Heart inflammation in Israel

well welcome to today's talk it's tuesday the 27th of april now globally cases are still increasing at the moment so this is what we see globally as of this morning and we do see that cases are carrying on rising now i know we're enjoying really quite significant improvements in many parts of the world in in the uk we're enjoying significant improvements we're not there yet but the direction's good but globally i'm afraid it is not and this is as we head into spring and early summer indeed in the well certainly spring in the in the northern hemisphere so this is concerning and a lot of this as we know is the new variants that have emerged and of course this is illustrated nowhere more powerfully than uh india so let's have a look at what's happening in india now in fact let's have a look at some graphics just to contextualize this um here we have um new daily confirmed covered 19 cases per million people so we see that the uk is going down the united states thankfully it's quite a relief we'll maybe talk about that later but the united states is going down but india's slightly higher than the united states in terms of cases per capita but when we look at the testing we see that india is testing way less certainly compared to the uk and quite a bit less than in the united states so what this means is these cases are grossly underestimated in india and as we'll see later on probably perhaps about 25 of the deaths in india are being officially reported as covered deaths as well so the official statistics grossly underestimating the pandemic in india this is not suggesting that there's a deliberate cover-up but the systems are slow and in some places essentially non-existent for recording these things so always very important to remember that in the context of the amount of testing just looking at a little more context share of people who've received at least one dose of covered 19 vaccines so the united kingdom united states both going well india it's way down at uh quite a bit less than the 10 line so another reason why things are problematic in india the slow roll out of the vaccine partly because the population is just so large this just takes a long time and it requires a huge amount of logistics because of the 1.3 billion people just briefly there the situation in europe so the uk portugal denmark germany netherlands sweden so well cases increasing in places like sweden and netherlands overall germany at best flat um france is probably somewhere similar to this so again no no no obvious respite with the better weather in europe now this is interesting case fatality rate uh of the ongoing covered 19 pandemic so case fatality rate as you probably know is the uh the number of people that die compared to the number of people that are formally diagnosed this is going to be a lot higher than the infection fatality rate because a lot of people who get the infection aren't formally diagnosed but this graphic is impressive impressive and encouraging and we see that the case fatality rate in the uk has dropped off really quite dramatically from over 14 percent there to way down to well under where it's about three percent there isn't and the united states is under two percent now of course this is not saying that two percent of people in the united states who get the infection die its way less than that these are those that are formally diagnosed and of course this massive drop-off has been caused by the uh protection effect of the vaccination program now one thing that really has disturbed me actually i was going to say annoyed but it's or no it's not strong enough it's disturbing people who are advocating therapeutics are sometimes anti-vaccine and people are advocating vaccines are sometimes anti-therapeutics and again sometimes anti-preventatives as well seeing vaccines as the only modality of prevention now of course it's vital this graphic shows how vital it is but let me tell you i want preventives i want vaccines and i want therapeutics as well so let's try and get away from this sort of territorialism that seems to have developed on social media any weapon we can get to clobber this virus i want it we want this pandemic over and done with we want people to stop dying and in this particular example we see vaccines are effective at that because it's the vaccination that's reduced the case fatality rate i can't remember who painted that that's from a while ago the virus stalking the countryside my apologies to the artist i can't remember okay so so that's a bit of context now um here we are looking at uh at india so cases these are the officially diagnosed cases under diagnosed of course so that was yesterday that was the day before well over 17 million officially diagnosed cases deaths about 2800 per day now that's a lot but and that's nearly 200 000 deaths but the reason that we're saying that the deaths are so underestimated is we're getting fairly accurate reports from cremation grounds hindus of course cremate we're getting fairly accurate data from uh islamic and christian burial grounds in india that um the amount of commotions and burials are massively more than this and it looks like this probably represents about 25 of the total so unfortunately and this is this is just tragic to say but it could well be that uh about ten thousand people in india are dying a day now and it's getting worse this is an absolute that's unfolding in india it's made worse by a thriving black market and an unprepared government both national governments