Health & Fitness

A largely hidden issue of the COVID-19 pandemic is the risk of medical malpractice, and the consequences for patients, health care workers and hospitals alike. As noted by Epic Brokers:¹

“There is … a risk of increased professional liability claims arising from COVID-19. Claims for alleged failures to properly test, treat, or diagnose are expected.

Negotiations are ongoing with state and federal governments to provide immunities to providers on the front lines of COVID-19 response. Some states have granted immunity to front line healthcare providers and healthcare organizations, as well as expanded ‘good Samaritan’ protections.”

Indeed, New Jersey² has granted full immunity — both civil and criminal — to health care providers battling COVID-19. Sweeping civil and criminal immunity has also been granted in New York. New York Governor Andrew Cuomo who, against federal guidelines, ordered ill equipped nursing homes to accept COVID-19 patients, also granted immunity to nursing home executives.

The immunity rule was reportedly³ issued after the Greater New York Hospital Association donated more than $1 million to the New York State Democratic Committee. Two New York legislators have since introduced a bill that would repeal Cuomo’s blanket immunity.⁴

Michigan, Massachusetts, Illinois and Connecticut have also issued immunity laws,⁵ and Iowa lawmakers introduced a bill to grant broad protections to health care providers, hospitals, nursing homes and a variety of other businesses in early June.⁶

Medical Errors Are Third Leading Cause of Death in the US

The problem with handing out broad immunity to any and all health care providers and executives is that it may lower the quality of care. If you know you cannot be sued under any circumstance, you’re less likely to take all the precautions necessary to avoid making a mistake.

It is likely this immunity to prosecution led to the egregious ethical and medical breeches documented by the undercover nurse Erin Marie Olszewski at the epicenter of the pandemic, Elmhurst Hospital in New York, which you can see in the section below.

Even without the pandemic, medical errors are the third leading cause of death in the U.S., according to Johns Hopkins patient safety experts.⁷ According to their data, 9.5% of all annual deaths stem from medical errors, including misdiagnoses and treatment mistakes. The situation may be even worse than that, however.

According to the 2017 paper,⁸ “Your Health Care May Kill You: Medical Errors,” more than 90% of medical errors go unreported. Even so, medical error rates in the U.S. are “significantly higher” than those in other developed countries, including Canada, Australia, New Zealand, Germany and the U.K., the paper notes.⁹

The 2017 Commonwealth Fund report,¹⁰ “Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care” also points out that the U.S. health care system continually ranks LAST in patient outcomes when compared to other high-income nations. This, despite the fact that the U.S. health care system outspends all other countries.

Nurse on the Frontlines of COVID-19 Shares Her Experience

While it’s important to not hold health care workers to irrational standards in the midst of an outbreak of a novel, never-before-seen disease, giving everyone a free pass no matter how obviously egregious their negligence can also put patients at unnecessary risk.

A standout case in point is the Elmhurst Hospital Center, a public hospital in Queens, New York, which has been “the epicenter of the epicenter” of the COVID-19 pandemic in the U.S. In a heavily censored interview, nurse Erin Olszewski addresses a number of problems at Elmhurst, including the hospital’s:

• Rule to not resuscitate COVID-19 patients
• Lax personal protective equipment (PPE) standards
• Failure to segregate COVID-positive and COVID-negative patients, thereby ensuring maximum spread of the disease among noninfected patients coming in with other health problems
• Listing COVID-19 negative tests as positive
• Routine use of mechanical ventilation of all COVID-19 patients

Of these, the seemingly systematic mislabeling of negative COVID-19 tests as positive and the routine use of mechanical ventilation are perhaps the most abhorrent, as it has undoubtedly led to the unnecessary death of many.

In her undercover video, Olszewski talks about how a stroke patient ended up contracting the disease due to being placed in the same room as a COVID-positive patient. He ended up on mechanical ventilation, drastically increasing his chances of dying due to lung damage.

Part of why mechanical ventilation is so dangerous is because you are given sedatives and paralytics. You’re essentially asleep for the duration, which could be up to a month. “There’s no way you can recover from something like that,” Olszewski says. What’s worse, according to Olszewski, many patients are not even told that they will be put to sleep. They’re merely told they will receive breathing assistance.

