Coronavirus / COVID-19

[slog]

My Daughter is on day 3 of Covid.   The hospital she works at called her today and said that she can come back after 5 days from when symptoms started, regardless of how she actually feels and no test required.

[Tale]

My Daughter is on day 3 of Covid.   The hospital she works at called her today and said that she can come back after 5 days from when symptoms started, regardless of how she actually feels and no test required.

CDC’s explanation: “The majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.”

So getting people to go back to work after that window (when things are desperate) is now an option.

[slog]

My Daughter is on day 3 of Covid.   The hospital she works at called her today and said that she can come back after 5 days from when symptoms started, regardless of how she actually feels and no test required.

CDC’s explanation: “The majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.”

So getting people to go back to work after that window (when things are desperate) is now an option.

Her job is to go around the hospital and nursing homes and draw blood from people.  I guess we don't really care all that much about the old people.

[HaemishM]

I didn't realize our societal disdain for old people was all that big of a mystery.

[Trippy]

For at-home sample collecting you might want to swab both your throat and nose for better results. Seems like Omicron doesn't multiply as much in the nose as the other variants do.

The UK has been recommending this even before Omicron and has a video on how to do it: https://www.youtube.com/watch?v=5qHTBlxfNes

This is an article written by an epidemiologist discussing some of the confusion that has come up regarding testing and Omicron:

https://yourlocalepidemiologist.substack.com/p/antigen-tests-and-omicron

[Trippy]

The above epidemiologist also has a good high-level summary of the state of things now that Omicron is spreading rapidly in many places:

https://yourlocalepidemiologist.substack.com/p/state-of-affairs-jan-4

https://yourlocalepidemiologist.substack.com/p/there-is-good-news

[Hammond]

So my covid test came back clear. UW did a PCR test which apparently is pretty accurate.

I am pretty much over whatever I had and I may just work from home tomorrow more due to weather than due to this bug.

[Samwise]

There's something to be said for not unnecessarily spreading around regular old cold/flu bugs either.  It'd be nice if we emerged from this pandemic with better habits around staying home sick in general.

[Tale]

There's something to be said for not unnecessarily spreading around regular old cold/flu bugs either.  It'd be nice if we emerged from this pandemic with better habits around staying home sick in general.

A rhinovirus (generally a standard cold) went around my son's daycare in mid-2021 and put a kid in hospital and almost my son too (GP was seeing him twice a day to try and keep him out of the covidy hospital). His gums turned bright red and he couldn't eat anything but ice cream or yoghurt for 9 days. The doctor said he's seeing non-covid viruses do weird things like this now that we are not spreading them so much.

(EDIT: mid-2021, not 2020)

[SurfD]

Just curious, since I know a few of you guys follow this stuff way more closely than I do, but when it comes to boosters and mix-n-matching vaccine sources, is there any good evidence on what's best to mix with a Pfizer based shot as a follow-up?

I am coming up due for a booster shot, and my first 2 rounds of Vaccine were Pfizer.  We are expecting a mobile booster clinic to hit our area sometime within the next few weeks, and (assuming there are options) I was just curious if there is a best choice for boostrer between the available stuff to go with my initial Pfizer shots.

[slog]

Just curious, since I know a few of you guys follow this stuff way more closely than I do, but when it comes to boosters and mix-n-matching vaccine sources, is there any good evidence on what's best to mix with a Pfizer based shot as a follow-up?

I am coming up due for a booster shot, and my first 2 rounds of Vaccine were Pfizer.  We are expecting a mobile booster clinic to hit our area sometime within the next few weeks, and (assuming there are options) I was just curious if there is a best choice for boostrer between the available stuff to go with my initial Pfizer shots.

Someone had a chart around here, and for Pfizer and Moderna was on top for a booster followed by Pfizer.

https://www.health.nd.gov/sites/www/files/documents/COVID%20Vaccine%20Page/Mix_and_Match_Booster_Fact_Sheet.pdf

I wouldn't sweat it too much, both will be good against Delta, not so good against Omicron, but will keep you out of the hospital.  Just get something soon.

