IM Doc pt 34
Feb. 3rd, 2022 12:04 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
temporaryrealityDuring a COVID-19 Surge, ‘Crisis Standards of Care’ Involve Excruciating Choices and Impossible Ethical Decisions for Hospital Staff
More Omicron: Diabetics Appear Even More Vulnerable as Diabetic Ketoacidosis Strikes
Our IM Doc sputtered early on in the Omicron wave about not only continued lack of guidance about treatment but also clues as to how Omicron symptoms and progress might differ from earlier variants, particularly given the lack of sequencing in many hospitals (including his) and now even test shortages. As we’ll discuss, there is yet more confirmation that Omicron is much less likely to produce debilitating and often deadly viral pneumonia than early variants. However, the ongoing claim that it is mild may be overdone.
We are not alone in wondering if the apparent higher frequency of less debilitating cases is a statistical anomaly due to incomplete data. We aren’t alone; Yaneer Bar-Yam has expressed similar concerns.
Take two populations of 1000 people.
Assume 200 of one group got symptomatic Delta and 350 of the second group got symptomatic Omicron. That’s hardly nuts in terms of relative penetration of the two variants, given the massive Omicron spike.
Assume 10 of the Delta group wind up being hospitalized and two die. Assume 13 of the Omicron group become hospitalized and two die.
On a population-wide level, Omicron is as deadly and leads to a higher rate of hospitalizations.
But that is not what clinicians will observe. They will look at the level of severe cases among the patients they see or know about. That will of course only be symptomatic cases.
Using the illustrative numbers above, Omicron looks less bad. Delta has a 5% hospitalization rate among symptomatic cases versus 3.7% for Omicron, and a death rate/symptomatic cases of 1% for Delta versus 0.6% for Omicron.
Another factor that may be giving doctors some relief is the shift away from viral pneumonia means that hospitalized patients are likely to have their cases resolve faster. In earlier Covid waves, the severely ill often spent 2 to 3 weeks in a hospital, which is far longer than for most ailments. That meant Covid cases would quickly consume hospital capacity.
However, an offset with Delta is that bad Covid cases, if caught early enough, could be treated with monoclonal antibodies. That’s largely out with Omicron. Most monoclonal antibodies are ineffective against Omicron and the few that work are in very short supply.
And consider:
And we’ve repeatedly pointed out from the very get go in South Africa that Omicron is putting an unprecedented level of babies to nine year olds in the hospital. The current vaccines do not produce an adequate antibody response in children under five to justify their use. So when the press demonizes the unvaxxed, that includes toddlers as well as young school age children not yet vaccinated either due to lack of availability or parental concern about limited safety testing on the young.
To have a solid handle on Omicron severity, we need large scale, population-wide surveys, and a ton of sequencing to identify Omicron versus Delta cases. That means we may have to wait for the UK to do the work, since they conduct periodic tests of 100,000 and lots of sequencing.
In the meantime, US testing is a shambles. Readers were describing the difficulty of getting a test in comments. From IM Doc yesterday:
The testing supplies and kits are simply non-available – except in the health department and the hospital.
So so many people are calling in – and we are just assuming they have COVID. There are not enough tests to even begin to appropriately deal with this problem.
The ones I am screening and are of a concern – we also check for RSV or the FLU – but by the time most people hear there is no COVID testing – they are not interested in anything – and it will likely be expensive. Never dreamed that 2 years into this – THE TESTING REGIME WOULD BE WORSE THAN IT WAS IN APRIL 2020. JUST SIMPLY UNBELIEVABLE.
The rage is palpable and getting worse by the minute.
IM Doc is also seeing Covid, presumably Omicron-induced diabetic ketoacidosis, as well as some other disturbing symptoms:
2 very distinctive things happening in this current COVID wave –
1). I have now had 2 DKA [diabetic ketoacidosis]’s in young healthy people who are COVID positive. This is just in the past week – I maybe see them 3-5 times a year – 2 in the last week is very different. I have also admitted 4 TYPE II DM – not in DKA – but they are in hyperosmolar coma with very elevated blood sugars – the lowest in the group was 683. All 6 of these patients are COVID positive – 4 with very mild cases – And I cannot tell you how unusual it is to see even 1 of these in 6 months. Almost exclusively type 2 DM who have fallen off the truck and gone on a Ding Dong binge or some such.
