COVID-19 - Wuhan Coronavirus (a non-political thread, see pg. 36 #1778)

[sterlingice]

Texas's data dashboard is (intentionally) just awful:
News Updates

They have a spreadsheet with very limited data and a couple of other sheets that look like they were put together by an intern.

Weirdly, they have an MIS-C dashboard, but not one for COVID itself.

You can dig in to a bit more data here:
Texas COVID-19 Data
However, they also mention that they migrated a bunch of their data into a new database back in July and somehow that's still not completed so the results aren't available...?

Again, it's almost as if they were trying to not provide the data.

SI

[JPhillips]

Originally Posted by Ksyrup

At this point, I feel like the only people we should care about are the people who can't help themselves - the young, the old, the infirm. Protect them, fuck the rest, and penalize those who put those who need to be protected in harm's way. Everyone else should be free to live and take whatever additional precautions they feel are necessary (masking, virtual attendance, etc.) to deal with the unvaxxed assholes they unfortunately may come across in public.

That's fine to say, but there are still almost 10k dying this week and that has to be dealt with in some manner. Given the opposition to public health restrictions, I think the only way out now is a variant that is more transmissible but less lethal. Maybe that's omicron.

[Ksyrup]

Who are they though? Who makes up the current 10K deaths a week? According to the CDC, 87% of Americans aged 65 and older are fully vaccinated. So if the vast majority of deaths are 40-80 year olds who willingly won't get vaccinated, I think at some point we "deal with it" by moving on and letting them dig their own graves.

Yes, there will be some level of otherwise preventable deaths and also some level of deaths no matter what we do. But it feels like we're quickly approaching diminishing returns with no viable answer on how we get to a "comfortable" place where some variant of Covid is always with us.

[JPhillips]

Hospital beds are being filled, ventilators are being used, and costs have to be paid by someone. We're again seeing hospitals at ICU capacity and we know the trickle down effect that has on other procedures.

I share the frustration, but I don't think it's realistic at the moment to just ignore the carnage and move on.

[molson]

Originally Posted by JPhillips

That's fine to say, but there are still almost 10k dying this week and that has to be dealt with in some manner.

Like with a vaccine?

[Brian Swartz]

Originally Posted by Lathum

I have a hard time caring about someone who willfully choses to put themselves at risk.

I know some people take that view. To me it's an attack on our common humanity. If we are only going to empathize with people who make decisions we approve of, we are effectively saying it's ok to treat the Other as subhuman.

There are few things that I would spend more energy and time stridently opposing.

[Ksyrup]

Decisions have consequences. Freedom cuts both ways. I am just giving them the same level of care they are showing themselves and others. Cutting these people any slack simply rewards bad, selfish behavior. Because while they have a choice, there's only one correct decision to make. So be free to die, and enjoy your choice while you still have time.

[JPhillips]

Originally Posted by molson

Like with a vaccine?

Yes. I'm in favor of more mandates, although that gets difficult because Trump appointees have shown they'll kill them. I'd also like to see Dems go much harder at the GOP for refusing to do what's needed.

My point isn't that we should coddle the unvaccinated, just that we can't realistically ignore them so long as the death and hospitalizations rates are so high. They're doing too much damage.

[molson]

I don't see anything else that can realistically be done. There's better treatments on the way. Otherwise, this is what it is.

[cuervo72]

Originally Posted by Ksyrup

Decisions have consequences. Freedom cuts both ways. I am just giving them the same level of care they are showing themselves and others. Cutting these people any slack simply rewards bad, selfish behavior. Because while they have a choice, there's only one correct decision to make. So be free to die, and enjoy your choice while you still have time.

Or in other words: "Cut me some slack, Jack! Chump don' want no help, chump don't GET da help! Jive-ass dude don't got no brains anyhow! Shiiiiit."

[RainMaker]

Originally Posted by Brian Swartz

I know some people take that view. To me it's an attack on our common humanity. If we are only going to empathize with people who make decisions we approve of, we are effectively saying it's ok to treat the Other as subhuman.

There are few things that I would spend more energy and time stridently opposing.

Would you say the same thing about a mass shooter? What about someone who wants to dump some toxic waste in your drinking supply? Just curious where the line is drawn at people who are actively trying to kill others.

[JPhillips]

Originally Posted by molson

I don't see anything else that can realistically be done. There's better treatments on the way. Otherwise, this is what it is.

