Hats off the the English for their extensive contribution in the treatment of Covid 19 during this pandemic. No other nation has piled up so much practical data in managing Covid 19. They gave us data that dexamethsasone (Recovery trial ) and tocilizumab (Recovery ) work. We Laos know that budesonide is an effective anti viral thanks to the Stoic and Principal trials supervised by Oxford. The latest form recovery os that a cocktail of monoclonal antibodies can significantly reduce mortality in critical patients with Covid provided that there was absence of natural antibodies in these patients.
English scientists have now urged the UK government to go slow in jabbing children, till there is more data on risks. This is pragmatic and sensible advice.
Children are somehow less affected by this virus and transmit less than 50% of what adults do. Moreover mortality is extremely low. One in a million in the UK and only 0.7% of 45,000 deaths in the US (CDC data).
Rarely children may develop a multi system inflammatory syndrome , but death is very low. Incidence of inflammatory multi system syndrome is about 2 in 100,000 children only.
Recently a paper has been published on 46 children admitted for multi system inflammatory syndrome in a renowned London hospital for children. Albeit 80% of these sick children received immunoglobulins, 50% got corticosteroids or inotropic support, and 35% needed a ventilator, every child survived.
There were some cases of residual weakness but these can be explained by other factors than only the virus.
All except one child was attending online classes at six months ; the mean age of the admitted children was 10 years. Two thirds were boys.
Considering we have no clue of long term adverse effects of gene modifying vaccines amid recent reports of more than normal incidence of myocarditis in children, we must be absolutely certain of the safety of vaccines in children , before embarking on a mass vaccination program.
We still do not know the cause of Christian Eriksen’s cardiac arrest during the game against Finland 4 days ago. The reason for the sudden collapse should be revealed at the earliest. Why should a young world class professional sportsman who has been regularly checked for a potential cardiac ailment need to be defibrillated on the pitch ?
In the meantime a high quality meta analysis of 21 randomised trials including more than 2700 Covid patients has shown a significant 68% reduction in mortality by ivermectin in patients suffering from Covid 19. (The evidence was of low to moderate certainty).
There was also an 86% significant reduction in contracting Covid by oral ivermectin. Low certainty evidence.
The meta analysis suggests that ivermectin is safe and effective in reducing morbidity and mortality in patients of Covid 19.
A recent paper from Brigham and Women’s Hospital published in Clinical Infectious Disease documents presence of the S1 portion of the spike protein in blood soon after a jab with the mRNA vaccine, developing as early as one day.
Crucially, the S1 protein is not restricted to the shoulder receiving the injection or the draining lymph nodes, but is found in the blood stream. The protein peaks at 5 days to persist till 14 days. The clinical implications are unclear as per the researchers, but one must bear in mind reports from Israel and the US of more than expected myocarditis in young males soon after RNA vaccination.
The myocarditis albeit so far has been mild, but has necessitated administration of intravenous immunoglobulin and oral steroids.
One of the best midfielders in the game of football collapsed just 2-3 minutes before halftime the day before in the European Championship game against Finland. Luckily he recovered after one DC defibrillator shock. He is in hospital and stable now. Christian has played for Tottenham Spur in the past and was screened then. He currently plays for Inter Milan and must have been rigorously screened in Italy too. This means arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy, bicuspid aortic valve, and mitral valve prolapse have been ruled out by 2 D echo. Channelopathies like QT and Brugada syndromes must have been ruled by 12 lead ECG as also WPW syndrome. There is no news that he suffered acute coronary syndrome. An educated guess therefore could be a congenital aberrant coronary artery that is not detected by an ECG, echocardiogram, or an exercise ECG test. An aberrant artery is compressed with each heartbeat as it courses between the aorta and pulmonary artery, triggering ischemia and creating an arrhythmogenic substrate. An aberrant coronary artery can be checked with a CT angiogram. Another possibility is lingering myocarditis following a mildly symptomatic Covid infection, which can be ascertained by serology testing (for antibodies) and cardiac MRI. As per the Inter Milan doctor, Christian has not been vaccinated against Covid. Here is wishing Christian a speedy and full recovery.
