The Downslope of the Omicron Surge, and What to Do as We Turn the Corner
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- Опубликовано: 6 июл 2024
- In this Covid Grand Rounds, we’ll begin with a George Rutherford update on the state of the pandemic - are we truly leaving the January Omicron surge? Is there any indication of backsliding? Should we be concerned about the Omicron sub-variant BA.2?
Following that, we’ll add Sarah Doernberg and Peter Chin-Hong to the conversation, posing a number of scenarios and soliciting their recommendations about masking, testing, boosters, and therapies. For example, if cases continue to fall, do I need to mask in the supermarket? Do kids need to mask in schools? How should I use home antigen testing? Does a person with two mRNA shots and a breakthrough infection still need a booster? Does anybody need a fourth shot? And which outpatients should get Paxlovid? Monoclonal antibodies? Remdesivir? And are any of them available?
Speakers:
George Rutherford, MD, Professor, Dept. of Epidemiology & Biostatistics; Director of the Prevention and Public Health Group
Peter Chin-Hong, MD, Professor of Medicine, Division of Infectious Diseases at UCSF Health
Sarah Doernberg, MD, Associate Professor, Division of Infectious Diseases at UCSF Health; Medical Director, Adult Antimicrobial Stewardship at UCSF Medical Center
Note: Closed captions will be available within 48-72 hours after posting.
Program
Bob Wachter: Introduction
00:03:55-00:14:07 - George Rutherford, MD (Professor, Dept. of Epidemiology & Biostatistics; Director of the Prevention and Public Health Group)
00:14:07-01:01:52 - Panel Discussion with Peter Chin-Hong, MD (Professor of Medicine, Division of Infectious Diseases at UCSF Health), Sarah Doernberg, MD (Associate Professor, Division of Infectious Diseases at UCSF Health; Medical Director, Adult Antimicrobial Stewardship at UCSF Medical Center)
Bob Wachter: Closing
See previous Medical Grand Rounds:
• January 27: Rebuilding What We've Lost in Covid: A Perspective from the ICU
• Rebuilding What We've ...
• January 20: The Revolution in Continuous Glucose Monitoring for Diabetes
• The Revolution in Cont...
• January 13: The Omicron Whirlwind: A Conversation with Eric Topol - The Current and Future State of the Pandemic
• The Omicron Whirlwind:...
• January 6: Confronting Racism Denial: Naming Racism and Moving to Action
• Confronting Racism Den...
See all UCSF Covid-19 grand rounds, which have been viewed over 3M times, here: medicine.ucsf.edu/covid-19-ne...
Thanks for doing these. I look forward to each of them!
Poor Bob wants this to be over so bad.🤣Great talk. Thanks.
We all do, I wish more could help make that happen. More masks, more social distancing, more vaccination, all the stuff we needed from the beginning.
I would like to know the opinion of the panel regarding how the UK and Denmark have managed the Omicron wave; both having peak infections and now dropping all measures !! These are opposing sides in the management of society.
Seems more like a non-strategy of conceding to the virus and sacrificing the vulnerable.
My largest worry is the affect of perpetual vaccines on our natural immune systems adaptability long term
No reason why it should be any different to repeated challenge by infection.
@@jimgraham6722 Care to tell us what exactly is mRNA??? Or the other mystery ingredients in these clot-shots?????
@@Lp78Ch ruclips.net/video/WOvvyqJ-vwo/видео.html
@@fremont111 Please don't insult my intelligence.
@@Lp78Ch you asked, i provided. a quick google will give you a plethora of videos to watch.
Even if there was a good supply of Paxlovid, how long would it likely be before some resistance set in?
UCSF: THANK YOU for your work - on this ongoing American and worldwide health disaster. Yes we are all exhausted.
Dr. Wachter out on a LONG limb of optimism about future predictions as to disease based on current models and mutation history.
1:25 “Collective sigh of exhaustion” sounds about right
35:31 I don't think it's very practical to try to portend what conditions will be like on March 7th.
I think it's a lot more practical to use periods of lower transmission to focus on getting a larger percentage of the population boosted, creating a stock pile of rapid tests, getting comfortable N95s to those who want them and creating a broader network of sewage surveillance so people can make the right decisions at the right time in their local communities should there be more immune evasive variants in the future.
