You know you are screwed when “fact checkers’ on Covid vaccination are funded by a foundation with massive stocks in Johnson and Johnson, a company making DNA vector vaccines.
It cannot get worse than this.
In-your-face scams have become the fashion this year.
The results are bound to be disastrous.
No wonder they are licking their lips in anticipation of jabbing 6 months old.
In the current world fiscal power is infinitely more powerful than nuclear energy.
Acute heart attack or ST-segment elevation myocardial infarction remains the biggest killer on the planet. More people succumb to an acute heart attack in a year than diabetes, hypertension, cancer, or lung disease. Importantly, Covid 19 is certainly not one of the biggest killers.
In the event of a heart attack one artery supplying the heart is completely blocked; that is 100% occluded. There are usually 3 coronary arteries supplying blood supply to the heart. The artery that gets totally blocked is termed the culprit artery.
The best treatment for an acute heart attack is to get to the closest hospital with a cath lab at the earliest. Time saved is heart muscle saved. The blocked artery needs treatment with coronary angioplasty and stenting to restore blood flow to the dying cells in the after heart.
In some patients another coronary artery may also be blocked, this is the non-culprit artery. It was believed earlier that the union culprit vessel is best left alone during the index procedure. But a large randomized trial, the COMPLETE trial, including more than 4000 patients with acute heart attack showed that opening up both the culprit artery and the non-culprit artery provided significantly better clinical outcomes than treating the culprit vessel alone. The composite of death and myocardial infarction was reduced from 10.5% to 7.8% in a follow-up of 3 years. The COMPLETE Trial was published in the New England Journal of Medicine in September 2019.
The decision to stent the non-culprit vessel was taken if it was blocked 70% or more, and if the blockage ranged between 50% to 69% stenting was done when the fractional flow reserve (FFR) was below 0.80. Usage of FFR in the cath lab confirms whether a 50% to 69% block is actually producing schema in the heart muscle being supplied by the non-culprit vessel.
This year another big randomized trial from France that included more than 1100 acute heart patients documented that using FFR for a non-culprit vessel having a 50% to 69% did not provide a clinical advantage over visual appearance during coronary angiography. The reason may be that in the setting of an acute heart attack FFR may be underestimating the physiological ramifications of a blocked artery.
Hence currently the take-home message should be that stenting of both the culprit vessel and the non-culprit vessel should be done either in the same hospital setting or within one and a half months of the heart attack if the non-culprit artery is 70% or more blocked regardless of ischemia.
But in case the non-culprit vessel has a block of 50% to 69% the patients should be assessed for ischemia by FFR after a month of the index procedure. In case there is a block in the non-culprit artery of less than 50%, treatment is medical management by pills.
Crucially the patient must get to the closest heart hospital as quickly as possible.
Single-dose oral ivermectin in mild and moderate COVID-19 (RIVET-COV): A single-centre randomized, placebo-controlled trial
Role of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control study
Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19 – A double-blind, randomized placebo- controlled trial.
Vaccinating people who have had covid-19: why doesn’t natural
immunity count in the US?
Cite this as: BMJ 2021;374:n2101
Clearly vaccines are not working as promised.
Vaccines do not stop infection, transmission nor serious disease.
In Israel, right now, almost one third of patients hooked to a ventilator are fully vaccinated.
Israel also has the highest number of Covid cases per million despite being one of the highest per capita vaccination rate in the world.
There is a deliberate attempt to erase the reality of successful early treatment by cheap drugs by certain powerful forces with vested interest.
Mass vaccination is definitely not the answer to the current Pandemic.
Especially when cheap, safe and effective drugs are available to tackle the Covid virus.
I do not manufacture, distribute, or sell ivermectin. I have no stocks in any company that produces ivermectin. I am not in any committee that sets down guidelines regarding covid treatment or management. There are absolutely no conflicts of interest where I am concerned.