I doubt anything will work, but we won't get back to normal so long as deaths and hospitalizations are still so high. Morally people won't accept 10k dead a week and practically a lot of the vaccinated are at risk when hospitals are full.

[RainMaker]

Originally Posted by JPhillips

Morally people won't accept 10k dead a week and practically a lot of the vaccinated are at risk when hospitals are full.

I think they absolutely will. If we've learned anything from this pandemic, it's how little this country values human life.

[Ksyrup]

Originally Posted by JPhillips

Yes. I'm in favor of more mandates, although that gets difficult because Trump appointees have shown they'll kill them. I'd also like to see Dems go much harder at the GOP for refusing to do what's needed.

My point isn't that we should coddle the unvaccinated, just that we can't realistically ignore them so long as the death and hospitalizations rates are so high. They're doing too much damage.

Again, I ask - to whom? Mostly, to themselves I believe. I tried to parse through online data and it was nearly impossible to find something simple that would allow me to see the ages and vaccination status of Covid deaths for the past 3 months. But that's what I would like to see.

[RainMaker]

If you can deal with the weird music, someone on Reddit charted out some of the data you're asking about. The beginning shows the rates between vaccinated and unvaccinated. The end shows the rates of death by age.

[OC] U.S. COVID-19 Deaths by Vaccine Status : dataisbeautiful

[Lathum]

Originally Posted by Brian Swartz

I know some people take that view. To me it's an attack on our common humanity. If we are only going to empathize with people who make decisions we approve of, we are effectively saying it's ok to treat the Other as subhuman.

There are few things that I would spend more energy and time stridently opposing.

It isn't about making decision we approve of, it is about making decisions for the common good.

You cool with someone who drives drunk putting others at risk even though you disapprove of their behavior?

[Lathum]

Originally Posted by sterlingice

What can schools do to "get it together" and be more normal?

EDIT: Not trying to be a smartass about this - but like schools in Texas have mostly been back to normal with optional masking and security theater-esque cleaning protocols. They pass out rare exposure emails like a week late but I don't even know if you have to take action anymore.

Of course, Texas stopped providing COVID data for kids because, if it you can't track it, it's not a problem: https://downloads.aap.org/AAP/PDF/AA....9%20FINAL.pdf

SI

We can start treating covid like any other illness. If you have it you stay home from school until you are better, like strep, flu, etc...My son is on virtual for 2 weeks because of a close contact on the bus. He can't test back and he is vaccinated. He had a breakdown today because he is frustrated. Meanwhile a kid who goes home with symptoms can test negative and go back the next day.

At this point you are choosing to not get your kids vaccinated. I am sick of my kids education suffering because of it.

[Brian Swartz]

Originally Posted by RainMaker

Would you say the same thing about a mass shooter? What about someone who wants to dump some toxic waste in your drinking supply?

I'd say the same thing about anyone. There's no possible example of human depravity so extreme that I think it's appropriate for me to be indifferent to their fate. When it comes to that, it really comes down to understanding that it's extremely likely I wouldn't behave a lot better if I had their genetics, life experience, etc. People who do those things are not generally fundamentally different from me/you/us, and we're not 'better'. Disregarding anyone cheapens everyone, etc.

Originally Posted by Lathum

You cool with someone who drives drunk putting others at risk even though you disapprove of their behavior?

I'm not sure what you mean by 'cool with'. Do I like the fact that they do that? No. Do I oppose the behavior? Yes. Do I think it gives me any license or justification at all to not care if they die/other bad things happen to them? No.

[Ksyrup]

Originally Posted by Brian Swartz

I'd say the same thing about anyone. There's no possible example of human depravity so extreme that I think it's appropriate for me to be indifferent to their fate.

I am not indifferent to their fate. I simply accept that they are indifferent to their fate.

[Brian Swartz]

On that we are in agreement.

[sterlingice]

Originally Posted by cuervo72

Or in other words: "Cut me some slack, Jack! Chump don' want no help, chump don't GET da help! Jive-ass dude don't got no brains anyhow! Shiiiiit."

"Stewardess, I speak jive"

SI

[Mota]

Originally Posted by molson

Like with a vaccine?