[HaemishM]

I think it's either another Pfizer or Moderna for a booster.

[Trippy]

Just curious, since I know a few of you guys follow this stuff way more closely than I do, but when it comes to boosters and mix-n-matching vaccine sources, is there any good evidence on what's best to mix with a Pfizer based shot as a follow-up?

I am coming up due for a booster shot, and my first 2 rounds of Vaccine were Pfizer.  We are expecting a mobile booster clinic to hit our area sometime within the next few weeks, and (assuming there are options) I was just curious if there is a best choice for boostrer between the available stuff to go with my initial Pfizer shots.

For boosters against Delta in lab tests Moderna was slightly better than Pfizer (the link I posted that slog reposted above) but Moderna also has an increased risk of severe side-effects including a 4x increased chance of myocarditis compared to Pfizer according to a Danish study, so there are tradeoffs.

I haven't seen any studies looking at real-world results comparing boosters against Omicron since Omicron is so new.

In Moderna lab tests against Omicron the full dose (100mcg) generates significantly more neutralizing antibodies compared to the booster dose (50mcg) -- 83-fold vs 37-fold -- so ignoring possible side-effects if you are looking for maximum protection against Omicron then a full Moderna dose is likely better than a booster (half dose).

A full dose of Moderna (100mcg) is also bigger than the Pfizer dose (30mcg for both regular dose and booster) which may explain Moderna's slightly better protection in both lab tests and real-world results up to but not including Omicron and the booster at 50mcg is also larger than the Pfizer dose. But the larger dose size(s) may also be what's causing the increased chance of a severe side-effects.

I personally went with a Moderna booster the beginning of December because of this larger dose size after getting Pfizer for the first two doses since I wanted that potential extra protection but you should talk to your doctor given the increase in risk.

[Trippy]

I haven't seen any studies looking at real-world results comparing boosters against Omicron since Omicron is so new.

Ashamanchill posted a link in our other thread to a news article about a study that was done comparing vaccine effectiveness including with boosters against Delta and Omicron:

https://hospitalhealthcare.com/covid-19/third-covid-19-vaccine-dose-37-effective-against-omicron-after-7-days/

The news article is confusing but if you look at the actual pre-print (non-peer reviewed) study and go to Table 2 near the bottom you can see the results:

https://www.medrxiv.org/content/10.1101/2021.12.30.21268565v1.full.pdf



This table shows that Moderna (mRNA-1273) as a booster is more effective than Pfizer-BioNTech (BNT162b2) as a booster against Omicron but the sample size was small for Pfizer and tiny for Moderna so both have large 95% confidence intervals with Moderna's interval being larger than Pfizer's. I.e.:

Pfizer booster >= 7 days vs Omicron: 34% (CI 95%, 16% - 49%)
Moderna booster >= 7 days vs Omicron: 59% (CI 95%, 16% - 80%)

Given the small sample sizes I wouldn't consider this conclusive evidence that Moderna is more effective as a booster than Pfizer against Omicron but I also wouldn't be surprised if other larger studies have similar results given what we already know about the dosing differences between the two and their effects on antibody production.

[Trippy]

Another Omicron booster study hot off the pre-print presses published two days ago looking at Moderna-only:

https://www.medrxiv.org/content/10.1101/2022.01.07.22268919v1
https://www.medrxiv.org/content/10.1101/2022.01.07.22268919v1.full.pdf

Against Omicron they found with booster 62.5% effectiveness, 95% CI 56.2% - 67.9%

This is similar to the above results for Moderna but with a larger sample size and therefore narrower 95% CI interval. So something around 60% may be what to expect with Moderna, at least until protection wans. Note this study only looked at people with all Moderna-doses, no mixed Pfizer and Moderna so somebody with Pfizer 1st & 2nd doses + Moderna booster may be less protected against Omicron compared to somebody with all Moderna-doses.

