Two vaccine shots, implications

you're most welcome to today's talk it's mayday so happy may day and it's a saturday saturday the 1st of may uh some news from around the world basically english-speaking countries things are looking better but there's calamities unfolding in asia which will be we should be looking at now let's start off with english-speaking countries here these are the trends so australia new zealand obviously hope you got the chance to listen to uh dr farrier yesterday the talk with nigel was very interesting on australia then we've got the united kingdom which is just drifting down ever so slowly or is that flat almost flat drifting down very slowly ireland a little more turbulent i'm afraid the vaccinations in ireland of course aren't what they are in the united kingdom united states definite downward trend this is very encouraging let's just hope the vaccination program really goes ahead a pace in the united states and canada well canada's the highest of the english-speaking countries unfortunately at the moment now starting off with some news from the uk first of all now the uk is awaiting changes uh for two doses people that have had two doses of the vaccine now in the united states the guidelines have already changed so that people that had two vaccine doses can behave differently mixing in households indoors for example in the uk that has not changed so as of now the rules state that people who have had two vaccines behave exactly the same as people who had no vaccines so stark difference here between the approach in the united states where people with two vaccines are allowed more liberties where in the uk they're not interesting difference the sociologists among you may care to comment on that somewhat outside my area of expertise but um so indoor gatherings um are going to be allowed in the uk wales iii england the 17th of may scotland the 17th of may and northern ireland the 24th of may but unlike the united states this is not going to be stipulated as conditional this is going to be for everyone regardless of their vaccine choices or vaccine status quite an interesting difference of approach on both sides of the atlantic ocean there uh professor jonathan van tan uh if two if if two people who both had two doses of vaccines and have both served at least 14 days after their second dose that's a good point at least 14 days after the second dose then i would be highly confident scientifically he puts this in funny language but you can see what he's getting at scientifically that if there were reputable vaccines then indeed it would be incredibly safe for those two people to meet incredibly safe so this is the deputy chief medical officer uh very well thought of in the uk unlike some other doctors who aren't quite so well thought of and and um he's saying well if you've had two vaccines then it's going to be uh scientifically incredibly safe but is that going to be reflected in national guidelines is as it is in the united states i strongly think it should uh you may disagree um but the united states has gone one way and the united kingdom is going another way so interesting difference paul hunter professor of medicine university of east anglia he says this is true he agrees with uh professor van tam if we're talking about the b117 which is the most prevalent strain in the united kingdom at the moment but what he's worried about and do what i'm worried about um is uh um other variants arriving in the uk which of course could could happen this issue is variants with escape mutations are less affected by the vaccine is the issue so um probably well we believe well we we know with the oxford astrozenica vaccine that the data in india is showing that people who have had the vaccine are not getting very sick or being hospitalized or dying well or are the art they are but minuscule amount absolutely massively protective against uh civilians massively protected um but for the pfizer actually we don't have the data on on the india variant as far as i'm aware at the moment we're awaiting that so so basically the still unknowns i think is what we're saying so the issue is that the venus with escape mutants so that's the little bit of a question mark there and we haven't come to a clear understanding of what those risks are which have clicked clearly so now um as of the 22nd of april the cover symptom tracker app tim spector group said that the uk indian or south africa variants have yet to make an impact on the uk now hopefully they're not going to but we have seen the effect that new variants have made before but let's hope that we're not going to get an increase in cases in the uk because of our very liberal uh allowances of people flying in from india only recently uh restricted uh m more on that in a minute actually um but let's look at india itself first of all um well new daily cases in india well i mean this graph speaks for itself doesn't it it is going up continuously rapidly and again i was saying this back from about here it's hard to see quite what's going to stop this at the moment and of course this line here which we can't see there but that line there is that that's three that's 300 000 cases that's 400 000 cases there so that's the 300 000 cases mark which has been broken through that's the 400 000 cases a day which has just been broken through now um and these are just officially diagnosed cases of course and we know that india has got really quite limited testing now the uh the united states has sent quite a lot of additional tests to india so this should help uh with understanding the true position but um still limited testing in india so therefore we know these are massive underestimates so over 400 000 new cases in uh that was on friday um yeah that was friday so over 400 000 cases on friday well over 90 million