The New “Endemic Phase” and a Vaccine Update
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- Опубликовано: 2 мар 2022
- In this Covid Grand Rounds, we’ll begin with a pandemic update from Monica Gandhi and Peter Chin-Hong. We’ll discuss the CDC’s new mask guidance, the Omicron sub-variant, infection-related and hybrid immunity, and what it means to enter the “endemic phase.”
In the second segment, Bonnie Maldonado of Stanford University will give us a vaccine update, including the evidence of waning immunity after vaccination, the prospects for a second booster, the state of vaccines for children, and new vaccine candidates, including Omicron-specific boosters. The session will be moderated by Bob Wachter.
Speakers:
Peter Chin-Hong, MD, Professor of Medicine, Division of Infectious Diseases at UCSF Health; Associate Dean for Regional Campuses, UCSF School of Medicine
Monica Gandhi, MD, MPH, Professor of Medicine; Associate Chief of Division of HIV, Infectious Diseases, and Global Medicine at ZSFG; Director of the UCSF-Gladstone Center for AIDS Research; Medical Director of the HIV Clinic, Ward 86, ZSFG
Yvonne Maldonado, MD, Professor and Chief of the Division of Infectious Diseases, Dept. of Pediatrics at Stanford University School of Medicine; Senior Associate Dean for Faculty Development and Diversity at the Stanford School of Medicine
Note: Closed captions will be available within 48-72 hours after posting.
Program
Bob Wachter: Introduction
00:02:46-00:29:43 - Pandemic update with Monica Gandhi (Professor of Medicine; Associate Chief of Division of HIV, Infectious Diseases, and Global Medicine at ZSFG; Director of the UCSF-Gladstone Center for AIDS Research; Medical Director of the HIV Clinic, Ward 86, ZSFG)
and Peter Chin-Hong (Professor of Medicine, Division of Infectious Diseases at UCSF Health; Associate Dean for Regional Campuses, UCSF School of Medicine)
00:29:45-01:03:05 - Vaccine update with Yvonne Maldonado (Professor and Chief of the Division of Infectious Diseases, Dept. of Pediatrics at Stanford University School of Medicine; Senior Associate Dean for Faculty Development and Diversity at the Stanford School of Medicine)
Bob Wachter: Closing
See previous Medical Grand Rounds:
• February 24: Clinical Problem Solving with Lisa Winston
• Clinical Problem Solvi...
• February 10: The 24th Annual Reza Gandjei Memorial Lecture: A Fireside Chat with Megan Ranney
• The 24th Annual Reza G...
• February 3: The Downslope of the Omicron Surge, and What to Do as We Turn the Corner
• The Downslope of the O...
• January 27: Rebuilding What We've Lost in Covid: A Perspective from the ICU
• Rebuilding What We've ...
See all UCSF Covid-19 grand rounds, which have been viewed over 3M times, here: medicine.ucsf.edu/covid-19-ne...
Vaccine effectiveness for 5 to 11 year old children dropped precipitously during the omicron surge. I believe it was 12 percent after 4 weeks. Pitiful efficacy.
Do not let healthy kids near this stuff.
@@MK-ih6wp kk ok
That's exactly what it is, 12% . People don't seem to understand, ALL the high "effecticy" numbers are for a VERY SHORT PERIOD OF TIME!!!
@@MK-ih6wp did you even listen to the video, especially the part around the 1:00 hour mark ?
they made it so weak to avoid peri/myocarditis that they effectively turned it in to mRNA homeopathic rainbow unicorn holy water. But without the magic efficacy.
Why do Germany and Denmark require a different technique for COVID vaccine administration? They require a slight withdrawal of the syringe plunger after needle placement to verify that no blood enters the syringe. They are concerned about the unintentional placement of the needle in a blood vessel prior to injection of the vaccine into the deltoid. Both countries think there is sufficient anatomical variation to make this a small but significant risk, especially in young males whose muscles are more innervated with blood vessels.
