Most Republican voters don't vote for Republican candidates or policies. They vote *against* imaginary Democrats, who they are told multiple times a day, every day, hate America & want it to be destroyed. These people, in other words.
Tuesday, July 06, 2021
Saturday, June 19, 2021
It's not over
Remarkably effective vaccines that prevent serious illness and death from Covid have been available to all Americans since April 16, two months ago. First shot + second shot + 2 weeks for the body to develop full immunity = 6 weeks.
Those spreading false Information about the vaccine, causing people to be afraid to protect themselves against a deadly virus are going to be responsible for almost all of the deaths from Covid from here on.
I only say "almost all" instead of all because no vaccine ever made is perfect. And people who are severely immune compromised may not to be able to make a sufficient immune response even when vaccinated.
Although he death rate has plummeted since the vaccines became available, there are still hundreds of Americans – wives, fathers, daughters, brothers, best friends, neighbors – dying every day from Covid. Except for a literal handful of the immune compromised, all were unvaccinated and all of their deaths did not have to happen, all of their deaths were preventable.
But this is what we'll be seeing for some time:
Manatee County, in the Tampa suburb of Bradenton, Florida –
"On Monday, June 18, 2021, more than two months after the vaccine became available to everyone, one of four IT staffers, who had been hospitalized with COVID-19 died, according to County Administrator Scott Hopes. A fifth IT staffer who went to the doctor on Wednesday, died at home Thursday from COVID-19.
The one staffer in the department who worked closely with the other five, but who did not contract the coronavirus, was vaccinated.
'These were not elderly employees,' Hopes said. Both staffer who died, a man and a woman, were in their 50's. Those who were hospitalized were as young as their late 30's, according to Hopes, causing him concern that we could be seeing one of the stronger variants in these cases."
06/18/21—The Manatee County Administration Building is closed until Monday after several people reportedly contracted COVID-19. Several weeks ago the county commission voted to lift the mask requirements inside the building
Monday, June 14, 2021
Dr Bob Wachter
Bob Wachter reports, June 13, 2021
I know everybody’s sick of playing 3-dimensional Covid chess. Sorry, but the Delta variant forces us back to the chess board. Ergo, this.
If you’re fully vaxxed, I wouldn’t be too worried, especially if you’re in a highly vaxxed region.
If you’re not vaccinated: I’d be afraid. Maybe even very afraid.
Why? Let’s start with the things that we know about the current situation, then layer in new information about the Delta (aka, Indian) variant, B.1.617.2 Then we’ll end with what I’d suggest you, and we, do.
Current U.S. situation is good. Cases, hospitalizations, & deaths are falling fast, largely due to our fabulous vaccines. In San Francisco, with 70% of people over age 12 fully vaccinated – we’re nearly in a post-Covid world. Everybody’s opening up, including (on Tues) California. That’s fine…for now.
Sadly, about 50% of the U.S. (older than age 12) remains unvaccinated, and in certain states (mostly southern), it’s more like 2/3rds are unvaccinated. We know that a small number of vaccinated people will get breakthrough infections, but they’ll rarely get very sick and will almost never die of Covid.
washingtonpost.com/opinions/2021/…
Unvaccinated people remain at high risk of getting Covid... if they’re exposed to it. In April, I argued that this is the most dangerous time for unvaccinated people (without prior Covid), since their bodies are no better at fighting the virus than they were in 2019, and the virus they’re likely to come in contact with (back then, it was Alpha [UK] variant) is better at infecting people. But unvaccinated folks had 2 advantages: 1) they tend to be younger, so less likely to get sick, and 2) they were less likely to be exposed to virus since community rates had fallen so much (due to kindness of vaccinated strangers). This remains true, which is why unvaccinated folks may do OK for a while, probably through summer.
But fall/winter now scares me a lot, much more than it did 2 weeks ago.
Reason: Delta.
From the start, we said the 3 things to know about variants are: a) are they more infectious? b) are they more serious? (ie, are you likelier to get very sick) and are they vaccine (or prior Covid-based immunity) resistant? Alpha was about 40% more infectious.
