IMDoc on the Covid treatment frontline:
About the French Guyana paper from the CDC
This is how science – the actual process – not the Fauci version – should be working.
I have repeatedly stated that I am seeing much much more vaccinated positives than one would ever have expected. As I have stated, they seem to be much sicker (though not critically so) and they tend to happen in clusters. For the past two months, this has stuck out from the dominant media narrative. I have never had to fight the cognitive dissonance between the media and my own eyeballs in my life.
I belong to a large non-public alumni group of my residency program that has literally thousands of IM docs all over America. The first thing a scientist does is to confirm that your observations are general or something you are just seeing. It was quickly obvious from that group that I was far from alone despite the “minimal breakthrough cases” media narrative.
So, then you do everything you can to hypothesize reasons why you are seeing what you are. I have been a physician for 30 years and that experience plays a huge role as well. Having this gigantic number of breakthrough cases just simply does not happen. I continue to see more than half the cases in vaccinated patients and so do many others. UNHEARD OF IN VACCINES BEFORE NOW.
Part of hypothesizing why is looking to the literature for evidence. Seldom is this found in RCT at this stage. Case reports and series like this paper are critical. They are seeing the same breakthrough ratio. And they have done a lot more viral research than you can. This is a gold mine for my own questions.
Is there anything in the paper that could possibly explain what I am seeing. Lots of times, it is not in the headline part but in all the test results and discussion. And yes, there is a very important finding deep in the results.
Why would clustering and sicker patients be so much more common in the breakthrough patients – there must be a reason for that?
If you look at the brief discussion of cT or cycle threshold you will see that the vaccinated patients have a SIGNIFICANTLY lower cT than the unvaccinated. That is the way the PCR test works. It basically means the vaccinated have a much higher amount of viral active particles than the unvaccinated. That would account for the breakthroughs I and my colleagues are seeing being a bit more ill. And it would explain the clustering. THe vaccinated breakthroughs have much higher viral load so they are much more contagious and the higher viral load makes them more symptomatic.
So we now have a suggestion and strong evidence that the vaccinated population may be spreading much more virus than the unvaccinated. I would say that is a critical public health issue and must be further researched immediately.
This Certainly needs much more work. THis is not confirmatory of any conclusions. But it is consistent with observation on the ground – unlike most of what the media has been spewing to the American people. But this is how science works. This paper is about the gamma variant but a conference yesterday with experts discussed that similar findings were being found in delta and lambda. The suggestion in this paper is now on the front of my mind. I am even now thinking of ways to confirm or falsify these conclusions going forward. This is science.
Another issue. The writers make the point that the breakthrough rate is extremely divergent from the expected rate. The difference is this paper documents what is happening in REAL LIFE. So much of what we are hearing on our media about vaccine efficacy is research being done in vitro. It is presented as gospel truth. I just want to scream.
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And this type of wide variation is to be expected in the real world – that is the way it goes. And another very severe confounding issue is the absolute gigantic chasm of numbers between these two data sets. I am in a very small area with a very small N. LA is gigantic. So theoretically, the LA numbers would have a much higher statistical power. However, there are an infinite number of confounding variables that must be taken into account in a side to side comparison. I have chills when I hear the media making all these god-like pronouncements about this place or the other. It is just very difficult to compare apples to oranges and they really should not be making blanket statements about every locality based on numbers coming from just one. This habit has been yet another bad side effect of our sterilization of the local health departments and the dependence on one centralized center.
The other issue left off your calculations is the number of people who are very ill and suffering at home. This is not a small number. I know this for a fact because there are about 10 patients on our call list that are COVID positive and very sick and we call them twice daily. They refuse to be in the hospital, largely for financial reasons. That is almost certainly an issue in LA as well.
Another possible confounding issue is if there is a much larger group of younger people who are not nearly as likely to be admitted whether vaccinated or not in either LA or here. The demographics and the attitudes of different age groups vary widely between different parts of the country.
The vaccine efficacy of 61% in my area is much closer to what is being experienced in Israel right now for what it is worth.
