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James Hamilton, M. D.

Mike McL., 

I like your example of the velcro and ACE-2 receptors. It brought to mind another example.

Remember that old cobblestone alley behind IC from Calumet to Indianola? There were a number of trees (what kind?) that produced what we called "cockleburrs" that look like our friend, SARS-CoV-2. Kids used to throw them at someone wearing a wool sweater creating a major problem for our moms. (By the way, that is similar to how velcro was invented.)

And, yes, I had a wool sweater. 

Jim 

David Dunn

Thanks for the comments everyone! (Especially concerning the WW2 info), I dont always check on here everyday. Since I just retired from the Ohio State Fairgrounds as of the 1st Sept. after 46+ years, I have been occupied with getting ducks in a row (via phone mostly), especially with SS, Medicare benefits etc. 

Thanks for remembering my nom de plume Mark. Youre one of the very few who knew I had another title. I hope to jump back in here in a few days with a little more feedback.

James Hamilton, M. D.

Dave D.,  

Congratulations on your retirement! Kick back and enjoy and hope you have many happy and healthy years to do so. Please add joining in more often on this Forum to keep us informed of your life and thoughts.

Jim 

Michael McLeod

Dave D - what nom d plume were you referring to? Was it "Duke O'Dwinn?"

Oh, and Jim I remember that alley well. Wasn't much to it but at the time it seemed a long walk. 

James Hamilton, M. D.

Mike,

 By the way, that cytokine storm study was from the Netherlands and looked at the blood levels of interleukins and tumor necrosis factor alpha (which are cytokines) and found them not to be elevated in these patients. That was just one study, however, so others need to be done to confirm it. The importance is that anti-cytokine medications may or may not be indicated. At present, I believe that cytokine storm does occur and treatment indicated until  those future studies are available. 

Jim 

John Jackson

And now for something completely different...

David Mitchell

John,

This reminds me of my poor friend - an agnostic, dislexic, insomniac.       He sits up all night wondering of there really is a doG? 

p.s. Kinnikinick is a real place, just south of Kingston, Ohio (which is just south of Circleville) on the way to Chillicothe. Blink and you would miss it while traveling down HWY 159 just before the big Kenworth Truck Headquarters as you approach Chillicothe.

Chillicothe was the state captial once we achieved statehood in 1803, before it was moved to Zanesville, and then Columbus. And it's also the birthpalce of great Jazz singer Nancy Wilson - who later graduated from Columbus West High School.

I get around.

Joseph D. McCarthy

John the poster forgot to include the most famous, ala Radar from Mash.  RADAR

Dave, you forgot that Ohio's most famous Play "Tecumseh" is produced in the Kinikinik area.  

Joe

John Jackson

In case you missed it, CDC director Robert Redfield (who in the past has seemed to me to pull his punches) in Senate testimony today said a Covid-19 vaccine is unlikely to be available to the general public until the second or third quarter of next year.  He also said masks are the best defense we have to bring the virus under control, possibly even better than a vaccine: "I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine.”

When asked about it, Trump said Redfield was "confused" and "I think he misunderstood the question".  Thank God we have a President who isn't afraid to put these scientific know-it-alls in their place.

Look for Redfield to be fired and replaced with Gerald Kushner (or maybe Ivanka) sometime in the next few weeks late on a Friday afternoon. 

Here’s a link from the ultra-liberal USA Today: 

https://www.usatoday.com/story/news/politics/2020/09/16/trump-cdc-director-robert-redfield-confused-vaccine-masks/5720828002/

Michael McLeod

Some interesting supportive journalism coming out now on the heels of the woodward expose.

Basically, he was just being lazy. And clueless.

Not so much evil as venal.

Just in over his head.

In explaining why he repeatedly misled the American public about the early dangers posed by the novel coronavirus, President Trump has argued that he did not want to engender panic — and suggested that his actions showed he took the looming pandemic seriously.

But a detailed review of the 10-day period from late January, when Trump was first warned about the scale of the threat, and early February — when he acknowledged to author Bob Woodward the extent of the danger the virus posed — reveals a president who took relatively few serious measures to ready the nation for its arrival.

