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 Last half of December 2021.

First, a full post - note that copy/paste was misbehaving this time around and the usually-available embedded media isn't showing up.:

Likewise, I'm being smacked with some weird formatting that's creating a table-like effect, which I don't want and which didn't show up when I first prepared this post. This may be something I have to keep playing with, so there may be modifications in the next few days.

Omicron: Fog of Information and Definitions

It’s a bit disconcerting to find we are a day further into a fast moving crisis yet I don’t have the sense anything both new and meaningful has emerged. But it still seems useful to try to clarify some of the claims floating about as well as a few new Omicron factoids that that have emerged but seem a lot less dispositive than the press enthusiasm would have you believe.

As usual we are very grateful for the help of our Covid Brain Trust and I am quoting more liberally from them than I did our also very valuable Brexit Brain Trust. The reason for hewing to our sources’ words more closely is I don’t want my interpretation to distort meaning.

And What Pray Tell Do You Mean By Severe?

Alarms appear to have gone off at WHO and the CDC after a spell of “initial signs are that Omicron isn’t that bad:

https://t.co/Xsr5nVgQRP



 

Oddly we have to go to Daily Mail rather than Twitter for a pointed recap of our CDC’s more downbeat outlook:

CDC issues grim forecast warning that weekly COVID cases will jump by 55% to 1.3 MILLION by Christmas Day and that deaths will surge by 73% to 15,600 a week as Omicron becomes dominant strain

And remember, even if Omicron is actually is less nasty on average, it’s so highly transmissive that hospitals will be overwhelmed:

 

And there is an offset that Thomas Peacock, the scientist first to post on B.1.1.529 before it was called even that, noticed immediately: that it probably evades monoclonal antibodies. Our GM was quite certain that would be the case, and our IM Doc now has pretty some pretty sick patients who are not responding at all to Regeneron, which has an EUA for use as a Covid treatment and is generally seen as effective. German researchers confirmed yesterday that Regeneron’s and Eli Lilly’s Covid treatments are not effective against Omicron. GlaxoSmithKline’s cocktail Xevudy still appears to work in vitro, but that may not translate as well in vivo.

The loss of some, perhaps all, monoclonal antibodies as Omicron remedies means that some patients that could otherwise have been treated outside a hospital will wind up being admitted. This is an offset to any average reduction in severity.

So it should not come as any surprise that, so far, deaths in Gauteng are tracking previous Covid waves:

 

Yet as our GM was correct to warn, the “mild” meme, as the hot take meant to preserve Christmas festivities and shopping, has become anchored. The press is pumping out even more articles to try to normalize Covid, such as the Atlantic’s Don’t Be Surprised When You Get Omicron. Gee, how about instead running a public service piece like “What You Need to Do to Not Get Omicron.”

GM reacted, quoting the article and then commenting:

One by one, the symptoms I knew so well on paper made their real-life debut: cough, fever, fatigue, and a loss of smell so severe, I couldn’t detect my dog’s habitually fishy breath.

Mild brain damage.

Once you know you’re infected, hang tight, limit your encounters with other people, and just take care of yourself.

As discussed earlier today, all the effective treatments need to be started early on. So what exactly is the advice to “just take care of yourself” on your own going to achieve?

And what are they going to do with the monoclonals and Omicron? There is only sotrovimab [GlaxoSmithKline] that actually still works and that is presumably in very short supply. But do they still refuse to give to the vaccinated (which are no longer actually vaccinated)?

IM Doc was even more disturbed:

This article is a sterling example of the vaccine only mantra.

“Stay home and take care of yourself.”

This is the terminal lunacy of VAX VAX VAX.

The problem is that many of these people are being told to stay home while they are turning blue and coughing up their lungs. And this week in my area 85% of the COVID outpatients are fully vaccinated with 30% of those boostered. It is as if the entire medical industrial complex has learned not a fucking thing in 2 years.

I cannot tell you how ashamed I am of where my profession is today.

The fact that our media is still putting out this kind of tripe to mislead the masses is yet another sign of the mass delusion.

IM Doc pointed out how the “mild” meme was doublespeak:

I think Americans think of “mild” as a head cold. I think the medical establishment thinks of “mild” as not being admitted. The non-admitted, however, can be violently ill, trust me.

GM wanted to understand exactly what “violently ill” meant. IM Doc again:

That is a medical intern phrase – it means very very sick – but not quite hospital level. And it is also very age dependent – younger people can handle this much better than older people.

I have 7 patients with COVID right now that my office and I are calling twice daily. They would all fall into this category.

By definition, they all have someone to watch them at home.

Some of the symptoms we are dealing with today – temps up to 103, severe shaking racking chills, sweating enough to soak the sheets 1-2 times daily, severe coughing, vomiting their guts up, severe myalgias.

These people are sicker than just a flu. However, not quite admission. Mind you, the criteria for admission has been higher lately, we have just not had the bed space – and people really do not want to be in the hospital.

This is most definitely not the average course of influenza….

We do not really have people deteriorating where they cannot get them to the hospital on time. WE KEEP A VERY TIGHT LEASH ON THEM. Unfortunately I do not think many Americans have a primary care practice that does this.

They also have very strict parameters to call us instantly.

And I call them twice a day. Most of the time there are 5-7 people. Some days upwards of 15. The highest has been 22 – but that is absolutely not the norm. It really gets quite crazy.

This is the large reason why I and my staff are so exhausted. To keep them out of the hospital and safe at home is just enormous amounts of work.

Unfortunately, I think myself and my practice are the extreme exception. I do not get the idea this level of care is being done by most practices. I just feel obligated to keep them at home as best we can.

IM Doc also underscored yesterday that even though he might have some Omicron cases (due to failure to respond to Regeneron) it was still too early in the course of a normal Covid case for any to be admitted.

