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Doctor Mike Hansen's 7 Predictions for 2021 || Ivermectin || Vitamin D || Severe COVID || Vaccine

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Doctor Mike Hansen's 7 Predictions for 2021 || Ivermectin || Vitamin D || Severe COVID || Vaccine

Doctor Mike Hansen's 7 Predictions for 2021 || Ivermectin || Vitamin D || Severe COVID 19 || Pfizer Vaccine for COVID

My 1st prediction is that we will have better medication to treat severe Covid. So far, it's been extremely frustrating that we don’t have a great medication to treat patients with severe or critically-ill COVID 19. We have dexamethasone, which helps to reduce mortality, but it's far from a miracle drug. Many therapies just haven’t panned out—convalescent plasma, Remdesivir, Tocilizumab, and so on. But 2 drugs come to mind that I think will have a chance at improving mortality, which I’ll be talking about in upcoming videos. One of which is Ivermectin.

My 2nd prediction is that this will be the best flu season in decades. Masks, social distancing, hand-washing. These effectively minimize the spread of not just COVID 19 but influenza and other respiratory viruses. And it seems to be more and more people have been getting the flu shot this year. And so far, the number of influenza cases, hospitalizations, and deaths??? I have not had a single patient with flu and don’t know of anyone personally how has had the flu. But we’ll have to wait for the official statistics to come out once flu season is over.

Mentioned Video:
How Doctors Can Predict Who Dies From COVID
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Prediction: Vitamin d deficiency will be much less prevalent in 2021 and beyond because everyone and their mother have been taking vitamin D since the pandemic started. Many studies show that the people who do worse with COVID 19 tend to be vitamin D deficient. How much of that is causation vs. correlation is still TBD. Regardless, it's important not to be vitamin D deficient. And on a related note, I think this pandemic will result in more and more people taking their health more seriously.

Prediction: doctors will be able to predict with a high degree of accuracy which people with Covid 19 will have severe disease. We already know the general risk factors for those at higher risk of having more severe COVID 19. Older age, being a male, medical co-morbidities like obesity, high blood pressure, diabetes, Type A blood. Still, more and more studies are being done to better predict disease severity for a given individual. This takes into account specific lab measurements done when they have bloodwork at the time of hospitalization.

Prediction: Vaccine will remain effective against the new strain. The SARS-CoV-2 virus incurred some mutations, and as a result, formed a new strain of SARS-CoV2, called the B.1.1.7 variant. It was first identified in the UK, is basically everywhere globally, and has been spreading faster than its counterparts. The mutations that it has incurred slightly altered its spike protein. Given the spike protein's importance in developing immunity, it’s fair to ask whether the vaccines will be less effective against this new variant of B.1.1.7 variant. Well, preliminary data from the UK suggests that the vaccines remain effective, and the US conducts its own studies. The CDC provides updates on its website for all known coronavirus mutations and ongoing efforts to sequence and understands their implications. While SARS-CoV-2 is statistically expected to mutate every couple of weeks, most of the subsequent viral structure changes are minimal. Like HIV, some other viruses are way more likely to have meaningful mutations regularly, which is the big reason why an HIV vaccine has been so hard to develop.

Prediction: I am getting my second vaccination shot tomorrow, the one from Pfizer. My prediction is that my second shot will go smoothly, just like it did the first. Knock on wood (head). Even though side effects from the vaccine are more likely to occur in younger people (I’m 40, say what you will), and they are more likely to occur after the 2nd shot, overall, most people will not experience side effects other than a sore arm for a day or two. So hopefully, all goes well, and I think it will. And based on the Pfizer vaccine study statistics published in NEJM, my confidence level will mirror that. So, 9/10. Related to this, I also predict that I will make a video on me getting the 2nd shot. But not just another video, a music video. 9/10.

Prediction: The pandemic will be over by fall. This mainly depends on the number of people who get the vaccine. We need probably 80% or so of the population to get it to reach herd immunity. This also means we still need to mask up and distance. But before we get to the end of the pandemic, we first have to get through the worst of the pandemic, which is January. People travel for the Holidays with indoor gatherings and parties, because of the cold/dry air, because of the new strain that is more contagious. January already is bad and will only get worse. This past week, we see the crazy number of covid cases and deaths in my hospital, which is going on throughout the country.

Doctor Mike Hansen
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Vitamin D and COVID 19 || Vitamin D for SEVERE COVID 19?

Vitamin D and COVID 19 || Vitamin D for SEVERE COVID 19?

2020 Is finally coming to an end. But the virus won't be anytime soon. Especially if people don't get the vaccine. December 2020 was the worst pandemic month. And January will be even worse.
Ivermectin for COVID 19?
Vitamin D for Covid 19? (SEVERE Covid 19)
Let's talk.

⏩ Timestamps, click to skip ahead!
00:00 - Intro
00:11 - January The Worst
02:38 - COVID Vaccine Allergic Reaction Issues
04:32 - Ivermectin for COVID 19 (latest update)
04:51 - Vitamin D for COVID 19 (latest update)

More people traveled through US airports this past Sunday than any other day this pandemic, about 1.3 million. Simultaneously, more Americans were hospitalized this past week than any other week of the pandemic.

This past week, about 40% of all ICU patients in the US had Covid 19, according to data published Monday by the US Department of Health and Human Services. That's up from 16% in late September, 22% in late October, and 35% in late November. More than 63,000 Americans have already died so far this month, which is the worst month of this entire pandemic. And next month is only going to be worse.
Three big reasons;
One, because of holiday travel and indoor gatherings.
Two, because of colder temperatures.
And three, that new coronavirus variant B.1.1.7 is more contagious, more transmissible. It's nowhere in the US, first identified in a Colorado man.
So I think that January is going to be the worst month of this entire pandemic.

Of course, the way we fight this is with distancing and masks, and the more people do this, the better the numbers will be. And the more people who get the vaccine, the higher the likelihood of bringing this pandemic to an end. Most experts believe that about 80% of the population needs to be vaccinated to reach herd immunity. Most polls show that about 60% of Americans want the covid vaccine. Based on my YT poll, 10,000 of you voted. And 47% want the vaccine. 37% don’t want it. And 16% are still undecided.

So this virus will not be extinguished anytime soon unless these numbers change. The soonest I expect this pandemic to be over would be by next fall. But people need to get the covid vaccine to make this happen. I’m glad that I was able to get my Pfizer vaccine back on Dec 15th. Other than some arm soreness in the first 24 hours or so, I didn’t have any side effects. So, I feel great. And I’m going to get by the second shot of the Pfizer vaccine a week from now. With the second shot, the chances of developing side effects are slightly higher than the first shot, so we’ll see, and I’ll keep you posted.