Injecting an mrna vac into the bloodstream not only makes it ineffective, but basically poison.
Logic makes one assume that if getting directly into your bloodstream intravenously kills you then even though intramuscular absorbs over a long period of time it's still going to wreak havoc on your body just not instantly
Dr. John Campbell has an informative you tube channel explaining the proper method how to administrator intramuscular injection (covid vaccine) by pulling back the syringe if blood enters the barrel then withdraw and find a new area. Intramuscular is in the muscle not in the blood stream which would be if blood was present in the syringe barrel.
@@carolweinlein6087 you mean nurse John Campbell not a Dr... And he's only after the Fame and money that's why he's so neutral and mostly pro vax is for the algorithms to keep him in the top . Since this crap started he's gotten to well over 20k a month just off of RUclips alone and most people will sell their souls for 1/4 of that so you better believe that his opinion is not his own.
The CDC guidelines do not recommend aspiration for vaccines or toxoids because the proper administration site in the deltoid muscle does not have large veins. Officially, aspiration for those injections is considered obsolete practice... not harmful but pointless.
YT rejects the link for the supporting site at CDC and the University of Connecticut School of Pharmacy has removed their link for "IM Technique Refresher Jan 2021 draft" is broken.
Thank you.
What about everyone over 65-70? Without a doubt they are at variable risk. Shouldn’t we have variable advice?
That is what their doctor is for.
I am in a household of three vulnerable adults - I am 69 years old but in robust health; another is on supplemental oxygen for stage 3 COPD, and another has extensive sequelae to a childhood of prednisone dependence. We are all at significant risk in the analysis and have the same guidelines. All are vaccinated/boosted; all minimize exposure.
There is no debate about what preventive measure is most effective: distance. Once we get beyond fifty feet life is good.
My husband is 70 , Not in perfect health Smokes like a Train!NO 💩💉
Had Omicron last ,No BIG DEAL!
@@flagmichael Or N95 3M or Honeywell be best
You can't predict it. Depends on the variant you get. My FIL had stage 4 cancer and got covid, and he kicked it's ass. He was arguably one of the MOST vulnerable that they talk about...
How will creatinine clearance be checked at a pharmacy before prescribing Paxlovid?
it won't. If you have a medical condition and your doctor thinks you need a blood panel, they order it. You won't be able to swan into CVS and ask for this drug. You need an Rx for a reason. If you are 87, you probably have decreased renal function due to age. You are probably also on a few drugs that are concerning when you wish to take this drug.
@@Cathy-xi8cb does ivm have the same kind of prescribing concerns/restrictions?
Yes!
EVUSHELD IS GD IMPOSSIBLE TO GET. US/HHS/LOCAL CENTERS NEED TO FIGURE THIS OUT. SOME OF US ARE STILL IN LOCK DOWN.
Yes, our government is out of control. I was terminated from O.S.M.H. for not releasing my vaccination status. Now I am 55yrs old with no unemployment insurance, no income, no severance because they said I was terminated with cause. The one lawyer I contacted basically said he didn't want to see me because it's legal. It's been over 3 months since termination and I'm now out of money to live and support my dependant. I'm just now starting to be able to speak out because of the pain they caused me. I'm a highly specialised biomedical engineer that supported all the local hospitals. Vaccination status was never a term for employment when hired. When and if I can find a job in my field of study, what is to prevent them from terminating me in the future. I am a victim of illegal acts by both my governments and employer but, not one to play the victim card. What do you recommend I do not willing to divulge my medical information? P.S. I'm not Typhoid Marry and if I was, I would isolate myself without a mandate!
Try Tennessee. They would love to have you.
I suggest you get vaxxed, protect yourself & others and tell your employer. It’s pretty simple.
@@jamiejones8508 These vaccines are useless now. Negative efficacy against Omicron.