Not sure what to make of this – but the timing is concerning.
2). All 3 of these guys are COVID positive – 2 under 30 – 1 much older – all 3 came in the past few days – with massively swollen testicles. All I can say is I certainly do not see this problem very often at all – to have 3 in the span of just a few days is really different. ALL 3 Sonos were orchitis. I cannot tell you how unusual this is.
It must be noted that everyone of these patients is vaccinated.
Maybe nothing – but maybe that Omicron is playing games with the endocrine organs.
Dr. Craig Spencer, Director of Global Health in Emergency Medicine at Columbia Medical School, also reported seeing apparent Covid-induced diabetic ketoacidosis:
The reason we keep emphasizing the risk of Covid is that the precautionary principle argues for conservatism when uncertainty meets serious outcomes. And it is simply maddening to see the “We must keep the economy open” forces seizing on preliminary data, particularly of the cheery sort, and treating it as dispositive. The sound course is to continue to be cautious until we have better information or better remedies.
And we now have the testing fiasco: there aren’t enough and so hospitals and doctors are flying blind. IM Doc, who practices in a very affluent area, has been distraught. From recent e-mails:
[and this a few posts later]:I am quite literally in the middle of a tsunami.
This AM we had 109 cases from the night and day before – rapidly falling way behind and there is no end in sight.
I can no longer call them COVID, however, we simply have no testing. I have 24 that have actual positive COVID testing – the other 85 we are doing sheer guess work.
Please remember – we were griping about busy days just a few weeks ago with 20 or so COVID patients. Just imagine what it is like here now. I have one staff out on quarantine. And the other one is just frazzled and overwhelmed and emotional after days of this. The other two have been pulled to other critical areas because they have zero staff. There was a time when we would all be on quarantine because of the exposure. I do not have adequate test kits to waste on testing them though.
The private home tests have completely dried up. Many patients have plenty that they have hoarded apparently – but not willing to share. People are being requested to stay home with mild symptoms – and so all I have is guess work on Zoom or the phone….
I have never felt so helpless or out of control in my life.
On top of this is all the usual stuff every day in a busy practice – abnormal mammograms, glucoses going off the wall, chest pain, infected toes – you name it.
I feel like I am drowning.
Our normally polite and measured IM Doc has had it:
Behold this video. I cannot tell you how livid Joe Q Public is becoming. And they get to listen to this dope for answers.
like this md has any standing to evaluate other’s credibility.
“Guidelines with stakeholder input” I am not even sure what that means exactly……
but that will fix the credibility problem… yeah
I have a good idea – release every single unrestricted VAERS and v safe report along with the entirety of the Pfizer and Moderna data. Then we will talk. Until then shut up. Your bumbling is making the credibility problems so much worse.
maybe I should be grateful we are at least acknowledging the credibility chasm.
LA County tallies most daily COVID deaths since April 2021 KCRA. IM Doc sputters by e-mail:
Paging Dr. Monica Ghandi….Yes, that Dr. Gandhi. The ID TV expert promising all for weeks that California was bulletproof for hospitalizations and deaths from COVID. The vaccine rate was just too high and there was no way it was going to happen.
Fun fact – I was witness to another expert being asked a question today – “Are these deaths from omicron or delta?” “Is anyone testing these strains?”
His answer – “Why would you need to do that? It is obvious from the data that Omicron is not lethal.”
These are world experts. You just cannot make this stuff up.
Scientist GM added:
Monica Gandhi has been one of the most reliable predictors of what is going to happen throughout the pandemic. Nearly 100% success rate, you just have to assume the opposite of what she says.
