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On 2/16/2021 at 3:02 PM, MediMike said:

In this situation since masking is the accepted norm at the moment you appear to be advocating for an intervention, i.e. the stopping of wearing a mask or a "demasking" if you will. 

What is the risk of transmission while vaccinated? Give me some science here man, if you don't know then you see to be abandoning the pretense of science and admitting that it's just a stubborn desire to do what you want.

What is the risk of wearing a mask? The benefits seem to be higher than you are arguing. I asked earlier and didn't get a response.

Your enforcing conformity argument is pretty weak.  When we're talking about public health I believe conformity to be of paramount importance.

I'm sorry if I haven't been clear enough, so allow me to recap:

- The value of mRNA vaccines appears to exceed all NPIs together by such a large margin that the relative value of NPIs in vaccinated individuals is negligible.
- The burden of proof is on those who would argue that NPIs used on vaccinated individuals are sufficiently valuable to mandate them.
- The whole point of going maskless in general public spaces (not among vulnerable individuals) is to advocate the science--vaccines demonstrably work--to the public.

Again, I'm not offended that so many of you see things a different way.  Yes, people are getting used to masks.  No, that's not particularly a good thing. No, we shouldn't pointlessly train them to use masks.  Countermeasure inertia is a real thing, and again, I have seen millions of dollars wasted--billions across the American IT industry--by organizations enforcing countermeasures that stopped being relevant years to decades ago.  Countermeasures superseded by better countermeasures still arguably have some benefit... but at a poor cost/benefit ratio.  Show me that that's not the case with masking after vaccination, and I'll amend my stance.

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I dunno, I thought there was plenty of explanation about how an mRNA vaccine works online.  I'm actually pretty sick of hearing how mRNA needs a lipid capsule to get into the cytoplasm, and never touc

Yikes.   time to go back to school and study immunology and read up on vaccines and mRNA.     asking thus question show a startling lack of understanding.  

way to own your own education still dismayed at lack of insight...... go open a book, read CME (NEJM has been providing FREE resources on covid for a year) heck even watch some news casts an

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21 minutes ago, rev ronin said:

I'm sorry if I haven't been clear enough, so allow me to recap:

- The value of mRNA vaccines appears to exceed all NPIs together by such a large margin that the relative value of NPIs in vaccinated individuals is negligible.
- The burden of proof is on those who would argue that NPIs used on vaccinated individuals are sufficiently valuable to mandate them.
- The whole point of going maskless in general public spaces (not among vulnerable individuals) is to advocate the science--vaccines demonstrably work--to the public.

Again, I'm not offended that so many of you see things a different way.  Yes, people are getting used to masks.  No, that's not particularly a good thing. No, we shouldn't pointlessly train them to use masks.  Countermeasure inertia is a real thing, and again, I have seen millions of dollars wasted--billions across the American IT industry--by organizations enforcing countermeasures that stopped being relevant years to decades ago.  Countermeasures superseded by better countermeasures still arguably have some benefit... but at a poor cost/benefit ratio.  Show me that that's not the case with masking after vaccination, and I'll amend my stance.

Look.  I hope that myself and a large portion of the medical and scientific world are wrong and the vaccine is able to prevent asymptomatic transmission, there is some evidence in the works and coming out that this may be true which is fantastic.

But what exactly are you basing your argument on? What is the COST of masking that you continue to espouse? This is me trying to understand your stance, I still don't feel like you've fully elucidated your position.  It seems that you have a significant degree of faith in the vaccine which I do as well, but until we know more details regarding the possibility of continued transmission what are you basing your decision to halt masking on? That is the big sticking point for me. 

Again, we'll have to disagree on where the burden of proof lies.  You have no evidence that as a vaccinated individual you are unable to transmit the virus to an unvaccinated individual.  In the interest of public health I believe that status quo (i.e. wearing a mask) should continue until we know that and/or have further information.

Advocate for science by following scientific principles and measures that protect the public, this would include continuing to participate in a low cost low impact intervention such as wearing a mask when interacting with individuals outside your household or "Fave 5" or whatever your state has decreed.

