The Fourth Surge, Vaccines, Boosters, Schools, and More
ฝัง
- เผยแพร่เมื่อ 11 ก.ค. 2024
- Medical Grand Rounds for academic year 2021-22 kicks off with this Covid-19 update. George Rutherford will begin by describing current trends in the fourth surge. The remainder of the session will be a discussion with Rutherford, Monica Gandhi, and Peter Chin-Hong covering all the key issues in the current confusing moment: vaccinations, breakthrough infections, boosters, schools, and more.
Note: Closed captions will be available within 48-72 hours after posting.
Program
Bob Wachter: Introduction
00:03:54-00:16:12 - Current Trends in the Fourth Surge: George Rutherford (Professor, Dept. of Epidemiology & Biostatistics; Director of the Prevention and Public Health Group)
00:16:25-01:04:56 - Panel Discussion with George Rutherford, 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; and Medical Director of the HIV Clinic, Ward 86, ZSFG) and Peter Chin-Hong (Professor of Medicine, Division of Infectious Diseases at UCSF Health; UCSF Health; and Associate Dean for Regional Campuses, UCSF School of Medicine)
Bob Wachter: Closing
See previous Covid-19 Medical Grand Rounds:
• August 12: The Fourth Surge, Delta Variant, Vaccines, Boosters, and More
• The Fourth Surge, Delt...
• June 17: The Delta Variant, and Lessons from the Pandemic (with Andy Slavitt) • The Delta Variant, and...
• June 3: The State of the Pandemic and Strategies to Encourage Vaccination
• The State of the Pande...
• May 20: Roundtable Discussion on New CDC Guidelines, the Current State of the Pandemic, and More • Roundtable Discussion ...
See all UCSF Covid-19 grand rounds, which have been viewed over 2.1M times, here: medicine.ucsf.edu/covid-19-ne...
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Thank you, I received my third dose, my wife is a nurse front line. Thank you for this information. From north Idaho.
Wow! What a great discussion. Open and honest! Please continue to have these discussions and make them available to us lay people.
Wellcome back! I missed these sessions so much!
The candor of this group in context of their deep level of understanding is refreshing. The energy of thought unleashed by this important unsolved problem inspires so many. Thank you.
Do i hear a trini accent?
You have a whole group of folks who were vaccinated with Pfizer at Walgreens which was doing the same 4 week interval for both Pfizer and Moderna shots. You should be able to tell from that group if there is a difference between the different mRNA shots based just upon the interval.
This Forum is excellent
Thank you
Medical Science 🧬
Vital
Very informative. Thanks for letting us listen in.
Excellent info … Thank you for all you do!
I love her! She is the most fair and knowledgeable. Thank you for having a descending opinion. It’s much needed and very rare. I would like to know more about speech development.
Thank you for the great valuable information.
Really great podcast. Thank you for the truthful, clear, & well-articulated information.
Thank you !!
Really good info. Many thanks and may we have continuing updated info like this in the future.
Monica & George are spot-on.
Welcome.... back
Have been following your very informative.... podcast from the beginning of the pandemic . 👏🏾 n thanks for all you guys do.
Theres intetesting talk about the vaccinated now shedding the virus causing spikes. Now all hospitalzation by vaccinated who have CV2 symptoms are recorded they are unvaccinated! There are many breakthrough failures with the jab resulting in many deaths and injuries.
Love these series
Thank you much!
I am so glad you are back
very good….thank you
J
Worth watching, and interesting discussion. As the moderator said, “This virus keeps humbling us.”
Fascination discussion regarding Delta Variant vs other Variants. and they tossed in How to make effective masks better by doubling layers.
It was good to have other points of view regarding how dangerous the Delta
Variant is to everyone. A short discussion on Mu Variant was helpful also.
These kinds of discussions are very good.