Delta-Omicron Recombination Unlikely

Some readers were concerned by news reports of Moderna’s chief medical officer telling MPs that Delta and Omicron might recombine. GM was perplexed. His reaction was even if that happened, it would not appear to give the new variant any real advantage. But Delta and Omicron circulating at the same time (as opposed to Omicron pretty quickly becoming dominant) could still be very nasty. GM:

There isn’t much that Omicron can obviously gain from Delta and vice versa. Omicron has the immune escape, it has FCS enhancement, it has the N protein packaging improvement, it has the Nsp6 deletion, so what exactly is there in Delta that will make it fitter by recombination? And vice versa — Delta has those transmission enhancing features too. Some of the AYs have accumulated further ORF and Nsp mutations, so there might be some room for improvement there, but it will be marginal.

The bigger problem will be that you will have sick people in the same rooms in hospitals and they might become cross-infected, which should worsen the outcomes.

The Lack of Interest in Treatments

Biomedical professor KLG had said from the get-go that he expected the approach to Covid to come to depend heavily on treatments, as it has with HIV. The fact that we have instead gone all in with limited efficacy, comparatively short-lived vaccines is a big departure.

PlutoniumKun of our Brexit brain trust had found some hints in the Japanese press that Japanese doctors were prescribing Ivermectin and added:

From what I understand of the Japanese medical system, it wouldn’t surprise me at all if they are giving it to patients without telling them….Those who have lived in Japan will confirm I think that getting a straight answer from a Japanese doctor on any medical topic is nearly impossible.

Epidemiologist Ignacio noted:

One of the problems with Ivermectin, IMO, is the hospital-centric view that dominates medicine. It is well known that some approaches with medicines might work in early stages of infection (very early so as to be considered nearly preemptive) and only or mostly work if administered timely. This is, or can be the case of Ivermectin. When you go an do clinical trials the result is “It has no effect” and that might be the case if the design of the trial results in too late delivery to notice an effect. But in real life practice it might be the case that words have circulated among Japanese doctors in the sense that it indeed does something.

IM Doc described how the CDC has hung doctors out to dry:

When you have been doing this as long as I have, you have a memory of what happened before and with that comes certain expectations about what should be happening now. I think that is what separates the older than 55 crowd from the under 40 crowd.

We do not even have to go back to AIDS. I am thinking of the last 2 events in my career where there was exceptional involvement from the CDC. In 2018, we had the vaping crisis. In 2012 or thereabouts, we had the West Nile issue. Although that virus had been with us since 2001 here in the USA, it really exploded in the summer of 2012 in the Deep South in the USA. I will not include the 2014 Ebola problem. The CDC was very involved there but that never really had to be taken nationally, these other 2 examples did.

In both cases, there was frequent, at times weekly updating from the CDC about treatment options and guidelines. There was intense discussion of what seemed to be working and what did not. In both cases, these treatment options were obviously non-approved for these purposes by the FDA. There was a crisis, and this is what we have available, and this is how you should be using them. This is what works. This is what does not work. And this is our evidence why we feel the way we do. This was constant from the CDC in both cases.

That has simply not happened at all in COVID. Here we are 2 years into this. There is not a single shred of treatment advice from the CDC outside of the inpatient setting. Let’s face it – most antiviral efforts have to be done immediately. That would mean where I work in an outpatient setting is the golden hour. If we wait till the patients are in the hospital they are going to have much worse outcomes. The agencies are saying nothing about outpatient therapy and have put forth nothing. We have worldwide studies on fluvoxamine, ivermectin, HCQ, steroids, VIT D, VIT C, Zinc, and I am sure there are many others. We now have monoclonal AB. A question – have you ever heard Dr. Fauci discuss monoclonal AB in a positive way? If you have please show it to me.

There has been no guidance at all about any of these therapy options. There has been lots of censoring, hectoring, belittling, and confusion. It is unusual to find a physician willing to engage any of these therapies, despite some of them having overwhelming positive signals in early outpatient therapy.

There is not ONE single bullet. By now, 2 years into this we should be throwing all kinds of things at these patients – anti-virals, anti-clotting agents, anti-inflammatory agents. But we are doing nothing.

Again, our CDC has done nothing to help with this at all. NOTHING. Not only the CDC. In previous events, there was treatment advice flowing from medical schools around the country. CRICKETS.

We have gone all in on the vaccine approach and have done so from the beginning.

Now, the bill is due. My office is literally flooding with vaxxed and boosted patients that are very ill. We are in a precarious situation with the hospitals of America. They are in much worse shape employee-wise than many Americans would dare dream.

I feel all alone. I feel it is my sworn job to keep as many of these people safe and out of the hospital as possible. But there is literally no help from the CDC at all VAX VAX VAX. Here is the problem – about 85% of these patients in my practice that are now positive and getting sicker by the day are already VAXED Many of them boostered. We are in the middle of a crisis with the hospitals – and we simply cannot fill them up the way we have.

Hyping of Way Too Preliminary Report of Omicron Bronchial Replication

This finding is being hyped in the mainstream media, such as Reuters, as if Omicron won’t take hold in the lungs and will nicely and courteously stay up in your bronchial passages:

 

Help me. It typically takes five to seven days from symptom onset for Covid to produce viral pneumonia, in cases where it advances that far. The NHS indicates that the most rapid onset of garden variety pneumonia is 24 to 48 hours, with several days more common, strongly implying that 24 hours is bleeding edge.

Thus concluding anything about possible disease evolution at 24 hours for pathogen that normally takes well over a week after exposure to get really ugly (recall symptom onset averages 5 days after exposure) is quite a stretch.

GM was also skeptical and pointed out that Delta was hard to make behave in vitro and that may be true of Omicron, further complicating reaching early conclusions:

They found greatly increased replication in bronchus cells but reduced replication in lower lung tissue.

And now the narrative is that it is becoming an URT [upper respiratory tract] infection.