and regional state governments massively underprepared so for example oxygen is selling at hundreds of times the normal price now what is happening a lot of the time in india is the hospitals are running out of oxygen and they're saying to the relatives well your relative who's sick needs oxygen go and get some and that's why there's a thriving black market people paying hundreds and hundreds of times the uh proper price for oxygen same in therapeutics there's hoarding and there's black marketeering it would be foolish to say that corruption is not a major problem in many parts of india and the unpreparedness of government now on this channel and and indeed we will keep clicking the wrong one sorry on this channel and we did talk about communicating with the health service and things on this back in january february 2020 i said clearly we're going to need an awful lot of oxygen now rightly so in those early days the government's governments around the world focused on making huge amounts of ventilators but it turned out that they weren't thankfully needed but what was needed is oxygen concentrators and we just haven't been sufficiently prepared for that um but why aren't the engineers developing really nice small oxygen concentrators that we can pack off around the world i'm sure they are now but um this was actually i anticipated this um not getting on for 18 months ago now well january 2020 and uh it was clearly going to be a need and unfortunately the indian authorities weren't prepared or not sufficiently prepared shall we say with some hospitals running out of oxygen which of course is terrible now this is the 300 000 line there new daily cases well um as we've seen over 300 000 for those last two days and here's the graphic well over 300 000 and and this is the rate of increase and it really is hard to see this this stopping for the next period of time are we talking days are we talking weeks we don't know but that there's an absolute um disaster unfolding in india as cases keep on increasing deaths of course aren't too far behind um deaths now as we've said about 2800 per day officially diagnosed although unfortunately we know that the number of burials and cremations are about four times that as the deaths carry on increasing so is it times three is it times four probably around about times four from the data from burial and commotion grounds this is just a terrible terrible situation now thankfully thankfully and we have been appealing for this for some time the international community is starting to respond u.s is allowing exports of vaccine components now we don't know the detail on this yet but we called for this loud and clear last week on this channel we called for this loud and clear two days ago on this channel three two days ago on this channel and uh prime minister modi has been talking directly to president biden and it looks like president biden may have intervened directly to suspend this aspect of the defense procurement act so that is really good news they're going to get these components uh these these whatever they are the ingredients for the vaccine off to india where they can make millions more vaccines good now the united states of course has not confirmed the astrozenica vaccine so they're looking at 60 million potentially being exported mostly to india this is going to take a bit of time but it'll help it'll help but remember we've got 1.3 billion people only 130 million are vaccinated so far a long way to go in india but the the domestic vaccine production that will be significantly ramped up as a result of this intervention will be excellent and it's encouraging us is sending medical supplies but importantly no intellectual property waivers yet that would allow alternative people to produce vaccine now i know i know there's downsides to that it means that the chinese could start making it and they could increase chinese vaccine diplomacy and the russians could start making a pfizer in a madonna vaccine of their own and they would use that for their own purposes so um basically i'm not qualified on on the on the geopolitical influences of that but um we need to look at something that increases vaccine supply the u.s sending medical aid to india spain sending medical aid to india germany just getting their act together to send medical aid to india but in the meantime a lot of people dying a lot of people dying unnecessarily a lot of people dying simply through lack of oxygen factors in india well there's been the large hindu festivals like the kumba mela people sleeping 20 to 30 to a hotel room sharing unsanitary toilet facilities um there's been a lot of political rallies that are still going on in india quite inexcusable and there's three new mutants three new variants that seem to be driving this infection as well now my understanding is that the united states is still accepting flights from india this is simply in my view madness if the united states is still accepting flights from india it's just absolutely incredible because we don't know the proportion of the increases in india that are caused by the religious festivals by the political rallies uh by the slow vaccine roll out or is the vast majority of it caused by these new variants that could spread to the united states why not just suspend flights for a period of time it is just unbelievable right a bit of better news now before we carry on um right office for national statistics in the united kingdom always out of date of course but the directions are good so england this