IM Doc pt 27
Dec. 15th, 2021 04:30 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
temporaryrealityGarbage in, garbage out study. Deaths almost certainly not being evaluated.
IM Doc has had proportionately vastly more cases in his rural county. Sent him this link:
Heart inflammation link to Pfizer and Moderna jabs
https://www.bbc.com/news/health-57781637
With this comment: “Either the patients in his county are having extremely bad luck or these #s are understated.”
His reply:
We have had 1 case for sure – a few others unclear – mainly young people dropping dead – and I have another that will be being biopsied/cardiac MRI in the next week in a distant academic center.
None of the drop dead patients were ever fully evaluated – The coroner here is actually a family practice doctor – and is loathe to crack the chest…
And as I heard this week from a cardiologist – who in big cities are seeing this way more often than I – it is actually very much concentrated in the younger and the more fit. The patients who get out and work out vigorously and frequently. Often folks on some kind of athletic teams. In his opinion – and I would tend to agree – there could be one of two things we are seeing. 1) Patients who have very fit myocardial cells are for some reason more at risk for this – that reason as yet unexplained ( there is precedent for this – AFIB is increased in chances in the 60 and up crowd if when they were younger they were into extreme aerobic sports like marathons and triathlons —- OR 2) Much more concerning when you think about it – the ones who are mainly coming to clinical attention are the very athletic ones because even with a fraction of decreased reserve they are aware instantly that something is wrong. There could be a literal army of overweight out of shape x-boxers whose hearts have been dinged but they would not really be aware of it because their main physical activity is a joystick maneuver. Unfortunately, if this is the case – there will be an army of heart failure patients becoming clinically apparent over the next few decades. We will not be seeing it anytime soon. There are some alarming surveillance numbers that indicate this might be happening – but nothing is concrete. This too has precedent in medicine – see the current J&J talc fiasco, or the DES problem in the mid 20th century – not really picked up on until the 1980s and after because the unfortunate cancer it caused – was in the female offspring of the original patients. I could go on and on.
From Reuters, via Yahoo:
UPDATE 1-Pfizer, Merck launch new trials of oral COVID-19 drugs
“Sept 1 (Reuters) – Pfizer Inc and Merck & Co Inc announced on Wednesday new trials of their experimental oral antiviral drugs for COVID-19 as the race to develop an easy-to-administer treatment for the potentially fatal illness heats up.”
https://finance.yahoo.com/news/1-pfizer-merck-launch-trials-180240611.html
smashsc Hmm,
Merck’s Ivermectin cost shows as low as $30 for 20 tablets on GoodRx
The Feds recently paid $1.2B for 1.7 Million 5-day courses of Merck’s molnupiravir – $705. per course.
It shouldn’t be surprising to this site’s readers which treatment Merck is focusing on
Pookah Harvey I have heard the argument that Merck as developer of Ivermectin would greatly profit from an antiCovid usage therefore their statement:
“We do not believe that the data available support the safety and efficacy of ivermectin beyond the doses and populations indicated in the regulatory agency-approved prescribing information.”is proof that Ivemectin is not viable for antiCovid treatment or prevention.
The problem is that Merck let the patent drop in 1996 and it is now a generic with several manufacturers. Merck could never jack up the price. I guess I shouldn’t say never. They can always use the tried and true method of paying off other manufacturers to stop production. Of course they then may have PR problems if the MSM decided to do their job.
IM Doc Yes – please do not assume that ivermectin will always be forever cheap. They could play all kinds of games.
A few examples.
Colchicine – a drug for gout and other inflammatory conditions, in some form has been around since the time of Henry VIII. When I was a young doctor in the 1990s, a 2 L bottle of pills could be had for a few dollars. Then the drug companies and FDA did their magic – and now it is no longer available in the previous format – and the new and only available stuff – COLCRYS – costs 400-1000 dollars for a few days.
The same exact game has been played with multiple asthma inhalers, insulin, BP meds, and multiple forms of chemotherapy. All used to be dirt cheap and very effective as generics – now are literally “break the bank” expensive. And there is no end in sight. Insulin in particular is so morally galling because those who discovered it in the 1920s, Banting & Best, basically gave it to the world for a pittance – not the blockbuster amounts Big Pharma gets today. Multiple actual dewormers and parasite drugs are on the list to have this same thing done and there are multiple old antibiotics that I understand are under the gun. The most famous parasite medicine incident and the hideous jack-up in price involved shenanigans by one Martin Shkreli.
I can see them easily doing this same game with something like Ivermectin. Just FYI – sources have told me that at least some of the antiviral COVID drugs under investigation by Big Pharma have exactly the same theorized activity on the virus as does ivermectin. They are not exact analogs but they do exactly the same thing. It really is a total joke – and is so emblematic of the total regulatory capture of our once proud CDC FDA and NIH. As I have stated repeatedly, once this whole thing blows over, my profession is going to have a big deep hole to dig itself out of.
These reports of breakthrough infections/hospitalizations (as in the WV story) are deeply unhelpful. All such reports should also provide data stratified by age and co-morbidities. What I’m hearing locally is that almost all vaccinated patients hospitalized with Covid are also basically very sick with underlying problems such as obesity and diabetes.
hunkerdown Unhelpful to whom, and why should I not deny them their interests for prioritizing themselves over people like me, to whom such posts are in fact helpful? Personal Pfizer holdings are not a public interest. But if you nationalize the company, we can talk about a jab.
IM Doc The vaccinated patients in the hospital with co-morbitities and age is largely true – at least where I am – However – that too is slowly changing. Admitting more and more vaccinated patients who are baseline healthy – and just really sick. And in the outpatient side of my practice – where people do not need to be admitted, it is now unusual that I see any unvaccinated patients – just being inundated with vaccinated patients. Many but not most of these people are quite ill – a lesser number nearing hospitalization status. We are still seeing large numbers of vaccinated patients infected all at once at superspreader events. Luncheons, church services, parties, etc. These events almost always require vaccination as a ticket to admission – and you can see how well that helps. That whole concept of vaccination proof, etc – is just such a joke it is not even funny anymore. So many people getting sick at these events where they feel they are safe because everyone is “vaccinated”. It makes politicians like deBlasio, et al look like total morons in my eyes. There are also lots of health care and personal service workers – like waiters and bartenders. It is really overwhelming the ability of my staff to deal with them all. And the majority of these patients have no co-morbidities and are not necessarily old.
I have learned to just not focus on the numbers that the various dashboards and news outlets are providing – I have to deal day by day with what is going on in front of me. I no longer even have time to think about numbers that are not consistent with my reality going on here on the ground.
Good question:
Why is basically the entire media lying about what Ivermectin is and calling it a horse drug?
— Zaid Jilani (@ZaidJilani) September 2, 2021
About the above Medpage Ivermectin article –
This sentence –
The agency added that the NIH has also determined there are currently insufficient data to recommend ivermectin for the treatment of COVID.
Not actually correct – the NIH current status on ivermectin is there is not enough data to recommend OR to discourage its use. The NIH changed this recommendation in December of 2020 as previously the NIH status on ivermectin usage was to discourage its use. Usually the status in which ivermectin is now placed would be accompanied with all kinds of funds to study the true efficacy of the drug, to see if it is successful. That of course is not being done at this time.
Interestingly, 2 of our other COVID modalities have exactly the same recommend/discourage status. That would be remdesevir and outpatient monoclonal antibodies. EXACTLY the same status on both of these as ivermectin currently. The NIH states there is not enough evidence to recommend or to discourage the use of either of these.
And yet we continue right on with both the others without a blink of an eye.
A little math –
Ivermectin course for COVID is less than twenty dollars.
A course of REMDESEVIR is currently right at 8800 dollars.
An outpatient treatment with monoclonal antibodies is right at 23000 – 25000 dollars with all the infusion costs added.
Remdesevir is loaded with all kinds of safety problems that I have seen with my own eyes. And it has the extra benefit of obviously not working – it literally does not do a god damned thing. Multiple studies have hinted at this.
The monoclonal antibodies are reasonably safe, unless you are one of the unlucky 1-3 out of 200 who have a very significant allergic reaction. Sometimes quite bad. They do seem to help to some degree.
But it is my immunologist and virologist friends who are having seizures about their use like this in massive 100-200 daily infusion centers, and the very high likelihood of producing all kinds of mutant variants with this therapy.
Your bankrupt government that is in hawk already for tens of trillions of dollars is currently “paying” for the last 2 choices – but not sure how long that will last.
Facebook feeds are now filled with all kinds of memes and stories with horse paste and horse pictures. But not a word about the other 2 or how expensive they are. I have seen all kinds of pics lately of my fully vaccinated friends and family in a monoclonal infusion center. They seem to have no clue they are bankrupting their kids future for a medication with the same NIH recommendation as ivermectin – which they are just laughing out of the room. They go right on blaming the unvaccinated for the pandemic in their feeds, all the while the antibodies they have just been given may be leading to the next mutation that will come up snake-eyes. And to boot, that one dose of meds they are getting is more than a lot of people in this country make in a year.
Yet, I continue to use ivermectin and budesonide with statistically obvious effects to keep patients out of the hospital compared to my peers who are not using it.
I have never dreamed in my life that I would live to see the American people bamboozled this easily. But here we are. I just keep working – very hard lately – it keeps my mind in much better places.
I spoke with one of my old students who is now a medical missionary in Africa this week. How this is being handled in the West has been an eye-opener for all to see where he lives. At least they have perspective in Africa. We have lost 600K people in the USA to COVID. The world loses upwards of 1 to million a year from diarrhea. The only difference between the two is that the diarrhea deaths are almost completely avoidable with appropriate care that is freely available in the West but not so much in Africa. And that is just diarrhea. They see the immense COVID freak out in the West and just shake their heads. My poor student just stated that he has to pray every day for strength not to despise what his culture has become.
My mind has been reliving the story of Lot and Sodom & Gomorrah a lot lately. But also to the Book of Daniel and Balthazzar’s feast. MENE MENE TEKEL UPHARSHIM. Written by a hand on the wall to leader of the most powerful country on earth at the time. NUMBERED NUMBERED WEIGHED AND DIVIDED. “Alas O Babylon, the Lord God Jehovah has weighed you in the balance and has found you wanting. Thy last day is upon you.”
Lord have mercy.
“Israel fighting record breaking surge in Covid-19 cases despite high levels of vaccination News.com.au (Kevin W). So much for Pfizer….”
To be fair, according to the linked article and other sources, while the vaccine does not prevent infection or transmission of Covid-19, it does decrease incidents of serious illness and death….for now.
We know that the asymptomatic infected can develop long Covid. To what extent vaccinations reduce the chances of developing long Covid is unclear for lack of tracking testing for and tracking of asymptomatic cases.
“While breakthrough cases of Covid-19 in vaccinated individuals remain rare, early research shows that a small number of those cases lead to “long Covid,” in which Covid-19 symptoms persist for weeks or months.
