Corona Virus: It's a Marathon, Not a Sprint

msteelers · Post by **msteelers** » Fri Jun 17, 2022 4:47 pm

Well that’s some good news. I need to call the pediatrician to see what’s happening.

Smoove_B · Post by **Smoove_B** » Fri Jun 17, 2022 10:30 pm

One for the 'beef

Pandemic math problem: If hospitals are 75-90% full but have lost 20% of their employees & 150,000 people are getting COVID-19 each day with BA.4/BA.5 soon taking over & 15-30 million people already have long covid what % of the hospitals will be unable to function in 6 months?

This is a perfect example of what I'm saying about we're going to try to ignore it, but it's not going to work.

RunningMn9 · Post by **RunningMn9** » Sun Jun 19, 2022 7:05 pm

Man, you really underestimate our ability to just accept what’s happening so that most people can still go fun places and do fun things.

Unagi · Post by **Unagi** » Sun Jun 19, 2022 7:14 pm

Like a vibrator that's run out of batteries: It doesn't matter if it technically doesn't work - as long as we can still get a little play out of it.

LawBeefaroni · Post by **LawBeefaroni** » Sun Jun 19, 2022 8:02 pm

I was a gala for the hospital yesterday. The CEO gave a great speech and he was tearing up talking about the sacrifices made by the staff. It was poignant and moving. Yet there we were, a room of 400 or so people in a ballroom. It was vaccine mandatory but still felt weird.

And yes, fatigue and burnout is going to really start to have an effect. Not just with MD specialists, but across the system. Nurses, facilities staff, PCPs, etc. I just talked with one physical therapist who is leaving the field entirely. New career at age 50.
Probably the 4th or 5th clinician I've had the same conversation with in the past month.

Smoove_B · Post by **Smoove_B** » Sun Jun 19, 2022 10:33 pm

RunningMn9 wrote: ↑Sun Jun 19, 2022 7:05 pm Man, you really underestimate our ability to just accept what’s happening so that most people can still go fun places and do fun things.

LOOK! There are not enough healthy skilled workers to fly right now on schedule. Just having the money for the ticket doesn’t entitle us to demand people doing oft-invisible work sick or jeopardize their lives or their families.

If you read through the Tweet, there's an interesting set of observations about what we've been conditioned to expect vs what is actually realistic at this point.

RunningMn9 · Post by **RunningMn9** » Mon Jun 20, 2022 1:42 pm

Apparently having money for the ticket DOES entitle us. Thus the many folks flying and complaining if there are any scheduling hiccups.

But what I meant was, we are prepared for things like the airline industry to suffer through the coming years, taking us places as best they are able - because that is what we want. And it’s also what the airline industry wants.

Whatever the consequences are, we are just going to suffer through them because at this point that’s what everyone not named Smoove_B wants.

Zaxxon · Post by **Zaxxon** » Mon Jun 20, 2022 1:50 pm

RunningMn9 wrote: ↑Mon Jun 20, 2022 1:42 pmWhatever the consequences are, we are just going to suffer through them because at this point that’s what everyone not named Smoove_B wants.

I can confirm that it's not what I want, but I suppose I'll be a good citizen and get back in line.

Smoove_B · Post by **Smoove_B** » Mon Jun 20, 2022 2:45 pm

RunningMn9 wrote: ↑Mon Jun 20, 2022 1:42 pm Whatever the consequences are, we are just going to suffer through them because at this point that’s what everyone not named Smoove_B wants.

Indeed. From the NYT today:

Covid is still killing an average of 314 people daily, one-tenth the number who were dying every day in January 2021, but, even so, an awful toll. At that rate, the virus is killing more than twice as many Americans every day as suicide or car crashes are. And many of those who survive the virus are debilitated, some of them for long after their infections.

Smoove_B · Post by **Smoove_B** » Mon Jun 20, 2022 2:51 pm

And just another data point. Perhaps people remember (I'm not sure anymore) that Israel has been aggressively vaccinating their population - they were among the first to start offering boosters. My point here is that they're way ahead of the United States (and most countries) in terms of how far they've gone to protect their population with vaccines, and yet:

This is concerning since Israel has been ahead of other countries on COVID boosters and also a huge omicron wave.

