immune system must play itself out.

Unfortunately, that is the only way. That has been a rule of living on this planet from time immemorial. I know that we feel we are indispensable – and we can figure any and everything out. Unfortunately that is just not the way this process works.

Really and truly – if you can find a single case where mankind has “solved” a global pandemic in the way you are suggesting – I will be all ears.

There will likely be some time when we have achieved the ability to “solve” this problem – and this may be the time – but at this point – there is absolutely no way to know that and so far things are not looking so rosy.

I would like you to direct me to any information from any source regarding any global pandemic contagion in the history of mankind that has been “solvable” in the manner in which you are suggesting.

There is but one solution – learn and understand how it is transmitted and educate the populace in methods to mitigate their risk as best they can. You never know, tools may in the future be determined that can help – the vaccines may be one such tool – but we are way too early to even begin to know that. Other than that – the war between the virus and our communal immune system must play itself out.

Unfortunately, that is the only way. That has been a rule of living on this planet from time immemorial. I know that we feel we are indispensable – and we can figure any and everything out. Unfortunately that is just not the way this process works.

Really and truly – if you can find a single case where mankind has “solved” a global pandemic in the way you are suggesting – I will be all ears.

There will likely be some time when we have achieved the ability to “solve” this problem – and this may be the time – but at this point – there is absolutely no way to know that and so far things are not looking so rosy.

> This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I think you and IM Doc are talking at cross purposes re: “Solvable.”

Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

(Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

> This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I think you and IM Doc are talking at cross purposes re: “Solvable.”

Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

(Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

> This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.

I think you and IM Doc are talking at cross purposes re: “Solvable.”

Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”

The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”

(Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

This is the same guy who just 6 months ago was stating emphatically that remdesevir was a game changer.

A silver bullet.

Please refer to this week’s Annals of Internal Medicine to see how that all turned out. Cliffs Notes version – not a silver bullet. No effect on mortality whatsoever and minimal change in length of stay. And all for 10000 bucks a whack.

Oh by the way who owns the patents for remdesevir? Why of course the NIH.

As readers have likely heard, the CDC issued new guidelines on Thursday which amount to declaring victory against Covid, with only 35% of Americans fully vaccinated and it not known whether “breakthrough” asymptomatic cases can spread the disease.
…
We have no basis for thinking that asymptomatic cases among the vaccinated operate any differently until we have evidence.

In case anyone missed it:
https://www.cbsnews.com/news/transcript-dr-anthony-fauci-face-the-nation-05-16-2021/?ftag=YHF4eb9d17
———————-

DR. FAUCI: Well, what’s happened, there’s been an accumulation of data on showing in the real-world effectiveness of the vaccines. It is even better than in the clinical trials, well over 90% protecting you against disease, number one. Number two, a number of papers have come out in the past couple of weeks showing that the vaccine protects even against the variants that are circulating. And thirdly, we’re seeing that it is very unlikely that a vaccinated person, even if there’s a breakthrough infection, would transmit it to someone else. So, the accumulation of all of those scientific facts, information and evidence brought the CDC to make that decision to say now when you’re vaccinated, you don’t need to wear a mask, not only outdoors, but you don’t need to wear it indoors.

JOHN DICKERSON: So, on that third point, let me ask you this. If I have no symptoms and I have been vaccinated, but I- but I am infected, what’s the difference between that? And if I have no symptoms and I’m infected but have not been vaccinated?

DR. FAUCI: Good question, JOHN. And what the- what the issue is, is that the level of virus in your nasal pharynx, which is correlated with whether or not you were going to transmit it to someone else, is considerably lower. So even though there are breakthrough infections with vaccinated people, almost always the people are asymptomatic, and the level of virus is so low, it makes it extremely unlikely, not impossible, but very, very low likelihood that they are going to transmit it. Whereas when people who are getting infected, who were without symptoms, who are not vaccinated, generally the titer or the level of virus, relatively speaking, is higher than in the vaccinated individuals.
—————

Where is his proof for these statements?

As readers have likely heard, the CDC issued new guidelines on Thursday which amount to declaring victory against Covid, with only 35% of Americans fully vaccinated and it not known whether “breakthrough” asymptomatic cases can spread the disease.
…
We have no basis for thinking that asymptomatic cases among the vaccinated operate any differently until we have evidence.

In case anyone missed it:
https://www.cbsnews.com/news/transcript-dr-anthony-fauci-face-the-nation-05-16-2021/?ftag=YHF4eb9d17
———————-

DR. FAUCI: Well, what’s happened, there’s been an accumulation of data on showing in the real-world effectiveness of the vaccines. It is even better than in the clinical trials, well over 90% protecting you against disease, number one. Number two, a number of papers have come out in the past couple of weeks showing that the vaccine protects even against the variants that are circulating. And thirdly, we’re seeing that it is very unlikely that a vaccinated person, even if there’s a breakthrough infection, would transmit it to someone else. So, the accumulation of all of those scientific facts, information and evidence brought the CDC to make that decision to say now when you’re vaccinated, you don’t need to wear a mask, not only outdoors, but you don’t need to wear it indoors.