Why data on breakthrough infections and long Covid is so limited?
Research suggests that between 10% and 30% of adults who test positive for the coronavirus will go on to develop long Covid. The condition can arise even in those who develop only mild Covid-19 or are asymptomatic, the New York Times reports.
However, most research relates to Covid-19 in unvaccinated individuals. So far, there’s little research on how often breakthrough infections lead to long Covid.
Zijian Chen, medical director at the Center for Post-Covid Care at Mount Sinai Health System, said, “It’s too early to tell. The population of people getting sick post vaccination isn’t that high right now, and there’s no good tracking mechanism for these patients.”
According to the Times, one reason for the lack of data is CDC’s decision to track only breakthrough infections that result in hospitalization or death.
“It’s very frustrating not to have data at this point in the pandemic to know what happens to breakthrough cases,” Akiko Iwasaki, an immunologist at Yale School of Medicine, said. “If mild breakthrough infection is turning into long Covid, we don’t have a grasp of that number.” Advisory Board Daily Briefing, 8/19/21
IM Doc For what it is worth –
This is considered to be a total joke diagnosis by many Americans. You just have to trust me – it is most definitely not. Both the NEJM and the ANNALS of INTERNAL MEDICINE have just in the past few weeks had large preliminary articles about patients suffering from this problem. We do not have a handle on how common it is or how long it will last. Things are just too new.
I am seeing LONG COVID symptoms in vaccinated breakthroughs at what seems to be the same level as the unvaccinated cases although I do not believe enough time with Delta has passed to be really sure. But I am definitely seeing this in vaccinated patients.
LONG COVID symptoms are mainly 2 big groups.
1) There are the neuro issues that are the vast majority of these cases – headaches, chronic nausea, chronic malaise, severe and disabling fatigue, brain fog, memory/recall issues, and a very difficult symptom to pin down – “feeling that something is wrong.” Severe depression and to a lesser degree suicidal ideation in folks who have never had that before is also present.
2) Also happening in many vaccinated breakthroughs are the lung issues. This is usually but not always reserved for those who are really ill and have X-ray changes of ground glass while they are in the hospital or very ill at home. This often leads to a long lasting but not necessarily permanent pulmonary function decrease. In many of the unvaccinated patients from last year, this has largely resolved but certainly not for everybody. I will be interested to see how this plays out over time for the vaccinated as well. They are certainly getting it just as bad as the unvaccinated patients did last year. And please note, these types of problems do not just happen with COVID. This kind of thing happens with so many other infectious disease that leads to ARDS. This will hopefully end up being like our experience in the past with non-COVID infections where with time and exercise this does seem to get much better over time.
#2 is very concerning – because it is happening at a large incidence in many many breakthrough cases as well. They may not feel sick enough to be in the hospital, but they are hypoxic and clearly having lung issues even at home while acutely ill with COVID. And they very often have these crippled lung issues for weeks/months after their infection. This is happening to healthy patients but is way more common in patients who are not active, who are smokers (including marijuana) or have medical problems like asthma.
There are other issues that happen with acute COVID, mainly blood clotting events but many others, that are also happening with breakthrough vaccinated patients. These almost always resolve after a time and seem to cause no long term issues. But we have in no way had enough time to really fully evaluate what the long term issues may be. The big concern with these issues is what happens acutely – as in strokes, pulmonary emboli, or sudden cardiac death. I have also seen with acute COVID big blood clot problems in very unusual places, such as splenic vein thrombosis. Once you get through the acute setting, these issues tend to be very manageable.
Lee Having developed symptoms of ME/CFS 15 years ago, and currently under treatment at Stanford Medical CFS clinic, I know well that long term post-viral illness is no joke. It was probably triggered by a severe respiratory illness I had in the first quarter of 2006.
Mikel “There are the neuro issues that are the vast majority of these cases – headaches, chronic nausea, chronic malaise, severe and disabling fatigue, brain fog, memory/recall issues, and a very difficult symptom to pin down – “feeling that something is wrong.” Severe depression and to a lesser degree suicidal ideation in folks who have never had that before is also present…”
Maybe not only the long term effects of the disease should be considered, but also the long term effects of the psychological trauma and/or disorientation of the entire pandemic, from the way it’s been politicized to the way identies are being formed around what is believed about it…and the way grief is processed.
lordkoos I would think that some of these symptoms such as depression, fatigue, malaise etc could be hard to separate from the feelings many people are experiencing from the general stress of living with the pandemic.
IM Doc I have been doing a great deal of research about a past pandemic which I have never spent much time investigating – the Great Russian Flu of the 1890s. This has always been thought to be an actual influenza – but recent genetic and virologic studies are showing us that this was very likely the introduction of Coronavirus OC43 to the world.
Many many physicians at the time were chronicling that the symptoms of this “flu” were different than any other influenza had ever been. Even Sir William Osler, in written statements in his textbooks of Internal Medicine, was of the notion that the symptoms exhibited by patients during that pandemic of the 1890s were really not like the normal flu. His books were written in the decades immediately leading up to the “real” influenza pandemic of 1918. And the one symptom that over and over described by numerous physicians that were writing at the time, including Sir Arthur Conan Doyle, was depression. This just does not happen to any degree in true INFLUENZA and many remarked on the difference.
It must be noted that the word “depression” is a rather modern word and a modern construct. This construct is from our very reductionist, form-filling out, check the boxes modern medicine. “Depression” today is a drop bucket of multiple different diagnoses of the past. FYI, there are many things like this in medicine, not just depression.
Conan Doyle and Osler would have used more prominently the diagnosis “melancholia” to describe what we commonly use as “depression” today. But interestingly enough, contemporaneous medical writers of the 1890s often used a completely different word with a completely different diagnostic meaning to describe what they were seeing in patients of that pandemic. That word is ACEDIA. I have seen it used repeatedly in my research of the pandemic of the 1890s.
The difference is completely lost on us today – but it is actually a very important distinction. ACEDIA is an old medieval concept which is very difficult to describe. Basically it means a depression of the soul. A SPIRITUAL depression. While melancholia was more of a behavioral depression. Mainly having to do with living with consequences of behavior or reaction to events in a patient’s life.
Interestingly, when I am really talking to these POST COVID patients today – it is indeed more consistent with the spiritual and soul exhaustion of ACEDIA – and not behavioral or reactive like most depressions are. I have occasionally seen this ACEDIA type of depression before, but it is now just one patient after the other. I am also seeing ACEDIA like depression repeatedly in patients who have never had COVID. It is a sign of the times. In the days of Osler and Conan Doyle, they had no way to test patients for the presence of the virus and just assumed everyone had been infected by the miasma. I think today I am seeing this in POST COVID patients and non-infected as well.
The writers of that era in the 1890s were unequivocal in what they were seeing in their coronavirus pandemic – an epidemic of ACEDIA in those who had had the illness. I find it profoundly fascinating that the exact same type of thing is happening in our coronavirus patients and our COVID world today.
What you say about Coronavirus OC43 arriving in the 1890s could be good news in the long run, though not directly for old fogies like myself! Some NC commenters will probably want to jump down my throat for mentioning it, but it has been suggested that natural infection, rather than – or after – vaccination, offers the best immunity to COVID, and the young seem to be at much lower risk of illness than adults. (Yes, I’m well aware they’re not 100% immune, and there are delta and MIS-C and the possible complications of long COVID to consider, but in terms of COVID itself, they don’t seem anywhere near as vulnerable as the elderly – on average.)
My point being, if this has happened before, with a coronavirus sweeping the world as a deadly pandemic before settling down to become a common cold, perhaps because we all get exposed as children and develop immunity, might it happen again? But like I say, that’s a long term view, with probably little bearing on what we do now, today – and some will no doubt continue to insist eradication is possible, which it may yet be.
HotFlash Herd immunity requires some culls. What was the death rate from the 1890 Flu? 50 to 60% infection rate, 3-4% death rate, so I read. So that’s alright, then. Bangs head on desk.
IM Doc If indeed it was OC43 the infection rate is now 100%.
It sweeps over the earth and we all get it every other year or so.
That is what the concept of endemic status is.
Endemicity isn’t necessarily a good thing. Many endemic infections still kill millions yearly malaria and AIDS being the ones that come to my mind instantly. There are many others.
We should obviously try as hard as we can to limit casualities. But at some point, we as humans will need to come to grips with the fact that these pandemic introductions are one of the costs of the privilege of living here. It is part of life.
There is possibly nothing we can do about it. We have repeatedly tried in both human and animal outbreaks and have never been successful even once. I have my doubts we will succeed this time. It will however eventually calm down and behave like its cousins like OC43.
Unlike the mantra of modern neoliberalism, we as humans are not in charge.
When you read contemporaneous writing from politicians and medical people both in the 1890s and 1918 flu you instantly realize that they were doing their best to make citizens understand this simple concept. The hubris approach of modern times that we are in charge would have been unthinkable then. We will see how it all plays out. I have my opinion that they were much more wise during those earlier pandemics.
I’ve always found it interesting to read literature that pre-dates modern medicine and psychiatry in particular. You see signs of depression in ‘The Sorrows of Young Werther’. I’m seeing it in snatches in Emma as I reread ‘Madame Bovary’ (which is very funny on what might you might want to call “bourgeois science” – Flaubert’s father was a surgeon, and his museum in Rouen is a joint literary/medical museum).
There’s also the ongoing debate about whether King Lear suffered from dementia. I sort of reject the framing of the debate – dementia didn’t exist then, because it had not been classified. King Lear’s mental state was wholly invented by Shakespeare, albeit doubtless informed by some kind of real world experience, some kind of knowledge, pertaining to a certain kind or kinds of senescence. It’s an interesting case study, medically, but do we gain anything classifying an illness that only truly exists in the mind of its readers and writers. Should authors now be discouraged from inventing new diseases given that we assume that we have a thorough grasp of modern medicine (and I don’t mean inventing a disease that is in itself purely functional as a plot conceit, like in dystopian/disaster fiction). I’ve mentioned once before in comments that I had a case of akathisia. I never would have imagined until then that such unbearable suffering could even be possible. Perhaps there are lots more anguishes yet to be imagined, or discovered.
Would you say those with acedia experience a ‘sense of doom’ as a symptom? or is it a bit less urgent or acute than that?
Skunk There are many references to “sweating sickness” in Medieval accounts. No one knows what it was, but it seems to have been prevalent.
IM Doc There is absolutely a sense of doom in many of them. But that is a common symptom in all kinds of depression.
Being grounded in medical history has been a lifesaver for me all through my career.
And yes there are so many things that are very clearly described in the past, that we have absolutely no idea exactly what they were.
Look up St Vitas’ Dance – one of the most amazing medical outbreaks in the history of mankind – and to this day we have not a clue what exactly happened.