[Trippy]

Increased risk of diabetes in those <18 years of ago with COVID-19:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm

New diabetes diagnoses were 166% (IQVIA) and 31% (HealthVerity) more likely to occur among patients with COVID-19 than among those without COVID-19 during the pandemic and 116% more likely to occur among those with COVID-19 than among those with ARI [Acute Respiratory Infection] during the prepandemic period. Non–SARS-CoV-2 respiratory infection was not associated with diabetes. These findings are consistent with previous research demonstrating an association between SARS-CoV-2 infection and diabetes in adults (4–7). The inclusion of only patients aged <18 years with a health care encounter possibly related to COVID-19 in the non–COVID-19 HealthVerity group could account for the lower magnitude of increased diabetes risk in this group compared with risk in the IQVIA group. In addition, patients without COVID-19 in HealthVerity had higher hospitalization rates than did those in IQVIA, suggesting more severe disease at the index encounter in the HealthVerity comparison group.

The observed association between diabetes and COVID-19 might be attributed to the effects of SARS-CoV-2 infection on organ systems involved in diabetes risk. COVID-19 might lead to diabetes through direct attack of pancreatic cells expressing angiotensin converting enzyme 2 receptors, through stress hyperglycemia resulting from the cytokine storm and alterations in glucose metabolism caused by infection, or through precipitation of prediabetes to diabetes (8). A percentage of these new diabetes cases likely occurred in persons with prediabetes, which occurs in one in five adolescents in the United States.††††

Another reason to vaccinate your kids if you can.

[Sir T]

My diabetes has gotten massively worse in the last 2 years so its possible I had a soft dose of Covid and it hit my diabetes. I've suspected that for some time.

[01101010]

Increased risk of diabetes in those <18 years of ago with COVID-19:

https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm

Another reason to vaccinate your kids if you can.

Their reliance on an ICD code to indicate diabetes is a little suspect, but they noted that in the discussion. I'd like to see the follow up to this study that uses lab results. Also this study suffers from a lot of the studies in that it is damn near impossible to sample asymptomatic folks since that would require a positive COVID test, either PCR or antibody and no one asymptomatic is getting tested unless required to... most of which are unvax'd folks at this point. It's a good effort, but there are some major holes in their methods. If anything, it gives direction to future, more rigorous studies.

[Trippy]

The University of California, San Francisco (UCSF) ran a test in San Francisco a few days ago comparing the performance of the BinaxNOW rapid antigen test with RT-PCR. As in, all people tested for two days at one location got both tests and the results compared. The samples collected used nasal swabs only (no throat / mouth), 40.5% tested positive via RT-PCR and from a random sample of those 97% were Omicron.

Essentially BinaxNOW did okay for those that were symptomatic (detected 128 out of 173 as detected by RT-PCR) and not so well against those that were asymptomatic or had been symptomatic > 7 days prior to testing (detected 64 out of 122)*. For those with the highest amounts of viral load (Ct = 30 cutoff) BinaxNOW was able to detect 123/126 for those symptomatic < 7 days and 43/59 of those asymptomatic or symptomatic > 7 days.

Direct Comparison of SARS Co-V-2 Nasal RT- PCR and Rapid Antigen Test (BinaxNOWTM) at a Community Testing Site During an Omicron Surge
https://www.medrxiv.org/content/10.1101/2022.01.08.22268954v1
https://www.medrxiv.org/content/10.1101/2022.01.08.22268954v1.full.pdf

Discussion

Test positivity of omicron SARS CoV-2 infection was extremely high- 40% RT-PCR prevalence- at a walk- up community testing site amidst the COVID-19 omicron surge in San Francisco. This cross- sectional analysis confirms that the BinaxNOW rapid antigen test detects omicron with a sensitivity similar to that observed for prior variants. The assay rapidly identifies persons with highest levels of virus, and thus those likely to pose the greatest risk for transmission at the time of the test (9). A positive rapid test enables immediate public health and personal action for isolation, disease mitigation, and clinical care, in a disease process where chains of transmission need to be broken and therapies are time-sensitive. With the increasing availability of this test in the United States, this information can inform optimal emerging public health strategies that hinge on rapid diagnosis and treatment.