But this makes no sense — in the same plot they have Delta showing the same pattern, and Delta was more severe than WT [wild type], not less, and this is what every study finds, so it’s not even controversial.

And they tested this only up to 48 hours, but that is not how this works in actual human bodies — it starts as an URT infection then moves further down. So if you have 70 times more virus in the middle lung, you should be seeding a lot more of it in the lower lung, even if it replicates a bit less there, and the net effect is negative…

Everyone is in a mad rush to put out results as quickly as possible and as a result they are not even thinking how damaging putting out incomplete data with premature conclusions can be…

But there is more to this story.

Another factoid, from Vineet Menachery:

https://twitter.com/TheMenacheryLab/status/1471258680511369217

“A bit inside virology, but #omicron grows very poorly and causes very little CPE. This makes interpretation of replication data difficult since most measures are dependent on CPE based measures. Doesn’t mean that data is wrong, but magnitudes maybe a bit fuzzy.”

Menachery is someone who studied coronaviruses before the pandemic, i.e. one of the few OG coronavirus scientists and someone who knows this stuff inside out

But apparently Delta is not that easy to grow either. Yet both are hypertransmissible. So there is some major poorly understood difference between in vivo and in vitro…

Then this preprint came out too:

https://www.biorxiv.org/content/10..1101/2021.12.12.472252v1

Which is mostly yet another neutralization study, but the supplement is interesting:

https://www.biorxiv.org/content/biorxiv/early/2021/12/13/2021.12.12.472252/DC1/embed/media-1.pdf

Figure S2.

Here, they grew it up to 96 hours in VeroE6 cells.

And you see a curious thing — Delta shoots up real fast, but even WT [wild type] grows much better than Omicron, which initially goes down at from 0 to 48 and only then ramps up.

Yet it is hypertransmissible like nothing seen before…

I have no explanation nor can I square any of this (or any putative reduced virulence) with the mutations in the virus.

It’s a wait and see for the fog to disperse…


Yves Smith

That is the worst dog ate my homework I have ever seen, and I have quite a few. IM Doc noticed too:

I am informed by a reliable source that the initial data was looking overwhelmingly amazing.

I have been doing this for 30 years , a decade and a half on an IRB.

I have to say I have never heard one time of a major medical study like this not being able to secure meds. It would be one thing if it was a difficult boutique hard to manufacture oncology drug.

But a drug that is being given millions of times daily all over the world?

Yves Smith

Please refresh your browser or reopen in a new page. The full post is up, not sure why you are not seeing it.

And relying on T-cell immunity is not a hot idea with a pathogen that one can get repeatedly. New T-cells are made by the thymus, as you probably know, and that’s pretty much done by adulthood. Doctors are already seeing T-cell derangement and exhaustion. We hoisted this from an e-mail by IM Doc in an earlier post:

Another concerning thing I am beginning to hear from my oncology friends is the absolute explosion of soft tissue cancers [note that is old school nomenclature] that are happening. This is especially true of malignant melanoma and renal cell carcinoma. One of my oncology colleagues noted to me the other day that he found it very troubling that these two in particular were going parabolic – the two soft tissue cancers whose etiology most have to do with a disordered immune system. Lymph tumors like lymphoma and myeloma are also apparently going off the charts as well.

And GM’s reply:

This was predicted already last year when it became clear what the virus does to T cells.

You go through a large T-cell exhaustion and derangement event and then you have fewer of them to monitor your own cells for malignancies. Thus one of the key mechanisms through which the body cleanses itself of tumors is diminished. An aged immune system is not so good with dealing with them, which is one reason (along with the sheer accumulation of mutations over time) why old people get cancer so much more frequently.

Well, the virus directly causes derangement of cellular immunity so logically it should also cause an explosion in cancers. If what your are seeing is confirmed as a trend, and if it’s these two types specifically that are exploding that is quite solid supporting evidence, then that hypothesis will turn out to be have been correct.

And that’s a slow ticking time bomb that is only now starting to go off…


 

Ancient Greek drug could cut COVID-19 deaths – Israeli scientist Jerusalem Post. IM Doc:

Yes – that may really work – colchicine has been an amazing all around anti-inflammatory drug for centuries. It is being used more and more for all kinds of stuff.

When I was fresh out in practice, literally a 2 liter bottle of pills could be had for pennies.

Then a few years ago – colchicine got SHKRELI’d – and it is now hundreds of dollars for 5 days.

Notice though how in Israel it is described as cheap medication –

Well – it is everywhere else in the world – but not in the USA. It was 30 years ago – but not anymore.

And about Pharma patents. Since this drug was used heavily by Henry VIIII for his gout – seriously doubt it is a patent. No – it was our own stupidity and greed that allowed the fleecing to occur. They are now slowly doing the same exact thing to insulin.

 

IM Doc

A bit of an update for my NC friends.

Things in my world are clearly headed off the rails.

All last week, we were experiencing a daily increase in ill COVID patients in the office. This is now becoming vertical. We have not been officially told that we have any Omicron in my area, however, things have subtly changed. I will repeat, I am not sure we are dealing with Omicron or with the long-dreaded Delta winter surge. It is hard to know with the testing regime that has been cobbled together right now.

The promised testing improvements under the Biden administration have failed to materialize. Indeed, things may be worse now. We have so so many patients doing testing on their own that numbers cannot be accurately maintained. But those kits are really becoming scarce, and unless they have been hoarded, they are not available. The medical system testing remains grotesquely spotty and intensely expensive. This complete shitshow would actually be funny if peoples lives were not depending on it.