In a chilling conversation, a physician states that not a single patient has been successfully extubated and released since the pandemic began, and many of these weren’t even COVID-19 positive to begin with. In a case like this, should hospital staff and administrators really get off scot-free?

July Is Medical Malpractice Awareness Month

A July 2, 2020, blog post¹¹ by the law firm Ashcraft & Gerel lists “10 surprising facts about medical negligence and error in the U.S.” Among them:

• More than 92% of American and Canadian physicians report having been involved in a medical error and “near misses”
• 1 in 25 hospital patients develops a preventable infection during their stay
• 1 in 4 Medicare patients is injured or killed by medical negligence in the hospital
• Human failures are responsible for 80% to 90% of all medical errors
• An estimated 1 in 3 seniors receiving care in skilled nursing facilities experience preventable adverse events

Despite the continuous rise in preventable medical errors, the rate of successful medical malpractice claims declined 55.7% between 1992 and 2014. Even when there’s strong evidence of negligence, physicians are acquitted half of the time, and up to 90% of medical malpractice claims are dropped without payout.

Pandemic Accelerates Risk Management Changes

According to The Health Care Blog,¹² “the pandemic might ultimately … accelerate changes in the way health care organizations think about risk management and their insurance coverage for it.”

In the video above, Margaret Nekic, CEO of Inspirien — a hospital-and-physician-owned medical malpractice and worker’s comp insurance company — discusses how liability carriers are responding to the changes brought by COVID-19.

For example, during this pandemic, many doctors have been asked to provide care outside their area of expertise, which increases the risk of errors occurring. They’re also using modified equipment. Of course, SARS-CoV-2, being a novel virus, did not, and still doesn’t, have a clear-cut treatment strategy, and doctors have had to experiment and innovate.

Health care workers are also providing testing outside of medical facilities, and while doctors are typically covered by their malpractice insurance regardless of where they work, most nurses are covered by the hospital in which they work, and may therefore not be covered if they’re providing testing or care in other facilities.

The Problem With Standard of Care

Now, while Johns Hopkins researchers have identified “unwarranted variation in physician practice patterns that lack accountability” as one of the primary contributors to medical errors,¹³ one could just as easily argue that the requirement to adhere to “standard of care” protocols may actually be part of the problem.

Doctors are afraid to deviate from the standard of care, even when they disagree with it wholesale or believe it might not be in a specific patient’s best interest, because this is the easiest way to get sued for malpractice.

It’s “easier” to let someone die than risk losing their medical license by doing something differently. This includes prescribing dangerous medications based on generalized recommendations rather than following a more individualized system of care.

As it pertains to COVID-19, we’ve seen how Elmhurst hospital has continued using mechanical ventilation even though front-line workers and researchers have stepped forward, warning that ventilation kills more COVID-19 patients than it saves and doesn’t appear to be an appropriate treatment for this disease.

We’ve also seen how early treatment with hydroxychloroquine and zinc, despite getting high marks from critical care doctors around the world, has been suppressed in the U.S. — based on fraudulent research, I might add — and both doctors and pharmacists have been warned they risk losing their medical license if they prescribe it.¹⁴ This, despite the fact that there really is no other carefully vetted COVID-19 treatment available yet, as potential therapeutics are still under investigation.

‘Pious’ Patients Are Most Likely to Die

Back in 2012, I interviewed Dr. Andrew Saul about his book, “Hospitals and Health: Your Orthomolecular Guide to a Shorter Hospital Stay,” in which he discusses the risks hospitalized patients face.

In it, he points out that knowing how to play “the hospital game” can help save your life. Importantly, so-called pious patients — those who keep quiet and question nothing — are the most likely to get killed.

One of the best ways to safeguard your health and life during a hospital stay is to bring a personal advocate, someone who can speak up for you and ensure you’re given proper care — especially if you’re so sick you cannot do so yourself.