To say that I was taken aback when Youtube pulled down my video entitled “ 2 Vaccine Shots Are A Must to Tackle the Delta/Indian Variant; But Till Fully Vaccinated Take Ivermectin”would be a gross understatement. I was actually nauseated by their mindless move. The video was less than 10 minutes. I was highlighting current data suggesting that a single vaccine shot would be highly inadequate in protecting against the Indian/Delta variant; I provided the link for the Public Health England preprint. The researchers point out that 2 shots would be far better but protection was still slightly compromised, it dropped from 66% to 59.8% with the ChAdOx1 (Covishield) and from 94% to 88% with the Pfizer mRNA vaccine.
I realised within minutes that there would be no one to champion my cause. All that bullshit about freedom of expression is just that ……loads of bull shit. I have waited for more than 48 hours but there has not been a whisper. I am not surprised one bit. We all have our own personal agendas whether we are politicians, bureaucrats, or journalists. Personal interest is not just of paramount interest, it is the only interest under the demeanour of integrity and single-minded purposefulness.
I have manifestly tread on some very important toes, which have cancelled my video with utmost immunity, like tossing out a fly in complete disregard. I was left with little choice, I uploaded my stuff on Vimeo and Bit Chute within hours. No one protested, there was not even a pretension. Are we servile people? Your guess is as good as mine.
My videos are a crystallisation of my thoughts, after practising clinical medicine for more than 40 years. I do not speak for any political party, NGO, or media outlet, and certainly not for any drug or vaccine company.
I also spoke of a research letter published a few days ago in The Lancet that underscored that there was a drop in neutralising capacity with the Pfizer vaccine against current variants of concern ( in 250 volunteers). Efficacy dropped 3 fold against the English/ Alpha variant and 6 fold against the Indian/ Delta variant. The conclusion drawn is that because of the reduction in neutralisation against emerging variants a third shot of vaccination should be considered. The letter bolsters this approach by mentioning that there was indeed a further drop in antibody activity when checked after 3 months of the second shot in 14 individuals.
I elaborated on the Indian/Delta variant by quoting reprints that concluded there reduced neutralisation activity by antibodies formed by the Pfizer vaccine. That the variant had added mutations in the 681, 452, 478 and 614 amino acid positions of the spike protein, which made the variant not only more transmissible but also more evasive against antibodies produced by natural infection or vaccines. The Indian/ Delta variant is dodgier.
I have been closely watching the behaviour pattern of this virus for the last one and a half years. I have observed both outpatients and patients admitted in Covid wards. I have scanned as many papers/ preprints/ news items on the Covid 19 virus that a single human can possibly can. The labour has been hard, rigorous and long. I have gone through all treatment trials of remdesivir, monoclonal antibodies, inhaled budesonide, fluvoxamine, barictinib, famotidine ,dexamethasone, tocilizumab, oxygen administration, interferon, lopinavir, chloroquine and of course ivermectin.
It is clinically obvious that, unlike last year, this time around entire households have got infected suggesting much greater infectivity of the Indian/Delta variant than the D614G variant operating last year. I do not need to be told by modellers in Warwickshire that a 40% increase in infectivity will result in 6000 admissions a day, and an increase in 50% transmissibility will force 10,000 hospital admissions a day. I and all of us in Delhi are aware that there have been many more hospital admissions this time around.
We were a very short time ago in an incredibly awful hole where there were neither hospitals beds nor oxygen supply. Everything was being sold in the black market, medicines and even hospital beds. There were reports of astronomical extraction of money for an ambulance or a taxi. A stunning and extraordinary display of greed atop the saddle of cruelty was on display.
Whether this variant was 40% more infective as mentioned by the English health secretary (health minister) or it was 30% to 100% more infective as uttered by professor “Lockdown” Ferguson mattered little to me. I knew the virus was far more infective this time.
Importantly, apart from being more infective, the wretched variant was clearly showing signs of greater virulence. This year, significantly more people were developing bilateral ground-glass opacities (GGO’s) and pneumonia. More patients were having a substantial drop in their oxygen levels. There has been greater mortality.