How have things changed? – Way way more vaccinated and boostered patients are now becoming positive. Many of them quite ill. Indeed, as OUTPATIENTS, I would say our vaccinated ill is basically on par with the vaccinated population at large. The same is true of the boosters. So, basically, just like Denmark, we seem to be at complete par. Ergo, the vaccines are basically worthless for transmission of the virus. So far, it remains about 60-40 unvaccinated-vaccinated in the hospital. However, the vaccinated are becoming more and more ill. And unfortunately, are needing to be admitted. This is NOT just nursing home patients. On the other side of the coin, for those who believe that natural immunity is the golden ticket, I have news for you. I have been steadfastly telling the brain trust that I have yet to see a previously infected non-vaccinated patient come in with COVID symptoms again. Well – that run is now over. I have seen two in the past 2 days. We will see how this trend develops in the coming days.

The symptoms are changing as well. For the majority, it is a bad head cold. But for those who are really ill, the respiratory symptoms that used to predominate are now replaced with intense nausea-inducing headaches at times leading to severe vomiting, intense fever, chills, and now I have been seeing a few patients with intense diarrhea. Interestingly, the muscle cramps and pain seem to all of a sudden be really bad.

Also, there is some decrease in a few patients in efficacy with the monoclonal antibodies. They just do not seem to be working as well as they did for some people. Furthermore, these treatments are being heavily restricted and patients must now meet strict criteria to get them. I have been told there is quite a supply problem. I am not sure that is true – just the scuttlebutt. It is alarming to me that intense preparation was not done on these anti-virals by our officials – but as Lambert pointed out in the links above from the Vice-President, it is clear that further variants were not even on the radar of our officials this year. Omicron came out of nowhere, don’t you know. Who could have expected this to happen? And it was also crystal clear that this antibody therapy was not on Dr. Fauci’s or Biden’s list of things to take care of. If you live in certain states like Texas or Florida and others, your governor and health officials had the foresight to secure your own supply, limited as it may be. Everywhere else – well – good luck. We are spending our time on vaccine mandates and passports for a non-sterilizing vaccine.

Sorry, if I sound very bitter – it is because I am. I get to watch people suffer every day because of the gross incompetence on display at almost every level of this country.

We had one big group of patients the other day from a big holiday party. It was the same despicable scene of all the guests showing proof of vaccination and a recent COVID test – running around the party unmasked, while the hired help all were masked. I know this because I saw the pictures and videos of the party. 12 fully vaccinated older ladies and 3 staff, many boostered, many fat and diabetic – 11 of the 15 are now positive, 3 in the hospital and 1 is fighting for her life. One of the daughters informed me this weekend that the very ill mother had told her twice that Joy on The View had repeatedly stated this year that parties were great if everyone is vaccinated. This misinformation is causing severe health problems for the viewers. Where are the Youtube and Twitter censors for this? This is hubris of the first order. As I have repeatedly stated, the Ancient Greeks believed the only entity able to clean up Hubris was Nemesis.

Let me put it this way – Santa is not the only character that is going to be flying through the midnight clouds this week. When Nemesis comes, she is like a thief in the night.

Part of being an excellent physician is to constantly assume everything will be the worst case scenario – and work for that not to happen. I apologize if over the past months, I have been a bit of a downer – it is how I work – always assume the worst case and prepare accordingly. All the while being the Rock of Gibraltar for your patients and their families. That is guidance that has streamed through medicine from the most ancient of times. I must say I do not have a good feeling about this at all. Our hospital, like many others across the country, is now with a very diminished crew. Our federal officials have not only not helped, they have actively done things to make this situation infinitely worse.

Again – I do not know if what I am experiencing is actually Omicron. And I would like to add as a medical professional for 30 years, I am just as confused as everyone else about our chances with Omicron. It is all fog right now – hopefully this will not be that bad. The next few weeks will be telling. I am praying daily.

I am likely going to be so busy the next few weeks that I will not be around here much. I will absolutely stay in touch with Yves and Lambert and the brain trust. But I have this feeling a tsunami is on the way.

This is what I would tell everyone to do right now – Be mindful of everyone in your life. Help those and look after those in your world who cannot help themselves. Elder and ill should not be in the grocery stores or post office or whatever in the coming weeks. Please please look after every one of them in your life. If you are fat, do something about it starting today. Walk, run, get out in the sun. De-stress. Sleep well. Eat exceedingly well. Get off the Doritos and Dr. Pepper. Start taking VIT D 4000 units daily today. Zinc 50-100 mg daily today [if positive and sick for a few days; standard issue daily lozenge or 1 or 2 pills daily (on the order of 5-10 mg) is perfect during the prophylactic stage]. VIT C 1000 mg daily today. Get POVIDONE/IODINE solution from the pharmacy or make your own nasal spray from Betadine ( recipes all over the web). Spray your nose and gargle twice daily. If you are going to or hosting a party, have every single person hose their nose down with POVIDONE before going in the house. Do it again as they are leaving. DO NOT, I REPEAT, DO NOT use the same nose spray for everyone. Each individual should have their own.

Most importantly, put down the flame throwers and blow torches. I learned a very important lesson during the AIDS crisis. We are all going to have work as a team or this is going to be the end of us all.

God Bless.
 

Danpaco

Speaking from personal experience, be very careful of taking that high a dose of zinc over the long term.
I recently got over a 2.5 months long vertigo/nausea episode brought on by taking 65mg of zinc daily for over 150 days. The recommended daily dose is 11mg for adult males, anything over 40mg per day can lead to zinc poisoning.
My vertigo went away three days after stopping the high dose of zinc and has continued to not be an issue. I’m happily back at work.
Be well all.

 
  1. IM Doc

    Yes

    Mistake on my part from the sleep derived brain. That is the therapeutic dosing when someone is already sick and positive. And only for a few days.

    A standard issue daily lozenge or 1 or 2 pills daily (on the order of 5-10 mg) is perfect during the prophylactic stage.

    Sorry all. Yet another reason why NC commenters are indispensable.