Covid: is it OK for medical staff to not treat the unvaccinated?
https://www.rt.com/op-ed/533903-medical-treatment-denial-unvaccinated-covid/
Well, a fat old guy like myself who’s been known to scarf down a bacon cheeseburger for breakfast really isn’t putting medical staff at any additional risk for this particular unhealthy behaviour: I got a couple of jabs of Moderna a few months ago, which means that I am less likely to end up in the hospital with the highly-infectious covid as the cause of my ails.
Yes, medical personel (and others) should not be forced to expose their own selves to harm from those whose actions helped create such risk of harm. In my case, should I collapse to the floor from chest-pains, none should attempt to load me onto a gurney until a small crane is available in order to lessen the risks of hernias or back injuries.
Swim across crocodile-infested waters on a dare? Could one really expect others to jump in to try to rescue them if toothy beasts start swimming in their direction midstream?
Objective Ace >Yes, medical personel (and others) should not be forced to expose their own selves to harm from those whose actions helped create such risk of harm
So no treating vaccinated individuals who left their house to socialize either, right? Just confirming consistency
LawnDart How about “reasonable care” or taking reasonable precautions to avoid infection? And what is “reasonable”? Maybe we can get some lawyers and linguists to take this chum of a comment as a reason enough to square-off in bloodsport.
I get that people with autoimmune disorders, persons with a history of bad reactions to vaccines, or women of childbearing years, don’t want to roll the dice on RNA witches brew, and that to me is a perfectly good reason not to get jabbed– conditions beyond their control. And kids… we were used as pawns back when I was a kid– it’s only gotten worse. And thus, it would be wrong to refuse to provide care should they catch a dose of CV.
But fear of microchips or anti-science/anti-vax “justa-flu” “only affects old people (f-em)” refusals? I ain’t jumping in the crocodile-infested river to save your nutjob arse (although I might root for you if I got $5 on the square marked 0:12 seconds– how long you might out-swim and fight off the hungry reptiles).
I disagree with Doc: you’re free to jump into that croc-filled river on your own free will in order to save those who have taken extreme risks/behaved with utter irresponsibility, but others do not have the right to compel you to do so.
To those in the field of medicine, past and present, who have put themselves at risk of injury for the sake of others, thank you for your service.
Objective Ace Lumping people into 2 groups — those you consider to have valid reasons to not get vaccinated and those whose reasons you disagree with — does make ones view of the world pretty straightforward.
I’d ask if you think everyone else shares (or should share) the exact same set of acceptable reasons as you? I’m also curious where you would put people who do not really fit in either of your stated groups: the 16-19 year olds no longer considered children; those concerned or with a history of blood clotting; or those with heart issues who are susceptible to myocarditis; etc
Basil Pesto like, “women of a childbearing age” is a *lot* of people. I’d understand your point to some extent if the vaccines were better than they are, but do you hold such strident views about, say, people who aren’t vaccinated with the annual flu vaccine? If not, why not? (acknowledging, of course, that Covid is far more serious than the flu)
IM Doc Here is the problem. The very fact that there is an article like this is profoundly disturbing to me.
I guess you could call me old school.
I did my residency and internship when a previous pandemic – AIDS – was raging. Panic and fear was palpable. We were doing all kinds of procedures as novices where one false move could have infected us for life. Multi drug resistant TB was everywhere in hospital rooms.
I was taught by some of the brightest and best internists of the 20th Century. The very first thing that came out of our Chairman’s mouth on the first day – “You are now a doctor. That means something. We do not run from pandemics. We run into them. Never forget that.” And I have not.
I can only imagine what these bright stars of Internal Medicine would think about these constant statements of denigration toward the unvaccinated – and the refusal to treat them. If I would have dared say a word like that around or about an AIDS patient I would have been smacked in the head and fired within hours.
I can guarantee all that there are some serious RPMs going on these doctors’ graves now.
I can scarcely believe what is happening to my profession. It is breathtaking. There are many days that I fear that myself and the old guys like me clearly do not belong. What keeps me going though is the knowledge that just like so many aspects of AIDS, this is going to all detonate very soon – and my profession is going to need old folks like us to pick up the pieces.
And I love taking care of and being around my patients. There is no more noble profession. I have way too many people depending on me to cut and run. And those worried about people being fired or de-licensed. There is simply not nearly enough of us in primary care to even begin contemplating doing anything like that except for the most egregious unethical behavior. And that has always been and will be in the immediate future not related to COVID. It is also a complete non-starter in every red state in this country. The torrential flow of physicians and NPs and RNs leaving the blue states this past year has also been something I would never have seen coming.
Cases per 100k population, SC is #1 in the USA at 105.7, followed by:
TN 99.8
KY 97.8
WY 92.3
MS 92.3
LA 91.8
FL 85.9
GA 83.9
WV 83.4
And so on. Anyone see a pattern? I see a pattern.
IM Doc Yes
I see a very similar pattern as last summer.It is after all the same virus but different variant this time.
The southern states got lambasted first in the summer/fall wave. Next came Arizona followed a few weeks later by the northern Rockies one of which is already in this list the others like Idaho are already deeply in trouble.
If things play out like last year it will very soon spread to the northern plains followed closely by California and the upper Midwest. And then finally New England. By that time in October/November last year the whole country was bad but the northern states and west coast were really bad.
A big outlier in this years pattern is Oregon which is way more affected than it was last year at a similar time during the wave.
I am assuming that is the pattern you are seeing as well.
Josef K IM Doc:
I was thinking of a different pattern, a political one: the highest-rate states tend towards lower rates of mask-wearing and vaccination, with the former being the major factor in the increases.
The pattern you point is interested, no doubt valid, but there’s no causality stated; would you agree it’s the reasons (predominantly at least) I put forth, or others (in place of them or in addition to them)?
David Leonhardt in today’s NY Times. Critiques of his math, etc., encouraged.
“But at least one part of the American anxiety does seem to have become disconnected from the facts in recent weeks: the effectiveness of the vaccines. In a new ABC News/Washington Post poll, nearly half of adults judged their “risk of getting sick from the coronavirus” as either moderate or high — even though 75 percent of adults have received at least one shot.
In reality, the risks of getting any version of the virus remain small for the vaccinated, and the risks of getting badly sick remain minuscule.”
The Rev Kev Are you prepared to risk your health and possibly your life on something printed in the New York Times? A newspaper with a proven track record for lying when it suited their purposes? Not having a go at you but with this evolving virus a precautionary approach would probably be wise.
IM Doc There are less than 25000 in the total area where I live. By their calculus, that would mean that all the physicians in our area would have seen about 5 breakthroughs in total since Delta arrived.
Well I worked this whole weekend.
11 on sat
9 on Sunday
12 yesterdayI had 54 total for the week last week. Things may be slowing down because I had 61 the week before. There are days with more than 10 repeatedly. And as time has progressed, these breakthroughs are not just head colds – yet another lie. Serious lung changes and other covid issues are becoming increasingly common among them.
And the thing is everyone knows it. This has been in the newspaper here repeatedly. These pundits and the doctors supporting them are doing absolutely grave damage to the credibility of the media and medicine. This may be generational in its impact.
I just cannot believe what I am seeing happen.
Hey NYT WSJ and all others – is the Pfizer and big Pharma advertising cash really worth your credibility? You are looking more like prostitutes every day. Average people are increasingly noticing it and tuning you out. Just look at the cratering numbers for CNN and MSNBC. This country desperately needs an independent media but instead we have you.
Eustachedesaintpierre You 5 last words – thank goodness for that & people like you.
” Even in a time of elephantine vanity and greed, one never has to look far to see the campfires of gentle people ” – Garrison Keillor.
vlade Not to question your numbers, but if you have a 25k vaccinated in your area, but are seeing on average say 9 breakthrough cases/day, for a couple of months, that means about 500-600 cases (for say two 10 weeks or so of Delta, no idea what the period you’re seeing this is for).
Which out of those 25k vaccinated means 0.5% (at least) are sufficiently sick to seek medical help.
Which seems quite a bit to me. Israel (that has pretty good data) says that in vaccinated, severe cases (can’t find what they call “severe” though) is less than 50 in 100k (as of early August, can’t find any recent numbers), so less than 0.05%, ten times less than what your numbers would indicate.
I’m just trying to make sense of numbers.
My state of Maryland is now publishing data on breakthrough cases:
About 3,369,018 Maryland residents have been fully vaccinated as of August 15, 2021.
There have been 11,454 COVID-19 cases among fully vaccinated Maryland residents.
Of those cases, there were:
883 cases hospitalized, representing 6.5% of all COVID-19 cases hospitalized
82 deaths, representing 5.3% of lab-confirmed COVID-19 deaths in Maryland
Approximately 7.8% of all confirmed COVID-19 cases in Maryland since January 2021 have been among fully vaccinated individuals.
IM Doc That has become a very common tactic to underwhelm the citizenry with the vaccinated positive percentage. To run the numbers all the way back to JAN.
I would be very interested to see what the numbers are since the advent of Delta. I would guess it would likely be different. Comparing things now to back pre-June is really comparing apples to oranges.
The Rev Kev “Doctors should be allowed to give priority to vaccinated patients when resources are scarce”
These people have literally no idea that they are playing with sweaty dynamite here. So forget Wapo writer Ruth Marcus and give me Dr. Marcus Welby instead. At least he followed his Hippocratic Oath. She says that this idea of hers to deny people medical treatment conflicts radically with accepted medical ethics but she is prepared to ditch those ethics not on medical grounds but moral grounds – her morals. This time she wants to do it for vaccine refusal without recognizing that there might be several reasons why people hesitate to take these first generation vaccines. But once you have dumped medical ethics you open yourself up to other ideas which I have seen over the years. You can then deny medical treatment because they are smokers, they are drinkers, they are too fat, they don’t go to the gym to keep themselves fit, they are too poor, etc. But here I will cede the ground to link to an article where a doctor weighs in on this whole idea-
https://www.rt.com/op-ed/533903-medical-treatment-denial-unvaccinated-covid/
IM Doc The principles of medical ethics have often been a response to the darkest of human times. Think Dr. Mengele.
I have spent my life telling students that the ethics are there not just for the patients protection but also for theirs and their society.
They serve us all during good times but more importantly can lead the way out of bad times.
The very fact that such prominent people are allowed to spew like this about the sacred is beginning to make me question every assumption I have had about the very concept of America.
On a more practical matter, what these knuckleheads seem to not be able to process is that I and every other HCW are in just as much danger from the sick vaccinated as the unvaccinated.
The imbecile is just overwhelming.
Lord have mercy.
I think it important for a little context in the above linked letter from the AAPS (American Association of Physicians & Surgeons ) to the AMA.
First off, I am not yet a member of AAPS but have been trending in that direction and now after this letter and other recent statements will likely become one.
Furthermore, here we are in a national medical crisis. AAPS has been on the ball with repeated statements like this and all kinds of takes on COVID issues. By contrast, in the middle of a crisis which has taken the lives of 600k Americans, the AMA from what I can tell has spent much of its time this past year on “birthing people” nomenclature and other such inanities.