JOHN DICKERSON: So, on that third point, let me ask you this. If I have no symptoms and I have been vaccinated, but I- but I am infected, what’s the difference between that? And if I have no symptoms and I’m infected but have not been vaccinated?

DR. FAUCI: Good question, JOHN. And what the- what the issue is, is that the level of virus in your nasal pharynx, which is correlated with whether or not you were going to transmit it to someone else, is considerably lower. So even though there are breakthrough infections with vaccinated people, almost always the people are asymptomatic, and the level of virus is so low, it makes it extremely unlikely, not impossible, but very, very low likelihood that they are going to transmit it. Whereas when people who are getting infected, who were without symptoms, who are not vaccinated, generally the titer or the level of virus, relatively speaking, is higher than in the vaccinated individuals.
—————

Where is his proof for these statements?

See my reply to Jeff W. It is impossible for them to have gathered relevant data. It would require very frequent testing of the vaccinated (more frequent than weekly, which is generally the gold standard in medical orgs), which we are not doing. Among other things, we wouldn’t want to spook the horses by suggesting the vaccines might not be perfect.

See my reply to Jeff W. It is impossible for them to have gathered relevant data. It would require very frequent testing of the vaccinated (more frequent than weekly, which is generally the gold standard in medical orgs), which we are not doing. Among other things, we wouldn’t want to spook the horses by suggesting the vaccines might not be perfect.

See my reply to Jeff W. It is impossible for them to have gathered relevant data. It would require very frequent testing of the vaccinated (more frequent than weekly, which is generally the gold standard in medical orgs), which we are not doing. Among other things, we wouldn’t want to spook the horses by suggesting the vaccines might not be perfect.

This is the same guy who just 6 months ago was stating emphatically that remdesevir was a game changer.

A silver bullet.

Please refer to this week’s Annals of Internal Medicine to see how that all turned out. Cliffs Notes version – not a silver bullet. No effect on mortality whatsoever and minimal change in length of stay. And all for 10000 bucks a whack.

Oh by the way who owns the patents for remdesevir? Why of course the NIH.

This is the same guy who just 6 months ago was stating emphatically that remdesevir was a game changer.

A silver bullet.

Please refer to this week’s Annals of Internal Medicine to see how that all turned out. Cliffs Notes version – not a silver bullet. No effect on mortality whatsoever and minimal change in length of stay. And all for 10000 bucks a whack.

Oh by the way who owns the patents for remdesevir? Why of course the NIH.

This is the same guy who just 6 months ago was stating emphatically that remdesevir was a game changer.

A silver bullet.

Please refer to this week’s Annals of Internal Medicine to see how that all turned out. Cliffs Notes version – not a silver bullet. No effect on mortality whatsoever and minimal change in length of stay. And all for 10000 bucks a whack.

Oh by the way who owns the patents for remdesevir? Why of course the NIH.

The Metropolitan Labor Council (150 unions) is selling out all New York City retirees as we speak, switching from Medicare to a Medicare disAdvantage plan to save the city 600 million a year by reducing care and adding expenses for 250,000 elderly people.
The union bosses get reelected year after year. They don’t sit down with the people they’re supposed to represent but with the politicians and CEO’s they’ve become more comfortable with.
We’re all gig workers now.

The Metropolitan Labor Council (150 unions) is selling out all New York City retirees as we speak, switching from Medicare to a Medicare disAdvantage plan to save the city 600 million a year by reducing care and adding expenses for 250,000 elderly people.
The union bosses get reelected year after year. They don’t sit down with the people they’re supposed to represent but with the politicians and CEO’s they’ve become more comfortable with.
We’re all gig workers now.

You can’t be denied Medicare Part B. You are heavily penalized if you don’t take Medicare B when you enroll in A and change your mind later. To be in Medicare Advantage, you’ve enrolled in Medicare B. You just need to switch out of Medicare Advantage:

You must have Medicare Part A and Part B to join a Medicare Advantage Plan.

https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf

Medigap plans are not Medicare B.

I could write a novel about Medicare Advantage plans – as in all the tragedies I have seen.

They hook the seniors with a big steak dinner for the pitch – and then gym memberships that they never use etc.

But in essence they have literally signed their lives and their benefits away.

These companies haggle over every little thing in the doctor’s office. The patients have literally no choice in their medications – and often the worst possible 1970s technology drugs are the only choice.

Need a referral to the rheumatologist – forget about it.