Thank you! This was a very informative Ground Rounds! Now I'm starting to think I will probably need a booster since I got the Pfizer vaccine. It's frustrating that the CDC hasn't been following all breakthrough cases in order to understand them better. It's also frustrating that they aren't more open about what data they are getting from the cases they are following. I wish more scientists had emphasized the need to space out the two shots earlier. I was wondering what you thought of the situation in Chile, whose citizens got vaccines from China? Cases there have been very low this summer (which is their winter)? I'm also curious why you mention looking only at Europe and UK's policies? Why don't you look at what is happening in Japan, Korea, Thailand, etc? They have been so much more successful at preventing cases and especially deaths than Europe has. It seems a bit of a subconscious bias, don't you think? I'm in Oaxaca, Mexico and I'd say 99.8% of the people wear masks inside and outside. They even wear them when they're alone in their car! Why not study the effectiveness of mask-wearing by studying the people in Mexico.
The directives change every 24-36 hours
Because it seems western countries only really care what other "western" countries are doing because they unfortunately fail at being able to distinguish the difference between political science and medical science.
What is known about the long term effects of this virus. I'm reminded of how long it took before researchers learned that HPV causes various cancers. When you speak of the effect of Covid for vaccinated individuals being "the sniffles", how can you be so sure that there will not be negative effects that are learned in future? And, why is the research being discussed in the US weeks behind that which is being discussed in Israel and the UK? American exceptionalism at work?
Excellent, as always. My only quibble is some of the speakers talked about the "optics" of boosters when we've done so little to help the rest of the world as important. I don't think the optics are important, I think not doing enough to help poor countries is what's important. I'm okay with having bad optics if boosters are helpful. Meanwhile we should do more to help the world.
To help the world, manufacturers need purchase contracts. Counting on manufacturers to build out capacity without preexisting contracts in place is wishful thinking. The solution is actually more buying from wealthy countries (with intent to donate), not less.
A good discussion as always. I have a question/comment: I received a first shot of AstraZeneca in Thailand end of June 2021, then I flew to Los Angeles and on arrival received a first Phizer dose. For the most of the rest of the world I am considered ‘fully vaccinated’ but from the CDC perspective I require a second Phizer because AstraZeneca is not approved in the USA. I will take the second Phizer to complete the US dosing - perhaps I should just consider the second Phizer as a booster?
I've had covid 2x and had 1 shot, if I was from parts of Europe I'd be considered fully vaxed, but in my home country of America I'm considered selfish and a super spreader. Go figure.
I wish they would advise us WITHOUT taking global concerns into account. Like, just me, an individual person, is there any downside of me getting a booster shot at 48 years old 6-8 months after my initial pfizer shots? And can it be the exact same dosage, exact same shot or is the booster in any way different from the first two shots? I am still unclear on this. I know that whether or not me personally does or does not get a booster shot has ZERO effect on the progression on the disease through 6.7 billion people.
If you are worried about a booster please work on your metabolic health. It not only improves your immune system but helps the booster work better.
He chose (cherry picked) the small study from Kentucky instead of the much larger and better studies from Israel and Cleveland Clinic which showed the opposite. That's bias on display folks. Look at all of them and be curious if they have different outcomes and actually follow the science.
Just listen and learn. The studies you are wanting will be forthcoming.
@@Turtledove2009 Israel is interesting
If the first two didn't work what's "third times the charm"?
With regard to vaccine ‘equity’ I would mention that the US State Dept has completely failed Americans living abroad. US citizens must pay US taxes worldwide no matter where they live - and US Embassy personnel including local staff all received US vaccines at the Embassy but this was not offered, and affirmatively denied, to US citizens living overseas. The French and the Chinese did provide their citizens overseas with vaccines at their Embassies.
America hates their citizens living abroad, I'm sure you have figured that out by now (tax policies, legal requirements, foreign spouses wanting spousal visas, google fi service activation when outside USA even if you are a US citizen, banking, refusing to ship products to well known US mail forwarders, constant problems with streaming services despite having US address and billing account when outside us, the list is very long in support of this). They cannot believe anyone wouldn't live in America "THE GREATEST NATION IN THE WORLD."
