MedCram discussions

welcome my name is kyle allred i'm excited to be here with dr john campbell and dr roger schwelt both are outstanding medical educators who have worked tremendously hard over the past year to make sense of the relentless amount of coven 19 information that has evolved over the past year and both have shared their perspective with a large audience you can read more about both of them in the video description below and i'm excited to hear both of your perspectives on a wide range of covet 19 related questions thank you to everyone who posted questions that we could use for this q a event and before we get started i want to give you both a chance to say hello so i'll start with you dr schwell in southern california good morning good morning kyle and and really a a wonderful big good morning to dr john campbell for joining us john it's it's really um something to have you on i've been watching for a long time you've you've been uh prolific you've been one of the clear voices on the internet in terms of describing and keeping pace with covet 19 so really really uh privileged to be with you and with you i've been watching you for a long long time now roger it's uh it's it's just amazing to be able to talk in lifetime and it's good afternoon from me and i'm seriously impressed that you guys are you guys must have been up at six o'clock this morning how's your breakfast got got dressed brushed your teeth and ready to go for seven o'clock it's impressive so so thank you thank you dr swell never never sleeps i've learned that by now working with him i suspected this yeah well i want to get started with a broad question uh for both of you and dr campbell i'll start with you on this one um as we're into 2021 and we look back on 2020 what is uh what is one or two lessons that you hope that we can learn as a society uh from this pandemic you know i think one of the main issues all the way through this is that people have been reacting to circumstances as they came along rather than anticipating rather than being proactive and i think we've seen this in the level of international organizations they didn't really compute this concept that there could be a pandemic because it hasn't happened in people's living experience they kind of thought it couldn't happen whereas of course we know it's happened before we know pandemics have come and gone throughout human history 1918 pandemic as a big example you know the majority of the population of the americas wiped out by smallpox and other dis all the communicable diseases on the with the arrival of europeans but but people just didn't seem to be able to conceptualize it so they couldn't think ahead so you know even people like the world health organization the government of the united states the government of the united kingdom it seems to me that they will be reacting to things so i think the big lesson is we need to anticipate potential problems because you know as well as the field of disease you know that there could well be another pandemic but there's so many other problems for us as an individual humans groups of humans and humanity and and i really just feel we need to be proactive anticipate things and uh not just wait for things to go wrong and then react to them as really has been the pattern that i've seen over the past over the past year in terms of people reacting to this pandemic excellent yeah dr schwell what are your thoughts oh i totally agree with john that is a very very deep and profound thought i mean i i also noticed that as well the other thought i had was just we could think in the theoretical we can think about oh we need a vaccine oh we need to do this so we need to do that but a lot of what has been left out of that equation i think is is bringing people along and getting them to buy into those sorts of things so for instance we have had a most amazing year in terms of vaccine development probably we've never seen anything like this in terms of how rapidly we got so many different candidates to to market but we see the problem in terms of the the misinformation out there and in terms of the uh the the thoughts in the population about whether or not they would want to actually have the vaccine you know there's been stories where these hospitals has have received the vaccine they finally have it and yet 50 sometimes even 60 of the health care workers that are targeted for vaccination refuse to even have the vaccination and i think it's because of misinformation i think that's where people like john and myself and a number of other points of light out there are really vital to educate in layman's terms what it is that's going on so they can buy into this the science is there but if people don't buy into it it's not going to work speaking i agree completely we've got to take people along with us otherwise we're just talking to ourselves and uh if people aren't buying into wearing masks vaccination the appropriate behavior then we're not getting anywhere it's an excellent point absolutely and speaking of sources of information and potential misinformation uh both of you do so much educating and and put out a lot of informative videos how do you decide what information sources are credible and and what's your process for receiving new information about cobia 19 and dr schwell i'll start with you on this one yeah well you know we've seen this in in the media unfortunately way back in in the days of walter cronkite uh that's a tv newscaster here in the united states um it was all about the the the you know the questions of journalists the when where who what all of that sort of stuff um that's kind of gone away and we've now have narrative journalism where there's a certain narrative they already know what the story is and they go out and find these these pieces to fit the narrative and you know when we get into a pandemic like this where we're certainly a virus is at the center of that pandemic and science describes what viruses do and the consequences of that where do you go for that i mean you you look on uh the network televisions here at least the united states and what you see is uh a drive-by type of snapshot and a without any explanation and so that's that just doesn't do it for the type of information that we need so where do you go well the thing that tells you the who when where and all of that in scientific journalism is papers it's scientific papers and that's not something that i learned until i went to medical school or you know or any kind of professional school that's where you learn how to critically appraise a topic and that's where you learn about the different levels of evidence with scientific journals and what is an observational study versus a randomized controlled trial and why would one be weighed over the other that's not something that's really intuitive to people in the general population so and it's not something that they necessarily need to learn but they need to at least get their news sources from people who do understand that and who understand why that's the case and so when you're getting your news sources now on coronavirus pandemic things of that nature make sure that it's evidence-based make sure the people that are telling you things are showing you the sources and you can read for yourself that's why that's why people like you know john and myself like to give the references for why we're telling you these things don't believe people don't believe us if you want to depend on us to sort of figure out what the what the science is you can do that but also always remember that it's got to be backed up by science mm-hmm dr campbell uh absolutely absolutely we're looking for for validity here is the key word isn't it you know what what is actually doing what it purports to do so we need things to be research based whenever possible and as roger said that the better the quality of that trial the better and and our gold standard is the randomized double blind control trial if we have it we don't always have this so sometimes we have to use correlations that can tell us where to look so it's knowing a bit about research and and research theory that really helps to to take out the good bits of that and to differentiate the good bits from from the bad bits but as well as that especially as clinicians what we have to do is follow national guidelines so in the uk we have a few organizations that actually give national guidelines and basically what they say is almost right by definition now the people advising on these national guidelines are very good experts and good clinicians but we have to follow national guidelines as well and basically the the main content and thrust between the national guidelines in the us and the uk is basically the same because it's based on people that understand this this basic empirical science and i think the other thing we do is it's surprising if we take the totality of medical knowledge i don't know what the latest figure is but maybe about a quarter of that is research based so you know actually with firm research findings behind that a lot of it you know is more intuitive it's more of an art process if you like but very often what we have to do is look at what makes sense based on our basic understanding of how the body works the physiology the structure the anatomy and how it goes wrong the pathophysiological processes and then we need to kind of make sense of what we're doing in terms of those so basically what we're saying is we can we can say what we want as long as we've got a rationale and ideally that rationale should be based on uh empirical research-based evidence it can also be based on national guidelines which is essentially the consensus of evidence expert evidence but also we need to base it on our understanding of the way the body works and the way the body goes wrong and and and the reassuring thing is is if those three types of evidence agree it's really quite nice so it gets a bit confusing when you might get uh an underpinning physiological rationale which would imply one thing and a research based paper which implies something else but normally we find with time that the amount of the the amount of harmony does grow and it does increase so um i think that they're the three things but we have to make sure it's based on that and of course particularly as people that um i suppose popularize this we need to give the evidence we need to be transparent as to where we are getting the evidence from so i don't i don't want anyone to listen to my opinion i can't give anything worse you know but if if i'm someone who is filtering uh expert opinion collective expert opinion scientific rationales and um research papers and condensing those and that's a completely different thing but i do believe as roger said the onus is on us to give the evidence and to make the evidence available both of you mentioned um to some degree following you know national guidelines um favoring you know solid evidence randomized placebo-controlled trials when when available you know in a perfect world of course we'd have a randomized placebo-controlled trial for everything and we just know what the best interventions are of course we're in the midst of a pandemic in randomized controlled trials take time they're expensive um so in light of that there has been an increase towards getting information from preprints you know articles that haven't been peer reviewed and have been posted on servers and very valuable information there but also the potential downside that these aren't peer-reviewed what are what are your thoughts on the role of a pre-print server you know pre-publication servers for a way to access information for not only scientists and educators but also just the general public uh and i'll start with you dr schwell on this question yeah thanks kyle so so when it's not peer-reviewed you're not getting as much input onto the possibilities of where the study could have gone wrong um or where there could have been confounders and and so sometimes many heads are better well most of the time many heads are better than one at