Mega-Thread: Coronavirus Pandemic

[Unholyground]

It's great, yeah. Hopefully will help get hospitals less packed with unvaxxed idiots causing harm to folks taht need treatment for non-covid reasons but are unable to find any hospitals with the space to care for them.

And on the mutations, I'll stick with the actual infectious disease specialists who are still warning about new mutations - https://www.latimes.com/world-nation...cientists-warn

Fearmongering still happens.

[Edge-]

Fearmongering still happens.

Oh come off it, everything related to covid has been "fearmongering" since the first case in the US was reported.

"We will not live in fear!"

Nonsense, it's justified and right to fear something like a virus that can kill you or leave you with longterm health complications. "Not being afraid" of covid doesn't make you (the royal you) some big brave alpha dog, it makes you foolhardy and ignorant.

[Poopymonster]

Oh come off it, everything related to covid has been "fearmongering" since the first case in the US was reported.

"We will not live in fear!"*

Nonsense, it's justified and right to fear something like a virus that can kill you or leave you with longterm health complications. "Not being afraid" of covid doesn't make you (the royal you) some big brave alpha dog, it makes you foolhardy and ignorant.

*Exceptions include: Gays. Fair wages. Masks. Yellow people. Brown people. Black people. Atheists. Catholics. Lutherans. Muslims. Democrats. Women. Taxes. Justice. Communists. Socialists. Equality. Nature. Reality.

[PhaelixWW]

*Exceptions include: Gays. Fair wages. Masks. Yellow people. Brown people. Black people. Atheists. Catholics. Lutherans. Muslims. Democrats. Women. Taxes. Justice. Communists. Socialists. Equality. Nature. Reality.

Well, sure, they may live in fear of those things, but they'll be damned if they let some piddly little pandemic make them act with a modicum of caution.

They're going to show that 'rona who's boss!

[Rasulis]

Just to circle back around to this for a minute...

San Francisco doesn't have the lowest mortality rate of major US cities, let alone by an order of magnitude.

SF has had 696 deaths, which is a mortality of 79.4 per 100k. Even the worst cities aren't an order of magnitude worse. NYC has had 36,949 deaths and a mortality of 417.5 per 100k, which is only ~5x that of SF. Fresno has had 2,415 deaths and a mortality of 438.9 per 100k, right around the same ~5x. And those are some of the worst cities in the US for COVID mortality.

But yeah, SF isn't even the lowest. Seattle has had 544 deaths, which is a mortality of 70.4 per 100k and is about 9% lower than SF.

Even during the delta/omicron surges, the two cities are pretty much neck-and-neck. Since 7/1/2021, just before the start of the delta surge, SF has had 129 deaths (14.7 per 100k) and Seattle has had 116 deaths (15.0 per 100k). Seattle was a bit lower during delta, but a bit higher since omicron started surging.

I stand corrected.

Updated new case for San Francisco. That really low numbers were apparently based on computer errors. The actual number is 800 cases per day, as opposed to 80 cases per day. Still less than one-third of peak.

Hospital bed occupancy is normal as can be seen on the second figure.

There were talks about twindemic of Flu and Covid in the beginning of December. So far, the number of flu cases in San Francisco has been low. Why? Probably a confluence of multiple factors. Masking. Covid might have culled the people that were vulnerable to Flu. High flu vaccination rate. Covid vaccines may also provide some degree of protection against flu viruses.

[Forogil]

The whole point was comparing major cities to other major cities, though, not to counties, states, or countries.

That was fine in itself; but I lacked a reference point to know whether any of those numbers were good or bad - and in case someone else needed it I posted.

I don't know if there is an international comparison of major cities. I would expect that the local variations will be smaller in many other countries; as there are more national policies and less of city-specific policies.

[Rasulis]

That was fine in itself; but I lacked a reference point to know whether any of those numbers were good or bad - and in case someone else needed it I posted.

I don't know if there is an international comparison of major cities. I would expect that the local variations will be smaller in many other countries; as there are more national policies and less of city-specific policies.