Brilliant
Loved it
I have been following this group since the beginning. Why not just use an N95 masks and not bother with cloth and surgical masks?
Cost is $3? Not washable? Not accessible $ for majority of the population. I make a reusable cloth mask with 2 layers of dense quilting cotton fabric sandwiching a polyester non woven fabric. I can tweak it for individual fit and it can be washed. I air dry them to reduce wear. This was suggested by the CDC at the beginning of the pandemic when commercial masks were scarce. Also a cloth mask can be made with a pocket for a filter. The mask can be tailored for individual fit. Filti Company makes the filter material, sold by the yard.
My elderly mother died in Georgia today of covid. She was vaccinated but when there is tons of virus in the community everyone gets sick. I’m afraid there will be more nursing home deaths like hers.
Yes, there will be many fragile elderly who will be infected by their caregivers, unvaccinated and vaccinated. They will not survive. Like with the flu, the vulnerable will be taken by communicable disease as well as their own disease processes. Most of them are aware their days are numbered. Not all of their families realize this. Sorry for your loss. Stay as safe as you can, living in an area where your neighbors aren't much concerned with your safety.
@@Cathy-xi8cb Thanks. I actually live in San Francisco where we do care about our neighbors.
Sorry for your mom and I agree. New virus that we have no immunity to as - it’s new. So vulnerable at high risk (and not neighbours or otherwise; why people argue it protects others is a mystery to me as there’s no evidence for that and even Pfizer states the same on the CDC
-Pfizer Q&A). It is circulating high (it seems). Wish we had community seroprevalence to confirm that. Best to you.
I'm so sorry for your loss.
If that's the case the vaccine is snake oil does nothing to protect you.
Did they talk about natural immunity from infection?
Yes they did.
Spain is already testing an amazing nasal vaccine which will be ready by January 2022. Laboratories: Hipra. Probably the best vaccine by far from all Covid 19 vaccines so far produced.
SUBSCRIBED!!!
My kids are in a school with optional masking, 8 days in and 1/4 of the kids are out for quarantine.
And the kids who are out are symptomatic?
@@JoanDefenbaugh They can't legally tell us that nor who tested positive.
I am so glad masks were talked about in this video . So many just talk about the vaccine which is important but masks are very important also . My neighbor who never wears a mask at work , really never wears a mask at all , has covid now and so does her small son…
And plenty of people who wear masks all the time have gotten covid as well.
Order is probably ventilation, distance then masks... In order of importance. Time in proximity and air changes (ventilation) also plays a factor.
These are the tips of dealing with infectious people with Tuberculosis, for which restrictions are more strict than covid.
Essentially if someone is smoking and you can smell it....you're at risk. If someone was smoking in a store, you'd probably smell it. If someone was smoking in a park, you probably wouldn't. If someone was smoking in a store, but left an hour ago and there's no air changes, the smell would linger. If someone was smoking in a store that had 10 air changes an hour, smell would be gone.
Have you guys covered nitric oxide & providone Iodine as viricidal prophylaxis? 💃🏼
I find it hard to believe that anyone can know where an infection came from for sure. Monica talks about rooms full of vaccinated and unvaccinated people, as if that were very risky. But aren’t the vaccinated people equally able to transmit infection? That is what I have read So why say that there were both vaccinated and unvaccinated people in the room? It’s like saying the room was full of left-handed and right-handed people and claiming that was very risky.
My understanding is that vaccinated people are not equally likely to transmit. The time that the are contagious is shorter as the viral load decreases more quickly. I base this on other talks given by Dr. Ghandi.
Indeed. The unvaxxed cannot produce the virus from the void. So for example if the unvaxxed has negative test, then they should be less danger to others than a vaxxed who does not go through tests. Also we should note that the since the vaxxine prevents hospitalization, an vaxxed infected person may be able to continue daily activities, while an unvaxxed may develop symptoms that other ppl can detect.