Another IM Doc sighting:
His comment:
I am really trying to picture American medical figures like William Osler, Palmer Howard, Harvey Cushing, or William Halsted daring to show up and entertain a group like the World Economic Forum.
I am simply unable to do so.
I just simply cannot imagine any of these heroes thinking an appearance in this kind of group would be appropriate in any way. They would have avoided it like the plague.
But that has not stopped Fauci. And in doing so, is giving us all kinds of indications of his true motives and accordingly the motives of the NIH and the FDA. WHAT ON EARTH DOES THE WORLD ECONOMIC FORUM OFFER THAT WOULD BE TAKING UP A MINUTE OF THE HEAD OF OUR COVID RESPONSE’S TIME?
Furthermore, the section in this tweet about Fauci’s take on the non-believers and even more importantly Moderna’s plans for boosters and further vaccine schedules is quite illuminating.
These people have learned nothing from the past two years. Nothing. They are doubling down at full speed. The hubris is overwhelming.
NotTimothyGeithner Reply ↓IM Doc
Lou Anton Reply ↓
Covid: “The Narrative Is Crumbling”
Our Covid brain trust had a wee discussion of how the dogs are no longer (much) eating the dog food of vaccines as the magic bullet for all problems Covid. Even if the press is hammering away at the story line, we’re seeing more and more defections…including from those inside the media tent.
Bear in mind that until recently, Kim Iverson was of the “let ‘er rip” school of thinking. Now she’s declaring that the vaccines, even boosts, do perilous little to stop Covid. She tears into the public health establishment for being “hyperfocused” on the vaccies , and the degree of neglect and misinformation amounts to crimes agains humanity. Mind you, our GM has been giving a more cool-headed version of this argument for over a year….but to see a version of it in the mainstream media?
Further consider: the media is a hothouse. Iverson would not dare take a line like this and risk career damage and being shunned socially unless at least a substantial minority of her peers felt the same way.
Iverson also tears into the officialdom for the lack of any guidance about what to do if you get sick except go hide and hope you don’t get so debilitated that you need to call 911. Recall that this isn’t just a problem for lowly patients. IM Doc has repeatedly inveighed against the CDC for failing to give advice to clinicians…one of its most important responsibilities in past infectious disease outbreaks. It’s completely punted with Covid. The US should be ashamed that third world countries are doing better by sending diagnosis and treatment kits to citizens, with care packs including thermometers, blood oximeters, test kits, zinc, Vitamin C, Vitamin D, OTC meds for fever, and sometimes the I drug.
But Iverson’s self-described rant hasn’t fully abandoned her previous view that getting Covid might not be terrible. She highlights “natural immunity” (as opposed to “Covid-induced immunity”) as her #2 topic, and it takes a while for her to work around to her point: If you have gotten Covid, how long are you unlikely to get it again and infect others? She frames it as important to know in terms of being able to care for others. But let’s not kid ourselves: the officialdom has been so fixated on vaccines as the one and only approach to Covid that they’ve been unwilling to concede that having gotten infected some protection.1
And speaking of treatments, IM Doc, who flagged the Iverson video, in recent weeks sent along a discussion of two cases where he was certain the cause of death was remdesivir. His explanation, using one as an example:
This patient although with a high BMI – had not ever had any kind of renal disease in any way but died of acute tubular necrosis – and this is almost always secondary to drug toxic effects. The patient had a CREAT of >7 – (normal being 05.-1.2). Almost assuredly killed by the remdesevir….
Another patient earlier this year shared the same fate.
Did COVID kill them? – No – as there is no evidence that COVID or any other respiratory virus causes this level of renal failure. And this is especially so in the absence of multiple systemic organ failure – when the heart, lungs, liver and brain appear relatively intact – the chance of COVID or any initial infection being the cause of renal failure in isolation is laughably low.
But were they killed by a drug that was being used for COVID? – almost assuredly.