is the week ending the 16th is nearly 10 11 days ago now isn't it the weekend in the 16th full date is now available in that week 90 000 people had the infection that's 0.17 of the population that is one in 610 people and that is down from 112 000 the week before so that is a good reduction from the week before down from that to that so that's good but wales prevalence the weekend in the 16th 3600 people 0.12 of the population slightly lower um 1 in 840 people but the week before it was actually lower so there's actually been a slight increase in prevalence from the week before in wales not not good so flat to um the office of national statistics says basically the same so i think i think they're happy to say that these are within the same sort of margins of error but um it means it's not going down the way we would like it to northern ireland 2800 people 0.15 the population one in 660 people 2 800 the week ending the 16th the week before the week ending the 10th uh 2600 so again very minimal that's basically flat those are basically the same numbers so um you know we would really like to see a continued reduction in the uk so the numbers are still lowish the low and they've been for a long time but it's not going away prevalence in scotland 9 300 people 1.18 of the population one in 560 people down from 10 500 the week before to 9 300 on the week ending the 16th so again not a massive drop off to be quite honest now this is more encouraging um this is the uh percentage of people uh the percentage of tests that were positive so this has gone down from about over two percent here in what january at the peak so this is the peak here isn't it january was the peak about then peak of the pandemic or this wave now the positivity rate is going down nicely to well under uh 0.5 fact there's about 9.2 percent isn't it now what this means is there is way less community transmission of the virus so this is encouraging and hopefully it's down a little bit more now now i think i'll just show you a picture of the uh the deaths from the uk here we see it here now the blue line is the deaths involving covered 19. the green line is um the deaths not involving covered 19. so we see here in the in the first wave a lot of the deaths were covered 19 compared to the non-coveted deaths and likewise in the second wave but we see the proportion of deaths caused by covid19 and people dying from other things uh here percentage-wise much higher and there it's actually about that the week ending the 16th of april it was actually uh 3.5 percent of deaths were attributable to covered 19 in that week and this line here is the uh the average deaths for that period of time so we can see that lately although the sun bank holiday influences that they're actually lower lower than than normal so about 3.5 of deaths there attributable to covered 19 so that is uh that is certainly encouraging reductions indicating less community transmission now what about the situation now in the uk um here's some summaries so people testing positive on the week down 6.5 percent so that was good deaths within 28 days a positive test down 6.9 patients admitted down 23 that's going very well and then you can look at all your local data there i i always include the links of course and if we look at the graphs for the cases again we see that dropping off really quite nicely but still flatish there not not going away healthcare again many less people admitted to hospital way less people admitted to hospital and the amount of people actually in hospital have we got that we yes we've got that so this is a patient's no that's patients admitted to hospital oh we haven't got patients in hospital at the moment but these are the number of patients ventilated so that is down so the number of patients admitted to hospital and we do we do know that the number of people in hospital is also significantly reduced looking at deaths again we see greatly reduced numbers partly because of the reduced cases and partly of course the great protection against severe disease and deaths that the vaccines confer so at the moment uh we're going the opposite way to india i'm pleased to say we're going the opposite way for the uk it's sad to say that india is going in the other direction now let's have a just a quick look at the united states here's the tracking information from the states so these are cases now they've updated this site and you can play with this and get all sorts of really quite interesting data on it you know once you're on it you tend to be there for about half an hour you think we'll just have a look at that but anyway just to summarize it cases are starting to go down in the united states now now this is quite a relief i must say because we had feared well we did anticipate this in cases in the us but we feared it would go higher but the vaccines do seem to be catching up so that is but still still bear in mind that's the 50 000 cases a year line down there so we're still looking at 54 000 new cases in that uh in that seven day moving average so still quite a lot um now how do we do this left axis daily deaths there we go so death's also down but again much flatter than we would like to see so um seven day moving average for daily deaths 661. so still need the vaccine program to carry on in the states and unfortunately from my reports complacency has broken out all over the united states and that's uh working the other way to the vaccines um now um vaccines in the united states uh this is the fisa bioentec vaccine leading the charge 