Vaxxed/unvaxxed?
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Vaxxed/unvaxxed?
I’ve had a double vaccination against Covid.
I’m just wondering what the general feeling is about unvaccinated and vaccinated pilots sharing a flight deck for many hours.
I’m just wondering what the general feeling is about unvaccinated and vaccinated pilots sharing a flight deck for many hours.
A paper in the Lancet in August 2021 from Oxford University and Wellcome indicated that vaccinated people were greater spreaders of virus than those unvaccinated (ref. google Data on breakthrough SARS-CoV-2 Delta variant infections Vietnam).
Since the vaccination neither prevents transmission or stops it why should anyone be concerned as to someones vaccination record. As reactions to vaccinations have apparently or allegedly occurred it may be the unvaccinated who could be at more concern over needing to take control during flight.
Since the vaccination neither prevents transmission or stops it why should anyone be concerned as to someones vaccination record. As reactions to vaccinations have apparently or allegedly occurred it may be the unvaccinated who could be at more concern over needing to take control during flight.
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As protection for vaccinated people is not 100% and the probability of unvaccinated people being contracting Covid and being more contagious than vaccinated people is high, all pilots and cabin crew who are not prevented from getting a shot due to health reasons should be vaccinated. Testing is an improvement but always works in hindsight. Flight decks may be quite safe due to ventilation and we had no infections of (still unvaccinated) pilots flying together even with one being found positive later, but briefing rooms, lounges, crew buses, etc. less so.
It is questionable whether one can be too sick to be vaccinated or wear a mask but still be healthy enough for a medical. It's also questionable whether someone denying a vaccination because of non-scientific reasons should be entrusted with a machine that flies based on scientific principles.
It is questionable whether one can be too sick to be vaccinated or wear a mask but still be healthy enough for a medical. It's also questionable whether someone denying a vaccination because of non-scientific reasons should be entrusted with a machine that flies based on scientific principles.
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Alpine Flyer
It'll be this one.
It isn't conclusive, but... surely... if you've had the vaccine and you think you're protected, you wouldn't care?
It'll be this one.
It isn't conclusive, but... surely... if you've had the vaccine and you think you're protected, you wouldn't care?
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Typhoon Tripacer
What the paper actually shows is vaccinated health care workers in 2021 with Delta had high viral loads compared with unvaccinated individuals in 2000 infected with Alpha (and other earlier strains). The study was assessing the higher transmissibility and breakthrough of Delta, NOT comparing vaccinated and unvaccinated individuals.
What the paper actually shows is vaccinated health care workers in 2021 with Delta had high viral loads compared with unvaccinated individuals in 2000 infected with Alpha (and other earlier strains). The study was assessing the higher transmissibility and breakthrough of Delta, NOT comparing vaccinated and unvaccinated individuals.
Capt Scribble
Nailed it.
Nailed it.
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As much as vaccinated people can get infected and possibly infect others, they're 90% less likely to end up in hospital. And I think that this is the driver of most mandatory or semi-mandatory vaccination policies throughout the world. With a high vaccine coverage, it becomes highly unlikely that so many people will get very sick at the same time that the health care system won't manage to take care of all of them. Remember that this was the rationale behind lockdowns for most of the world - few countries aimed for eradication (China, Australia, New Zealand and a couple of others), most only aimed for not overloading their hospitals. And for many countries with a high vaccination coverage the daily number of cases is no longer significant. They're only concerned with hospital admissions - and any decisions regarding restrictions are based purely on that.
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That should be the question, but you and I realize both that such a pragmatic view cannot be expected worldwide.
I am vaccinated. I respect anyone’s opinion if they decide not to be. But I don’t want to listen to colleagues complaining that they can’t eat out on a layover and that ABC rules in XYZ country are ridiculous. Those regulations are completely out of our hands and being vaccinated makes many layovers much more comfortable.
