I'll be really surprised if that's necessary and it likely only will be if COVID remains common enough in the developing world that mutations keep popping up frequently. That likely won't happen in places where most of the populace is vaccinated.

As you know, I'm sure, the flu virus is less stable than coronavirus and exists in a greater number of varieties such that mutations are regularly occurring and almost impossible to suppress. Hence the need for a new vaccine every year (the vaccine offered in the northern hemisphere is usually based on the latest mutations and prevalent varieties of virus found that northern summer (southern winter) in the Southern Hemisphere.

But such a pattern of regularly occurring mutations isn't likely in coronavirus, especially if vaccination is widespread even in poorer countries.

Flu has a widely available vaccine that at times is 40% effective, and a HUGE amount of the public never gets.

I know, I've been offering it for years, and lots of people say no. And those are just the people who see the doctor.

Influenza vaccination has never been a prerequisite for normal life, like, ever....

But yes, among the elderly COVID is far more deadly, I'm aware of this

So, let me make sure I am getting you right:

If Covid had the same death rate as the flu, we could deal with a higher r rate. However, since it is a lot more deadly, an r rate of 1 is basically the floor to judge when we are "good to go"?

Flu shots are indeed required in some contexts (e.g. participating in the US Antarctic Program, maybe some retirement homes etc?). They probably should be required in more (universities, service workers). Even if it doesn't help every year, it will help a lot overall.

^ I think that this perspective is perfectly reasonable (although I don't plan on living in so much fear personally, but I'm much younger than you) in the post-vaccine world as long as it transitions to a take the necessary precautions to protect yourself policy as opposed to top-down mandates, which are just so destructive to peoples' livelihoods, economies, and generate so much resentment.

Meh, it's not like we aren't going to keep up with (perhaps?) yearly booster shots for COVID to address the variants.

It's a matter of swapping out the mRNA for the latest variant, shoot it into people, and "poof" you're good. We got this! :tup:

The mood everywhere is so somber, I don't get it. More people should be happy, we are really getting close to the end of the worst of this.

That's not true. See 1918 pandemic.

I wouldn't say "good to go"... but if COVID had the same mortality rate as the flu, but still had a higher reproduction rate (r) then there would still be more people dying of COVID, but just not as many as there are dying now. So it would be a less concerning situation than what we're actually dealing with right now.

Actually, we've seen this situation in the U.S. fairly recently. I believe this was similar to the 2009 swine flu outbreak.

The very first Influenza vaccines weren't even available until the 1940's, long after the Spanish Flu pandemic was over.

So I stand by historic facts: Influenza vaccination has never been a prerequisite for normal life.

Besides, even today millions--perhaps billions--of people never get vaccinated regularly against Influenza.

Okay, but governments did step in to manage the spread of influenza during the 1918 pandemic. If vaccines were available in 1918, it is obvious that government policy would be tailored to the distribution of an influenza vaccine. Our situation today is not without precedent.

On the contrary, when I participated in the US Antarctic Program one of the more interesting things we did was a study of the spread of flu and parainfluenza viruses to the isolated winter-over crew when the summer crowd returned carrying them. So, of course, we didn't want anyone vaccinated--we wanted them all "virgins" in respect of flu.

;)

Of course not. Besides the fact that flu is less deadly, some years the flu vaccine is only about 40% effective (compared to 95-100% for COVID vaccines) and less than half the population gets it. So if we were in any way dependent on it, we'd be in big trouble.

Some developments:

https://www.bloomberg.com/news/artic...bloombergdaily

By the way, we are now averaging over 2 million shots/day in the US.

Sounds like the results of your study were that we need to have it!

https://i.imgur.com/aXmEmzF.png

More and more I'm thinking the "worst of this" may be in the psychological and intellectual damage to a generation of children many of whom have now spent a year without socializing with friends or getting much of an education.

