Anyone gotten mad at a patient on COVID vaccine discussion??

[CAAdmission]

2 hours ago, MediMike said:

To confirm you are referring to the multiple waves of COVID which killed a million U.S. citizens as a trivial disease?

Following along the path of many viruses, Covid has evolved into a relatively indolent disease and it is now a cold virus. Just like adenovirus, some people will continue to catch it and die through some combination of genetics, bad luck, and perhaps a bad astrological sign. But for most people, it's a cold. 

The susceptible million people you refer to above - most of whom had comorbid conditions - would have died when they caught it, with or without masks, gloves, plexiglass, paxlovid, fish tank cleaner, or anything else. It's folly to think anyone can live anything approaching a normal life and escape catching covid. 

 

2 hours ago, MediMike said:

Since you are not daft you saw that the Cochrane review consisted mostly of studies with low virulence, low impact disease processes with low adherence to protocols? 
I have no interest in changing your fatalistic approach to medicine but you’re interpreting the evidence wrong. If you put garbage studies into a review than you get garbage out the other side.
 

If masks had a meaningful impact, one would have been discovered. They might have had a trivial impact on delaying the inevitable for someone, somewhere. Just to make sure I understand - you are calling Cochrane garbage? That has historically been a pretty highly regarded source.

[CAAdmission]

46 minutes ago, rev ronin said:

Worse than theater; theater doesn't hurt anyone who chooses not to participate.

Well said. For me, the scariest thing about the pandemic was how vehemently any opposing viewpoint was crushed. No one was free to question anything, and there was no openness to discussion. Any hint of dissent was stamped out with cries of "fraud" and "misinformation." 

I feel like that was the true death of science in this country. 

[rev ronin]

51 minutes ago, CAAdmission said:

I feel like that was the true death of science in this country. 

Naah, just when the rotting corpse stunk so bad everyone couldn't avoid noticing. The irreproducibility crisis in scholarly publishing demonstrated that those who had a vested interest in publishing would "find" interesting things to publish, regardless.

Science only works when people:
1) Believe that objective truth exists, is worth discovering, and use the right tools to discover that truth.
2) Hold the truth to be more important than their individual ideologies,
3) Tell the truth no matter how much it conflicts with their own wishes.
4) Tell the whole truth, not some out-of-context spin.

People have this irrational belief that scientists are responsible for the above.  They're not. Some are, but most are just human beings who are susceptible to being part of a tribe. This is why us folks with ASD tendencies make good scientists: we don't care.

[MediMike]

2 hours ago, CAAdmission said:

Following along the path of many viruses, Covid has evolved into a relatively indolent disease and it is now a cold virus. Just like adenovirus, some people will continue to catch it and die through some combination of genetics, bad luck, and perhaps a bad astrological sign. But for most people, it's a cold. 

The susceptible million people you refer to above - most of whom had comorbid conditions - would have died when they caught it, with or without masks, gloves, plexiglass, paxlovid, fish tank cleaner, or anything else. It's folly to think anyone can live anything approaching a normal life and escape catching covid. 

 

If masks had a meaningful impact, one would have been discovered. They might have had a trivial impact on delaying the inevitable for someone, somewhere. Just to make sure I understand - you are calling Cochrane garbage? That has historically been a pretty highly regarded source.

You're right, COVID has evolved into an indolent virus and there is probably little benefit to masking now.  Studies did show benefit to masking, in fact multiple studies have shown a benefit to masking. I find it interesting that you believe nothing would have changed if we had thrown all caution to the wind early in the pandemic. I'm curious what you recommended your elderly parents to do when they went out, did you actually recommend against masking? Again, I think you are fairly fringe but are of course entitled to your own beliefs.

But tell me you don't understand how a meta-analysis and review works without telling me you don't understand how a meta-analysis and review works.  If you are trying to assess the utility of an intervention in a disease process but include studies which aren't assessing that disease process...well...that's garbage isn't it? There's nothing wrong with Cochrane's methodology, but they admit in their own paper that the risk for bias was high, that a large chunk of the studies were conducted in non-epidemic influenza seasons with "lower respiratory viral circulation and transmission compared to COVID‐19".

Even their own conclusions note these severe limitations.

"The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children.

There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect."

So if you want to run around and say that when looking at heterogenous studies with low adherence rates to protocols (meaning low mask utilization), the effectiveness of surgical masks to prevent infection during non-epidemic viral illnesses is low, then sure, I'll hop on board with your conclusions. Otherwise all you're doing is regurgitating opinion pieces.