There’s still debate over whether Alpha is more serious (some studies say yes, others no). But there’s no question that the vaccines (at least the 3 approved in the U.S.) work just fine against it. This meant that – even though it became the dominant virus in Israel, the UK & now the U.S. (here, it’s 69% of current cases covid.cdc.gov/covid-data-tra…), relatively high vaccination rates in these countries prevented it from becoming much of a problem (although unvaccinated people ARE at higher risk of catching it and dying).
CDC’s home for COVID-19 data. Visualizations, graphs, and data in one easy-to-use website.
https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Why is Delta scarier? First, it appears to be even more infectious than the Alpha variant, probably by a similar amount (~40% more infectious than Alpha.)(h/t @EricTopol for @BBC table below) This means the same exposure that a person might have had last year is now about twice as likely to result in Covid. Second, it's looking like it is more serious, though we need more data to be sure. Third – and this is the big one – it does appear to be somewhat immune resistant. Before getting too freaked out about this, it’s worth noting that the data are reassuring, in a way: the efficacy of 2-doses of Pfizer is 88%, only a smidge lower than the 95% we’re used to, and still great.
Vaccines highly effective against B.1.617.2 variant after 2 doses
https://www.gov.uk/government/news/vaccines-highly-effective-against-b-1-617-2-variant-after-2-doses
But the first dose data is concerning. Normally, a few weeks after dose 1, you’re about 80% protected (this was the argument for delaying 2nd doses when jabs were scarce). But for Delta, Pfizer dose 1 is only ~33% protective. gov.uk/government/new… This creates 2 problems: 1) People stay vulnerable until after shot 2 (& many let guard down earlier); 2) Loss in efficacy for dose 1 points to some degree of vaccine/immune escape. And – though this isn’t proven – I’d worry that a fully vaccinated elder, or someone whose immunity stems from an infection >12 months ago, won’t be sufficiently protected over time, if immunity falls below a threshold needed to thwart Delta.
Delta variant makes up 6% of US COVID-19 cases
https://www.cidrap.umn.edu/news-perspective/2021/06/delta-variant-makes-6-us-covid-19-cases
What to do? For a vaccinated person, watch the Delta % in your region (currently ~6% in the U.S. & rising) & Covid cases in your community. cidrap.umn.edu/news-perspecti… If you’re seeing more cases & more Delta, I’d restore some precautions (esp. if you're high risk) – at least indoor mask wearing (if you’ve stopped; BTW, I haven’t) in places w/ unvaxxed/unmasked folks.
If you’re unvaxxed, get your shots! You may be reassured by a low a local case rate , but don’t be: it may be due to summer plus the still-low Delta fraction. Both will change.
As you can see, Delta has made me nervous: I’ll now bet we’ll see significant (incl. many hospitalizations/deaths) surges this fall in low-vaccine populations due to combo of seasonality, Delta’s nastiness, & “back to normal” behavior. If you’re unvaxxed, you’ve made a bet that Covid is yesterday's news, & that now seems like an awful bet. Moreover, I worry that a right-leaning Governor who opened up early & proudly (& has gotten away with it so far) will be stubbornly unwilling to reverse course, even in the face of surging cases & deaths.
And there’s the matter of timing. If your strategy was “I’ll consider a shot if I see an uptick in cases,” that’s also a loser, since once a surge begins, you won’t be well protected against Delta for 4-6 weeks after shot #1. By that time, you may be very sick, or dead.
Is the threat real? UK has been a step ahead of U.S. on vaccinations, & cases/deaths have fallen faster in UK than in U.S. But look at recent UK case # s – they’ve doubled in past 2 wks, as Delta became dominant strain (now 91% of UK cases). Reassuringly, deaths remain low since unvaxxed are mostly younger & less likely to get sick. But don’t be surprised if we see upticks in hospitalizations/deaths, esp. if Delta proves to be more serious (it’s looking that way), and if it begins to dodge immunity in those with low or waning protection.
We’ve been lulled by the amazing efficacy of the vaccines & by fact that prior variants haven’t been all that nasty (esp. w/ regard to immune escape). Delta should ring the alarm & spur action. We need FDA to fully authorize our vaccines, to step up research on boosters, & faster approvals for kids. We also need > outreach to unvaxxed (incl. info on Delta) & vaccine mandates in risky settings (healthcare, nursing homes).