I am vaccinated. I respect anyone’s opinion if they decide not to be. But I don’t want to listen to colleagues complaining that they can’t eat out on a layover and that ABC rules in XYZ country are ridiculous. Those regulations are completely out of our hands and being vaccinated makes many layovers much more comfortable.
here_we_go_again
Quite. More than that, it shows that breakthroughs shed virus! This is not surprising. By definition, this is the subset of vaccinated people who became sick. This is NOT a comparison of vaccinated and unvaccinated people. This is a comparison of Delta variant shedding in sick people vs shedding in patients with "old strains detected between March-April 2020". This high level of virus shedding in sick people with the Delta variant underlines the importance of vaccination.
This is the conclusion that the authors come to. I think they are best placed to understand the implications of their work:
Quite. More than that, it shows that breakthroughs shed virus! This is not surprising. By definition, this is the subset of vaccinated people who became sick. This is NOT a comparison of vaccinated and unvaccinated people. This is a comparison of Delta variant shedding in sick people vs shedding in patients with "old strains detected between March-April 2020". This high level of virus shedding in sick people with the Delta variant underlines the importance of vaccination.
This is the conclusion that the authors come to. I think they are best placed to understand the implications of their work:
Breakthrough Delta variant infections are associated with high viral loads, prolonged PCR positivity, and low levels of vaccine-induced neutralizing antibodies, explaining the transmission between the vaccinated people. Physical distancing measures remain critical to reduce SARS-CoV-2 Delta variant transmission.
Vaxxed
a. Had Covid in March 2020 after a JFK flight
b. Participated in an anti-body research trial in Nov 2020 and still had high levels of antibodies
c. Got jabbed in Jul/Aug this year.
Why?
1. I probably won't be able to continue as a international pilot if I didn't.
2. Provide best possible protection to my colleagues, friends and family (using best scientific advice available at the time).
3. Was not worried about side effects (mild anyway), as I wasn't for any of the other vaccines (or medicines) I've had in my 46 yrs on this planet.
a. Had Covid in March 2020 after a JFK flight
b. Participated in an anti-body research trial in Nov 2020 and still had high levels of antibodies
c. Got jabbed in Jul/Aug this year.
Why?
1. I probably won't be able to continue as a international pilot if I didn't.
2. Provide best possible protection to my colleagues, friends and family (using best scientific advice available at the time).
3. Was not worried about side effects (mild anyway), as I wasn't for any of the other vaccines (or medicines) I've had in my 46 yrs on this planet.
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Here's what COVID does to your body when you're vaccinated - and when you aren't Dr. Dipti S. Barot
Oct. 15, 2021Updated: Oct. 15, 2021 7:50 p.m.
For the first several months after COVID vaccines became widely available, I often had to fend off queries from skeptical patients about whether the risks of getting the vaccine were worse than the benefits.
“Why should I get the vaccine when I have heard about all these side effects?”
My answer was to immediately point to our local hospital and tell them about how almost all the COVID beds and intensive-care units were filled with the unvaccinated.
More recently, however, as reports of some breakthrough infections of the vaccinated began to make news, the FAQ by unvaccinated patients started to change.
“Why should I bother getting the vaccine when I can get COVID anyway?”
This line of questioning isn’t unique to my patients. In the words of still unvaccinated NBA superstar Bradley Beal: “I would ask the question to those who are getting vaccinated ‘Why are you still getting COVID?’”
Well, here’s my answer to Mr. Beal and anyone else who has a similar inquiry:
COVID vaccines are wildly successful in reducing transmission, hospitalization and death. Unvaccinated people are eight times more likely to be infected, 29 times more likely to be hospitalized and 11 times more likely to die than their vaccinated peers. However, while these vaccines were designed to create long-lasting immunity in the blood, they are less effective at creating local immunity in the upper airways. As a result, both the vaccinated and unvaccinated can accumulate large viral loads of the very effectively replicating delta variant in their noses and throats (though the viral load comes down more quickly in a vaccinated person, making them contagious for a shorter period of time).
However, this is where the similarity ends between those who are protected by vaccines and those who are not. The immune system can be complicated, but some basic understanding of how it works can go far in relaying the importance of getting your COVID shot.