Instead, enabled by top administration officials, Trump largely attempted to pretend the virus did not exist — spending much of his time distracted by impeachment and exacting vengeance on his political enemies. He also carried on as usual with showy political gatherings and crowded White House events.

David Mitchell

Joe!!! 

Good catch, man!

I actualy thought about adding some info about the Tecumseh drama re-enactment but couldn't remember exactly where it was staged. All I could remember was  that it was somewhere around Chillicothe.

Nothing gets by you does it?

James Hamilton, M. D.

John J.,

I had seen that report of Dr. Redfield's statements. I have a few MEDICAL comments that I would like to share, without getting into politics.

Most health care personnel are aware that masks are more likely to protect other people from contagions rather than the wearer of the mask. I think it is not a very good idea for any doctor, especially a high profile individual, to make a statement that he or she would prefer a mask to protect themself rather than a vaccine. This is particularly true since no vaccine has yet been released for the general public. There are currently about 400 vaccines in various stages of development and maybe 3 or 4 that are entering, or close to, Phase 3 testing. Several different SARS-CoV-2 sites are targets of these vaccines.

Obviously the duration of antibody or T-cell immunity is not yet wholly known, but some studies are finding a longer duration of neutralizing antibody protection than was originally thought. Even a modest duration would be helpful in slowing or stopping the pandemic - sort of a herd immunity response. Repeat immunizations may be needed but that is true of several other disease preventing vaccines.

With the number of anti-vaxxers that are vocal opponents to almost all vaccines, Dr. Redfield's words can be counter productive to the public's appreciation of a safe and effective vaccine, thus decreasing the number of individuals willing to receive it.

I do not know when or which vaccine will be relased first. Some of the medical literature does indicate the end of this year is certainally possible.

At any rate I think that most people will be safer taking a vaccine than wearing a mask for the rest of their lives. I will roll up my sleeve for a safe and effective vaccine. But, if some want to further protect me more than themselves, go ahead and wear their masks. And, hopefully, they will cover their noses as well as their mouths.

Jim

David Mitchell

Joe and Tim,

How are you guys in relation to the fires? Or at least, how is your air quality?

My daughter in law in Portland is telling some chilling details abbout the air quality ratings, which have come down from "Extremely Hazardous - 500" to just merely "Very Unhealthy - 220". She and their 11 year-old son have not been able to go outside for over a week. They are fortunate to have air conditionng, while most in Portland do not. Their neighbors and friends are weak, nauseous, and have headaches and sore throats. The hardware stores are all out of A/C flters.

My oldest daughter in Puget Sound said they got a tiny bit of rain and she saw some blue sky for the first time in a while, but it "smoked over" again shortly thereafter. 

Michael McLeod

Ok Dr. J. you are SCARING me now if you are going to start using capital letters for emphasis. Generally when I start seeing people who need to do that to make their point I'm thinking the conversation is headed downhill.

Daniel Cody

John,

Don't you think we need a heavy lift from a radiologist to develop "herd mentality"

James Hamilton, M. D.

Mike McL.,  

Sorry for breaking any journalistic rules by using the upper case. I simply wanted to emphasize that I was rendering my professional and not my political opinions on the topic.

I did not intend to put fear in your heart! 😬

Jim

John Jackson

Jim, Dr. Redfield, himself a virologist and vaccine expert, motivated his comments about masks and vaccines by saying that vaccines typically don’t protect all who receive them and he mentioned a possible figure of 70% success rate for initial vaccines producing the desired antibodies.  If masks are worn by everyone, then everyone gets some degree of protection and I took his comment to mean that the protection afforded by everyone wearing masks might afford an overall protection greater than the protection of an initial vaccine.

I’m guessing Redfield, as head of CDC, decided to emphasize the importance of masks because he can no longer countenance Trump’s increasingly belligerent ridicule of mask wearing.  Jim, putting on your MEDICAL and not your POLITICAL hat, was Trump setting a good example when, speaking about Biden on Sept. 3 to a crowd of supporters in Pennsylvania, he asked them if they know "a man that likes a mask as much.  It gives him a feeling of security.  If I was a psychiatrist, I'd say this guy has some big issues."