Have you looked into the novovax? It’s protein based like the original vaccines and doesn’t use MRNA. It uses sugar soap sap as an adjuvant and has the whole inactivated virus NOT just the spike protein so is more effective.
I’m so sorry. Missouri, Texas, etc… come. We will take care of ya.
why do they call it a vaccine?
Because it is a vaccine?
Having Pharmacies dispense medicines without a prescription from doctors will be problematic because they don’t have time to go over the list of medications especially in the geriatric population nor will they have the most accurate list .
What medication being dispensed without a Rx ??????
@@janiceperkins4340 my understanding is they are wanting the Pfizer Covid medication to be dispensed by the Pharmacist only .
@@andrewcohen786
Oh, I understand
Do you mean in terms of drug interactions? Many other drugs are sold over-the-counter. I don’t think it’s inherently bad. What are the specific risks in this case?
@@MarcosElMalo2 we aren’t dealing with your average Tylenol or Zyrtec.
Did we know at what tissue temperature did SARS COV2 better replicate?
At TWiV659 at min.29 Christian Drosten indicate very low tissue temperature better to replicate SARS COV2.
May be ,,mask wearing,, increase also mucoseal respiratory temperature, and diminish SARS COV2 replication?
The protein based vaccines like NOVOVAX might be more accepted -with influenza vaccines doses are reduced by only a half from 6 months to 35 months . After 3 years old it is the full dose . It is taken up much more by at risk children .
Great discussion and information. Would like more discussion of other elements that appear to be ‘highly protective’ for individuals and groups. For example Vitamin D at ‘very healthy’ levels seems to be as protective against severe outcomes and perhaps more protective against infection than the vaccines and also more consistently protective across different variants. Further, proper ventilation and humidification with filtration and perhaps UV light is likely to be more universally protective than masking for indoor settings. And, all of those would seem to be more economical and lower risk (ie no myocarditis impacts) than the vaccines.
Wrong on so many counts. D has not been proven to do anything in solid studies. Vaccination has proven to be protective in a ton (watch this video). And no one thinks masking does it all, least of all these docs.
@Cathy, disagree about evidence in favor of Vitamin D. Open to hearing specifics from you that show levels of 50 or higher have shown severe outcomes. And my comment, due to the level of discussion from UCSF professionals - some here, some on other channels and other grand rounds - is to bring a discussion of Vitamin D especially to this forum.
@@markgivens3225 I would refer you to Medscape's roundtable discussion, posted on Dec. 1 2021. All docs, all facts. Benefits are greatest for the folks who are deficient, and the folks who are deficient are generally at-risk people with poor health. Tons of studies. They list them for you. Enjoy.
@Cathy, also perhaps you make inaccurate assumptions about me. I am personally vaxxed and boosted. and continue to seek best current information, from a variety of sources, to make informed Medical care decisions for myself and advise my loved ones. From all of that information spread across 2 years (actually dating to vaccine knowledge circa 2000 and adenovirus vector knowledge circa 2010), it may be that vaccines are ‘the best single slice of Swiss cheese’ but to say they are ‘the best means to prevent severe infection’ does not quite ring true. Open to more discussion and data.
@@Cathy-xi8cb What is your problem? Do you automatically assume everybody is a rabid antivaxxer? You are what's wrong with the current situation we're all stuck in.
re: wanting a cold for immune diversity.... reminded hearing TWIV virologist/immunologist say wrong approach, always exposed to plenty of viruses
Medical authoritarinism is central problem, even worse when married to government authoritarianism. New era upon us!
Didn’t watch the video, did you? The discussion was centered on the loosening of restrictions and returning to normal, which is now beginning. Current events are outpacing your argument and your fear of “medical authoritarianism” is proving to be unfounded.
Thank you for continuing these. Truly a public service.
Amber ¿¿¿¿¿ time short time will prove it all lord only KNOWS .
@@gertstearns6527 - Huh?