It means despite all this 1) some people remain vulnerable due to inadequate or waning immunity and 2) new variants are immune evasive.

Some remain vulnerable because they have never had Covid or COVID vaccination. So their immune system can be surprised.

Some are vulnerable despite prior infection or vaccination or both because they have inadequate or waning immunity due to advanced age, chemotherapy etc

Add to this the fact that the virus is constantly mutating, and variants are evading immunity conferred by prior infection with older strains or vaccines

Although vaccines/ prior infection protect against severe disease, they don't prevent infection & transmission as well.

Until we can dramatically reduce transmission (clean indoor air, masking, etc...) this is the wheel of insanity we're all one.

Blackhawk · Post by **Blackhawk** » Mon Jun 20, 2022 2:54 pm

Me. Today. That is most peoples' range for decision making. Deaths today scares people. A hundred million disabled people in ten years is so far out of their thought range that it might as well be imaginary, despite the massive impact that it will have on our society. And on them. In a few years when services continue to crawl or vanish due to a lack of able workers, while at the same time that shortages hit due to climate change, they'll shake their heads and wonder what happened.

Defiant · Post by **Defiant** » Mon Jun 20, 2022 3:56 pm

Smoove_B wrote: ↑Mon Jun 20, 2022 2:51 pm And just another data point. Perhaps people remember (I'm not sure anymore) that Israel has been aggressively vaccinating their population - they were among the first to start offering boosters. My point here is that they're way ahead of the United States (and most countries) in terms of how far they've gone to protect their population with vaccines, and yet:

Actually, while Israel started off really well, they're not very ahead of us much at the moment, at least when it comes to vaccination or first booster. 66.7% of Israelis are vaccinated (vs 66.1% of Americans), and 33.4% are boosted (vs 31.2%).

https://www.bloomberg.com/graphics/covi ... tribution/

Smoove_B · Post by **Smoove_B** » Mon Jun 20, 2022 4:03 pm

Huh. I thought they were much better off than the United States....that's interesting. Thanks.

Max Peck · Post by **Max Peck** » Tue Jun 21, 2022 9:39 am

It's starting to look like our summer reprieve may be drawing to a close. It's difficult to say what is happening, since the province is only releasing COVID data once per week and the local public health department is only releasing data twice per week. The waste water monitoring is still releasing data more or less daily but they're no longer releasing any information on variants, so while I suspect this may be the start of the BA.4/BA.5 wave I can't say for sure. Given the reports I've been seeing that BA.4/BA.5 may be more oriented to the lungs again instead of the upper respiratory tract, I'm expecting the BA.4/BA.5 wave to hit harder in terms of severe disease than we saw in the initial Omicron waves. Given that the health care infrastructure is fragile even in the absence of severe COVID stress, that would not be pretty.

Smoove_B · Post by **Smoove_B** » Tue Jun 21, 2022 10:25 am

I've been seeing lots of random articles about Canada - usually related to hospital systems being overwhelmed. I hadn't been following the actual levels though to see what it looks like in any given region. I did see that for the U.S. the BA.1x and BA.2x variants are predominantly moving through the NE but the BA.4 and 5 variants are taking over the Midwest. I'm not sure if it's the same in Canada - where depending on your specific location certain variants are surging while others aren't. I didn't see any specific guesses as to why that might be happening, but that seems different than what has occurred before.

I guess we'll see what happens here in the NE - if BA.4 or BA.5 gets a foothold and starts to cause more cases. Or if there are just going to be two distinct waves (based on variants) that affect the U.S. population at the same time but potentially in slightly different ways.

As I keep saying, the experiment (that we are encouraging) continues.

EDIT: Really important points made here and where we are in June of 2022.

Normalizing mass casualties & disability is a dangerous game.

Each week: 2100 people die from Covid
For survivors: 1 in 5 have Long Covid

The pandemic isn’t over. Especially for our most vulnerable.