Consider:

https://tucson.com/news/local/with-t...3443e0102.html

For some time now it has been predicted we could see a "roaring Twenties" mentality in the population as a whole with 5+% economic growth rates like we haven't seen in some time. That's something to look forward to. But I wonder if the kids will ever get over this.

Oh, no doubt. But it was interesting to see what kinds of contact transmitted it. Unfortunately, I don't know where my copy of the paper is. I personally got a parainfluenza virus from the "outsiders".

By the way, they are getting a lot tougher. Gall Bladder Ultrasound on all W/O personnel? Wow.

I think the kids are going to be better.

The push to reopen schools is basically a tidal wave at this point. If Chicago Public Schools reopen (which they already have), then we're in a good place.

Come on, how about some optimism?

My Mom and Dad are finally getting their first vaccine shots tomorrow! :tup:

I'm very optimistic about most things and have been right along: The economy, control of the disease through immunization, the ability of science to conquer it (even if some low information folks don't cooperate by wearing masks and getting their shots).

But we have really scr*wed the kids. I think they should give every 16 year old in America a standardized test a year or two from now just to see how badly but we'd need to use something--maybe the SAT--where we have a comparison from the "before times".

Was it in the American Journal of Epidemiology? I may have found it... (can PM you a copy). Or perhaps it's one of references 7-10 (all in Antarctic J US Rev) in the paper I'm looking at... mostly talking about rhinoviruses though!

And yes, the absolute worst part of working in the Antarctic/Arctic is the awful PQ process. How many times do I have to take this stupid pulmonary function test to prove that in fact my lungs work... Also, most people would have a PPD on there, but since I had the BCG they make me do a blood test instead (which is on a different page :) ).

Fortunately the kids are all on tiktok/snapchat/whatever anyway. This would have been MUCH worse 20 years ago.

2 million shots a day? That is certainly something to be happy about! This thing should be over in no time.

As far as being optimistic about our urban environments? I am far from it. I know we have all shared our opinions on what the future might hold, but I am anything but convinced it will be pretty.

Wow. Really?

They’ve screwed everyone under 40 and maybe 50.

The approach here in Florida has been best. Leave things pretty much open (to the point that places like restaurants are demonstrably unsafe for the elderly), and let people make prudent decisions about their own health and well being.

Of course that only works when you have a robust healthcare system, not the shaky underfunded and underinvested public system in the UK.

America has shit healthcare, though, so letting people fend for themselves isn't going to be pretty. Also, it's Florida. Is losing nightclub culture really that bad? Serious question.

America has excellent healthcare. It’s just expensive.

The UK literally does not have sufficient (or modern enough) hospitals, or enough nurses, to deal with high rates of hospitalisation. This isn’t just a Covid issue, it’s almost every winter flu season. See: https://www.theguardian.com/society/...-overstretched

And people aren’t getting Covid in restaurants, bars and gyms. Offices were responsible for more cases than all of those last fall, and the majority of cases by far are occurring in people’s homes. Just as in the US, there is media coverage of higher rates of infection in minority communities, but this is mostly because big South Asian families have 14 people over for Sunday lunch and they all get Covid.

If anything, the fact that basic NHS healthcare is free further reduces the disincentive to take risks created by the prospect of huge medical bills.

Sounds like you aren't/ weren't into the nightclub scene but that doesn't make its hypothetical demise a good thing. Bars, nightclubs and the hospitality industry in general has been decimated...and they were what put a lot of people especially in places like South Florida to work.

This gets political but since the Moderator in Chief introduced the issue, the main shortcoming of the US healthcare system is access. Something like 90% of people have insurance and for them it's excellent and if they have good health insurance it's about the best in the world.

But for those without insurance it's very problematic. And the hodge-podge of payment systems generally is insane. Also, the really good care is pretty much concentrated in urban areas. Plenty of people in rural areas, especially in the West, live miles, even hundreds of miles, from fairly mediocre care.

So if you can access the system and someone else (government or insurer) is paying most of the bills, it's hard to beat . . . anywhere.