The AMA is what everyone think is America’s physicians lobbying and political arm. Nothing could be further from the truth. In the past 40 years, AMA has become a corrupt horrific influence on medicine. They are more interested in the interests of the power elite – hospitals, insurance companies, and Pharma. They certainly do not give a rats ass about patient care. They own the ICD coding system. So every time you are billed, their proprietary system gets a little cut. They rake in millions of dollars to fund their corruption every year this way.
AAPS is actually an ever growing physician group whose purpose is to represent the physicians, patients and the actual health of Americans. It was a fringe group of outliers. But rapidly gaining on the AMA in physician member numbers. Physicians are leaving the AMA in droves.
I am not surprised by this stand. The questions in the letter are important and the ossified AMA and other agencies cannot answer them without revealing their rank corruption.
This group is the group representing patients and physicians that most people think the AMA is. This letter shows that just like I have been telling you, there is a very large contingent of physicians across America who are just not eating the dog food anymore. Slowly but surely, the battle is being joined.
mistah charley, ph.d. Doctor, the Wikipedia article about the AAPS states:
AAPS is generally recognized as politically conservative or ultra-conservative, and its positions are fringe and commonly contradict with existing federal health policy. It is opposed to the Affordable Care Act and other forms of universal health insurance.
The Washington Post summarized their beliefs in February 2017 as “doctors should be autonomous in treating their patients — with far fewer government rules, medical quality standards, insurance coverage limits and legal penalties when they make mistakes”. The organization requires its members to sign a “declaration of independence” pledging that they will not work with Medicare, Medicaid, or private insurance companies.
Are these assertions about AAPS accurate? And would you personally pledge not to work with Medicare, Medicaid, or private insurance companies?
IM Doc As I stated above, it has been in the past a largely fringe group. As the ama has become more and more corrupt, physicians have been joining that are not in that fringe.
That is indeed why I have not signed up in the past.
However, as more and more are seeing the absolute disaster that our organized medicine has become, these groups are becoming the only choice for true patient and doctor centered health care. The AMA and all the various boards and governing bodies could absolutely care less about patients. It really is unfortunately true.
The group has attracted a lot of concierge docs in the past – that is no longer the case.
I am not at all sure about the Medicare stance since every PCP I know that is in the group have practices larded with Medicare patients.
If they are for reforming our Medicare system, I am all for that. Especially the crime against humanity known as Medicare advantage plans. Furthermore, this group was 100 percent against Obamacare. I was actually an ardent supporter. Enough time has passed to make me realize that was likely one of the worst things to happen to patients in history. They were right, I was wrong. Having huge chunks of your practice paying astronomical premiums all the while with 10000 dedictibles leads to people not with health care but people with NO care. This group of “right wingers” as you point out they are referred to by wiki ( I never go there anymore for very good reason – the latest of which was the whole Philip Cross fun of last month on this very site and much of their entries on medical issues are just flat out wrong) predicted that was exactly what would happen with Obamacare and here we are. I am daily confronted with people with “insurance” as outlined by Obamacare who have desperate medical issues but have no way to pay their 10000 deductible. Amazingly cruel and yet every.single.day. Yesterday’s entry was a young man with seizures out of nowhere who cannot afford the 2100 for an mri. He has a 10000 deductible but he is “fully insured”. It is a true disaster every day but you will never hear that from the AMA but you will hear it from the right wingers as you call them.
I have learned as I am older that dealing with dogma and those who criticize others often have their own agenda which may even be worse. That is the sense I get when I hear wiki entries like the above.
Until we realize our health care system is a complete disaster for almost everyone, I refuse any longer to criticize or belittle anyone with ideas because of their politics. Our system is that bad.
The physicians across the country I have interacted with that have joined are not rabid right wingers. I have noted in the recent past that anyone who does not agree with the narrative is immediately branded a right winger. And pages like wiki are often the cudgel used to do so. Since I have been commenting on this site about Covid, that has been said about me personally in comments quite a few times. Anyone who knows me would find that statement LOL hilarious.
Being a member of this group would greatly hurt your reputation and credibility:
They don’t just support a political agenda… they’re pushing quackery.
IM Doc I will do some more research into this today –
However – I believe absolutely nothing that wikipedia has to say about any organization – left or right. When they can make up things out of whole-cloth on multiple medical history entires in the past I have encountered – I can not trust a thing they say. Anyone can make a mistake – but when a Medical History professor like myself can repeatedly email them and try to correct their severe misrepresentations – and get nothing but a laugh or scorn back or just complete blow off – I have no use for them. After those experiences – I trust literally nothing on their website to be accurate in any way.Parker Dooley Suggest you check out Physicians for a National Health Program. They are more about benefitting patients and not just encouraging docs to go all concierge.
lordkoos Wikipedia is a terrible source if you expect to get a balanced view of anything having to do with health care. Their editors seem like an extension of the AMA (and perhaps they are). Wikipedia is virulently against any type of alternative medical practice, even ones that have been proven to be beneficial such as acupuncture, which is covered by most insurance policies as a health treatment.
Wikipedia on acupuncture: “Acupuncture is a pseudoscience, the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery.”
I had a similar experience to IM Doc when I attempted to edit a wiki page to defend an alternative practice that Wikipedia referred to as “quackery”. I had taken a 4 year training in this particular practice and had found great benefit in my own life from it. It was obvious to me that the person in charge of editing the page (a Dr David Gorski from Michigan, he’s on twitter) had zero direct experience with the practice in question, and no interest in finding what was true or looking at studies etc. At this point I have little trust in Wikipedia in general, and none at all when it comes to health care issues.
IM Doc I have just now looked at their membership application – correct me if I am wrong – but I see absolutely nothing on there about signing a pledge not to work with Medicare, Medicaid or private insurance companies.
What I do see on the top of the page is a Latin motto – which translated means – Everything for the patient. There is also a call to oppose government-run medicine. After the debacle that Medcare Advantage plans and Obamacare have become – I join them in their concern there. I would also add to that – the corporate run medicine we have – but this group is not really the corporate type. Mostly private practitioners running their own businesses.
Some of the things on their website I disagree with – but I can say the same if not more so about the AMA.
https://aaps.wufoo.com/forms/join-aaps-physician-member/
It appears you can fill out that application online and submit your fees – and you are a member – no pledge signing required.
I will ask my colleagues who have joined if they were asked to sign such a pledge. I have looked through the website at length – and noted no such verbiage anywhere. What I do see talked about quite a bit is their opposition to MOC (Maintenance of Certification). That is a very large issue in medicine these days – and is way beyond what I have time to discuss here. Let me just say – this physician who has seen the MOC system abused for decades for the financial benefits and corruption of the various Boards and the detriment to patient care – has nothing but praise for anyone standing up to expose the fraud that it is.
As you quoted the Washington Post above – long gone are the days of their glory with things like Watergate. I hold them, the NYT, and the WSJ about to the same expectations of journalistic excellence these days as the National Enquirer, Rachel Maddow or Tucker Carlson. The fact checkers constantly employed by the Washington Post have recently been producing one howler after the other. Our entire media landscape is slowly becoming a tragedy.
Just checked – 2 of the 5 friends I emailed this AM got back to me and have absolutely no idea what the Washington Post is talking about – they have never been asked to sign any kind of pledge like that. One of them has attended the national convention recently – and absolutely nothing like that was even mentioned.
And both of them have lots of Medicare and private insurance patients. If the other 3 have anything different to add – I will update. I am unable to have the time to find your reference to the Washington Post in 2017 – but according to my friends, they appear to be inaccurate in their reporting.
Ian Perkins This appears to be the 2017 Washington Post piece in question. I’ve skimmed through it, and noticed no mention of any pledge, though it does imply the AAPS membership generally held some ‘right-wing’ views. But as you say, that was then, and now may be different.
https://www.washingtonpost.com/news/powerpost/wp/2017/02/09/through-views-and-alliances-hhs-nominee-has-long-opposed-government-role-in-health-care/
IM Doc, your contributions here have been invaluable to me as this pandemic has progresses and the public health response regresses.
With that said, I can tell you from first hand experience that the AAPS is a group of hard-right cranks who prioritize profits over people’s health, overtly.
I worked on the political side of the ACA fight many years ago and I remember this outfit well. They were on every Tea Party bus slamming the ACA, an already conservative bill that aimed to further subsidize the insurance industry, as some sort of death-panel care rationing grandma-killing nightmare.
They’re real pieces of shit, even if they might have made some good points about the overreaches and failures of the American public health system during this crisis.
IM Doc As I stated above – I was an ardent supporter of Obamacare. ARDENT.
It has proven to be a disaster in almost every way. These “cranks” were right – and I get to live the tragedy of it all with my patients on a daily basis.
At the same time as the advent of Obamacare – came the advent of all the GoFundMe pages, bake sales, carnivals, etc for communities to support “insured” patients who cannot afford their cancer and other care. If that is success – I hate to see what failure is.
The Tea Partiers absolutely were “pieces of shit” – I hate people who turn our discourses into this kind of stuff. BUT they happened to absolutely correct in their predictions of how bad this is turning out for so many people.
As for it being a “conservative” bill – I am always very interested in having people who proclaim that explain something to me –
That bill was made law with Barack “Mr. Progressive” Obama as President, the House under absolutely dominating Dem control – and the Senate with a filibuster proof majority. How did that confluence of absolute Dem control pass a “conservative” law? – It is like the Dems now see what a disaster it is – and like to call it conservative – but that is not the way it went down. Please tell me – I am all ears – how did that happen?Had they done something that was really for the people – I would have been elated – M4All – etc – but that is not what was done with that complete Dem lock on the government – instead we have this nightmare.
This “working class” Dem for one will never forgive them for it.
Fiery Hunt I hear ya, Doc. Don’t let ’em get ya down,,,
I don’t care what political strip people are…on any specific issue, I’m with whomever is looking out for the working/middle class. For example…with Dems re:abortion rights and with Republicans re: ACA.
Anyone who still supports ACA and private insurance is absolutely NOT on the side of working/middle class people/patients.
About the deSantis article above – and his stance on the current COVID vaccines –
‘It’s about your health and whether you want that protection or not. It really doesn’t impact me or anyone else.’”
I am not sure that there could be a more fitting epitaph for this entire fiasco.
And it is the same false reasoning on both sides.
This is the exact way that most people think about vaccines – even today I am having this discussion over and over again with patients. I am vaccinated. Therefore, I will not have the virus, I cannot get sick – and I cannot spread the contagion.
And the reason this is in their minds this way is because this is true of most every other vaccine there is. But this is most definitely not true with non-sterilizing vaccines.
We have placed into our world a non-sterilizing vaccine which is completely different than what people are accustomed to. For public health and safety, Plan B must be initiated – yet no such plans are even on the horizon. Plan A of total freedom from infection and spread is not only unworkable – it is actually quite dangerous.