But I get disturbed when I read reports of young people in the West who are sent back home to get sicker without being provided any kind of treatment. I get even more disturbed when leading newspapers publish pieces on the sufferings of these young people afflicted with covid. Some of these young people land up in hospitals and even get admitted to intensive care.
What is shocking is that even after more than a year of chaos powerful people are adamant in their stance against ivermectin Actually it will be now 2 years according to credible reports, since the start of the pandemic.
This unyielding rigid stand against ivermectin is not only unreasonable but downright suspicious with so much data of efficacy with ivermectin available in the literature.
I doubt if any doctor in the NIH, CDC, or the White House group has treated a patient with covid.
We now have a large Indian trial including more than 3500 health care workers published in a peer-reviewed journal that reveals a relative 83% reduction in infection with ivermectin prophylaxis. There was in fact a 10% absolute lowering in infection. Cases were confirmed by a PCR test.
Adverse effects were seen in only 1.8%, these were mild, brief, and settled down without hospitalization. Frankly, 2 tablets of ivermectin are just not capable of producing serious side effects. Ivermectin has been used for more than 3 decades.
Symptomatic infection was reduced from 15% to 6%. Is it just lack of empathy or compassion that drives the propaganda against ivermectin, or is something more simple like fiscal benefit?
But will the New York Times, Washington Post, Guardian, Sunday Times, Times of India, or Indian Express bother to do a write-up on this study? Absolutely not. You can be sure they will not touch it.
The New York Times instead, as I say in my video, goes to great lengths to describe how an unvaccinated American young man lands up in intensive care for 11 days. What the newspaper does not explain why this young man was not given any treatment while he languished at home after being found to be covid positive. He was packed off with an oximeter and little or no other advice. He took no treatment, deteriorated at home, and was compelled to arrive to the hospital emergency.
Was any one of the known effective medicines tried on him? No, they were not. Certainly not ivermectin, nor fluvoxamine, nor famotidine. Not even budesonide?
Scaremongering at its very best.
Move over Mr. Francisco Scaramanga. You were fiction buddy, this is for real.
This recent single blind randomised trial shows that there is significant reduction in ambulatory systolic and diastolic blood pressure by walking briskly thrice a week for 3 months in patients with resistant hypertension.
Hypertension is considered “resistant “when blood pressure cannot be controlled with 3 anti hypertensive medicines including a diuretic (water tablet).
Meta-analysis of randomised trials including more than 62ooo patients has already revealed that (in the old) reducing systolic blood pressure by 10 mm Hg and diastolic blood pressure by 4 mm Hg lowers rate of stroke by 30% and acute heart attack by 23%.
Reduction of diastolic blood pressure by 5-6 mm Hg cuts stroke by more than 35% and heart attack by 16%.
This randomised trial published in JAMA reports reduction of office systolic blood pressure of 10 mm Hg after only 3 months of brisk walking , and day time lowering of systolic blood pressure by 8 mm Hg and diastolic blood pressure by 6 mm Hg.
Regular brisk walk or cycling not only reduces high blood pressure but also high blood sugar and increased weight.
So if you suffer from high blood pressure and a doctor advises against a brisk walk or a jog do NOT take him seriously.
John Rahm an almost certain medal prospect in the Tokyo 2020 Olympics was disallowed from competing because he turned out covid positive despite full vaccination.
He was found to be positive in June and was forced to withdraw from the Memorial tournament, then.
There are no details of his second covid positive test a month later. Most probably if it was a PCR test, it has picked up dead remnants of the covid virus.
Rahm had to take four PCR tests in the United Kingdom before coming to Tokyo. He failed three consecutive tests as per the Spanish Olympic Committee.
Rahm, as per reports, was administered the Johnson and Johnson vaccine. The explanation provided for the first positive covid test in June was that he competed within 14 days of vaccination.