I have mentioned in the erased video about a preprint by the ICMR that has compared the pathology in hamsters infected by the Indian/Delta variant with hamsters infected by an earlier variant. The researchers have found a significant difference in viral loads in the lungs of the sacrificed animals as also disease in the lungs. Both viral quantity and lung pathology were considerably greater in the hamsters infected with the Indian/Delta variant. There was more congestion and haemorrhage accompanied by greater numbers of inflammatory cells and septal thickening in the lungs infected by the Indian/Delta variant.
So we have a situation around us. There is a variant of concern that is significantly more infective and virulent. These are not anecdotal reports or subjective impressions. A doctor in the US however well informed will just not have any clue of the clinical ramifications of the Indian/Delta variant or how to tackle it. This variant, let us face it, is deadlier.
No wonder the English are mulling on extending their lockdown by a fortnight or even a month. The Indian/Delta variant is the predominant virus in many parts of England. The English experts are aware of the greater virulence and infectivity of the Indian/Delta variant and hence do not want to take any chances.
The English health secretary announced in their parliament that of the 12300 infected people with the Indian/Delta variant, around 126 have been hospitalised. That is 1% hospitalisation in the Indian/Delta variant cohort. But there is one striking feature almost all infected patients have not been vaccinated. Only 3 patients (carrying the Indian/Delta variant)with both vaccination jabs have landed in the hospital.
The inference is simple and reassuring. Regardless of its infectivity or virulence 2 shots of vaccination ensure that only a minority will get hospitalised with the Indian/Delta variant.
I ended the video by stating the obvious; a single jab policy could be disastrous, 2 shots should be mandatory for protection against the current variant and future variants. I am still undecided about a third shot and would wait for more research to support such a protocol.
I also mentioned that a recent paper published in Nature informs us of plasma cells that burrow into the bone marrow and are capable of generating antibodies against the Covid19 virus for years.
I also towards the end talked briefly about tablet ivermectin, which albeit has been used as anti-parasitic medicine for decades, has also been found to be exquisitely effective against early Covid 19 infection. I have used it in hundreds of patients with wonderful results. Not a single patient landed in hospital or died. Each one recovered, their ages ranged from 10 years to almost 80 years.
Ivermectin has also been very effective as prophylaxis in numerous randomised trials, in fact, a large comparative trial from AIIMS, Bhubaneshwar, has demonstrated an almost 90% reduction in infection in health care workers with just 2 tablets a month of ivermectin. To employ ivermectin for pre-exposure or post-exposure prophylaxis as being done in Uttar Pradesh would be a pragmatic and effective decision. Millions of people can be saved from being infected, especially in rural areas. The medicine is dirt cheap and easily available in the country.
So till the necessary proportion of people are infected in this country, once a week tablet ivermectin should be the way to go.
We just cannot rely on the advice provided by the WHO. The WHO has lurched from one faux pas to another in the last eighteen months. The mistakes have been awful and arbitrary.
I am compelled to mention a few.
Full-grown “scientists” in the WHO were sceptical that there would be effective immunity against Covid 19. This went against the grain of all common sense immunology/microbiology. It was being asserted (for the first time in human history) that the human body would be unable to make antibodies against the virus. When the expected backlash appeared WHO cunningly began to hint that antibodies would be temporary. We know now that not only is their robust antibody formation but reinfection after natural infection is very uncommon, and even if it does occur the intensity is considerably lessened.
The WHO took more than a year to revise its definition of the RT-PCR test. Finally, in the January of 2021 the WHO realised that the PCR was an aid to the diagnosis and not an end to itself. Also, it finally realised that there is something called the cycle threshold value (Ct). A high Ct value (used for almost a year in the West) is of little value. In fact the Car of Covid (currently under a lot of flak connected with the “lab leak” theory) Dr Anthony Fauci finally conceded that a Ct above 35 picks up only dead bases of the virus.
For some inexplicable reason, the WHO never cared to explain the importance of the Ct value with PCR testing. The change in approach became evident only this year. Very queer.
Another crucial change by the WHO has been the acceptance that the virus is “airborne”. Why should it take a bunch of full-grown “scientists” more than a year to realise that the virus is airborne and hence can hang in the air of a poorly ventilated room for almost 3 hours? That almost 99% of transmission in the case of Covid19, therefore, takes place indoors. Why did the esteemed scientists of the WHO not bother to employ palpable evidence spotted by most outside scientists? It is baffling and mind-boggling to say the least. So many millions infected and so many hundreds of thousands dead.