Yes, but from what I'm reading, 2 doses of a vaccine give you about 37% effectiveness against Omicron. The 3rd booster shot gets you into the 70'ish percentages. So it's not the endgame anymore, the game has changed.

[molson]

Its still the end game, it's just a less definitive end game. The vaccine will be tweaked and onward we go.

[Lathum]

Pro sports are at a real crossroads. Cases exploding in the NBA and NFL. Games being PPD. Curious to see what they will do.

[bhlloy]

I think the NHL and NBA need a bubble to get the season done (or shave about 20 games off the schedule) and the NHL at the Olympics is an absolute pipe dream at this point.

NFL can probably get through it with less travel and larger rosters if the players aren’t absolute morons, but I have no idea what you do if a team has an outbreak during the playoffs or even god forbid the week of the super bowl. Imagine trying to sell a SB game where both starting QBs are on the Covid list.

[sterlingice]

They'll eventually scale things back to where if you're asymptomatic and have had a negative test or two, you're cleared to play. I just think it's going to take 1 more season/year to get there, barring some super awful variant where mortality rates go up.

SI

[Edward64]

Somewhat interesting read on Sinovac. Small sampling size but out of 25, none showed "neutralizing antibodies". So I guess this mean it'll be infectious as heck in China but assume still relatively mild outcomes.

From what I've read so far, omicron is no where near as bad as Delta in terms of hospitalization and mortality. But because it can infect so many more people, chances for more mutations is going to be a problem.

But then from prior reads (and posts), mutations are generally supposed to be less severe and lethal? Lots of science, immunology mumbo jumbo context that I'm sure we don't know about.

China's Sinovac vaccine 'inadequate' against omicron variant, study finds - MarketWatch

A study has showed that China’s widely used Sinovac vaccine failed to produce sufficient antibodies to neutralize the omicron variant.

A team at the Department of Microbiology of the University of Hong Kong analyzed serum antibodies from 25 people fully vaccinated with CoronaVac, developed by Sinovac, as well as a separate group of 25 more who had received two doses of the COVID vaccine from Pfizer PFE, +0.62% and its German partner BioNTech BNTX, -0.52%.

None of the 25 vaccinated with two doses of the Sinovac vaccine showed any neutralizing antibodies against the omicron variant.

Of the Pfizer-BioNTech group, five showed neutralizing ability, though with vaccine efficiency “significantly reduced” to 20% to 24%. Compared with the original COVID strain, neutralizing antibodies against omicron dropped by 36 to 40 times in that group, the study said.
:
:
Scientists are still racing to learn how well current vaccines will hold up against the rapidly spreading omicron variant, which was brought the world’s attention by South African scientists in late November.

A large-scale study of omicron in South Africa, also released Tuesday revealed that two doses of the Pfizer and BioNTech vaccine provided 33% protection against infection but 70% protection against hospitalization, the Associated Press reported.

[flere-imsaho]

Originally Posted by Ksyrup

I've been as pro-vaxx and pro-mask as anyone (particularly someone who still considers themselves to be "conservative" (in the apparently ancient/irrelevant meaning of the term today)), but I'm struggling to understand what the go-forward strategy is for dealing with Covid.

I suspect we'll settle into a rhythm where we see twice-yearly boosters to deal with the variants and the cadence will be similar to the flu, for those who routinely get vaccinated.

Pfizer's treatment drug is showing incredible efficacy, so once that's available widely we should stop seeing almost anyone who is vaccinated suffer severe consequences.

Probably for the next year we'll still see strain on the hospital system due to the unvaccinated, but eventually a combination of those people dying + those people building up some antibody load + the Pfizer drug will put this to bed.

It would, of course, be over a lot sooner if everyone got vaccinated, in fact there probably could have been a good shot at flat-out eradicating it, given the manufacturing capability Pfizer alone has shown, but this is not the world in which we live.

[flere-imsaho]

Originally Posted by Edward64

From what I've read so far, omicron is no where near as bad as Delta in terms of hospitalization and mortality. But because it can infect so many more people, chances for more mutations is going to be a problem.

But then from prior reads (and posts), mutations are generally supposed to be less severe and lethal? Lots of science, immunology mumbo jumbo context that I'm sure we don't know about.

It's complicated, but generally the problem a more lethal strain of the same virus has is that it can't outcompete a less lethal strain for hosts. The less lethal strain has an easier time spreading because it a) doesn't kill so many of its hosts and b) a lot of its hosts don't even realize they're carrying the virus.