Smoove_B · Post by **Smoove_B** » Tue Jun 21, 2022 9:26 pm

I was waiting for an article and not a series of Tweets, so here you go - a reinfection red flag:

A new report on Covid reinfections is quite concerning. It’s currently a preprint but these same authors with access to the US largest healthcare system, the Veteran Affairs, have published numerous eye-opening studies during the pandemic, in leading peer-review journals, on topics which include Long Covid cardiovascular outcomes, diabetes, breakthrough infections, the toll on mental health, and kidney disease. I have not previously seen any substantive differences from their preprints compared with the final publications. So with that context let’s look at their findings from >250,000 people with 1 infection, ~39,000 people with 2 or more infections, and nearly 5.4 million uninfected controls. It’s the first study to characterize the risks of reinfection.

...

Finally, there is the “dose-response” effect of multiple reinfections. By that I mean with additional episodes of Covid, for every outcome there was a stepwise increased risk, both relative (left panel) and absolute (right panel).

Obviously these findings are worrisome since reinfection was quite rare before the Omicron wave hit, at 1% or less through the Delta variant wave. But now reinfections have become much more common. Why? The Omicron BA.2, BA.2.12.1, BA.4, and BA.5 have progressively increased immune escape and there is limited cross-immunity with BA.1, the Omicron version that about half of Americans got infected with early in 2022. We await an independent replication of these reinfection findings, but I note much of what these authors have thus far published from the Veterans Affairs information resource has indeed been replicated.

So what about the future?

The worry is centered about the immune escape of these subvariants, which was characterized in a recent Nature paper with the conclusion “Together, our results indicate that Omicron may evolve mutations to evade the humoral immunity elicited by BA.1 infection, suggesting that BA.1-derived vaccine boosters may not achieve broad-spectrum protection against new Omicron variants.” That is to say, besides vulnerability to reinfections, the Omicron BA.1 specific vaccines, due to become available this Fall, may not provide enhanced protection as anticipated.

...

We are already seeing evidence of some less protection against severe Covid, that requiring hospitalization, with recent reports of vaccine effectiveness, such as 77% in 21 United States hospitals among immunocompetent individuals with 3 shots. Recall the mRNA vaccine effectiveness vs. hospitalization was 95% through Delta. We don’t have adequate data for vaccine protection vs BA.4/5 yet, but it is certainly possible there will be some attrition which has fortunately not been noted between BA.1 and BA.2.

There's a bit more but I've quoted enough.

malchior · Post by **malchior** » Tue Jun 21, 2022 9:37 pm

COViD finally hit my home. My wife was shipped against her better wishes and judgement to sales training in Indiana. She came back and got sick a day after she returned. Since then nearly 20 co-workers are now positive. She is fuming. Especially since they also expect her to be available to put out fires remotely.

Isgrimnur · Post by **Isgrimnur** » Tue Jun 21, 2022 9:42 pm

Sick days are sick days! [/Bob Parr]

LawBeefaroni · Post by **LawBeefaroni** » Tue Jun 21, 2022 9:45 pm

Isgrimnur wrote: ↑Tue Jun 21, 2022 9:42 pm Sick days are sick days! [/Bob Parr]

Not for those left standing. Expect this kind of thing going forward. People aren't just going to get 30 free COVID days when they get sick 3 times a year. Especially if they have partial WFH already.

Blackhawk · Post by **Blackhawk** » Tue Jun 21, 2022 9:52 pm

Forgive me for using metaphors that are more in my own wheelhouse here.

There is a 1-in-5 chance for survivors to have long COVID, which includes potential life-long complications.

Is there any data touching on that is 1-in-5 per infection (if you get infected five times, are you rolling a fresh d100 and trying to get 21+ each time?) Or is the risk different on reinfection (if you didn't get it the first time, do you get a cumulative bonus on subsequent rolls?) And can you get long COVID multiple times, with new problems/worse problems each time (do the long COVID penalties stack?)

If it's every time, and we're all going to be getting infected 2-3 times per year, after a few years long COVID will be pretty much a feature of humanity going forward.