There are many more silly errors made by their Excellencies in the WHO but this one takes the cake. A huge uproar has been created regarding the origin of this virus. Suddenly Fauci looks extremely vulnerable and the knives are out for him. Undoubtedly the Yanks financed Chinese scientists to juice up coronaviruses and make them more deadly. They conveniently suspended “gain of function” experiments within their own shores but gave millions of dollars to Chinese scientists to pursue the lethal research.
The controversy is whether the virus came from a lab leak or whether it sprang from nature. If it came from a lab future research will be banned, but you and I know that such research will go on surreptitiously. If it came from nature we should expect another Pandemic in the not so distant future because there will be no change in human nature.
But I must get to the point and not digress from the principal issue. The WHO decided to send a commission to investigate the origin of this virus to Wuhan, China from where the Pandemic began sometime in 2019. Please read carefully, the WHO collects a small cohort of reputable scientists and slips in Peter Daszak of Eco Health Alliance fame also. The problem is, and this is a huge one, Peter is the guy who was the pipeline for the funding of the Wuhan Institute of Virology by the Americans ( NIH/ ministry of defence).
So we have the man who has been laundering money to the Chinese to specifically experiment on gain of function in coronaviruses to investigate whether the Chinese scientists were doing gain of function tests. Sounds bizarre but the entire world knows this. The entire Western media is bleating about this strange conflict of interest. I should rephrase ……glaring and brazen conflict of interest.
THE GUARDIAN 3 JUNE 2021
I bring out the chicanery of the WHO because I have a sneaking suspicion that it may have had a role in getting my video taken down. It cannot stand anyone mentioning ivermectin as a prophylactic or therapeutic against the Covid 19 virus.
THE SUNDAY TIMES 8 JUNE 2021
If the reason for the cancellation was that I insisted on calling the variant the “Indian variant”…………it too is being downright absurd. Granted it has been given a new name, a Greek number “Delta” but the entire world still calls it the “Indian variant.” In fact, just about every newspaper in the UK has headlined the Indian variant with implications on their lockdown. One of their oldest and esteemed newspapers “The Times” calls it so, as also does the “Daily Mail” and also “Sky News.” The reason is that calling it the “Indian variant” is simpler for their readers to understand, there is no malice in it. British newspapers as also most English print media continues to term the B 1.617.2 as the “Indian Variant”, along with giving news of the “Kent” or “English variant .”
MAIL ONLINE (DAILY MAIL) 8 JUNE 2021
If I have been punished for making a purely scientific-educational video ( with the necessary links) on the Indian/Delta variant with the sole intent of providing information to the public, so be it. I have resolved NEVER to upload a video ever on YouTube. I have always been a clinician and a damn good one…. I will continue to be so. I shall also keep my eye on this virus.
More than one billion (one hundred crores) doses of ivermectin have been given in the last 30 years with not a single death. There are reports that more than 3 billion doses have been administered. Five to 10 tablets of ivermectin (of appropriate strength) taken over 5 days under the guidance of a physician cannot harm anyone, it is just impossible. There is absolutely no chance of getting a heart attack, cancer, respiratory failure, kidney or liver failure. On the contrary, there is every chance it will save you from going to a hospital and getting hooked to a ventilator. Again there is absolutely no probabilty of triggering a torsade de pointes or ventricular fibrillation or complete heart block. No chance of sparking restrictive, dilated or hypertrophic cardiomyopathy. No chance of a blood clot in the cavernous sinus of the brain or in a splanchnic vain. No probabilty whatsover of developing Bells palsy, transverse mylitis or the gullain barre syndrome. And no young boy will develop myocarditis within 4-5 days of finishinbg the short course.
The WHO analysis on ivermectin is not even worth writing about, it has cherry-picked data, arbitrarily downgraded the quality of evidence and come to the implausible conclusion that the drug is ineffective and worse not safe ( without a shred of evidence for the latter conclusion). There was no vote taken to make the final decision. Dodgy to say the least.