So basically you have a less lethal strain out there, infecting hosts left and right and causing those hosts to build up antibodies. Along comes the more lethal strain, encountering these hosts. It either a) loses against those antibodies and can't propagate or b) wins, but then kills the host and doesn't propagate as much.

[Mota]

This is to show how quickly it is changing from Delta to Omicron. Data is from Ontario Canada. They anticipate Omicron to be the dominant strain by January.

Date % Delta % Omicron
Sept 1 99.4% 0%
Oct 3 99.0% 0%
Nov 1 97.1% 0%
Dec 1 99.9% >0%
Dec 9 90% 10%
Dec 10 88.7% 11.3%
Dec 12 79.2% 20.8%
Dec 13 69.2% 30.8%
Dec 14 68.1% 31.9%

R(t) Delta = 1.10 R(t) Omicron = 4.29

[bhlloy]

And honestly, if I’m understanding this right it doesn’t really matter that Omnicron is less lethal than Delta if it’s infecting 4x the people. Hospitals are going to be completely overwhelmed just due to the sheer numbers - presumably it would need to be nearly 4x less severe/lethal to have no effect.

[molson]

The overall numbers really haven't boomed that much in the U.S. yet. Maybe something to people not knowing they have it, whereas heavily tested populations like sports leagues see the bigger impact. I'm reading that all of those cases have mild or no symptoms.

[bhlloy]

The UK is seeing the case numbers boom - hospitalizations haven’t caught up but they are expecting them to.

[bhlloy]

DOLA - I’m also not sure we should take the status of 20-35 year olds who are among the .1% most physically fit population to be representative of what happens when this thing really hits the wild.

[Mota]

Originally Posted by bhlloy

The UK is seeing the case numbers boom - hospitalizations haven’t caught up but they are expecting them to.

Hospitalizations usually lag 2 weeks behind the numbers. That's when we'll have a better idea. I'm of the belief that the infections aren't as bad, but with the sheer number of people that will be getting it, it will push any health dept to the limit.

[molson]

The UK's ebbs and flows look a lot different than the U.S.'s. The U.S. had the Fall Delta boom and then dropped more than half going into early November, before creeping up again, and now actually going down slightly the last week or two. The UK never had that kind of drop, their new cases have been consistently high since July.

Maybe there's testing differences, or the U.S. had developed a hardy population of COVID survivors, and more of our most vulnerable killed off already.

[Ksyrup]

I suppose the only way to argue against this is to claim it's all just made-up, bogus data? Or it's using selective Covid data for Dems but including every kind of death for GOP? Or that you don't care, if you're going to die, you'll die on your own terms 10-20 years ahead of your life expectancy, which is a right our forefathers fought the British for?

That’s one way to turn Texas blue, but I don’t support it. https://t.co/Bikrc7Nreb

— Eric Kleefeld (@EricKleefeld) December 16, 2021

[Lathum]

‘Hamilton’ Is Latest Broadway Covid Cancellation – Deadline


We are supposed to go see Hamilton next Thursday. We are really looking forward to it and I suspect it may not happen. If it doesn't happen I'll be really bummed for my niece who we are taking. She is 22 and a student. Her mom, my sister, is a widow and dirt poor so she has never really done anything like this. We even rented a limo to take us in. Should be a great day, I hope it happens.

[whomario]

The UK will also run out of tests well before hitting peak infections. Also, re:mild. Figuratively half the country being laid low with 'only' flu like sysmptoms isn't exactly going to be smooth going, either. I mean, even with extra protection at work this will impact hospital workers as well. Meaning trouble even IF you go to crisis standards in terms of isolation measures for those infected.

Originally Posted by Edward64

But then from prior reads (and posts), mutations are generally supposed to be less severe and lethal? Lots of science, immunology mumbo jumbo context that I'm sure we don't know about.

1) Mutations are random. Entirely. It's literally the virus copying itself and screwing up. Some do it more than others (Measles almost none, HIV constantly). This one does it less than, say, Influenza, due to a rudimentary proof reading mechanism. But still plenty, aided by getting a billion chances.