We also need to seriously invest in better air quality in mass transit systems to limit airborne transmission. Make the air in buses, subways, trains, and airports clean, filtered, and inhospitable to airborne pathogens.
I agree with your themes of monitoring and preparing. However, the optimist in me and present trends do suggest that we will be past the worst of CoVId as we currently know it before the end of March in most of the US.
Monitoring can be be made fairly.inobtrusive, strategically implemented PCR of sewerage and air filter pads as well as a cadre of randomly selected volunteers to act as sentinels.
Boosted? Against what? Boosts don't stop Omicron. Nothing does. May as well give normal saline as a "boost"!
Pfizer loves them tho...great for their bottom line!
Please. Enough with the obsession with this virus. It's not smallpox or ebola. It's not even diptheria.
Go back to living like normal humans again!
Can you give a reason that Texas and Florida have a faster downturn of the virus even though they didn't follow our restrictions?
Sure; they don't in all areas of the state. Plenty of folks are dying in both states. But if all of your pals have already been infected, there are fewer people, going forward, to infect again. At least until another variant emerges. This is a marriage of simple math and virology.
Why not touch on the fact of how states who did things so different than California ended up with similar curves?
What states did you have in mind? Let's take CA and TX, for example. CA has the highest number of deaths in the US and TX is second. Similar death numbers overall (81k) but very different in terms of per 1M population. CA is #38/50.
Thank you
Confirmed community PCR cases, case numbers of hospitalization, ventilatory assistance, and death are all useful metrics for immunosuppressed populations in order to help gauge risk when out in public and in healthcare settings - particularly moving forward as infection mitigating protocols and mandates are beginning to fall away at state/local levels. In the same way that I rely on regular review of CDC influenza data and maps each fall/winter as one metric to guide travel/self-protective measures during those months, knowing how much COVID disease is present in any given community/state is critical for those of my cohort if we are ever to regain more fluid movement within our communities and throughout our country.
Quick question: What is the death rate from Omicron and how does that compare to the common cold or flu? Kaiser found 1 death out of 52,000 patients with Omicron.....
The death rate isn’t the only thing to look at though, long haul Covid from Omicron does exist. Some get blood clots, some have respiratory side effects that make it hard to breath, loss of senses can affect ability to eat, brain fog, etc.
DR Omicron about .2%, vs about .8% for Delta at its peak. It is still around 3 times that of seasonal flu where annual vaccination of vulnerable groups helps keep serious complications at bay.
You will not be able to find any reliable data on that, because the denominator (how many people are truly infected with Omicron) will never be clear. Lots of people get it, but don't get tested. Many people with those at-home tests stay home.
What about early treatment?
These boneheads will never mention early treatment. They still live in March 2020.
Paxlovid is clearly discussed. Rewatch the video, and you will hear how early treatment with Paxlovid makes a difference in outcomes.
Thanks for making this video! These videos have been a great public service!
Very interesting. I have had 3 full Moderna shots, and ended up with heart damage after the 3rd. I am immunocompromised and not able to get more Covid vaccinations and would love to see you covering what else I can do to boost my immune system in the meantime.
Vitamin D 6,000 IU per day, along with zinc and quercetin
@@Lp78Ch this, plus C, is what I took when I had covid.
I'm also curious about hesperidin. One study demonstrated a 14.5% reduction in symptoms.
You need to detox from the toxins in the shots. Glutathione is the key - studied since 1970 for immunity repair, immune booster and viral protection. There are toxins in the shots and glutathione will detoxify your body as well. We were poisoned years ago intentionally and we had all the same problems. We healed with glutathione, fish oil, fermented olive oil, sauna therapy and alkaline water (your body will be artificially allergic to gluten, wheat and dairy for a while till you detox). See our youtube channel on toxicity testing, and links to doctor protocols (Dr Horowitz) and links to recommended glutathione brands. ruclips.net/channel/UCjMnQQI5Hv5DgROJF5E5hXQ
An issue selldom discussed is the importance of beeing in good basic physiological shape, e.g. BMI, weight, blood pressure, blood sugar, minimize low level inflamations, etc.
To my understanding this has a big impact on severety and mortality.
Yes we have vaccines, masks, isolation, but we don’t have any medical prevention even though it’s been 2 years now. Why not?
Rewatch this presentation. They went fast, but they did cover it. Mask, distance, test your buddies, and avoid high risk situations. Isolate from your infected family.
