Covid vaccine confusion. Mar25,2021.

    There are many on the market and more coming.  Here is a link that compares them and takes out all the misinformation and misuse of various terms.  Please take 5 minutes to watch it.

https://www.youtube.com/watch?v=K3odScka55A

We do recommend  taking any available vaccine at this time.  There is a lot of confusion  and terms used.  Please keep in mind that for large companies this is a business of immense profit, so there is a lot of leaked information to both support and demote each others studies.  Unfortunately, in todays world due to time constraints, we have to take the data provided by the "car salesman"(working for vaccine company) as the only one available and therefore requires  scrutiny.

Here are some certainties.  1. Any vaccine will prevent the severe form of covid, the disease, that can put people in the ICU.

2.  All vaccines will reduce the burden of covid in the world. Doubtful that it will eliminate it. 

3.  You can still acquire mild covid illness even though you have had vaccination.  You will recover.

4.  Highly unlikely that invisible carriers are a problem and even exist to any significant degree.

5.  Not recommended for infants and children at this time.

6.  Mild side effects are common,  temperature, site soreness, fatigue.

7.  Covid is capable of causing serious  blood clots.  Vaccines probably not, the scientific evidence is poor at this time. The Astra-Zeneca vaccine may rarely be associated with a clot at the back of the nose and base of the brain, but this is being monitored currently.  Headlines often originate from competitors indirectly pointing to low value information as clinical fact, to gain a better market share. 

8.  There are numerous people who are immune, or whose system can recognize and address it like any other virus and not create problems. We just dont have a good way of identifing them.

9.  We are lobbying government and health departments to involve us, and allow us to vaccinate you, but no indication that it will happen.  It took 4 mos, for our own staff to start  immunization, despite being both high risk front line workers and working in the Canada's covid hotspot.   We will have to remain mostly virtual until the process is completed in a few months, and we obtain a suitable color designation that allows normal care to become more personal. We regret that we could not convince the gate keepers otherwise.  Please work with us in this very difficult time.  

Covid vaccine. Needles before bullets!  March 15,2021

We know you are hoping to get your COVID-19 vaccine as soon as possible and are seeking the latest information. Here is what we know now (March 12, 2021).

AstraZeneca Vaccine
We (have/have not) received the AstraZeneca COVID vaccine in our clinic.  The Astra Zeneca vaccine is being offered only to people ages 60-64 (if you are 60-64 as of the day of vaccination, or if you will be or have been 60-64 in 2021). It is available in pharmacies and some family doctors’ offices in certain health regions. We will let you know as soon as possible when the vaccine becomes available to us. Please do not call us to try to book an appointment. We need to keep our phone lines free for patients with immediate medical needs.

Vaccines for patients over 80 (born in 1941 or earlier):
If you are 80 or older and do not live in a care home, your local public health unit will have details about vaccinations in your area.  Also see local links in next artilcles.

Provincial online system
Eligible residents can now register for appointments starting on March 17.

For more information about COVID vaccines visit the Ministry of Health website: https://covid-19.ontario.ca/covid-19-vaccines-ontario

Please be assured that we will let you know if we have any vaccine and if you are eligible to receive it from us. Please take the first vaccine offered to you.

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.

https://www.youtube.com/watch?v=2IQrcVuNEAU

https://www.youtube.com/watch?v=yb5LYysNQGI

    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. 

https://www.youtube.com/watch?v=2DKDei0Istw

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.

Lockdown and Shots..

    Happy New Year!  The pandemic is a year old.  The message from government and politico-docs continue to be confusing and difficult to understand.  Although primary care doctors are on the front line, we have no pipeline, meetings or coordination with other parts of the system such as health departments and political sources.  This makes answering your questions difficult at times.  I have been active attending meetings and updates on the number of inroads and progress in treating this years virus, particularly by a group of non-biased science based doctors who deal with covid daily. Browse for FLCCC on the internet'.  Good advice on what vitamins help, how important excercise and fresh diet devoid of sugars are. 

    There has been a race by large companies to provide vaccines. Great profits are the golden goose to the winner.  Canada ordered early, and have had vaccine supplies for about a month now, but have barely vaccinated a 100,000 people.  With the help of primary care docs, pharmacists and some others, we distribute large amounts of flu vaccine yearly, and have capabilities of giving over a million shots a week if focally tasked with it.  From the onset storage was a problem.  Lets hope that better co-operation, communication and co-ordination will be able to solve this quickly.

   We have no idea of how and when you will be able to get a vaccine, and will update this feed when it happens.   Both the Moderna and Pfizzer vaccines are new products to the human race. They are expensive and privately produced for profit. They are mRNA vaccines that can replicate protiens carried by the virus using our own machinery and allow the body's immune system to react.  A second dose is required to  get the long lasting effect.    IMPORTANT.. This means that from the time of first injection to considering some degree of immunity it takes 6 WEEKS.  Technically your risk continues during those 6 weeks.  Both vaccines underwent large scale testing and seem quite safe, but longer term data is yet to come.  Most respiratory viruses including covid naturally mutate, and there are variants.  These vaccines can protect against some variants,  but the technology allows for a new vaccines to be developed rapidly, exciting but expensive. We may be in for a very expensive annual vaccination program.  Vaccines will put a dent in the numbers, and no indications that will erradicate the virus.  In the last months, there's been lots of chatter in front line trenches of ways to prevent and soften the disease using combinations of existing, cheap, safe medications such as invermectin, vit d, vit c, zinc and steroids.  I sincerely hope that those in charge of policy, at least look at prevention as a complement to vaccination.  I fall in the high risk group and will take the vaccine with my patients.