[rev ronin]

If anything, the Cochrane exam is too generous on Covid-19 mask effectiveness.  Remember how it was droplet... until time demonstrated that droplets were so small they might as well have been aerosol? So what other masking trials are lumped in there? Oh, right... droplet-transmission.

I wish masks would have worked, but a lot of the thinking--not necessarily yours--stems from an argument from authority or sunk cost fallacies.

If you follow docs like Vinay Prasad on Twitter, you'll find he mocks both the "Ivermectin works!" and the "Masks work!" crowd. Why? Because the CIs for their interventions after multiple trials ("But they didn't try with Zinc AND hydroxycloroquine for prophylaxis...") meta-analyzed showed no benefit.

None of this excludes a specific use case that might actually be effective... it's just that no real evidence exists that there is one.

[CAAdmission]

6 hours ago, MediMike said:

I'm curious what you recommended your elderly parents to do when they went out, did you actually recommend against masking? Again, I think you are fairly fringe but are of course entitled to your own beliefs.

Had that been an issue, I would have advised them to stay home altogether and I would have done their shopping for them, because I was pretty sure that using a mask was not going to be efficacious. 

I get where you are coming from. It defies conventional wisdom that masks don't really have much benefit. We are "type-A" people, so healthcare providers always want to jump into action and recommend doing something. As @rev ronin points out, there really was no comprehensive, meaningful cost-benefit analysis undertaken. For one, there are now cities like Baltimore and Chicago where almost all students in the public school system lack proficiency in both math and verbal skills. The potential socioeconomic impact on long-term health for these people might be much more significant than catching what amounts to a cold. 

The efficacy of the Covid vaccines will be extremely difficult to meaningfully assess. Enthusiasts will note that they showed a high rate of preventing death and hospitalization. A reasonable alternative hypothesis for the death rate dropping is that the people who were going to die had already done so while the vaccine was in development. Here's a couple questions for you: As you agreed, the virus appears to have become relatively indolent.

• Do you think this is because the virus markedly changed, or because there are less susceptible people around?
• Are you going to continue to receive and recommend Covid boosters for the rest of your life?

The last big Covid sham is the origin of the virus. There was a microbiological research facility in proximity to the epicenter of the outbreak. But anyone who even suggested that lab might have a role in the genesis of the disease was utterly excoriated as a liar, a racist, or a xenophobe. Oops, how the worm turns:

https://www.cnn.com/2023/02/28/politics/wray-fbi-covid-origins-lab-china/index.html

 

People are lamenting the loss of trust in the healthcare system. This situation occurred because the government came out with frequently changing, half-baked recommendations which turned into demands backed by force of law.

As I have said previously, good messaging would have been:  "We feel that X currently appears to be the most effective recommendations for decreasing the risk of Covid."

Instead we got: "We know best, and we demand you do X. There will be consequences for anyone who expresses disagreement and does not comply, including loss of a medical license."

[MediMike]

7 hours ago, CAAdmission said:

• Do you think this is because the virus markedly changed, or because there are less susceptible people around?
• Are you going to continue to receive and recommend Covid boosters for the rest of your life?

Yes, the virus has changed like most newly emerged viral pathogens changed.

Yes I am because the folks I see with COVID are miserable and if I can avoid it I certainly am going to, similar to getting a flu vaccine.

As to the rest of your post, you still didn’t answer if you would tell your parents not to wear a mask in the midst of the pandemic when they went out grocery shopping. 

You have one federal agency (FBI) saying the believe a lab origin while the article specifically notes 4-5 other agencies calling a natural origin, similar to your posting of the original article sparking this discussion you are pushing half truths man, just like in every other conversation we’ve had over the years.

As you’ve moved away from the original topic of your analysis of the Cochrane study I think we’re probably done here, let it be a lesson for any of our younger career PAs or PA students to read your research in depth before jumping to conclusions.

[sas5814]

There are several agencies weighing in now and the director of the FBI has now said he thinks it escaped the lab. Most of the agencies who have an opinion one way or the other says its "low confidence" information.

At this point where it came from is pretty moot beyond holding China responsible if it came from their lab.

As for masks I am in the "make up your own mind" camp. The data is so jumbled and confusing and contradictory I don't feel like I can make a recommendation beyond what is likely to cause the least harm.

