"You don't usually give vaccines to folks that are immunocompromised."

You mean in a clinical study or in practice or something else. Regardless, this isnt really true. It may be in some circumstances but not all.

Clinically, the immunocompromised are often those most encouraged to be vaccinated. The exception is live virus vaccines which are in the minority of vaccines. Even live vaccines are still used in immunocompromised patients at times. MMR is live. I recommended at provided it to all my HIV patients that had reasonable control, even if it wasn't perfect because the actual diseases for them would be much worse.

In studies, it depends on the study and it's criteria.

That's not true. Myocarditis has an incredibly large spectrum. Most cases are never recognized.

In the presence of a viral syndrome, the diagnosis only requires an elevation of serum cardiac enzymes. How often do physicians assess for this? Almost never. Because we don't think about it and frankly don't care for mild illnesses.

How often do routine viral syndromes like a cold cause myocarditis? We don't really know because its not well studied. However, I can tell you from experience, its not unusual to detect mild elevations of liver and cardiac enzymes when checked incidentally in the presence of a viral illness.

At least it is not only 4 light years away....

First, its really disturbing to me the authors are publishing a non-peer reviewed study and acting like this is the only possible conclusion.

Any person with no immune protection fares worse.

Look at the data close enough and you'll see there was still some benefit to vaccination after infection.

The media is a huge part of mis-information problem. Their headlines are misleading and frankly they have no business reporting on non-peer reviewed data.

Just because a substance is chemically stable doesn't mean it is biologically inactive. Many/most physiological processes are triggered by molecules interacting with receptors (ie. neurotransmitters like serotonin or dopamine, sex hormones like testosterone or estrogen).

Receptor stimulation does not always require a chemical interaction to occur.

There are a whole host of these substances used in plastic manufacturing that are known to strongly mimic estrogen and make their way into the liquids they are used to contain. There is plenty of quality data on this topic already.

Yes, this is the real dilemma. COVID-19 is very mild for a large portion of the infected. It makes detection and limitation of spread much more difficult.

Most viruses with a high-ish death rates make everyone quite ill. This one is clearly an exception.

This guy gets it.

I'm a physician but have worked in clinical informatics for the last 5-10 years and even work with some AI / machine learning gurus like you. The system is insanely complicated. I'm constantly learning new things after 20+ years in health care.

I share your feelings on the matter. I'm frequently amused by how easy some people outside the field think it is. The politics of it all is grossly oversimplified. The tech pieces also grossly oversimplified. Even people within health care have a lot of misconceptions about how things work. Its an odd field because often the people with the best ability to make sound decisions are not the ones making the decisions.

If you want to know the definitions used in the study for severe, moderate and mild disease, look up the study protocol and read it. Its publicly available.

Almost everyone has a too simplistic view of the immune system. Even the experts, if they are really an expert, will not claim to be able to predict how a vaccine will perform.

This is why high quality outcome based studies have to be done.

Outcomes have to be meaningful, not just quantification of physiological markers. Useful outcomes (those that patients will care about typically) - does it keep me from dying? Does it keep me from getting sick, missing work? Does it prevent me from developing complications of the disease (ie. permanent lung damage)? Does it prevent me from transmitting the disease to my high-risk family or friends?

Not so meaningful, does it keep my white blood cell count from rising? Who cares unless that is highly correlated with some other meaningful outcome. The lay press and people often place way too much value on studies without meaningful outcomes.

The practice of medicine is all about collecting information, placing it in the right context and using good judgement. Tests used without any context can be more harmful than good for many reasons. One is because there is no such thing as a perfect test.

Things like a thorough history and exam are where things should start. A good clinician will have a working probability of what the different possible problems are and the tests that in that situation that will be helpful to rule in or rule out working diagnosis. Some of the possible diagnosis may have tests to shed light on what's really going on. The result of the ordered tests will shift the probabilities around until you are comfortable you have the right diagnosis. A good physician is familiar with the false positive and false negative rates for tests and can ballpark on the fly how a given test result changes the likelihood that a given diagnosis is correct or not. If you are familiar with Bayesian probability, that's pretty much how it works.

The ability to do this well is probably one of the single biggest concepts in medicine that distinguishs a great physician from the rest.

There no such thing as tests in clinical medicine without false positives and false negatives. There are some that have very low rates. None are perfect.

My guess is they want to have arrangements for the contract workers similar to their own full-time employees for the purposes of the COVID-19 pandemic. The problem Amazon has, is the more they treat contractors like full-time employees, the more likely it is a court (if they are every sued over this issue) will decide the contractors are in fact Amazon employees. Amazon doesn't want that to ever happen. To minimize that possibility, Amazon is providing the funds in the form of donation. To make this look like an authentic attempt to help the contractors without treating them like employees, they are also soliciting donations from the public.

Now you could argue all day about the ethics of having all these contractor employees. I'm not speaking to that. I'm just pointing out what is probably the reason they are dealing with their contractors and COVID infection they way they are.

If things like VPN access are made easy to install and use, the vast majority will do it. Those that don't are the exception, relatively rare and usually older. Been there and done that.

This is one reason I hated working for a large health care system informatics related stuff. A few docs would be a problem but the admins and IT staff act like all physicians are a pain.

They're busy people with a lot of responsibility that they take seriously. When viewed that way, its easier to work with them.

Sure there are examples where physicians have more control of these issues but that is not typical when viewed holistically. Even in the small, independent clinic situation it isn't that simple.

It is common for vendors to take advantage of legacy issues like software running on legacy operating systems like Windows XP such that the clinic is forced to buy in to all sort of other stuff too. As someone who works for a vendor and works with other vendors, the business people fall over themselves to find ways to make the health systems get tied into their systems more and then get stuck being forced to upgrade to more expensive products in the future. it is not nearly as simple as the clinics aren't willing to fork out the money. Often health systems and clinics are purposely only presented absurdly expensive solutions when the vendor could offer much cheaper and satisfactory solutions but that won't make the vendor as much.

That's often because the system makes it hard for them to do their job well. Good systems tend to make these problems go away. Non-clinical people are often clueless when it comes to what it takes to properly do our job. Yet they ultimately make most of the decisions.