Covid19 shots, Needles before bullets! March10,2021

         It is hard to believe that a year and half later, Covid19 still dominates conversation.  Once again, our phone lines lit up when some well-intentioned  government employee announced that doctors offices are giving out covid vaccine.   The frontline doctors in Peel have heard nothing about it.  It would be a good idea, but there hasn’t been a shred of meeting or communication to pitch it to the local docs.  In fact several of my peers pitched the idea to politicians and health departments almost one year ago.  Nothing has happened to evolve this plan.  It would take quite some time to solve logistics, of supplies, storage, transportation, etc.   The front lines are quite overwhelmed and tired looking after all the non-covid sick that have emerged during the pandemic.  We will post updates here.

     To those caught up in current vaccine chaos, we apologize for the numbers and links provided, and turned out almost impossible to access.  Lets all take some refuge, and be glad that we are fighting this “war” with needles and not bullets. 

  Which Vaccine?   Take anyone available.  There will be at least 4 diff ones.  Drug companies spend a lot  of funds promoting the best statistics that their own studies show.  There have been no head to head trials to truly say which one is better, if any.  We are conducting the trial in real time, so that data will eventually emerg, and few will care, just as the various yearly flu vaccines arrive from multiple makers.

   Things for certain, are that all the vaccines have been shown to reduce or prevent the serious covid disease.  If you get covid illnes, you will recover, but disease sends you to hospital.

   If you have had the covid cold, dont panic about vaccination.  You are ahead of the pack and have proven that your system handles this virus normally.

  You can still take a vaccine if you wish.  Better science data will emerg.

   Pregnant women should not take the vaccine currently.

   Children were not part of any studies, so even the manufacturers suggest cut off at 16-18 year olds.   More, proper science will replace fake news.

   Problem with the older population is that these vaccines were developed and tested very fast.  Companies do this often, because a group of young, healthy 30-60 yo leads to favourable results in trials.   Despite that, the roll-out has decided that our eldest and sickest should get vaccine first.  Consider it a trial.  So far, the rumour has it that most did just fine.  I image, we will soon be giving vaccines to everyone.

   The point of vaccination is to prevent spread and lessen disease.  Our administrative elite on this planet have read the messages from front line commanders and agree, that vaccinated people should be considered as unlikely suspects to spread disease.  Consider your self a non spreader of any “hidden” or secret covid virus lerking in your body about two weeks after vaccination. 

   I do not believe or endorse a vaccine passport.

You could still get covid illnes,  (mild cold type), but this would not necessarily imply vaccine failure.

Covid Update Mar 8, 2021.  Fake news or simply unprepared once again.  If anyone can locate some reasonable accountability in our system, please forward to those around you.  We are in need of positive true news in the worst way. Despite  media announcements, we have found out first hand that a great deal of misinformation and misleading information has come forward with it.  Website and links, that never seem to be open or available, phone numbers given to patients that are never answered. I visited one immunization site while on hospital duty, and was surprised to see that most who had made appointments did not seem to fit into the first phase criteria?  Difficult to say why, perhaps embelishment  of information or inefficient screenig.  It seems to make the roll out appear quite chaotic.  What is worse is that physicians also have no ability to contact anyone of substance to obtain information and clarification.    Dr.Kujtan and staff, were bounced out of the January slots and still await word of immunization.  It will then take at least 5 weeks to be in a position to resume some form of face to face visits above that currently being done.  We think  June would be a likely time. 

Our  public health department announced last week, resumption and stepping up of vaccine priorities. Unfortunately, once again, their web site does not work and they dont seem to answer their phones.  Recorded messages give little information.    It has been difficult to contact other resources for help as well.      Anyway, there may be some guarded news for those patients OVER 80 years of age.

Another avenue to pursue is to follow this link.

https://trilliumhealthpartners.ca/covid-19/A/index.html

this link will take you to a place where you can pre-register at the trillium health center.  In our area, we are hoping to get vaccines into those over 80 starting March 8, 2021. 

Alexander Graham Bell, would be rolling in his grave, if he lived to see that his wonderful invention has become  a source of frustration and not the miracle it began to become.   We seem to spend hours of our lives on a regular basis, simple holding a communication device in limbo.  For this reason, we will not insult you with providing a phone number.  

COVID-19 ALERT VACCINE  Feb 22,2021

The provincial government announced last week that those aged 80 and above should contact their doctor to be vaccinated. We were unaware of this announcement before it occurred, and we do not have any further details regarding what information should be collected from your patients, to whom this information should be provided, how patients will be notified and where they will be vaccinated.