AFAIK, there was just one study (which was not peer reviewed) that claimed to show that vaccinated and unvaccinated people are equally likely to transmit the virus. The problem with that study is that it didn't measure transmission, but just compared the PCR cycle threshold (Ct). However, the PCR test does not differentiate between contagious viral particles and small fragments of genetic material from the virus, which cannot infect anyone. So the study did not really show what it claimed to show.
I think we should look closer at the cruise industry where entire ships of vaccinated ppl are in a closed loop environment and are still transmitting the virus. I think testing, although it has it's own issues, is a better way to go for the near-term for risk mitigation on jobs where ppl are in close contact.
@@WeAllNeedWisdom2 what is your stance on the fact that people who have contracted covid can throw false positives for up to 3 months. So if you're only testing the unvaccinated, they are less likely to catch and throw covid than any other group (vaccinated or unvaccinated not recently infected) because they just had it but they're still testing positive due to how high their antibody levels are...should we really rely on testing?
That will result in us quarantining and essentially punishing the people that are in all actuality the SAFEST to be around.
How many surges there will be, and how many boosters before u die? Is there more than a million variants to cope with?
Well the greek alphabet has only 24 letters, so no more than 24
Did you not watch to the end?
What is difference between “vaccine evasion” and “transmissiveness”?
Vaccine evasion refers to viral variants that can cause disease in vaccinated individuals. This is common with HIV vaccines. It may occur with COVID vaccines, but this is not entirely clear. (Recent infections in vaccinated persons may reflect waning immunity more than vaccine evasion.) Transmissiveness refers to how easily the virus moves from one person to another. The delta variant is so transmissible that it has pushed out nearly all the other variants. Once more people are vaccinated or infected, the critical question is if there will be a new variant that can evade the vaccine. Since coronavirus mutates less than some viruses, maybe this will not come to pass. Maybe better vaccines in the near future will be less susceptible to evasion.
@@backwashhouston1174 Thank you much.
Is the issue of vaccination in developing countries as much an issue of patent protection as it is Western greed? Why put the blame on individuals rather than corporations and the politicians supported by them who want to keep these patents churning out money?
How can you TRUST any of these STATICS
You weight the evidence. There is no place for trust in science.
Dr Gandhi, please use a better mic! I can make out only a fraction of what you’re saying
Very helpful content. I personally would like to help some hesitant folks to fear the new technology less by having a better understanding of why ADE concerns are really not likely . I've heard a couple of expositions on this but still found it difficult to absorb and convey as a lay person. It may simply be the deeper nature of the subject of course as I suspect is the case. Thanks for your honest work on our behalf.
A scientifically literate person would NOT confuse positive test results with infection. In order to know if a person is infected you would have to run an infectivity assay. This is the only way to know if the genetic material is from an infectious particle(s). This is basic stuff taught in virology courses worldwide!
3 weeks gap on pfizer vacs? Not enough. I had to waite 3 months!
We were 5 weeks between doses of Pfizer because of the long queue. Maybe this will turn out to be a blessing?
During/prior to my first Pfizer shot, I was on Ibuprofen and Tylenol. Then I read that there may, may be reduced effectiveness of the vaccine if one was on Ibuprofen, Anti-inflammatories, Tylenol. This theory was proposed/suspected as a possibility based on some non-adult data. I haven’t found any follow-up study re this. But, for that reason, I (63 years old) really want a third shot.
That one was debunked a long time ago.
If you have concern about a breakthrough infection causing severe illness or death, that concern is perhaps exaggerated. If you have concern that your risk of a mild breakthrough illness is modestly elevated due to previous use of anti-inflammatory treatment or age, you may be correct. A third injection might provide additional protection, at least short term. Will the FDA approve such an approach?