picking that out and saying you know this is what the study shows but it may be showing this for a reason other than what the authors thought you know we live in echo chambers we all do and we all think about things and the same ideas what's good to do is get outside people people who are not who haven't been looking at the same thing for a year or two to say you know what this this makes sense but have you thought about this have you thought about that and that's really why the peer review process is so important so when you don't have the peer review process you lose out on that and there could be situations where you're seeing something that is quote published or at least pre-printed that's not published that's giving you an idea that really hasn't gone through that filter so realize that when you haven't gone through the filter you may be getting stuff that um that that may be misleading or incorrect um no i agree completely i mean we have the expression sometimes you can't see the wood for the trees when you're actually in something um very often you can you can miss the obvious and we we have another principle here it's sometimes called the tea lady principle where there's no no degradation of tea ladies but what it means is you could have an expert team who are working away on something and they're so into it and they're not seeing the totality of the picture then someone comes in with a cup of tea who's not connected with the project and uh you say to them well what do you think and they say well why don't you turn it upside down you know or something you know something basic like that and they do that and then the experts say oh yeah maybe that works so you know we really need to that as roger said that the more heads that are involved in this the better and that to me that involves expert heads of course which is what peer review does but it also it involves this kind of common sense review which is important as well but for a pre-print paper we do need these at the moment because things are changing so quickly and we've got to remember that human suffering and death is the is the consequence of doing nothing very often but there again we have to have good rationales for out for our interventions so what what i tend to do looking at a pre-print paper is very often it will have been internally reviewed by a particular institution and if that institution is of of good quality then i i tend to think well that this peer review is not peer reviewed yet not yet but it's been reviewed internally by the institution that therefore it's probably not too bad but as well as that you've just got to put your own interpretation on it does it make sense to you does this seem to be following the basic science because you know basic scientific principles are contradicted then there's probably something wrong there you know if a paper comes out showing that homeopathy is an effective treatment i would think well i'm not sure that's consistent with the basic science and then that would be a problem yeah i was just going to add to that too i mean look at look at the situation that we're in right now we've got um the fda is approving things for covet 19 on an emergency use authorization basis and that that tells you everything that you need to know is they're willing to lower that bar for instance um convalescent plasma was approved without a control group and uh we we have that today and so the the question is and obviously that wasn't a randomized controlled trial there was no control so the the the people in the ivory towers as we like to call them um they understand this they understand that there's a pandemic and that the the risk of not doing something is that people continue to die but the risk of doing something risky is that more people uh uh die as well and so there has to be struck a very fine balance about how much evidence are you willing how much evidence integrity are you willing to let go to get something out there faster so that it can help more people yeah any treatment is always a risk benefit analysis isn't it any treatment that's going to work or any surgery that's going to work has got the possibility of side effects because it's having a physiological stroke anatomical intervention on the human body so there's always that always that risk of risk of side effects but while does that risk benefit analysis i always feel very very strongly that you know that the first principle the the the hippocrates way back in ancient greece you know first do no harm so if if someone comes to me and this has happened many many times people have come to me for help and i've been unable to help and that that's a pity but that happens but if someone comes to me and i do harm then that is really quite unconscionable and um i don't know about i mean it's not the sort of thing you might talk about publicly but i i could give you some instances where people have actually been worse off because i i've treated it and that is a really bad it's about it's a bad bad feeling so we have to balance that the risk benefit analysis but we really don't want to to cause someone harmed by a clinical intervention right exactly i i'm reminded of a professor of mine in oncology saying you know roger that they they used to say don't just stand there do something well sometimes it's actually don't just do something stand there and that's the right thing to do yeah i've been in a few first aid situations and as a professional uh who's done trauma training in a first aid situation very often my role as the professional as to stop first aiders doing first aid you know because the interventions would be potentially harmful and you don't want people moving unconscious patients first aiders have learned first day so they feel you have to do it and and even professionals can be in that situation as roger said very often the best thing to do is nothing or at least wait until we're sure what to do i want to ask a quick question on following the advice of our uh national institutions whether it's the cdc or fda here in the united states i assume it's the national health service and in the uk yeah the national institute for clinical excellence and yeah perfect um these institutions uh of course have great scientists in them they've also been wrong on occasion this has been an evolving pandemic and they've made recommendations that have been later revised um they've been slow to make certain recommendations um how can people um have their trust uh restored or maintained in these organizations and i'll start with you dr campbell yeah well we need these organizations because we do need a national guideline because otherwise you know we do tend to have uh anarchy and we don't want that so they've been they've introduced these guidelines and okay they haven't always always been 100 percent correct but all we can ever do i mean when roger goes into to practice clinical medicine it would be nice if he could use research findings that were found out next year and the year after in the year after but of course he can't you know you know you you can only go by what you know now and current knowledge is always always going to be limited so as individuals and these groupings they made decisions based on the best available knowledge now and really that that is all you can do the key thing is is to modify it or to change it or even even to repeal it as new knowledge comes along because all we know is what we know now insight into the future would be pretty wonderful but you know we haven't we can't do that yet what do you think yeah and i would say this everybody makes mistakes that's not in question everybody gets things wrong what really stands out and makes people different in my mind is the willingness and open-mindedness to accept their mistakes and change their behavior once they find that out and so to me seeing seeing the fact that these organizations have changed their stance is not a black mark on their reputation but rather one that's showing that the science is working that the process is working and that people are updating what their recommendations are i think that it's our job to educate the public that that's the case when they see things changing that's a good sign that means that they're looking at the science they're looking at the data and they're coming up with a different plan then the worst case scenario would be to get something wrong and and be obstinate and not change that would be the worst case scenario there's no way you're going to ever have perfection and understand perfectly what it is that happens i mean look at look at the example of of estrogen replacement therapy we had all of the studies that seen the show retrospectively that it was a good idea to replace all women with estrogen replacement after menopause and with the women's health study publication in 2002 when it showed that it actually increased the incidence of strokes we made a reversal we switched now there's been some you know criticism and controversy that maybe if you keep women on estrogen replacement immediately after menopause that you don't get some of those side effects and that could be debated but the point is is that when the studies were done they made an about face and they changed their behavior once we found out that masks seemed to help the recommendation initially was that mass didn't help and we made that switch you know initially the recommendation was to stay away from steroids but the uk recovery trial proved that beyond the shadow of a doubt to be the wrong stance and we've now dexamethasone is the cornerstone of treatment in covet 19. so so i think that's good the fact that things are changing shows that we're willing to adapt we're willing to accept the science and the human body is essentially infinitely complicated we will never understand it i mean maybe roger could tell me how consciousness is generated but i haven't got a clue you know and these are such fundamental things that we really don't know i mean the complexity inside a single cell is is completely beyond comprehension the way these molecular machines work so we're always going to be on a journey we're always going to be progressing um but i guess that's what keeps us keeps us on our toes and keeps it interesting dr schwell you mentioned uh steroids dexamethasone and i want to read a question from a viewer word for word because i think it's a great question have there been any new promising treatments besides steroids and rem desevere and the second part of the question is are doctors giving vitamin d to inpatients now so i'll turn that over to you dr schwall yeah so i love to talk about vitamin d especially since we've got dr campbell here uh john um so i think there's probably no treatment modality and john can can uh weigh in on this too other other than dexamethasone there really hasn't been any other treatment modality that has been studied as rigorously and has shown that steroids work i mean there's been a meta-analysis with different steroids dexamethasone probably has the best number needed to treat and and and particularly it works best late in the course so that's another that's another thing i think that we've found out the the most going back to your very first question what are some of the lessons learned the lesson that i've learned in terms of this is that copic 19 is a two-part disease there's an early course where certain things seem to work very well and there's a late course where other things seem to work well and those things that worked well early don't work well late dexamethasone are is one of those treatments that works very well late in the course but doesn't seem to work very well early in the course and that has to do with what's going on pathophysiologically very early on i believe there's a suppression of the immune system the innate immune system suppression of of interferon response and the key there at the early part of the course is to is to enhance immunity and to help out the immune system whereas later in the course when the adaptive immune system kicks in and there's this cytokine storm