    I really need to be careful about this on this kind of forum. Thank you for pointing this out.

grayslady

Re: antibody shortages, the Chicago Tribune published a long article on this four days ago. From the article:

The federal government is paying for the antibodies and giving them to the states. The Illinois Department of Public Health then distributes them to providers. The antibodies themselves are free to patients, though providers may bill patients or their insurance companies for services associated with providing the infusions.
For the time period stretching from Nov. 29 to Dec. 12, the state allocated 8,638 courses of monoclonal antibodies to more than 100 providers across Illinois, with Innovative receiving nearly 500 for its two locations, one of the largest allotments in the state, according to a recent health department memo to providers. When deciding where to send the antibodies, when there’s a shortage, the state takes into consideration which areas are in greatest need as well as how much a facility has been using…

Gov. J.B. Pritzker said Tuesday that the state is “making sure that monoclonal antibodies are everywhere in the state. And that’s not a small feat. It’s hard to get a hold of them. There’s a bit of a shortage of monoclonal antibodies but we are managing that throughout Illinois.”

Interesting that the high income North Side of Chicago has two outpatient clinics receiving 6% of the State’s total allocation. To be fair, Innovative seems to have enough skilled technicians. My pulmunologist, who works for one of the country’s “top hospitals” told me the other day that in the past year 1500 employees have already quit due to burnout. The tech who performed my DVT ultrasound the other day had been shifted from mammograms since so many doctors are concerned about blood clots from Covid that more ultrasounds are being ordered, and mammograms are apparently on hold.

 
  1. IM Doc

    This has been a different year for mammograms. The COVID vaccines make changes happen on the mammograms that could lead to unnecessary testing. Therefore, many women are messed up on their scheduling and the numbers being done are down.


Kris Alman

Re Southwest executive, he was triple vaxed. Wondering how much earlier his booster was given and whether his tests were antigen tests that can’t pick up omicron.

https://www.wsj.com/articles/southwest-airlines-ceo-tests-positive-for-covid-19-11639768155
He tested negative multiple times before the hearing and tested positive after returning home, said Southwest spokeswoman Brandy King.

She said Mr. Kelly, 66 years old, is fully vaccinated, received a booster earlier this year and is experiencing mild symptoms.

 
  1. IM Doc

    I just heard on the news that Elizabeth Warren now has COVID.

    I must admit the first thing that came to my mind was if she was in the room with the Southwest CEO who was coughing a lot massless and later found to be positive.

     
    1. flora

      Dear IM Doc, (and please forgive this untoward intimate address, as I do not know you but highly regard your comments here), I am reminded that the hospitalliers and hospitals were a Middle Ages invention, born from charity. Prior to that invention the poor and sick were left to fend for themselves as best they could. Judgement of “worthiness for treatment” was replaced by care for all, regardless of social largely agreed upon “worthiness”.

      I say this because, while I’m disappointed in Sen. Warren’s treatment of Bernie, she is no less worthy of treatment than the least among us. She is a human in need of treatment, regardless of whatever her political ideas. my 2 cents.

       
      1. IM Doc

        Oh I agree
        We all need to be treated the same vaxxed or not. I have been yelling for months at students who have a righteous attitude toward the unvaxxed. I meant nothing bad about sen warren. I only wish all the best. My comment was mainly about the flippancy being demonstrated by our elite. There are now photos going around of her maskless in meetings and on her plane. We are all going to have to take this seriously including our elite. It would make my job do much easier of our elite were actually practicing good habits right now.

        I meant nothing bad towards her at all. Sorry it came out that way.

         
        1. flora

          Thank you for your reply. I hope I understood exactly your original meaning as you describe. I’ve never thought otherwise about your comments, and only wanted to add on my 2 cents for whatever they might be worth. Best

           

  1. IM Doc

    First of all – what are we doing allowing a surgery center to be owned by a personal injury attorney?

    That is almost as bad an ethical lapse as Dr. Fauci’s own wife being the head of Ethics at the NIH. Unfortunately, that is true.

    There was a time and day not that long ago when medical ethics meant something. Neither one of the above scenarios would have even gotten close to being implemented.

    The other thing I would say is how frequent it is in my professional life for spine surgeons to be cesspools of unethical behavior. There is all kinds of unethical things going on in medicine these days – but when something is really bad, there is a higher chance it is a spine surgeon.

    This kind of stuff pains me.

IM Doc

In the 1980s when I was a student, in the middle of the worst part of AIDS, I had the privilege of being on a service with an ancient Infectious Disease attending.

He waxed poetic all day, and I learned a tremendous amount.

He spoke a lot about pandemics. He wanted to make sure we all knew that he was certain we would see a pandemic in our lifetimes that was airborne and respiratory. “You cannot run from history”.

And I will never forget what he added at the end – “It will almost assuredly be a coronavirus.”

What am I saying? – So much of this was known by experts for decades. They were often ignored and even laughed out of rooms. Even after SARS 1, coronavirus research was at best on the back bench.

The people doing the laughing are now in charge. That gives me no comfort at all.

 
    1. IM Doc

      Look at the 1890s.

      Also the repeated coronavirus pandemics in veterinary medicine in the 20th century.

      It was just a matter of time.

       

Interestingly coded language in the title of this article (not using the words vaccine, Pfizer, or BioNTech - but it's about those things)

Cumulative Analysis of Post-Authorization Adverse Event Reports of PF-07302048 (BNT162B2) Received Through 28-Feb-2021
 Scribd. IM Doc’s hot take:

I really need to look this over.

This is very early in the vaccine drive ending on 2-28.

Just at a glance there were over 1200 deaths and over 2000 anaphylactic reactions…..

Amazing just how bad they have been lying.

This is devastating and is an indication of how low this could possibly go.

More than 11000 not recovered as of the date 2-28 from whatever se [side effects] they had.

I assure you no IRB [Institutional Review Board] on earth would let this see the light of day with these numbers.

I would need to get the dates, but March 1 was I am certain still in the time frame when minimal vaccines were available and were being rationed by age, etc. This makes that all the more concerning.