One concern with these covid vaccines is the potential for allergic reactions. Reactions to vaccines, in general, are rare. The American College of Allergy, Asthma, and Immunology (ACAAI) has updated its advice regarding allergic reactions to these new mRNA vaccines. They say that anyone with a severe allergic reaction to the first shot should not get the second shot. People with allergies to medications, foods, insects, and latex are no more likely than the general public to be allergic to these covid vaccines.

It's still unclear whether having had an allergic reaction to an older type of vaccine means people will react badly to the mRNA vaccines. People who have had a previous allergic reaction to a specific component of the new vaccine, such as propylene glycol or lipid nanoparticles, should hold off on getting the vaccine. Regardless, these people should discuss the covid vaccine's benefits and risks with their health care providers, ideally, an allergist. These are the latest recommendations at the time of this video, and they are subject to change.

Now, with this new coronavirus variant, which scientific experts are saying is more contagious.
Does that mean the covid vaccine will be less effective to new coronavirus variants?
This is still an unknown at this point.
And if the vaccine is less effective against this new variant, how much so?
Again, an unknown. Most scientists think that the vaccine will remain effective against it.

A lot of people are also talking about the parasitic drug Ivermectin. Is it useful against COVID 19? Too early to tell.
Some weak studies show it might help against COVID 19, but nothing conclusive so far. We will need a large RCT to know if it works or not, and that hasn’t happened yet.

What did just come out, though, from Brazil, is an RCT for giving Vitamin D to patients with severe COVID 19? We know that vitamin d deficiency is linked with a higher risk for severe COVID 19. Still, when vitamin D was given to critically ill COVID 19 patients who had lower vitamin D levels, it did not shorten their length of stay in the hospital or decrease mortality. The way that I look at it, it's important not to be vitamin D deficient in the first place, as getting a large dose of vitamin D when you are critically ill is not going to save you.

- Doctor Mike Hansen

#covid19
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Should I Prescribe Ivermectin for COVID 19? || Ivermectin Update 2021

Should I Prescribe Ivermectin for COVID 19? || Ivermectin Update 2021

Ivermectin is a cheap and widely available drug that is getting many buzzes right now, with its potential to prevent and treat COVID 19, which I’m cautiously optimistic about. We’ve seen the hype before with different drugs that ultimately did not pan out. For Ivermectin, the buzz started when researchers in Australia showed that in vitro, meaning in a test tube, SARS-CoV-2 replication was reduced about ~5000-fold over a 48 h time span.
In April, I made a video about this, and I explained how this drug is thought to inhibit viral replication. And is also widely believed to have anti-inflammatory properties.

#covid #covid19 #coronavirus
COVID Update Today by Doctor Mike Hansen (YouTube Video Playlist)


Since April, I’ve combed thru multiple studies, as scientists worldwide have been looking at ivermectin, and so far, 14 studies have been completed. But these studies are not without their flaws. There are retrospective studies, which introduces bias, and most of the studies have small numbers, and some studies are published as preprints before a thorough peer-review process can be completed. The benefit of pre-print studies being published is that knowledge can be quickly shared worldwide. The hope is that prospective randomized studies will follow these observational or anecdotal studies. The drawback is that studies are frequently published and retracted once they are more critically reviewed. For example, I was able to find 3 ivermectin pre-print studies that have since been retracted. But I need to know, should I be prescribing ivermectin for COVID? If so, at what dose and for how long? Well, in this video, I’m going to objectively break these studies down.

The gold standard for a scientific trial is a prospective study that is double-blind and randomized with a treatment and control group, and it should be well-matched in as many variables as possible to reduce the risk that unforeseen factors, and not the medication's action, are causing the effect that researchers are studying. A prospective study enrolls participants to evaluate a treatment protocol, follows them for side effects, and evaluates the results. A double-blind study is one in which neither the investigators nor the treatment recipients know whether they have received the treatment or a placebo. Amid a pandemic, decision-makers have been trying to balance the need for evidence-based medicine and good clinical practice with the urgent need for safe and effective treatments for COVID 19.

Advocates who are on the side of pushing more treatment protocols through this process, even if it ming on sub-standard clinical evidence, will argue that the death rate continues to increase and will argue that there is not enough time to justify a full prospective study, which can take months. They also note that the medications they are choosing to treat COVID 19 with have been FDA approved for other uses and therefore are considered safe, even if they have not been tested to verify safety and efficacy for COVID 19.
Ivermectin is sold over-the-counter in many countries to treat people and animals for parasitic worm infections. In countries in Latin America such as Peru, Guatemala, and Bolivia, its been in great demand as people believe that it protects them from COVID 19. Researchers in Latin America points out that the evidence is scant that ivermectin protects against COVID 19. However, they have difficulty recruiting participants to run a clinical trial and test their hypothesis because nearly everyone has already taken the drug.
Bias can lead to beliefs that become difficult to dislodge and question. If people believe medication will work, it can become difficult to get them to challenge this belief. Many will justify using unproven remedies by saying that it has a good safety profile and will not hurt even if it does not work. A zealous belief that medication will cure can lead to users ignoring side effects, a confirmation bias.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#covid #covid19 #coronavirus
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Covid 19 Vaccine Explained || Covid 19 Vaccine Latest Update Today

Covid 19 Vaccine Explained || Covid 19 Vaccine Latest Update Today
*Correction - It Should be Pfizer (not Phizer)

⏩ Timestamps, click to skip ahead!
00:00 Introduction
1:43 How is it possible a vaccine that, under normal circumstances, would take years to approve could be ready to roll out so quickly and prove to be safe?
3:30 What are the covid 19 vaccines (Moderna, Pfizer), and how do they work?
6:03 Safety and Side Effects of covid 19 vaccine
6:35 How effective are covid 19 vaccines?
7:31 How long does the covid 19 vaccine protection last?
Does it protect against asymptomatic disease?
Does it prevent people from spreading the virus to others?
8:26 Do I still need a vaccine if I had covid 19?
8:39 Is the vaccine safe for me with my underlying medical condition?
8:59 Why do the mRNA vaccines (Pfizer and Moderna) require super cold temperatures?
13:04 Who can get the vaccine? And When?
16:44 What restrictions will need to remain in place, and for how long?
17:53 Are mutations going to affect the vaccination?