and pneumonia it's to suppress the immune system i think dexamethasone is probably one of the best things for that that's dexamethasone in terms of rem death severe you know that's that's kind of a tale of two cities there um we've got american randomized controlled trial data that shows that that a rem deserver works early in the course but then you've got this who trial what do you do with the data there that shows that really it didn't help at all um but again that was a little bit more later in the course the real question though that you asked is there anything else uh vitamin d uh i'm not gonna i'll i'll let john talk about vitamin d first since he was uh one of the first people on this back in february but i certainly have a lot to say about vitamin d but i really haven't seen anything yet emerge other than monoclonal antibodies early in the course in terms of the data that we have randomized controlled data so that would be i think another topic that we can talk about is getting people early in the course of the disease who are positive who are at risk factors for have risk factors for progression to get monoclonal antibodies and there's a couple of options out there but i've already said a lot i'll i'll have it to john now i agree completely roger the the tight the time criticality of the interventions are clear i think we did a video recently on on the monoclonal antibody therapy that it has to be given early before the virus kind of gets into the cell so that that you know the earlier that is given the better but we know we know that steroids are massively anti-inflammatory they will just stop inflammatory processes they're very powerful drugs and the immune response is tied in with that inflammatory response so to give steroids when we have an active uh viral disease would be contraindicated exactly what we don't want to do and yet and yet as roger says later on in the course where we're dealing with the the bodies what is essentially an immunological stroke or autoimmune reaction almost to the virus then it's essential to damp that down so the alveoli don't fill up with these these inflammatory fluids absolutely time critical and the vitamin d1 of course is very interesting now the spanish study that both of us have covered um that they gave calcify diol didn't they which was the active form of vitamin d so so when i take my vitamin d3 tablet it's going to take days to a week to convert that into the active form so really the time to be taking vitamin d is when you're healthy when someone becomes ill if we give them vitamin d2 or vitamin d3 that's not going to build up into the active form the calcifidiol in the blood for some days or even a week and by that time the disease can uh kind of progress so it's you give them the calcium for dial as the spanish study did they're giving the active former ready so again they're kind of cutting out a few days of time so so that this time criticality is really vital and it would be so nice if we had a very broad spectrum very effective antiviral drugs but i'm afraid it's a major failure of human progress so far that we don't have such a thing we have them for anti-for bacterial infections for antibiotics but viruses are complicated and we don't have good antiviral for some things we we have like herpes simplex we have antiviral treatments for that but but um but generic antivirals i'm afraid we are still still uh struggling on towards that and we're not there yet by any means but the monoclonal antibodies are are very promising a lot of people have asked about ivermectin and uh and wondered if this could be a potential therapeutic um that you know wondering about the evidence so far for it and the second part of the question is should um organizations and even governments look into this medication as a potential and so i'll start with you dr schwell on this question yeah so so we covered ivermectin fairly early many months ago and it was very preliminary and um we mentioned that there was some uh you know some possibility about ivermectin working i think at the time the preponderant theory was that ivor ivermectin somehow inhibited proteins from going into the nucleus and and causing um the immune system to be shut down i think the the current the current thinking is and what sort of woke us up to this ivermectin was the senate the united states senate hearing where dr corey gave a testimony that group that's looking into ivermekt and that's paul merrick's group out of eastern virginia medical school and the uh the the the group that they've put together believe that ivermectin works in a completely different manner it actually blocks the ability of the virus from hitting the ac2 receptor almost like a monoclonal antibody and so they believe that this may be beneficial in preventing and also in treating early sars kobe 2 cobit 19 infection so there's a number of studies that have looked at this let's talk about you know the the research for this what i would like to see and i'm sure john as well would be a large randomized controlled trial multi-center that's peer reviewed and published and is is conducted in the country where you want to actually have the treatment because populations around the world are different and you know one of the things that we're seeing with this is there's there is randomized controlled trial data um some of them are up to two three four in size which is good but it hasn't been peer reviewed hasn't been published as far as i can see and the the data is showing that and these populations have by the way a higher incidence of parasitic infections and so they're not exactly the same populations we see in the united states the other the other interesting aspect about this too is that the mortality at least in the united states is higher than in some of these countries uh where they're doing this and so a lot of these studies where i'm looking at the mortality in both arms are very very low um and so it's it's hard to parse out that enough to say is if we look at what the group that has raised the awareness of ivory mechanic i think iver mekton is if boy if it works it will be it will be amazing so i'm hoping that it works if you look at that group that's brought it up what they're asking for which i think is perfectly reasonable is for the nih to look at the data to figure out what needs to be done to move forward so that this could be potentially available in the united states look ivermectin either works or it doesn't work and it doesn't matter who says it works or who doesn't say it works it either works or it doesn't and we know how to figure that out we do that by large multi-center randomized controlled trials and i think that's what needs to happen the good news is is that i did see that there is a randomized controlled trial that's currently undergoing a a trial in uh at temple university in uh in philadelphia i don't know when that's gonna be completed or when we're gonna have results on that but i'm hoping that that happens fairly soon and look you know the people that are proposing this aren't quacks these are are well respected um academics that have been working in critical care for quite a long time and have published a number of papers what we need to do is be have an open mind take it seriously but again remember that there are potential side effects in giving ivermectin so we have to make sure that that what we're doing is is good and responsible yeah the idea of having a drug which is is relatively inexpensive uh which has got a known safety profile which is generic it can be people can make it in very large amounts without without any uh copyright issues on the drug it is a great idea and that's what happened with steroids of course these drugs are readily and freely available we now know how to use them it just seems a pity to me that drugs like ivamectin and hydroxychloroquine have got tangled up in in in politics to some extent and i mean politics with a small p there not really party politics so um it's it's one of the things that we're actually not entirely free to talk about at the moment because um you know you know it's a there's a lot of emotion around about and there's a huge amount of disinformation round about it now as roger said the people proposing this are very high quality people so i i spent an evening looking at it and i i read their information and when you and it all did kind of make sense but when you actually look back to try and get the original trial data as roger said i i was really quite frustrated so i studied in bangladesh for example that seemed to show efficacy but we've got a different age profile there we've got a different level of parasitic disease we've got we've got malaria we've got we've got so many other things that could be confusing the picture so i'm not sure we can really take too much from that so i didn't really find any uh clinical trial that i felt i could report on reliably so all i can say at the moment is we don't really know it's an interesting possibility if it works i i would be i would be absolutely delighted the same as roger because people know how to use it it's relatively inexpensive it's available all over the world it's on it's on the world health organization list of essential drugs but that's for treating parasitic disease of course this is uh this is re-labeling repurposing so the the bottom the bottom line to that question carl at the moment is we don't really know so i think i know the answer to this but just to clarify you both have heard about reports of patients um either attaining ivermectin to take it prophylactically for cova-19 or even attaining the veterinary form of ivermectic you know horse horse paste um i imagine neither of you think that's a wise idea at this point with ivermectin do nothing to take nothing that your own doctor does not prescribe yeah i mean it's as simple as that yeah exactly exactly i want to move on to the um the recent mutation that uh dr campbell you're you're in the thick of this in the uk and and certainly it's popped up here in the united states and it's probably more widespread than we know at this point um but tell us your perspective on this mutation and specifically there's concern from folks that will this make the vaccine less effective will it make testing less effective it could even make the treatments the few very few treatments that we have less effective so so this is a mutation the virus is mutating all the time of course so really it's a variant and there's actually there's a cluster of mutations that tend to go together so there's a deletion of the amino acid 69 and 70 i think it is and it's b5o1y so there's a change in an amino acid and this cluster tends to go together but it's now there's evidence now we now know i think we can say we now know this form is more transmissible and it looks like from the data we have it's about 55 percent more transmissible and what that means is that the level of interventions we were taking to prevent the spread of the disease that were working are now no longer sufficient because we're dealing with a more transmissible disease so to keep that r value below one we have to be taking now more rigorous precautions than they were before because of the increased transmissibility now the data we have from public health england shows definitely it's more transmissible but it's not showing it's making people sicker which is a good thing now there is some question mark at the moment and we don't know this yet there's an intimation in the data that it may be increasing the infectiousness and how quickly the disease is spreading through younger people uh basically talking about the teenager group the the under 20 group that there is some very very early intimations that it might be making that younger group sicker but we have no firm evidence on that yet because what what we found in the course of this pandemic over the past few months is that there's been increased incidence in a particular demographic in younger people or older people and it's been a different time so this could be a coincidence but that's my