Our data support the recommendation for repeat rapid antigen testing for persons at risk for COVID-19 who have an initial negative BinaxNOW result. Persons who have low levels of virus detectable on PCR but not antigen test may be either at the upswing or downswing of the viral dynamic curve for SARS Co- V-2 (10). In the setting of an acute surge, it is likely than many persons are on the upswing, and may subsequently develop higher viral loads associated with greater infectiousness and detectable on repeat testing 1-2 days later.

* Interestingly there's a "off-by-one" error somewhere, there were a total of 296 cases detected by RT-PCR but the above numbers only add up to 295 (173 + 122).

[01101010]

The University of California, San Francisco (UCSF) ran a test in San Francisco a few days ago comparing the performance of the BinaxNOW rapid antigen test with RT-PCR. As in, all people tested for two days at one location got both tests and the results compared. The samples collected used nasal swabs only (no throat / mouth), 40.5% tested positive via RT-PCR and from a random sample of those 97% were Omicron.

Essentially BinaxNOW did okay for those that were symptomatic (detected 128 out of 173 as detected by RT-PCR) and not so well against those that were asymptomatic or had been symptomatic > 7 days prior to testing (detected 64 out of 122)*. For those with the highest amounts of viral load (Ct = 30 cutoff) BinaxNOW was able to detect 123/126 for those symptomatic < 7 days and 43/59 of those asymptomatic or symptomatic > 7 days.

Direct Comparison of SARS Co-V-2 Nasal RT- PCR and Rapid Antigen Test (BinaxNOWTM) at a Community Testing Site During an Omicron Surge
https://www.medrxiv.org/content/10.1101/2022.01.08.22268954v1
https://www.medrxiv.org/content/10.1101/2022.01.08.22268954v1.full.pdf

Discussion

Test positivity of omicron SARS CoV-2 infection was extremely high- 40% RT-PCR prevalence- at a walk- up community testing site amidst the COVID-19 omicron surge in San Francisco. This cross- sectional analysis confirms that the BinaxNOW rapid antigen test detects omicron with a sensitivity similar to that observed for prior variants. The assay rapidly identifies persons with highest levels of virus, and thus those likely to pose the greatest risk for transmission at the time of the test (9). A positive rapid test enables immediate public health and personal action for isolation, disease mitigation, and clinical care, in a disease process where chains of transmission need to be broken and therapies are time-sensitive. With the increasing availability of this test in the United States, this information can inform optimal emerging public health strategies that hinge on rapid diagnosis and treatment.

Our data support the recommendation for repeat rapid antigen testing for persons at risk for COVID-19 who have an initial negative BinaxNOW result. Persons who have low levels of virus detectable on PCR but not antigen test may be either at the upswing or downswing of the viral dynamic curve for SARS Co- V-2 (10). In the setting of an acute surge, it is likely than many persons are on the upswing, and may subsequently develop higher viral loads associated with greater infectiousness and detectable on repeat testing 1-2 days later.

* Interestingly there's a "off-by-one" error somewhere, there were a total of 296 cases detected by RT-PCR but the above numbers only add up to 295 (173 + 122).

These are the validity/reliability studies I really enjoy. Put up two interventions or testing modes and see how they compare - as long as you have a gold standard as one and the comparison group as the other.

[Hawkbit]

Got my booster on 1/7/2022. Spent all day working on warehouse roofs on 1/14 in the wet and cold, by 1/16 I had a cough and sniffles. Somehow, without working around anyone for a few days, I managed to get Covid again. This time it put me out for about five days and I'm back feeling better, almost 100% within a week. The first time in 2020, pre-vaccine, it took me 3-4 full weeks to get back to 80%, and maybe all of last year to finally feel 100%.