The big US cities used to have their own running tally of Covid's cases, hospitalization and death. That ended around the end of 2020. Now we only have county level numbers. Some county dashboards break the numbers down to city level. Those are the exceptions and not the rule.

Miami used to provide Covid data for the city. They stopped doing that January 2021. Now we only have data for Miami-Dade. Which is basically cut and paste of the CDC website for Miami-Dade.

[Forogil]

In the EU vaccine passports register vaccinations, recovered from infections the last 6 months, and negative PCR tests.

So a Czech singer got the bright of getting infected with covid to travel without getting vaccinated, but alas, she didn't recover:
https://www.euronews.com/2022/01/19/...-a-health-pass

[Edge-]

In the EU vaccine passports register vaccinations, recovered from infections the last 6 months, and negative PCR tests.

So a Czech singer got the bright of getting infected with covid to travel without getting vaccinated, but alas, she didn't recover:
https://www.euronews.com/2022/01/19/...-a-health-pass

Man, I feel like this column is relevant: https://www.latimes.com/business/sto...f-anti-vaxxers

Don't feel bad in the slightest. Play stupid games, win stupid fuckin prizese.

[Rasulis]

Man, I feel like this column is relevant: https://www.latimes.com/business/sto...f-anti-vaxxers

Don't feel bad in the slightest. Play stupid games, win stupid fuckin prizese.

If they are not clogging the hospitals, I would be more than happy to ignore them.

[Edge-]

Non-Death Cult: Please get a quick covid test before coming to in-person committee meetings. It's quick, simple, free, and ensures that we're all safe.

Death Cultists: WE'LL BRING THE PLAGUE WITH US! SOME AMERICANS DON'T HAVE THIS CHOICE SO WE'RE STANDING WITH THEM RATHER THAN DOING EVERYTING WE CAN TO PROTECT OURSELVES AND OUR COLLEAGUES! FREEEEEEEEEEDDDDDDDDOOOOOOOOOMMMMMMMMM

https://www.cnn.com/2022/01/19/polit...ing/index.html

This country ain't gonna survive the pandemic, yo.

Republican Rep. Marjorie Taylor Greene of Georgia, for example, has accrued $88,000 in fines for refusing to wear a mask on the House floor -- or roughly half her congressional salary. The fines are automatically docked from lawmakers' paychecks.

Because they're just racking up bills to virtue signal to their bases like the rich fucks they are. Because they don't care. Covid is a game to these fucks.

[PhaelixWW]

Because they're just racking up bills to virtue signal to their bases like the rich fucks they are. Because they don't care. Covid is a game to these fucks.

Where's the "Help MTG pay the fees demanded by the evil, socialist left as she demands freedom for all!" grift?

You know it's coming.

[Edge-]

Where's the "Help MTG pay the fees demanded by the evil, socialist left as she demands freedom for all!" grift?

You know it's coming.

She's super rich, hence why this is all a game. I guess $88K is "play money". Not like there are millions out there struggling who could really use some of that money to pay for things like rent and utilities and like, food. That's $88K well spent on "owning the libs" and proving covid isn't really that bad!

[PhaelixWW]

She's super rich, hence why this is all a game. I guess $88K is "play money". Not like there are millions out there struggling who could really use some of that money to pay for things like rent and utilities and like, food. That's $88K well spent on "owning the libs" and proving covid isn't really that bad!

I mean... where do those fees end up going, anyway?

[Unholyground]

Oh come off it, everything related to covid has been "fearmongering" since the first case in the US was reported.

"We will not live in fear!"

Nonsense, it's justified and right to fear something like a virus that can kill you or leave you with longterm health complications. "Not being afraid" of covid doesn't make you (the royal you) some big brave alpha dog, it makes you foolhardy and ignorant.

There is still a lot of fear mongering going on, the vast majority in ICU on ventilation are unvaccinated, anyone in High Care is someone who doesn't know how to take care of themselves when sick. I had covid bad to the point where I was coughing up blood, I am still here, it sucked a lot and was about a 2 month recovery but I managed to pull through. Actual scientists who know how to properly look at the numbers agree that we are entering the endemic.

[Edge-]

Actual scientists who know how to properly look at the numbers agree that we are entering the endemic.