We have one third of our our society who feel that they are vaccinated and protected and who cares if others are not.
While the other third is cudgeling everyone else with vaccine mandates and passports with zero evidence that any such thing will work in an environment created by a non-sterilizing vaccine. But what does work are all the bang-on effects of social and economic meltdown. No benefit provided, but all the ongoing damage is happening and encouraged.
And then all the “deplorable” unvaccinated who threw up their hands long ago – most of him have very legitimate concerns about the vaccines – and absolutely no one addressing them. Instead, a constant barrage of belittling, health-care shaming, moral superiority condescending and now outright lying directed their way.
All the while, no one is pressing hard on Plan B consisting of masks, ventilation, vigorous testing, vigorous quarantine and so many other measures that are sorely needed right now. No one is having any kind of serious discussion with the people about life style changes and risk factor modification. No one.
And the PCPs of America are stuck in the big middle of this morass, patients getting madder by the day, with no guidance whatsoever. The big topic of the past 2 weeks has been boosters – coming up almost every visit. Not an official peep out of our health authorities for guidance. Just a mishmash of contradictions and off the wall talk.
I never dreamed such a hellscape would ever happen in this country. It is truly incredible.
I’m playing a gig this Saturday for a Seattle dance club, it will be the first I’ve done where all of the musicians (including the singers!) as well as the audience will be required to wear a mask. It’s a large space & hopefully it will be well ventilated. Although I have a few more bookings this year, it will probably end up being my last gig of 2021 the way things are trending.
IM Doc Please be careful –
About 10 days ago – I had to admit 2 members of a swing dancing band to the hospital. It was part of a larger superspreader event. Everyone in attendance had to show proof of vaccination – I understand about 80 were there – and yet we had 14 vaccinated breakthroughs from that event – with 2 of them – the band members – having to be admitted. So far everyone is OK. But those 2 and 2 of the others got really really sick.
It was in a large ballroom. Lots of singing, drinking, instrument playing, and dancing. Masks were not required because they were all vaccinated. They all thought they were good because there was a vaccine mandate for entrance. They thought wrong.
Please be careful and take care of yourself.
Three big differences. And remember the smallpox vaccine in 1905 was still in the Wild Wild West of pharmaceuticals – long before the FDA and CDC were even thought of. Read HG Wells TONO BUNGAY – or Sinclair Lewis ARROWSMITH.
1) The vaccine for smallpox had been around for decades. The side effects and complications were well known – by all providers and health authorities and the safety concerns were easily handled because of the familiarity. This is not the case with the COVID vaccines even now. I have just had yet another patient develop a DVT and seek treatment on TUE of this week after having his 2nd Moderna last week. Related? Who knows? – we have no idea what the exact safety issues are with these vaccines. We have educated guesses – but my personal experience so far with the CDC and VAERS and FDA have been they are trying to do all they can to minimize problems. I have very little faith in the validity of our current safety knowledge.
2) Smallpox is absolutely orders of magnitude more lethal than COVID. Smallpox outbreaks were just horrific in their death and morbidity counts back in the day. Despite all the panic porn, COVID remains a much different level of threat by orders of magnitude.
3) The vaccinations for smallpox were absolutely sterilizing – it ended with the person that minute. That is most definitely not the case with COVID vaccines – there is individual benefit ( how long that will last – who knows?) – but the public health “herd” benefit with these vaccines is very nebulous right now – and they may actually cause much more harm than benefit as we go along. We will see. There is also increasing evidence that at least some of the mutation pressure is happening in the vaccinated. This was NOT the case in smallpox vaccines and never was.
The difference between the two is overwhelming. It is easy to see for anyone with a background in vaccinology or infectious disease. We are however not listening to these experts – instead we are listening to Big Pharma and media and political shills with their own agendas that have nothing whatsoever to do with public health.
Eustachedesaintpierre Just a thought – but isn’t it the case that boosters will always be a reactive measure, as the tweeking unless we get a steady state Covid, will always depend on the particular evolution of a new variant. If that is indeed the case we will I suppose be for at least the foreseeable future condemned to playing catch up, with perhaps the added risk of vaccine breakthroughs.
I am I guess just wondering what force is actually running this shitshow – feel free to enlighten me.
IM Doc Look how long it has taken us to get 50% of the country vaccinated – 8 months or so. Viruses move much quicker – especially one with this kind of turnover.
We would be 3 steps behind at all times.
I have never yet had a decent explanation of a very simple question I have – How is a booster toward the wild original virus spike protein going to do anything at this point – that virus is now extinct in the wild? If this was a vaccine that had the entire virus – that is a different story – but these vaccines are just to one small part….the part that changes all the time.
I have never had anyone in any way shape or form in any academic center ever be able to answer that question. They turn into Elmer Fudd.
IM Doc When we moved from the big city and now live in the fruited plain – I took the skills from my childhood and planted an orchard, built greenhouses, and started working with chickens again. Bees and honey. Mushroom racks. The whole enchilada. Dozens of fruit trees in the orchards. 4 large greenhouses now.
We get all of our other protein from fishing and hunting – and we buy a fourth of a grass finished cow from our neighbor rancher at a much reduced price of ZERO dollars every 9 months or so. His family constantly helps us consume our eggs and other vegetables and fruit in return.
Harvest time is here. Wife and I have been working hard with the kids – and we are now over 1000 cans of jams, salsa, marinara, pickles, mushrooms and other vegetables. We have filled 2 freezers with frozen fruit and we have not even started the apples yet. When done – we will be good for the year.
About the only thing we buy from the grocery store is sugar and flour and some non-seasonal fruits like melons. We get all butter and milk from the farmer down the road.
I have never felt so free – and we do not worry too much about the prices in the grocery store. There is however a price – a lot of work. But I am OK with that – I have not been as fit as I am since my 20s. It has been the best thing for me mentally too. And I am bound and determined to make sure my kids have these skills handed down to me from my family.They used them to survive the Great Depression and WW2. It will be up to the kids if they use them or not – but by God – they will know how. It does wonders for the soul to see them climbing trees and picking fruit – and tending to the chicken coops.
a vaccine I only need to take once (possibly with a booster), like polio or measles, is sterilizing
Yes, but that’s the trouble when technical terms get into the mainstream. Polio, measles and smallpox vaccines certainly work, but vaccines or previous infections aren’t necessarily so good at preventing subsequent infections, only illnesses! From ‘Individuals cannot rely on COVID-19 herd immunity: Durable immunity to viral disease is limited to viruses with obligate viremic spread‘, linked to in the Atlantic article,
“Poliovirus vaccination provides insight into the nature of protective antiviral immunity. Intramuscular immunization with inactivated virus prevents paralytic disease but not GI infection, with repeat vaccination necessary to reduce shedding of infectious virus. Similarly, even natural respiratory infections with measles or variola (smallpox) viruses, famous for inducing life-long immunity to disease, do not prevent respiratory reinfection, which though asymptomatic and nontransmissible, can be detected by increased antiviral antibody titers [7,8].”
IM Doc While these issues are true – I think it must be stated about SMALLPOX – it has been eradicated from the planet in the wild – may still be alive in freezers somewhere. And the others are so extremely rare that they are miniscule in their occurrence –
I would also like to ask the writer of that article – after the statement above about the polio vaccines – What do you think the ORAL sugar cube form is for? Why is it that we give BOTH to patients?
With regard to The Atlantic article about vaccination –
There is a highlighted sentence directly under the title of the article ( I am not a journalist – I am sure this sentence in the layout has a name – do not know what it is, though).
Complete protection against infection has long been hailed as the holy grail of vaccination. It might simply be unachievable.
The very instant I read that sentence – as a medical doctor and a medical historian – I know instantly that this person has no idea what they are talking about – and has not bothered to do the most basic of research in the topic.
One word –
SMALLPOX
It has been achieved – it is not unachievable. But it took a STERILIZING vaccine. And ON TOP OF THE VACCINE, all kinds of other efforts which were completely different based on the part of the world. The top priority – Truth being told to the population at all times. A concerted effort with non-compromised leaders and spokespeople. And to have the entire health system on board in an organized manner. Also, not a small amount of PR was required then, because the vaccinations left permanent scars on the skin. The authorities got out ahead in front of this issue – and did not wait until it detonated when people started noticing it and sharing it with friends. Furthermore, smallpox vaccination rates were nowhere near 100% – but when you have a sterilizing vaccine, it does not need to be so. Political and health leaders did absolutely no kind of shaming or belittling. The messaging was almost all positive and congratulatory. It is also important to realize that this eradication occurred in an era of mass media but long before we had the Internet and especially social media. I do not think we can even begin to overestimate the absolutely horrific effect social media has had on our response this time. Most patients I see every day literally want to throw their hands in the air – they have completely given up.
There is ZERO wild smallpox on the face of this planet today. ZERO. The only place it is left intact is purportedly in the freezers of viral labs at the CDC and in Russia. I am not even certain about that.
Polio is a very similar story, but is not completely eradicated from the planet – just a sliver is left. And one could argue the same about measles, mumps, and others that have been made so uncommon that young doctors would not recognize the symptoms if seen in the ER.
Coronaviruses are a completely and totally unique virus family in almost every way conceivable. The pox viruses are much more amenable to vaccination efforts. But that in no way means that science will never find a way to eradicate a coronavirus aided by vaccinatinon.
But ERADICATION via vaccination would require a STERILIZING vaccine. And that is not where we are today. The sooner our health agencies and media begin to level with the people and not put out this kind of article the better we will all be. I was gravely concerned when the messaging earlier this year was so misleading that it was giving people the idea that the vaccines were causing eradication. The mainstream narrative today saying this was never the case just 4 months ago is totally deluding itself just like with so many other issues. “Why we never said that – everyone always knew it was never going to prevent you from getting it” – all over the news today – is belied by the statement on my vaccination consent form right in front of me – THIS VACCINATION WAS GIVEN AN EUA for PREVENTION of COVID-19. Right there on the form. It was a classic case of miscontruing concepts without actually lying that misled the vast majority of my patients. Big Pharma is very very good at that.
I am of the firm belief, that after the Biden performance last night, unless an intense leveling is done with the American people about appropriate expectations and soon – there will be enormous political consequences for his administration. More than half the country thinks that forced vaccination of these NON-STERILIZING vaccines is going to end this pandemic. That is not the case at all. And I can see a future of a lot of disappointment and anger.
There is precedent for where we are today – the FLU shots. Also non-sterilizing. But nobody discusses the flu vaccination in terms of eradication – because it is simply impossible with non-sterilizing vaccines. Level with the people. They clearly understand the flu shot. They clearly get it – the flu shot will not eradicate the virus from earth – it will however make you less likely to get really sick – WHEN YOU GET THE FLU. And we have learned to live with the flu with the tens/hundreds of thousands of casualties every year. Until something much better comes for COVID, it is going to be a similar story.