The first time I got it I know exactly how it happened, this time I have no idea. Luckily the timing of my absence made it so no job sites had to shut down and nobody else got it. Really flipping weird though.

[slog]

The wife's Aunt was supposed to go in for a procedure this week and had to take Covid test. She's 72 fully boosted, and no symptoms at all.  She also has no idea how she caught it.

[Tale]

Got my booster on 1/7/2022. Spent all day working on warehouse roofs on 1/14 in the wet and cold, by 1/16 I had a cough and sniffles. Somehow, without working around anyone for a few days, I managed to get Covid again. This time it put me out for about five days and I'm back feeling better, almost 100% within a week. The first time in 2020, pre-vaccine, it took me 3-4 full weeks to get back to 80%, and maybe all of last year to finally feel 100%.

The first time I got it I know exactly how it happened, this time I have no idea. Luckily the timing of my absence made it so no job sites had to shut down and nobody else got it. Really flipping weird though.

Omicron in dad's hospital - he (double vaxed) was deemed a contact and was isolated - didn't catch it.
Omicron in dad's nursing home on levels 3 and 4 - he was on level 2 and didn't catch it.
Omicron in sister's childcare centre - she (boosted) worked with two kids who had it and didn't catch it.
Omicron in son's childcare centre - he (too young for vax) played with a kid who had it and didn't catch it.

My family dodging it in Matrix bullet-time (so far).

[schild]

Got my booster on 1/7/2022. Spent all day working on warehouse roofs on 1/14 in the wet and cold, by 1/16 I had a cough and sniffles. Somehow, without working around anyone for a few days, I managed to get Covid again. This time it put me out for about five days and I'm back feeling better, almost 100% within a week. The first time in 2020, pre-vaccine, it took me 3-4 full weeks to get back to 80%, and maybe all of last year to finally feel 100%.

The first time I got it I know exactly how it happened, this time I have no idea. Luckily the timing of my absence made it so no job sites had to shut down and nobody else got it. Really flipping weird though.

Omicron in dad's hospital - he (double vaxed) was deemed a contact and was isolated - didn't catch it.
Omicron in dad's nursing home on levels 3 and 4 - he was on level 2 and didn't catch it.
Omicron in sister's childcare centre - she (boosted) worked with two kids who had it and didn't catch it.
Omicron in son's childcare centre - he (too young for vax) played with a kid who had it and didn't catch it.

My family dodging it in Matrix bullet-time (so far).

https://www.dropbox.com/s/swr4626aktgxv7y/people_who_still_dont_have_covid.MP4?dl=0

[Zetor]

Just got vaccine #4 -- it's been almost 6 months since my booster, so I decided to take advantage of the govt's "oh shit we have a bunch of Pfizer juice that'll expire by Jan 31, everything must go" thing to get 3rd and 4th vaccines for people. (this may sound excessive, but I like a lot of people in Hungary got Sinopharm+Sinopharm as the first and second dose, which is worth basically fuck-all). Now I just need to get an AstraZeneca and Moderna dose from somewhere to become the very best there ever was...

But yeah, over here it's all but endemic: almost everyone I know (friends, family, colleagues) got it during the last 2 weeks, with like 3 exceptions. Test positivity rates in Hungary were 76% earlier this week. thisisfine.png

[Sky]

It's endemic here in NY now. Last year's massive holiday spike was a spike, this year's was just an uplift in the plateau. We had been sitting at roughly 1/3 of the 2020 holiday spike and now we're at 1/2 of it (using hospitalizations as the only reliable metric). We were at that 1/3 plateau from the beginning of Sep 21 through Thanksgiving, then we settled into the new normal of 1/2 of the peak hospitalizations of the 2020 holiday spike. So while the numbers didn't quite reach the pinnacle (in reported cases or actual hospitalizations, though reported cases are no longer being graph tracked ), the sheer length of sustained hospitalizations and deaths is stunning. We went from a full month of no deaths at all (and only 6 deaths for June, July & August 2021) to 20 deaths a week. For months without respite nor sign of wane.