Smoove_B · Post by **Smoove_B** » Tue Jun 21, 2022 9:52 pm

Yup. That's what's happening now - seeing it posted on social media constantly. Working while sick has been normalized. So enjoy getting Covid 3+ times a year and just working through it. As pointed out, you can't possibly be expected to have 3+ weeks of sick time away from the office. That would be ridiculous!

Smoove_B · Post by **Smoove_B** » Tue Jun 21, 2022 9:54 pm

Blackhawk wrote: ↑Tue Jun 21, 2022 9:52 pm Is there any data touching on that is 1-in-5 per infection (if you get infected five times, are you rolling a fresh d100 and trying to get 21+ each time?) Or is the risk different on reinfection (if you didn't get it the first time, do you get a cumulative bonus on subsequent rolls?) And can you get long COVID multiple times, with new problems/worse problems each time (do the long COVID penalties stack?)

Yes, that's what the article I linked to was studying - finding that each subsequent reinfection of Covid was increasing the chances of some kind of long-term health complication.

These new variants are totally screwing with our immune system (seemingly) - disabling it in such a way that it makes it more likely that "child" variants of whatever strain busted through your original state of immunity will have an easier time bypassing your immunity the next time, causing some type of illness. This should be raising alarms, not having us proclaim the economy is back on track.

If it's every time, and we're all going to be getting infected 2-3 times per year, after a few years long COVID will be pretty much a feature of humanity going forward.

Now do you understand why I keep saying we can't continue like this? Sure, we're going to try, but I can only imagine what America is going to look like by 2025 if we do.

Blackhawk · Post by **Blackhawk** » Tue Jun 21, 2022 9:57 pm

At which point it becomes practically guaranteed to get multiple reinfections, it becomes practically guaranteed to get multiple 'cases' of long COVID for every man, woman, and child, and if the penalties stack... give it a decade and humanity is non-functional. We're all asleep on the couch.

Smoove_B wrote: ↑Tue Jun 21, 2022 9:54 pm Yes, that's what the article I linked to was studying - finding that each subsequent reinfection of Covid was increasing the chances of some kind of long-term health complication.

I thought it might, but I needed to clarify with nerdy metaphors.

Smoove_B · Post by **Smoove_B** » Tue Jun 21, 2022 10:18 pm

Blackhawk wrote: ↑Tue Jun 21, 2022 9:57 pm I thought it might, but I needed to clarify with nerdy metaphors.

I like to think of it more like what happens when you Leroy Jenkins into a boss battle and immediately get hit with lots of DoT elemental effects, all working you over at once.

But yes, it's also why I'm in the camp that believes we're living through the largest mass-disabling event humanity has likely ever experienced. Sure, some people will make it through unscathed, but if things continue on this path the world is going to look very different in 2030 and beyond.

And that's not even considering climate change, elections, political upheaval, etc... All that stuff is just going to be extra on top of what we're apparently all doing to each other right now with the Covid.

Kraken · Post by **Kraken** » Tue Jun 21, 2022 11:15 pm

Meh, I don't worry about reinfection since I haven't been infected the first time yet...AFAIK.

I expect that to change over the 4th weekend, when I must journey into the heart of darkness that is Western Michigan. I'll only be there a little over 24 hours but I'll have to interact closely with many relatives and strangers in my role as the elder brother at my sister's memorial service. There will be hugging. Just hope I can make it home before symptoms start.

LordMortis · Post by **LordMortis** » Wed Jun 22, 2022 7:37 am

LawBeefaroni wrote: ↑Tue Jun 21, 2022 9:45 pm
Isgrimnur wrote: ↑Tue Jun 21, 2022 9:42 pm Sick days are sick days! [/Bob Parr]
Not for those left standing. Expect this kind of thing going forward. People aren't just going to get 30 free COVID days when they get sick 3 times a year. Especially if they have partial WFH already.

My brother in Colorado works on a shop floor and gets 0 COVID days and COVID has run through his shop twice now. You get sick and want PTO, tough. Nice way to discourage spread of disease, generally.