The paper that launched ivermectin was written by a group of brilliant scientists in Melbourne, Australia. This was the first research demonstrating ivermectin destroyed the Covid19 virus in 48 hours. Clinicians took note of this paper and the rest is history. Hundreds of thousands of lives have been saved across the planet. Interestingly the lead author of the first research paper is Dr Leon Caly whose mother comes from Kerala!
I have always maintained that this virus and this Pandemic are much bigger than any politics, religion or government, not to mention the WHO or Big Pharma. I may be a microscopic speck, smaller than the Covid19 virus (that is 60 to 140 nanometers in size) but I have never been petty. There is still a big heart, shaped by years of interval training.
YouTube has some ridiculous guidelines that are unleashed on a whim or something else.
I had never in my wildest nightmares imagined the current oxygen and medicines crisis. This is a country with more than 200 nukes, aircraft carriers, state-of-the-art fighter jets, fully armed submarines, and one of the largest if not the largest land armies in the world. It has one of the largest economies and some of the brightest minds win the planet. Yet, tragically, people are dying inside hospitals because of wanting for oxygen.
Complete panic has set in. I keep getting calls for a bed for a covid patient. Other doctors must be getting contacted much much more. The situation is dire, anyone can sense the fear and chaos in the capital of India.
There have been major goof-ups by the powers that be. The collective wisdom of concerned people seems to have evaporated. But there is little point in elaborating the obvious. It will serve no purpose.
The need of the minute and not just the hour is to remain composed and calm. We need our wits about us as never before. Fear mongering, sacred mongering, disease mongering, or blame mongering will get us nowhere. The virus has been around for at least one and a half years. We now have enough data on its genome structure, pathogenesis, epidemiology, clinical features, and treatment to manage this crisis.
I do not believe in making seemingly clever statements that in the coming days so many lakhs will get infected and so many thousands will perish. I know from numerous epidemiological studies that the infection fatality rate is around 0.05% to 0.08%. To put it simply if 10,000 people get infected around 5 to 8 will die. A small number but traumatic and shocking enough for those directly connected with the death.
Around 3000 people died yesterday, most probably due to an infection that was contracted 10 days ago when 250000 people were affected. It is common knowledge that for every one person testing positive for covid there are at least another 10 roaming around. The math gets simple now. The infection fatality rate in India is still around 0.1% if not less. I am erring on the side of caution. It could be less.
After more than one and a half years of this Pandemic, we have learned from a humongous amount of data that the majority of people who get infected are either asymptomatic or have mild symptoms. Very few (less than 5%) need admission in intensive care.
Moreover, mortality in hospitals has decreased substantially across the world because of improved knowledge and resulting care. Sweden has managed to cut down mortality by more than 50% by employing evidence-based medicine. The same pattern is visible in hospitals in other countries.
We now have antivirals at our disposal that significantly lower viral load while hastening recovery. Multiple randomized trials have shown significantly improved clinical outcomes and reduced mortality with the anti-parasitic drug ivermectin. Ivermectin prevents entry of the covid virus into the nucleus of the host cell. It also acts as an anti-inflammatory and probably prevents clumping of red blood cells/ platelets. The drug is cheap and freely available in the country. The dose is just one tablet of 12 mg for 3 to 5 days.
A large randomized study (PRINCIPLE trial ) including 1700 covid patients has shown significantly shorter recovery time with inhaled budesonide and this treatment is a part of the official government protocol to treat patients at home. Budesonide is both an antiviral and anti-inflammatory. The recommended dose is 800 mcg twice a day.
The trick is that treatment should begin at the earliest before the virus gets a foothold in the body. Viral load is the highest initially and after 10 days of symptom onset, it does not matter because the virus by then has ceased to be viable. The virus may be picked up by an RT-PCR test for another month but this will be gene debris or dead virus. The person concerned is no longer infective after 10 days. The process of 2 consecutive negative PCR tests is thus redundant.A recent study in National Basketball League has also demonstrated that after 10 days of isolation an athlete was unable to infect another person while in the bubble.
Apart from ivermectin and budesonide a cheap antacid named famotidine has also shown hastened recovery. But these are anecdotal reports from China. An observational trial using famotidine with cetirizine found improved clinical outcomes in patients with Covid. As both famotidine and cetirizine are histamine blockers it is hypothesized that these 2 medicines prevent the hyper-immune response seen in a few unfortunate patients.