Dean

The numbers come from the original clinical trial where 18,801 participants received Pfizer vaccination. If the Pfizer vaccine caused 1200 deaths (Which IM doc stated the data in the article shows) out of the 18,801 that is a rate of over 6% deaths in the vaccinated. As of December 2021 over 100 million Americans have been given 2 doses of Pfizer vaccine. If it killed over 6% that gives over 6 million.

 
  1. IM Doc

    These numbers have nothing to do with the tens of thousands from the original trial cohort – That has nothing to do with this analysis.

    This is a cumulative analysis. These are done all the time in research or experimental drugs. I can assume we now do them on EUAs done on a mass scale as well. As I have stated many times, this is the largest PHASE III Trial ever conducted in human history. And it has been under no supervision of an IRB in any way shape or form as has been done for decades.

    The denominator in this situation would be how many subjects had been vaccinated with the Pfizer vaccine up until FEB 28th of this year. It would be in the millions – but NOTE it would not be every vaccinated subject because Moderna and J&J were also being given at the same time. I just do not know the exact number. I have to admit I have not gotten the magnifying glass out on the fine details on this paper – have not had time. Usually this total denominator number is very visible – it may be – I have just not yet found it.

    If I had to guess I would say 10-20 million. And yes, that may seem like a low level of mortality – 1000 out of ten million. It is not. That is actually very high. This level of morbidity and mortality in any other protocol in a drug trial would have caused instant cessation in times past. Had this data been shown to my IRB, I can guarantee you the non-medical individuals on the committee would have settled for nothing less than complete suspension of the trial – only to be resumed once much much more was known.

    We are told in medicine that this has type of oversight has been suspended because of the dire status of the pandemic. I am OK with that as long as everyone has been as transparent as possible just as it was promised. It is crystal clear from this data presentation that transparency has been nowhere on their radar all year long. Those who have pointed out the extreme red flag signals in VAERS for example have been censored and heckled without mercy. But here we are.

    When thinking about transparency, I would also point you to the statement of Dr. Rubin, the editor in chief of the NEJM and one of the vaccine committee members. When asked about side effects of the vaccines in kids his statement was something to the effect that we are just going to have to get it out there and see what happens. He made that statement knowing full well this data in this document. Please do not tell me this data was not fully known by everyone on that committee. It makes one wonder what other data they know about – but has not been revealed. I always will come back to the promises made upon the rollout. Yes – we are doing this in this extraordinary time without all the usual testing – BUT in return we will be completely transparent with what happens and what comes out.

    They think we are all chumps.

     

Re: a post about an in-hospital experience with medical personnel not using PPE appropriately,

IM Doc confirmed that this attitude is not uncommon:

I was taken aside a few weeks ago and told that my PPE was over the top and scaring patients.

I was told I was vaccinated and could not spread the virus and was protected. Just two weeks ago. I told them to go fuck themselves and the side eye continues to this day.

IM Doc

First of all – to everyone here at NC – a VERY MERRY CHRISTMAS!

An anecdotal update from my area.

All physicians here have been vaccinated. Many boostered. As of last night, myself and 2 others are the only ones able to physically show up – everyone else is positive, sick and/or in quarantine. The already diminished nursing staff is much the same.

At our facility this AM were 103 names on a list of patients who had become positive over the preceding 24 hours needing an appointment. I have seen many of these patients this AM on the computer. There has not been a single unvaccinated one in the group. At the very least, the vaccinated patients represent the exact percentage of the vaccinated in the population – and even that seems to no longer be the case. Lots of “vaccine required” family gatherings being disrupted and some members placed in quarantine. Legions of very pissed off people.

It is absolutely the case that the symptoms are clearly milder. Thus far, I have had no new admissions in the past few days. However, there are quite a few of these people who although not hospital level are indeed very very ill. And I want to remind everyone, even though this seems not to affect the lungs as drastically, thereby minimizing admissions, we have zero clue if any of the other issues with COVID are diminished as well. WE ALL MUST BE CAREFUL.

This is the new and alarmingly different part:

Unfortunately, there is a growing angst and even anger and at times outright hostility. People who were promised they would not get sick, who were promised they would not have disruptions like this are getting increasingly peaved.

This thing is spreading like wild fire. And very thankfully, we so far seem to be maintaining manageable hospital admissions. You have no idea how thankful I am of that. However, the ER and urgent locations are just overwhelmed – and largely with patients who are not really that sick and yet demanding PCR tests and other things. The tempers are running hot. The waiting rooms are crammed full and just imagine the “fights on the airplanes” videos – and that is what health care has become lately.

I am exhausted, you are exhausted, and God knows the nurses and staff are exhausted. PLEASE DO NOT TAKE THIS OUT ON THE HEALTH CARE STAFF. I am urging angry patients to take a walk outside and return only when they have cooled down. And to place their anger at appropriate channels by calling their congresspeople and insisting on an investigation of our federal agencies.

Take home points – if you are vaccinated or boostered – PLEASE do not assume you are bullet-proof. YOU ARE NOT. Please do not think you are not going to share the wealth with elderly infirm Grandma – you very likely will.

If you have even a hint of a symptom – please stay home. Testing ability is in profoundly short supply. Indeed, in my area – we are running very low and will not make it through the weekend. HAVING NO TESTS DOES NOT MEAN YOU ARE NEGATIVE. If you are ill, STAY HOME.

And for God’s sake – show some respect for yourself and your neighbors and your community. Do not cuss out nurses in front of 5 year old kids. The “b” “c” and “f” words have no place in a hospital. I have had to already do my best to console a 30 year old single mom nurse last night after a tongue lashing – the likes of which I have never seen before. “Ma’am I am so sorry you did not plan better – but we have no tests to accomodate your demand for pre-flight testing. I am sorry that is the way it is.” The resulting torrent of 4 letter words would have made George Carlin blush. Do not act like a fool for all to see. Many of us seem to be losing it – becoming unhinged. We are better than this.