main concern at the moment that this is more transmissible and is it affecting younger people more we don't really know yet now in terms of the vaccine and indeed in terms of reinfection so we've actually done studies in the uk public health england have done retrospective analysis on this and they've looked at people that have definitely been infected and they're looking at how many people get re-infected and there's a very small proportion of people do get re-infected very small proportion nearly all have asymptomatic illness but that proportion is there it's perhaps less than one in a thousand it's a very small amount and it's been shown that with this new new mutation it's no more likely to cause reinfection than the old that than the old form of the virus so what it's looking like is when people make immunity to the virus that immunity is active against the old form of the virus and this new variant of the virus the immunity is what we would call cross-immunity it's working for both types and the other thing about this is the the protein structure of the virus what we call the proteome of the virus this new mutation has changed less than one percent of actually the protein structure in the virus that means 99 of the protein structure in the virus is the same as it was and of course the immune system is primarily learning to recognize these foreign proteins so even if it can't recognize that one percent of the foreign protein it makes sense that it can recognize the other 99 and that is what's happening that people aren't getting reinfected at a higher rate and from that it is very rational but very reasonable to extrapolate that the vaccines will also work because if the the vaccine if we take the oxford vaccine for example it's not it's not producing one antibody it's a polyclonal response it's producing many different types of antibodies and it's inducing natural killer cell activity the nk cell activity the large lymphocytes now we used to think that they were non-specific but it is we have recent data now that shows that they are specific and they can be alerted to the presence of a particular type of virus the vaccines are also stimulating the the small lymphocytes the t cells and the b cells the cytotoxic t cells that will kill virally infected cells the b cells that will make the antibodies and it's also stimulating what we call the phagocytic cells these are the cells that eat viral particles and eat virally infected cells that the macrophages and the neutrophils are also stimulated so the immune response is not simple it's it's it's um the the immune system is attacking from this way in this way in this way in this way and um the the the idea that such as basically a simple mutation and a simple change in the proteome would dramatically affect that is not really uh a worry at the moment so i'm more than happy that the current vaccines will work and even even if there was a big shift the vaccine manufacturers can change the the configuration of the vaccine for the rna um for the messenger rna vaccines quite readily and and also for the viral vector type vaccines the oxford type vaccine could be changed if it needs to but it doesn't at the moment so i'm not worried about that vaccination is still our way out of this dr schwall what are your thoughts yeah i mean i think john answered that uh uh better than like having that he answered all of the points he hit on all of the points that i think are relevant to that question excellent well let's move on to to vaccines then specifically and uh dr schwell you've you've had the vaccine um the uh the pfizer vaccine was offered at your your hospital and um you were able to get that what was it two weeks ago now your first dose yeah about a little over two weeks so the question is um how concerned are you both about the reports of allergies in some people that have gotten vaccinated short-term side effects long-term side effects just the overall safety and efficacy of these vaccines yeah so i think uh if we add up all of the the media accounts i think that's a very accurate way of finding out uh how many allergic reactions there are because you know that every allergic reaction is going to be in the media we're probably less than a one in a hundred thousand at this point and you know if you were to be giving out a big campaign and giving out peanuts i think we probably have more allergic reactions to that than we would to the to the vaccine so this is completely reasonable this is completely with what i would expect there to be um what we're going to see and i want to get people ready for this is uh in about a month or so maybe about a couple of weeks we're going to start to see people completing their second shot and then seven days after that we'll then have quote-unquote immunity based on the studies that we've been looking at and then now get ready because there are gonna be people that are gonna be coming down with coven 19 even after the vaccine and and why is that because it's not a hundred percent effective it's 95 effective that means five percent of the people or or yeah five percent of the people that get vaccinated will potentially still be able to get coronavirus or covet 19. and so don't let that scare you into saying well look the vaccine is is not efficacious it's not worth getting just like don't worry about these allergic reactions that you shouldn't get it because uh people are getting allergic reactions look the the the you have to look in the population and compare to the population anytime you put a foreign substance anything into somebody uh you're going to get the potential of allergic reaction so just be prepared put it in context put it look at the numbers make sense of the numbers and and and think about this rationally that uh nothing is a hundred percent the point here is is that we're trying to reduce the number of uh of covet 19. there's good data that the rna vaccines both at least we have data in moderna but probably also related to the pfizer vaccine and probably also the oxford in fact we do have data in the oxford vaccine that shows that vaccination not only reduces covet 19 but also reduces infectivity the encouraging thing about the vaccines is and with the oxford vaccine so far it's looking like it's 95 or higher that people who have had one dose of the vaccine even though they can become infected don't get sick and this is the key thing we need to stop people getting sick and keep them out of hospitals so in in the in the oxford trial nowhere new had the first dose of the vaccine went on to be hospitalized and that is remarkably encouraging and with the pfizer it's looking like about 90 of people after the first dose don't get sick so again you've got to think about the protection against infection in absolute terms which of course we want but we've got to think about the uh the protection from getting sick if we do get infected and for both of them that's looking quite promising which is why the uk has gone on to this one uh one one shot to regime to try and vaccinate as many people as we can and and roger's absolutely right if you hear if someone has an anaphylactic reaction you're bound to hear about it it's the new the news is going to pick that up now the the the the modern uh the modern er and the uh the fisa vaccine uh people will know that this is based on a single strand of rna but rna is basically water-soluble so it won't get into the cell so it's necessary to surround that with a lipid-based uh capsule so each piece of messenger rna is in this lipid based capsule and the lipid based capsule is actually different between the moderna and the pfizer vaccine so the lipid based capsule for the pfizer vaccine for example needs to be kept at what is it minus 70 80 degrees centigrade whereas for the moderna vaccine that lipid capsule only needs to be kept at about minus 20 degrees centigrade that's where the difference comes in and that there is a like a chemical configuration in in the vaccine of this lipid coating it could be that one of those components is causing the allergic reaction and the manufacturers are going to be able to take that out but having said that the people that i have heard of of having the allergic reactions are are predisposed to having allergic reactions we call these people a topic they have allergic reactions to quite a to quite a few things they produce these immunoglobulin types to things that they're not supposed to but produce them too and they carry epipens already so these people know that so so for people that are prone to allergic reactions to have a very small incidence of allergy reactions it doesn't surprise me at all and it doesn't really concern me because these people know if they're getting vaccinated to get vaccinated in hospital so i i have no history of allergies so i'd be quite happy to get vaccinated in a in a sports center for example in a mass vaccination campaign but for people that are prone to allergic disease we would vaccinate them in hospital and if people have these allergic reactions in hospital we are very good at treating them that they they are eminently treatable and okay the person might feel pretty bad for a short period of time but uh in the vast majority of cases they're going to be absolutely fine because we give the appropriate treatments so as roger said 1 in 100 000 allergies doesn't surprise me at all doesn't concern me what is a pity is that the media pick up on this and this this is ammunition to to the anti-vaxxers campaign but but as someone who's been giving drugs and vaccines for many many years now it doesn't surprise me it doesn't concern me at all to be quite honest yeah kyle i would just add that uh you know people who get penicillin shots it's one in 8 000 that gets an allergic reaction according to the current data here it's one in a hundred thousand for the vaccine if only the media would publish the 12 times that uh somebody got an allergic reaction from a penicillin shot uh than they did from a vaccination shot then we would have people being anti-antibiotic yeah headline but vaccine causes 12 times less allergic reactions than an antibiotic i mean as you said roger peanuts i mean it's about 1 in 71 and 80 kids in the uk have a level level of allergy against against nuts it's it's really high um all the simple non-steroidal anti-inflammatory drugs the the ibuprofen and things like that that they have a very high incidence normal aspirin as a pretty high incidence of allergic reaction so the the latex gloves you know people i'm sure there's more people allergic to latex than there is to the new vaccine yeah what would you say to someone i mean you you guys both mentioned how rare uh allergic reactions are with these vaccines and putting them in context with other things like penicillin uh what would you say to someone that says well you know that's fine it's only in a 100 thousand or so they get an allergic reaction but i don't know about long-term side effects with these vaccines and i also um you know i take really good care of myself i have a strong immune system i don't get sick often um why why should i get the vaccine if i get sick with cobalt 19 i'll just let my own immune system fight it off what would you say to that question i'll start with you dr campbell on this one well you you just never know if you're the one that's going to get sick you know i i've met so many people who said well i can't i don't know why this happened to me but but but it does that's the nature of disease it does happen to people and although we have recognized comorbidities increasing severity with age increasing severity with other comorbidities that's on a population level you know if i get infected although i have no particular comorbidities i don't know if it's going to kill me or not you know there's always that possibility we can't predict all of these things and it's this risk benefit analysis again isn't it you know i'm pretty happy with the safety of the vaccines i'm more than happy to get that i don't really want to get this disease because there's maybe a two percent chance