Still trying to stay at 0% infection rate but it's getting trying. I'm about as comfortable being alone and not doing anything outside of my home as anyone but getting on 2.5 years is stretching it pretty thin. I'm only imagining the anxiety I feel if/when I do re-integrate with society.

coopasonic · Post by **coopasonic** » Wed Jun 22, 2022 12:09 pm

LordMortis wrote: ↑Wed Jun 22, 2022 7:37 am I'm about as comfortable being alone and not doing anything outside of my home as anyone but getting on 2.5 years is stretching it pretty thin. I'm only imagining the anxiety I feel if/when I do re-integrate with society.

I'd say I was better at it, but I actually have 3 other people and 3 pets living in my house so I am not really doing alone. I also go into my office 2-3 times a month for half day meetings and spend half of my working days on calls... so yeah, what's alone?

Zaxxon · Post by **Zaxxon** » Wed Jun 22, 2022 12:18 pm

Popping some positivity into this thread--we've raved about Ed Yong's pandemic coverage; now enjoy his book about something completely different.

I'm particularly enjoying the audiobook, narrated by Yong. I did not realize he had such a wondrous accent.

With bonus COVID coverage (he's been talking to Smoove, hasn't he?):

hitbyambulance · Post by **hitbyambulance** » Wed Jun 22, 2022 2:01 pm

Zaxxon wrote: ↑Wed Jun 22, 2022 12:18 pm Popping some positivity into this thread--we've raved about Ed Yong's pandemic coverage; now enjoy his book about something completely different.

I'm particularly enjoying the audiobook, narrated by Yong. I did not realize he had such a wondrous accent.

With bonus COVID coverage (he's been talking to Smoove, hasn't he?):

i just saw this one posted on my library recommendations page last night, and added it to the queue

actually the microbes book looks good as well

https://www.goodreads.com/book/show/272 ... multitudes

malchior · Post by **malchior** » Wed Jun 22, 2022 3:51 pm

All these flight cancelations we've been seeing...I was just told pretty authoritatively by a commercial pilot that it's 95% COVID. It is wreaking havoc with crew scheduling. Not a big shock but fun that COVID was pretty much last mentioned in relation to flying troubles widely in April. Now they've pivoted to talk about years of under investment in training and general pilot shortages.

Smoove_B · Post by **Smoove_B** » Wed Jun 22, 2022 4:20 pm

It's almost like demanding that masks be removed somehow negatively impacted their ability to function. I mean, I'm not a data scientist but I might be able to connect the dots for them if they'd let me.

Can't wait to see how much money Congress gives airlines to "train new staff" that the CEOs somehow magically turn around and use to buyback stock.

But seriously, keep telling me how ignoring Covid is going to work out for the economy. We have a window/grace period *right now* where we could start pivoting for the Fall/Winter seasons. I'm guessing we're going to just continue to ignore and pretend like everything is fine until there are massive disruptions and then we'll all stand around and say no one saw it coming.

Also, if you haven't been following the rollout (national) for <5, it's been a goddamn mess. Pediatricians not interested in being front-line vaccinators, state and local governments not coordinating large-scale vaccination efforts or outreach. We truly have given up.

EDIT: Broadway is dropping their mask requirements for attendees. I wonder what's going to happen?

Defiant · Post by **Defiant** » Wed Jun 22, 2022 7:51 pm

Of course, I imagine a lot of people think the reverse - "I had it and it wasn't too bad, so I'll be fine if I get it again"

Edit: I'm thinking this is the paper referred to?

LawBeefaroni · Post by **LawBeefaroni** » Wed Jun 22, 2022 8:29 pm

But is that because you're re-rolling the dice or because you are more susceptible.

Driving in a car a second time increases your risk of death from a car accident. Doubles it, in fact.

Smoove_B · Post by **Smoove_B** » Wed Jun 22, 2022 8:46 pm

Defiant wrote: ↑Wed Jun 22, 2022 7:51 pm Of course, I imagine a lot of people think the reverse - "I had it and it wasn't too bad, so I'll be fine if I get it again"

Edit: I'm thinking this is the paper referred to?

Yes, I'd posted a write up last night - hopefully an easy to digest impression.

In short, there's value in delaying your first illness. After that, there's value in delaying your second.