As someone who is retired military and on Medicare, I haven't paid a dime for healthcare in years and I've had a couple of major operations and spent several weeks in the hospital during that time. Also, I regularly see a specialist at UCSF which usually ranks in the top 5 or 10 hospitals in America which means among the best in the world (there's a reason the world's super-wealthy often come here for care).

I am convinced the reason the twenty-something recent grad techie crowd seems to be fleeing the cities is because they are DEAD. San Francisco feels literally like there should be tumbleweeds blowing down Market St.

People flocked there because (1) there were plentiful well-paying jobs and (2) the place was a fun place to live, especially if you were young and single, whether gay or straight. It was a gourmet paradise, and there was nightlife aplenty. And besides tech, tourism was about the largest economic sector.

Mostly the tech jobs still exist, except you can do them from almost anywhere including Idaho. The restaurants are closed to indoor dining though many have been saved by elaborate outdoor "mini parks". But some have gone under and more may before its over. Meanwhile, the bars and clubs are closed completely; the Symphony/Opera/Ballet (all world class in the "before days") are shut down; there is no theater, live or filmed. And property crime is out of control, from shoplifting to vandalism to burglary. Many businesses are shutting permanently just because they are being robbed blind (there are reasons for this beyond COVID but the empty streets and lack of business aggravates things). And the hotels are closed except the ones the city has filled with the homeless.

I left myself . . . for Arizona where it's easier to isolate (single family home vs middies condo building) and I'm not missing anything because in SF it's all closed anyway. The city just dropped from California's "purple tier"--the worst--to red which allows them to open up restaurants again and also museums, but with lowered occupancy. I've got my fingers crossed that when I go back in April there'll be some life in the old girl.

https://uniim1.shutterfly.com/ng/ser...845406/enhance
For this, other states and international situation: https://www.bloomberg.com/graphics/c...-distribution/

Brazil is at 11 million doses, 7.5 million people vaccinated. Watching the US and the UK that were on their worst moments when the program started, Brazil has a painful way ahead. Even today there are too many deaths in the US and the UK. Brazil registered almost 1,900 deaths yesterday. The worst day so far.

About things on the ground, the entire São Paulo state receeded to the “red phase”, when only “essential services” operate such as supermarkets, drugstores, etc. Restaurants and bars only for delivery. Schools will be opened, as they were closed since March 2000.

Thanks. I’m aware of the dynamics but was simplifying for the sake of brevity.

But yes, as I have explained countless times to Brits, American healthcare is better than British healthcare for 90% of the population, and catastrophically bad for that small minority.

Fixing the latter issue is a better approach however than switching to a system more like the UK’s, where everyone has access to the same mediocre medical care (and really, because of limited resources and rationing, only the elderly have access to anything, whereas younger people are just told to rest and drink lots of water unless they have cancer).

..

People absolutely are getting COVID in restaurants, bars, and gyms. Especially bars and gyms, each of which have documented cases of super spreader activity.

This is nice but I’m concerned we are going to hit a ceiling some time this summer, with all of those dolts who will refuse the vaccine

Yeah, I've always heard that there are three goals of healthcare to be good:

1. Access
2. Quality
3. Affordability (which relates to access)

America has an amazing quality, we just suck in the other two categories.

Ah, I am not too worried about that.

First, most of the people refusing the vaccine probably aren't 65+, so this should keep our deaths low.

Second, most people in dense cities will get their vaccines, which have been hot spots for spread.

Third, and this is messed up, the rest of us will be vaccinated, so...Darwin and all.

Efforts to limit spread of COVID have just about eliminated flu this year. In a big way that's reassuring--to me it shows most of us are doing what we should do to stop COVID.

https://uniim1.shutterfly.com/ng/ser...888511/enhance
Newsletter, AZ Dept of Health Services

Also really drives home how much more contagious COVID is than the flu!