This is third grade schoolyard taunting (a Trump specialty): mask wearers are mama’s boys and sissies.

And if you’re worried that Redfield’s remarks undercut public acceptance of an eventual vaccine, I suggest these as far more important reasons why polls show that less of half of Americans say they would be comfortable getting vaccinated for COVID-19:

1.  People on my side of the fence are worried that, given Trump’s completely unrealistic obsession to have a vaccine widely available in time for the election, he will bully the already-politicized and compromised CDC to release a vaccine before adequate testing for both safety and effectiveness.

2.  Many people on your side of the fence, with ample encouragement from Trump and right wing media, think the virus is a hoax or not a big deal at all, so why bother to vaccinate?  If masks are for sissies, are vaccines any better?

And Dan, maybe “herd mentality” was what Michael Steele, former National Republican Party Chairman, was referring to last night when he said “What’s wrong with this country that we have to beg 40% of our people to wear masks just to save their own sorry asses”.

Michael McLeod

Don't have a cow, Dan. The president wouldn't steer us wrong.

Joseph D. McCarthy

Hi Dave M.  I took a walk today now that the outside air is breathable.  We had over twenty days of Unsafe (sorry Mike for the Capital) air quality in the Bay Area.  We are in the midst of a few days of breathable before it turns bad for the weekend.

My daughter lives in Portland in an older house East of the downtown (about three miles).  They have air-conditioning, but the older windows are allowing plenty of smoke into the house.  She has gone to using the plastic covers that you tighten with a hair dryer over windows.  We used them in Ohio and Pennsylvania for the cold during the winter.

And Dave I only remebered Tecumseh because I took my wife and daughter to see in one intermittent rainy night while we still lived in Columbus.  And I think I still have the forty plus year old album of the show.

So Tim how bad is it up North?

Last but not least.  Congratulations Mr. Dunn on a Phenomenal career. 

Joe

James Hamilton, M. D.

John J. and All,

Again, here are some of my thoughts and opinions.

I would be quite happy with an initial vaccine that could reach a 70% efficacy rate. Some of the influenza vaccines in the last few years were not even that good. Of course, predicting which flu strains will be prevalent each season involves science, art and luck. Even though SARS-CoV-2 may have gained some minor mutations, among the various vaccines being developed I believe these will be covered since many attack different viral sites and mechanisms.

One must also look longitudinally over time (years) and what happens to individuals - and populations - who receive yearly flu shots. Even though there may not be a perfect match with the flu strains and that year's vaccine, those who have been getting yearly immunizations may be less likely to get, or have a milder course of, the flu.That is because cross-reactivity can exist and build up. I suspect the same will happen with coronaviruses.

I have said on this Forum several times that I am in favor of masks. But I do not believe they should be government mandated. Individual buildings and businesses can mandate them and patrons must observe that.

As all of you have probably observed, many, many people do not wear them correctly. Some masks are much better than others and some are very inadequate. Those "bandana" types - the ones that look like bandits in the old West wore to rob stagecoaches - are probably the least effective. But you see them everywhere.

If the government were to mandate masks (and there still remains the question if that is constitutionally legal), what kind would they demand and at who's expense? Would this be another socialistic freebie?

Let's face it (no pun intended), there is no 100% risk free world from this or other pandemics. When this all started months ago I believe I wrote a post about how pandemics end. That was quarantine, hygiene (personal and community) and vaccines.

I think very few people on either side of the fence believe this pandemic is a hoax. I do think that some measures taken were, in retrospect, overrated such as quarantining the well and not just the infected. But that was before mass testing became more available, and we still need more of that. Again we are still learning about this virus and how best to deal with it. I cannot overemphasize that point (but I will avoid using capital letters!).

I will take a vaccine that is safe even if it is less than perfectly effective (which it will be). Safety? Of course. I do trust that the scientific and medical communities will not release a vaccine that is knowingly unsafe. All medicines and vaccines have side effects. That is a fact. Some of those side effects do not become apparent until post-marketing studies are performed. And some even after that. And some that are never proven to be undeniably caused by that product. Zantac, anyone? Late night lawyer ads?