officially diagnosed deaths carrying on and increasing but again we know these are greatly greatly represented vaccines in india not great i mean well it sounds good all adults are now eligible for that vaccine in india if there was any but there's not it was the over 45s one dose 10 in the population two doses 1.5 of the population so quite why the indian authorities are saying that everyone now can uh is eligible for vaccination over the age of 18 when they haven't got enough room in the over 45s is a bit bemusing and it's sad to see that there are a lot of politics coming into play in india people who haven't got oxygen are allowed to say they haven't got oxygen sometimes in some states because that's disinformation i mean we're we're into a nonsense uh situation here and um it's it's become somehow some aspects of the the indian management of the pandemic have become totalitarian and um this is a big political issue meanwhile the people suffer of course and the poor the people are the more likely they are to suffer corruption uh is rampant of course in india um people being sold gases that aren't oxygen people being sold uh bogus drugs people paying for tests to get into hospital but then they don't get in um it's so sad you've got such a heroism in some aspects of indian society and individuals and you've got such despicable behavior in others as well it really is sad to see the good people suffering because of the actions of the of the uh of corrupt individuals uh india australia um now there was an indian cricketer i think it was um and he he went he wanted to go back to uh sorry it was an australian cricketer working in india and uh apparently a lot of australian cricketers play cricket in india and he wanted to go back to australia obviously and he went via somewhere in the middle east and then ended up in australia that's now a criminal offence if you if you are in india now and you work your way back to australia you get is the five-year prison sentence in australia completely draconian regulations but of course this will protect the entire population of australia so from monday it's a criminal offence for citizens to return home so this is australian citizens from india are not allowed to go from india back to australia whereas in this country we had indian people from or people living in in england indian people living in england probably with dual citizenship or something flying to india for a wedding then flying back you know the liberalization that we had that has given this virus the these variants the opportunity same in the united states the still flights going i mean i think i think there is going to be restrictions next week on flights from um in fact i've got it here i've got we'll do that in a minute fourth of may it is um but the the the the opportunity that we've given for this virus to this variant to spread around the world is just despicable it's almost as if we've been let down by our politicians again so um criminal offense so the australians have taken steps to present protect the population of australia india united states so there's restrictions from the 4th of may most non-indian in most non-us citizens uh who've been to india within the last 14 days will not be allowed into the u.s now reading between the lines there that means that people with dual citizenship india and the united states will be allowed in some of them will will carry this mutant i would strongly suspect wouldn't you so stark difference in approach between the um the australian authorities and the united states authorities and who knows what what would happen here if the indian variant did become loose in the united states we simply don't know and uh i for one would be uh would be uh quite content not to find out and i'm sure if you're in the united states should be quite content not to find out but it looks like you might might be finding out so radically different approaches australia i think i see protecting its citizens united states is going to allow dual citizens back in to the united states there you go india and france um first cases of the uh india mutant detected in france in the south west patiently who are currently hospitalized in bordeaux um two more cases in the southeast in the this area this department of marseille um two more cases and these were two people returning from india without any link to one another because the virus is so prevalent in india this has got to be a significant risk so they weren't epidemiologically linked so just another example of flying around the world causing problems as we talked about in january 2020 tempted to say i told you so but i won't well i've said it now haven't i but you know what why on earth didn't the world our health organization advise stopping flights in february january february 2020 then we wouldn't have had a pandemic you know i could see it from sitting in here just looking at public domain data but but they couldn't it's just i feel badly let down really bad really really badly let down and all the people that have suffered so the people that are suffering in india now if this pandemic had been truncated in january 2020 they wouldn't be suffering now guess you're a bit angry sometimes uh right uh france also have a 10-day quarantine for arrivals from india brazil south america chile and argentina let's hope that's enough should be depending on the capacity part of the reason the australians have said that you can't come for if you're an australian citizen you can't go from india to australia is they don't have the hotel quarantine capacity it's a capacity issue because return to australia has always been restricted anyway even for australian citizens now talking about the india situation the sequencing rates how do we know what is where well the answer is one heck of a lot of the time