@@Cathy-xi8cb I meant medical intervention. Like something that stops you from being sick, or if you do get sick makes you better. Obviously the methods you reiterate haven’t been working well . Promising stuff like VitD.& The I word have been debunked, (instead of researched)but no alternative is available. They’ve let us down ithink
@@barryth Sorry; there isn't any perfect prevention for ANY virus so far. They all have some degree of escape. Flu vaccines have been around for decades, and are less effective than the COVID vaccines. Wait for Paxlovid in your CVS this summer, but there isn't anything that is failsafe. That stuff only happens in the movies. In the real world, people die or become disabled all the time and there are no cures for an amazing list of things. What has been done in 2 years is nothing but a miracle. We have never seen anything as effective as the vaccines and Paxlovid created this fast.
I love these talks. I've watched many. I find it so interesting that I'm starting to see some cracks of daylight between the presenters. Months ago, they were lockstep in their opinions. This is not 100% so anymore. Regardless, this sort of information helps inform my thinking about how I live a healthy life during a pandemic.
Rats are fleeing the sinking ship.
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What kinds of investments do you make. I totally agree with you. I have a lump sum right now doing next to nothing in a savings account. but it's hard for me to take part in the market right now due to the fulltime nature of my job. it will be way to stressful to combine so I don't even think about-facing it
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What is the mortality/admission rate of unvaccinated, recovered people vs fully(3) vaccinated? Omicron has an infection rate that appears not to be able to be controlled, by the control measures hitherto tried.
Excellent presentation
About 36 minutes in, a relatively young 53-year old fully boosted and seemingly healthy man is unable to overcome his psychological fear of unmasking, as he waves around a surgical mask (not an n95) that might, MIGHT, reduce transmission by 10-15%, based on one of the stronger studies out of Bangladesh.
Dear folks, you're going to have to overcome the psychological hurdle of covid at some point.
In other words, grow a pair.
The Bangladesh study didn't publish absolute risk reduction. There were 20 fewer cases in the surgically masked vs. non-masked groups (out of over 200k people). And the study can't attribute that minuscule effect to mask use. It may have been a difference in social distancing.
@@hmbdata and it's still the best study we have to date.
@@nostyle126 That and the Danish experiment which lacked the power to detect a significant effect. The other 11 or so experiments on masks and flu also show no evidence for effects of masks.
@@hmbdata yup.
Why is REMDESEVIR so hard in view of many being able to get IV ASCESS ?
Because it has to be delivered on three consecutive days requiring 7-day facility operation, with nursing supervision, and insurance covers it, not the government. it is over 2K per 3-day treatment. In comparison, that nurse could be seeing a lot of people in the hospital in the ER, two folks in the ICU, etc. And all that money could be going to someone with cancer or heart disease instead of someone who decided that the vaccine might kill their gonads.
One thing seems clear from the discussion: The influence of wealth and power centers doesn’t exist. 🙄
Spending significant taxpayer money on eg real upgrades to schools’ HVAC systems can’t be contemplated. Masks on kids all day can be, never mind contemplating whether they touch inside or around them and maintain effective fit for hours on end. Imposing regulation on business? Unimaginable. Scaring workers with accurate info on airborne route and what factors increase the chance and rapidity that a relatively catastrophic variant might emerge? Antiviral resistance? That’s a no-no. Why is the Pfizer drug going to roll out slowly? If it’s because in critical part that the limiting ingredients are located in China with whom we need to provoke and threaten so the populace won’t revolt against “defense and security” spending? We know not to talk about that!
Interesting to contrast your panelists timidity with the stance taken by scientists in Denmark. Praying for your panelists.
More like praying for Denmark.
@@SonofGalahad The Baltic Canary.
Dr Dorenberg’s thought that she will blindly follow public health as a trained physician with skills to evaluate her own family’s risk is the reason why California has been one of the most locked down areas in the USA without any benefit in terms of COVID hospitalizations or deaths compared to less locked down areas.
Hello? Florida moved on like a year ago. Hello? Anyone home?
Was just there. You folks are still dying. And not the old ones. The airport had IT issues because so many people were out sick. Sad.
Don't tell me it can be worse!!!
There’s a major confound: People infected but not reported (for lots of reasons). So “trends” are important, not “individual cases”. Ummm… Not trends that are based on total number of infections/cases. Pretty cloudy communication there, seems to me.