You seem to be saying that now we have seatbelts we can lose the speed limits. 

As I mentioned above, I hope that I'm wrong and it will be a wonderful day when I can show my exceptionally handsome face around the unit again.  I've heard it brings joy to the hearts of both the nursing staff and patients and has been known to increase the random individual's P:F by a factor of 2.

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Rev I disagree with you 

 

costs can’t be the sole motivating factor 

society has norms that cost money. Ie drivers licenses, home owners insurance with a mortgage, shirts and shoes to get service.   

I simply do not see the validity of your cost argument when Hanes is selling boxes if ten cotton masks for cheaper then underwear.   We are not mandating expensive and scarce N95 or respirator use.  It is just put something over your face.  In AK on cold days lots of people wear masks for the comfort of them, and now it appears the increased inspiration humidity is protective against infection due to more moist resp mm.   
 

 

I do see the IT waste of money but I wonder if these experiences in the past have introduced  a personal bias for you as I don’t think life limb disability and infectious worldwide pandemic can be compared to an unneeded computer antivirus(or any other IT cost your reference) upgrade or expense.  
 

I do however appreciate your viewpoint and how it is making everyone stop and think.   

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6 hours ago, MediMike said:

You have no evidence that as a vaccinated individual you are unable to transmit the virus to an unvaccinated individual.

I am intentionally taking this out of context, and sort of apologize for that, but do you realize how close to anti-vaxxer reasoning this is?  It's not meant to be an insult, but if this is the core of the keep-masking-even-when-fully-vaccinated argument, and it seems it is, I'm... I dunno what the right word is.  Chagrined, maybe? A bit sad, a bit disappointed, a bit frustrated.

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I'm planning on look into this more this weekend and will try to look at other people's opinions/arguments on this. I see Vinay Prasad wrote an article opposing continued masking, and although he has been somewhat of an outlier for most of the pandemic I have a lot of respect for him. Looks like ZDogg also made a video about it which will probably be entertaining and informative. Not sure how much more there is out there, though. Anyone have any other sources to look at?

 @rev ronin I'm not sure what your argument is other than vaccines are effective, its on us to provide evidence for continued masking (I think I did an okay job of that with the current literature) and that there is some hidden cost that we are unaware of. Is there anything else I'm missing? 

Regarding advocating for the science - don't you think there is a better way to do that? Ad campaigns, talking to our patients.

My question is, why relax prematurely when the evidence you are looking for is probably just over the horizon and masks having almost no downside. And if your argument is that masks lead to huge financial burdens, can you be more specific or provide some data that shows this? Is the lost money from masks more than the lost money from shutdowns/deaths/government relief? Is there evidence suggesting masks have little benefit post vaccination?

Sorry for the long post, I know there is a lot to respond to. Mostly curious if you have sources for us to look at.

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Regarding the Moderna vaccine:

"...we observed a decrease in titers of neutralizing antibodies against the B.1.351 variant and a subset of its mutations affecting the RBD. In serum samples obtained 1 week after the participants received the second dose of vaccine, we detected reductions by a factor of 2.7 in titers of neutralizing antibodies against the partial panel of mutations and by a factor of 6.4 against the full panel of mutations."

Thankfully, it looks like there was no change in neutralizing antibodies against B1.1.7 and B.1.351 isn't spreading very quickly yet. Would be good to keep it that way.

https://www.nejm.org/doi/full/10.1056/NEJMc2102179

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8 hours ago, rev ronin said:

I am intentionally taking this out of context, and sort of apologize for that, but do you realize how close to anti-vaxxer reasoning this is?  It's not meant to be an insult, but if this is the core of the keep-masking-even-when-fully-vaccinated argument, and it seems it is, I'm... I dunno what the right word is.  Chagrined, maybe? A bit sad, a bit disappointed, a bit frustrated.

Nice try dude, but you're grasping at straws and I'm pretty disappointed in you. Especially since you have yet to answer anyone's request for these horrible costs that come with masking.

We do have evidence that our current vaccines can eradicate the diseases they were built for and reduce the spread and transmission of said diseases. We know this by the eradication and near eradication of a large number of them.