I am not wearing a mask at work right now unless my patient is sick or prefers I wear one (or I am sick but then I wouldn't be at work.)

[briansk]

I expect that as the years go by and a retrospective analysis is done, we will come to find that the majority of measures instituted did very little to change the natural outcome of the disease. While the measures instituted were (for the most part) done in good faith, the results did not meet expectations. 

Call me a conspiracy theorist if you will, but I believe the origin is the Wuhan virology lab and there were people in our government that knew or suspected as such and misled to protect themselves or their financial partners. Once the virus began spreading, damage control measures were instituted. This led to shutting down the scientific process and  anyone who disagreed with the narrative was silenced or labeled as  dangerous. Lawmakers, big tech, big pharma, and others are all complicit in this coverup. Follow the money.

We as healthcare providers always are looking for something to do to help our patients, so we did what seemed like reasonable measures at the time (cloth masking, isolation, 2 weeks to flatten the curve, shutting down schools, etc). Unfortunately, I think we will come to find that most of these measures were futile. 

Hopefully we will learn from the mistakes made throughout this pandemic the next time.

[sas5814]

24 minutes ago, briansk said:

Hopefully we will learn from the mistakes made throughout this pandemic the next time.

I think we (medicine) have learned a lot. The problem comes when politics get involved. Then reason goes out the window and all the yelling starts.

[CAdamsPAC]

24 minutes ago, sas5814 said:

I think we (medicine) have learned a lot. The problem comes when politics get involved. Then reason goes out the window and all the yelling starts.

I recall in the early 80s' the county health director in San Francisco being excoriated for suggesting that individuals who engaged in high-risk behaviors associated with HIV do not donate blood along with reducing these behaviors. This was before the screening of blood for HIV was possible and the politicians and social justice crowd came after him in full force for his risk reduction suggestions! Again, a public health issue became a clarion call for the morality police, social justice warriors, and politicians to saddle up and ride to the sound o the guns!!!

[rev ronin]

4 hours ago, briansk said:

Call me a conspiracy theorist if you will, but I believe the origin is the Wuhan virology lab and there were people in our government that knew or suspected as such and misled to protect themselves or their financial partners.

No one with any comprehension of security risk doubts the Wuhan lab leak. That's not even up for debate. What's more nuanced is what SORT of a lab leak was it?

- Was it a low-level custodial employee selling lab animals slated for euthanasia into the wet market, in violation of explicit orders, because he wanted to make extra money? Or was it some other sort of careless leak, or maybe even an intentional leak?

- If it was an intentional leak, that kind of rules out the CCP, because why would they release a bioweapon in their own backyard?  Sorry, but it would be far more likely to be the U.S. or a nonaligned country to do it. Say... India. If the U.S. and China get hacked off at each other, who benefits? Well, I mean, other than Raytheon, Boeing, and the rest of the U.S. Military-Industrial complex....

- Was it an engineered bioweapon, or just a random coronavirus collected from the jungle for study that then got out in an urban, connected setting? Think Hanlon's Razor.

You see, there's not ONE lab leak theory... there are several. Anyone who thinks we disproved any of them, let alone all of them, isn't thinking suspiciously enough.

[CAAdmission]

6 hours ago, MediMike said:

As to the rest of your post, you still didn’t answer if you would tell your parents not to wear a mask in the midst of the pandemic when they went out grocery shopping. 

During the "two weeks to flatten the curve" phase, I would have insisted that elderly relatives sequester at home. That's just common sense. Hell, I was as big a masker as anyone then. I was picking up the mail with salad tongs. We didn't know if we were dealing with the Andromeda strain or not. It became apparent to me that masks were not effective 2-3 months in. 

 

6 hours ago, MediMike said:

You have one federal agency (FBI) saying the believe a lab origin while the article specifically notes 4-5 other agencies calling a natural origin

Two. For some reason the energy department chimed in with the same conclusion. More info will follow. 

 

6 hours ago, MediMike said:

As you’ve moved away from the original topic of your analysis of the Cochrane study I think we’re probably done here, let it be a lesson for any of our younger career PAs or PA students to read your research in depth before jumping to conclusions.

If the conclusion is that masks are awesomely effective against respiratory viruses, I agree. I encourage those same young PAs to consider how they will weigh input from very respected resources like Cochrane vs input from random internet PAs. 