And just try to report that to the FDA – they laugh out loud in your face. And remdesevir is known to nuke kidneys. It happens in up to 1/3 of the patients and was the cardinal reason it was suspended in Ebola. Unfortunately – it does absolutely NOTHING – for the patients – there is no benefit that I have ever been able to see – NOT EVEN ON ONE PATIENT. Almost every country on earth has realized this – and no longer use this agent – except the USA.
However, Iverson makes the mistake of treating mild and asymptomatic cases, particularly among the young, as inconsequential. For starters, an estimated 20% of asymptomatic cases end up with long Covid.
And as GM predicted, Omicron, by not being as well suited to attack the lungs and instead going over ACE2 receptors, which are all over the body, is not much reducing lungs to bloody pulp but instead can producewidespread organ damage which takes a while to manifest.2 Martha r sent this example from a full year ago:
An Eagle River family spent 10 days in an intensive care unit, including Christmas Day, while their 6-year-old son battled a syndrome that presents in some children who have had COVID-19.
All four members of the Dye family tested positive for COVID-19 in November, parents Jerry “Heath” Dye and Hailey Dye said. The Dye children, 2-year-old Lucas and 6-year-old Cameron, barely had any symptoms while Heath Dye and Hailey Dye said they were exhausted.
“The COVID part wasn’t all that bad for us. It seemed like we had the most common symptoms that you hear about and stuff like that. It was more four weeks after — when we — when Cameron got sick and things changed drastically,” Heath Dye said.
In December, Cameron Dye was running a 104.5-degree fever. A large rash started to spread from his ankles up his entire body. The family took him to urgent care, which treated him for strep throat and scarlet fever. The treatment didn’t relieve his symptoms, and in a few days, he was admitted to the ICU at the Children’s Hospital at Providence Alaska Medical Center.
He had congestive heart failure and fluid in his lungs. The doctors said Cameron Dye had multisystem inflammatory syndrome, a new condition that the Centers for Disease Control and Prevention says comes with inflammation of the major organs in some children four to eight weeks after a COVID-19 diagnosis.
From Mayo’s listing multisystem inflammatory syndrome, dated last November:
Multisystem inflammatory syndrome in children (MIS-C) is a serious condition that appears to be linked to coronavirus disease 2019 (COVID-19). Most children who become infected with the COVID-19 virus have only a mild illness. But in children who go on to develop MIS-C, some organs and tissues — such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin or eyes — become severely inflamed. Signs and symptoms depend on which areas of the body are affected….
Rarely, some adults develop signs and symptoms similar to MIS-C. This new and serious syndrome, called multisystem inflammatory syndrome in adults (MIS-A), occurs in adults who were previously infected with the COVID-19 virus and many didn’t even know it. MIS-A seems to occur weeks after COVID-19 infection, though some people have a current infection.
Note that the Alaska case occurred with the wild type virus, which had neither the brute replication force of Delta or Omicron.
With Omicron being more severe in children and hitting other organs proportionally harder than the lungs than other variants, it looks likely that we’ll see higher levels of multisystem inflammatory syndrome and other long-term ailments than we did in the past.
Returning to the official narrative, GM opined that it still can be spun to serve our putative leaders:
Vaccination has been used to shift the frame of thinking about COVID and that shifting continues.
First, it was a way to shut down any discussion of eliminating the virus. We were going to solve this with vaccines alone, and remember that what was actually peddled was that vaccines stop transmission and that once we vaccinate enough people, transmission will stop. That was known to be false by all that were actually paying attention, but the trick was played very cleverly – people are mortally afraid of being called anti-vaxxers, because that threatens their social class status, so the majority of voices calling for actual infection control went quiet once we had vaccines.
Saying that the vaccines suck and that they have been oversold was enough for you to be labelled anti-vaxxer. I myself have experienced it on numerous occasions.
That has continued ever since but the frame has been gradually shifting — as the vaccines have been eroding it has been still socially unacceptable to say they suck and we cannot rely on them, but meanwhile we moved from saying they stop transmission to saying they are there to prevent you from getting sick, not getting infected, and now to saying that yeah, you can still get sick, but that’s OK, as long as you don’t die. But as that progression has unfolded, most people were successfully accustomed to the view that getting infected and sick is something normal, and the idea that we can actually stop transmission with public health measures was almost completely forgotten.