Covid measures effectively killed the flu. I don't think I've even had a cold since I started working from home a year ago. Those crammed cubicle farms really are a germ bath.
https://scontent.fmia1-1.fna.fbcdn.n...a7&oe=6066C3C9

https://www.bbc.com/news/world-us-canada-56288038

I am relying on anecdotes for this one, but just in the past week I saw multiple patients over 65 who seemed very reluctant to get vaccinated.

My aunt and uncle living in Queens, NY are also very reluctant to get the vaccine, and they are in their 80’s

As stated, older age groups and those with pre-existing conditions will be more susceptible to succumbing to the virus because their weaker immune systems are less able to mobilise an effective response. I think some are failing to see the wood for the trees, irrelevant of age or condition, any loss of life where preventable is unacceptable.

That the number of victims in the US who have succumbed to Covid-19 within the 25-34 age group is similar to the toll from 9/11 shouldn't be seen as insane or fear mongering, but a dire perspective of the inadequate response to this disaster. This isn’t even a problem unique to the US, the UK and countless other so-called developed countries have failed their citizens. The shambolic response to this crisis is going to have ramifications lasting decades.


”Told to rest and drink lots of water” :koko:, this is a poor attempt at comedy surely…

The NHS is far from being a utopian healthcare service provider and it has significant issues to resolve, but this ”mediocre” system ends up with average life expectancies 3 years above of those in the US, despite per capita healthcare expenditure being a staggering 2.3x higher in the US. Those exorbitant medical costs are inflated out of all proportion, even for basic drugs and procedures. Those same excessive costs and grossly inefficient medical insurance sector probably go a long way to explaining why medical costs are the leading contributor behind bankruptcies in the US are; a staggering half a million families per annum.

If this crisis has demonstrated anything, it is when you strip the politics out and let the NHS get on with managing healthcare - as it is with the Covid-19 vaccination programme - it excels. The UK is third in the world for vaccinations (33.0 per 100 people); far ahead of most of Europe and a third higher than the US.

What reasons do they give and were you able to talk sense into them?

Frankly, I am coming to accept that we will just have to go with Darwin in quite a few of these cases. Vaccinate or, well, you know. The "fittest" are getting their shots.

Far fewer cases are coming from these places than from people meeting inside their own homes. That’s based on actual studies, not the ill-informed pronouncements you repeatedly make. (I still can’t believe you suggested their was a vaccine for Spanish flu in 1918).

Offices are also a much larger source than these places that have been closed:
https://www.bbc.com/news/uk-55843506

The "it's their immune system" thing is only part of it and when you're talking about 90+ individuals, maybe the least of it. These people have very tenuous respiratory and circulatory systems as well. It doesn't take a lot of the sort of stress that COVID causes to just cause multiple system failure.

People who don't live in the US, and even many who do, simply don't understand the place.

It's a huge country with huge empty places--places where the nearest little community hospital may be hundreds of miles away and there may be no doctor at all. I once was sent by the state of Florida to staff a little clinic in a house trailer in a part of the state where there were no practicing doctors in 4 adjacent counties (and, of course, no hospital). Florida is not one of our most rural states. There are even very affluent communities--one I can think of is among the homes of the Walton family who own Walmart--that have pretty rudimentary medical services. In the case I'm thinking of, if you need real specialty care you have to be FLOWN out to get it.

The simple remoteness of medical care and the lack of sophistication about medical matters in some portions of the population accounts for a lot of the lower life expectancy rates IMHO. COVID is an example--anyone who has COVID needing hospitalization and showing up at a capable hospital is going to be provided care regardless of insurance or other ability to pay. But if you don't HAVE a local hospital or if you are stubborn and think you can tough it out, you won't get care.