Until we begin to treat the citizens of the world as adults, and not kids – and quit bamboozling – we are never going to have buy in from every group as has happened in the past.
My two cents.
jimmy cc there will be enormous political consequences for his administration
one can always hope….
Ian Perkins Do smallpox vaccines completely prevent infections, or just transmissible infections? Polio vaccines prevent the latter, but don’t achieve the former entirely – which is somewhat academic, as they both work, but if we’re quibbling the use of words, “Complete protection against infection has long been hailed as the holy grail of vaccination. It might simply be unachievable” might be accurate.
See my comment above – https://www.nakedcapitalism.com/2021/09/200pm-water-cooler-9-10-2021.html#comment-3604595IM Doc I would suggest – that making statements such as that sentence are really misleading to everyone but those who have been schooled in virology and vaccinology. Those words mean something completely different to me than my patients. The difference between an “infection” and a “transmissible infection” is debating angels on a pinhead for most people.
I get the feeling that they are realizing that the whole COVID vaccination story is getting shot through with holes – and they are pulling at straws.
I just had my front desk person read this article. A college graduate in English. She did not understand it the way it is being presented. Again – this is common BIG PHARMA dissembling.
IM Doc It seems to me the argument here that most people get that the writer is trying to convey – is OH well – the COVID vaccine is not working out as well as we would hoped – but no big deal – neither did any other, when you really think about it and use arcane terms.
Nothing could be further from the truth –
When is the last time I saw a polio infection or a transmissable polio infection? NEVER
When is the last time I saw a smallpox infection or a transmissable smallpox infection? NEVER
I can go on with measles mumps, etc.When is the last time I saw a COVID infection or a transmissable COVID infection – well I have seen 8 this AM – all in vaccinated patients.
And most people get that – and look sideways at articles like this trying to explain this away via word games.
Covis19#
I would like to ask GM why Denmark with 76% overall vaccination rate and i think 86-87% for 12-110 year old people aren’t experiencing these dramatic increases.
It is like we are on a different planet. All restrictions have been lifted, people go to music festivals with +15.000 spectators and still the number of new cases pr. day is stable at a very low rate yesterday it was 458 cases if I remember correctly
Basil Pesto yeah, a friend of mine lives in CPH. He agrees with a lot of what I say about Covid but at the same time, he’s pretty bullish about how Denmark is doing right now. I haven’t had a close look myself, but I also don’t know when their vaccination campaign started. I gather they’ve been doing some other things throughout the pandemic pretty well too.
IM Doc I have found this very interesting as well.
I was reading a Twitter feed last night about this very issue ( unfortunately I cannot currently find it – will keep looking ). The tweets were written by a US epidemiologist lamenting the fact that all the non-vaccine measure that have been done in Denmark have been overwhelmingly positive. They were organized. They were truthful and transparent from Day 1. They have apparently early on actually fired a few Health Officials who were scaremongering and inappropriate. They made their vaccination approach very team oriented and apparently very positive. Those were the things I recall. There were others. And basically the point was made that they took their playbook directly from the USA approach to both polio and smallpox. Another sentiment expressed was they had no intention of emulating the current USA approach to COVID.
I am not sure any of those things could be done successfully here in the USA in our current environment. Denmark is not the USA.
Please note that forced vaccine mandates were not part of the Denmark plan at all. Calling others unclean, unmasked, etc. was not part of the plan. And had they done vaccine mandates – nothing like this link would ever have been allowed – https://twitter.com/Newsweek/status/1436357805041242125
That one link right there tells me all I need to know. The USA is a completely un-serious country. I just cannot believe our leaders – it is like they are purposely sabotaging their credibility and our health efforts on purpose in all possible ways they can.
Sweetgreens went too far, but the link between nutrition and health is very strong. It’s not just BMI, it’s junk vs nutrients…
For evidence based examples
https://nutritionfacts.org/book/how-not-to-die/
I don’t think it’s too strong to say that if most of the world adopted a whole food plant based diet, health outcomes would be much better. And, less pressure on the environment by reducing the industrial food complex.
IM Doc More than a year ago, I wanted to get my nurses and office staff on some kind of project in the office that would actually be constructive and positive in their work on the pandemic. You have no idea, but the amount of screaming and yelling directed at doctors and their staffs is at an all time high. And much worse now with all the breakthroughs.
We all decided to double down on diabetes because that is the biggest single risk factor for covid severity in everyone other than age. And you cannot really fix that.
And they did with gusto. Diet education. Exercise. Diabetic education. Fine tuning meds. Praising patients without ceasing. A marked increase in follow up calls.
Our average a1c reading in August 2020 was 8.1.
August 2021 that average a1c was 6.9.
I could not be more proud of my staff and their intense efforts to do something anything positive for covid. It is important for all hard workers to have positive success and the feeling of contributing.
I have always felt with health issues that carrots work much better than sticks. It is also beyond me that the CDC has not been all over this issue on a national basis since it was known in the very beginning. I have no words.
Vandemonian IM Doc, I suspect that CDC’s reluctance to promote your approach is related to the absence of a market based impact. Looks like you and your team forgot to put medications front and centre of your campaign – where’s the benefit in that? In fact, your patients may have reduced their medication use overall. Did you track that?
newcatty Another note of appreciation for IM Doc’s contributions to all that is knowledgeable, fair, kind and honorable in his profession. Not only are your patients fortunate to have you as their Doc, but your staff is fortunate to have you as their “boss”.
IM Doc That is the one aspect of this whole operation totally in my purview – I do not have exact numbers – but the med use, especially insulin, is down as well. Most people do not realize actually how toxic insulin is. It is so much better for the body to diet and exercise and lose weight than to pump it full of insulin.
By the way, there are all kinds of videos of Dr. Fauci himself lauding this “eat well, sleep well and exercise” approach to infectious disease avoidance and overall general health. Something happened to him at the beginning of COVID – and I have not heard him mention it once. He literally talked about it all the time preCOVID. I have heard him talk in person multiple times – and he used to just dwell on this. Eat well, exercise, etc.
I am certain there are many others – but this is just one example from MAY 2019.
Go to about the 16:50 mark – and it lasts about a minute. He was asked if he would wear a mask when ill – and you can hear his answer…….
https://www.bloomberg.com/news/videos/2019-05-22/david-rubenstein-show-anthony-fauci-video
now if anyone in the Commentariat wants a gold star, compare/contrast with the polio vaccine rollout…..particularly if one has first-hand anecdotes
IM Doc Right off the bat – the first hand anecdote I do not want to have repeated is this right here –
https://www.nytimes.com/1955/05/05/archives/bulbar-polio-kills-doctors-grandson.html
That is the best link I could find to the story right now. But it is very important nonetheless. Dr. Alton Oschner was the closest thing to someone in stature in the 1950s as Dr. Koop was in the 1980s. He thought it best to vaccinate his 2 grandchildren on TV in New Orleans for all to see how safe it was. The debacle that was about to unfurl in the country was known as the Cutter Event. That particular vaccine ended up being very problematic and killed thousands of kids all over America – maiming many more. There were those in the federal health apparatus that were deeply concerned beforehand – but were ignored. It is a blemish on public health for all time.
Unfortunately, one of the children was dead within weeks, the other was maimed with polio the rest of her life.
I do not believe in any way shape or form that enough safety data is known for the COVID vaccination of our children in what for them is a very low risk disease process. There are studies now coming down, especially in boys, that COVID vaccine risk may be higher than COVID risk. Let me put it this way, with conviction, my sons will not be vaccinated whatsoever until much further safety and efficacy data is known. As in absolutely not. With the oncoming mandates, I am concerned it will be no time before this is mandated for the kids and I see, just like with the vaccines for adults this past winter, legions of physicians vaccinating their kids on Facebook. It is called stupid human tricks. I simply cannot comprehend this whole impulse. It has the potential to backfire “bigly”.
GM There are studies now coming down, especially in boys, that COVID vaccine risk may be higher than COVID risk
The COVID risk is hidden.
The immune system damage incurred is not visible in kids because they are kids, but is still very real. T-cells are a limited resource (we don’t really have a thymus past a certain age), and this virus is triggering massive overstimulation, dysregulation, exhaustion, accelerated aging.
Problem is that this will be conclusively proven only when 60 years from now it turns out their life expectancy is 70 instead of 80 (and that assumes this infection will be their first and last, while under current policies it will be the first of many, and they will definitely not live to 70).
Of course that does not mean that the vaccine should have been rushed the way it has been, but it has to be kept in mind.
IM Doc I have learned the hard way to never trust Big Pharma with anything. The fact that this vaccine program was handed over to them and not some other agency ( which we really do not have ) without all the baggage is the problem for me. I will NOT trust Big Pharma or anything they say with the lives of my kids. Anything that gets put into my kids in any way has to have years of use outside in the real world. They are fully vaccinated with everything else with a few exceptions because I trust the experience garnered over the years. I have too many scars from multitudes of patients over the years that have learned this lesson the hard way.
It is one thing to have a drug reaction that is unexpected. It is another thing entirely to have drug reactions and problems that were known by Big Pharma and covered up or hidden during the research phase. And they have made a habit of this repeatedly. How many drugs have been taken off the market very rapidly – only to find out they knew there was a problem?
I do not think I am alone in this assessment – not by a long shot. Among medical people or the public. The behavior and events this year have done nothing but fuel the concerns. I hear about it every day.
Over at (Steve) Bannons War Room on Rumble the allegation is made that we’re facing a pandemic of the censored, not one the unvaccinated. Dr. Robert Malone and a couple of other doctors are interviewed about the systemic forces being applied to stop doctors from treating covid early and aggressively with a wide range of repurposed drugs and other measures, and to stop the actual transmission of information on the success of such measures via the scientific literature as well as the internet. Note that Malone (who is himself vaccinated) emphasizes that these early treatments are not intended to compete with or replace vaccination, but should be applied alongside vaccination. These doctors claim that many thousands of people have died needlessly because the system would not treat them until they were well advanced in their illnesses.
I see little from Biden’s speech annotated above to suggest he cares about this.
https://rumble.com/vmgj15-episode-1257-from-rome-doctors-against-madness.html
(Yes, you have to ignore the overboard theme song about the CCP that goes with all episodes…)
GM Dr. Robert Malone and a couple of other doctors are interviewed about the systemic forces being applied to stop doctors from treating covid early and aggressively with a wide range of repurposed drugs and other measures, and to stop the actual transmission of information on the success of such measures via the scientific literature as well as the internet.
COVID is treated with repurposed drugs right now — dexamethasone and other steroids used to suppress the overstimulated immune system are exactly that.
IM Doc And they shamed doctors for months for using dexamethasone for COVID. During the big problems in MAR/APR of 2020. In my hospital, we were absolutely forbidden to do so. It is ridiculous – because that is the exact same drug class used in all kinds of sepsis syndromes. But NOPE – did not happen. Until pulmonary/critical care physicians all over the country just started doing it anyway. The success made them back down. A lesson that these overlords are determined not to repeat with any others.