Our initial response to any pathogen is the same, whether vaccinated or unvaccinated: Our innate immune system recognizes an invader and launches a non-specific response to the attacker. This first line of defense — consisting of white blood cells such as neutrophils and monocytes — is immediate but short-lived, lasting hours to days.
We know the main points of entry for the coronavirus are our noses and throats. Both the vaccinated and unvaccinated who feel ill can experience familiar symptoms like cough, sore throat, nasal congestion, fever, body aches, headaches and something unfamiliar that often freaks people out the most: loss of taste and smell.
These symptoms can last a week while the other part of the immune system tries to marshal the resources to fire up the second line of defense: the adaptive immune response.
Here is where an unprotected, unvaccinated patient can have a very different experience from one who is vaccinated. Those who have been vaccinated carry deeper immunity circulating in their blood that will prevent their organs from getting overwhelmed with the virus.
Those without that protection can enter the fight of their life. Here’s why:
The adaptive immune response, the more specific of the responses, can take days to weeks to fire up. It is a race against the virus to see which will be faster.
This part of the immune system is made of white blood cells called lymphocytes, and some of the cells that offer long-term protection are “memory” B cells and the “killer” T cells. The vaccinated body has B cells that have been primed to swiftly recognize and remember what the spike protein of the virus looks like and make specific defender antibodies. And it makes T cells that are ready to rapidly attack and eliminate infected cells. When this part of the immune system has been given this leg up, talking to my vaccinated COVID patient sounds like this: “Yeah, the cough has gotten a lot better and the body aches are gone. I am definitely on the upswing.”
For the unvaccinated, however, the fight is just beginning.
Without the aid of a vaccine, the immune system takes longer to produce longer-lasting, more specific antibodies to fight COVID — antibodies that would have already been there had their adaptive immune system been exposed to the vaccine beforehand. And while an unvaccinated person’s body is taking its sweet time ramping up these defenses, the COVID virus is replicating, taking over cells and doing a hop, skip and jump down to the lungs while wreaking havoc along the way.
Talking to an unvaccinated patient in week two of symptoms can sound more like this: “This cough is not going away, and I feel out of breath when I walk around the house and my oxygen level on the machine goes down to 94%.”
There is a good chance you can hear these patients struggle to catch their breath when they are speaking.
These and other high risk patients are who we try to hurry in for what’s known as monoclonal antibody treatment, an infusion of synthetic antibodies made in a lab which can prevent further deterioration of symptoms. (Vaccinated patients have already made a natural version of these antibodies via their own adaptive immune system.) This treatment is still under emergency use authorization by the Food and Drug Administration, but for some reason many patients are more open to getting it than the Pfizer vaccine that now has full FDA approval.
If an unvaccinated patient is unable to get monoclonal antibody treatment in time — as many still aren’t — or it isn’t effective, that likely means a hospital admission with possible prolonged stay. From here, there are innumerable paths to extreme illness or even death.
In trying to fight the virus without an assist from the vaccine, patients who show up or are sent to the emergency room have myriad of fish out of the water symptoms: the inability to catch their breath, heaving breaths like they are running marathon; that’s how hard patients at this stage of the illness are breathing, except they are not moving, just existing. And just existing is exhausting. They complain of burning lungs that feels like needles are poking them, tightness and a weight in their chest, feelings of exhaustion and drowning. Their respiratory rates are often double or triple the typical 12-16 breaths per minute.
At this point, most patients have worrisome oxygen levels. Standard oxygen therapy often doesn’t cut it, nor does cranking up high-flow oxygen. Instead, patients need the oxygen forced down their lungs with a BiPap machine, a type of noninvasive ventilator where a mask is strapped to your face. Often times, patients are proned — lying face down to improve ventilation.
Meanwhile, inflammatory cells and fluid are flooding their lungs, where the virus is slowly overtaking the tiny sacs that are responsible for air exchange. These sacs, the alveoli, usually exchange carbon dioxide for oxygen so that your body can send this freshly oxygenated blood to your heart, brains and other vital organs. But now, the cells that do this gas exchange are overtaken by the virus. Each cell that is taken over bursts forth more virus to infect more cells. The very cells that take our carbon dioxide and exchange it for fresh oxygen are blocked from doing this vital task. It’s no surprise that oxygen levels drop.