The Covid-19 pandemic is being caused by a single strand positive polarity RNA virus named Severe Acute Respiratory Syndrome Corona Virus 2 or SARS CoV-2. The official name was given on 11 February 2020 by the International Committee on Taxonomy of Viruses, and this was announced by the World Health Organisation the same day.
The first cluster of cases was identified in Wuhan, China, but since then almost 200 million cases have become infected by SARS CoV-2, and there have been more than 4 million (forty lakhs) deaths by this virus. India currently carries a burden of 32 million cases with 425000 deaths.
The initial impression had been that SARS CoV-2 only causes pneumonia bit soon it became apparent that there was a multi-system involvement. The virus attacks the lining of small blood vessels called capillaries, this is termed endotheliitis because the lining of blood vessels is named endothelium. Capillary wall inflammation results in multiple small blood clots (thrombi) that compromise blood flow to various organs. The inflammation of capillaries can be caused directly by SARS CoV-2 or by the immune/inflammation reaction it elicits. There are reports that the virus may similarly infect other organs apart from the lungs such as the heart, brain, kidneys, and liver.
There are reports of cardiovascular involvement and thrombotic complications with Covid 19. Infection and inflammation by SARS CoV 2 can increase the risk of heart attack (acute myocardial infarction or AMI) and ischemic stroke. A recent study from Sweden published in The Lancet has highlighted the enhanced risk of acute myocardial infarction and ischemic stroke.
We already know that there is a slight increase in the risk of acute myocardial infarction and stroke with flu, pneumonia, acute bronchitis, and other chest infections. Against this background, Swedish investigators investigated the association if any with Covid 19 and myocardial infarction or stroke. They looked at data from their registers for 86,742 Covid 19 patients with a median age of 48 years and 43% being males.
Two methods for the analysis of data were employed. In the first method, the cases served as their own controls, called the self-controlled case series (SCCS). Here incidence of myocardial infarction and stroke as compared with before and after a patient developed Covid 19 infection. Secondly, they compared the incidence of myocardial infarction and stroke with a comparable group of 348,481 matched controls. The matched controls were similar in age, sex, region along with adjustment for income, education, comorbid disease, and country of birth.
The risk of acute myocardial infarction was about three times higher in the first week after Covid 19, 2.5 times in the second week.
The risk of ischemic stroke was similarly increased by three times in the first week following Covid 19, and by 2.6 times in the second week.
Intriguingly there has been a decline in the cath lab for acute heart attack procedures by almost 30% across the globe. Cities in India too have recorded a reduction in the rate of primary percutaneous coronary intervention procedures (PPCI). The reasons for the observed decline in cases could be an actual reduction in the incidence of acute myocardial infarction brought about by staying indoors during lockdowns or delay in arrival to hospitals by patients with acute myocardial infarction. This delay could be the fear of contracting Covid 19 in hospital, a prospect that cannot be dismissed outright.
The Swedish study reports an increased risk of acute myocardial infarction and stroke soon after Covid 19, but this spike may not be big enough to make up for the lower rate of hospital admissions for heart attack. The Swedish study has estimated excess risk for acute myocardial infarction and stroke at around 0.02%, that is 1-2 cases per thousand.
The independent risk of suffering a heart attack or stroke with Covid 19, however small, cannot be taken casually. The Swedish study is the largest of this kind and hence the data presented is robust. The researchers have noted that the average incubation period is 5 days for Covid 19, and 98% of patients develop symptoms from 2 to 12 days of getting infected.
A study from Denmark has reported an increased risk of acute myocardial infarction following Covid 19 by 5 times, and raised risk of ischaemic stroke by ten times. Covid 19 is associated with a risk of atrial fibrillation that may in turn raise the rate of ischaemic stroke. The risk of stroke has been noted to be 7.6 higher with Covid 19 than with flu.
The higher risks of acute myocardial infarction and ischaemic stroke associated with Covid 19 infection are best explained by direct effects of the virus on endothelial cells and also the heightened inflammatory response that leads to greater coagulability of blood accompanied by exaggerated clumping of platelets. Long-term effects on the cardiovascular system remain to be ascertained.