[CAAdmission]

29 minutes ago, rev ronin said:

- If it was an intentional leak, that kind of rules out the CCP, because why would they release a bioweapon in their own backyard?

If I put on my James Bond villain mindset, I could easily see the CCP doing an intentional release.

They have an aging population crisis. 

They bioengineer a disease that will kill off "non-productive" members of society almost exclusively - the elderly and the chronically ill. It also gives them another chance to forcibly assert their authority over their people and to make problematic dissenters disappear. They know it will wreak worldwide havoc, particularly among large economic rivals like the US. 

Likely? No. Outside the realm of possibility? No. The CCP has little regard for human life. 

[rev ronin]

5 minutes ago, CAAdmission said:

If I put on my James Bond villain mindset, I could easily see the CCP doing an intentional release.

They have an aging population crisis. 

They bioengineer a disease that will kill off "non-productive" members of society almost exclusively - the elderly and the chronically ill. It also gives them another chance to forcibly assert their authority over their people and to make problematic dissenters disappear. They know it will wreak worldwide havoc, particularly among large economic rivals like the US. 

Likely? No. Outside the realm of possibility? No. The CCP has little regard for human life. 

Ooh. More evi... err, utilitarian than I thought of. Good job.

[CAAdmission]

 

Here's the full hit parade by a Hopkins MD/MPH. I don't know if I would buy all of these 100%, but there are some truths here:

https://nypost.com/2023/02/27/10-myths-told-by-covid-experts-now-debunked/

10 myths told by COVID experts — now debunked

Opinion by Marty Makary • Monday

In the past few weeks, a series of analyses published by highly respected researchers have exposed a truth about public health officials during COVID:

Much of the time, they were wrong.

To be clear, public health officials were not wrong for making recommendations based on what was known at the time. That’s understandable. You go with the data you have.

No, they were wrong because they refused to change their directives in the face of new evidence. When a study did not support their policies, they dismissed them and censored opposing opinions.

At the same time, the Center for Disease Control weaponized research itself but putting out their own flawed studies in their own non-peer reviewed medical journal, MMWR.

In the final analysis, public health officials actively propagated misinformation that ruined lives and forever damaged public trust in the medical profession. Here are 10 ways they misled Americans:

Misinformation #1: Vaccinated immunity is better than natural immunity

A Lancet study looked at 65 major studies in 19 countries on natural immunity. The researchers concluded that natural immunity was at least as effective as the primary COVID vaccine series.

In fact, the scientific data was there all along — from 160 studies, despite the findings of these studies violating Facebook’s “misinformation” policy.

Since the Athenian plague of 430 B.C., it has been observed that those who recovered after infection were protected against severe disease if re-infected. That was also the observation of nearly every practicing physician during the first 18 months of the COVID pandemic.

Most Americans fired for not having the COVID vaccine already had antibodies that effectively neutralized the virus, but they were antibodies that the government did not recognize.

Misinformation #2: Masks prevent COVID transmission

Cochran Reviews are considered the most authoritative and independent assessment of evidence in medicine. And one published last month by a highly-respected Oxford research team found that masks had no significant impact on COVID transmission.

When asked about this definitive review, CDC Director Dr. Rochelle Walensky downplayed it, arguing that it was flawed because it focused on randomized controlled studies.

It recently came out that masks didn’t have that much of an affect with preventing COVID-19 transmission.Jeenah Moon/Pool via REUTERS

But that was the greatest strength of the review! Randomized studies are considered the gold standard of medical evidence.

If all the energy used by public health officials to mask toddlers could have channeled to reduce child obesity by encouraging outdoor activities, we would be better off.

Misinformation #3: School closures reduced COVID transmission

The CDC ignored the European experience of keeping schools open, most without mask mandates. Transmission rates were no different, evidenced by studies conducted Spain and Sweden.

Misinformation #4: The vaccine has no side effects

Public health officials downplayed concerns about vaccine-induced myocarditis — or inflammation of the heart muscle. They cited poorly designed studies that under-captured complication rates. A flurry of well-designed studies said the opposite. We now know that myocarditis is six to 28-times more common after the COVID vaccine than after the infection among 16- to 24-year-old males. Tens of thousands of children likely got myocarditis, mostly subclinical, from a COVID vaccine they did not need because they were entirely healthy or because they already had COVID.

