Bobref

Feature articles in Practice Update are peer reviewed before publication. Dr. Temte is the former chair of the U.S. Advisory Committee on Immunization Practices (ACIP) in 2015

Perhaps you’d like to see what the professionals have to say about this. Not in a press conference. Not with a political agenda. Just doctor to doctor. My wife sent this to me. She’s a nurse practitioner and head of infection control at a Chicago Hospital. https://www.practiceupdate.com/c/b5bf643b-c8c2-4989-a214-ba428701ad73?elsca1=soc_share-this-email&elsca2=social&elsca3=email Published in Gastroenterology and 11 other channels Expert Opinion / Commentary · April 21, 2020 COVID-19 – A Glimpse Into the Future Written by Jonathan Temte MD, PhD How can we see into the future? The simple answer is that we can’t. We are left only with guesses as to what may be. Some of these are educated and informed; others are wild speculation. It is the former that I will focus on today; informed predictions of what may happen with the global pandemic of COVID-19 in the coming weeks and months. At present, we have no vaccines for SARS-CoV-2 and no evidence-based therapeutics for COVID-19. What we do have are public health measures, such as “social distancing,” for prevention and medical interventions consisting of supportive care. Leveraging our public health tools, however, buys time for the development and testing of vaccines and therapeutics. A very thoughtful and thorough projection is available, based on sophisticated modelling by Kissler and colleagues.1 Their efforts take into account the possible contributions of seasonality, duration of immunity, and cross-protection imparted by prior infection with the two other betacoronaviruses in common circulation (HKU1 and OC43). Then, they provide a variety of scenarios that simultaneously assess the effects of the length (4 weeks to indefinite) and strength (0–60% reductions in Ro) of social distancing. First some basics: Seasonal coronaviruses are seasonal; they circulated primarily in the late autumn, winter and early spring months in temperate regions; Immunity to HKU1 and OC43 wanes fairly rapidly, over the course of about a year; Some cross-protection exists between these two viruses, and perhaps, extends to SARS-CoV-2; Both of these seasonal coronaviruses are less infectious than SARS-CoV-2. The modeling efforts lead to some interesting and some uncomfortable conclusions: SARS-CoV-2 can proliferate at any time of the year (as we are seeing now across the globe); If immunity is not permanent, SARS-CoV-2 will eventually enter into regular circulation as our fifth seasonal coronavirus; If immunity is permanent (or very long-lasting), SARS-CoV-2 could disappear after a few years; High levels of seasonality will lead to a smaller initial peak, but larger wintertime outbreaks; Low levels of cross-protection from OC43 and HKU1 might allow resurgence of SARS-CoV-2 following a period of low activity lasting a few years. When social distancing is added without seasonality, the following scenarios emerge: Short durations of social distancing do little more than displace the cases into the near future; Longer durations of higher-intensity social distancing effectively reduce case burden in the near term, but result in significant outbreaks during autumn and winter; Permanent social distancing of moderate to high intensity works well to keep SARS-CoV-2 at bay (but would be unpalatable to almost all of us). Finally, and what I think are the most likely projections, are of those with social distancing added into a seasonal world: Short durations of social distancing slightly delay the peaks of COVID-19, but result in high overall infection rates; Longer durations of social distancing push the peaks into the winter months and increase the overall infection rate; Intermittent social distancing, based on good surveillance, may be needed to keep case load in check until vaccines are available or a sufficient percentage of the population has been infected, become immune, and herd effects take over. I suspect our best choices here require a Faustian deal, buying time now at the expense of a future catastrophe, in the hope that effective therapeutics and vaccines become available and that critical data emerge regarding the extent of population immunity, duration of immunity, and its rate of decline. Perhaps the last and best words for COVID-19 predictions are those of Ebenezer Scrooge, “Are these the shadows of the things that Will be, or are they shadows of things that May be?”2 Only time will tell.

I have no doubt your thought process is a well-considered one. It just doesn’t come off that way sometimes due to the phraseology. When you use all those catch phrases, it’s just too easy to assume you’re the conservative equivalent of a “libtard,” and dismiss your point of view without considering it.

Here’s some well-intentioned free advice. Like most free advice, it may be worth no more than what you paid for it.😜 You have a legitimate point of view on these and other issues, and it adds to the open discussion that makes the GID worthwhile. But when your posts are continually laced with Limbaugh/Hannity/FoxNews conservative-speak, e.g., “libtards,” “liberal mainstream media,” “fake news,” it makes it way too easy for those of an opposing viewpoint to dismiss your points as being made by a “right-wing nut.” If you actually want people to take your views seriously, consider making the points without the meaningless rhetoric as a side-dressing. Of course, if being taken seriously is not one of your objectives, as opposed to just venting after a few beers without actually saying anything of substance, have at it. As I said, just some well-intentioned advice.