When the BiPap machine is not enough to keep patients stable and oxygenating their blood, the unvaccinated must move to a ventilator. Many clinicians have described this as the 50-50 point, where the odds of survival are like a coin toss.
This is when — alone, because visitors are not allowed during the pandemic — an unvaccinated person will say goodbye to family on FaceTime. Unless, of course, the patient did not have the luxury to plan this because of the need to be intubated as an emergency. My ICU colleagues tell me that it is usually it is the family who is crying on the screen and not the patient — because the marathon-breath breathing patient is too exhausted to muster the strength for sobs.
Imagine not having enough energy to cry for your last goodbyes.
The unvaccinated patient is then readied for a machine to breathe for them with sedatives and paralytic drugs. Perhaps this is a patient who can make it. But perhaps this is the patient who then goes into kidney failure and also needs to be connected to a dialysis machine. Or perhaps this is a patient for whom the ventilator isn’t enough and needs to be put on a heart-lung machine called ECMO, because at this juncture the patient needs a machine to do both the job of the heart and the lungs. And, hopefully, while all this is going on, the patient doesn’t have blood clots in the brain called “shower” emboli or suffered from a spontaneous pneumothorax — a punctured lung, or any number of life-ending complications that can so readily occur at this stage.
Patients only get to this point if they live in a state that had mask and vaccine mandates and have hospitals that aren’t overrun and rationing care a year and a half into a pandemic. So, they have access to BiPap, ventilators, ECMO and ICU beds. They’re lucky enough not to have their family scouring for a hospital bed on social media.
By this point, if they survive, unvaccinated patients are unrecognizable with a puffy, fluid-logged bodies, connected to endless lines and tubes and wires and catheters, suffering from not just the ravages of the virus, but from the effects of all of these necessary but invasive interventions that have kept them alive.
For medical staff, it was one type of trauma taking care of patients at this stage when there wasn’t a vaccine. But when a patient who chose not take a vaccine hits this point in their disease course, the care team hits a depth of devastation and despair like no other.
The pervasive feeling of “it didn’t have to be this way” haunts the room, especially with younger patients in their 30s and 40s who have been admitted in larger numbers during this delta wave.
It is called the novel coronavirus for a reason — it is a strain not previously identified in humans. Because of this, we have not developed immunity from it, and thus, it makes all of us more susceptible to getting it and spreading it.
So, yes, you can still get COVID if you are vaccinated. But my ICU colleagues will likely not be sticking a tube down your throat to help you breathe because your adaptive immune system lost its race with the virus. Yes, you can still get COVID if you are vaccinated. But you will likely not be the patient my nephrology colleague will have to put on dialysis because of the kidney damage done by the virus.
If you were going to be in a fight for your life, would you want to be armed and ready or still fashioning your weapons after the enemy has attacked? That is my answer to NBA players like Beal and others who are still unclear on the reason for vaccination. Being unvaccinated means that you are unarmed and unprepared for an attack, with luck as your only weapon.
Without a shot in your arm, you’re heading into the fight of your life blind.
Oct. 15, 2021Updated: Oct. 15, 2021 7:50 p.m.
For the first several months after COVID vaccines became widely available, I often had to fend off queries from skeptical patients about whether the risks of getting the vaccine were worse than the benefits.
“Why should I get the vaccine when I have heard about all these side effects?”
My answer was to immediately point to our local hospital and tell them about how almost all the COVID beds and intensive-care units were filled with the unvaccinated.
More recently, however, as reports of some breakthrough infections of the vaccinated began to make news, the FAQ by unvaccinated patients started to change.
“Why should I bother getting the vaccine when I can get COVID anyway?”
This line of questioning isn’t unique to my patients. In the words of still unvaccinated NBA superstar Bradley Beal: “I would ask the question to those who are getting vaccinated ‘Why are you still getting COVID?’”
