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About cangelmd

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    Celebrity, princess
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  1. I have had many excellent dishes on Celebrity, in the MDR as well as specialty restaurants, but I have to admit when I saw this thread, the first thing I thought of was the worst food I had on Celebrity - the meat loaf in Blu. We were toward the end of a transatlantic, and I should have said lets go to OVC and just have a salad, but dinner is our most looked forward to evening entertainment, so there we were and I tried the meat loaf - just say no to the meat loaf and have a different wonderful choice. The Indian food is great - if you like it or want to try something beyond the OVC offerings, they do an Indian multi-course dinner one evening in Sushi on Five. This was on Reflection, but I think they have done it on other ships as well. Favs I haven't seen mentioned are the lavash crackers at dinner, the bouillebaisse in Le Petit Chef and the pizza on Edge.
  2. Yes, true, and I'm sure that CLIA is hammering that point home - at least I hope they are! I live in a town with a cruise ship, yes it is small small potatoes compared even to Galveston, but we are on the hook for a couple of million in mortgage payments on the terminal while Carnival isn't cruising. My adjective is the one that I think is being used internally both at the CDC and in Congress. Based on what we are seeing coming out of the CDC, they are working very very hard, and I think that cruising is just quite low on the priority list.
  3. Heat seems to kill the virus (I'm not sure about humidity, I've heard that, but haven't seen it from a "professional" source, but it doesn't seem to prevent the spread. Because of the profound effect of the lockdown (yay us) and the general lack of testing in the US, we don't really know if heat slows the spread. When you talk about heat in this context you are actually talking about being outside, which involves UV that definitely kills virus (my work scrubs get an hour or two of hanging out on a clothesline in the back yard for this reason) and some social distancing and better ventilation as well as temperature. Likely, just like flu (I hate to say that because it always gets shot down) and other respiratory viruses, summer and the human behaviors that accompany summer SHOULD slow the spread somewhat, but that effect may be lost in the huge change that the lockdown made. Also, don't forget that we think there is little to no natural immunity which should make transmission easier than other respiratory viruses, all other things being equal. Lastly, when you read those graphs (and our county looks just like that, little bit different scale), remember that we are testing more and more, so all the cumulative case graphs look like that. :).
  4. Agreed, but I'm beginning to think the CDC isn't going to let them. I think it will be subtle and not clearly stated, but the CDC will either drag their feet about approving a plan, or send it back to them for tweaking over and over OR will throw in so many caveats and requirements that it will not make financial sense for them to sail or will not be an experience that they can sell successfully. It could be as simple as the CDC doesn't have the time and manpower to deal with a whiny industry that doesn't even pay US taxes. I truly, truly hope I'm wrong, and obviously this scenario does not apply to ships leaving from foreign ports. I don't think there is much sympathy on Capitol Hill or in the CDC for cruising - not sure about the administration, but having 2 of the 3 against you doesn't help. Also think of how it would play out in the media, they have already crucified the cruise lines (with some justification, they aren't entirely blameless victims), if cruising begins without every t crossed and i dotted, it will be all over the press. I guess I'm coming around to the idea that if I was CEO of a cruiseline and I had any hope of making the finances work, that I would hunker down, hope to the Lord that the rosier predictions of widespread vaccines by next summer pan out and plan for that...
  5. And this is why the more I think about it, and the longer this goes, the more convinced I become that there will be no cruising without a vaccine and enough vaccine to cover most all people. Hotels have been looking to scrap daily maid service for years and Covid is a handy excuse. The service on a cruise is part of the experience, even diluted as it has been over the last 10 years, I’m not sure how this will pan out going forward. Its inflammatory and probably not fair to say the CDC has it in for the cruise industry and is trying to send a message, but I do think there is little incentive for CDC to prioritize cruising, or even cut the industry a break. CDC is mostly providing guidelines and suggestions, but for cruises they actually get to decide yea or nay, and I suspect that behind the scenes the reopening plans have to be either proof of vaccination by almost everyone onboard or an equivalent level of safety.
  6. In short, no. I’m afraid cruise ships are way down the priority list for the CDC and there is so much that is changing so fast about this virus and the CDC recommendations. For example, we just got tentative guidance from CDC about when healthcare workers can go back to work after a positive test. That came through about 2 weeks ago, but was based on internal CDC studies with no supporting corroboration- confirming data came this week. I’m talking basic info like we have a nurse who had mild to moderate symptoms almost 4 weeks ago, has felt well for over 2 weeks, but still tests positive - can s/he come back to work? Information about how best to measure infectivity is going to explode this summer, but it will take time to correlate and assimilate this data and turn it into recommendations. I think the CDC is going to require some sort of testing of passengers and crew, and in order for the safety measures to be financially workable for the cruise lines and “vacationally” bearable for the passengers, we will have to understand what those test results truly mean. I don’t see any “new onboard rules” before October at the earliest, and on,y the most limited cruising before 2021.