three percent chance it's going to kill me that that chance is always there and as well as that the thing with the vaccine is even if even if you could guarantee which of course you never can you could guarantee i'm going to be safe am i going to pass it on to other people there's this social responsibility so vaccines for me are just this win-win situation it protects me which i'm pretty happy about but it also protects those around me and contributes towards herd immunity so it's a win-win situation that's i i'm so jealous of roger having had this i really am i haven't had mine yet i'm really looking forward to it anything i hope you get it soon um i'm going to be getting my second shot later this week and i heard the second shot's a little worse so we'll see how it goes it kind of makes sense because you've already developed some immunity to that and then when you introduce the antigen again you're going to get more of an inflammatory reaction and as you know the inflammatory reaction can be localized but you also get this systemic inflammatory reaction which is what makes you feel bad so um but you know okay you need to book a day off work you know and just take it easy for a day or two after the vaccine that is a a price well worth paying yeah for not getting this disease taking away the risk of dying and taking away you as someone who could potentially spread it to someone else it's uh to me it's a small price to pay and i'm more than happy to pay it and yeah kyle i totally agree with uh with john's assessment there that question i don't really have much to add absolutely the same points another potential consequence of coca-19 i mean dr campbell you mentioned the risk of of course dying or or having a severe infection another potential risk is uh this this long covets in syndrome or long callers and so i'm curious what both of your thoughts are about that but certainly people that have experienced that are um have been some of them have been very vocal you know we we need more um recognition for this and more awareness around uh the post-covet infection effect so i'll start with you dr schwell just general thoughts on that well they're absolutely right we do need more and we are getting more information because as this pandemic goes on that information is going to come in a lot of people see this as a black and white issue you're either dead or you're not and unfortunately it's not that way it's a gradient there are people who are who've survived it who are alive and yet are experiencing daily uh debilitating symptoms the recent study came out showing that in in healthy athletes who have come down with the covet 19 and recovered 60 percent of them had signs of myocarditis or inflam inflammation of the of the heart tissue that's very concerning it's concerning to me in terms of what what are we going to see down the line we all remember way back learning about in in in school about these people who had infections never got antibiotics and started to to get conditions of rheumatic heart disease mitral stenosis and we don't see that anymore because we have antibiotics but what are we going to see now because of this this post-inflammatory type of syndrome we don't have the answer to that what i suspect is going on is that when you get infected with the virus you know the immune system is is ripping it apart and presenting different antigens and epitopes to your immune system different parts of different body parts if you will of the virus and that is going to generate a a wide and broad antibody and immune response against many epitopes when that happens the chances of you getting an autoimmune condition like guillain-barre like narcolepsy things that have happened before in in post-viral states goes up whereas if you get the vaccination you're getting a very specific epitope very specific protein and you're making a very specific response against that virus it seems to me that the the the chances of getting a post-vaccination issue is going to be smaller than getting a post-infectious viral syndrome i think i think the whole issue of post-viral syndromes and post-viral fatigue is is under recognized um i i i know two or three people just from from personal contacts who've never been quite right from viral infections from from quite a long time ago i mean roger said something there that really concerns me actually you mentioned myocarditis and this is inflammation of the myocardium the heart muscle itself and if people have that it's absolutely essential that they rest so if people are not recovered from this illness it really is important i think that they don't go and play squash they don't go jogging they don't go out cycling they really take it easy until the doctors are very happy that they've made a good recovery i've actually seen people who've had relatively minor viral infections go out do some vigorous exercise and they've gone into fatal uh fatal cardiac dysrhythmias that that can happen so post-viral syndromes are underrated anyway now i think i think it's gonna turn out to be two types there's going to be this specific post-coverage syndrome which i'm hopeful is going to resolve now there is studies on this you know more people resolve after three months than one month and people do get gradually better over time but what is really concerning is in some people the virus is going to damage tissues and if you damage like heart muscle tissue uh if you if you damage the structure of the lungs if you damage the structure of the kidneys then the ability of those organs to to recover is limited if the actual architecture of those organs is damaged so there could be a residual long-term organ damage from that and we don't know that yet so in the united kingdom the health service is actually recruiting in combination with academics a group of 60 000 people that are currently being followed up and are going to be followed up long term and they're going to be seen regularly at clinics so there's going to be a long covered follow-up program in the uk so data will be forthcoming on that but i'm hopeful that most of the people that get this fatigue get the prolonged fever um a very common report that people have given to me is they get very fast heart rate the heart rate goes up to about 130 140 with even very minor exercise i'm hopeful that will resolve over a period of time but we could well have this core of people that that are left with long term uh damage and we have seen this in previous pandemics the this did happen somewhat after the um after the 1918 pandemic that there was a condition called uh post encephalitic parkinsonism where people were left with damage to the to the basal ganglia of the brain and long life parkinsonism as a result of the acute viral infection caused by caused by actual tissue damage um so we're just hoping that this is going to be small but we can't put numbers on it yet one yeah and i just i was just going to add kyle i mean that doesn't say that that doesn't mean that there aren't long-term complications to the vaccine which i think gets the original question um but generally speaking and if you look back there have been long-term complications from from vaccines in general if you look at narcolepsy for instance was uh was one of the issues back in the vaccination for the flu back in 2009 um but usually we see those things within a few months of a vaccination so it's not like we're going to be having to wait two to five years to see the results of that we usually see those pretty pretty quickly and so i think we should have some data on that once that goes there really isn't a reason and again you're not it's not like you're choosing between complete normal health and taking a vaccine which may have complications you're choosing between in a pandemic having the post-viral effects of getting the virus versus the post effects of getting the vaccine i know which i do i'd go with the vaccine risk rather than the infection risk that is for sure no i i agree completely that the idea that something is going to drop out of the ceiling in 18 months time and hit us when we weren't expecting it i think the chances of that are pretty close to zero and to your point dr schwell i think it's important to also point out some of these complications um or side effects that arise um during a trial during a vaccine trial like gian beret syndrome which is a scary thing you know it's a it's a nerve syndrome where there's there's a contemporary paralysis potentially or worse but comparing the importance of comparing that to also background how many people experience something like that gianberry or bell's palsy without a vaccine or or with a a typical infection so i think that's something again from from my vantage point that's lost with media reports it's like hey look this person got was in the the vaccine arm of a trial and they got this bell's policy this facial paralysis but turns out there's a proportion of people that get that regardless that's that you know we call that background and uh sometimes that's lost in these news reports we had this with the mmr a few years ago in the uk people were saying there was autism after the measles mumps rubella vaccine and there was a report on the news where where a child had had the mmr vaccine they went to visit him next month and he developed autism you know they took one case completely out of context you know it turns out there is no correlation here at all this was completely bogus science and uh i mean for example in the oxford vaccine when they were doing the trials in brazil uh there was actually three deaths from trauma there was one person was actually murdered one died in a row traffic accident and and one died from from blunt trauma to the head and of course that's nothing to do nothing to do with the vaccine at all it's just if you're taking large numbers of people that then things can happen you know living human life is dangerous it's not risk-free right there's one thing i wanted to point out about that um myocarditis study that you you mentioned dr schweltz um one potential limitation just for people to be aware of from my understanding and correct me if i'm wrong dr schwelt is that that study looked at athletes but there wasn't really they didn't have a before and after forum so there was some concern maybe the car the radiologist overread a potential myocarditis there so there wasn't a true control group but just something for people to look into i think and and that's the purpose of peer review and and critical appraisal absolutely but again we're going to have more data that's going to come out it's going to be if this causes significant long-term comorbidities we're going to find out about it i mean i think there is some pathological data unfortunately from post-mortem studies that that does that does show the virus has directly damaged the lungs um the myocardium uh the the brain and the kidneys and i think there's this post-mortem data on that now but we're just hoping but of course the post-mortem data thankfully is self-selecting data these are the people that had most severe disease we don't do post-mortems on the on the vast majority of people that thankfully survived so so we don't have that data yet but we know what we're saying is we know this tissue damage can happen we just believe it to be at a very low rate absolutely well neither of you are in the business of predicting the future um but as as we're in a new year now and we're we're looking ahead and there's a you know for some people maybe a sense of hope uh that we made it through the year 2020. um what do you anticipate over the next three months six months over the next year um what are what are some of your predictions as you look ahead for how things will go with this pandemic and the second part of the question is do you anticipate another pandemic coming down the pike do you think this is something that's going to happen unfortunately more more frequently i'll start with you dr schwell on this one well i think that right now that the the spike that we're going through is going to eventually