Ah, no true scientist, then.

https://www.ndtv.com/world-news/ende...er-who-2715741

I'll stick with the scientists who are still warning that the pandemic is nowhere near over and we're nowhere near out of the woods yes.

That has triggered a debate on whether the virus is on the verge of passing from the pandemic phase to becoming an endemic disease that humanity can live with -- with the implication that the danger will have passed.

But the WHO has warned that the sheer numbers of people infected will mean many people are still falling seriously ill and dying.

[Rasulis]

There is still a lot of fear mongering going on, the vast majority in ICU on ventilation are unvaccinated, anyone in High Care is someone who doesn't know how to take care of themselves when sick. I had covid bad to the point where I was coughing up blood, I am still here, it sucked a lot and was about a 2 month recovery but I managed to pull through. Actual scientists who know how to properly look at the numbers agree that we are entering the endemic.

What is endemic? If we use Flu as the measuring stick, then we are not remotely close to endemic with Covid.

[Forogil]

Ah, no true scientist, then.

https://www.ndtv.com/world-news/ende...er-who-2715741

I'll stick with the scientists who are still warning that the pandemic is nowhere near over and we're nowhere near out of the woods yes.

That's not what WHO is saying.

They are saying that many will die in the coming month or two - but they don't contradict that it may be endemic after that.
Obviously an endemic disease can also cause a large number of deaths each year.

Or to quote Dr. Mike Ryan: https://www.scmp.com/news/world/arti...nger-warns-who

The World Health Organization on Tuesday warned against the notion that the Covid-19 pandemic becoming endemic would mean the disease was no longer dangerous.
“Endemic malaria kills hundreds of thousands of people; endemic HIV; endemic violence in our inner cities. Endemic in itself does not mean good – endemic just means it’s here forever,” Ryan told the Davos Agenda round table on vaccine equity.
But, he added: “We will not end the virus this year. We may never end the virus. Pandemic viruses end up becoming part of the ecosystem. “What we can do is end is the public health emergency.”

(Note to self: Next time search for quotes first.)

[Forogil]

They don’t contradict that it could become endemic. They do contradict the concept that endemic means safe though. Still isn’t endemic as of today.

They implicitly indicate that they believe it will become endemic this year.
And 'safe enough' depends on what you accept, as the list shows lots of people can die to various endemic issues and we still continue normally.
Some things are just seen as part of life, and for many diseases we get vaccinated and then ignore it.

Obviously that will differ between countries.

[Rasulis]

Caution: Paxlovid Interacts With Many Heart Meds — The Skeptical Cardiologist asks clinicians and patients to take note

After looking closely at the drug-drug interactions listed for Pfizer's new oral COVID-19 drug ritonavir-nirmatrelvir (Paxlovid), I realized that a large percentage of my patients are taking medications on the list.

The antiviral was granted FDA emergency use authorization in late December for the treatment of mild-to-moderate COVID-19 in patients at high risk of severe illness.

Patients with hypertension, coronary artery disease, atrial fibrillation (Afib), and hyperlipidemia should pay close attention to what follows if they are considering starting the drug, as they likely will need to stop or modify their cardiac medications and monitor their blood pressure and heart rates closely while taking it.

Ugh. Tricky, since for best results, Paxlovid needs to be taken within 3 - 5 days of initial symptoms.

Ritonavir has long been used to increase the levels of anti-HIV medications by strongly inhibiting the CYP3A system, which metabolizes many cardiac (and non-cardiac) drugs including nirmatrelvir, the active anti-SARS-CoV-2 antiviral.

Cardiac patients taking antiarrhythmics are highly likely to experience significant drug-drug interactions if they take ritonavir-nirmatrelvir, and should consult with their cardiologist about the best approach.

The FDA's Health Information for Providers document on ritonavir-nirmatrelvir lists several drugs that are highly dependent on CYP3A for clearance and elevated concentrations are associated with serious and/or life-threatening reactions: ranolazine, amiodarone, dronedarone, flecainide, propafenone, quinidine, bepridil, and systemic lidocaine.

