HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.

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THE MAN IN A BLUE SARONG

I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.

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PATIENT “OWNERSHIP”

I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

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process as well. However, the necessary phases of vaccine development were all carried out, but without the customary bureaucratic slow pace. The usual independent advisory committees evaluated the data from the manufacturers. Their experts (with only a few dissenting individuals) felt the results, as far as efficacy and safety, were statistically reliable and met criteria for clearance under Emergency Use Authorization (EUA). Given that the number of U.S. deaths was nearing 500,000, it was judged that the vaccine benefit definitely exceeded risk on a population basis; and in most opinions, also on an individual basis when looking at the accelerating rate of new infections and deaths predicted.  The engineering of vaccine bulk production before waiting for regulatory approval of the Phase 3 study results was a major time saving factor, probably moving delivery time forward by at least a year. Federal funds for development also meant corporate boards of directors didn’t hesitate on equipment and staffing budgets. Safety concern is a theme currently pushed by Russian, Chinese and North Korean groups impersonating Americans on social media.  Numerous activists in the anti-vax community (many selling supplements and vitamin/mineral programs claiming to prevent or lessen COVID-19 disease severity) also promote this view.  There are a few sincere, credible critics who question the amount of time given to detect rare adverse events or common but subtle side effects that might manifest months or years after vaccination.  Those are hypothetical situations that have rarely (never?) been seen in vaccines. Most of those critics do support the risk/benefit decision to proceed with EUA status after the dramatic fall of cases following vaccine rollout in January 2021.


Immunity from natural infection is superior to vaccine induced neutralizing antibodies so we should vaccinate only the vulnerable elderly and younger with comorbidity.  Once most of the “invulnerable” have recovered from natural infection we will have “herd immunity” without the economic ruin of social distancing and other restrictions on commerce.


This “quarantine” of the elderly with a laissez faire approach for the younger population and businesses/schools was taken by Sweden early in the pandemic, but before vaccines were available they reversed course due to the number of infections and deaths seen with no evidence of “herd immunity” having been reached. Most epidemiologists feel at least 80-90% vaccine/post-infection antibody immunity is needed to control infection and hospitalization rates. In the absence of vaccines or effective prophylactic drugs, they found the elderly could not be adequately protected. Unexpectedly, it was also found that morbidity in the recovered patients was significant. The economy was still affected due to fear of the disease. The question of relative strength of antibody response between the natural infection versus the vaccines is complicated and consensus hasn’t been reached. Decreasing neutralizing antibody activity is seen as time goes by in either case. Patients who have recovered from alpha variant Covid-19 disease can suffer from a second infection, usually more than 3 months from recovery and from a slightly different strain of virus. It may be mild or severe. Some studies show up to 30% of individuals with the alpha variant infection or with vaccination (in elderly or immunocompromised) may not form neutralizing antibodies. U.S. delta experience is yet limited and may show a different pattern.  Cell mediated immunity is difficult to measure and few studies are published comparing vaccines with natural infection cell mediated immunity, particularly as time passes.


The adverse events (complications) caused by the vaccines are much more frequent and serious than admitted by the vaccine companies or the government health agencies. It has been “reported” that at least 7,000 people in the U.S. have died due to the vaccines.