@@eclairebandersnatch2832 I would like to know the source if you happen to remember. When I did a search for follow-up study, I couldn't find any. Any help you could provide re this would be appreciated.
@@backwashhouston1174 I don't know. In the meantime, I'm still taking extra precautions to prevent/reduce likelihood of exposure. (I'm also concerned re "long COVID" since I'm over 60 and already have a nasty chronic health condition.)
If the unvaccinated are the only people dying and hospitalised presently, can someone make a comparative state to state statistics, taking into account population density and mask protocol say compared to last year. If the numbers are lower or at par (given that we are dealing with 20 fold more infectious vatiant) then we can plausibly look at the Delta as a more infectious and less severe variant. If that is so, maybe, just maybe we can also say that vaccines protect but not entirely the reason.
In France, elementary school age children are masked and run around the playground as they did before Covid. Thank you for the great discussion!
Monica, thank you for speaking fairly and not cherry picking! The other speakers here should take a lesson from you!
She has been one of the few high profile qualified voices of reason during this pandemic.
@@andymullarx6365 I actually think this whole group has been effective and qualified.
People that have solid organ transplants are well aware of their fragile health, regardless of COVID. They were always vulnerable to communicable illnesses. Anyone in a nursing home, or the family of nursing home residents should be aware that needing that level of care means that the next cold infection could result in death. Especially because the medical care in a nursing home is very poor indeed. Their direct care staff don't understand infection control as well as a smart middle school student! (Some of them left school in middle school). Perhaps this pandemic will force more people to understand mortality risk.
Better would be if this pandemic caused us to appreciate the challenges and risks inherent in providing health care and to do a better job honoring and compensating the people who do the work appropriate (instead of referring to them as dimwitted middle school dropouts....)
4rth booster recommended for all who survived 3rd.
can vaccination block virus , NO
can vaccine bring down motality rate , it depends , take extra precaution
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Distracted by George’s beautiful French doors
ModeRNA, the dark horse, for the win 🏆.
India was First SARS COV02
VARIANT D
THEN
UK
progress EU
What studies and trials have the CDC designed and funded in the last year with cloth masks that show the efficacy in preventing COVID-19 ?
None
Please encourage safer at home for anyone needing to wear a mask or get inoculated.
Awful sound folks. Need to improve that audio. By the way, UK is not a model of any kind of success, totally on the contrary. They are the worst in Europe and almost as bad as we are.
Testing, testing, Isolation and Comprehensive Therapys from the Experts. What is needed is Good Leadership with Good Hearts for all Humanity! God 🙏🙏🙏 Bless us all with Loving Kindness and Compassion and Wisdom with Abundance of Things from the Universe to Share and Appreciate for Peace and Harmony 💞!
Dr. Gandhi why aren't you wearing your party dress? Where's the Happy Days Are Here Again song?
Monica is great and very credible as she is honest about what is known and not known. The other panelists need to be more careful about simply reciting unsupported conventional wisdom/liberal dogma. If the audience wanted that they could go to any number of outlets like the NYtimes or NPR.
They're followers for the most part and she operates somewhat independently based in emerging data as opposed to preconceived notions and cronyism. Peer pressure is often attributed to children only even though it's a lifelong factor in many people's lives.
I'm frustrated by airline mask policies. CDC / NIOSH states that N95+ masks with vents are as effective or more at source control than surgical and cloth masks (though not as effective as unvalved N95+ masks, obviously). I want to wear a full face respirator (N100) on a flight this winter, so I talked to United. May I? No, masks with valves are banned. What if I put a surgical mask over the valve? No. What if I tape it so air is forced to pass through the surgical mask? No. What if I wear a surgical mask under my respirator? No.
Seems like madness. Why hasn't the CDC stepped in to standardize *reasonable* mask policies?
I think your mistake was asking. Nobody on earth is going to object to anyone who has double masked a surgical mask over a valved N95. Personally, I wouldn't wear a valved N95 alone, because most people see them as selfishly posing a risk to everyone other than the wearer, and I don't want to contribute to other people's already heightened nerves and anxiety.