Because they've been studied for years. How long has this vaccine been studied? 

Chagrined at my argument? At least I have one man. You can keep your disappointment in whatever secret box you keep your argument against masks. Think we're clearly done here.

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If you're too frustrated to continue, I understand.  I've not had enough time to pour text into the discussion like you and @TheFatMan have.

To back up a bit, someone took exception to me celebrating the fact that a fully-vaccinated me almost certainly wouldn't die from a future covid infection as if it were selfish. Hardly; it means I can be even more aggressive in being close enough to my patients to serve them better.  The first rule of rescue I drive into all of my newbie EMTs: you can't help anyone else unless you're safe and healthy.

But I agree, I probably haven't been as explicit about what 'costs' actually mean. Here's a few costs of mask mandates from my own life:

- Some Karen neighbors of mine decided to try and recall my county sheriff because he said he was not going to arrest people for not wearing masks.  Washington State supreme court just recently shot 'em down, noting that LEOs have broad discretion on how to enforce the law.

- 78 year old patient in my pain practice this morning.  He can't hear me with my mask on, even with his hearing aids turned all the way up.

- Fire department chaplaincy.  I ran a few death calls with a mask early on, but the rapport with the bereaved just was not there--it was a tangible barrier. I sat outside on a porch in 45 degree weather a few months ago, maskless and sitting a few feet apart, talking with a 17 year old man for an hour or so about what happens next to him an his younger sister since we'd transported his widowed mother for acute alcohol abuse. I didn't touch him once--not a hug, not a gentle hand on the shoulder.

Those are three snippets that immediately come to mind.  But in a world that's despairing and divided, one year into "two weeks to flatten the curve", the cost of masks is that they are a tangible reminder of despair rather than hope.  You can't really smile under a mask in any meaningful way.  It's hard to recognize my patients when I've never seen their faces, just their eyes.

Masks are better than nothing.  Masks were, for a long time, one of the most effective ways to reduce R0, in combination with social distancing.  But put mask illness prevention next to mRNA vaccine illness prevention, and you see how relatively ineffective masks are. For those who remain unwilling or unable to be vaccinated, or just haven't come up on the priority lists yet, masks are probably the best thing they have. But every single person we can safely unmask is one smile closer to civility that we badly need in a country where the only thing a clear majority of Americans believe in is that we are headed for a civil war.

I mean, sure, there's physical costs, civil liberties issues, waste/trash issues... but all of them pale in comparison to the lack of compassionate human contact that is a direct result of covered faces.

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I went to the VAERS and WONDER report from CDC and plugged in Vaccines, manufacturer, COVID and Death.

815 deaths related to COVID vaccination.  You can search by state and can search by symptoms, age, (cannot search by race) .  It's interesting.  Lots and lots of data. 

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22 minutes ago, Incognito said:

I went to the VAERS and WONDER report from CDC and plugged in Vaccines, manufacturer, COVID and Death.

815 deaths related to COVID vaccination.  You can search by state and can search by symptoms, age, (cannot search by race) .  It's interesting.  Lots and lots of data. 

VAERS isn't data. It is consolidated anecdotes.

I read some of them as well. Some of the smash hits were "cut my head," and "patient in hospice died one week after vaccine."

Someone once described turning into the incredible hulk after a flu vaccine and it was accepted. 

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14 hours ago, rev ronin said:

Everyone in primary care should know what VAERS is not.

I am well aware of what VAERS is not.  There are vaccine injuries that are documented on VAERS that have been compensated.  It exists for that reason apparently.  But maybe CDC should not be associated with it?  I don't know.  The VAERS system is referenced in vaccine information statement (VIS)  approval papers that patients sign and patients are encouraged to report symptoms, adverse events, etc. on VAERS.  

The Federal Vaccine Injury Compensation Program exists and VAERS is a vehicle for patients to be compensated.  I predict that sometime in the future someone's family will eventually be compensated for the COVID vaccine death.  Just my opinion. 