Apart from the risk of increased ischemic cardiovascular events by Covid 19, there are also reports of direct inflammation of heart muscle termed myocarditis. Contrary to earlier reports, the incidence of myocarditis is low after Covid 19. Myocarditis is best assessed by cardiac MRI that can n to only reveal inflammation of heart muscle but also inflammation of the pericardium, which is the sac enveloping the heart. Again long-term effects of Covid 19 myocarditis are currently unknown because there has not been adequate time for follow-up.
Patients with myocarditis usually present with chest pain accompanied by ECG changes and increased troponin levels in the blood. A 2 D echocardiogram may demonstrate reduced contraction of the left ventricle. But cardiac MRI is best for a definite diagnosis short of endocardial biopsy that may be difficult in many cases, especially if mildly symptomatic. Autopsy series have shown a very low incidence of myocarditis, but these are very sick patients who have died because of Covid 19. Usually, Covid 19 presents with minimal or no symptoms. All heart associations recommend that a sportsperson with confirmed myocarditis should resume training after 3-6 months of symptom onset under the supervision of a physician.
So how does one prevent heart attack during the current pandemic? Firstly one must avoid infection by SARS CoV 2. This is best done by wearing a mask, maintaining distance, and ensuring proper etiquette during coughing or sneezing. Hand washing will also help. Vaccines have been found to be effective in preventing severe disease, hospitalization, and death.
Along with the above, the usual lifestyle adoption is required to prevent cardiovascular disease. Firstly some form of exercise for as little as 20 minutes in a day will go a long way in reducing weight, lowering blood pressure and blood sugar. This could be in the form of a brisk walk, a jog or even a game of badminton. Exercise becomes of paramount importance amid frequent lockdowns that corral up the public.
Blood pressure must be kept in check and optimal blood sugar should be maintained if a person is suffering from diabetes. A healthy low oil largely vegetarian diet cannot be over-emphasized. Crucially, it is imperative that if symptoms of chest discomfort, palpitations, or breathlessness develop a doctor is speedily consulted.
An acute heart attack if not treated quickly can be catastrophic. Nearly 25% of acute heart attack patients die within 30 minutes of onset. There is undoubtedly a credible fear of contracting Covid 19 on visiting a hospital but this must be tempered with the knowledge that an acute heart attack if left untreated could lead to death.
In conclusion, the risk of increased incidence of acute heart attack and ischemic stroke is clear and present in the current pandemic. Covid 19 by itself can directly cause cardiovascular events causing immediate challenges and also for the future. A sedentary lifestyle coupled with the fear of visiting a hospital despite symptoms shall most certainly amplify problems of cardiovascular morbidity and mortality. Tradeoffs are a part and parcel of life and also clinical medicine, we are constantly balancing benefit with risk.
There are now 3 case reports published that describe an acute myocardial infarction soon after the first dose of the Moderna mRNA vaccine.
The first case is a 96 years old lady who had no previous cardiac history. She developed chest pain one hour after being administered the first dose of Moderna Covid vaccine. Her ECG showed ST-segment elevation in the V1 V2 and aVL leads. A bed site ultrasound revealed anterior wall motion abnormality. The patient refused cardiac catheterization and was therefore put on medical treatment consisting of a heparin IV drip. Her troponin was raised. The patient was discharged in a stable condition after 3 days.
The second case, also a woman, developed chest pain within 24 hours of the first Moderna Covid vaccine shot. In the hospital, a bedside ultrasound revealed inferno and lateral wall motion abnormalities. Troponin was raised. Coronary angiography showed a totally blocked left circumflex artery. The patient underwent stenting of the culprit artery.