Well, here’s my answer to Mr. Beal and anyone else who has a similar inquiry:
COVID vaccines are wildly successful in reducing transmission, hospitalization and death. Unvaccinated people are eight times more likely to be infected, 29 times more likely to be hospitalized and 11 times more likely to die than their vaccinated peers. However, while these vaccines were designed to create long-lasting immunity in the blood, they are less effective at creating local immunity in the upper airways. As a result, both the vaccinated and unvaccinated can accumulate large viral loads of the very effectively replicating delta variant in their noses and throats (though the viral load comes down more quickly in a vaccinated person, making them contagious for a shorter period of time).
However, this is where the similarity ends between those who are protected by vaccines and those who are not. The immune system can be complicated, but some basic understanding of how it works can go far in relaying the importance of getting your COVID shot.
Our initial response to any pathogen is the same, whether vaccinated or unvaccinated: Our innate immune system recognizes an invader and launches a non-specific response to the attacker. This first line of defense — consisting of white blood cells such as neutrophils and monocytes — is immediate but short-lived, lasting hours to days.
We know the main points of entry for the coronavirus are our noses and throats. Both the vaccinated and unvaccinated who feel ill can experience familiar symptoms like cough, sore throat, nasal congestion, fever, body aches, headaches and something unfamiliar that often freaks people out the most: loss of taste and smell.
These symptoms can last a week while the other part of the immune system tries to marshal the resources to fire up the second line of defense: the adaptive immune response.
Here is where an unprotected, unvaccinated patient can have a very different experience from one who is vaccinated. Those who have been vaccinated carry deeper immunity circulating in their blood that will prevent their organs from getting overwhelmed with the virus.
Those without that protection can enter the fight of their life. Here’s why:
The adaptive immune response, the more specific of the responses, can take days to weeks to fire up. It is a race against the virus to see which will be faster.
This part of the immune system is made of white blood cells called lymphocytes, and some of the cells that offer long-term protection are “memory” B cells and the “killer” T cells. The vaccinated body has B cells that have been primed to swiftly recognize and remember what the spike protein of the virus looks like and make specific defender antibodies. And it makes T cells that are ready to rapidly attack and eliminate infected cells. When this part of the immune system has been given this leg up, talking to my vaccinated COVID patient sounds like this: “Yeah, the cough has gotten a lot better and the body aches are gone. I am definitely on the upswing.”
For the unvaccinated, however, the fight is just beginning.
Without the aid of a vaccine, the immune system takes longer to produce longer-lasting, more specific antibodies to fight COVID — antibodies that would have already been there had their adaptive immune system been exposed to the vaccine beforehand. And while an unvaccinated person’s body is taking its sweet time ramping up these defenses, the COVID virus is replicating, taking over cells and doing a hop, skip and jump down to the lungs while wreaking havoc along the way.
Talking to an unvaccinated patient in week two of symptoms can sound more like this: “This cough is not going away, and I feel out of breath when I walk around the house and my oxygen level on the machine goes down to 94%.”
There is a good chance you can hear these patients struggle to catch their breath when they are speaking.
These and other high risk patients are who we try to hurry in for what’s known as monoclonal antibody treatment, an infusion of synthetic antibodies made in a lab which can prevent further deterioration of symptoms. (Vaccinated patients have already made a natural version of these antibodies via their own adaptive immune system.) This treatment is still under emergency use authorization by the Food and Drug Administration, but for some reason many patients are more open to getting it than the Pfizer vaccine that now has full FDA approval.
If an unvaccinated patient is unable to get monoclonal antibody treatment in time — as many still aren’t — or it isn’t effective, that likely means a hospital admission with possible prolonged stay. From here, there are innumerable paths to extreme illness or even death.
In trying to fight the virus without an assist from the vaccine, patients who show up or are sent to the emergency room have myriad of fish out of the water symptoms: the inability to catch their breath, heaving breaths like they are running marathon; that’s how hard patients at this stage of the illness are breathing, except they are not moving, just existing. And just existing is exhausting. They complain of burning lungs that feels like needles are poking them, tightness and a weight in their chest, feelings of exhaustion and drowning. Their respiratory rates are often double or triple the typical 12-16 breaths per minute.