we uh we don't we don't if you're in iceland you've pretty good idea so iceland is sequencing 78.8 samples which of course is very good australia's 63 point 60.3 percent but of course these are based on smaller numbers so it's more manageable likewise for new zealand given the number of positive cases in new zealand the fact that they're only sequencing just less than half of their positive cases is pathetic so they're going to cross they should be doing much better than that in new zealand denmark it's excellent 20 taiwan 16 uk 8.7 which is good um this is over this is over about the past six months i think norway 5.6 vietnam 5.5 vietnam leading the united states by a long way the united states 1 very poor very poor for the united states the vietnam situation with a lot of extreme poverty and difficulties and well many difficulties uh over five times the sequencing rate of the united states india it's uh well it's north point it's uh it's virtually nothing it's not 0.96 um very very low sequencing rate so out of 18 million cases and the sequence 10 and twenty six sequences so very uh very low now i've written 102 there i can't remember what it's for it'll come to me later anyway out of 18 million cases uh 10 and a half thousand sequence in other words what's going on in terms of the variance in india well it's hard to tell and i mean the the the the uh the initial information was saying that the indian mutant is quite prevalent in maharastra the mumbai area uh and uh the uk variant is more prevalent in the new delhi north of india area but given that amount of sequencing you can probably uh make something up that's equally accurate it's a very crude indicators now also on the india situation your us governments just sent 100 million dollars worth of supplies encouraging to see u.s state department citizens should leave as soon as it is safe to do so so the u.s state department is advising american citizens to leave asap uh the australian authorities are saying you can't well you can leave but you can't come back in australia um which country is more likely to be exposed to the india variant pretty obvious spread to small cities in towns now my friends in india were saying just last week that most of the cases in india are in the cities and when it spreads to the small towns and villages it's going to be more devastating because they simply have well virtually no medical facilities in many parts of rural india so that is going to be a an issue and and there isn't i mean i've worked in indian villages and there's no one there i mean i mean i've been peripherally involved in training up some like healthcare workers from from indian villages and that these are basically um well they're not doctors or nurses or professionals of any sort of sort they're just people who want to help their community and we could give them some basic uh education but well it was pretty basic pretty basic stuff health promotion rather than rather than medical treatment so many people that get sick in indian villages are probably never going to see a nurse or a doctor is the sad reality of the situation so so that this is happening now spread now occurring under reported corruption and black markets are going on in india alongside extreme nobility it has to be said the two are side by side in india and it often is thus unfortunately medical debt is a huge problem in india huge problem in india and it's only going to be getting worse and remdi sevilla is very very very highly thought of in india so i was talking to an indian doctor friend yesterday and he said if you don't give rem disavir which is remarkably expensive even in india it's expensive and the patient dies then the relatives blame the doctor for letting the patient die because the doctor didn't give rem disappear so the doctors are more or less obliged to give renders of it when they can um because otherwise they get blamed if the patient does die and unfortunately patients are dying quite frequently from other causes mostly simple lack of oxygen of course um and other basic drugs like dexamethasone which are very simple drugs to give adjacent countries pakistan well trend increasing there it looks like it's going down a bit but there are worrying noises coming out of pakistan so quite what is happening there hard to say um hard to say nepal but certainly it's certainly worrying um i i would suspect i think i put it stronger than that i think it's inevitable the india variants go to go through pakistan in a very similar way to india and again i've done a little bit of teaching in nepal um new cases beautiful country lovely people very very poor um but the cases are going up now so lower population of course that's the 6 000 mark per day but as as with india in the last week or two it's that it's the that direction that is concerning and the health facilities in nepal are perhaps uh well are worse equipped to to cope with this influx of patients than they are in india so really pretty ominous for that part of the world um and i believe things are difficult i mean i haven't checked it for the last couple of days but brazil and south america also also difficult so these countries at the moment are are the more fortunate ones um but let's spare a thought for asia um brazil and and mexico at this time now i'm going to look at rendezvous now so so that that's the news part of we're going to look at rem deservier um is this effective does it i mean is it so over hyped in india really um and of course there's uh other anti-viral drugs which are if an antiviral drug is not impatent then of course the pharmaceutical industry wouldn't make money by promoting it but rem disavilla is impatent and it's phenomenally expensive in the states i've checked the price in the uk um this is straight from the national institute for health