I would follow the City of San Francisco (which Monica has been fairly critical of) nearly every time during a pandemic. They have been the model. Also an infection after vaccination is not a "breakthrough," as only one vaccine currently prevents infection. All the rest do not. Instead, they prevent severe disease.
What vaccine prevents infection?
Sorry. That is the medical term for infection after full vaccination: "breakthrough". And these are scientists. They would want to use the correct term.
Generally vaccinations do not prevent infection, eg; Polio and Flu. The only vaccine that I know does prevent infection is the vaccine against HPV.
You must have forgotten the COVID tidal wave that hit San Francisco in August 2021. Delta hit San Francisco harder than most other California cities, but you won't hear anything about it from the good people at UCSF.
They were described as “breakthrough cases” because the initial claim about the vaccines were that they prevented or decreased the risk of even getting the disease… you are correct that very quickly they found out the vaccines do NOT prevent infection, and therefore infection should be expected.
I applaud efforts to make COVID therapies more easily available. But why not equip public health departments to test and treat rather than corporate pharmacies? I ask political influencers to remember the supporting public health is a better long term plan than supporting corporations.
I think the bottleneck is in manpower. The public healthcare people are undoubtedly already overtaxed by the ongoing pandemic.
The government has defunded public health to the point that your idea would not work. And if you have seen videos of the public threatening them, you won't find many that would take a job in public health in the near future.
I don’t think the problem is corporate greed as much as it is ideological bias against public health and govern programs in general. A possible solution is “stealth public health” where the government uses pharmacies to dispense required medicines, just as they did for vaccinations.
Tribunals coming
Omicron isn't 'a little less severe' - it's a lot less severe. Why can't he say it? It is, after all, the truth.
Gee, IDK. All those people dying in the US (over 1K per day) aren't infected with Delta.....
@@Cathy-xi8cb Risk of hospitalization: 40%-80% less than Delta. Risk of death 60% less than Delta. That's a lot less severe in my universe.
Now - how many people are dying of the flu at the same time? What's the matter - you don't know? Or maybe you just don't care.
(COVID data below from googling "covid chart us")
Probably because it was the leading cause of death in the US from January 12 through March 1, with average daily deaths higher than the on-average 1830 Americans who die every day from heart disease, the perennial #1 cause of death around the world. Delta, at its worst around September 20 last year, killed between 2000 and 2100 Americans per day. Omicron peaked above 2670.
Why would that happen? Probably from underestimating it. The Delta peak reached about 160,000 new cases per day (August 29) while omicron peaked over 800,000 per day in mid-January.
What it lacked in virulence it more than made up for in transmissivity.
Absolutely true!
My husband and I both had Omicron 6 weeks ago, neither of us is in Great health, neither one of us had any 💉
Headache slight fever w/body aches, nasal congestion, for 2 day! No Big Deal.😁😎
@@Cathy-xi8cb
The count is WAY OVER INFLATED!
Did you not know, even if you die from a car accident and happen to be positive, it still counts as a virus death!!!!
And if you still don't believe the numbers are inflated, you're beyond hope.😥
Trust in public health is gone for a generation. Maybe 2. Medicine needs to divorce public health. Public health needs to divorce politics and business.
Absolutely Agree!
I'll never trust again.
@@janiceperkins4340 - Why?
@@MK-ih6wp - Smallpox?
Duh, really?
"Collateral damage" from mask wearing, school closures, fear induction as policy etc is spoken casually and is never given a metric. Just the potential
Just the potential to modulate hospitalization rates slightly is traded for catastrophic damage to so many. Never seriously mentioned or calculated. What would you call this dyscalculia (ignoring the larger damage)?
If it is endemic, why are emergency measures, and emergency approvals still in place, Time to move on from this train wreck!
Rubbish
Nuremburg is coming to a "theater near you!"
It sounds like children should wear a cheep cloth mask to only reduce the viral load on their exposure. Is that what Yvonne meant?