😂🤣😅 How naive! Everyone knows that it’s the Trilateral Commission - secretly headed by the Pope - that runs things.

We’d rather be the boss of the astronauts. And we won’t be satisfied with the moon. We’re shooting for Mars. https://www.nd.edu/stories/mission-to-mars/

We also do not know what the re-infection profile is like. It is far from certain that having contracted the disease will confer immunity, or how much, or for how long.

Let’s assume we do have a Fall sports season, and it is scheduled to start at the usual time. 3 days before the first game, the coach is notified that one of his players has symptoms and has tested positive for the SARS-CoV-2 virus. What do you do?

Actually, the Irish bookended UCLA’s 88 game winning streak. After that game in Jan. 1971, the Bruins didn’t lose again until the Walton-led team was upset at ND 81-80 in Jan. 1974. Irish scored the last 11 points of the game.

Interested to hear what some of my friends without Chicago connections thought of the first two episodes of “The Last Dance.” I was here during that time and, although I’m not a basketball fan, the Jordan phenomenon completely captivated me. I’m hoping this series will show the people who only know Jordan as a prolific scorer that his scoring was only a small part of the story. For me, the fascinating part was that a single player basically imposed his will on an entire league ... some would say, on an entire industry. I’m convinced we will never see his like again. I hope that comes through to the people who were only familiar with his stats, or who were too young to see it happening like I did.

I don’t think so. But they won the national championship with a 1 loss season. See if you can guess who gave them the single blemish on their record that season.

Whether we will or won’t lift some restrictions and what the effect of that will be are interesting question. But the most interesting question, to me, is not what will happen, but what should happen.

I get to go to “senior hours.”

The “flu” is actually several different strains of viruses. The annual flu shot is merely an amalgam of 3-4 different vaccines against the strains of the virus that epidemiologists predict will be most prevalent that season. But a flu shot doesn’t protect against any other strain of influenza. So, it’s relatively common for a person to get a “flu” shot, and still get the flu. It’s just a different strain than the ones covered by the vaccine. I think SARS-CoV-2 is a game changer. I think we are going to be pushed to the ethical brink by having to make a choice between the deaths we are willing to absorb in the name of keeping the economy going the way it was before vs. maximum infection control.If all we were interested in was keeping the most people healthy, there would be no large gatherings until there was a vaccine that worked, or until we had an effective, readily deliverable treatment that keeps people off ventilators and out of ICUs. As far as which way it’s going to play out, I predict the pressure to “restart” the economy — especially in an election year — will become too great. Restrictions will be relaxed. As a result, we’ll experience a secondary wave of infections and deaths, probably this Fall. There will be some restrictions re-imposed, but probably not to the extent before. So, until there is a vaccine, we’ll keep seeing infections and deaths. The numbers will depend on what restrictions we are willing to put up with to protect the vulnerable segment of the population.

A few. For example, the starting 5 for UCLA’s 1970 champs was Sydney Wicks, Curtis Rowe, Henry Bibby, Steve Patterson, and Terry Schofield. Larry Farmer was first off the bench, I think.

It is not appropriate to compare a Coronavirus vaccine to combat a virus that no one knew existed a year ago, with an influenza vaccine, which is a totally different type of virus, and which had been undergoing research on variant strains for literally decades. This article explains very nicely how, under the best of circumstances, mass production of a vaccine is 12-18 mos. away, and there are serious doubts as to how effective it might be, since there’s not adequate time to do the customary trials. https://www.livescience.com/coronavirus-covid-19-vaccine-timeline.html .

“Ill formed?” If you mean “ill-informed,” I’d say the guy who said Ronald Reagan in 1984 was “worse than Biden” was the ill-informed one. The American people gave him 525 out of 538 electoral votes. Think Biden will do that well? Fact is Biden is basically a recycled Hubert Humphrey without the engaging personality.

Could not resist this one for some of my Purdue friends (cough, cough ... @Coach Nowlin... cough). I believe this gem was attributed to Bobby Knight.

“If all goes OK” is a mighty big “if” where this sort of thing is concerned. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30796-0/fulltext

Sheltering in place is making some people cranky. Seems like I may have touched a nerve here.

OK, you can’t mention David Lee Roth and Sammy Hagar. Got to be one or the other. 😉

You omitted my #2: The Lizard King! https://youtu.be/kE32pvvaDT8

I would have bet nothing could exceed the ineptness of the GOP, but I was wrong. To go through the year long publicity stunt that was the impeachment process, and the best the Dems could come up with is Sleepy Joe? Somehow, the American political process has mutated so that it now operates to de-select any person of substance as a viable candidate.

Trying to find things to occupy my mind and relieve the boredom, all while sheltering in place. So, who is the greatest “front man” in rock & roll history? Share your thoughts and, if possible, maybe a YouTube clip or something. For me, call me “old school,” but it’s pretty hard to get beyond Jagger.