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11 minutes ago, Incognito said:

I am well aware of what VAERS is not.  There are vaccine injuries that are documented on VAERS that have been compensated.  It exists for that reason apparently.  But maybe CDC should not be associated with it?  I don't know.  The VAERS system is referenced in vaccine information statement (VIS)  approval papers that patients sign and patients are encouraged to report symptoms, adverse events, etc. on VAERS.  

The Federal Vaccine Injury Compensation Program exists and VAERS is a vehicle for patients to be compensated.  I predict that sometime in the future someone's family will eventually be compensated for the COVID vaccine death.  Just my opinion. 

Which COVID vaccine death are you referring to? You believe you have found one which is reputable and actually due to the vaccine? Moderna or Pfizer? And what was the cause of death?

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8 minutes ago, MediMike said:

Which COVID vaccine death are you referring to? You believe you have found one which is reputable and actually due to the vaccine? Moderna or Pfizer? And what was the cause of death?

MediMike: Sorry, I was not clear on the compensation for vaccine injury.  I did not mean COVID vaccine injury in my post, but vaccine injury in general.  My friend's son had a terrible reaction to Menactra (I think it was that one) when he was immunized before college at age 16.  He was a star football player, had a scholarship, and got Guillain Barre syndrome, a very severe case.  He lost his scholarship, was extremely disabled for a long time, ended up not psychologically dealing with this and went down a very destructive road.  They got a very LARGE compensation from VICP and took about 2 years of court battles with their lawsuit (or whatever it was called).  

 

A COVID death lawsuit to the VICP will take years to settle.  

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But on the other hand does anyone know anything about the doctor in Florida who died 2 weeks  after the vaccine?  Apparently healthy, in his 50's.  No underlying conditions, and was determined it was related to the vaccine?  https://www.msn.com/en-us/health/medical/healthy-south-florida-doctor-died-2-weeks-after-receiving-covid-19-vaccine/ar-BB1cALmY

I first saw the article a few weeks ago, then another one that said it was absolutely related to the vaccine, and today the newest news is that it couldn't possibly be related to the vaccine. 

So who knows what the truth is anymore?  

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45 minutes ago, Incognito said:

But on the other hand does anyone know anything about the doctor in Florida who died 2 weeks  after the vaccine?  Apparently healthy, in his 50's.  No underlying conditions, and was determined it was related to the vaccine?  https://www.msn.com/en-us/health/medical/healthy-south-florida-doctor-died-2-weeks-after-receiving-covid-19-vaccine/ar-BB1cALmY

I first saw the article a few weeks ago, then another one that said it was absolutely related to the vaccine, and today the newest news is that it couldn't possibly be related to the vaccine. 

So who knows what the truth is anymore?  

Sorry to hear about your friend's kiddo, sounds terrible. To my knowledge though there has been no association between the meningococcal vaccine and GBS. In fact I think per the CDC the only confirmed cases of GBS due to vaccination were the 1979s swine flu vaccine.

I hadn't heard about the FL OB/Gyn, but what sound like petechiae, thrombocytopenia and a CVA go hand in hand with TTP in my mind. Curious what the "emergent surgery" was, unless he had a spontaneous ICH or hemorrhagic conversion.

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So we've had millions of doses of vaccine delivered, no confirmed deaths, no probable deaths, one possibly related death.  We've had about 1:100,000 anaphylactic reactions, which is 10x higher than for normal vaccines.  FWIW, one of the NPs I work with WAS one of those anaphylaxis reactions--Not fun at all for her, but very survivable, and she knew the risk going in because she has a known autoimmune disorder.

Now, the second shot, especially if you've actually been Covid-19 infected, like I probably had been, absolutely sucks... But to the best of my knowledge no one who has gotten even one dose of any of the Covid-19 vaccines has died of Covid, and either zero or almost zero of them have gone into the ICU, either.

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And in happier news...

"Promisingly, the data showed that after 21 days, just a single dose of the Pfizer/BioNtech vaccine was 72 percent effective at preventing not just covid-19 but SARS-CoV-2 infection itself; the vaccine was 86 percent effective in decreasing infection seven days after the second dose."