Also, notice how nobody realizes how quick that has happened — when has previously a vaccine gone from offering insufficient but still pretty good protection to offering very little? Except for flu, but everyone knows flu vaccines sucks, and even if they don’t, they’re only good for a few months. This one, however, was advertised as one-and-done, and even when eventually it had to be acknowledged it will be an annual vaccine (false too, it’s a 3-shots-a-year vaccine right now), that it might suck really bad some years because you can’t reliably predict antigenic drift, as with flu, is never ever mentioned.
But that wasn’t enough, people had to be made happy about getting infected and resistance to corporate pandemic policies had to be completely crushed.
Artificially creating the vaxxer/anti-vaxxer opposition helped to do that with up to a third of the population — for those that whether for political reason or due to previously held anti-vaxxer beliefs didn’t want the vaccine, if they weren’t exactly happy about getting COVID annually before, it now became a personal matter of sticking it to their enemies and oppressors.
But you still have much of the rest of society. Part of it was taken care of once the mainstream media started the campaign that hybrid immunity is the best immunity.
But the vaccine mandates and green passes came into play in order to shift the frame even further. It’s a ridiculously inefficient epidemiologically measure, but it has a repressive character to it.
So what happens? People rail against these things as they see it as impinging on their freedom and as useless because everyone around them is getting it regardless of vaccination status. And that moves them towards being happy to get infected, because they have never been told what that means in the long term.
That effect was also used to sneak in new monstrous policies such as the 5-day isolation — lots of people are genuinely happy about that because apparently few are capable of running the consequences through their heads a few moves ahead and realizing that this does not mean they will be “free” from restriction but that they will be forced to go to work even when they can’t get out of bed and power over their bodily autonomy has been taken away from them and put into the hands of their bosses.
And finally it was used to neuter opposition from the supposedly non-mainstream voices, who turned out to be ignorant about the situation both scientifically and socioeconomically, but who are now openly advocating for letting it rip and ending of vaccine mandates, as if the two things are somehow linked. Because the frame of discourse was moved to present those as the only two possible alternatives.
So now we have this perverse situation in which infection control is seen by many as corporate-driven oppression, when the reality is that corporate interests sabotaged infection control from the start.
But with the potential to further fray official credibility, any Omicron retreat be followed by a new wave:
So brace yourselves for a wild ride.
_____
1 The reality is Omicron is so different from previous variants that as we have seen, it greatly diminishes the efficacy of vaccines even among the boosted. And we are now flying blind with how much protection having gotten a previous variant (and then charitably assuming one has a good guess as to which variant it was) vs. Omicron.
1 As GM previously said:
The problem for all of us is that COVID is really three diseases at once:
1. The acute URT infection
2. The hyperinflammatory reaction in the alveoli that causes ARDS
3. The systemic infection that damages hearts, kidneys, beta cells in the pancreas, endothelial cells, the brain (though perhaps not directly), etc.People mostly die immediately from #2.
They also die from #3, and will be dying of it in very large numbers in the future, but that does not enter the official statistics and thus can be ignored politically.
With Omicron we get worse #1 (high ACE2 in the bronchi and above them in the URT), less severe #2, and we have no direct data on #3, but logic says it is worse, for the same reasons #1 is worse.
But because #2 happens to be the immediate killer that grabs attention, the rest can be ignored with a sufficient amount of propaganda.
And that is what happened.
[a little Freudian-slip humor] IM Doc noticed this “advertising faux pas”:
Bob Reply ↓IM Doc
The unvaccinated, when they get Covid, exhale much more virus than the vaccinated, and they exhale virus for a longer period of time; so they are a particular threat to the people around them and to the people trying to take care of them.
I wonder if special care centers could be set up for the [voluntarily] unvaccinated, where they could be taken care of by unvaccinated medical personnel?