#covid #covid19 #coronavirus

COVID Update Today by Doctor Mike Hansen (YouTube Video Playlist)


We’re talking about the Pfizer and Moderna vaccines here. Then other vaccines are on the horizon as well that are not mRNA vaccines. 6 vaccines are getting federal government support in the US, and dozens in being developed worldwide. Several of these are in Phase 3 clinical trials, which is the last step before seeking the FDA's go-ahead. With the 2 vaccines from Pfizer and Moderna, they synthetically make messenger RNA, a genetic blueprint that signals to the body's cells to start manufacturing a specific protein in the body. Not just any protein, but part of the spike protein of the virus. The body’s immune system then says, “Hey, we don’t recognize this spike protein guy; we should kick him out of the club. “So the immune system reacts accordingly. Except when the immune system reacts accordingly, it’s a whole cascade of events, with white blood cells causing a whole bunch of commotion, sending chemical signals to other parts of the body thru the blood, with cytokines, interferons, interleukins…and antibodies are made, which are proteins that bind to pieces of foreign invaders, so that the body is protected the next to go around. This process sometimes causes symptoms to develop, like some arm pain, maybe a little fever, body aches, headache, sometimes nausea, fatigue. And this is what sometimes happens with the flu shot. People sometimes think they got the flu from the flu shot, but that’s never the case. It was the immunological reaction to the vaccination. But back to these mRNA vaccines for COVID. They come in 2 doses, to be taken a few weeks apart. Why? Because the 1st dose, also known as the prime dose, although it does the job, is less than ideal, meaning the level of protective antibodies that develop, they’re there (show hand), but we want them up here (raise hand) to offer better protection. So with the prime dose, the antibodies take 2 weeks to develop. But then we want the second dose, the booster, to get the immune system reactivated. Once that re-activation occurs, immunogenicity is achieved, typically 7-10 days after the booster is given. And when people experience the immune reactions from the mRNA COVID 19 vaccines, it’s not with the 1st dose; it's after the booster.

The independent board that analyzes the participants in the study found that severe side effects included fatigue (9.7%), muscle pain (8.9%), joint pain (5.2%), and headache (4.5%). Less than 2% had fevers of 39°C to 40°C that lasted a day or two. The numbers were lower for the Pfizer vaccine: Severe side effects included fatigue (3.8%) and headache (2%). Now compared to the flu shot, including the high-dose flu shot, these numbers are slightly higher. But otherwise, the trials showed that these vaccines are safe. And they’re very, very effective. In Moderna’s clinical trial, they gave either the vaccine or a placebo to 30,000 people. Of the 15,000 who received the vaccine, 11 developed Covid. Of the 15,000 who received the placebo, 185 developed Covid 19. That’s 94.1% efficacy. None of the 11 people who received the vaccine became severely ill, but 30 of the 185 who received the placebo became severely ill, and one of them died. The vaccine had similar efficacy rates for elderly people and for people in racial minority groups. In Pfizer's clinical trial, the vaccine proved to be 95% effective, and one study participant who received the vaccine developed a severe case of Covid. Both of them give 95% efficacy against symptomatic disease and almost 100% against severe disease.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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BEST Predictor of COVID 19 Disease SEVERITY?

BEST Predictor of COVID 19 Disease SEVERITY?

Some people with COVID 19 do just fine, Others die. And then there is everyone in between. So what determines disease severity?
Yeah, most of us know the risk factors by now. It’s mostly older age, being a male, obesity, diabetes, high blood pressure. But not everyone with severe COVID 19 fits that mold; for example, there was the case of the 28-year-old female who needed to have a double lung transplant in Chicago.

But what about the number of viral particles you are exposed to?
Or how many viral particles invade your body before the immune system defeats it?

The number of viral particles that land on your mucus membranes when a covid 19 infected person coughs or sneezes is the viral dose. An infection can start with a few viral particles. However, the higher the amount, the more likely the immune system will not clear all of the viral particles, and an infection takes hold. The viral dose required to make you sick seems very low for COVID 19 as it is spread through casual contact. The CDC changed its definition of close connection to a cumulative exposure of 15 minutes or more in a relationship with an infected person because it appears that even a series of small exposures may also cause disease. We may not know the minimum infectious dose of SARS-CoV-2 needed to result in illness or whether multiple small doses or a single large dose is more likely to lead to severe disease. The amount of virus someone gets into their system depends not only on the duration you are exposed to someone with the covid virus but also the viral concentration you are exposed to and proximity. And this is why social distancing and wearing masks is so necessary to mitigate this process. Viral load is the level of replicating virus in the body and is measured by copies per ml. We can determine whether the SARS-CoV-2 virus is present in the human body by collecting samples from the nose, respiratory tract, blood, or urine. When the SARS-CoV-2 virus reaches the respiratory tract and binds to the ACE2 receptors on human cells, viral particles enter respiratory cells and reproduce, specifically in Type II alveoli. The newly made viral particles infect other cells, and the cycle continues. This cycle can carry on and exponentially increase the number of viral particles until the immune system has a chance to tame it and hopefully stop the replication process. Whatever that number maybe, this is what we refer to as the viral load. Studies have shown that the higher the viral load in nasopharyngeal swabs or in the blood, the more severe the disease will be, with higher viral loads equating to two times or higher odds of needing a breathing tube (intubated). And this is regardless of age, other risk factors, and severity of illness at the time of presentation to the hospital. Quantifying the viral load is a tool physicians can use for risk stratification.