I want everyone to remember the Blessed Meaning of this Day.

May God Bless Us – Every One.

 

Administration’s Obvious Covid Flail: Officially Abdicates as Case Count Hits Record; Scientists and Press Misrepresent Data to Put Happy Face on Omicron

Forgive me for doing a cursory job on such an important and sorry set of Covid developments. But I had really intended this to be a holiday week and instead I’m up to my eyeballs in family duties. But the raw facts are so bad that to a fair degree, they speak for themselves.

It’s become painfully evident that the “follow the science” and Biden Administration campaign promise to act as the adults in the room are a sick joke. Policy all politics. Public health long ago left the barn and is now in the next county. Biden threw in the towel on Monday after having promised on the campaign trail to shut down the virus:

 

While constitutionally, public health is indeed a state and local responsibility, the Feds have the say over interstate commerce, and they also have many other powerful levers they can pull though their bully pulpit, data collection and dissemination, and their ability to fund nationwide programs. We’ve instead had inconsistent, often inaccurate, and actively damaging messaging (“if you are vaccinated, you are protected”; “the vaccinated can stop masking”) but also making things worse by not understanding how poor the CDC’s data is (something the agency has abjectly failed to address) made worse by officials apparently believing their own spin.

The latest is the CDC making horrendous decisions based on its own crap information. The agency admitted that its December 18 estimate, that Omicron represented 73% of all cases, was too high and the point estimate should have been 22.5%.

This CDC bad call, just like its 2020 fail on test kits, has real world implications. IM Doc had been complaining that his hospital could no longer get Regeneron when his patients were clamoring for it. He learned from his mafia that the CDC had believed its 73% Omicron estimate and based on monoclonal antibodies not being effective against Omicron, it wasn’t cost justified. IM Doc is sure some of his patients have Delta and he now can’t treat them properly.

Yet alarmingly, we are also seeing Saint Fauci and Rochelle Walenksy, despite their repeated abject failures, act as they are in running Covid policy, in defiance of Biden and the states. Fauci tried to assert authority over the airline industry during his Sunday talk show rounds by pumping for a vaccine mandate for domestic air travel. This was extremely presumptuous in light of:

The industry lobbying Congress during formal testimony for an end to masking, based on the claim that planes have super duper filtered air (yes, but what about the guy near you coughing or talking and his Covid cooties getting to you before a filter?)

Delta [the airline] petitioning for reducing vaccine quarantines to five days for the fully vaccinated…despite evidence that for Delta [the variant], and even more so for Omicron, the vaccines do little if anything to reduce spread

Many employers retreating from the >100 employee Federal vaccine mandate while it is in legal play, demonstrating they are not on board

The real possibility that the Supreme Court will overturn or restrict the employer mandate, and that could have implications for other Federal vaccine schemes

On Monday, the Administration capitulated to Delta’s request and reduced the recommended quarantine to five days, and Fauci reversed himself on a vaccine mandate for flights.

Even former Administration backers were gobsmacked. From the Financial Times:

Eric Topol, director of the Scripps Research Translational Institute in California, said: “It seems pretty chaotic. You have an announcement yesterday on isolation guidance with no data, no evidence, nothing. And this is from an administration that says it wants to stick to the science.

“Then today, we have the drastic changes to their genomic estimates. The last 24 hours show that the credibility of the agency is lower than it has been at any point during this administration.”

Topol has even more unkind words in The very bad day at the CDC, which I strongly urge you to read in full. He makes clearer than the press does the degree of the CDC’s data failure.

Scientist GM’s take on the quarantine reduction:

So now if you work in, for example, retail or fast food, your boss can force you to come back to work on Day 6, where you will proceed to infect all customers you interact with.

Also, people will die on the job because of this. How is that going to play out in practice?

You test positive, then you go through the flu-like phase of COVID. A lot of people will not at all be in any shape to come back to work on day 6, many are still really sick at that time.

But bigger problem comes later — you have come back to work, you start your shift, then the day-10 rapid deterioration kicks in, at which point you need to be in the hospital ASAP. But you just started your shift and will be fired if you leave so you try to carry on.

One hypothesis about why we no longer see people randomly dropping on the street as was the case early on on in China, Iran, Italy, etc. is that everyone is aware of COVID now and has tested positive before it gets to that point and is thus either in hospital or isolating at tome. While those people randomly dropping dead were the rapid deterioration or heart attack/stroke cases that thought they had the flu at the time nobody was aware of COVID and were thus were freely walking around.

We are about to test that hypothesis now…

P.S. This is straight up premeditated mass murder at this point

He added:

It includes HCWs [health care workers], but this is definitely not about them.

They could have been handled with a specific provision.

And that provision could have been temporary.

And it could have been to the effect of “if you test positive, you are assigned to the COVID ward, but you must absolutely not step foot in the oncology department next to the chemo patients”.

This is nothing of the sort — this is a permanent irreversible policy shift for everyone.

So from now on wherever you go to buy anything you have to be aware that the people working there might be on their Day 6…

IM Doc confirmed the management response:

The ERs and urgent cares in the affected areas are being cremated as we speak. The hospital units not so much – at least yet. You should hear some of the horror stories I am hearing from colleagues.

It has indeed now risen to the level of a public health menace.

After years of nurse mis-treatment, on top of COVID burnout, firing tons of staff over vaccine mandates – and now seeing whole units being quarantined – they see the writing on the wall.

The only one of those issues that is readily fixable is changing the quarantine time. Calling in the National Guard is simply not going to do much at all – as they are finding out the hard way right now.

So much for the whole argument that the vaccine people have had – I DO NOT WANT TO GET CARE FROM AN UNVACCINATED HCW – Well now you are going to get care from a HCW who may very well still be contagious.