   I agree with the shelter in place order, except the part about closing ski hills while keeping LCBO's open??  I hope it was a typo. Complete erradication is doubtful.  We all worry about the hospitals being overrun. Some already are.  Hospitals are always full to the brink in January.  This year it will be much worse.  You cant provide good care in that environment and patients suffer when resources are lacking, backed up and overwhelmed.  The working idea is to SLOW the spread of virus in our population.  I applaud the vast majority of people who exert common sense in their daily decision making.  The term  "lockdown" is misleading.  Some Chinese cities are truly locked down and citizen rights dont exist.  We hope that common sense trumps dictorial rule.  Evidence is weak that is works, but options are scarce.  

   I also need to clarify the announcement about medical care.  When the premier stated that doctors visits are fine, I didnt expect a deluge of calls for regular monitoring items such as normal physicals, requests for screening tests etc, as a way to fill the lockdown days.  The system is overwhelmed and backed up.  Clinics, labs and hospitals are full of covid and rarely discussed, but contribute significantly to the spread of disease.  We are faced with deciding, wether to coax a patient out of safe lockdown and send them to a place where the risk of exposure is high to deal with a deferrable problem.   I am watching my medical colleagues burn out one by one.  We are providing phone advice, virtual consults and  do personal visits as a last resort. Our support systems are broken. Covid is overwhelming our ability to do diagnostic testing, elective surgery, education and prevention.  Please use common sense or stay in your bubble for the next month.

   All I want for Christmas...

The stragedy, that we have adopted during this chaotic period has resulted in a belief that we can spend our way out of a pandemic.  No cost should be spared!  In a system where regular elections occurr every few years, it seems that we have adopted a strategy of passing on debt, clean ups and mistakes to the next group. While I applaud and welcome the newest genetic technology in vaccination against covid. I often get bewildered why we dont have more open discussion about treatments and alternatives that hold promise in other world nations.   It is arragant to conclude that third world experience cannot teach and make inroads. 

  What a wonderful Christmas it could be if we had a simple pill that would significantly eliminate covid transmission, enhance treatment and reduce deaths?  What if there was such a substance. What if it has been around for decades, but poorer nations discovered its effectiveness before we did.  What if it has already been awarded a Nobel Prize in Medicine, and has saved millions of children in third world countries from dying of parasitic infections. What if it had potential to work on the AIDS virus, flu virus and others as well.  What if I mentioned that it has been available around the world including Canada for at least two decades, is relatively cheap and can be effective with one dose.  For the last two months, I have been following the internet medical scuttlebutt  about IVERMECTIN.  Remember that name.   Dr.Pierre Kory is President of the Frontline Covid-19 Critical Care Alliance, a group of ICU,   lung doctors and others who work with covid patients on a daily basis.   This is a large group, non funded whose task early was to work on protocols of treating severe Covid cases, due to feeling helpless. When the standard was simply go home and wait, they were advocating for things like Vitamin D, and C, lifestyle, excercise, etc.  Collectively they have 1000's of peer reviewed articles published.  This group has diligently, collected and analyzed literally hundreds of INVERMECTIN related studies, news items, research manuscipts.  It was quite clear that repeatedly, the effects were reproducible and appeared quickly.  Other studies, became unblinded, since the positive effect was so great that it would not be ethical to not offer the drug to placebo groups.  Most of the studies so far were in South America, Sub tropical Aftrica and India where the drug is routinely used in massive amounts.  This group went to Congress last week and begged them to simply look at the data that they had compiled. No cost, no financing, no profits, simply look and decide.   I took up that offer and looked at the data and was very impressed with the potential and low side effect profile.  But in Canada we seem to claim victory in washing our hands, hiding and rolling up our sleeves eventually.  We could do more. 

   One sign of a good thing, is when fake news starts demoting it on the internet. I think we have learned our lesson from the Putin propaganda machine of how effective fake news can be used to achieve an altenative goal.  There is little reason to not start large scale Canadian Studies immediately,which could compliment the vaccine effort, but at a fraction of the cost and time.  Most times, it takes months and huge patient numbers for studies to uncover some sort of small positive effect.  Three common themes end study trials prematurely.  Obvious emerging harmful side effects,  no effect what so ever, and thirdly, an effect so obvious that  everyone can tell who got the real medicine.

  I would love to ethically offer every one of my worried patients a dose of medication. We could potentially celebrate holidays, hug one another, reduce lockdowns, and augment social distancing regiments.   It may be early, but not too late.  I urge everyone to at least look at the evidence.