Coronavirus outbreak

[vickster]

As is normal on here can you please provide evidence that if someone saw a GP in Wolverhampton with a clear need for surgery that he would be referred to 3rd party physiotherapy instead of being referred to a Consultant.

This explains the pathway in Wolverhampton
https://wolverhamptonccg.nhs.uk/images/WIMS_FAQ_Final.pdf
If not acute/urgent rheumatological condition, patients will go into this Wolverhampton Integrated MSK Service (WIMS) pathway - first stop is an MSK AAP it seems (a physio not an orthopaedic surgeon) who then assesses for onward referrals to secondary care.

Enjoy

 

[Ajax Bay]

Meanwhile, back on topic
I thought this recently reported research interesting
Nocebo responses explain up to 76% of COVID vaccine (systemic) side effects

Some vaccine side effects are very real, but many may be anxiety and mis-attribution.
The harmless interventions (ie faux vaccines in the control half of a trial) can lead people to report harmful side effects, particularly when people are expecting such side effects. Researchers have coined these phantom adverse reactions "nocebo responses." Nocebo responses are thought to stem from expectations of side effects, anxiety-induced effects, and the mistaken attribution of common, non-specific ailments, like headaches, to the placebo.

This Harvard study quantified just how big a role they played: it used meta-analysis (18 Jan JAMA Network Open). It looked at vaccine side-effect data from the many clinical trials. It concluded that nocebo responses accounted for 76% of systemic adverse reactions—like headache, fever, and chills—after the first vaccine dose and 52% of systemic reactions after the second vaccine dose.

There was a clear difference in the local (eg upper arm) side effects. Only 16% of placebo recipients reported local side effects, like pain or swelling at the injection site, while 67% of the vaccine group reported such effects.

Overall the nocebo response rate clearly seems to be skewing our experience with COVID-19 vaccines: the researchers argue that highlighting the potential for nocebo responses could reduce side effects and help improve vaccine uptake.

 

[classic33]

Meanwhile, back on topic
I thought this recently reported research interesting
Nocebo responses explain up to 76% of COVID vaccine (systemic) side effects

Some vaccine side effects are very real, but many may be anxiety and mis-attribution.
The harmless interventions (ie faux vaccines in the control half of a trial) can lead people to report harmful side effects, particularly when people are expecting such side effects. Researchers have coined these phantom adverse reactions "nocebo responses." Nocebo responses are thought to stem from expectations of side effects, anxiety-induced effects, and the mistaken attribution of common, non-specific ailments, like headaches, to the placebo.

This Harvard study quantified just how big a role they played: it used meta-analysis (18 Jan JAMA Network Open). It looked at vaccine side-effect data from the many clinical trials. It concluded that nocebo responses accounted for 76% of systemic adverse reactions—like headache, fever, and chills—after the first vaccine dose and 52% of systemic reactions after the second vaccine dose.

There was a clear difference in the local (eg upper arm) side effects. Only 16% of placebo recipients reported local side effects, like pain or swelling at the injection site, while 67% of the vaccine group reported such effects.

Overall the nocebo response rate clearly seems to be skewing our experience with COVID-19 vaccines: the researchers argue that highlighting the potential for nocebo responses could reduce side effects and help improve vaccine uptake.

That'd be the same for most medications, they all have listed side effects which many don't even think about. The added disadvantage this time has been the larger publicity given to the vaccines and potential side effects of each of them.

Maybe people will cut down on the the amount of over the counter medications, if they start checking the possible side effects.

 

[Ajax Bay]

Given that mandated mask wearing is over in UK (except in settings where the authority dictates otherwise), this Planck paper added to my understanding of the facts. [Precised] I shall continue to wear my FFP2 mask in sustained proximity in enclosed circumstances near people I don't know, bolstered by the knowledge that it has value (to me and another).
Significance: It is not clear how exactly the risk of infection is affected by wearing a mask during close personal encounters or by social distancing without a mask. Our results show that face masks significantly reduce the risk of SARS-CoV-2 infection compared to social distancing. We find a very low risk of infection when everyone wears a face mask, even if it doesn’t fit perfectly on the face.
Abstract: There is ample evidence that masking and social distancing are effective in reducing SARS-CoV-2 transmission. To calculate exposure and infection risk, we use a comprehensive database on respiratory particle size distribution; exhalation flow physics; leakage from face masks of various types and fits measured on human subjects; and rehydration, inhalability, and deposition in nose/mouth.
For a typical SARS-CoV-2 viral load and infectious dose between two speaking individuals:

• social distancing alone (no masks), even at a distant 3m, leads to 90% risk of infection after a few minutes
• if susceptible wears a face mask with infectious speaking at a distance of 1.5m
• with a surgical mask, the upper bound only reaches 90% after 30 min
• with an FFP2 mask, it remains at about 20% even after 1 hour.
• both wear a surgical mask, while the infectious is speaking, risk remains below 30% after 1 hour
• when both wear a well-fitting FFP2 mask, it is 0.4%.

We conclude that wearing appropriate masks in the community provides excellent protection for others and oneself, and makes social distancing less important.

 

[Alex321]

Given that mandated mask wearing is over in UK (except in settings where the authority dictates otherwise), this Planck paper added to my understanding of the facts.

Not in the UK, only in England.

Masks are still required in various places in other parts of the UK.

Though it possibly will be in Wales after next Friday (haven't checked what changes in rules are coming in Scotland or NI).
[EDIT]
Nope, will still be required after next week. Earliest mask mandate may be lifted in Wales is now the next review on 11th February.

 

[Seevio]

As the virus becomes more and more widespread, the death within 28 days of a positive diagnosis becomes more and more meaningless. In the extreme example, if everybody caught covid and survived, then almost every death would be recorded as a death within 28 days.

While I haven't seen figures to show deaths caused as a result of covid, as opposed to with covid, there is this that shows a remarkably low number of deaths due to covid with no other co-morbidities. Most of these deaths were in 2020 prior to mass vaccination and when deadlier strains were predominant. Again, this does not include people who were ill with other stuff where covid tipped them over the edge.

With the omicron variant appearing to be pretty much weak-sauce but still providing immunity to other variants, it may be wrong to pretend we can limit the spread and instead concentrate on treating those who have life threatening illness.

I'm going to regret posting this in the morning.

 

[Deleted User]

This explains the pathway in Wolverhampton
https://wolverhamptonccg.nhs.uk/images/WIMS_FAQ_Final.pdf
If not acute/urgent rheumatological condition, patients will go into this Wolverhampton Integrated MSK Service (WIMS) pathway - first stop is an MSK AAP it seems (a physio not an orthopaedic surgeon) who then assesses for onward referrals to secondary care.

Enjoy

Thank you, glad I didn't have to follow that route then.😉.

 

[vickster]

Thank you, glad I didn't have to follow that route then.😉.

Indeed, but now you know your referral to physio had nothing to do with having a phone rather than face to face appointment

 

[Deleted User]

Indeed, but now you know your referral to physio had nothing to do with having a phone rather than face to face appointment

It did because he didn't listen to what I told him, I was going 'private ', for the consultation only.

It's still a poor approach in my opinion because I clearly need an opp but time and money would have been wasted on Physio.
Oh well, no consequence to me really and just reinforces the route taken was the best.

Cheers anyway.

 

[cougie uk]

I'm luckier than one doctor I was seeing/been seen by. Their name appeared amongst the list of hospital staff who died from covid-19.

God that's awful. And Johnson claims that they had it tough sitting around in offices.

 

[cougie uk]

As the virus becomes more and more widespread, the death within 28 days of a positive diagnosis becomes more and more meaningless. In the extreme example, if everybody caught covid and survived, then almost every death would be recorded as a death within 28 days.

While I haven't seen figures to show deaths caused as a result of covid, as opposed to with covid, there is this that shows a remarkably low number of deaths due to covid with no other co-morbidities. Most of these deaths were in 2020 prior to mass vaccination and when deadlier strains were predominant. Again, this does not include people who were ill with other stuff where covid tipped them over the edge.

With the omicron variant appearing to be pretty much weak-sauce but still providing immunity to other variants, it may be wrong to pretend we can limit the spread and instead concentrate on treating those who have life threatening illness.

I'm going to regret posting this in the morning.