THISISFINE

[Fraeg]

Well after two years of dancing and dodging it finally got me.  My fiance, her son, and myself all fully boosted.  I tested negative 2/1/22 and positive on 2/3/22, and my fiance tested positive shortly aftwerwords.  Our 15 year old gamer has kept his door shut while mainlining Destiny 2 and Conan Exhiles and has tested negative and is symptom free.

We know precisely how we got it.  Two hours in a car with friends on a trip to Napa for my fiance's 50th on 1/30/22.  At least the wine and food were great  
The couple we were with had flown out from Idaho to California a few days prior.  They started feeling symptoms on the 1st/2nd... so yea.

Were we stupid, I suppose, I mean we knew the risk, but threw the fucks out the window for that day.  The previous day Saturday the 29th she did 50 miles for her 50th. 12 miles running, 33 biking, and 5 kayaking.  Various friends run/walked, biked sections with her and I paddled the last bit with her.  We followed it up with an outdoor pizza party at a local brewery.  Nobody from that event has gotten sick other than us so we are confident we can eliminate that event.

Anyways, symptoms are mild for both of us.  Cough, sore throat, little taste for about 36 hours.  I am planning on doing a bike ride tomorrow so yeah... lets hear it for modern science.  If that had happened to 16 months ago who knows what the hell would have happened... granted we never would have done a Napa trip like that pre vaccine.

*edit* my brother is a general surgeon on the East Coast and has been working on Covid patients since May of 2020.  At this point he just calls it The Pandemic of the Stupid in reference to the unvaccinated.  His statement has been basically:  If you come into a hospital with serious symptoms and are unvaccinated medical staff are just going to go through the motions.  You are not going to get any crazy Dr. House or Greys Anatomy heroics. 

Like a quote from Apocalypse Now or Bladerunner he stated last July to me in a quiet voice "I just have seen so much death, so much death"

anywho that was a cheerful bit to close on.  Have great weekends folks.

[Tale]

Get well soon. Be careful about doing that bike ride.

[Khaldun]

I'd take another booster in a month or two if it were on offer.

[Strazos]

If I need to be boosted against this bullshit every month, I'll do it.

Was back in the US (Tahoe and Napa) for three weeks. Either we didn't catch it at all, or we were both asymptomatic and cleared it all out before our saliva tests two days before our flights back home. We tried to stay masked up in public, except when actively eating/drinking. Most other people we saw were far lazier about masking.

That said, both locations have high vaccination and booster rates, so perhaps that helped. Vaccines seem to work, obv.

[Tale]

I have covid. Tested positive this morning along with my 2-year-old son who likely brought it to us from daycare. Wife didn't go with us for a test, but assume she has it too... there's no isolating from a toddler. Both of us adults are triple vaxed. I feel quite sick but not alarmingly so.

Suspected it yesterday on my bicycle. Heart rate 150bpm felt like 170bpm, so much so that I thought the heart rate monitor was faulty. Then I reached a small hill and couldn't continue. Knew there was something wrong with me, and knew there had been a covid case at daycare.

[Trippy]

Just saw that the US two days ago issued a Level 4 "Do Not Travel" advisory for New Zealand because of their COVID-19 outbreak. Went to check their cases and: Yikes!

https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories/new-zealand-travel-advisory.html

[Chimpy]

They are like 90+% fully vaccinated as a country though, and they had virtually no lingering "natural" immunity since their total number of cases for the whole pandemic was less than an average day of new cases in Boise.

[Tale]

Just saw that the US two days ago issued a Level 4 "Do Not Travel" advisory for New Zealand because of their COVID-19 outbreak. Went to check their cases and: Yikes!

https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories/new-zealand-travel-advisory.html

NZ death toll for the entire pandemic so far: 76.

[Rasix]

Kid's school dropped their mask mandate as our county transmission rate finally hit low. Let's see how this goes.