Misinformation #5: Young people benefit from a vaccine booster

Boosters reduced hospitalizations in older, high-risk Americans. But the evidence was never there that the lower COVID mortality in young healthy people. That’s probably why the CDC chose not to publish their data on hospitalization rates among boosted Americans under 50, when they published the same rates for those over 50.

Ultimately, White House pressure to recommend boosters for all was so intense, that the FDA’s two top vaccine experts left the agency in protest, writing scathing articles on how the data did not support boosters for young people.

Biden’s idea of making sure everyone was vaccinated didn’t pan out.

 Misinformation #6: Vaccine mandates increased vaccination rates

President Biden and other officials demanded unvaccinated workers, regardless of their risk or natural immunity, be fired. They demanded that soldiers be dishonorably discharged and nurses be laid off in the middle of a staffing crisis. The mandate was based on the theory that vaccination reduced transmission rates — a notion later proven to be false. But after the broad recognition that vaccination does not reduce transmission, the mandates persisted, and still do to this day. A recent study from George Mason University details how vaccine mandates in nine major U.S. cities had no impact on vaccination rates. They also had no impact on COVID transmission rates.

Misinformation #7: Covid originating from the Wuhan Lab is a conspiracy theory

Google admitted to suppressing searches of “lab leak” during the pandemic. Dr. Francis Collins, head of the NIH, claimed (and still does) he didn’t believe the virus came from a lab. Ultimately, overwhelming circumstantial evidence points to a lab leak origin — the same origin suggested to Dr. Another Fauci by two very prominent virologists in a January 2020 meeting he assembled at the beginning of the pandemic. According to documents obtained by Bret Baier of Fox News, they told Drs. Fauci and Collins that the virus may have been manipulated and originated in the lab, but then suddenly changed their tune in public comments days after meeting with the NIH officials. The virologists were later awarded nearly $9 million from Fauci’s agency.

Misinformation #8: It was important to get both vaccine doses quickly

Data was clear in the Spring of 2021, just months after the vaccine rollout, that spacing the vaccine out by three months reduces complications rates and increase immunity. Spacing out vaccines would have also saved more lives when Americans were rationing a limited vaccine supply at the height of the epidemic.

Misinformation #9: Data on the bivalent vaccine is “crystal clear”

Dr. Ashish Jha famously said this, despite the bivalent vaccine being approved using data from eight mice. To date, there has never been a randomized controlled trial of the bivalent vaccine. In my opinion, the data are crystal clear that young people should not get the bivalent vaccine.

Misinformation #10: One in five people get long COVID

The Centers for Disease Control and Prevention claims that 20% of COVID infections can result in long COVID. But a U.K. study found that only 3% of COVID patients had residual symptoms lasting 12 weeks. What explains the disparity?

It’s often normal to experience mild fatigue or weakness for weeks after being sick and inactive and not eating well. Calling these cases long COVID is the medicalization of ordinary life.

What’s most amazing about all the misinformation conveyed by CDC and public health officials, is that there has been no apologies for holding on to their recommendations for so long after the data became apparent that they were dead wrong. Public health officials said “you must” when the correct answer should have been “we’re not sure.”

Early on, in the absence of good data, public health officials chose a path of stern paternalism. Today, they are in denial of a mountain of strong studies showing that they were wrong.

At minimum, CDC should come clean and the FDA should add a warning label to COVID vaccines, clearly stating what is now known. A mea culpa by those who led us astray would be nice, too.

Marty Makary MD, MPH is a professor at the Johns Hopkins University School of Medicine and author of “The Price We Pay.”

 

[SedRate]

13 hours ago, CAAdmission said:

If I put on my James Bond villain mindset, I could easily see the CCP doing an intentional release.

They have an aging population crisis. 

They bioengineer a disease that will kill off "non-productive" members of society almost exclusively - the elderly and the chronically ill. It also gives them another chance to forcibly assert their authority over their people and to make problematic dissenters disappear. They know it will wreak worldwide havoc, particularly among large economic rivals like the US. 

Likely? No. Outside the realm of possibility? No. The CCP has little regard for human life. 

Very interesting perspective. 

[CAAdmission]

 

[CAAdmission]

Looks like Covid is really here to stay. First it was in the white tailed deer population, now NYC rats:

https://www.eurekalert.org/news-releases/982167

[CAAdmission]

Here's an overview of Britain vs Sweden:

https://www.telegraph.co.uk/news/2022/02/13/sweden-right-covid-along/