Here is a 7th COVID AMA thread.

Before Covid was It recommended to wash one’s hands in soap and water for 20 seconds? Or is it a new thing?

@RedDeerGuy1 Yes. 20 seconds.

Are you seeing many covid patients who had already been vaccinated? If so, is there any general picture, such as how long since vaccination or how high the incidence of other complicating conditions?

What about incidence among healthcare colleagues who had been vaccinated?

And are you starting to get a break yet? I mean some relief and restorative downtime for you personally.

“Are you seeing many covid patients who had already been vaccinated?” None

“What about incidence among healthcare colleagues who had been vaccinated?” A scattered few. Most have been vaccinated

“And are you starting to get a break yet? I mean some relief and restorative downtime for you personally.” Ha! Thanks. Sort of, yes. I’m off service for a month but I’m down at my other house dealing with contractors and home repairs.

If you’ll permit me as a follow-up to this segment, even if not strictly a covid question:

https://www.fluther.com/224586/here-is-a-6th-covid-19-ama/#quip3699847

If someone had been on 2L of O2, 24/7, and went to the hospital with COPD exacerbation (but not covid), would you put him on a BiPAP with 16L even if the sheer force of it seemed to be stressing him past bearing?

@Jeruba Totally depends. If I’m trying to avoid intubation maybe.

Thank you.

@Caravanfan I assume you’ve been vaccinated by now. Have you changed any of your personal pre-vaccination precautions? If you went to a movie theater would you still wear full PPE?

@gorillapaws “Go to a theater?” Buahahahaaaaaaaaaa!!!! (Wipes tears from eyes). No. I’m still as paranoid as usual. I still wear N95 masks everywhere. :-)

@Caravanfan When you are with coworkers away from patients (in a break room for example, or corner of the cafeteria maybe) and all of you are vaccinated, are you back to normal now without masks? Sit at a table and have lunch together? Maybe you were doing that before the vaccines with your work family pod anyway.

When do you think you will feel comfortable not wearing your N95 mask?

Do you avoid all indoor activities even with distancing? Exercise, theatre, restaurants, etc.? For instance my performing arts theater is only 20% occupancy with specific distancing between seats.

There seems to be differing opinions by experts on whether or not you should wait 90 days after contracting covid 19 to get your first vaccination. Do you have an opinion on that?

@JLeslie Nope. Everybody wears masks. I will have lunch with someone without a mask but we sit on opposite corners of the table. I act exactly the same as I did before being vaccinated. I will only relax once the all-clear whistle is blown.

I wear an N95 mask because the behind-the-ear ones irritate my ears. I just find the N95 to be more comfortable despite the tightness.

Exercise: I haven’t been to a gym in a year.
Theater: I haven’t been to a theater in a year
Restaurant: I have done outdoor seating but that’s it.
Museum: Haven’t been to a museum in a year, although I reupped my membership to SFMOMA just to support them.

Now, the one place where I have relaxed a bit is that my band does come over and we play, mask optional. But we play in the garage with the garage door and side door open and we stay 6 feet apart. However, with our recent lockdown I cancelled band practice for a month. Now that it’s better I reinstated it. But my band mates are as careful as I am so I know their exposure is low.

@Caravanfan Weren’t you planning on driving to Nevada in full surgical PPE to watch Dune? Or was it the new Bond film?

@gorillapaws Ha! Good memory. Both. But neither are out yet, and I was kind of being tongue in cheek. It looks like Dune will be released on HBO Max so I can watch it at home.

Do you know what we can expect as more and more people get vaccinated? What I mean: will there be a gradual relaxation of covid practices as more people get vaccinated, or will we need to hang tight until a certain percentage has been vaccinated and only then things can begin to safely relax, or something else?

@sadiesayit As cases continue to drop with increasing vaccination, then we can expect in the coming months for things to open up.

1. What do you do when a designated next-of-kin who is present and is without an AMD (advance medical directive)

• seems unable to make a heathcare decision for the patient?
• makes a heathcare decision for the patient that you think is wrong?

2. What do you do when a designated next-of-kin who is present and is holding an AMD and/or a POA

• makes a heathcare decision for the patient that you think is wrong?
• is plainly drunk, on drugs, or otherwise impaired?