The PCR Test for COVID 19
A reverse transcription-polymerase chain reaction test (RT-PCR test) is used to detect the SARS-CoV-2 infection on a swab of nasal secretions. A lab technologist prepares the swabs for processing and adds the fluid from the swabs and other chemicals to the PCR machine. The PCR machine goes through a series of heating and cooling cycles during which it makes copies of any viral RNA in the sample. Each time the PCR machine goes through its series of processes, it doubles the number of RNA strands present. The PCR machine can report whether the covid 19 virus was present and, if so, how many cycles it had to go through to amplify the RNA enough, so it is detectable the cycle threshold. If no virus is present in the sample, the PCR machine can go through innumerable amplification cycles, and the virus will still not be current. If low levels of virus are present, it will take more PCR amplification cycles to get enough RNA to make the SARS-CoV-2 sample detectable. If there are large amounts of SARS-CoV-2 in the model, fewer amplification cycles will be required to get an observable sample. More irregular amplification cycles to get a detectable level of RNA equals a higher viral load.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#covid #covid19 #coronavirus

Ivermectin and COVID 19

Ivermectin



Invitro antiviral activity

Against a broad range of viruses

HIV, dengue, influenza, Zika virus

Invitro antiviral, SARS-CoV-2 activity

99.8% reduction in viral RNA after 48 h

Worldwide use for treating COVID-19

About 3.7 billion doses of ivermectin have been distributed globally over the past 30 years

EVMS CRITICAL CARE COVID-19 MANAGEMENT PROTOCOL



Preexposure prophylaxis in high-risk patients

Postexposure prophylaxis

Symptomatic patients at home

Mildly symptomatic patients in hospital

Progressive Respiratory symptoms

Ivermectin has emerged as the “wonder drug” to prophylaxis and treat COVID-19

Ivermectin inhibits viral replication and has potent anti-inflammatory properties

There is the potential for serious drug-drug interaction

Additional, studies are urgently required to confirm these very impressive preliminary findings

Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 (7th December)



Front Line COVID-19 Critical Care Alliance (FLCCC)

One Sentence Summary

Review of recently available clinical trial results demonstrating efficacy of ivermectin in prophylaxis and treatment of COVID-19.

Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019

The ICON Study (October 2020, South Florida)



Research Question

Does ivermectin benefit hospitalized coronavirus disease 2019 (COVID-19) patients?

Study Design and Methods

Consecutive patients hospitalized

Four hospitals in Florida

Confirmed COVID-19

March 15 and May 11, 2020

Treated with or without ivermectin

Primary outcome

All-cause in-hospital mortality

Secondary outcomes, mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, length of stay

Severe pulmonary involvement

Need for Fio2 ≥ 50%, noninvasive ventilation

Invasive ventilation

Results from reviews

N = 280

Ivermectin treated = 173

Overall mortality 15%

Mortality with severe pulmonary involvement = 38.8%

Not given ivermectin = 107

Overall mortality 25% (OR, 0.52)

Mortality with severe pulmonary involvement = 80.7%

No significant differences were found in extubation rates or length of stay

Most patients in both groups also received hydroxychloroquine, azithromycin, or both

Interpretation

Ivermectin treatment was associated with lower mortality during treatment of COVID-19

Especially in patients with severe pulmonary involvement

Randomized controlled trials are needed to confirm these findings

Ivermectin news

Doctor Dies After Getting COVID 19 Vaccine? || Florida Doctor's Death

Doctor Dies After Getting COVID 19 Vaccine? || Florida Doctor's Death

An obstetrician/gynecologist (Dr. Gregory Michael) in Miami, Florida, received the 1st dose of the Pfizer vaccine on Dec.18th. Shortly after receiving the Pfizer vaccine, he reportedly developed acute immune thrombocytopenia. He died 16 days after getting the covid vaccine. Dr. Gregory Michael's cause of death is a result of a brain hemorrhage. Obviously, this is horrible. It’s tragic, and you feel for his family.

But it makes you wonder, was his death a result of the covid 19 vaccines?
And if it resulted from the covid 19 vaccine, should that change your perspective on the covid 19 vaccines?
So I’m going to tell you my thoughts on this, but first, let's learn a little more about what happened.
Pfizer is actively investigating the case.

Over 10 million people in the United States have received at least one shot of either the Pfizer Covid 19 Vaccine or Moderna Covid 19 Vaccine, the two authorized in the United States. Me personally, I received both doses of the Pfizer vaccine. So far, there have been about 40 cases of anaphylaxis, meaning a severe allergic reaction. None of which were reported as fatal. Many people have had other side effects like sore arms, fatigue, headache, or fever, which typically last a day or so.

The Miami-Dade County medical examiner’s office is investigating Dr. Gregory Michael's death, and as of right now, there is no official autopsy report. But based on the reports, let's see what we can make of his case.

Dr. Gregory Michael was healthy. He did not smoke. Did not take any medications. Never had any reaction to any medication nor vaccines. Supposedly three days after he gets the 1st dose of covid 19 vaccine, he developed tiny reddish spots, or petechiae, caused by bleeding under the skin of his hands and feet.

This prompted him to go to the ER. He gets blood work done, and his platelet levels are low, which is something called thrombocytopenia. Platelets are one of the components of blood clotting. If platelets are too low, it makes people more prone to bleeding. Normal platelet counts range from anywhere from 150 000 to 400 000 or so. People can have spontaneous bleeding, including internal bleeding, but that doesn't typically happen unless the platelet levels are less than ten thousand. His levels were reportedly zero, and because they're so low or absent, he gets admitted to the intensive care unit for two weeks. Doctors tried to get his platelet count higher as he had experts from all over the country involved in his care. Presumably, they tried several different treatments. Typically we give platelet transfusions, which is really a blood product that we're transfusing. But also, we give steroids, specifically glucocorticoids, such as salmeterol or methylprednisolone. If that doesn't work, we try other drugs like Ramaplastum or eltrombopag to stimulate the bone marrow to make more platelets. Sometimes we give immunoglobulins, sometimes we give a drug called rituximab, which is a monoclonal antibody. If all else fails, the last resort is to take out the spleen because sometimes a spleen plays a role in sequestering and destroying platelets. So they were actually planning on doing a splenectomy, meaning removing his spleen. Still, shortly before that, he ends up developing a hemorrhagic stroke that took his life in a matter of minutes. In other words, he bled into his brain.

A sudden get severe thrombocytopenia to the point of bleeding to death because no matter what the cause is, this kind of thing is incredibly rare. I've never had a similar case like this in the intensive care unit. Now there are some cases like this reported with certain drugs medications can lead to thrombocytopenia. As a result of drug-induced antibodies being made by the immune system, they attack the body's platelets. Drug-induced thrombocytopenia refers to acute immune-mediated thrombocytopenia, and it should be suspected when someone has sudden severe thrombocytopenia.

*** Please watch the full video to get the proper details.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#covid #covidvaccine #vaccine

Vitamin C and Zinc Studies Report - COVID 19 Update

Vitamin C and Zinc Studies Report - COVID 19 Update

Welcome to another COVID 19 Update, based on a recent study that looked at giving vitamin C and Zinc for mild COVID 19 illness. Zinc gluconate and vitamin C, aka ascorbic acid, are commonly available over-the-counter supplements that people often take to treat viral illnesses. Zinc is known to play a role in our immune function by helping to produce antibodies, in addition to enhancing our white blood cell's ability to fight infection, especially when it comes to neutrophils, a type of white blood cell. There is also some evidence that zinc deficiency increases pro-inflammatory cytokines.