It is not correct to call it weak.

https://www.the-scientist.com/news-opinion/how-mild-is-omicron-really-69610

 

[fossyant]

That'd be the same for most medications, they all have listed side effects which many don't even think about. The added disadvantage this time has been the larger publicity given to the vaccines and potential side effects of each of them.

Maybe people will cut down on the the amount of over the counter medications, if they start checking the possible side effects.

This - folk really don't look at side effects of meds and then cause all this fuss about a vaccine. Other meds are far far worse. I've had some pain meds in the past (usually for 'other conditions' but their side effects block nerve pain). Let's say I gave them a go, but the side effects weren't worth the benefit from reduced pain.

Like with everything, it's a balance.

 

[mjr]

As the virus becomes more and more widespread, the death within 28 days of a positive diagnosis becomes more and more meaningless. In the extreme example, if everybody caught covid and survived, then almost every death would be recorded as a death within 28 days.

Only if everyone caught covid at the same time, which is more than extreme: it's practically impossible, due to random chance (see the second of 2021's Royal Institute Christmas Lectures by Professor Van Tam) and infection-based immunity lasting more than 28 days.

While I haven't seen figures to show deaths caused as a result of covid, as opposed to with covid,

The figures for deaths with covid as an underlying cause, compared to deaths with covid merely mentioned, are published by the ONS so why haven't you seen them? They're far easier to find than that FOI request response (or at least they were before the antivaxxers started search-engine-optimising that FOI response). "COVID-19 was the underlying cause of majority of deaths where COVID-19 was mentioned anywhere on the death certificate in December"

there is this that shows a remarkably low number of deaths due to covid with no other co-morbidities. Most of these deaths were in 2020 prior to mass vaccination and when deadlier strains were predominant. Again, this does not include people who were ill with other stuff where covid tipped them over the edge.

As covered previously: having another illness does not make these people whose deaths should be dismissed lightly, some of them will not have known of their comorbidities before catching covid and some of the comorbidities may have been triggered by covid, amongst other things. We know from other data that many of these were not people who were expected to die any time soon and the average shortening of life was something like 10 years IIRC.

With the omicron variant appearing to be pretty much weak-sauce but still providing immunity to other variants, it may be wrong to pretend we can limit the spread and instead concentrate on treating those who have life threatening illness.

The evidence is strong that we can limit the spread with various measures, so I do not understand your use of "pretend" there. Do you believe that omicron can jump through FFP3 masks and nonsense like that suggested by Piers Corbyn & others?

I can see a sort of logic to those who argue that some measures aren't effective enough to be worth their cost, but I really do not understand people who claim no measures work at all.

What does "concentrate on treating those who have life threatening illness" mean there? Is it suggesting that people put in ICU with omicron (a smaller % of a bigger number of cases) are not having their lives threatened, or should be lower in triage than other illnesses?

It may also be very wrong to embrace omicron: it may be less lethal in the early stages, but it's still too early to tell what risk of long-covid is posed by it. We might be melting a path through a snowdrift only to be hit by an avalanche later.

I'm going to regret posting this in the morning.

How about now?

 

[mjr]

Meanwhile, back on topic
I thought this recently reported research interesting
Nocebo responses explain up to 76% of COVID vaccine (systemic) side effects [...]

Because of my past, I am very sceptical of "nocebo" studies. This one seems to avoid many common pitfalls, so its result may be closer to reality than many, but I think two aspects of the methodology seem a bit odd at first glance:

1. it excludes serious adverse events without giving a reason. Maybe it's in the supplements; and

2. it extracts first-dose adverse events and second-dose adverse events from each two-dose trial separately. I strongly suspect that if someone reports an adverse reaction to the first-dose, they are less likely to take a second dose, but I didn't spot this being checked or controlled for. If that suspicion is correct, that makes the drop to only about half of the second-dose adverse event reports being explained by "nocebo effect" even more curious.

 

[Illaveago]

It was interesting to hear 2 expert virologists speaking on the Beeb just now .
It seems that working culture will have to change as a result of this virus . Whereas bosses have been forcing people into work with coughs and sneezes and therefore spreading the infection throughout the workforce and throughout the population , sick pay or some other financial support will have to be introduced or supported and the way in which sickness is treated will have to change .