3. What if you just suspect the AMD-holding next-of-kin is on drugs? Say, talking a little off and looking or smelling compromised, and maybe having too-large or too-small pupils? Are you legally bound to act on his or her decisions?

4. What if there are two of them, and they disagree, and time is running out?

I wish I could say this is entirely hypothetical, but it is not.

And

5. Do questions like these come up very often?

6. What legal protections do you and other practitioners have when they do?

@Jeruba Your question is out of the scope of Covid. I recommend you speak with an attorney.

Well, I wasn’t asking for legal advice but rather what you or a practitioner in your position might do under those circumstances, which could well come up in the context of covid. But I understand your hesitancy. Thank you anyway.

@Caravanfan Do you reuse your N95s? If so, how (long) do you store them until they’re safe to use again? I keep hearing conflicting advice.

@Jeruba My sympathies. I really am so sorry you have to go through this. Wish I could give you a hug.

@longgone When I’m doing patient care and I am coming out of a COVID room I generally discard them and get a new one. When I’m doing something like going to the store I will reuse until I think they kind of look grody. I probably should change them more often, but I don’t.

@Jeruba Agreed. I’m sorry, I just don’t feel comfortable with that kind of advice.

It’s all right. I understand. I really was just asking what you do in those circumstances. I haven’t been in them myself, but the question still has meaning to me.

@Jeruba Okay. For all your questions, if we feel poor decisions are being made, then we involve an ethics team.

@Caravanfan Non-covid question…who is usually on an ethics team?

@Jeruba No advice. Just hugs.

@Caravanfan Usually a combination of physicians, nurses, administrators and social workers all who have been trained by taking ethics courses.

How long are the current vaccinations supposed to be good for?

We don’t have historical data yet, so this is about expectation, not hardened fact.

@Jeruba Nobody knows.

Ok. How did they arrive at a one-year frequency for flu shots? Just direct observation? Or have dosages been calculated to that interval? I never even thought to wonder this before.

@Jeruba Well, flu is different in that it’s seasonal, and that the strains are different every year.

Does aerobic exercise increase your oxygenation levels? (I just shoveled snow for an hour.)

@janbb No, but it does increase your physical fitness.

^^ That I knew. Thanks.

@Caravanfan, if you get your two shots of, say, Pfizer or Moderna, and then a better, more comprehensive vaccine comes out, what then? Can you get another vacc, or is it too late?

Of course I don’t mean cutting the line and getting extras when some people have had none yet. I’m just asking about doubling up, in terms of efficacy versus some deleterious effect.

@Jeruba There should be no problem in getting different vaccines. There is, of course, no data on it but theoretically it shouldn’t be an issue.

Should I not take a ibuprofen tonight (Wednesday) for a back ache if I am getting the 2nd shot on Friday?

@janbb Taking ibuprofen won’t affect your shot in any way.

Do you know what’s going on with the vaccines and the South African strain? I’m hearing from people I know and seeing headlines suggesting the vaccines aren’t as effective against it, but I don’t understand what that means (assuming it’s true).

Are warm or cold compresses better for a sore post-shot arm?

@janbb Probably cold is better.

Next question – Any problem taking zolpidem after getting the shot today?

@janbb No.

Thank you. I have no more questions right now. Appreciate the help!

@Caravanfan Have you seen any information about J&J doing a trial for a booster to increase the protection? I assume it will be done eventually. I haven’t seen anything.

@JLeslie No idea. AFAIK it’s one shot.

Do other and better known vaccinations leave such lingering effects at the site of the shot? I’ve never before had any that lasted beyond about two days, but I still feel this somewhat, three weeks later.

If the area is still itchy or sore or feels heavy when the second shot comes due, is it better to use the same arm or the other one? I’d rather not have both arms fall off. (jk, of course . . . falling off is ok)

No lingering effects.
The arm choice doesn’t matter.

@Caravanfan—asking with what is probably some misplaced curiosity on my part, but—does someone’s reaction to a vaccination have any correlation to how they would have responded to the actual illness?

Why/why not?

@sadiesayit. No. The vaccine will cause a mild arm soreness or maybe a day of fevers. The virus can be lethal. That’s because the vaccine is just a small RNA snippet that encodes the Spike protein. The virus is the whole virus and can cause infection. The vaccine does not cause infection.