At this point, most patients have worrisome oxygen levels. Standard oxygen therapy often doesn’t cut it, nor does cranking up high-flow oxygen. Instead, patients need the oxygen forced down their lungs with a BiPap machine, a type of noninvasive ventilator where a mask is strapped to your face. Often times, patients are proned — lying face down to improve ventilation.
Meanwhile, inflammatory cells and fluid are flooding their lungs, where the virus is slowly overtaking the tiny sacs that are responsible for air exchange. These sacs, the alveoli, usually exchange carbon dioxide for oxygen so that your body can send this freshly oxygenated blood to your heart, brains and other vital organs. But now, the cells that do this gas exchange are overtaken by the virus. Each cell that is taken over bursts forth more virus to infect more cells. The very cells that take our carbon dioxide and exchange it for fresh oxygen are blocked from doing this vital task. It’s no surprise that oxygen levels drop.
When the BiPap machine is not enough to keep patients stable and oxygenating their blood, the unvaccinated must move to a ventilator. Many clinicians have described this as the 50-50 point, where the odds of survival are like a coin toss.
This is when — alone, because visitors are not allowed during the pandemic — an unvaccinated person will say goodbye to family on FaceTime. Unless, of course, the patient did not have the luxury to plan this because of the need to be intubated as an emergency. My ICU colleagues tell me that it is usually it is the family who is crying on the screen and not the patient — because the marathon-breath breathing patient is too exhausted to muster the strength for sobs.
Imagine not having enough energy to cry for your last goodbyes.
The unvaccinated patient is then readied for a machine to breathe for them with sedatives and paralytic drugs. Perhaps this is a patient who can make it. But perhaps this is the patient who then goes into kidney failure and also needs to be connected to a dialysis machine. Or perhaps this is a patient for whom the ventilator isn’t enough and needs to be put on a heart-lung machine called ECMO, because at this juncture the patient needs a machine to do both the job of the heart and the lungs. And, hopefully, while all this is going on, the patient doesn’t have blood clots in the brain called “shower” emboli or suffered from a spontaneous pneumothorax — a punctured lung, or any number of life-ending complications that can so readily occur at this stage.
Patients only get to this point if they live in a state that had mask and vaccine mandates and have hospitals that aren’t overrun and rationing care a year and a half into a pandemic. So, they have access to BiPap, ventilators, ECMO and ICU beds. They’re lucky enough not to have their family scouring for a hospital bed on social media.
By this point, if they survive, unvaccinated patients are unrecognizable with a puffy, fluid-logged bodies, connected to endless lines and tubes and wires and catheters, suffering from not just the ravages of the virus, but from the effects of all of these necessary but invasive interventions that have kept them alive.
For medical staff, it was one type of trauma taking care of patients at this stage when there wasn’t a vaccine. But when a patient who chose not take a vaccine hits this point in their disease course, the care team hits a depth of devastation and despair like no other.
The pervasive feeling of “it didn’t have to be this way” haunts the room, especially with younger patients in their 30s and 40s who have been admitted in larger numbers during this delta wave.
It is called the novel coronavirus for a reason — it is a strain not previously identified in humans. Because of this, we have not developed immunity from it, and thus, it makes all of us more susceptible to getting it and spreading it.
So, yes, you can still get COVID if you are vaccinated. But my ICU colleagues will likely not be sticking a tube down your throat to help you breathe because your adaptive immune system lost its race with the virus. Yes, you can still get COVID if you are vaccinated. But you will likely not be the patient my nephrology colleague will have to put on dialysis because of the kidney damage done by the virus.
If you were going to be in a fight for your life, would you want to be armed and ready or still fashioning your weapons after the enemy has attacked? That is my answer to NBA players like Beal and others who are still unclear on the reason for vaccination. Being unvaccinated means that you are unarmed and unprepared for an attack, with luck as your only weapon.
Without a shot in your arm, you’re heading into the fight of your life blind.