Defiant · Post by **Defiant** » Wed Jun 22, 2022 8:57 pm

LawBeefaroni wrote: ↑Wed Jun 22, 2022 8:29 pm But is that because you're re-rolling the dice or because you are more susceptible.

Driving in a car a second time increases your risk of death from a car accident. Doubles it, in fact.

I know what you mean (and I'm not sure yet), but that's a flawed analogy, because if you're driving the car a second time, you've presumably survived the first drive and are not a zombie (I guess there's a chance your injuries haven't killed you yet, but it shouldn't double the chances).

And thanks for posting that, Smoove - I probably saw it and forgot about it, whoops.

Smoove_B · Post by **Smoove_B** » Wed Jun 22, 2022 9:15 pm

I see so many Tweetplanations (is that a thing?) where someone will take like 37 posts to describe a new study or finding. While I appreciate the desire to get info out there ASAP, I always try to wait for something more substantive to just read. That study has been big news over the last few days and it's starting to spill out into more mainstream media. Will it change anything? I doubt it. But if people keep hearing it, maybe it'll change something...

Max Peck · Post by **Max Peck** » Wed Jun 22, 2022 9:21 pm

I've formulated my own Vehicular Analogy Model* for reinfection:

Going to the supermarket while wearing a mask is like driving a car.
Going to the supermarket while wearing an N95 respirator is like driving a car with your seatbelt on.
Going to a bar without wearing a mask is like driving drunk.
Getting infected with SARS-CoV-2 is like crashing your car.
Repeatedly getting infected with SARS-CoV-2 is like repeatedly crashing the same car.
Eventually the car is totalled and you are maimed or killed.

* Peer review pending.

Freyland · Post by **Freyland** » Wed Jun 22, 2022 10:23 pm

Max Peck wrote: ↑Wed Jun 22, 2022 9:21 pm I've formulated my own Vehicular Analogy Model* for reinfection:
Going to the supermarket while wearing a mask is like driving a car.

Going to the supermarket while wearing an N95 respirator is like driving a car with your seatbelt on.

Going to a bar without wearing a mask is like driving drunk.

Getting infected with SARS-CoV-2 is like crashing your car.

Repeatedly getting infected with SARS-CoV-2 is like repeatedly crashing the same car.

Eventually the car is totalled and you are maimed or killed.
* Peer review pending.

Peer Review points out that you can total your car without significant injury. Your study is experiencing Claim Bias.

Max Peck · Post by **Max Peck** » Wed Jun 22, 2022 10:43 pm

Then we'll simplify the model and eliminate the predictive element.

Revised Vehicular Analogy Model:

Going to the supermarket while wearing a mask is like driving a car.
Going to the supermarket while wearing an N95 respirator is like driving a car with your seat belt on.
Going to a bar without wearing a mask is like driving drunk.
Getting infected with SARS-CoV-2 is like crashing your car.
Repeatedly getting infected with SARS-CoV-2 is like repeatedly crashing the same car.

We'd need to conduct large scale experiments to determine the effects of crashing cars. Perhaps the initial assumption of cumulative damage to the vehicle and probable injury to the occupants would be borne out. Perhaps, though, crashing a car causes it to become stronger, making it more resistant to future crashes and better safeguarding its occupants. And what if we apply horse liniment to the upholstery?

LawBeefaroni · Post by **LawBeefaroni** » Thu Jun 23, 2022 8:44 am

Defiant wrote: ↑Wed Jun 22, 2022 8:57 pm
LawBeefaroni wrote: ↑Wed Jun 22, 2022 8:29 pm But is that because you're re-rolling the dice or because you are more susceptible.

Driving in a car a second time increases your risk of death from a car accident. Doubles it, in fact.
I know what you mean (and I'm not sure yet), but that's a flawed analogy, because if you're driving the car a second time, you've presumably survived the first drive and are not a zombie (I guess there's a chance your injuries haven't killed you yet, but it shouldn't double the chances).

Yeah, it's pretty flawed but I guess the question is does a prior infection increase the chances of severe symptoms or is it just a second roll of the dice?