Note that ritonavir coadministration is contraindicated with dronedarone, encainide, flecainide, propafenone, and quinidine. The first four are used for the maintenance of sinus rhythm in patients with Afib. If a patient is on one of these, the choices would be: Stop them if the increased risk of the development of Afib is acceptable, or use an alternative to ritonavir-nirmatrelvir

I don't use quinidine and haven't seen a patient on it for 15 years.

Amiodarone has unique pharmacokinetics and even if stopped for several days, would still be in the cardiac tissue and have effects for weeks to months. Whether any patient on amiodarone could safely take ritonavir-nirmatrelvir is debatable. Input from cardiology, pharmacy, and infectious disease would be warranted before giving ritonavir-boosted nirmatrelvir to a patient on amiodarone.

Many of my Afib patients take flecainide for the maintenance of sinus rhythm. Some of them will definitely go into fibrillation if they miss one or two dosages, so we will have to carefully weigh options and individualize the approach for each patient should they reach criteria for taking ritonavir-nirmatrelvir. Flecainide can be started and stopped safely as an outpatient and often restarting it converts patients safely back to normal rhythm.

The NIH COVID-19 Treatment Panel's statement on ritonavir-boosted nirmatrelvir lists disopyramide, dofetilide, and mexiletine as other antiarrhythmics warranting alternative COVID-19 therapy.

FDA also lists lovastatin, simvastatin, atorvastatin, and rosuvastatin as also being influenced by ritonavir-nirmatrelvir.

Fortunately, there is no short-term risk to stopping these drugs, so my advice to patients will be to stop taking the four statins as soon as COVID-19 is diagnosed and resume them 7 days after stopping ritonavir-nirmatrelvir.

Calcium channel blockers are also included among ritonavir-nirmatrelvir's drug-drug interactions.

These drugs are predominantly utilized for hypertension, thus if levels increase then blood pressure can drop too low. We sometimes utilize diltiazem also for Afib or premature beats; higher levels of diltiazem could result in both lower blood pressure and heart rate.

If ritonavir-nirmatrelvir is started in a patient on a calcium channel blocker, the most reasonable approach (supervised by a physician) would be to cut the dose in half and have the patient monitor the BP at home during the 5 days of ritonavir-nirmatrelvir and for 3-5 days after.

Most patients with Afib are taking either warfarin or one of the newer direct oral anticoagulants (DOACs).

FDA flagged two anticoagulants for ritonavir-nirmatrelvir users. Those on warfarin have to be wary of any new medication and should have their INR checked to monitor levels. Of the multiple DOACs, rivaroxaban (Xarelto) is the only one that should be stopped, according to the FDA.

Apixaban (Eliquis) is the blood thinner I most often use in my patients with Afib. While it is not mentioned by the FDA document, the manufacturer has recommended when co-administering with another preparation containing ritonavir a dose reduction to 2.5 mg twice a day. If the patient is already on a 2.5 mg dose, concurrent use should be avoided.

Much of what was reviewed in a detailed article from June of 2021 is relevant to ritonavir-nirmatrelvir and cardioactive medications.

The drug interactions with ritonavir range from insignificant to mild to strong. There are some differences from the NIH recommendations in this chart.

Note that caution is recommended if a patient is on the antiplatelet drug clopidogrel (Plavix) and ticagrelor (Brilinta) is contraindicated. These drugs (plus aspirin) are essential in the early months after placement of a drug-eluting coronary stent. Consultation with a cardiologist is mandatory before stopping them.

Some beta-blockers, commonly used for a variety of indications by cardiologists, are on the caution/monitor category as are two angiotensin receptor blockers widely used for hypertension.

Based on this information, I think it makes sense to monitor heart rate and blood pressure twice daily on any cardiac patient taking ritonavir-nirmatrelvir and adjust medications accordingly.

Ranolazine, an antianginal drug I almost never prescribe but frequently stop, is contraindicated with ritonavir-nirmatrelvir. Similarly, ivabradine, a drug I've never prescribed is contraindicated.

We still have some patients with permanent Afib on digoxin and I would advise halving the dosage for 10 days and monitoring heart rate for them if ritonavir-nirmatrelvir started.