As far as the treatment given people for whom cost or accessibility is not any issue, in the case of COVID, in the early days, there wasn't much unless you needed mechanical respiratory support. People need to accept that even with modern science, we don't have specific therapies for everything and especially in the case of entirely new diseases, it often takes a while to understand the pathophysiology well enough to know what to do for them. Actually, the learning curve with COVID has been very steep. Consider that in ONE YEAR we have effective monoclonal antibody therapies (and one of the scandals is those aren't being used enough), multiple highly effective vaccines and we understand the role the immune system plays in the disease and how to modify it much better than we did a year ago. Far from having to be embarrassed, the biomedical sciences of today have a lot to be very proud about.

Where there has been failure has been where most of us would have expected: The economics of it all. In countries like the UK, governments have simply been too parsimonious with their medical systems. In countries like the US, in order to avoid what Americans see as Brave New Worldish government control, a creaky and wasteful system of payment has been created (although, remarkably, we have a parallel system for the elderly called Medicare that works very well yet we refuse to extend it to everybody).

Clearly I’ve hit a nerve. That’s what happens when you question national myths.

I don’t know a single person who has experienced both the US and UK healthcare systems and doesn’t prefer the US. All of these people had insurance in the US, of course. Brits just don’t know what they’re missing, and think having to show up at the local GP nearest their home address in the middle of the workday to sit in a dilapidated waiting room in order to ask for a referral to see the specialist they already know they need to see is normal (for example).

What an American finds fascinating about the British system (and are we getting too close to "politics here"?) is some of the ancient buildings, albeit modernized inside to some extent I'm sure, still in use.

In CA, there's a law that every hospital in the state has to be "seismically safe" by 2030 (I believe is the date)--capable not only of withstanding the maximal predicted earthquake but continuing to function. Since many of the older buildings would be very expensive to bring up to this standard, a very high proportion of hospitals in the state are being replaced, not rebuilt. In San Francisco, at least 4 of the hospitals are or will be brand new. And these buildings are totally different from the hospitals of past eras. Mostly, they contain only private rooms (often with facilities for relatives to stay in the room with the patient). Many of the rooms can be set up with negative pressure to make them suitable for isolating infectious people (as for COVID). Naturally, all the equipment, operating suites and the rest are brand new. And they are designed for maximum efficiency so that nurses sitting at their station can monitor many more patients (often with the help of electronic monitoring equipment) than in older facilities.

In the rest of the US, the dominance of privately owned hospitals means those in a community compete. It's not a totally efficient competition because the typical sick person isn't competent to judge hospital quality, but their doctors decide for them. And they can judge the hospital based on things like the comfort of rooms (again, those private rooms) and quality of food (excellent chefs are getting common too). Typically, the BUILDINGS in many communities are privately owned (often by public REIT corporations) while the actual medical care is managed by a non-profit company or medical group) though in some cases the whole thing is for-profit. But it's all kept modern and up to current standard because patients have alternatives and hospitals in urban communities get reputations for be good places for care or bad.

Then there's the training of the doctors. It's pretty simple. Doctors come from around the world for US training and many US specialists these days were born abroad (as with tech, South Asia seems an especially common place of birth) and trained in the US. I don't think there's any question that the best of US care is the best there is. The average standard is, of course, lower but certainly as good as the average in other developed countries. And for those sophisticated enough to seek it out, the best is accessible because it's usually at a teaching hospital that's part of the state public university system (which means it takes Medicare, Medicaid and just about all other forms of insurance).

White collar offices have mostly been closed in the U.S. for a year, while gyms have been mostly opened. I'm not sure what point you're trying to make.

Add a third state, Connecticut, to the list of states to 100% open. Masks are still mandatory, and physical distancing is still required.

https://www.ctpost.com/news/coronavi...e-16000493.php

In the UK, the advice has been to work from home, but some people and companies have still been going in to the office. For example call centres haven’t seemed to figure out a work from home setup (as simple as this should be). And even with a very limited number of white collar employees going to their offices, there were still more infections stemming from these environments in the fall than from all of the leisure activities that were open then but have been closed again.

Restaurants have been really unfairly penalized throughout. It’s a scandal.