OG doc. AMA on COVID-19

yeah. they were all in the waiting period between the first and second doses of their vaccine regimes. as in, they had the first round, not the second round. should have made that more clear.

Resubscribing hopefully.

This site seems to have lost a bunch of my subscriptions, and I still don’t know how to subscribe, so hopefully this will do it.

I’m doing fine after getting my first Astrazeneca jab last week.

Dude… Click WATCHING in the lower left of the thread. Easy for most “prof’s”.

I wasn’t even subscribed to my own AMA… Fortunately, top men showed me the light.

Under “watching” it said I’d be notified of every reply. In most forums that means an email, which I don’t care for. So didn’t click that. I’ll try it.

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I looked at the Covid dashboard for Ottawa and while not super detailed it would appear that the numbers are up but doesn’t seem like the age range the media is projecting.

Based on everything I’ve seen though it seems like Toronto is the hot spot.

I wish the dashboard sites would list the total number of beds and ICU beds available in the city. Just says how many are admitted.

I think there are about 1600 ICU beds in Ontario usually. They increased that number to 2300 with COVID.

525 COVID patients in Ontario ICUs right now. It’s not dramatic.

So roughly 30% occupancy of the regular bed totals.

Not the greatest numbers but could be worse. I imagine the spread of the ICU beds are probably concentrated in the major cities.

I don’t get any emails. You might be able to set that up in your profile but yeah the hell with that. Watching works :+1:t3:

Hi Mata, thanks for all your input over the last year, super helpful even to those of us who only read but never posted before :slight_smile:

I have one question regarding vaccination and pregnancy: I searched the thread and saw your latest recommendation from early January which is that “the risks and unknowns favor no vaccination for now”. Has your view changed since then given the more recent (but still limited) data?

My wife is 34 years old, 20 weeks pregnant with our second child, and healthy. Her OB is recommending getting vaccinated, as are most of our doctor family and friends. They say the recent data shows the risks of COVID-19 in pregnant women are higher than in otherwise healthy young women, and now probably outweigh the very low risks from vaccination. They’re not super insistent on it especially after we tell them we lead a pretty safe life (live in Boston but spend time mostly at home outdoors, some indoor shopping), but still recommend it. We do have a 2-year old that stays home with us but we take to parks/jungle gyms/aquarium/etc and want to put him in daycare starting in May (not full-time, just a few hours a week for his own development), so that increases our exposure somewhat.

This summary article is reassuring: Is it safe for pregnant people to get the Covid-19 vaccine? - Vox
It says that the American College of Obstetrics and Gynecology, the Society for Maternal-Fetal Medicine, and others are at minimum suggesting the vaccine should at least be offered to pregnant women (though not going as far as to recommend it just yet, leaving it as a personal decision). The American Society for Reproductive Medicine is recommending it though.

Secondary question, assuming you’re not totally opposed to vaccination during pregnancy, is around timing. Many doctors are saying to wait until after the first trimester so that the baby is essentially fully formed, but it seems Israel is now promoting it at all stages: https://www.haaretz.com/israel-news/.premium-israel-recommends-covid-vaccination-in-all-stages-of-pregnancy-updating-guidelines-1.9501486
This is also relevant: COVID Shot Earlier in Pregnancy Better for Baby

There are plenty more articles we looked at (some with horror stories about pregnant women who weren’t vaccinated and caught COVID), and more data is coming out all the time, but would love to hear if your position has changed recently. Thanks a lot!

These are good questions.

First off: full disclosure, I rarely treat pregnant women, so my experience and knowledge is very limited.

Many infections in pregnancy are benign, but there are others like Varicella (chicken pox) that may be life-threatening.

I’m a little concerned that pregnant women have been vaccinated for COVID in the “real world” despite that they were purposely excluded from phase 3 trials. Obviously, many got vaccinated without knowing they were pregnant. Still, we can analyze the 40 000 that have been vaccinated so far. In short:

  1. We do know that pregnant women have higher risks from COVID, based on 1 meta-analysis of 77 cohort studies of 11 000 women. For the same age, pregnant women had a 62% higher risk of being admitted to the ICU and a 88% higher risk of needing a ventilator (I’ve seen higher numbers elsewhere). These numbers look scary, but again remember that the baseline risk is small (if the chance of being admitted to the ICU is 1% a 88% increase means 1.9% which isn’t that impressive). Nevertheless, if the data is true that 5-7% of pregnant women get admitted to the ICU, this is indeed a large number. There are also heightened risk of miscarriage.

  2. The risks for the baby appears small if the mom gets COVID.

  3. The short-term side-effects of the COVID vaccine to pregnant women appear infrequent.

All in all, I’m not against it, but I would prefer if a robust phase 3 prospective trial was available to confirm this (instead of phase 4 post-marketing data). I know that a few phase 3 trials have started (including the Pfizer one mid February)

I think most obstetric societies are SUGGESTING FOR vaccination. This is weaker support than a RECOMMENDATION FOR. So, yes, based on these data, my opinion has changed lately although I still have reservations, especially since you guys appear risk averse and are probably not around COVID positive people. I can’t inform you on timing of the vaccine.

Conclusion: Your OB surely knows a lot more than me and I would defer to him/her.

Here’s a pretty decent paper: https://www.nature.com/articles/d41586-021-00578-y
Another one: https://www.nichd.nih.gov/sites/default/files/inline-files/NICHDCouncil_Erbelding_090720V2.pdf

Fantastic, thanks so much for your thorough reply doc. BTW my wife and I are both from Montreal and grew up there, with our parents and siblings and friends still there. Wouldn’t be surprised if we’re only 1 or 2 degrees of separation away, either through BJJ or the medical community :slight_smile:

If you did BJJ in Montreal, I likely have tapped out from a straight armbar against you at some point.

Ha! I did train at GAMMA in Montreal from about 2000 to 2005 before moving to the US. Did my fare share of tapping too…

Ok I’ll stop derailing the thread.

mmm, at this moment i am kinda screwed.
received my first jab of AZ Feb and would got the second one in May.
My country stopped AZ below 60 and no solution yet.

Elective surgeries are getting cancelled in Canada again. I think it’s an Ontario thing

The fuck is wrong with Canada?

Many things.

Let’s just say that all countries that have succeeded with vaccine production / distribution / administration have done better than those that did not (like Canada).

The US, UK, Israel are leading the way.