The single most influential sets of mutations are those aiding spread directly. It could of course also be sth. indirect like causing less symptoms (people spread it more unwittingly), but more likely it's stuff like replicating better, replicating for longer, being better at 'docking' onto the next person etc. That's just the most logical advantage and (best i know) more likely simply due to a lot more available combinations of mutations. And remember that the 'base virus' and the first relevant variants already was extremely well adjusted for the whole "don't be too severe to spread" thing by having a pretty sizeable incubation period/pre-symptomatic viral load, lots of replication in the upper respiratory tract and illness progressing relatively slowly even in those then getting very sick (with Influenza you are bedridden within 2/3 days, with Covid a person entering Hospital today might have well been infected 2 weeks ago and doing just fine with a bit of a cough for days on end).

This article explains much of what i now have typed as well, silly me for not looking first ...

https://www.nytimes.com/2021/12/10/o...ve-milder.html

Since i got going now, my 2 cents on this and other stuff (and i am not privy to first hand knowledge ...). Overall i think it has been a great failure of most journalists/Media as well as PH communication not to explain some of the basics and instead going straight for, figuratively speaking, chapter 10 or just not explaining anything, dumbing things down beyond the point of actually teaching anything. There's a few exceptions of course (The Atlantics Ed Yong had a couple good explainer type articles for example, some scientists do great work on Social Media or some on Podcasts. In Germany the preeminent Scientist working on Coronaviruses, ever since the first SARS, has a hugely informative Podcast etc).

Anyhoo ...

2) The vast majority of mutations are meaningless, because they are in areas of the genome that play no part in interacting with us (not playing a role for infection, replication or pathogenicity). Many others are in these areas but still don't really change the overall characteristics. Others still are dead ends because their end result is being less good at spreading than others in the same region or rather being not good enough to sustain R>1 in the region under the given circumstances. Then there are those that do, these are the ones the public gets aware of, getting greek letters attached.
But there's been literally hundreds of lineages, not even counting individual mutations (a shit ton).

In case anybody wants to have a look:

Cov-Lineages

3) This virus is well good enough at sneaking in and out of hosts that there is very little difference killing the host or not makes. But ... Why would this be even remotely relevant for 21st century humanity anyway for a virus like this ? Unless dramatically different in the other direction (the Ebola route) ? Even if one wanted to go into some simplified modelling here: 99,9% of people that die are isolated to some extent (or contacts take extra precautions) many days before dying. You don't have people running around infecting people until they die. (Heck, even if they were: By the time people die many, especially the 'fitter' one before catching it, aren't even infectious anymore. Viral load is going like a Bell curve). I really don't think it makes a difference for the virus if it kills 0,05% or 5%. And as said, it already makes it's host most infectious when symptoms are still mild and pretty infectious even without/before symptoms. A variant evading immunity or being more infectious by producing more virus more quickly (Delta) has much more potential to set itself apart.

Again, none of this is anything happening by design but is a numbers/odds game more than anything.

4) Actually there isn't ANY reliable and relevant info on severity yet, except some early ones from the UK and DK, which were super small sample size yet for severe cases. All else we have is annecdotal data (yes, "less total patients" in South Africa, where hospital cases are flying up though now btw, is also annecdotal).
We had the exact same dance with Delta, with hot takes taking lower total numbers early and lesser percentages of severe cases (due to increased testing compared to earliest waves and of course then Vaccines/Immunity) as proof of decreased pathogenicity.
You need a significant amount of data points in a country equipped to collect and calculate that data by also looking at demografics, immune status and health records. If the UK or similar (Canada also does a good job with these analyses, also Denmark though the lower total numbers, as a small country, mean it takes longer) says it's milder across demografics and immune status based on their data, then we'll know.

5) There is no question it will be milder on average per infection because again a lot more people are protected to some degree (it would need to evade that by a whole damn lot to be otherwise given the increase in vaccination and esp. in the UK Infections). But that is not the same as the variant itself being milder than another variant (mostly Delta) is right now in the same population with the same protection or lack thereof.

6) And yeah, as said by others: If instead of 20% now 50% get infected over the Winter, that's a whole other cruel math exercise unless it's spectacularly less severe than Delta (and the odds for that are stupid low imo).
The same issue we have with Influenza btw: the different strains ('variants') and viruses (it's not just 1) aren't all that different in terms of pathogenicity (best i know at least), but you have seasons with many cases and those with few cases, based on the 'rythm' of the dominant strains/viruses, the amount they change (and evade prior immunity/vaccines) and how well the vaccine fits the bill (essentially you need to guess in advance based on early data from the early weeks of the waves on the other hemisphere, i.e. the US vaccine is based on the data from f.e. Australia in March/April, then produced for Sept/Oct), which of course also effects outcomes.
But the same is true here: If VE against severe disease were to drop from 90 to 75% this would mean more than twice as many severe cases. Despite obviously still protecting well more people than not.