Criminals
Love to see Monica! I heard she got “cancelled” for speaking her mind. So sad for UCSF!
???
There's literally hundreds of other things more deadly than this pandemic ever was
Like AIDS.
Pretty sure it is two, not hundreds. Cancer and heart disease.
Yeah like the common cold!
@@physics4290 yeah. Or government mandated immunodeficiency syndrome.
@@physics4290 well let's see cardiovascular disease has killed more annually than the over exaggerated reported numbers for covid and it's been like that for over 40 years then there's the coincidence that we aren't counting the 88,000 people that died from the flu in the us alone annually
Or the 120 give or take a few people that die from car related accidents daily in the us alone
And let's not forget that the method they use for tracking how dangerous covid is is the spreadability metrics meaning if you had covid but died of anything else you are counted as a person that died from covid even if you don't have covid but your paperwork shows that within 8 weeks ago you had copied they still check it on your death certificate and there's only one type of check on the death certificate there's not a thorough explanation or anything it's just yes 📝 the CDC even on their website said that their report is not accurate and does not accurately reflect the amount of people that have died (from) covid and that is merely a vague reference number nothing more nothing less and so because covid spread so easily and pretty much everybody's had it that means that probably 70% of reported cases were people that died from other things and had nothing to do with covid
Let's not forget also the majority of statistics taken from news channels reporting covid deaths were taken from the category of 65 and older which are frail is a Frito-Lay's chip
There was so much wordplay used in this pandemic to trick people into doing things it's ridiculous
And let's not forget that they already did a practice hypothetical on this entire pandemic a few years prior I even have the documents on it I forget the name but I can find it if you care.
They need to fashion better masks =transparent non scary breathable protective voice viable .
I am a therapist with special needs children. I wear excellent well-shaped KF94 masks, and there is no problem with them understanding me at all. I have no issues with my respiration or maintaining a good seal around my face. Kids aren't frightened of me, even the little ones, and they don't need to see my mouth to do treatment. The 3-layer cotton masks with a filter and the "Donald Duck" KN95 masks don't work as well for me with kids all day.
It's just a mask." "It's just six feet." "It's just two weeks." "It's just non essential businesses."" It's just for the useless eaters" "It's just for non essential workers." "It's just for going into bars." "It's just for going to a restaurant" "It's just to keep from overwhelming the hospitals." "It's just to make the cases go down." "It's just to flatten the curve." "It's just a few inmates." "It's just to keep others from getting scared." "It's just for a few more weeks." "It's just a few more months" "It's just for a few more years" "It's just for going into church.” "It's just a small bracelet." "It's just a phone app." "It's just for tracing." It's just for tracking " " It's just more dying people " "It's just for the greater good" "It's just to let others know you're safe to be around." "It's just to let others know who you've been in contact with." "It's just a few more deaths." "It's just for large gatherings" "It's just a few violent protests." "It's just a vaccine." "It's just 2 vaccines" "It's just 3 vaccines" "It's just 4 vaccines" "It's just a little microchip." "It's just a blood test." "It's just a scam." "It's just for medical information." "It's just a vaccination certificate." "It's just like credit cards." "It's just a few places that don't take cash." "It's just so you can travel." "It's just so you can get your driver's license." "It's just so you can vote." "It's just 200,000 more cases" "It's just another 400,000 doses" " It's just more booster shots" "It's just another booster shot" "It's just more variants" " It's just another scientific study" "It's just another injection in your body" "It's just more studies" "It's just to not let people make their own decisions" "It's just for people with underlying causes" "It's just more lies from the CDC" "It's just more lies from the FDA" "It's just more vaccine mandates" "It's just Fauci lieing" "It's just about get the vaccination or lose your job" "It's just the Omicron BA2 variant" "It's just no scientific evidence to back this claim" "It's just until it doesn't become a threat" "It's just time to take out these tyrannical dictators" "It's just (The New World Order.)
this is aging like milk. this ghandi woman doesn’t want the smoke
😙⚰
Everyone should know by now to get your VitD level above 50 60 70 80 ngml...