Studies done on the first SARS virus have shown that zinc might inhibit its ribonucleic acid polymerase that's the enzyme that allows the virus to replicate its RNA. But the biological activity of zinc against viruses may require ionophores like Pyrithione to accomplish this. Vitamin C is an antioxidant that may play a role in our immune system’s ability to fight infection. In vitro and in vivo studies in chicks have shown that they could be protective against coronavirus. Human trials have found that it may decrease susceptibility to viral respiratory infections. When it comes to the common cold, there is limited evidence to suggest that high doses of oral vitamin C and zinc might reduce the duration of symptoms and decrease the severity of symptoms.

But what does that mean for zinc in real life?
Based on a review of 13 studies, if zinc is taken within 24 hours of the first signs of a cold, it might reduce a mean length by a day. And with vitamin C, some research suggests that it can shorten colds by 8% in adults and 14% in kids, but it doesn't appear helpful if taken after the symptoms start. Vitamin C in the INTRAVENOUS form has also been looked at for non-COVID 19 patients is variable. A meta-analysis review investigated its use in critically ill patients. It failed to show a significant association with mortality but inconsistent associations with secondary endpoints, including duration of patients requiring a breathing tube with a ventilator and length of stay in the hospital.
But what about zinc and vitamin C for the treatment of COVID 19?
The COVID 19 A to Z study was a prospective randomized clinical open-label trial at multiple hospitals within a single health system, involving sites in Ohio and Florida. Enrolled participants remained in their own home settings, and all study visits and/or procedures were conducted virtually via telephone, email, computer, or laptop. So we are not talking about hospitalized COVID 19 patients. We're talking about patients with mild, perhaps moderate illness here. A total of 214 patients were randomized, 132 women, 82 men, and 45.

Patients were randomized in a 1:1:1:1 ratio, meaning 1/4th received vitamin C, 1/4th received zinc, 1/4th received both vitamin C and zinc, and 1/4th received neither, just standard of care, which is nothing more than rest, hydration, and maybe some Tylenol or ibuprofen, but no supplements. The vitamin C group received 10 days of 8,000 mg vitamin C after being diagnosed with COVID 19 based on PCR testing. The zinc group received 50 mg of zinc gluconate at bedtime. The zinc and vitamin C group received 8,000 mg of vitamin C and 50 mg of zinc.

So we are talking big doses here, much more than what most people take. Patients then tracked their symptoms daily, including potential side effects from vitamin c and zinc. During the course of study, patients admitted to the hospital were considered treatment failures and were no longer required to continue study supplementation or track their daily symptoms. The trial's primary endpoint was the number of days required to reach a 50% reduction in symptom severity score from peak symptom score. Secondary endpoints were the number of days required to get a total symptom severity score of 0, cumulative severity score at day 5, hospitalizations, deaths, adjunctive prescribed medications, and adverse effects of vitamin C and Zinc.

Based on statistical analysis, there was no significant difference in the primary outcome of days required to reach a 50% reduction in symptoms among the 4 study groups. Patients who received usual care without supplementation achieved a 50% reduction in symptoms on average 4.4 days compared with 3.7 for the vitamin C group, compared to 4.9 days for the zing group, and 3.4 days for the group that received both.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#vitaminc #covid19 #zinc

How Doctors Can Predict Who Dies From COVID

How doctors can predict which patients are more likely to die of COVID

There are a number of studies that have come out about COVID 19 prognosis. We now have a powerful way to predict which patients with COVID 19 pneumonia are more likely to die, and more likely to require longer stays in the hospital.

We already know that less than 15% of people who get COVID 19 have severe disease to the point of requiring hospitalization. Less than 5% of people who get coronavirus require ICU. For those with COVID 19 pneumonia who require ICU, and for some of the other patients in the hospital who might not necessarily need ICU, these are the patients who have the cytokine storm that we keep hearing about, meaning the immune system is going haywire, and there is a ton of inflammation taking place in the body….especially the lungs. But now, we have a more specific way of predicting who is more likely to develop cytokine storm, and therefore more likely to die, and who is more likely to require a longer stay in the hospital….and it's based on the bloodwork we get when patients are hospitalized.

When we get bloodwork, we’re doing various lab tests. Most commonly a complete blood count, or CBC, and a complete metabolic panel, or CMP. We often check other things as well, like troponin, d-dimer, LDH, ferritin, and CRP. A complete blood count is specifically looking at 3 things: levels of hemoglobin, platelets, and white blood cells. We can see not only the total number of WBC, but also the breakdown of the percentages of the types of white blood cells, meaning, what percentage are neutrophils, monocytes, lymphocytes, eosinophils, and basophils. Lymphocytes generally make up about 15-45% of WBC. This is very important as it pertains to COVID-19, and you’ll see why in a little bit.

The CMP stands for the complete metabolic panel, and that is looking at levels of sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, glucose, calcium, bilirubin, albumin, and liver enzymes like AST, ALT, and alkaline phosphatase. Some of these also have important implications when it comes to COVID 19 disease severity. Because In the recent study done at Temple University, they analyzed over 500 hospitalized COVID-19 patients, all of which had inflammation in their lungs seen on CT scan of the chest (show). They determined the criteria for COVID 19 cytokine storm. For patients who met these criteria, their length of stay in the hospital was on average 15 days, compared to 6 days if they did not meet the criteria.

Mortality was 28.8% in the group that met criteria, vs 6.6% in those who did not meet criteria. So if they met cytokine storm criteria, their likelihood of dying was 4 times higher. And how accurate was this prediction model? Pretty accurate, as this study had a specificity of 79% and a sensitivity of 85%, which is a lot of predictive power. Most of the patients who met the criteria for CS did so at the time of admission or shortly after. This suggests that there is an early and rapid progression in these patients, and also suggests that there is a low likelihood of developing cytokine storm after 10 days of hospitalization.

So based on these specific lab parameters, this is how doctors can predict which patients are more likely to die of COVID-19. And I do find that this study correlates with what I’ve seen in my personal experience with hospitalized covid patients. And yes, the man whose CT scan I showed you earlier in this video, met all of these criteria for cytokine storm, and he did so as soon as 24 hours of being admitted to the hospital.