and care excellence never like that name i don't i don't i don't mind the nice bit but whenever you have to say your care is excellent you know that probably means you've got doubts about it but there you go um anyway check it out for yourself there's the reference and here we have it remdi severe one vial normally a 10 day course of course indicative nhs price and that's uh 340 pounds per vial if it's a 10 day course well you can work that out for yourself can't you and i believe it's even more expensive in the states i don't know what the price is in india it can't be this much because that's utterly unaffordable by most people in india but that's the indicative uk price but is it effective so um there's there is some good data on member severe for the treatment of covered 19 that this final report came out on the new young journal of medicine 5th of november 2020 because we always need to look back to the evidence to see what's being done is evidence based so this was a good trial randomized uh placebo-controlled trial intravenous this is an intravenous drug so it's fairly high tech you know you need you need um people that can put up intravenous lines so you're talking about doctors experienced nurses to do that it's not a treatment that's probably going to happen in indian villages very often um 10 day course typically this trials in patients hospitalized with covered 19 who did have evidence of low respiratory tract infection so this was already poorly people now of course we know that this is a phased illness so here's the um here's the graphic we've used for this quite a few times i think that's from the east virginia medical school so if the virus is only alive during this period of time then that's the only time it's worth giving antivirals we were talking to dr corey a few days ago and he was saying that doctors are faced with poorly patients when it because of immune dysregulation and they're giving them disappear but the virus has already gone so what's the point in that and this viral debris is dead because this is a phased illness this is the time to give anti-virals so we'd have to give it early on in the in the disease process for to have any benefit at all um but that was that was done mostly in this trial so that's so that's okay they recruited a thousand patients thousand sixty-two then disavea group that's big enough placebo group that's big enough so there you go you can compare the results between the two so the rem deserver group median recovery time 10 days need for oxygen uh they needed it for 13 days mortality by day 15 was 6.7 percent mortality by day 29 was 11.4 percent that was the rem disappear group so that's the group that got it now um with the uh with can we get both of those on at the same time maybe not so the this was this was the control group medium recovery time was 15 days as opposed to 10 days so slightly quicker recovery time in the remdi severe group compared to the controls need for oxygen in the placebo group the control group 21 days need for oxygen in the rem deserve a group 13 days and in the disavow group less people needed to go on to oxygen in the first place mortality in the members of a group at day 15 was 6.7 percent mortality by day 15 in the placebo group was 11.9 percent for the placebo group mortality by day 29 11.4 percent in the remember severe group mortality by day by day 29 was 15.2 percent in the control group so we see all these parameters are showing remembers of it does have some antiviral beneficial effect well some beneficial effect we can't say this antiviral from this so mortality by day 29 in the room there is a very group 11.4 bear in mind these were people that were already poorly in hospital versus 15.2 uh by day 29 in the control group so um just to run through that again um 10 days in the rendezvous group 15 days in the in the controls in the placebo so that's good that's better for them to serve here need for oxygen was 21 days in the in the controls mortality uh in the members of it in the mortality in the control group was um 11.9 that was it 11.9 so 15 21 11.9 that's right and the mortality by day 29 was 15.2 percent so we see in every parameter there the control group are not doing as well as the remember severe group but it's not massive it's not massive so that the hazard and it's very expensive and the hazard ratio was a 73 so um 73 percent less so the if you if you had the them deserve your chances of dying were 73 as opposed to one in in the control group in other words that's the beneficial effect of 27 isn't it is that right 27 yeah so so yes there is a benefit but this of course is in patients that are already hospitalized and already poorly but it is very expensive so from this um if i was hospitalized with um um covered 19 already hospitalized and already what was the criteria uh evidence of low lower respiratory tract infection then yes clearly you would want this because it does have some efficacy but it is expensive and it is intravenous and it has to be given at the right period of time and other therapeutics are not regularly considered which is unfortunate so there you go there is some benefit but it is very expensive and it's all over it's all over in indian social media serious adverse events uh remember severe group 24 percent placebo group 31 so again we see less serious adverse events in them disappeared group so that is showing uh that level of efficacy hazard ratio of 73 0.73 so there we go um a bit of what's going on in a bit of science today um no idea how long that went up for went on for but if you're still with us then of course thank you for thank you for watching

Channel: Dr. John Campbell

Views: 214,376

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

Id: hVo0pVC9Swk

Length: 27min 29sec (1649 seconds)

Published: Sat May 01 2021