Or you can just take 6,000 IU every single day. Those vitamin D gummies are yummy. It's like eating gummy bears.
@@Lp78Ch If you taking such high levels of vit D3 then you need ensure you take enough Vitamin K or K2 to prevent/reduce risk of calcfication of veins/artries Me am stepping up my consumption of natto, lady fingers & green veg
For general health? Yes, of course. It’s not going to provide you with special extra protection against Covid-19 beyond what you get from improved health.
@@MarcosElMalo2 You're wrong. There have been many studies that looked at the link between D levels and COVID outcomes. Strong correlation.
Anything above 2000iu a day is overdose and possibly toxic.
BS. all poison.
Education would help you tremendously.
Should I start with the Louis Pastuer theory?
@@flagmichael Education didn't help _you_ at all.
mandates are not law ignore that womans annoying voice
Sorry Monica. I don't want to be intubated by a non-vaccinated nurse when I am so ill or so old that I have a greater vulnerability to severe illness. Losing faith in your ability to see the trees while knowing about the forest.
I appreciate your concerns. I think medical centers could take precautions with unvaccinated healthcare workers and protect vulnerable patients. But I do hear what you are saying.
@@maryjaneburton6055 Actually, at this point only _SERIOUSLY STUPID_ people still think unvaccinated nurses will give them COVID. Cathy is seriously stupid.
I concur. I have an older vulnerable relative & I’m concerned that the UK discourse that covid is no longer an issue & people no longer need to isolate if they have covid will not go well for him or people like him:(
Read the recent Pfizer data its a nightmare.
Fair point.
There is no such thing as "hybrid immunity." Just stop. This is getting stupid.
Sure there is...it's the best immunity possible.
@@GSHAPIROY That is what they say, but that is not what the data shows. The CDC published a paper last month showing that boosters after natural infection did very little to increase protection since natural immunity already gives very good protection from hospitalization (much better than vaccinated only, it showed).
@@GSHAPIROY Shane Crotty made that term up on the fly. It doesn't exist in real life.
@@GSHAPIROY odd thing for a random viewer to say.
@@AN-jw2oe Many of the unvaccinated who were hospitalized in that study had prior undiagnosed natural infection that failed to protect them. We know that testing was poor and that most infections went undiagnosed. There was a slight increase in protection (over vaccination) from hospitalization if the natural infection was so symptomatic that it got diagnosed. The problem is that symptomatic natural infection like that comes with a very increased risk for autoimmune disease. They left that part out! I don't want to make antibodies to 29 viral proteins during a natural infection when I can protect myself by making antibodies to one spike protein in the mRNA vaccine. I'm guessing that is 29x the risk something is going to cross react with my own tissue. No thanks!
Pandemic propaganda.
Putin pawn, be this creep.
It's going spiritual war for human souls. We are in the End Times.
🙏 Turn to the LORD before it's too late. 🙏
Jesus is the only way to GOD and heaven.
Why did dad have 178 million years of dinosaurs as the dominate life form on Earth?
Rubbish
Pretty stunned that you continue to have Monica Gandhi representing your university considering that many well credredentialled peers have come done hard (and rightly so) on her irresponsible statements. I won't be listening to any podcasts in which she participates. You are damaging your credibility by keeping her in the public eye. The damage has been done. If she feels she can rehabilitate herself she should do it on her own-not on your university podcast.
Totally Agree! Gandhi is a total pretender---trading on her immuno-babble---same with Wachter! Throughout the pandemic, both traded in immuno--babble bullshit-both should be fired! Compare them to Dr. Vinay Prasad, or the others are UCSF who spoke up and didn't carry Newsome's and Fauci's water bottles. Horrible people! Hope they are held accountable!
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, *%7። %%%%%*+
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