This is a clusterfuck of obscene proportions. I can scarcely believe what I am seeing.

And if we are to hold Biden to his word – why would anyone listen to the CDC anymore – this is not a federal problem as of his speech today. Why is the CDC even making proclamations like this.

And he confirmed shortly that his hospital’s personnel department had sent out a “celebratory e-mail,” for those coming off the new shortened quarantine to contact their supervisor pronto since there were many open shifts.

Other news tidbits are similarly damming if you have a modicum of the backstory. The Financial Times tells us Biden’s promised 500 million home test kits are yet to materialize:

Last week, the US president announced that the federal government would respond by distributing 500m at-home tests. Speaking to reporters on Wednesday, Biden said his administration had “a bit of progress” on distributing the test kits.

In fact, the normally Democrat-friendly Vanity Fair broke the story that the Administration had nixed an October proposal of a mass home test program by Christmas. On top of that, Biden hadn’t even signed a contract when he announced his scheme; a Johns Hopkins expert said it would likely be a year before the kits were distributed.

Walensky, like Fauci, is also operating well beyond her authority. She not only fell in line with Fauci on giving in to the airlines on the length of recommended quarantines, but she also appointed herself as arbiter of broad social policies:

 

Neither Fauci nor Walensky were subject to any democratic approval process. Decisions about non-health impacts are none of her business and should be left to those who are supposed to be in charge. Unfortunately, there appears to be a gaping power vacuum and she’s all too willing to seize ground.

A final issue, which will get only brief treatment, is putative experts and the press are pushing every bit of Omicron hopium they can find, to the degree that they are baldly misrepresenting research….which even if the spin were accurate, should be treated with caution. We still don’t know enough about Omicron to be certain of much save its very high level of transmission and resistance to vaccines and monoclonal antibodies. As Lambert put it:

If you believe in the precautionary principle, then you don’t amplify “emerging data” where the policy implication is to do nothing.

One reader with a medical background sent a link to the hopium in question, a very small South African study where the title of the preprint, Omicron infection enhances neutralizing immunity against the Delta, flat out misrepresents what the data actually says. As GM said:

The PR spin is profoundly misleading and the opposite of what the data says, but unfortunately in this case the scientists themselves are to blame as they are pushing that narrative too.

The data shows little actual cross immunity.

I would not be surprised if Omicron burns through the whole world and then in mid-2022 it all starts again in some part of the world with a new strain….

Here is the first Delta/Omicron cross-neutralization data:

https://secureservercdn.net/50.62.198.70/1mx.c5c.myftpupload.com/wp-content/uploads/2021/12/MEDRXIV-2021-268439v1-Sigal.pdf

There is some cross-neutralization, but if you look at the unvaccinated subjects, half of them were below the limit of detection at the follow up. Which was two weeks after the initial presentation.

So they were infected with Omicron but are not showing appreciable neutralization against Delta.

Overall, including the vaccinated, titers went up 14.4x against Omicron, but 4.4x against Delta.

Which is touted as great protection against Delta, but it really is not, as titers are going down from there.

This might be enough to push Delta down in the short term, though it will not be a fast displacement into oblivion.

But it will do nothing against future variants a year from now.

And yet what does the abstract of the paper say?

The increase in Delta variant neutralization in individuals 39 infected with Omicron may result in decreased ability of Delta to re-infect those individuals. Along with emerging data indicating that Omicron, at this time in the pandemic, is less pathogenic than Delta, such an outcome may have positive implications in terms of decreasing the Covid-19 burden 42 of severe disease

Which fits well with a very disturbing trend over the last few weeks — most of the top scientists in South Africa have come out in support of the governmental policy of abdicating completely from infection control and have given statements in the spirit of “Omicron is mild and will end the pandemic”.

I have no information of why that is being done, but the suspicions are obvious and natural — this has all the hallmarks of political pressure from on top.

Because those people do/should know better scientifically.

And even if the “mild” narrative were true (the UK’s Imperial College is not on board, and the UK, between having an actual national public health service plus regular surveys of 100,000 people, has some of the best Covid data in the world), that is not necessarily good news. It appears if anything that more are getting symptomatic Omicron than Delta. In particular, note the relatively high level of symptomatic Omicron in children and young adults who have robust immune systems and showed a much lower level of symptomatic cases under Delta…and this with much more of the population, even young adults and teens, vaccinated than before.

The reason for concern is that a new, reasonable size study (n>500) found that 67% of those who had mild to moderate Covid developed long Covid. There’s no reason to think Omicron will be more forgiving.

Yet the CDC keeps digging its hole even deeper:

 

The Administration can barely keep up its pretense of being in the business of protecting the public. Every man is now on his own, at least in the US.

IM Doc

I work in a highly vaxxed county – greater than 80% among adults – in the USA

Our big winter surge started here about 2 weeks ago – and has dramatically escalated in the past few days.

So we are just now starting the hospital aspect of this issue.

Our stats from December 1st to now – is about 60% vaccinated – 40% unvaccinated in the hospital. I do not know the exact booster numbers for the vaccinated – but let’ just say several.

Even though the numbers have clearly gotten worse for the vaccinated – the 90/10 ratio was commonplace until about a month and a half ago – it is still the case the the unvaccinated account for almost all of the ICU patients.

Of note, our overall hospitalization rates per capita have been much lower than average throughout this whole affair.

It must also be said I am in a rural area – with many other factors – people here are much more healthy, they are not crammed together like sardines, and there is much much more community mitigation efforts than I am seeing displayed from our big cities. There is a community wide effort to educate people about low pulse ox – and not to sit at home and get sicker by the day. Family members and friends abound for almost everyone – to keep an eye and ear out for those who are ill. The outpatient doctors here also have much more aggressiveness in caring for patients and keeping them out of the hospital than is going on in the big cities where corporate medicine rules.

End of 2021


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