Pfizer Vaccine Explained || The CDC has given the Green Light -- COVID 19 Vaccine Update

Pfizer Vaccine Explained || The CDC has given the Green Light -- COVID 19 Vaccine Update
COVID 19 Vaccine Pfizer is here. And I have a lot of my patients in the pulmonary clinic asking me about it. So far, every single one of my pulmonary clinic patients tells me (both those with and without covid 19) that they want the vaccine. And I'm happy when they tell me that. And I tell them pretty much everything I said in my last video. And pretty much everything I'm going to tell you in this video.

Fresh off of FDA Authorization, EUA, that is, the Pfizer vaccine has finally arrived. The CDC has given the green light for the vaccine, and it is being shipped right now. And I’ll be getting it in a few days, along with my colleagues. Most people don’t realize just how big of a deal this really is. Not just because of the current situation we’re in. This vaccine, this mRNA vaccine, has never been done before. The technology to make an mRNA vaccine began back in 2002 with the first SARS virus.

But this covid 19 vaccine, from the time of conception to the time of getting EUA from the FDA - less than a year. This is a historic moment. Looking back in history, this will be a medical breakthrough moment. Because not only is it 1st of its kind, it's 95% effective. And it's very safe. And it is the key to shutting down the virus. Scientific and public health experts ensured that this vaccine underwent rigorous scientific standards for safety, effectiveness, and manufacturing quality to support emergency use authorization. It’s a HUGE testament to scientific and medical innovation. And we can expect 20 million people to get vaccinated in the next few weeks – that being health care workers and people living in long-term care facilities like nursing homes. We are talking about the Pfizer vaccine, which goes by the scientific name BNT162b2. It’s an mRNA vaccine, meaning messenger RNA. In a lab, a tiny piece of genetic material is made. This genetic material called mRNA is a specific genetic blueprint that tells the body's cells to make a particular protein. It's the same protein as the spike protein of the coronavirus. Once the cells make that protein, the immune system recognizes it as foreign. Hence, the immune system in response develops antibodies to fight against the protein, which means it will fight against the coronavirus.

This Pfizer vaccine is given in 2 separate doses, 21 days apart. The first dose is to prime the body, the second dose is to boost the response. There were 43,000 total people in the study, age 16 and older. Half of them received a placebo, the other half received the vaccine. There were only eight Covid 19 cases among people who received the vaccine, compared with 162 cases among those given the placebo. There was 95% efficacy in people ages 16 and older. And almost 100% effective at preventing severe COVID 19 disease. Of all the 21,720 people who got the vaccine, only 1 developed severe COVID 19. If you look at the placebo group, there were 9 cases of severe COVID 19. When the groups were analyzed by age, sex, race, ethnicity, obesity, and presence of a coexisting medical condition, the vaccine's efficacy rate remained consistent. Some people wonder, is the 1st dose enough? The short answer is no, but it does provide some protection between the first dose and the second dose, the vaccine efficacy of 52%. This is why the booster dose is still necessary.

Severe systemic events were reported in less than 2% of vaccine recipients after either dose, except for fatigue (in 3.8%) and headache in 2% after the second dose. None of the people who received the vaccine died or required hospitalization or a trip to the ER. People who developed symptoms related to the vaccine…this is called vaccine reactogenicity…meaning side effects that occur due to the body’s immune system reacting to the vaccine. And reactogenicity is categorized as local reactogenicity, meaning the location of the injection site in the arm. The people who did get some symptoms included injection-site pain and redness, fever, fatigue, and enlarged lymph nodes. Symptoms were more common after the second dose and more common in younger people. And then there is systemic reactogenicity, things like fever, fatigue, headache, and the like. Overall, most people who got the vaccine did just fine, without symptoms. The ones who did get symptoms, the vast majority of them only had mild to moderate symptoms that lasted no more than a day or two. Overall, there is not enough data to make conclusions about the vaccine's safety in subpopulations such as children less than 16 years of age, pregnant and breastfeeding women, and immunocompromised people. If someone has a history of a severe allergic reaction, it's probably better for them to hold off on getting the vaccine for now, only because there is not enough data in the study to know for sure.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

#covidvaccine
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COVID Vaccine Update - Johnson and Johnson vaccine from Janssen

COVID Vaccine Update - Johnson and Johnson vaccine from Janssen

The NEW COVID Vaccine from Johnson and Johnson has arrived. It has 2 BIG advantages compared to the mRNA vaccines. One, it's a single dose. Two, it does not require super-cold temperatures. This will make it way easier to mass vaccinate.

The study was called the ENSEMBLE Trial, a randomized, double-blind, placebo-controlled phase 3 study, meaning that thousands of patients are enrolled and assess the vaccine's safety and efficacy. Unlike the Pfizer/BioNtech and Moderna vaccines, which are mRNA vaccines, the Johnson and Johnson vaccine is a recombinant vector. In this case, it takes another virus, an adenovirus, to modify that virus to cause infection in the body. However, that virus can still serve as a delivery messenger to deliver the genetic code for a portion of the SARS-CoV-2 virus. Specifically, the genetic code that codes for the spike protein of the virus. One of the huge advantages of this Johnson and Johnson vaccine is that it is a single-dose vaccine. The other significant advantage of this Johnson and Johnson vaccine is that it can remain stable for two years at -20°C (-4°F), at least three months of which can be at temperatures of 2-8°C (36°F–46°F).
Why is this significant?
Because that means unlike the mRNA vaccines, regular refrigeration will suffice for mass distribution.

But how effective is this Johnson and Johnson vaccine?
The ENSEMBLE trial enrolled over 43,000 participants ages 18 years and older from the United States, Latin America, and South Africa. About 1% of patients enrolled in the study developed covid. It was 66% effective at preventing moderate and severe Covid by day 28 after vaccination among all participants, including those who lived in regions with the new emerging viral variant such as P1 variant in Brazil and B.1.351 variant in South Africa. Protection against SARS-CoV-2 was most significant in the United States at 72% and worst in South Africa at 57%. About 95% of those in the trial who developed covid in South Africa were found to have been infected with the B.1.351 variant. That B.1.351 variant has been found to have some resistance to antibodies generated due to previous infections and other vaccines. Within the B.1.351 variant, the E484K mutation has appeared sporadically in multiple samples for months. Still, until recently, it didn't appear to offer the virus an advantage in populations with no preexisting immunity. But it's a different story in places like South Africa, where many people had been previously infected. In South Africa, there has been a very high reinfection rate to the point where the previous infection does not seem to protect you.