GM My understanding is that there was a good reason at least for that — people got damaged from being pumped with too much steroids during the SARS-1 epidemic back in 2003 (the post-SARS syndrome is primarily due to the virus, but some aspects of it were because of the steroids too). Thus the reluctance to use them initially.
Unfortunately, the death toll in the first wave would have been 40% of what it was had they just applied them from the start…
P.S. This is actually bad news for a different reason — even I myself have on numerous occasions noted that the SARS-1 CFR might be lower today with modern treatment, say, 5%, not 10%. But more recently I realized that we lowered the SARS-2 CFR by going back to the SARS-1 treatment, i.e. SARS-1 was indeed that bad. Which is not good news for the future, if SARS-2 keeps evolving towards higher virulence — there is plenty of room for that in the evolutionary space…
A primary care office can at times be a gauge for the nation.
Based on what has already been yelled at me on Friday and now today, this has already failed. This has made many Dems in my practice absolutely furious. I cannot remember a political speech that has garnered as much discussion in my office – but pretty much everyone was talking about it – and not in a good way.
I really get the idea that the only groups where this is finding favor are the very small Twitter mob, some of the more vocal millenial liberal groups, and the news media. My older than 40 crowd, liberal or conservative, have recoiled in disdain. Especially those alive during the polio and smallpox vaccine efforts.
An elderly Dem asked me today – paraphrased – “Can you point to any time when Eisenhower, Kennedy, or LBJ threatened every worker in America with being fired during polio/smallpox? No you cannot – because they did not. They kept it positive. They made it popular. They turned it into a civic duty. They criticized no one. And the undermining of governors in the way he did – just forget about it……He is really not the paragon of virtue to do this anyway.” And that man is a big Dem donor and a former Dem officeholder.
My initial impression is that this is not going well with a huge chunk of the American people – especially older ones – and uniquely very unpopular with Blacks and Latinos.
Working link for “Massachusetts National Guard Activated To Help Deal With School Bus Driver Shortage” article at-
I bet that we see more and more of these types of stories going forward.
Kevin Indeed, fighting fires, helping hospitals, traveling to Poland..
IM Doc This was about 2 weeks ago – https://gov.idaho.gov/pressrelease/gov-little-activates-national-guard-again-directs-hundreds-of-new-medical-personnel-to-help-idaho-hospitals-overwhelmed-with-unvaccinated-covid-19-patients/
I would like to make sure everyone knows – COVID itself is a huge part of this problem. But so is the fact that nurses and hospital staff have been walking off the job all over America. And this was before the vaccine mandates.
The hospital I work in is literally crippled at this moment.
The entire vaccine mandate executive order from Biden is being done through OSHA. I have begun to pray daily that someone in OSHA has the sense to make this not so bad and include both natural immunity or weekly testing as an alternative to forced vaccines. That would actually make it doable. Furthermore, I would have little if any problems medically or morally with such a plan. I know for sure many of my HCW patients who are unvaccinated would stay in those cases. And it has the benefit of making sense medically.
The only thing that would hold this back at this point is those political actors determined to stick it to the unvaccinated. And given what I am seeing, they may very well prevail. Tragedy will ensue – not just in our hospitals, but also schools and businesses. I have many many business owners as patients now quaking in their boots because they know they will not only have no staff – they will have no customers. People getting fired tend to hold on to every dollar.
We all should be praying for such wisdom right now – or our hospitals and nursing homes are going to crater.
“… include both natural immunity or weekly testing as an alternative to forced vaccines.”
Please correct me if I’m wrong.
It is my understanding that antibodies from vaccination and infections wane and become undetectable after a few months and that if there is long term protection then it resides elsewhere in the immune system but is not measurable.
Also, assuming high prevalence of infection, since the vaccinated and unvaccinated can both test positive for the virus and are contagious, I would imagine a considerable portion of the population at any given time will be, regardless of their immune status, subject to quarantine.
On the upside, vaccines reducing hospitalizations in understaffed facilities is fortuitous. Ever the optimist, me.
IM Doc Vaccination immunity and infection immunity are likely going to wane over time. It appears that natural immunity is going to wane much more slowly. Although we are way too early in this to make any firm conclusions.
You have no idea what will happen to our nursing homes and many hospitals if the vaccine mandate goes through. Even losing 5% of the staff that is still there will be a disaster. At that point, it will be very difficult to deliver adequate care to anyone.
So far the vaccines have been reducing hospitalizations, however, I have already admitted 3 vaccinated patients to the hospital this week, and it is only Tuesday. I have admitted 5 unvaccinated patients. My gut feeling is this is slowly but surely offering less and less protection as well. I am only counting the actual COVID patients. There are others in the hospital with something else that turn out to have positive COVID tests. It is rare to see any of these people get really sick.
I think we are going to have to compromise here on these mandates – I firmly believe it is the only way that we are going to not have a disaster in our health care system. Vaccination, natural immunity, or frequent testing – makes sense and will not cause the walk outs.
Brian Beijer Vaccination, natural immunity, or frequent testing – makes sense and will not cause the walk outs.
I don’t quite understand. Shouldn’t this read “Vaccination, natural immunity AND frequent testing – makes sense and will not cause the walk outs”? I mean, we’ve already well established that the vaccinated are almost as likey to transmit the Corona virus as the unvaccinated. If we’re insisting that everyone return to work and not taking other precautionary measures; shouldn’t everyone be tested weekly?
Sawdust Is there a way to demonstrate natural immunity on its own? As I understand it, you (hopefully) only get a positive test result if you are currently infected with Covid. What if there’s a pretty good chance that you’ve already had it but never got tested?
IM Doc You can be checked for IgG antibodies to SARS Cov2 – and this has been very highly correlative with patients I have in my practice with known POS PCR testing in the past. If the IgG are positive, you have already been infected. If negative, things are a bit less clear.
Both Qwest and LabCorp offer a test known at Tcell COVID or somesuch. Most employers are demanding this as well to demonstrate natural immunity. This is all new just in the past few weeks at least in my area. To be honest, I have not looked into the efficacy of these tests. They may be much better at determining natural immunity than IgG tests are. I just do not know – I have not had a lot of time lately for research.
That is on my list of things to do this week – do a deep dive into the science and numbers on these tests being offered. I have a feeling this is going to become a very important issue very quickly.
I would dare anyone to follow in my steps every day and try to explain all of this contradictory information to patients. Yesterday, it was this paper where no one needs a booster. Friday before, it was only booster the Pfizer. Thursday, it was everyone needs a booster right now this minute.
I have many patients who are very bright, who know how to read scientific studies, and who have very appropriate and often very piercing questions. Many of them have the papers in hand with yellow highlighted statistics.
And they have every right to ask questions. I just have no way of telling them what the correct answers are.
As a veteran of other pandemics like AIDS, I can assure you this level of national attention was never focused on all the conflicting data and papers that were coming out daily in that era. Never in a million years. All of this was debated vehemently behind closed doors in medicine and public health. It was only when consensus about validity was reached that things made it out to the public. Often, many studies with very dramatic conclusions were found to be deeply flawed when we were able to hash them out with one another first outside of the public eye. They never made it to primetime news.
Somehow, I think that was a much better system. The effects of social media and instant distribution of medical papers to the entire world has really caused much much confusion and angst. I view it as one of the main contributors to the confidence problem we have today. I see tweets and web posts daily from this or that expert – making very scary statements about this or that table of numbers – with really no evidence or statistical power for their assertions. It literally scares people to death.
I can tell you without hesitation that the past two weeks, confusion and chaos has reigned supreme about these boosters with my patients. They often show me the same MD on their Twitter feed saying two different contradictory things within 24 hours of one another. I see no one in charge at the federal level steering the ship. I see a hundred minions with a hundred agendas all over the place spinning things their way. The longer this ineffectual leadership is allowed – the more confusion it generates. That is why I comment here – trying to do my efforts to tell the truth the way I see it – hoping I can decrease the angst – but I have often thought that maybe I am adding to the chaos as well.
Never thought I would ever see this in my country.
As a veteran of other pandemics like AIDS, I can assure you this level of national attention was never focused on all the conflicting data and papers that were coming out daily in that era. Never in a million years. All of this was debated vehemently behind closed doors in medicine and public health. It was only when consensus about validity was reached that things made it out to the public. Often, many studies with very dramatic conclusions were found to be deeply flawed when we were able to hash them out with one another first outside of the public eye. They never made it to primetime news.
I’m not so sure about this in this case.
AIDS was a relatively slow moving pandemic. It still demanded quick action, but on the scale of months and years.
With COVID we are talking hours and days because if things are left to their own, it will infect nearly everyone within a few months (it has done that already in a few places with very young populations that allow the damage to be tolerated for long enough to get to that point).
If it was left to the “scientific community” to hammer it out between themselves, everyone would have indeed gotten infected long ago.
That is what the current “consensus” is anyway, in case people have not noticed. The big shot senior-level scientists are going along with the program, for completely non-scientific reasons, and are giving interviews about how we have to “learn to live with the virus” and how everyone will get infected multiple times. Some are even going as far as saying that this was always known from the beginning.
If anything, it is the availability of things like Twitter that has allowed people to find the correct relevant information in real time. Which would not have been the case if there was the filter of the “scientific community”.
Remember that WHO “Fact check: COVID is NOT airborne” tweet? Well, it has been that sort of thing from the beginning.
How did regular people know that the pandemic is starting and it will be very serious? From social media, already in late 2019 and in early January 2020. The other key source of near-real-time information has been preprints. Not from official channels.
When and where did every relevant development after the beginning of the pandemic become apparent? Long before it was noticed by the “scientific community” as a whole and mostly on Twitter — people in the affected areas noticed things and shared them, and those who followed the right sources of information took notice. Reinfections in Iran, second wave in Manaus, second wave in South Africa, B.1.1.7/Alpha appearing in England, the appearance of Delta (the start of the second wave was pointed by a few independent Indian researchers on Twitter in mid-February, that Delta is a beast first became apparent by statistical analysis from a scientist in Belgium posted on Twitter already in April, etc.), and many others. B.1.621/Mu was first noticed in a preprint. Etc.
The “scientific community” has been soundly asleep on all such occasions, only awakening to record the damage long after it’s too late to stop it.
People know COVID is airborne only because of social media, if it was left to the authorities, they would be herded into unsafe classrooms and workplaces without that knowledge. They still have been herded that way but at least the information is available out there.
So yes, we do have the problem of social media drowning people in misinformation. But at least with social media there is also correct relevant info to be found within the general stream of noise. Without it and with the usual gatekeepers, we would not even have that…
IM Doc I would add argue that in the AIDS pandemic, we had a much more functional CDC and a completely different FDA. There were all kinds of hiccups – but nothing like what we are witnessing today.