120 million doses moderna 100 million doses uh jansen johnson johnson back now of course and increasing in doses now on that topic um here's the cdc update again i include the link for your perusal make sure i'm not misinterpreting this that is the link on the restoration of the jansson johnson johnson vaccine program i'll just give you a few uh headlines from that cdc and the fda recommended the the restoration of the use of the jansen johnson johnson which is good reports suggest an increased risk of rare adverse events called thrombosis and thrombocytopenia syndrome so that's what they're now calling it they're calling it tsts i think we know this now the thrombus is the blood clot where there shouldn't be one the thrombocytopenia is the low level of platelets in the blood and as i think most of us know now it's the platelets necessary for blood clotting and uh syndrome is is a is a collection of possible symptoms because there are a collection of possible symptoms here a lot like uh aids acquired immunodeficiency syndrome it can present in a wide variety of ways so that's what they're now calling that we know the numbers of course were very very small rare um well we looked at the figures quite a few times they weren't they were around about one in a million mark working it was very very rare nearly all reports have women younger than 50 years old so this seems to be affecting premenopausal women albeit rare now i quoted these figures quite a few times i can't remember them off hand it was um what was it about one case per 1.2 million vaccinations it was very very rare very rare side effect but that's why they paused that roll out um potential benefits out outweigh known and potential risks according to the cdc and fda but their proviso is women younger than 50 years old should be aware there are other covered 19 vaccine options available well not in the uk there's not you just get the one you turn up and you're giving it but if if that's the case in the us then that's fine and it makes sense now um i've got something else on vaccine in a minute let me just just briefly tell you um for three weeks after receiving the vaccine look out for possible symptoms of a blood clot with low platelets and this is what they advise to look out for now if any of these do present of course you would seek immediate immediate medical attention it's a very persistent headache with uh or blurred vision shortness of breath chest pain leg swelling persistent abdominal pain or easy bruising or bleeding which would indicate low levels of platelets so that all makes sense you will get immediate medical help and of course doctors now know they're not to give heparin for this condition which is was part of the reason for the delay of the rollout now i don't want to create um any problems with the vaccine program because vaccination is essential therapeutics more therapeutics would be good more prevention would be good as well again i'm not trying to separate these components i think that was really uh unhelpful to do that but israel has led the way in the pfizer vaccine of course and channel 12 on israel reported on friday this is from read about this is the times of israel i think this is from it's also reported by reuters um more than 5 million people vaccinated but 62 recorded cases of myocarditis now we're not saying these are caused by the vaccine yet but this is uh one of these apparent correlations that have come to light now the myocardium of course is the so the heart is pumping away all the time and the the myocardium is the contractile muscle of the heart so that's your bicep there that's your tricep there that's what makes your arm move the myocardium myo muscle cardium heart the muscle of the heart and itis is inflammation of so in israel they're reporting according this is the leaked report it's not unofficially yet um but they're reporting 62 cases of myocarditis 56 of those came after the second shot and of course the only one is the fizer vaccine so these are mostly after the second shot so presumably that means six were after the first shot of the fisa vaccine uh most of the affected were men under the age of 30 six of the patients were treated and released from hospital in good condition two deaths unfortunately details have also been sent to the u.s food and drug administration center for disease control who are also investigating this and of course the israeli medical authorities work very closely with the cdc and the fda rightly so because it synergizes their information now if you think about it the incidence of this side effect here is is much higher uh that than what we were reporting on the uh the blood clots um the the the thrombosis and thrombocytopenia after the uh jansen johnson johnson vaccine this is 62 out of 5 million so it's a higher amount although 56 thankfully went home so basically what i'm pointing out here is um the the the adenovirus vaccine seem to have got a bit of a a bit of a bad press really it's based on data but there's problems with all vaccines and and well i think that's fair to say there's problems with all vaccines anything that works can have potential side effects so um but we need to be smart and i'll show you how i'll show you how i think we're probably going to do that um but let's just carry on with this report about the pfizer myocarditis side effects or potential let's call it at this stage we're certainly not calling it side effects we're just calling it correlation or excessive cases it's being investigated at the moment