[whomario]

This is also another great piece by Ed Yong, looking at things more broadly and expanding on the disconnect between individual (could have been plenty worse) and collective ramifications, that have been the crux of the matter ever since the start. It is going to be just fine for most people, but not enough to not be felt collectively and then trickle towards more people suffering indirectly.

America Can't Beat Omicron One Booster at a Time - The Atlanticublisher" content="https://www.facebook.com/TheAtlantic/"/>ublished_time" content="2021-12-16T12:00:00Z"/>

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[Mota]

To show how quickly Omicron is changing things in Ontario since my update yesterday...
Date % Delta % Omicron
Dec 1 99.9% >0%
Dec 9 90% 10%
Dec 10 88.7% 11.3%
Dec 12 79.2% 20.8%
Dec 13 69.2% 30.8%
Dec 14 68.1% 31.9%
Dec 15 47.0% 53.0%

R(t) Delta = 0.97 R(t) Omicron = 4.55

[Lathum]

Just saw on the ticker WFT has 21 players on the virus list including 12 starters.

[Brian Swartz]

Originally Posted by molson

s said by others: If instead of 20% now 50% get infected over the Winter, that's a whole other cruel math exercise unless it's spectacularly less severe than Delta (and the odds for that are stupid low imo).

I get the 'we don't have enough information to know' part, and that makes sense - unfortunate that there's as much jumping to conclusions as is happening from some outlets in that case. But I'm curious why you think the odds are stupid-low for it to be a lot less severe. It seems clear that it's a lot more contagious, why is it unlikely to have a similar severity shift?

[SirFozzie]

One thing that I saw today is that Omicron is 70 more times likely to spread in the Bronchial tubes then Delta, which is mostly lungs. It's when COVID gets in the lungs is at it's worst.

https://www.theguardian.com/world/20...onchial-tissue

[Mota]

I was reading up on it some more, and the hospitalizations in Europe seem to be tracking evenly with cases. We're still early in the trending, but it does seem to indicate that it's not "just a bad cold".
Our science table which does the evaluations predicts that at best it is 25% less severe, but 4x more infectious, so they think this will be the worst wave of them all.

[molson]

Originally Posted by sterlingice

They'll eventually scale things back to where if you're asymptomatic and have had a negative test or two, you're cleared to play. I just think it's going to take 1 more season/year to get there, barring some super awful variant where mortality rates go up.

SI

Looks like they're moving in this direction in the NFL. They already were clearing players fairly quickly - TJ Watt tested positive on Monday and was back by Sunday's game 6 days later. Now, after this weekend's games, as soon as a vaccinated player who tested positive then tests negative once, they're back the next day, if they have no symptoms.

[Solecismic]

Originally Posted by Mota

I was reading up on it some more, and the hospitalizations in Europe seem to be tracking evenly with cases. We're still early in the trending, but it does seem to indicate that it's not "just a bad cold".
Our science table which does the evaluations predicts that at best it is 25% less severe, but 4x more infectious, so they think this will be the worst wave of them all.

Would even 10% less severe have a huge impact on hospitalization rates? Expecting COVID not to keep mutating doesn't seem realistic. I get that we might well be headed toward yearly boosters.

I found the CDC site - particularly this page - rather helpful in making my decision to have the third booster (had it today).

CDC COVID Data Tracker

Given these numbers, though, I don't understand why the NFL has a COVID protocol anymore. These are young, healthy people who have unusual access to medical care and can choose vaccination. They stand a much larger chance of being in a serious auto accident than being hospitalized for COVID. Is there something I'm missing here?

[Lathum]

Originally Posted by Solecismic

Is there something I'm missing here?

Perception and liability

[RainMaker]

Protip: Make sure you get the booster when you don't have to work the next day. It is not fun.

[Lathum]

Originally Posted by RainMaker

Protip: Make sure you get the booster when you don't have to work the next day. It is not fun.

I was totally fine...