We have repeatedly emphasized with the government  and public health that doctors have a key role to play in prioritizing and advising their elderly patients. We will let you know when further reliable information is available.

Feb 12, 2021

   The good news….. There really is none.   It is difficult for covid to be called a pandemic anymore. It has met the definition, began 15 mos ago, spread around the world, present everywhere and a large number of humans have encountered it successfully, and fewer have not or could manage to resolve the encounter given their other health conditions.  Lets be clear. “Variants” are not new virus, but simply a normal change in one protien, no more so than new tires change your car model.  What gets minimized and not talked about is how our health has suffered due to our collective behaviour as a society and by our leaders. One of my patients summarized all the underlying messages into one statement.  “I spent a year hiding, masking, washing my hands and hoping for a sore arm soon, so that I dont kill anyone else.”  I hope that history judges us correctly, but have some doubts. The advice worked for a few weeks, but as the months went on, much more refinement was needed.  Patients required explanations, nutritional support, advocation for anti-viral supplements, excercise, and alternate socialization.  In dealing with covid, we have paid an enourmous cost in terms of our health; heart disease, mental health, cancer, addictions, relationship breakdown, social isolation, unemployment and so on. There is a tsunami of worstening health issues about to hit once restrictions are lifted and sensible measures continue. I hope I am wrong, but the a bigger crisis looms. Media, politicians and health docs, may see dropping  numbers as a “win”, but there is no win in the big picture.

   However, there is some good news in other countries, that probably due to economic pressures, discovered effective strategies.

   Several months ago, I brought attention the Nobel Prize winning drug Ivermectin, that is cheap, generic and has been used in over a billion humans. Originally used for river blindness, it turns out to inhibit a protien needed to allow covid to invade the cell. Great evidence exists that it can reduce transmission and certainly improve the disease form of disease. Peru, India, and now the EU, (Slovakia and Bulgaria) are endorsing use with amazing results. Most of our dogs with heart worm, and cattle take it regularly, but in Canada we only use it for the scarce scabies infection in humans. Cheap and no side effects, it can reduce deaths while waiting for expensive vaccines. Some US centers are using it, and families have successfully gone to court to endorse use in the their ventilated loved ones with positive results.  Merck the original developer, astonishingly has not endorsed its own drug.  Interestingly, they were given $380 million US last april to develope covid treatments. They abandoned the vaccine race, and recently invested half a billion to buy a European company and its drug, MK7110 that can modify another protien in the immune cycle. The end result may be similiar to invermectin but at a vastly profitable margin.

    Another promising drug comes from a slug and researched at the Icahn School of Medicine in the US. Aplidin is a cancer drug used in Australia. It inhibits eEF1A a protien in our cells that is essential for covid to survive.

    Cochicine which is used for gout, has also been shown promise from a Quebec study.

     Another inhaled drug from Israel called, EXO-CD24 being developed for ovarian cancer was found to reverse the deadly cytokine storm when covid infection turns into covid disease.  All 30 patients on ventilators recovered with 5 days of inhalation. 

The rest of the world is getting a handle on how to handle the covid part of our lives. I can only we can catch up on the collateral damage that accumulates while we wait.   There is a lot of hope beyond vaccines, and for those that can think outside of the box in the face of adversity.

The covid test. Feb 1,2121. As much as I support Public Health Measures, I also understand how the oversimplified explanations have caused confusion. 

Covid is a respiratory virus, behaving similiarly to numerous others.  The human race has never exerted so much expense and trouble tracking an invisible entity, only to find that a year after emerging it is everywhere, like the others.  Case numbers mean little if not properly disclosed and explained.  The commonest test we use is called the RT-PCR employed on swabs. It is not conclusive for INFECTION.  It looks for practically invisible pieces of RNA that are similar to that found on one viral protien, reproduces it and multiplies it by billions of times and concludes at best that the test swab encountered some RNA resembling the virus.  If there is a great deal of viral RNA present, then the test will not require as much magnification known as “cycling”.  It cannot distinguish between functional virus and digested RNA.  If the test cycle is set for too high a magnification, the test will be positive more often.  In Ontario, the test cycles are set “high” so it tends to be positive more often. False positives occurr, if a similar RNA piece is encountered from another virus, or poor handling, etc.  Someone on whom this test is run, and meets the parameters arbitrarity set is considered  POSITIVE.  These people are commonly referred to as CASES.   It does not necessarily mean you have an infection, but most of the time implies it.  This is very important to understand and tease out the data.  As humans, we carry numerous microbes and viruses that intereact with us and cause us no harm.