@Caravanfan Thanks. I know the vaccine doesn’t cause an infection, I guess I was just wondering if the way your body responds to the vaccine can tell you anything about how it responds when there’s an actual virus attacking you… Like, if you get some flu-like symptoms after the vaccine, does that mean your body’s immune response is working “better” than someone who doesn’t experience those symptoms? Or does that mean you would have been more likely to have complications due to an overactive immune system response? Etc.? I don’t think it would be the case, but I don’t know enough about how the immune system works to know why not. (And I’m sure my asking the question shows just how little I understand.)

Can one mix and match different vaccines? From different suppliers?

Not recommended, although you can probably mix and match the Pfizer and Moderna.

I am so glad to be fully vaccinated.

Any idea when the elementary school aged kids can get vaccinated?

@Dutchess_III I read September or later. It stuck in my head because it was going to be after school starts. They are still recruiting children 6 months to 11 years for the trials,

Asking for a friend: If a person with an auto-immune disease is fully vaccinated but an antibody test shows no antibodies, would a third shot be helpful?

@janbb Actually I have no idea, sorry. I’ll check with my peeps.

^^Thanks. It’s important to them.

@janbb Your friend needs to make sure they had the right type of antibody test. Here’s an article. I have been wondering about the antibody question also, because of the Pfizer study where so many elderly people didn’t produce antibodies. I assume a study used the correct test though. I still don’t really understand if maybe someone can not show the antibodies and still be immune. Maybe the body will still recognize the virus and react.

I heard the CDC director today say that immunocompromised people also may not get a good immune response from the vaccine, I don’t think they know yet the full information on that. She said those people should talk to their doctor, which I think is a crap answer, because a doctor would not likely know more than her, unless maybe he would actually run an antibody test. I figure doctors are going to tell their chemo patients and people on immunosuppressants to still take precautions, but I’m not a doctor. I mean, those people need to be cautious even without covid around. The CDC director did not say anything about a third shot.

I have no idea if this will apply to covid vaccine, but my mother never reacted to the smallpox vaccine, so they made her do it again. A few years later she was going to travel and they advised she get the vaccine again since she never reacted, and she refused it, because she had no reason to believe it would leave a mark on the third try. I tell that story, because I think it is possible in the future they might advise another booster for people high risk showing no immunity.

I assume they have not done any trials for third doses, so they might be loathe to recommend it at this point.

The answer;

Current antibody tests are pretty useless in answering this question. The FDA in a rush approved dozens of antibody tests with little standardization. Some test against the spike protein, which is in the current vaccines, others test for antibodies made against other parts of the virus, which should never test positive in someone who had the vaccine but not a covid infection. There is no clearly understood threshold for what level of antibody confers protective immunity, and no standard threshold for reporting an antibody test as positive. And tremendous variability in the antibody tests as to their level of sensitivity. There is also little understanding of how protective cellular immunity is after antibody levels wane, it may be quite effective.
So about the only thing about antibody tests you can say is that if a test is positive, it is a pretty good indication you either had covid or had a covid vaccine. A negative test tells you nothing.

That was my experience @Caravanfan. I am 99% sure Rick and I had Covid in Feb of 2020, but an antibody test 8 months later came up negative.
Now that I’ve been fully vaccinated I think I’ll have another out of curiosity.

@Caravanfan I should have pulled that out of the article, thanks for posting.

What’s the protection percentage after one shot of Moderna or Pfizer?

I think I heard something like 80%, but that seems somewhat high.

@Brian1946 One shot? Not sure. Better than zero.

@Caravanfan I’m curious, what happens when a vaccine “doesn’t take.” Is it simply that the recipient’s immune response fails to develop antibodies like the majority of people? If they were given additional doses would they eventually develop those antibodies? or are they just SOL? If someone fails to develop antibodies for vaccine A, are they also unlikely to develop antibodies for vaccine B? In other words, is there some percent of the population with immune systems that consistently fail to respond to vaccines in general?

@gorillapaws I have a new thread. Check general.

But the answer is that if you get a vaccine you are considered to be immune. The only way you know if the vaccine didn’t work is that you get covid. Antibody tests are useless.

Here ya go:
https://www.fluther.com/226659/here-is-the-very-last-covid-ama-thread/