This is a statistic quoted by many of the disinformation sources and accepted by many people as fact. It was even brought up in one of the Kentucky House of Representatives Committee meetings on Sept 7. A Representative asked a couple of times why the FDA had not retracted approval of a vaccine that violated a claimed FDA threshold of 25 deaths. The Committee was pushed to require the statistic in any educational material or public service announcements (PSA) put out by the Department of Health.  The source for this 7,000 number is the Vaccine Adverse Event Reporting System (VAERS) managed by the FDA and CDC.  Depending when the VAERS database was queried the death number may be from 4-7000.  The presence of an event in the system does not indicate it was caused by vaccination. Individuals receiving a vaccine can register with VAERS and report any symptoms or problems they feel may be related to their vaccination. Vaccine manufacturers are required to record any deaths or significant events that come to their attention under EUA rules. I am currently a participant in the J&J Phase 3 trial and file a status report twice per week. Health care providers, health departments, hospitals, in-home nursing also enter deaths or any events they may be aware of into VAERS. CDC does review the reports for significant patterns and investigates deaths to the best of their ability. On the CDC website, adverse events section; it reports no mRNA vaccine caused deaths were identified. CDC did attribute 3 U.S. deaths as of April 2021 to the Thrombosis and Thrombocytopenia Syndrome (TTS)  following Johnson and Johnson ( J&J) vaccine inoculation. Twentynine TTS patients were identified after pausing vaccinations when about 8 million doses had been administered. The Astra-Zeneca (AZ) vaccine is almost identical in components to J&J. Used in the United Kingdom and a few other countries, TTS deaths have been reported. I have not seen an estimate of the frequency of its occurrence with AZ vaccine. Vaccine related TTS occurs within a 6-16 day window following vaccination.  An antibody to Platelet Factor 4 is felt to be the cause. There are occasional media stories about vaccinated patients who died dramatically in a short time after their vaccination. Some with thrombocytopenia and hemorrhage, some with thrombosis. Very few received the J&J vaccination. Whether these might be related to vaccine is speculative. They could also be due acquired Thrombosis and Thrombocytopenic Purpura (TTP) disease or an occult underlying sepsis.


The above paragraphs detail some of the more reasonable concerns of patients, but  with “facts” distorted or presented to them without context. There are also many more bizarre conspiracy theories that are promoted on social media. Following are a several. None have a factual basis.



So who is promoting all the social media disinformation? The onslaught comes from too many persons and organizations to list in detail but I will describe two.


On Aug 10, 2021 the AP reported that Facebook removed the Russian related advertising company Fazze, with 65 Facebook accounts and 243 Instagram accounts from its platforms. The company attempted to send messages to dozens of social media “influencer accounts” offering them “whatever their fee was” to discourage Astra-Zeneca and Pfizer vaccine use and to feature their negative ads and You Tube videos. Very few influencers took them up and they were reported to Facebook quickly. Earlier, Fazze had attempted the same in India, France, Germany and Britain  (Reported on msn.com and theguardian.com).


In late March 2021 Imran Ahmed of the Center for Countering Digital Hate (CCDH, counterhate.com) released a news article entitled The Disinformation Dozen.2  It was featured in an interview on the NPR Website May 14th. It lists the top 12 persons identified as spreading Covid-19 vaccine disinformation on the internet. They were identified from a sample of 812,000 posts on Facebook, Instagram and Twitter from the period Feb 1–March 16, 2021. The twelve were responsible for 65% of the content within the 812,000 posts/shares in their sample. Most of the individuals are associated with the anti-vax community and some maintain their own organization websites that either sell Covid “preventative or treatment supplements” and/or solicit donations to support their cause. Most have several accounts from which they post. Following the article and a Congressional hearing in which the article was referenced and Mark Zuckerberg testified, almost all of them were supposedly banned from Facebook. As of May 14, however, Ahmed found that 10 of the 12 were still on Facebook and all were on at least one platform. The Center estimates that 95% of anti-vax disinformation is not caught by Facebook’s policing algorithm. Go the the CCDH website for the complete list and details of the twelve.  Below is the #1. Many of the others follow a similar profile.


Joseph Mercola, D.O., ranked as the most prolific social media spreader of anti-vax disinformation:


Dr. Mercola lives in Cape Coral, FL according to an article on the New York Times website, 7/24/2021.  At least 3 separate fact checkers have credited him as a leading source of vaccine disinformation.  He has been an activist in the anti-vaccine community for at least ten years and sells “natural cures”.  He has run several different internet websites through the years and his current site is simply “Mercola”.  He is reported to run 17 Facebook pages as well as additional Instagram and Twitter accounts. He is reported to have 1.7 million followers on Facebook in English and 1 million followers in Spanish. He employs several people to promote his views online and has been responsible for over 600 disinformation articles on Facebook. He has published 2 previous anti-vaccine books and 8 “natural health” books. The FDC warned him at least 3 times prior to Covid that his product claims were illegally representing their abilities to cure, treat or alleviate medical conditions. He has been warned again since Covid emerged. He has pushed hydrogen peroxide nasal nebulizer and vitamin D for Covid treatment; and at one point tanning beds for cancer treatment.  The Fed Trade Commission (FTC) forced him to refund 2.6 million dollars to purchasers of his beds. Regarding Covid, he has claimed there is proof that Covid is a bioweapon from China, Pfizer vaccine is no more than 39% effective, masks are ineffective, the mRNA vaccines alter genetics and make your body a permanent viral protein factory.  He has claimed there were no more deaths in the U.S. in 2020 April–Dec 31, than in the same 2019 period; and therefore the Covid epidemic is a hoax.  He has pushed his claims on the Tucker Carlson and Laura Ingraham shows as well as at rallies and anti-vax “seminars”.  After being banned from Facebook spring 2021, he has removed all of his previous posts and will remove all current posts within 48 hours. The only product on his website that appears to be for sale today is his recently released 2021 Covid-19 exposé  book. Go to his biography on Wikipedia for more detail.


Another area of disinformation/controversy involves use of the drugs Ivermectin and Hydroxychloroquine in the treatment or prophylaxis of SARS-CoV-2 infection.


This is complicated and deserves a more detailed discussion.  These are endorsed by some sincere physicians but also by many others who are simply Trump MAGA supporters or generic anti- vaxers seeking a vaccine substitute. The FDA does not approve either of them for Covid-19 therapy currently. There is some antiviral activity in the laboratory for both and an early published Chinese Hydroxychloroquine study concluded that there was significant improvement of clinical condition in hospitalized patients. For several months it was standard therapy in China as well as France and Italy. Ivermectin was looked at in an early observational study with similar findings and promoted by a group that included some respected pulmonologists and infectious disease physicians. It is currently approved for COVID-19 treatment in some countries.


For further information regarding almost any Covid-19 issue go to the CDC website: www.cdc.gov.  It has the most current information on most issues.


References



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In June 2021  infections by the delta variant of the SARS-CoV-2 virus exploded in the U.S., taxing medical facilities to the breaking point just as it had in Europe in April and May. With its contagion 2-5 fold that of the original alpha variant, a fourth surge began and by September 3rd the new case rate and hospitalizations were greater than the peak last winter. Deaths, however, have been lower and Sept 3rd were about 1500 per day nationally; less than the 3,400 deaths per day in mid January 2021. Somewhere between 95-99% of deaths are reported to be occurring in unvaccinated individuals. In a sane world the need for vaccinating as many people as possible would be undeniable.


So why are we stuck at less than 60% of America fully vaccinated? Surveys of the unvaccinated have shown many different issues in the minds of the reticent. The following are the most common, with factual defense attached.


I just haven’t gotten around to it, doesn’t seem urgent to me — and I’m young and healthy and won’t have much problem if I get it.  It’s no worse than the flu.


This is common among those under 50. The vast majority of Covid-19 deaths were in >70 year-olds, justifying the lack of concern in younger individuals for their personal safety. This was the attitude pushed early in the epidemic by President Trump. It has been reported that in traditional media between Jan 1 and May 26, 2020 that he or his surrogates with reference to him, down-played the pandemic in 517,000 articles

BY TERRY CLARK, MD, FCAP

(47% of 1.1 million total articles identified as Covid disinformation, 23% specifically claiming “Hoax”).  Even this number was dwarfed by the millions of people reached through each of his Tweets. The great majority of Republicans, including Dr. Rand Paul, as well as the right wing media, labeled the alarm raised by authorities and Democrats as a hoax. Even with improvements in treatment over the last 12 months, mortality with alpha variant was about 1.5% of known infections. Early surges saw mortality rates of 4-6% as hospital capacities were exceeded. It is too early to determine the eventual mortality rate for the delta variant; but it is definitely more deadly for younger people, including children, than the alpha variant was. Mortality from usual influenza strains is much lower; only about 0.1% of cases.


The development of the vaccines was rushed and safety was probably compromised. Plus, the effectiveness really wasn’t as high as claimed. And they don’t have full approval.


The Trump Administration did pressure the manufacturers to release their Phase 3 trial data prior to the November presidential election. Democrats probably added to public distrust with their accusations of political pressuring and distrust of the