There are a lot of good Twitter feeds out there today. They are literally drowned out by the minions of those whose main goal is clearly either panic porn or complete dismissal of the problem. People who do not really understand medical statistics and epidemiology are having a field day scaring people to death.
I am now witnessing on Twitter the literal flaying alive of a doctor named John Mandrola. A cardiologist – who has dared to put his name on a paper concerning the incidence of vaccine-induced myocarditis in kids. Minions of Twitter folks are threatening him with his license, calling him all kinds of names and doing all possible to destroy his reputation. Interestingly, the paper he is on has found the incidence to be in exactly the same ball park as all the other papers. That is his sin. The fact that it is right on target with other papers does not matter to the Twitter mob – he has an Internet following, he has spoken against the narrative, he must be destroyed. Non-medical people reading this stuff are just overwhelmed with dissonance and all kinds of misinformation presented in very inappropriately emotional ways. This is not even the tenth time this year I have seen similar things occur. It is my absolute belief that because of this type of thing, Twitter and Facebook have been far more damaging than anything good that has come of them.
As far as cable news, we did not have a death count ticker on the chryons for months on end during the AIDS epidemic either. Right in front of Rachel Maddow and Tucker Carlson with gleams in their eyes. That ghoulishness has set the emotional stage for so much of what has happened.
And as far as the papers coming out daily – I long ago have tried to tune it all out. But last week, I saw a paper from the ID dept at a major US univ discussing the fact that the COVID virus has run out of places to mutate. All is well. This is almost over – SARS COV2 is out of its bag of tricks.
Followed the next day by a paper from an equally excellent place stating these mutations could go on for eternity. As an MD after looking at both, it is easy to tell they are both garbage. But they were online and on Twitter and being hotly debated by people all over this country. They are papers – THEY ARE SCIENCE – THEY ARE GOSPEL TRUTH – when nothing could be further from the truth – when you have some experience with garbage papers all your life. The average Twitter user has no clue what to even look for. I have found most of the time they are arguing over headlines.During the AIDS pandemic, there was no Internet. We discussed the important papers of the day and had imminent visitors, and our own faculty helping us duke it out. It was a slower pandemic as you say – but I wonder how much of that “slower” has to do with the reporting of it as well. It was certainly not slower in the rate of death certificates for me personally.
I will always contend that the AIDS media and public health environment in the 80s and 90s had its problems – but was much more sane – and did not cause near the problems among citizens as this morass is today. I deal with it every day of my life.
IM Doc I forgot to add one more thing. And ask the other commenters if they have a different experience….
Anyone old enough to be alive in the AIDS epidemic – Did you ever hear Johnny Carson mocking AIDS patients or laughing about AIDS deaths? I sure did not. That would have been considered a career killer back then.
But look what happened this week. I sure do not watch this show – and I just happened to find out about this today because it was being replayed.
Correct me if I am incorrect – but he is talking about Florida COVID deaths – and lamenting the fact that there will be 50000 orphaned ferrets. Funny. Real funny. On national TV – ABC.
I cannot remember anyone on national TV making fun of all the death going on in NYC in MAR and APR of last year. Maybe I did not see it – but it would have surely made the zeitgeist if present. Why is it OK to make jokes about COVID victims now? Or is it just funny because he is “owning” Southern rubes? Who cares?
I cannot even believe this man still has a job after that kind of thing. But that is yet another example of how mass media and social media memes are completely debasing our feelings and our response to this entire situation. And explicitly giving large swaths of our population permission to actively denigrate the unclean and unwashed. I find the whole thing deeply alarming.
Tom Stone IM Doc, there were people who called AIDS God’s Judgement on homosexuals and there was shunning of AIDS caretakers in the workplace, but there was nothing like what is going on now.
This is horrifying to anyone with an ounce of decency and it is being encouraged by truly evil people.IM Doc Yes indeed Mr. Stone.
I spent many nights as an intern watching people die who had been tormented by those you describe. And karma was right there watching with me.
Interestingly, as she often does, karma paid a visit to many of those tormenters. Sometimes very immediately as in Jimmy Swaggart. Sometimes, karma takes her time. Look at Jerry Falwell – and how just recently karma revealed that he raised one of the most horrible human beings in modern pop culture exposing him for all the world to see.
Karma is whimsical. But I cannot help but think she is waiting in the wings thinking of next moves that she will one day spring on people like Mr. Kimmel.
She never misses.
I have learned as I have become older to just sit back and watch karma do her work. It takes so much anguish off my mind and soul.
Never thought it would be a blue state where this happened first – but I feel we should be getting used to this.
That is a temporary restraining order against the State of New York. They are at this time not allowed to follow through with the state vaccine mandate for health care workers apparently until further notice.
I think there are lots of responsible people out there in health care who realize just what a complete disaster this mandate plan would be for staffing. It is not a guess, I know that many of these legislators and judges are hearing some back channel warnings – maybe even from their own primary care docs.
Look right here. This is the official press release from the American Hospital Association from Friday Morning – the day after Biden released his plan. Interesting to read through this – they admit in the first half that they are all for the mandates, but spend the last half describing what a disaster they would be and that they need to work together to come up with some other workable way. Firing people is not going to be too helpful right now.
We live in fascinating times.
We live in a society where everything is politicized, and with something as big as a pandemic, it’s no surprise that this is, too. I’m sure a lot of people can remember having to get vaccinated before being allowed to attend school, or join the military. Talk to people about the polio vaccinations, and they’ll tell you there wasn’t nearly this much pushback. For religious people to complain about these mandates, well, it comes off as being rather hypocritical on their part, to be complaining about someone else forcing their beliefs on them. So, there may very well be some staffing issues because of these mandates, but the other side of that is there is a lot of support for them as well. Besides, how much can we trust a health care provider who won’t undergo certain medical treatments themselves, due to religious beliefs? Are these same beliefs affecting the treatment that they provide to others?
rowlf Has any other vaccine been fast tracked like the Covid 19 vaccines? Has the FDA a history of approving products that had to be removed from use later on?
Come to think of it, what are the Covid 19 vaccination rates at the CDC and the FDA? 99%? Are they leading from the front?
IM Doc I cannot recall a single patient saying a word about aborted fetuses as being the cause of their hesitancy.
I have however – had large numbers of 20-30 year old female CNAs and other staff in my office very worried about losing fertility. Their being fired would be the proximate cause of hospital failure – this is THE group of concern. This is not a religious issue – this is a natural human impulse – to have kids.
I have no idea if this is a real concern or not – what I do know for certain is this has been being discussed on social media from the beginning. This has been all over the Internet for months. When the health officials have made it a habit of lying, manipulating, and dissembling about so much else, I cannot blame these people in the least for their concerns.
The federal health officials have completely ignored this problem from day one. They have acted like it does not exist. I have been at a conference back in April with FDA officials where a physician went out of their way to warn them this was happening…..their response – “We do not have the time to deal with conspiracy theories.” And here we are. Complete and total incompetence. I did not find it ironic at all that during the very same week that the mandate program was announced, suddenly in the national media were stories about trials starting to investigate fertility. Too little too late. AND MORE IMPORTANTLY – announcing those trials has the side effect of making all these young women feel “You know – there may be something to this after all.” I have never seen such complete incompetence in my life. Such complete ignorance of primal human desires to have kids.
Since you brought up past pandemics – it is important to note the smallpox campaign. Very early on, it was brought to political leaders’ attention that the vaccine would cause a scar on every patient and that may cause hesitancy. Did they try to hide it? Did they mock Americans for being conspiracy theorists? Did they call people stupid? Did they ban people from the media? HELL NO. That instant, they got on the media and told every single American this would happen – and it would be a “badge of honor”. And we all know the end of this story.
So many lessons have been learned by our public health folks in the past. And this current generation has decided that the best course of action is to flush all those lessons right down the stool – or worse, they have shat all over them.
I find it incredible how many people are BLAMING the great unwashed and dirty throng of unvaccinated. That is morally incorrect in many cases given the abysmal nature of how this has all been handled. The real blame belongs with the total incompetence of our politicians, the media, and our health officials.
I was poking around in a dusty old used bookstore recently and found an essay from Voltaire on smallpox inoculation. After today’s earlier discussion of the rona vaccine mandates and early 20th century smallpox vaccination mandates in links, I thought this might be of historical interest – Letter on Inoculation with Smallpox.
Not a medical historian so maybe IM Doc can correct me if this is mistaken, but based on Voltaire’s take, the practice didn’t develop in the West by scientists, but as a form of folk medicine through empirical trials. Lots of snobbery about it at the time – evidently for some Europeans, inoculation was the “horse paste” of the 18th century. I’m sure Dr. “The Science” Fauci would have disapproved had he been alive.
Also interesting is the supposed rationale – without inoculation smallpox could kill or disfigure young women whose parents were planning on selling them into harems. I wonder if some of the women would have rather had smallpox…
Years ago in school I learned that it was slaves who introduced the practice to the West but this article indicates it was in use in the Near East as well. According to Wiki, the Chinese were doing it a long time too:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407399/
“ I had from a servant of my own an account of its being practised in Africa. Enquiring of my Negro man, Onesimus, who is a pretty intelligent fellow” -Cotton Mather
Several years ago, I was browsing a digital archive of newspapers from the 1770s to the 1790s and came across a few classified ads related to smallpox inoculation. One was for a doctor who was setting up shop after receiving training for it in Europe. The other two were for the same doctor. In the first, he was notifying residents that he was moving to another town, but that he would stop by periodically to offer inoculation. In the second, he apologized for considering leaving and stated that the residents had convinced him to stay. America had at least 125 years of experience with smallpox inoculation and vaccination before the court’s decision in 1905.
I checked to see if I could link to those, but it is subscription only. Thankfully, LOC has a page from the Gazette of the United States in New York from 1789. In the middle column, there is a brief mention of a British doctor successfully applying the same techniques used to inoculate against smallpox to horses for one of their illnesses.
Good review of the anti-vaccination case around 1800 – “The Creator stamped on man the divine image, but Jenner placed on him the mark of the beast”: https://publicdomainreview.org/essay/the-mark-of-the-beast-georgian-britains-anti-vaxxer-movement
The same debate applied to the earlier practice of variolation, which is what Voltaire discusses – infection with a mild form of actual smallpox, rather than cowpox. Cotton Mather and the Puritans were in favour, relying on an unusually enlightened take on providence.
Vaccination with cowpox was actually first practised by Benjamin Jesty, a farmer and citizen scientist, whose observations seemed to confirm folk wisdom about the immunity of milk maids:
I would really need to dig deep into this article but the smallpox immunization has been around for centuries. Jenner was the first to do it with vaccination. The process before this was called variolation and my guess is that what is being referred to here.
I will just say it took practice and apprenticeship to do the procedure correctly. One false move and well you could actually start an outbreak.
They had gotten pretty good at it by the mid to late 1700s and this was ordered to be done on the troops by Washington in some battles.