Once the hyperimmune situation sets in and the patient is on noninvasive or invasive ventilation corticosteroids are the answer. The large RECOVERY trial has demonstrated significantly reduced mortality in patients on ventilators and noninvasive ventilation. There was an absolute 12% reduction in deaths with only 6 mg of dexamethasone given over 7-10 days.
Another RECOVERY trial with an IL-6 inhibitor called tocilizumab trial has shown a further 8% absolute lowering in mortality. Researchers and clinicians believe that if dexamethasone is failing addition of tocilizimab improves clinical outcomes in sick patients. There may be a synergistic effect.
A word on remdesivir is needed; remdesivir is an antiviral injection that by interfering with the polymerase enzyme stalls viral replication. The drug is administered by intravenous injection. Three randomized trials have been done. Not one showed a reduction in mortality. The study done by the company did show quickened recovery time. Remdesivir is of little use in patients on ventilators. It should be used in the early phase of the disease, keeping in mind that it is unable to prevent deaths.
The present hue and cry over remdesivir is unwarranted. The fact that it is being sold in the black market is bewildering as the beneficial effects are marginal with this drug.
What then is the way forward? We must like Israel move towards some kind of equilibrium with this virus. Knowledgeable people call such a state herd immunity. Herd immunity is to be achieved by vaccination and natural infection. Vaccines undoubtedly have short and long-term adverse effects, but these have so far been far and few. Some adverse effects have been gruesome but then almost a billion people have received one injection already. India has jabbed 140 million people as of today, and this is no mean feat, considering the logistical hurdles and vaccine hesitancy.
I notice that more and more people are queuing up for vaccines now. This is the fear factor but it helps. There are currently 2 vaccines available in India. The inactivated whole virus vaccine has been reported to be effective against the new variants. The other vaccine is the adenovector-based platform designed by Oxford that carries a DNA with the spike gene-making instruction. Both are intramuscular shots to be given 4-6 weeks apart.
According to the Oxford investigators, efficacy was more than 80% if their vaccine was given 12 weeks apart as only 54% when given before 6 weeks. Their data in the US trial however showed 76% efficacy with a 4-week dosing interval.
The third vaccine to be made available is the Russian Sputnik V that is similar to the Oxford vaccine in that this too has an adenovector DNA platform, but the adenovirus used is human, whereas it is a chimpanzee virus in the Oxford vaccine.
Importantly any of these vaccines can be taken as we lurch towards herd immunity. I personally would have pursued a program of vaccinating the vulnerable first, instead of vaccinating everyone above 18 years or older. I would have preferred a graded program in which the elder decade is injected first instead of all at once. The latter will lead to considerable logistical confusion.
It is imperative to remember that the chances of contracting the virus are high at a vaccination center because people forget to keep their distance.
Till a substantial proportion of the population is vaccinated the ONLY way to go is to educate and educate and educate the public to AVOID crowds and enclosed spaces. Wearing a mask in such situations is plain common sense. I have been pleading on common sense in every video that I have made since last September but to little effect. My language has been simple and direct. Crowds of any kind are a big no-no for the next 2 years. Reads badly but this is the sad truth.
The virus is not going to vanish all at once, and neither can it be eradicated by a magical wand. Lockdowns will only postpone the inevitable, the virus will wait till the lockdown is lifted.
There is also an uproar on the new variants. Without going into details let me assure you that the new mutations can be easily tackled by nonpharmaceutical interventions (NPI) that I have already written about. The “double mutation” may be more infective ( no proof so far) but there is absolutely no clinical suggestion that it is more virulent. There is now considerable data that the English variant does not kill more than the initial variant.
Most mainstream media, both western and in this country, was calling the English variant the “deadly virus” without any evidence. This was both irresponsible and silly but was a fear-mongering business as usual.
The current surge in India is not because of a new strain or a “deadly virus. It can and must be tackled. It will be tackled. There is little need for panic but basic commonsense precautions are mandatory. Unnecessary travel must be avoided, and for the time being keep all domestic help at bay ( making sure you give them their salary).
Avoid crowds like the plague.
The fault, dear reader, lies not within the virus, but in ourselves, that we are underlings.