The second patient was a male who had chest pain with radiation to the, lower jaw soon after the first Moderna vaccine jab. The symptoms began within 24 hours. A CT coronary angiogram revealed a totally blocked left circumflex coronary artery. On invasive coronary angiography in the cath lab there was a 90% block in the left circumflex artery that was predicated and stented.
Excellent antegrade flow was achieved in both cases.
The take-home message is that albeit an acute heart attack is uncommon post-vaccination it must always be kept in mind if a person develops chest pain soon after the first dose of the Moderna mRNA vaccine against Covid 19. The exact pathogenesis remains to be established, but these 3 cases presented with a thrombus in their culprit vessel.
But the question remains, what exactly triggered the thrombus in the culprit coronary artery?
It is more or less clear that the effectiveness of vaccines is dwindling substantially after 6 months, and this must have been known to the companies that manufacture them. The level of antibodies against the Astra Zeneca (AZ) vaccine is markedly lowered after a mere 70 days, as published in the Lancet.
Public Health England has published data (in the NEJM )that the effectiveness of the AZ vaccine against the Delta variant is less than 70% and around 88% with the Pfizer vaccine.
University College London suggests that effectiveness is just 0% against mild infection and 60% against severe infection.
The Israeli health ministry has acknowledged a study that effectiveness against serious infection against the delta variant is around 50% in those over 60 years. This is understandable as old people are unable to ramp up antibody production.
None of these studies have measured T cells or memory B cells that may endure much longer and tackle the severe infection. On the field, however, breakthrough infections are on the rise.
Against this information we now learn from there noted British journalist Piers Morgan that he contracted the Covid 19 virus in the Euro Cup finals between England and Italy. He developed a high fever accompanied by cough and body aches. One of his favorite wines tasted like “rusty water” because of his loss of smell and taste. Albeit he is on the road to recovery his doctor has advised high dose corticosteroids to prevent “long covid.”
There is no randomized trial on high-dose corticosteroids to prevent long covid. Or is that despite 2 jabs of the AZ vaccine Piers still managed to get severe Covid.
Piers also mentions Andrew Marr (with the BBC) who contracted the virus in the G7 Summit despite, yes, 2 vaccine jabs. I do not have the details of the gravity of Mr. Marr’s illness.
The fact remains that 2 vaccine jabs are no guarantee against contracting C -19. Which brings us to the question as to why Piers was not offered effective early treatment for his illness. It is time that Piers does some research on ivermectin, fluvoxamine, and anti-androgen drugs.
It would do the community and people at large on the planet if Piers writes on ivermectin or the impact of early treatment. Common sense dictates that if the virus is tackled within 2-4 days there is very little possibility of any immune reaction developing in the future.
I have a soft corner for Piers because I have watched him face 6 balls (ouch !) from Bret Lee, one of the fastest bowlers emerging from Aussie. Bret could easily touch 150 K/hour in his peak, and that is faaaaast. If nothing else Piers has guts. The over may not be in the league of a Shoaib Akhtar bowling to Sachin Tendulkar, Malcolm Marshall attacking Sunil Gavaskar, or Dennis Lillee hurling a cork ball at Vivian Richards, but it is still worth watching. “Bring it on” urges Piers after being struck by Bret Lee, some pluck.
If only Piers had been provided ivermectin right away on the 13th or 14th of July. Here is wishing him complete recovery from the damn virus.
The first man to set foot on the moon was Neil Armstrong, way back on 20th July 1969. Neil Armstrong was an ace pilot and an engineer who supervised the Apollo 11 mission, which was the first space project to land on the moon. He became following this probably the most famous man on the planet. I still remember the grainy pictures beamed on our TV at home of him and Buzz Aldrin hopping on the moon’s surface. The famous line was uttered that “That’s one small step for man, one giant leap for mankind.” This was from more than 240,000 miles away. Possibly Armstrong dropped “a” before “man” or maybe he did not.
Just as famous was the line radioed back to mission control “The Eagle has landed,” when the lunar craft finally descended on the surface of the moon.