subside i'm hoping in february or march for a couple of reasons number one we're not having as many uh get-togethers uh holiday get-togethers as we have had in the last month or two and number two you know as as john as a believer i'm a believer that vitamin d is actually playing a role in this and as the as the sun starts to come back up to the equator and hopefully toward the the tropic of cancer uh we're going to see more sunlight more ultraviolet b radiation that means more vitamin d in our bodies and so hopefully that's going to help and knock down the infection rate i suspect that the effect of vaccination is really not going to be seen on this pandemic until we get later in the year and and hopefully with the campaigns like we're seeing in the uk and in the united states we'll hopefully have a better uh winter season next year if if things pan out i'd like to hear what john has to say especially about where we're going to go with vitamin d um this year well you know i go to the supermarket now from time to time when i can't avoid it and if i go in the afternoon the vitamin d shelf is always sold out so the message is getting through now we we're our government is actually giving out vitamin d to vulnerable people between december and march for four months they're going to give them a free supply but as far as we know they're still arguing about the dose now the scottish government's doing this but it's only at the 400 international unit levels which is 10 micrograms it's nothing there's nothing so i'm really hoping that the government are going to uh sort of increase their thinking on that and give a realistic dose which would probably be something like 50 micrograms which is 2 000 international units and as well as that the other big factor as well as vitamin d which roger completely accurately says of course but people are just not ventilating enough because we don't like being cold so when we're in public areas a really good idea in public areas would be to have carbon dioxide meters and if the carbon dioxide goes up in public areas then it's reasonable to assume that the the expired uh droplets and aerosolized uh water droplets in the air would also be increased because i go into supermarkets now and other places and really they're just not well ventilated so as as as the weather gets warmer we ventilate more we really need to dilute that viral load that's what masks are doing they're diluting the viral load that's what good ventilation is doing we'll dilute the viral load but we're just not getting that right yet so so as roger said spring will increase ventilation but we need to get that message out quicker now as regards what's going to happen over the next few weeks in the uk it's not good it's not good we have escalating cases um we know that there was more interaction over christmas uh we know there's more cases uh coming down coming down the pipeline um and we we know that you know two weeks after that there's going to be people getting sick and hospitalizations now hospitals in the uk are ready more full than they were at the peak of the first wave in april the 12th of april uh 2020 we're already beyond that point and we've got these high infection numbers now i think it was about 57 000 new cases per day in the uk and we know in two weeks time a percentage of those are going to need to be hospitalized and it's still increasing and the level of restriction that we're now implying although we've got what we call tier four over many parts of the country it's looking like that may well not be enough because of the increased transmissibility of this new variant now with the old variant that would have been enough the r value would have been below one and things would be getting better but we've got this extra complete burden of this new variant now so cases are going to get keep increasing um for for some time and even if we get stopped the case is increasing we've still got the hospitalizations we've got this expression now in the uk it's it's baked in so there's so many um so many hospitalizations and tragically so many deaths already baked into the figures so in the uk for the forthcoming months it's going to be really really quite difficult and uh that there are going to be more cases and deaths and uh as i read the data in the states it's it's similar it varies in different parts of the states of course but but the trend is up the death trend is up and unfortunately that's going to carry on because the herd immunity effect is not going to really kick in with any significant effect on transmission realistically until march april that that kind of time frame so we just have to keep emphasizing over and over again we need the hands face space ventilate message that's not going to go away until the the really getting towards the end of 2021 if then if then in terms of another pandemic there's two views about this uh sars coronavirus two some people think it we can eradicate it as we did with sars coronavirus one back in 2003 other people think it's going to become endemic my thinking is it could be with us for a few seasons but as long as the vaccine uptake is high enough i'm i'm pretty confident we can eradicate this virus so you know we could be sitting here in five years time and and the sars corona virus too may not exist in the wild that that is that is that's my hope it's possible as regards another pandemic i've actually been teaching my students for about 30 years now there'll be another pandemic or and not not that i worked that out for myself i got that from the virologists you know that they've always been saying this there will be another pandemic i'd suspected it would be a genetic shift in the in influenza um but it's not it's turned out to be this uh this coronavis that we weren't expecting but you know you know carl i think it sounds absurd to say this from where we are now i think we've actually been quite lucky because this is a viral pandemic that's got thankfully thankfully a relatively low death rate it's not as transmissible as the measles virus or other viruses so we could have had a virus that made that zoonotic spill over leap from the animal reservoir or from the you know the outside there there's about 10 to the 23 24 viral types you know more than we can possibly imagine we could have had a virus that infected people that was as transmissible as measles and as deadly as whatever you want to take to take ebola or take the middle east respite syndrome you know we could have had a virus that had those characteristics so if this pandemic with relatively low death rates terrible but relatively low compared to what it could have been and relatively low transmissible still enough to cause a pandemic but lower than it could have been if we've learned from that that pandemics form a real existential threat to the future of humanity that then maybe we've got off lightly lightly maybe that that's a good thing if the yeah if the death rate was higher with this um if it was as uh deadly as let's say ebola would that then make the the spread uh less possible though i mean is it no no no it would probably still spread in the same way it depends it depends the the the reason really that we have this pandemic now is with sars coronavirus too that people are most transmissible immediate shed most virus immediately before they get sick and immediately after they get sick so for example the middle east respiratory syndrome we still get the odd case of that mostly in arabia from from camels it's another corona virus but the reason that didn't become a pandemic i think this was first identified in 2008 2009 something like that but the reason this didn't become a pandemic is not because it's not transmissible but because the the people shed their highest viral load when they were at their sickest so when people first got ill if they isolated at that point they were shedding a remarkably low viral load then a week later when they were very sick they were shedding high viral loads so what happened when when middle east respiratory syndrome first came along is quite a few healthcare professionals died who were actually looking after these patients when they were shedding high viral load but because you can say that person is really sick therefore that person needs isolated then it was containable and we didn't have a pandemic the whole problem with this is that people are transmitting it when they're feeling fine that is the issue when they're just a bit pre-drawn or just starting to feel ill so um we could have had a virus which was really deadly and really quite transmissible as well um we've been i still think we've been fortunate yeah i was going to say that um that that's exactly the reason why they were able to contain mirrors and sars is because of the lack of pre-symptomatic uh transmission uh but i i didn't answer that question about whether or not this could be another pandemic the answer is yes it's not a matter of if it's a matter of when is the next pandemic i mean there are so many coronaviruses in bats there are so many uh possibilities of the flu it and and if you are sitting back and looking at this from the last year and thinking wow how poorly did our government act and and uh and get in terms of of of helping and getting things rolled around that should be an impetus to every single person listening to this to look at their own lives and say what is it that i can do to make sure that my immune system is in tip-top shape and ready to um to meet this next pandemic whenever it happens and not just to do it for the pandemic because here's the great thing it's it's redundancy the things that you can do to improve your immune system to handle the next pandemic are exactly the same things that you can do to have a more healthy and longer and less symptomatic life on this planet and it all boils around just having the right dietary choices exercising doing all these things it's amazing that everything lines up in the same direction for some people it's been a wake-up call and they've made those those changes they become more interested in their own health care and in the things that they can do and and here's the key i think one of the big things for 2020 kyle to answer that very first question is people are learning that preventative medicine lifestyle changes now can have a big impact down the line and and be a benefit in multiple different ways it is it's amazing it's amazing things that are good for the individual in the short term are good in the long term and also pretty well are good for the good for the planet you know eat food not too much mostly plants sort of sort of sort of philosophy and on that point slight slightly bright border point kyle but i really do need think we need to rethink our relationship with animals because you know the the viruses because we're animals the viruses we are most prone to getting you know we're not likely to get sick with bacteriophages they're viruses that specialize in infecting bacteria we're not so likely to get sick with with viruses that affect plants or fungi they are special specialists to those organisms the ones that are going to spill over into us are from animals and um you know the obvious example is that is the wild animal trade-in in asia for example which is still is still going on at quite a quite a level but but the huge what you could call monoculture that we have you know we will breed up millions of cows or pigs or chickens with very little genetic diversity between them and that really is is a potential recipe for new emerging viruses so i really think we just need to rethink our our whole ecological relationship with the planet and with animals in particular prevent this happening again well i think that's a good segue into um maybe both of you sharing a little bit about your uh some of your own personal choices as far as your routine to stay stay safe from coven 19 or lifestyle uh things that you participate in or supplements and you know i know we could spend another hour on this so let's try to be brief with this answer but i'll start with you uh dr schweld