  7. My opinion: cruising will start back close to the end of this year or early next. It will be limited in length with few or no foreign ports. It will involve some social distancing and some masking and signing a mountain of paperwork relieving the cruise line of any liability and outlining how you are going to,get yourself back home if you get sick (this will be irrelevant until cruises are 5 days or longer, which I don’t think will be the case initially). What I know is that there is an adage in lab medicine - tests can be fast, cheap or reliable, you can generally get 2 out of the 3, but it is extremely rare to have all 3, and virtually unheard of in infectious disease testing. New technology is wonderful, but the level of accuracy implied by the media is practically impossible with a TAT of 5 minutes. The rapid testing platforms that have been used for Covid or that are being discussed have trade-offs - you will either let people on that are in early stages of infection or deny people boarding that are negative - it is inevitable. It all comes back to risk, perceived or real, no one sues the airline or cruise ship if you get flu on board. Norovirus is a risk we take on a ship. People find those risks acceptable. I’m not implying that Covid isn’t serious, you do NOT want to be early in this game with a bad case! What I mean is that returning life to normal will most likely require a mixture risk reduction strategies - some treatments, some consensus on effective prevention, prevalence testing so we know what the risk really is and can make sensible educated decisions about how that applies to us.
  8. I don’t think flu shots are ever 100% effective, and in our area there was a fair amount of Flu B circulating and the shots tend to be formulated to,protect against Flu A more than B. - not sure what was in south Florida or New York. Flu shots do help make the illness less severe, even if you still catch flu. I also think if you get a shot regularly, some immunity carries over from year to year, but flu shots just don’t give lifelong immunity like measles shots.
  9. I am hopeful that the vaccine will be more than 60% effective. Flu vaccines have low “effectiveness” because of factors that are particular to influenza viruses. First generation of a vaccine produced as rapidly as this one is going to be, could be an issue, I suppose. i think it is quite likely that one will have to have more than one shot over a short time period OR that yearly boosters will be required. i wonder if the vaccine is 95% effective, what % will need to take the shot to give herd immunity.
  10. Please consider a flu shot this year even if you don’t routinely get one. We, the physician we, don’t need any extra ILIs this next flu season - influenza-like illnesses. People who wouldn’t ordinarily go to the ER, urgent care or even their physician’s office for the “flu”, are going to be encouraged to go for any real symptoms to get a test to exclude Covid. Every case of influenza that can be avoided frees up resources for someone who might be spreading a life threatening illness. This has been your PSA, back to regular programming 😃
  11. LOL, first world problems. i realized this morning, I miss the vacation planning as much or more than the vacation. Two separate vacationing partners floated ideas about upcoming trips to me - one asking if our yearly beach trip was on, the other with ideas about substitutes for a Nov cruise if that became necessary - it hit me we can’t plan anything yet. The beach will likely happen, it’s less than 2 hours from my home, has begun a slow opening, and our friends own a house there, but the other person’s idea for a cruise substitute involves flying, and who knows about that?
  12. Based on pre-op testing in my area, which NOT truly random, but is a selected population of non-symptomatic people, I think this is about right. We are testing for active disease, not antibodies and are seeing a little less than 1 percent. Our state R value is just under 1, but I live in the county/city with the most cases and deaths - so I would describe us as a hard hit area in a not as hard hit state. I think a population study in our county would be between 0.8 and 3%, and much closer to that 0.8%. The highest I’ve heard was a study in NYC and pockets outside NYC and Boston where the Ab rate was 15-20%. The encouraging thing I’m seeing from our public health is the new cases slowly skewing younger and the rate of increase is steady (R value under 1), but it will be another 10 days before we really know. This is pure speculation on my part, but I think as more and more people come to know someon personally who has gotten sick, especially severely sick, the rate of mask wearing will go up and that will help tremendously
  13. Keep in mind that multiple causes of death can and should be listed on a death certificate (and that state requirements can vary somewhat). If the person with pancreatic cancer died with respiratory failure and a positive Covid test, Covid is part of their cause of death, even with advanced cancer. Also, “they” want all patients with positive Covid tests who die, at least right now, to have Covid listed so those persons can be located in the states’ databases for research purposes and to help”clean up the statistics” later. There’s been a lot of angst about politically motivated inaccuracies, but honestly, based on past epidemiological experience, Covid deaths are much more likely to be undercounted, than overcounted. Most coroners will be very reluctant to list a case as Covid without a Positive test, even if very suspicious, understandably.
  14. Yes, we joke a lot about inventing a vaccine for the common cold and retiring richer than Bill Gates, but the truth is that there might not even be a realistic market for it. You might need a shot every year and it only reduces the average number of colds from 3 to 2. Try selling that to a public that resists flu shots and MMR for goodness sake. If mask use becomes commonplace this fall and winter, and we continue emphasizing hand washing and social distancing, I think it will be interesting to see if those impact the rate of common cold.
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