And thank you for the efforts to do these numbers – you should be a medical student.
One other little pearl to think about. ANYTIME anyone in medicine reports a 100% rate of anything – assume they are lying until proven otherwise. I would assume that to be the case in every field. There is no such thing as perfection.
When the LA report came out last week that their hospital admissions were 399 and all 399 were unvaccinated, I knew right off the bat that they were lying. That just does not happen in medicine. These people need to find better liars. For instance, if they had said 356 were unvaccinated, which is still a respectable number, I would not have raised an eyebrow. But they went for the gold, and earned hundreds of hilarious comments in my doctor’s forum that evening. The average physician in America who is hip deep into these tragedies is really getting tired of all the shenanigans.
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For several weeks – dating back to mid May – I was seeing groups of fully vaccinated patients becoming positive – but asymptomatic. Most of these situations arose because one member of the family or group was found to be positive because of foreign travel – or having surgery or whatever.
As this became more and more common – I began to be very concerned about what the future may hold. And the Health Department and CDC were just ambivalent.
The guidance of the local health department was to ignore this – “they are vaccinated – there is no way they can spread, etc.”. Just as the CDC guidance was telling them to do. I do not much like to have armed nuclear warheads sitting around, and I am very persistent – so I ordered the contact tracing on my own – every close family member or close contact was checked. And to my absolute horror – large clusters of them were positive. But at that time, they were asymptomatic- almost every single one. I have been dutifully reporting these numbers to Yves and Lambert for weeks.
Then about a month ago – something changed. People were then starting to become ill – and come to clinical attention that way. There were no longer just the asymptomatic patients. And again – on my own – ordered the contact tracing – and found the same thing. Multiple vaccinated family members positive. Multiple bridge group members positive. Multiple church members positive, etc etc. And lately – socials around the July 4th weekend were also clustered. At that point in time – there was no one sick enough to be in the hospital. But the vaccinated positives were clearly more ill than the unvaccinated positives. Heavier coughs, more SOB, more febrile. This included even the younger ones among them. But again – no one sick enough to be hospitalized.
And then – this week – we have had a seismic shift. We have admitted multiple very ill vaccinated patients – two of which were critically ill. At the same time – we are admitting unvaccinated patients as well. Some of them too are now very ill. We have had deaths this week – all of those patients were unvaccinated. But I am not holding my breath – we now have two critically ill vaccinated patients that I am not sure are going to make it. I do not have the best handle on these situations this week because I am in quarantine. But right at this minute – we have more COVID patients in the hospital since January – and it is right at 50/50 vaccinated/unvaccinated – and I would say they are equally ill.
It has been fascinating to watch this very orderly step up in severity over time. And then this week the bottom dropped out. And I live in a very vaccinated county – the paper reported this AM a 72% vaccination rate. The only stragglers were the 12-18 group which is below 50. The “herd immunity” concept is certainly not working here. And the local medical folks are just horrified that this is getting this bad after working so hard for this really good vaccination rate. It is reminding me greatly of the ramp up we had last summer – it is almost the same in every way – except it got much worse much quicker. I am hoping it will burn out – but not looking like that so far.
I will share something else. I have a very small limited patient size – I am in a small town. But I am very attentive to media reports of numbers from other locations. Big cities and big sample sizes give perspective. When I heard last weekend that there were ZERO vaccinated patients in the hospitals in LA – I grew immediately concerned – because that was not our experience at all – It is basically a WHAT HAVE WE DONE WRONG MOMENT….So I called three of my old students who are now on the front lines in the LA area – to the one – the response was “I have not a clue what they are talking about – that is just not true…”. Among the three of them the averages they were seeing were about 75% – 85% unvaccinated in the hospital – and all had had very ill vaccinated patients. I did not feel so bad then. But My God, the media cannot be trusted with a single god-damn thing. I have never seen such a bunch of liars in my lifetime. It is a real tragedy – when we need them the most they are doing propaganda. And do not even get me started on the Health Dept people who are misleading the population like this.
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