Not intending to sound so critical. Appreciate the data and perspectives from these smart people. Just thought we may wish to specify which kinds of trends are suggestive of what. And I heard, eg “hospitalization”, which as a superficial/general label sounds sensible. But it seems that I heard the idea used often and (I think on first listen) at least somewhat confusing.
Thanks for this! I’m a medical journal editor and science writer. Masters in social science.
agree with Reynolds
What do you think about masks outside for little ones who can’t be vaccinated yet. Let’s say a 3 year old male playing at a playground around kids where we don’t know vaccination status or safety overall of the kids or parents.
Kids are not affected by Omicron at all. Why are you worried??
@@Lp78Ch everyone could be. There’s no such thing as complete immunity.
@@amberj3941 Take some Vitamin D, zinc, and quercetin and you're all good to go against Omicron.
Amber; a very young child cannot distance themselves, but they are able to wear a mask for up-close fun outside and inside. My preschool patients aren't getting infected very often or getting very sick when they do become infected. None of them are masking outside. The child's health conditions, and those of the people they interact with at home and with extended family, will inform your decision to mask outside or not.
Cats!
Why is this miracle drug supply "constrained"? Couldn't the mighty U.S.A. simply do whatever it takes to ramp up production in a matter of days? Could the mighty U.S.A. not simply nationalize the means of production of this miracle substance? In the absense of any such normally expected official emergency response, it's hard to take seriously official emergency proclamations. Emergency? What emergency?
Paxlovid can't be cooked up easily. Sorry. It isn't Tylenol. Just like you can't make a good cake in an Instant Pot, you can't make a lifesaving new drug just anywhere, with anything. If you can avoid becoming infected in the next 6 months or so, using the same masking and distancing you have been doing for 2 years, you have a fair chance of getting hold of Paxlovid then.
@@Cathy-xi8cb I love your sensible and informative comments. They're a breath of fresh air.
I learned this morning of progress with the two new protein-based vaccines, Novavax and Corbevax. No connection to mRNA technology --- and sounds like either will be DYNAMITE for some of the huge numbers of unvaccinated folks in Africa et alia. Hoping to hear comments from the panel today regarding the annoying cat-fight that is going on RE: "Natural immunity is better than Vaccine-Induced immunity".
Natural immunity is "better" than vaccine induced immunity.... better at what?
I believe an old video here stated that vaccination was more protective than natural infection. Natural infection was providing protection for about 3 months but VAX was closer to 6-8mo. Also the risk of natural infection of course.
@@amberj3941 That has changed. I watched a few vids that published the studies that natural infection is actually better that vaccines. The effacy of the vaccine wanes much faster than infection.
@@lolaz1936 I'm not a science major, but even I knew that. Vaccines can only mimic what our natural immune system does.
@@Lp78Ch Agree. However, the CDC doesn't seem to acknowledge that fact. Therefore the general public doesn't want to accept it. Very sad.
This video is SO frustrating! 1/2 way through and the data isn't there. There are SO many more informative videos out there that give much more thorough data. Sad, when I as a Joe Shmoe, know more. Not worth watching the rest.
Kids under 5? R u serious? Ridiculous. Insult to common sense. C'mon man.
With omicron here it is its own vaccine so the sooner you get omicron the better.
When God brings you the plagues there is nothing you can do! Except stop thinking you know anything outside his will and laws of nature!
God heals and man runs around like aimless ants mass killing! Everyone must be ready for the new reset!
Scamicron
Omicron is not the end. As we speak…new variants are growing in unvaccinated corners of the globe.
New variants are growing everywhere, including all the 95% vaccinated corners of the globe. These are non-sterilizing vaccines, which means you can still spread the disease even after 3 jabs.
@@Lp78Ch But less so in vaccinated people.
@@toby9999 There is absolutely no proof for that. In fact, it is quite possible the the vaccines are making things worse.
Stop waving your arms.
Makes the whole presentation unwatchable.
All of this micromanagement is just nonsense. It is long past time to lift all mandates and restrictions.
Fine as long as you take full responsibility for the consequences including financial economic impact.
@@jimgraham6722 Kaiser Permanente data reveal that only 26.6% of the Omicron cases in California comes from vaccine-free people. Maybe all those fully-vaccinated idiots should pay for their adverse events???
You are hurting mankind for your opinions and God gave you Omicron to clean it up and let his PEOPLE go!