on this one some highlights of your own um strategies for that yeah so i i look back on this very early in the pandemic when i really didn't have a lot of choices for my patients because things hadn't come down we didn't even know about steroids and the first question i had was what did we do back in 1919 when we had this you know we didn't have oxygen in hospital in the hospitals at that time they wore masks they knew that but a lot of the things that i saw uh looked looking back before the advent of antibiotics and and medications fda trials and randomized controlled uh treatments and trials and things of that nature was this uh basically focus on adapting and improving the immune system the person's own immune system to deal with what it was that they were dealing with and this dichotomy came about we we talked about this on a number of our medcram updates uh dr your reg who was a austrian psychiatrist to use the fever of malaria to treat his neuro syphilis patients we started to research a little bit about what does hyperthermia do to the body you know it's one of those natural systems of the body to cause a fever when you have a viral infection and we saw that increasing the body temperature whether it be through saunas hot water baths things of this nature can improve uh interferon which is one of those things that we found out pretty early on that's lacking in the early part of covet 19. and so just as a personal choice i didn't have any randomized controlled data but i certainly wanted to take something that wasn't very risky at all and apply it to my own life uh doing something like contrast showers where i take a hot shower and then followed by a cold shower that's been shown to improve the immune system there's even a techniques of hydrotherapy where you can place hot towels on on the body to warm up and increase core body temperature going into a sauna going to spa we looked at finland early on so these are things that i've done as well if i feel like i'm coming down with something i don't know if it's cobit 19 or just a regular cold i'll do this you know i've supplemented with vitamin d we've talked about that i've noticed that uh this is the you know i used to get catch uh pretty bad flu every year even though i'd get the flu vaccine uh and i still recommend doing that and uh you know this is not a cure-all this is not something that's going to protect me 100 the vaccine doesn't even protect 100 so i still do social distancing i still do wear masks when i go to the hospital i do all of those things but in addition to all of that um i've been i've been going into the sauna or the spa doing contrast showers if if somebody calls me they've had coveted 19 or they have it i'll tell them to do all of the standard stuff but i'll also say hey try this as well so long as there's no contraindications to it so i think it's um you know think about this if it does turn out to work and i think randomized controlled trials are are definitely needed for hydrotherapy and covet 19 but if it works this is something that somebody could do in their own home while they're waiting to see whether or not they get sick enough to be admitted to the hospital it's not costly nobody needs to write a prescription it can come out of the the bath and you can do it right there so i i think it's it's pretty low risk so long as they don't have you know they don't burn themselves or they don't have issues with arrhythmias with hyperthermia and it's important i'm really glad you brought up that point about fever this i've been trying to teach this for a long long time you know the reason that the body has a fever in response to a bacterial or a viral infection it's not a mistake it's not the body getting it wrong you know there are specific pyrogens fever-inducing cytokines that are highly specific that fit into totally specific receptors in the hypothalamus that trigger detailed prostaglandin-based mechanisms right in the brain that that adjust the fever mechanism and put the temperature uh set point up so the body warms up to it this is not a mistake it's a beautiful detailed piece of physiology and then for me to come along with some paracetamol or tylenol and just get rid of it you know you know to me was just the height of arrogance you know as if we know better it really is important to differentiate between symptomatic treatments and causal treatments so if i have a splinter i i could pull that splinter out and take away the pain that would be a causal treatment or i could give myself intravenous diamorphine and take away the pain which would be a symptomatic treatment you know you know we really need to look at what is causing and go with the causal stuff and um fever is you know basically when you're at home when you actually get when you actually get an infection fever really in that day is your only defense you know that that is what is helping you now i agree with roger 100 we need to optimize this we need good nutrition um the the vitamin d i i wish we were just monitoring vitamin d routine you might my gp won't my general practitioner won't do my vitamin d levels it's not done as standard um you know why why aren't we doing this now it's not that you're going to make your immune system better if your immune system card is working perfectly and you look sort of young and fit and healthy i'm sure it is what what i can't do is make your immune system better i can't improve that i can't improve your optimized physiology but there's so many things can reduce the efficiency of your immune system you know like like like lack of vitamin d which is an immunomodulator lack of protein for example is going to we know for a long time that people with protein deficiency are more prone to infections because they can't make the antibodies so there's so many things that can reduce the efficiency of the immune system if you smoke cigarettes that's going to paralyze the cilia in your respiratory system so um what we want to do is optimize the efficiency of your immune system and and that's that that's what we do we can't make it better so there's no such thing as a tonic or a booster we can just make it as good as the physiology allows it to be well dr campbell uh dr schwell has talked about well first of all dr schultz made it very clear this is not about giving medical advice and any stuff absolute medication should be discussed with one's own medical dr schwelt has shared uh the the level of vitamin d he's taking um do you you're up in northern northern england there it is there's your vitamin d um so two questions if you're comfortable sharing it no problem if you're not dying what does this what dose do you take and uh right do you take it all year yeah right good question uh one of my hobbies is growing plants so in england we have we have a plot of land called an allotment which you rent off the council so it's not this is unpleasant and i wouldn't normally share it but i take my shirt off and uh get plenty of sun exposure during the summer um now you're gonna make vitamin d when the sun is is 45 degrees or higher in the sky and you're going to make if you if you're in your shorts for example and you you've got your torso and your your legs exposed to vitamin d in half the time it takes you to get sunburned so if it takes you two hours to get sunburned on a particular day if you are out for an hour in that time you're going to make about 20 000 units of vitamin d wow and and we know that that of course that that is if you're the same color as me it's a really important point darker colored skin people are going to make it more slowly so um and and this is big studies have been done on this in the states african americans have much lower vitamin d levels than than white americans hispanic americans have lower levels of vitamin d and what have we seen in the differential of the um of the severity of the covered and indeed of the death rates so so you know for me i'm gonna i'm gonna make vitamin d about 20 000 units we know we can store vitamin d and we know that the fat soluble vitamins are adequate a d e and k and when i when i was when i was learning this and it's probably the same for roger and for you carl um if it was drummed into our heads that you can get fat soluble vitamin uh hypervitaminosis and uh you know you can overdose on a d e and k this was kind of drummed into people and i think this is part of the problem but it turns out that people aren't storing vitamin d over winter they're not storing it for long enough so when i get the sun more more more than 45 degrees and i get some overall body exposure in medicine we have this thing called the rule of nine it's it's how much body surface area you expose so an arm is nine an arm is nine the front of the leg is nine back of the front of the leg back of the leg is nine each so a leg is 18 torso is 18 back is 18. so it's how much of that surface area you're exposing so i i kind of build that up and then i kind of guess how much vitamin d is that's made now the great thing about sun exposure if you if you're exposed to the sun for longer yes it's bad for the skin and you've got risks of melanoma and things like that but you homeostatically stop producing higher amounts of vitamin d it will get to a higher and higher level than it will stop whereas when you take supplements that that's not the case so most guidelines will say don't take more than uh 4 000 international units of vitamin d a day that's kind of the guidelines in the uk is the top amount and that that's 100 that's 100 micrograms so so what i've been doing since since since uh let me see since september when the sun is no longer at 45 degrees in the sky because i live pretty far north i've been taking 2 000 units a day which is 50 micrograms it probably i probably i'm going to increase that now a bit because now it's completely pretty well completely dark all day so i'm probably going to go probably going to go up to 75 micrograms a day which is 3 000 international units and the other important thing is is a fat soluble vitamin so take it with fatty food it will be absorbed uh i have no evidence for this but i believe it will be absorbed more efficiently if you take it with meals so the short answer question question kyle is is 2 000 international units a day which is 50 micrograms and so when the shirt stays on while you're gardening that's your cue to start taking the vitamin d supplements pretty pretty well when you're when your shadow is is longer than you are you you're you know the 45 degree thing in the sky you're not making very much and uh you know human beings are are tropical creatures we're not supposed to live as far north you guys you live in california that's much much more sensible approach to life but but you know i i live way way in the north and uh you know basically we're only making vitamin d for probably four or five months of the year yeah and you'd be surprised at how many people even in southern california are vitamin d deficient we we are creatures that live inside there was a recent survey that was done in the united states i think seven percent of our waking hours are outside we like to go in uh in buildings and and the the paradox is is that we recently had an outbreak here in the united states uh increase in the in cases in the early part of the summer in arizona and in texas and in florida places that you would not expect to see that based on what we've just talked about but you realize that people are going inside because it's hot outside and they're staying out of the sun on purpose and you've got air conditioning that's blowing the virus around inside and not doing a lot of ventilation with with new air so all of this can be explained pretty easily absolutely it's cheaper not to cool more air or when it's cold it's cheaper not to heat more air so they tend to recycle more and of course that that's going to recycle the the aerosolized droplets and the droplets from the infection you know i'd just say one more thing car that the the thing that really convinced me about vitamin d was um they dug up a skeleton in my country