@@gferraro8353 No she said N100 - a valved N100 and a valved N95 look basically the same.
Just use a FPP3 (N100) without valve.
@@zedgarden Find me a full face respirator from a reputable manufacturer (like 3M) without a valve.
@@eclairebandersnatch2832 I said "full face respirator". This isn't a reading test.
Full face respirators protect the eyes, prevent face touching, and have a *much* better seal than cloth masks. The large filter elements also make breathing easy when you have to be in it for long periods of time, and the airflow path is unidirectional. Literally the only negative in the books against them is "other peoples' reactions to them". But all around they're a superior disease control measure.
That said, I would love an outflow filtration attachment, to be able to do, say, N100 on inhalation and N95 on exhalation or whatnot. Doesn't appear to exist, though; I've looked. Best I've managed (will try to get it accepted on my next flight) is to put a surgical mask between the facepiece and the valve cover and then snap the valve cover back on over it, sealing the surgical mask in place and forcing air to go through it on the way out. Which is a way better filtration than the way people normally wear surgical masks (where much air flows out through gaps), but that doesn't mean it'll get accepted...
I bet you guys were against Ivermectin right
Of course.
Of course not. It's a great drug.
If you have worms.
@@karenrobertsdottir4101 Lice too, I've read.
Doctors prescribe it to children and babies (only for the treatment of head lice, ringworm and scabies).
Joe Rogan was not double blinded with the river blindness disease, so his experience proves nothing.
Of course most of the AMA crowd is whether or not it works, It's hard to determine if it provides a consistent proven benefit which they won't reach consensus on but it's not a risky drug as the media is suggesting by conflating a small number of overdoses with veterinary Ivermectin versus human Ivermectin taken in proper dosage. They know what they're doing when they use that deceptive technique to demonize the drug altogether even though off-label use of drugs by is part of ordinary procedures by doctors particularly when it's a drug with a long track record as a safe drug as Ivermectin is, Its safety profile is out there to be reviewed by the curious. I don't know if it works but if an MD writes a prescription for it for the treatment of Covid the pharmacist should fill the order and refusal to do so is just political on the pharmacists part. We knew wokeness would infect the professional ranks some years back and we are now seeing a prime example of it with these renegade pharmacists. They are not following the science but are using their privileged position to interfere with the patient doctor relationship for woke motives. SJW's with degrees are just the new reality of the reset.
This comment section aged like 🥛
Vaccinated mother's breast milk as a supplement? Am I onto something or is that idea just nuts.
The theory is reasonable. In practice the effect may be vanishingly small compared to vaccination or antibody injections in part due to the relatively small dose and oral route of administration. Even masking and social distancing may be more effective.
Masks and passports forever. :-(
It’s not about being fair or not fair-this virus doesn’t care. That there are other approaches, yes-question is on their efficacy. Fairness it seems is not particularly relevant.
Too much politics, almost no discussion of science. For example, there are many possible public health measures ( if human rights is not a issue then many many many more). A scientific discussion should be about comparing these possibilities. Things like, according to my calculation, if this is done, then this would happen, if that is done, then that would hAppen, and the reasons are a b c. Instead the whole hour is about, we should do this. But who are “we”?
If you had been following the series and following studies to date, you will be able to follow their discussion.
@@Turtledove2009 l have been following most discussions since January 2020. Also my point is they are scientists, so should talk science instead of public health policies, which is politics.
Hard to follow dr Peter, if you are not an American english speaker. Buț he makes sense fnally, YOU KNOW.
Dr. G. Speaks reason and not that idiotic comment about masks and vaccines. Please. Go deeper than information from a newspaper.
Wake up it's Bio warfare, military op
Sorry , illinformed.
can vaccination block virus , NO
can vaccine bring down motality rate , it depends , take extra precaution
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