um one possible reason for the lack of similar findings in other countries was the low rate of vaccination amongst younger people so israel of course vaccinated a lot of younger people uh whereas the us and the uk and quite a few other countries are vaccinating older people so if it turns out that this is a complication if it turns out that this is a complication of the fisa vaccine then israel will probably be the first place to see it if it's a complication that's affecting younger people we don't know we're just flagging this up as a finding from the times of israel and israeli tv at the moment uh there's a specific concern regarding the frequency of occurrence observed in men under the age of 30 days immediately after the second shot so the the these are in uh quote marks so this is the israel the times of israel quoting the the report they say they're quoting the report so younger men at this stage according to initial findings uh that still needs to be verified there's an impression that the number of cases is higher than you would expect especially in those under 30. so overall findings of this complication or of this correlation one in a hundred thousand uh younger men younger people one in uh 20 000 and i think that's younger people altogether rather than just young men so it's just strange that um there's been such a lot of discussion about the oxford astrozenica vaccine especially in europe um not yet approved in the u.s of course they're waiting for their own trial data which should really have been out a while back i don't know why that hasn't been out yet um and and yet we see potentially uh the these uh this with other vaccines because there's a potential risk anytime an active treatment is given i think yeah there's a potential risk so um that is i mean one in 20 000 young people that that's getting on for being quite high that isn't it certainly higher than the blood clots with the uh um with the with the anson vaccine are these findings duplicated in the states don't know yet um we have to wait and see we cannot yet tell if there is more cases than normal or if there are similar numbers annually and the proximity is just a coincidence so we don't know yet is what the israeli report is saying of course they're carrying on collecting data as you would certainly expect now in israel children aged 12 to 15 plan to be vaccinated when the fda when the united states the fda authorizes the vaccine for that age group so here the israelis are vaccinating or are going to start vaccinating depending on fda approval so they're actually um they're actually following the uh the the fda rather than their own authorities they're using the fda as a proxy for israeli um authorities by the looks of that health minister in israel uh once that age group has been vaccinated the country will reach herd immunity so remember and that age group that they're talking about there is uh 12 to 15. so once the adults have been vaccinated and people down to the age of 12 have been vaccinated what the health minister here is saying is that israel will reach herd immunity once that age group has been vaccinated therefore no need to vaccinate younger children which is encouraging so given what we know now when this vaccination program started i said what we will probably find is that a particular vaccine works better in a particular group so one vaccine might work on older people one vaccine might work on people with diabetes one vaccine might work better on younger people that's what's what i thought or men and women or whatever it is it turns out that the vaccine choice may be the one that minimizes the side effects now this is good news in a sense because it means all the vaccines all the vaccines are essentially working well at reducing hospitalization serious illness and death so the choice of vaccine may well be the choice that minimizes the risk of side effects so given what we know so far vaccine choice may be that younger women might be better advised to take the fisa vaccine that's a possibility and the younger men who may get the side effects from the fisa vaccine are advised to take the janssen vaccine so we know that in the states younger women are cautioned against the janssen vaccine so maybe they should take the pfizer in israel it seems that younger men have been having a problem with pfizer so maybe they should take the anson so uh interesting the states are advising younger women to be cautious with the janssen the data from israel shows younger men may be more affected adversely by the pfizer and given that that is the case maybe maybe authorities around the world will start saying well younger women have the pfizer younger men have the janssen vaccine um will this be the case it could well be vaccine choice when we have a multiple choice of vaccines are determined by minimizing side effects rather than optimizing beneficial effects now just one more thing to show you um this is from um you can't see that i'll tell you what i'll do i'll do that tomorrow we'll we'll leave it there for today that's enough for today um we'll look at those cases in the czech republic tomorrow so that gives you a motivation to that gives you a cliffhanger doesn't it for tomorrow um no i wasn't gonna do anything else today no i think they're the main things for today um so um as always thank you for for being with us

Channel: Dr. John Campbell

Views: 347,097

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: WiuVlYWvWkU

Length: 33min 1sec (1981 seconds)

Published: Tue Apr 27 2021