But the worst of all is what happens in the hospital. They simply do not pay for any kind of post hospital rehab care – NONE. So your grandma is in the hospital after a massive stroke – and has been deconditioned by 21 days in the hospital. This is after the Medicare HMO has told the case managers that they are only going to pay for 3 days. Grandma cannot walk – grandma cannot do her daily activites – she can do nothing – but GET HER THE HELL OUT OF THE HOSPITAL NOW. By the way, everyone else – including those still on traditional Medicare get to go to a rehab unit. BUT NOT GRANDMA. They do not pay for them. Here is the thing – if your grandma’s doc is a chump like me – and OK with getting all kinds of demerits from the hospital – grandma may be lucky to sit it out in the hospital for 2 weeks while having her Medicare changed back to traditional so she can go to rehab. If not – she is DCd home – and then starts a merry go round of ER visit hell until she gives up and dies.

Folks – this is the way it is. They have to be able to afford the 10s of millions in salaries for their executives somehow. And I have never understood the whole system. Many of these patients are transferred back to traditional Medicare during these crises. The Advantage plans get all the benefits of the “cost savings” and traditional Medicare gets stuck with the gigantic bills. The taxpayers are getting hammered.

The city workers of New York likely have no idea what they are getting signed up for. This is all such a tragic mess. I just cannot believe my country anymore.

I could write a novel about Medicare Advantage plans – as in all the tragedies I have seen.

They hook the seniors with a big steak dinner for the pitch – and then gym memberships that they never use etc.

But in essence they have literally signed their lives and their benefits away.

These companies haggle over every little thing in the doctor’s office. The patients have literally no choice in their medications – and often the worst possible 1970s technology drugs are the only choice.

Need a referral to the rheumatologist – forget about it.

But the worst of all is what happens in the hospital. They simply do not pay for any kind of post hospital rehab care – NONE. So your grandma is in the hospital after a massive stroke – and has been deconditioned by 21 days in the hospital. This is after the Medicare HMO has told the case managers that they are only going to pay for 3 days. Grandma cannot walk – grandma cannot do her daily activites – she can do nothing – but GET HER THE HELL OUT OF THE HOSPITAL NOW. By the way, everyone else – including those still on traditional Medicare get to go to a rehab unit. BUT NOT GRANDMA. They do not pay for them. Here is the thing – if your grandma’s doc is a chump like me – and OK with getting all kinds of demerits from the hospital – grandma may be lucky to sit it out in the hospital for 2 weeks while having her Medicare changed back to traditional so she can go to rehab. If not – she is DCd home – and then starts a merry go round of ER visit hell until she gives up and dies.

Folks – this is the way it is. They have to be able to afford the 10s of millions in salaries for their executives somehow. And I have never understood the whole system. Many of these patients are transferred back to traditional Medicare during these crises. The Advantage plans get all the benefits of the “cost savings” and traditional Medicare gets stuck with the gigantic bills. The taxpayers are getting hammered.

The city workers of New York likely have no idea what they are getting signed up for. This is all such a tragic mess. I just cannot believe my country anymore.

You can’t be denied Medicare Part B. You are heavily penalized if you don’t take Medicare B when you enroll in A and change your mind later. To be in Medicare Advantage, you’ve enrolled in Medicare B. You just need to switch out of Medicare Advantage:

You must have Medicare Part A and Part B to join a Medicare Advantage Plan.

https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf

Medigap plans are not Medicare B.

Many of these patients are transferred back to traditional Medicare during these crises.

How do they go back to traditional Medicare? To switch from Medicare Advantage to Medigap part B, you usually have to go through underwriting. Or do they just drop the Medicare Advantage, stick with Part A, and just go without a part B plan?

I’m confused.

Many of these patients are transferred back to traditional Medicare during these crises.

How do they go back to traditional Medicare? To switch from Medicare Advantage to Medigap part B, you usually have to go through underwriting. Or do they just drop the Medicare Advantage, stick with Part A, and just go without a part B plan?

I’m confused.

You can’t be denied Medicare Part B. You are heavily penalized if you don’t take Medicare B when you enroll in A and change your mind later. To be in Medicare Advantage, you’ve enrolled in Medicare B. You just need to switch out of Medicare Advantage:

You must have Medicare Part A and Part B to join a Medicare Advantage Plan.

https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf

Medigap plans are not Medicare B.

You can’t be denied Medicare Part B. You are heavily penalized if you don’t take Medicare B when you enroll in A and change your mind later. To be in Medicare Advantage, you’ve enrolled in Medicare B. You just need to switch out of Medicare Advantage:

You must have Medicare Part A and Part B to join a Medicare Advantage Plan.

https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf

Medigap plans are not Medicare B.

You can’t be denied Medicare Part B. You are heavily penalized if you don’t take Medicare B when you enroll in A and change your mind later. To be in Medicare Advantage, you’ve enrolled in Medicare B. You just need to switch out of Medicare Advantage:

You must have Medicare Part A and Part B to join a Medicare Advantage Plan.

https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf

Medigap plans are not Medicare B.