The Apollo 11 mission took off using a huge Saturn V rocket standing 363 feet. There is a documentary “Apollo 11” and also a terrific film “First Man” that has Ryan Gosling portraying Armstrong. Armstrong despite his immense fame did not care too much for grandiose pronouncements or striking statements powered by grand eloquence. Armstrong throughout his life remained a perfect gentleman with his feet firmly on the ground. This was an extraordinarily humble man right till the end. But what an end!
Few in India know that Armstrong died because of an easily avoidable error made by a nurse. Armstrong underwent a CABG surgery in early August of 20112. The surgery was unremarkable and Armstrong was recovering pretty well, he had even begun to walk following the operation. A nurse removed the temporary pacing wires attached to Armstrong’s heart in the ward itself. Sadly this tore apart heart muscle and there was instant severe bleeding into the pericardium (sac lining the heart) and hypotension. He was shifted to the catheterization laboratory where attempts were made to revive him, but had to be transferred to the operation room where all attempts at salvaging him failed. Armstrong lingered for another week before he died.
Temporary pacing wires are often attached to the surface either the right or left ventricle, and also the atrium. They are secured by a curve at the tip with or without a stitch. This is done during surgery. The wires are usually pulled on the 3rd to 5th postoperative days. Actually many surgeons prefer not to pul out the wires but just cut them on the surface of the skin. There is always the small risk that when the wires are tugged the heart wall can be ripped open, whether it is the ventricle or especially the atrium. Armstrong must have been on blood thinners ( aspirin).
Temporary epicardial pacing wires are placed to tackle postoperative arrhythmias that have the potential for hemodynamic instability. Pacing wires have been used to suppress atrial and ventricular tachyarrhythmias, as also as a safeguard in case heart rate drops after surgery. There may be rare complications, which can be deadly, as what happened with the first man to step on the moon. The most common complication is that the wires do not work when needed. Importantly removal of these wires can result in injury to venous grafts and tear of the chamber to which the wires are attached. The result is bleeding into the pericardium accompanied by a severe and sustained drop in blood pressure (also called cardiac tamponade).
Certain patients, however, may not require these temporary pacemaker wires, patients who undergo off-pump CABG, and those who already have a permanent pacemaker. There have been studies done trying to discriminate patients who could be at high risk for a temporary pacemaker. Diabetes and pre-operative arrhythmias are strong risk factors, and if the pacing was needed as the patient came off bypass. Most centers using bypass during CABG continue to place temporary pacemaker wires. Temporary epicardial pacing wires are also placed routinely during valve surgery, but high-risk patients can be teased out before surgery. Postoperative support if required is for 1 to 2 weeks.
The good news is that now we are on the cusp of using a pacemaker that can dissolve within a month or two after the operation. A fully implantable, bioabsorbable pacemaker that can pace the human heart is being developed. Animal studies have been successful. There will be no possibility of infection or any complication during yanking of pacing wires. This device is very small and made of water-soluble biocompatible materials. It has no wires or battery. It will do its work of protecting the patient from possible arrhythmias and melt away. The device is 16 mm in width, 15 mm in length, and weighs just 0.3 g. The device is capable of receiving commands and power from an external source on top or a few inches from the heart. It has successfully captured and paced rabbit and mouse hearts. The pacemaker largely dissolves by 3 weeks and almost completely by 12 weeks.
The dissolving pacemaker is stitched on the surface of the heart and therefore there is no risk of a residual fragment traveling in the bloodstream. Human trials are eagerly awaited. The future looks promising but one must bear in mind the usual caveats of suboptimal effectiveness and unanticipated adverse effects. Till then we will have to continue with the temporary epicardial pacing wires attached to an external generator.
The richest man in the world , Jeff Bezos, went up 65 miles above Texas ,yesterday. It was a gigantic unadulterated ego trip lasting 11 minutes, even as millions on the ground stared into a dark abyss infested with the Covid 19 virus.