in a place called cheddar gorge that was 15 000 years old and they looked at the dna in this skeleton and from that they could tell that this guy and it was a man they could tell they had blue eyes and and really quite dark coloured skin so the english had dark coloured skin 15 000 years ago and the the advantage to being white is you make more vitamin d more quickly so the original humans would all have dark dark-colored skin we are tropical creatures so um the the original the original evolution of humans or if you believe in creation adam and eve that they would be dark-coloured the the the adapt the adaptive advantage the adaptive advantage as we go further north to allow us to colonize further north is that we make more vitamin d so the only but i know of two biological advantages to being white because it's a stupid idea because you get sunburned but the advantages are you make vitamin d more quickly and we also make uh i think is it nitric oxide i think i think roger that reduces blood pressure and dilates you know so um the the the the photochemical effects on the skin but the main one is vitamin d so that that is why we change our ancestors change from being dark colour to being light-colored that's how important it is to get enough vitamin d well and then we also know that just sun exposure itself tends to uh to have more melanin in in the skin but the other the other thing i thought was interesting is is those cultures that tend to do sauna bathing uh etc are are typically northern latitude uh cultures like the finns the swedes the germans yeah and heating the body temperature up and helping the immune system that way absolutely yeah one other point on vitamin d since we're since we've talked quite a bit about vitamin d is potential vitamins to take with it and i know there's not a lot of data on this but i've looked at the data and i've been convinced to take uh vitamin k2 and some magnesium along with my vitamin d when i take it and dr schweltz talked about this recently in videos what are your thoughts on that dr sam yeah i don't know a lot about that but the problem is if you take a huge amount of vitamin d and you'd have to work pretty hard at this but it can increase your blood calcium and and and then from the from the blood it can go and you can calcify tissues so uh you know in some people you can get this like calcification of tissues which is a bad idea you don't want to calcify your your heart muscle for example and my understanding is that the vitamin k2 helps to keep it out of the tissues but i don't really have any detailed knowledge on that but i i think you'd have to take pretty large doses of vitamin d for that to be a problem whereas vitamin k deficiency it's not something we really hear about you know a normal balanced diet will give you enough vitamin k excellent well we are about at the let's see hour and a half mark uh wow really yeah wow it's been john it's it's so it's just so neat it's so nice just i feel like i'm i'm in your living room and we're you locked oh yeah absolutely yeah well next time we should have a cup of whiskey uh afterwards kyle yeah i'll go for that i think there's some anti-viral effect to that um uh in high concentrations above 60 yeah but there's some evidence actually that alcohol actually could it could increase the risk of uh of um a viral uh transmission at least in the mucosa the upper mucosa but anyway always the voice there is actually a serious point there people and uh i've been talking i don't know if you've seen any of the videos but i talked to a professor of immunology in baghdad and she's got friends in iran and that they were actually drinking uh methanol toxic alcohol so so that they thought that because you have a 60 of solution of alcohol that cleans your hands obviously to drink it they thought would be better and there's been fatalities it's just absolutely you know the the the need for clear information is just so overwhelming you know so so just to clarify let's keep the alcohol on the hands and not not drink too much but in terms of antivirals yeah i agree yeah and i would just say as a as a comment kyle and john um that if anybody in a medical authority in the uk is listening please please please uh uh prioritize giving the vaccine here to uh dr john campbell because he is a national treasure and we need more and more people like him all around the world that are saying the same message and hopefully it'll it'll uh increase the validity and the believability of what we're saying which is true and people start to listen and um and hopefully we'll make some progress thank you for that roger i guarantee that i'll fall on deaf ears but i i am delighted you've had yours thank you there is one more question i had written down that i want to ask you both and we'll uh we'll wrap this up and it's just about testing so looking back at the year 2020 um what lessons can we learn from from testing for covet 19 and what developments do you hope to see moving forward in 2021 for uh coven 19 testing because we're not out of the woods yet if you as you both have pointed out the vaccine uptake is going to take some time and we have no guarantees that the vaccine how long it's going to work for we hope very long but we we don't know that for sure so what are your thoughts on testing i'll start with you uh dr schwall so one of the things that was perplexing to me early on was that everybody was coming up with their own tests and it was taking such a long time i think the u.s took 46 47 days uh to to develop their own uh test whereas the the the you know the the asians had their own test already why did we have to to do and waste all of that time and why are we now a year later still having issues with uh testing availability not getting results back within 24 hours i think we may have had i think that the term that summarizes it is that the the good is not the enemy of the perfect we we wanted perfection and because of that we got uh we were basically a mile wide and an inch deep whereas if we thought this more rationally looking at antigen testing you know we've had dr michael minneon to talk about the possibility of using daily antigen testing at least three times a week antigen testing to find out with southern whether someone is infectious this may be the answer to opening up schools and i think that's really where we need to go in terms of this hopefully they don't get their act together before the whole pandemic's over hopefully the pandemic becomes over very shortly but if it doesn't i think a lesson to be learned there is to not treat this like a laboratory diagnostic test uh but rather a epidemiological tool to get this thing under control now i agree completely i don't know if you've got the saying there but in england we say why reinvent the wheel you know it's already been invented once and and the world health organization have made a few things that we might question in this pandemic but one of the good things they did way back in the early days this would be in january they put together a kit and an instruction manual on how to produce simple tests and the authorities in thailand that they delayed by almost 20 hours while they made this test you know they literally did it the next day it was fantastic and they were testing people in thailand i think on the 23rd of january you know it was really really quite early that the cdc wanted to go their own way as roger said 43 44 day delay and that's when that's when the pandemic took root in the united states it was such a tremendously unfortunate wasted opportunity that that happened so i think one of the big morals here is if someone invents something good let's just copy that let's just follow that so um you know the the the fisa moderna vaccines are brilliant they were developed in the states i'll have that you know the oxford astrozenica vaccine was developed in in the uk the the the they're spreading that out now in india the indians are planning to vaccinate 300 million people in the next few months and i think they're going to do it i really do because but they're using basically they're using partly a british vaccine but they're not saying oh that's british we'll make our own indian one they have made their own indian one as well but they're using both you know let's use anything we've got here and let's just have so much more international communication you know we've been teaching the to speak speaking the same language of science here you know we understand each other um there's no reason why this shouldn't be done much more internationally altogether schools probably a slightly different one in the uk they're talking about mass rollout of the lateral flow tests for schools here which of course are are less reliable and there is some early data from liverpool where in the in the uk where they did mass screening and on lateral flow tests that people were changing their behavior because they got a negative result so as roger said as an epidemiological tool yes this is absolutely vital we can't if you haven't got an epidemiological tool to to make this invisible virus visible then we're fighting an invisible enemy which is is a bit tricky but um it did concern me that people in liverpool were getting this negative test there is a lot of fel force negatives and then there were visiting elderly relatives for example which is not a good thing so i'm not quite sure that it can work in practice in schools and as well as that you could have a negative test that was a genuine negative test and then literally 10 minutes later you could be infected so yeah i'm not quite sure if that's the way to go i think we've got some pretty hard decisions to make over this just next two or three months while we're waiting for the virus to kick in but any tool we've got let's use it absolutely um well let's uh this has been a great uh discussion thank you both so much and uh any parting words before we uh we wrap it up dr campbell no i've i've i can't believe it's been so long really really interesting to talk to you gentlemen i really appreciate the opportunity and it's uh i'm curious to see if anyone watches this video we'll see well if you've made it until now in the interview congratulations well stuck with us yeah oh well yeah should we have an award or something yesterday certificate or something that's right again um john thank you so much for for joining us i i hope that we do this again soon especially if there's uh new updates and things as they as they progress um this has gone so well and i really appreciate you joining us and uh it was a pleasure to be here yeah and the other thing carl that a lot of people don't realize is that roger and myself have a large back catalogue of videos from from pre-covered days which are somewhat neglected now so absolutely if you're bored one evening there's no reason to not be stimulated that's correct yeah well thank you to everyone watching thanks for joining us thanks again for submitting questions for this uh we really appreciate it and uh we hope to do this again and see you all soon thank you and i would just say uh have everyone um look at both of our uh channels here we both have channels on youtube and there's a lot of information on both these channels that are that are not redundant and but rather uh supplementary and complementary absolutely yeah absolutely yep and you can also check out our website medcram.com dr campbell do you have a website or is it primarily not at the mo not at the moment no no i had technical problems with that i often have technical problems just one of them i doubt that since you're putting videos out daily i'm i'm sure you've got them pretty pretty well dialed in by now not really all right well you're very humble and a very and a gentleman thank you so much thank you for having me i really appreciate it

Channel: Dr. John Campbell

Views: 683,358

Rating: 4.8024168 out of 5

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

Id: C7J8SPczl6w

Length: 98min 45sec (5925 seconds)

Published: Mon Jan 04 2021

Reddit Comments

[u/[deleted]]

Very good advice