News story on the pre-print (I know I know) of the SIREN trial, serially tested asymptomatic HCW who received the vaccine as well as those who received the vaccine AND had confirmed prior infection.

72% ain't perfect but it's better than nothing for sure!

https://brief19.com/2021/02/24/brief

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25 minutes ago, MediMike said:

72% ain't perfect but it's better than nothing for sure!

And again, that number is pretty modest and doesn't tell the whole story.  There are multiple levels of protection:

- Preventing any Covid-19 infection at all
- Preventing severe Covid-19 disease
- Preventing death from Covid-19

The last two numbers are what doesn't get enough press: even if you DO get sick, you don't die, and don't get ICU-admitted.  Life may suck for a while, but the vaccine has finally reduced Covid-19 to the "it's just like the flu" that some skeptics had been advocating all along.

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There are 3.7 cases of TTP per million people per year in the US. We've now given ~20 million doses with 1 known case of TTP (that I know of) following vaccination. Could it be related? Maybe, but I'd think we'd see a pattern of cases that is higher than the normal baseline rate of cases.

You could also manipulate the data to show that the vaccine decreases your chances of getting TTP. Does it really? Probably not, but who knows.

 

EDIT: There have been nearly *50 million* doses administered in the US, making TTP even less likely to be caused by the vaccine.

Edited by TheFatMan
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Not to go back in time too much, but I thought I'd share this article I read today that I thought did a great job of explaining some of the new data coming out, what we can expect post vaccination, what is 'probably' okay to do afterwards, and how to communicate that with our patients. 

TL;DR:

"And while most people are still unvaccinated, the vaccinated should be thoughtful about protecting those who haven’t had a chance at the vaccines yet. But those reminders shouldn’t drown out an accurate understanding of the fact that the vaccines are really effective."

https://www.vox.com/future-perfect/22291959/covid-vaccines-transmission-protect-spread-virus-moderna-pfizer?fbclid=IwAR07Z-_y5hv71liSJ5EwZ4vZ7WvfsJDgBUWYzy2B8j1Q_URjHunpVtkIF0E

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8 hours ago, rev ronin said:

And again, that number is pretty modest and doesn't tell the whole story.  There are multiple levels of protection:

- Preventing any Covid-19 infection at all
- Preventing severe Covid-19 disease
- Preventing death from Covid-19

The last two numbers are what doesn't get enough press: even if you DO get sick, you don't die, and don't get ICU-admitted.  Life may suck for a while, but the vaccine has finally reduced Covid-19 to the "it's just like the flu" that some skeptics had been advocating all along.

Agreed.  If you're vaccinated.

My concern, again, isn't the individuals who are vaccinated, it's those who aren't.

We're getting there, heard hopeful herd immunity levels around October 21st if we keep vaccinating on schedule.

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22 hours ago, MediMike said:

Agreed.  If you're vaccinated.

My concern, again, isn't the individuals who are vaccinated, it's those who aren't.

We're getting there, heard hopeful herd immunity levels around October 21st if we keep vaccinating on schedule.

Herd immunity is not a boolean.  It's already well underway.

We have 28.4m lab-confirmed cases, 50m vaccines delivered.  Let's assume that ends up at 50 m people 100% immune to Covid-19... so we've got 15% immune 85% vulnerable.

So, when we started, a random connection between two people was 100% vulnerable to Covid transmission, 0% safe.  Now, with 15% of each end safe, such a random connection between Americans is 72% safe.  That's back of the envelope math, and if it seems too good to be true, it isn't, and it's probably even BETTER than that because...
- Dose 1 of the mRNA vaccines appears to be quite helpful, and
- The case rates of Covid-19 are probably twice (or more!) the lab-confirmed cases.
That should more than offset the fact that protection from natural infection or vaccines isn't perfect.  Of course, this doesn't model superspreader events well, but nothing seems to because we still don't know what those even are.

That, by itself, won't drop R0 below 1, but it's well on the way.  The time for optimism is not October, but now.  We're never going to win over anti-vaxxers by downplaying the tangible societal benefits of the vaccines.

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