A “CARRIER” is someone who tests positive and harbours virus capable of transmitting to another human.  It is almost impossible to determine who is who, and most health departments oversimplify it, and consider all positives as carriers or sick.   COVID ILLNESS can be defined as having a positive test, along with at least 3 clinical symptoms such as fever, sore throat, fatigue, cough, muscle aches. The majority of this group survives.   COVID DISEASE is quite rare and implies an unusual response to the illness.  It invlovles severe shortness of breath, pneumonia, drop in blood oxygen, and a metabolic overexcitation of our immune system called cytokine storm.  This small group is the ones that need hospitalization, possible ICU care, intubation and do poorly if burdened with other medical conditions.    Ideally, if you could find a highly effective vaccine or protective medications that work in this group, it would be all you need.  However, the problem is that we cannot identify who is who.  Around 95% of people who go for testing are negative, despite the test being set at high sensitivity levels, which increase false positives.   You may appreciate why simply reporting a positive number of tests each day, without stratifying the results can lead to false assumptions.  This in turn can lead to well intentioned policies that may not meet their goals, yet burden society financially and obscure a storm of other health problems.

Covid deaths seem to be another daily news item.  Without a good analysis, it is assummed that a certain number of positive cases simply go on to randomly  expire everyday. This is highly inaccurate.   Someone who has had a positive covid test and succumbs is attributed as a covid virus death.  What is worse, the reporting differs widely around the world and even in North America.  To measure the true burden of an illness, you need to examine and tease out the death data.  Someone who has an incidental POSITIVE covid test, and dies of cancer, heart diesease, diabetes etc,, seems to be lumped into the covid statistics. I tried to find valid data on how many deaths are due to COVID DISEASE and failed. This type of reporting has obscured a concept know as the DEATH GAP.  Many scholars are now looking at the “death gap”. In basic terms it states that deaths from other causes are rising rapidly as compared to other years, and suggests that it is not due to this one virus, but due to the health effect consequences of the how the pandemic is being handled.  In military jargon, it is referrred to as “collateral damage”.  The death rate in Canada, has slowly increased since 2010, largely due to our aging population.  I was surprised to see that in 2020 there was no large spike, as you might expect.

If I was Mel Gibson and this was a Vietnam War movie, I would be yelling “broken arrow”. We have reached the critical pandemic point.   Medical services are not normal as announced.

Our hospitals are at the overwhelmed tilting point. Every bed in the province will shortly be occupied along with hallways and other areas.  Ability to staff and provide care is strained.  Most difficult will be the struggle to provide ICU beds and ventilators which require intense resources.  Consider a visit to any medical hospital or clinic as a hotspot for potential transmission. For this reason and on ethical grounds sending patients with minor complaints for medical testing, even if it is available, must be done with great scrutiny and consideration for transmission. Up to now, we knew that the average person being infected had over a 99.7% chance of good recovery.  The 5 to 10% who required hospitalization to achieve this didn’t matter because we had facilities. This no longer is the case and changes of the whole scenario. For the first time in my career we will be looking at who gets a ventilator and who doesn’t.   Good quality care is limited in a chaotic strained medical environment.

 I  am in the highest risk group for severe Covid complications. As a front-line physician seeing community patients I have patiently waited for the last six weeks to partake immunization so that this vital community work can continue. At first it was confusing due to lack of communication and no word or guidance of how to obtain immunization. Then the bouncing off lists games began, and as it currently stands there are no further vaccines available despite numerous low risk people have received them. It presents a problem because we are faced with repeated quarantine when unexpected encounters occur and we have no access to the tax funded protective supply. It almost seems unethical to coax people out of safe residences into infectious environments to perform deferrable tasks. It could and does result in catastrophe for their vulnerable loved ones. It feels a little bit like the battle of Paschendale, where the 5 am whistle to attack the vastly outnumbered enemy is about to sound and thousands of my fellow soldiers have guns but yet to receive bullets. The generals with plenty of ammunition well behind the lines solve the problem by ordering the use  of bayonets during the 2 km walk in open fields towards enemy machine gun nests.
  
What seems more disappointing is that while we wait months for more vaccine and then more time for it to take affect, any discussion about viable alternatives seems to be suppresed and dismissed.  The death rates in vulnerable population are predicted to further skyrocket in the next weeks. I sincerely hope that we are not made to feel that it is solely the fault of a few citizens who exercise poor judgment at times. The quicker we realize our failures, the sooner we can re-group and correct things and re-aim our strategies.