But how protective is the Johnson and Johnson vaccine against SEVERE disease?
It was 85% effective in all regions by day 28, and there was no severe covid after day 49.
Does this mean the Johnson and Johnson vaccine is 100% effective at preventing severe covid by day 49?
We will only know for sure with time and once the entire data from the study becomes available. It’s also worth noting that no one who received the Johnson and Johnson vaccine was hospitalized with covid or died with 28 days of getting this covid vaccine.
Preventing severe disease in a high percentage of people will significantly alleviate this virus's devastation.

How safe is the Johnson and Johnson vaccine?
Serious adverse events, meaning side effects, were rare, with more participants in the placebo group reported adverse events than the vaccine group. This implies that some of the adverse events reported by patients in the placebo arm may have contracting actual COVID disease. The overall rates of fever were 9%. The percentage of people who developed high fevers, meaning Grade 3 fevers, defined as greater than 39°C or 102.1°F) 0.2%.

So, Johnson and Johnson vaccine will soon be filing for Emergency Use Authorization in the United States. This comes just in the nick of time because we have to mass vaccinate as quickly as possible before the new variants become the dominant strain. Because if that happens, the consequences could entail ineffective antibody protection, which means we would take a giant step backward to get this pandemic under control.

So far, about 450,000 Americans have died as a result of COVID. Even if the entire population started doing everything right – wearing masks, distancing…we are still likely to see over 100,000 deaths over the next 3 months. So realistically, we are much more likely to see way more than 100,000 people die over the next 3 months. So it’s a race not just to save lives. It’s a race to get as many shots in arms as possible. And it's even more so a race to do this before the new variants become the dominant strain.

Doctor Mike Hansen
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#vaccine​ #covid

Boston researchers studying Vitamin D as possible weapon in fight against COVID-19

Researchers at Brigham & Women's Hospital are looking into whether or not Vitamin D can lessen the severity of COVID-19 symptoms, and the possibility that it reduces the chances of coronavirus infection.

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What is it like to be fully vaccinated against COVID 19? || COVID Vaccine 2nd Dose

What is it like to be fully vaccinated against COVID 19? || COVID Vaccine 2nd Dose

This is what happened after I received my Pfizer Vaccine 2nd Dose for COVID 19 vaccine.

How long will I have protective antibodies?
Will it be effective against the new strains (variants) of SARS-CoV-2, with its new mutations?

Scientists have identified an escape mutant that may decrease the efficacy of Covid 19 vaccines. The mutation -- called E484K -- has been found in a variant of the coronavirus first spotted in South Africa two months ago, which has since spread to 12 other countries. This variant is being called an escape mutant because it's been shown it might be able to escape some of the antibodies produced by the vaccine. So far, scientists say they highly doubt E484K will render the COVID 19 vaccines useless because the variant won’t escape all the vaccines produced by vaccines. The vaccines trigger multiple antibodies to be produced that attack different antigens of the spike protein.

#covid #covid19 #coronavirus
COVID Update Today by Doctor Mike Hansen (YouTube Video Playlist)


Researchers in Seattle and elsewhere have looked at plasma from patients who recovered from Covid 19 to see if their antibodies can fight off E484K and other mutations. What they found is that E484K challenges the ability of some antibodies to neutralize the covid virus. Scientists are also looking at other COVID variants as well.

So I think the big takeaway here is that for some of the variants, it will likely result in some vaccines being somewhat less effective, but its also important to remember that as new variants emerge, so can corresponding covid vaccines because it's easy to obtain the new variant RNA, and then tweak the vaccine to accommodate the new strain of the virus. Also, Moderna came out today and said that their vaccine results in protective antibodies that last for at least a year.

Can the same be said for Pfizer?
Probably, but this is not definitive at this point in time.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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Moderna Covid Vaccine Update: Is the Moderna Vaccine Safe? Allergic Reactions and Side Effects

Moderna Covid Vaccine Update: Is the Moderna Vaccine Safe? Allergic Reactions and Side Effects

Allergic Reactions!
Bell's Palsy!
Side effects!
Pregnant Women!
Breastfeeding mothers!
How safe is the Moderna Vaccine?
Moderna enrolled over 30,000 volunteers age 18 and older in its double-blind placebo-controlled study. 11,000 were from communities of color, 7,000 were 65 and older, and 5000 were under 65 with conditions that increased their risk for severe COVID 19. Half received the vaccine, and half received a placebo, so 15,000 in the placebo group, 15,000 who got the vaccine. Symptomatic COVID 19 was confirmed in 185 people in the placebo group and 11 people in the vaccinated group, making the vaccine 94.1 percent effective. Researchers actively monitored the vaccine recipients for local and systemic side effects for seven days after vaccination, recorded unsolicited side-effects for 28 days, and more severe side effects and medically-attended adverse events from day 1 through 759.

Summary of The Safety Profile
Like Pfizer, those under the age of 65 experienced more frequent mild to moderate side effects than those over age 65. The safety profile was similar across age groups, genders, ethnic and racial groups, participants with or without comorbid conditions, and participants with or without evidence of prior COVID 19 infection. These systemic side-effects are unpleasant and are at a higher rate than seen in most vaccines. In most cases, they are more likely related to the lipid nanoparticles with super tiny amounts of polyethylene glycol.

Moderna reported no anaphylactic or severe allergic reactions to the vaccine, but a hypersensitivity reaction was reported in 1.5% of vaccine recipients and 1.1% of placebo recipients. The FDA's website has the list of ingredients found in all vaccines and advises that people with a history of severe allergic reactions check the list and discuss the risk of vaccination with their doctor. A Boston doctor had a severe allergic reaction to the Moderna vaccine. He did have a history of having an allergic reaction to shellfish in the past as well. He was rushed to an emergency room, treated, and released. It was also initially recommended that pregnant women or those who intend to become pregnant in three months should not get the vaccine due to their inclusion in the studies. But the American College of Obstetricians and Gynecologists (ACOG) has recently released a statement supporting vaccination for both pregnant and breastfeeding mothers.

Other Reactions
Bell's palsy was observed in three people in the vaccinated group and one in the placebo group. Bell's palsy is a condition that causes temporary weakness or paralysis in the muscles on one side of the face. It is frequently a reaction to a viral infection. A recent study in Italy reported that out of 38 people presenting to a local emergency room for symptoms consistent with Bell's Palsy, 21 percent had COVID 19. In 2019, at the same emergency room, 22 people were treated for Bell's palsy. Bell's palsy usually resolves on its own within six months. Bell's palsy incidence as a side effect from the vaccine will be tracked and compared to Bell's palsy incidence in the unvaccinated population.
Guillain-Barré Syndrome, a neurological disorder that can cause muscle weakness or even paralysis, has not been reported during coronavirus vaccine clinical trials. Ine Advisory Committee on Immunization Practices (ACIP) does not list Guillain-Barré Syndrome's history as a general vaccination precaution.