And, while we are on the topic of vaccines, flu shot time is upon us. We usually get ours in late September. There are a few different kinds again available this season. A new high dose quadravalent and an adjuvated quadravalent is now on the list. I have not gotten my most trusted publication on this year's choices yet but I expect it soon. From what I have read so far, I am leaning toward one of the new quads. The last several years we have opted for the quads instead if the trivalent shots. Regardless, I recommend flu shots for just about everyone. This year especially due to the potential need for hospital beds for COVID-19 patients if there is another surge of that disease.

Jim

David Dunn

Thanks Jim, I will try to make it on here more often. Looks like I should have more time! And, yes, Mike, I had only the one pen name. 

So, if I retired effective the 1st of Sept., I still havent gotten the Medicare Part B thing straightened out, after numerous phone calls (no in-office visits). Last month, SS told me that I needed to make an appointment to sign up for Medcare part B. So, when my appointment called at 1:31 pm on the 31st, I was told to have form L-564 faxed in to them from my workplace. After two weeks, I pro-actively called to make sure everyhting was in order. I was told that I had needed to send in Form 40-b WITH the L-564, and since I didnt my form L-564 was thrown away. I had to start over. So yesterday I drove down to my Human Resource person at work and filled out the forms in person, and she faxed them in to the number I was given. I tell people I love redundant communication, so that we Know that were on the same page.  I asked and asked if I did everything right so far, and if there is anything else I need to do. Supposedly now SS will send me a letter, followed by a card for Mediacare part A & B, within a couple of weeks.( there is a Penalty for not filng in a timely manner).

Im only posting this, for others benefit, just in case, and to maybe find out if anyone else has had to deal with this red tape..

David Barbour

Dear Dr. Jim,

Is it constitutional for the powers that be to force me to wear pants?  They really limit my mobility.

How long would I be walking free out in the street without pants?  Honestly.

DB

James Hamilton, M. D.

Dave B.,

 I believe lawyers will be looking into the mask wearing issue if that is ever mandated by government and would likely end up in the courts. As for not wearing any pants, I would suggest trying it only in a city that defunded the police and then you will only have to deal with social workers and the mental health personnel. 👖 

Jim 

John Jackson

Jim, thanks for your discussion which was quite useful, but I disagree about mask mandates – there is no right to engage in behavior that puts others at risk.  Should parents be allowed to insist that their children infected with chicken pox or measles attend school so they don’t fall behind?  Are smoking bans in public buildings also unconstitutional?  Do you have a right to drive when you’re drunk as long as you don’t kill someone?

You've said you're in favor of masks, but you totally dodged my most important question so I’ll ask it again: even if mask mandates are illegal, was Trump sending the right message when, speaking about Biden on Sept. 3 to a crowd of supporters in Pennsylvania, he asked them if they know of "a man that likes a mask as much.  It gives him a feeling of security.  If I was a psychiatrist, I'd say this guy has some big issues."

That sounds to me like Trump's saying mask wearers are cowards and sissies.  Am I missing something?

James Hamilton, M. D.

John J.,

 Wow, John, that's your most important question?

OK, I looked up more of what he said that day. He was apparently talking about Joe Biden's tendency to have his mask hanging from one ear as he talks. If you think President Trump was calling people sissies, well, so be your opinion. The following day Joe Biden said that presidents are supposed to lead and not try to sound masculine. This from the candidate who challenges others to push- up contests and said that if they were in high school he would take President Trump behind the gym and "beat the hell out of him". That same next day President Trump also expressed the need for for hygiene, social distancing and wearing masks under certain conditions.

Yes, John, these two are going to exchange barbs for the rest of their campaigns. I have stated my own thoughts on masks, hygiene, social distancing, medications, vaccines and other aspects of this pandemic. However, for this presidential race I am more concerned with policies and results than I am with either of the two's bantering. You and I have different opinions on the candidates whom we support and certainty different political views. We also have different ways in which we express our thoughts on these topics.

Let's respect those differences. 

Jim