For me, Delta adds to my resolve to keep mask on indoors when unvaxxed/unmasked people may be around. And I'm getting psychologically prepped for some restrictions to return in fall (tho highly vaxxed places like SF will likely do fine). Nobody wants that, but the virus doesn’t care what we want.
Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF). In 2021-22, the Department was ranked the best internal medicine department in the nation by U.S. News & World Report. Wachter is author of 300 articles and 6 books. He is past president of the Society of Hospital Medicine and past chair of the American Board of Internal Medicine. He has written two books on safety and quality, including Understanding Patient Safety, the world’s top selling safety primer. In 2004, he received the John M. Eisenberg Award, the nation’s top honor in patient safety. Thirteen times, Modern Healthcare magazine has ranked him as one of the 50 most influential physician-executives in the U.S.; he was #1 on the list in 2015. He is a Master of the American College of Physicians and an elected member of the National Academy of Medicine. In 2020-21, his tweets on Covid-19 were viewed over 200 million times by 170,000 followers and served as a trusted source of information on the clinical, public health, and policy issues surrounding the pandemic.
Thursday, July 09, 2020
Comet NEOWISE - July 2020
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| Exeter, England |
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| North window, Arches NP |
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| Austria, Bregenz Forest |
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| Calgary, Alberta, CA |
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| Spicheren, France Can you find it? Another spectacular photo showing the comet's two tails by the same photographer, Sebastian Voltmer, at this link. |
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| From the International Space Station above noctilucent clouds |
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| Lebanon Chosen as Astronomy Picture of the Day |
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| Near near Flagstaff, AZ |
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| Paris, France |
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| Sonoma County, CA |
Tuesday, February 04, 2020
Coyote and badger
tw-align-center>
A coyote and a badger use a culvert as a wildlife crossing to pass under a busy California highway together. Coyotes and badgers are known to hunt together.— Russ McSpadden (@PeccaryNotPig) February 4, 2020
🎥Peninsula Open Space Trust pic.twitter.com/oS9BL5JOoK
Wednesday, January 01, 2020
"continue" by Maya Angelou
Maya Angelou wrote this poem as a birthday gift. When you wish
someone happy birthday, you are marking another year, another trip around the
sun, and wishing that the next orbit will be filled with health and happiness
and goodness. It rings true to me as a way to ponder the meaning of our next
trip around the sun that begins today, the New Year of our calendars rather
than our birth day.
“continue”
– by Maya Angelou
On the day of your birth
The Creator filled
countless storehouses and
stockings
With rich ointments
Luscious tapestries
And antique coins of
incredible value
Jewels worthy of a queen’s dowry
They were set aside
for your use
Alone
Armed with faith and hope
And without knowing
of the wealth which awaited
You broke through
dense walls
of poverty
And loosed the chains of ignorance which
threatened to cripple
you so that you
could walk
A Free Woman
Into a world which
needed you
My wish for you
Is that you continue
Continue
To be who and how you are
To astonish a mean
world
With your acts of
kindness
Continue
To allow humor to lighten the burden
of your tender heart
Continue
In a society dark with cruelty
To let the people
hear the grandeur
Of God in the peals
of your laughter
Continue
To let your eloquence
Elevate the people to
heights
They had only
imagined
Continue
To remind the people that
Each is as good as
the other
And that no one is
beneath
Nor above you
Continue
To remember your own young years
And look with favor
upon the lost
And the least and the
lonely
Continue
To put the mantel of your protection
Around the bodies of
The young and
defenseless
Continue
To take the hand of the despised
And diseased and walk
proudly with them
In the high street
Some might see you
and
Be encouraged to do
likewise
Continue
To plant a public kiss of concern
On the cheek of the
sick
And the aged and
infirm
And count that as a
Natural action to be
expected
Continue
To let gratitude be the pillow
Upon which you kneel
to
Say your nightly
prayer
And let faith be the
bridge
You build to overcome
evil
And welcome good
Continue
To ignore no vision
Which comes to
enlarge your range
And increase your
spirit
Continue
To dare to love deeply
And risk everything
For the good thing
Continue
To float
Happily in the sea of
infinite substance
Which set aside
riches for you
Before you had a name
Continue
And by doing so
You and your work
Will be able to
continue
Eternally
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