With the latest guideline, the only people who should not get the vaccine are those who are known to be allergic to any of its ingredients, which is a cutoff that holds true for every single medical product. Ingredients include lipid nanoparticles and polyethylene glycol. Anaphylactic reactions can occur with any vaccine but are usually extremely rare—about one per 1 million doses. As of 19 December, the United States had seen six cases of anaphylaxis among 272,001 people who received the COVID 19 vaccine and 2 recorded cases in the UK. As with everything we do, from driving a car to eating food that may be potentially allergenic, we weigh the risks and benefits that need to be weighed against each other. In this case, the risks and potential consequences of COVID 19 far outweigh the risks from the vaccine.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#covid #covid19 #coronavirus

ABC's Dr. Jennifer Ashton on COVID-19 variant, vaccine rollout, Vitamin D treatment

ABC News chief medical correspondent Dr. Jennifer Ashton answers questions about the latest COVID-19 headlines, including the COVID-19 variant, the vaccine rollout and whether Vitamin D has the potential to help COVID-19 patients.

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'Vitamin D' strengthens immune response to Covid-19: Experts

There is no clinical evidence to prove low levels of #VitaminD lead to severe #COVID19 symptoms but there is a definite connection between the “sunshine vitamin” and immune responses to the disease, say experts as the pandemic spreads across the world and concerns mount over a new mutant strain. #CovidVaccine

Edit - Sowndarya Murali

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USF developing a blood test to 'predict' whether you'll die of COVID-19

Doctors at USF Health are working on a test that could predict how bad your reaction will be to the coronavirus before you even develop any symptoms. All your doctor would need is a vial of your blood. Researchers behind the test say it has the potential to customize medical care and save lives.

The Sad Reality About COVID-19 Pandemic in 2021

“Extra’s” Billy Bush spoke with Dr. Armand Dorian, who is giving an update on the COVID-19 pandemic in the new year.

Dr. Dorian shared, “The current situation in Los Angeles is the worst it's ever been. We have not a single bed available for patients. “

“We need to work more quickly to get the vaccine out,” the USC Chief Office for Verdugo Hills Hospital of USC stressed. “2021 is not starting off on the right foot.”

I got the COVID 19 vaccine. This is how I feel.

I got the COVID 19 vaccine. This is how I feel.
Eye of the Tiger ????.

For More Information Please Watch These Videos:
COVID 19 Vaccine Pfizer - Are You Ready?
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Covid 19 Vaccine Explained || Covid 19 Vaccine Latest Update Today
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I received my first shot was about 34 to 36 hours ago. Basically, I felt like another flu shot, had a little bit of soreness in my arm. Right now, it's actually better than it was about 12 hours ago. I'll be getting my second dose exactly three weeks from when I got my first dose. That’s the one I am even more curious about because people who do get symptoms related to the vaccination, where their immune system responds to the vaccine, are more likely to occur after the second dose. It's also more likely to occur in younger people. I am age 40. I am not that young, but I am not that old. We'll see how that goes. I don't anticipate anything bad happening till now. People look at the news, and they see that they hear about one case about A health care worker in Alaska who got the vaccine. She had no history of allergic reactions to vaccinations in the past, and she had an allergic reaction. She went to the hospital, and the doctors are saying she's doing just fine.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#covid #covid19 #coronavirus

Good News : Tocilizumab (Actemra) & Sarilumab (Kevzara) for COVID 19

Good News : Tocilizumab (Actemra) & Sarilumab (Kevzara) for COVID 19

Tocilizumab (Actemra) & Sarilumab (Kevzara) are IL-6 inhibitors studied for COVID 19. Good news came from a preprint of a trial run by REMAP-CAP, a multihospital group of researchers investigating multiple treatment options for COVID 19 simultaneously. Patients in the U.K.'s intensive care units with COVID 19 might be eligible to receive tocilizumab, a medication used to treat rheumatoid arthritis, other inflammatory diseases, and cytokine storm. The potential benefits of this drug include saving lives and reducing hospitalizations by seven to 10 days. U.K. researchers reported in a recent study that is yet to be peer-reviewed that patients receiving standard care have a mortality rate of 36%. In comparison, those receiving tocilizumab or sarilumab have a mortality rate of 27%, a reduction in relative risk of mortality of 24%.

The REMAP-CAP study, which has not been peer-reviewed but shows good results led to the recommendation to make tocilizumab available for ICU patients. The study is a randomized controlled study that enrolled over 800 patients. Patients received either tocilizumab, sarilumab, or standard care. The study's Eligibility criteria included being admitted to the ICU with severe pneumonia and requiring respiratory support with a positive diagnosis of COVID 19. Contraindications to receiving tocilizumab include an allergy to the medication, a coexisting infection more than 24 hours after being admitted to the ICU, elevated liver enzymes, low platelet counts, low white blood cell counts, or being immunocompromised. Patients could also receive dexamethasone or Remdesivir as indicated.

One of the main issues with COVID 19 is the severe respiratory distress associated with the disease. Severe respiratory distress has been linked to a cytokine storm. One molecule involved that stimulates the hyperinflammatory state or cytokine storm is interleukin-6 ( IL-6). The level of IL-6 has been tracked as a marker for the severity of COVID 19 disease.

Tocilizumab is a recombinant humanized monoclonal antibody approved to treat cytokine storm by targeting IL-6. Isolated observational studies early in 2020 showed that tocilizumab decreased other inflammation markers, such as C-reactive protein. Tocilizumab targets IL-6, whether membrane-bound or free in the blood. Side effects include upper respiratory infections, sore throats, headache, elevated blood pressure, and abnormal liver function. There are many drug-drug interactions with tocilizumab. Tocilizumab stays in the blood for about 14 days. During this time, patients are at increased risk of having undiagnosed infection progress and, therefore, are warned to report any infection's first signs or symptoms. The patient will not exhibit fever and signs of inflammation while on this medication. This means that a hidden infection can advance without notice. The results of the study released by the REMAP-CAP investigators were more optimistic than previous studies' results.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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