Unfortunately, this pandemic has prevented family members from visiting those that are hospitalized to act as their advocates. Many times, this leaves them at the mercy of hospital staff and physicians that are immune from prosecution and negatively motivated to consider any natural therapy, even something as simple as vitamin D, for fear of repercussions from violating the “standard of care.”

This makes it even more important, if you are ever hospitalized now, to question everything. It’s also important to remember you have the right to do so. As noted by Saul in that interview:

“The most important thing to remember is this: the hospital power structure. No matter what hospital you go into … the most powerful person in the most entire hospital system is the patient …

You might have set that up with a document. If you have a power of attorney, a living will, or other types of paperwork or someone is responsible, then we know who’s responsible. But let’s say that it’s just an ordinary situation — the patient has the most power — [but] the system works on the assumption that the patient will not claim that power …

A patient can say, ‘No. Do not touch me.’ And they can’t. If they do, it’s assault, and you can call the police. Now, they might say, ‘Well, on your way in, you signed this form.’ You can unsign it. You can revoke your permission.

Just because somebody has permission to do one thing, it doesn’t mean that they have the permission to do everything. There’s no such thing as a situation that you cannot reverse … the patient has the potential to put a stop to anything; absolutely anything.

If the patient doesn’t know that, if they’re not conscious, or if they just don’t have the moxie to do it, the next most powerful person is the spouse. The spouse has enormous influence and can do almost as much as the patient. If the patient is incapacitated, the spouse can probably do much more than the patient.

If there is no spouse present, the next most powerful people in the system are the children of the patient … You’ll notice that I haven’t noticed doctors or hospital administrators once. That’s because they don’t have the power. They really don’t. They just want you to think that [they] do.

It is an illusion that they run the place. The answer is — you do. They’re offering you products and services, and they’re trying to get you to accept them without question …

[W]hen you go to the hospital, bring along a black Sharpie pen, and cross out anything that you don’t like in the contract. Put big giant X’s through entire clauses and pages, and do not sign it. And when they say, ‘We’re not going to admit you,’ you say, ‘Please put it in writing that you refuse to admit me.’

What do you think your lawyers are going to do with that? They have to [admit you]. They absolutely have to … It’s a game, and you can win it. But you can’t win it if you don’t know the rules. And basically, they don’t tell you the rules. In [the book] ‘Hospitals and Health,’ we do.”

Surviving COVID-19

There are no easy answers when it comes to COVID-19, but considering you may not have the ability to sue for malpractice under any circumstance (depending on where you live), taking a keen interest in your treatment would be advisable.

I’ve written several articles over the past few months detailing some of the treatments that appear to be among the most effective, such as the MATH+ Protocol and early intervention with hydroxychloroquine and zinc.

For home use, at first sign of symptoms, you could try quercetin in lieu of hydroxychloroquine, as the primary mechanism of action in COVID-19 is their ability to shuttle zinc into your cells, and it is the zinc that provides most of the benefits. Ketone esters may also be helpful for certain symptoms.

Importantly, rather than waiting for a likely harmful vaccine, get proactive and start optimizing your vitamin D level. You can learn more about this in “The Most Important Paper Dr. Mercola Has Ever Written” and “How to Fix the COVID-19 Crisis in 30 Days.”

As the old adage goes, an ounce of prevention is worth a pound of cure. Your safest bet to avoid becoming a medical error statistic is to stay out of the hospital, and to avoid hospitalization for COVID-19, you really need to focus on strengthening your immune function and reversing any underlying comorbidities such as insulin resistance and obesity.

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As businesses and groups fluctuate between gathering or not, many have taken to doing a symptom check in the hope of reducing exposure to SARS-CoV-2. This usually consists of asking several questions, such as whether you have been exposed to anyone with an active infection or if you’ve had symptoms.

The CDC recommended non-contact temperature assessments to be conducted at homeless shelters and encampments.¹ Yet, the World Health Organization and the CDC acknowledge this may be inadequate since asymptomatic individuals might be able to spread the virus.²

Some companies in the U.S. instituted temperature checks for associates returning to work. Amazon announced they were doing this on more than 100,000 workers each day.³

Yet, in one study of 5,700 people triaged for hospitalization with COVID-19, researchers found only 30.7% had a fever.⁴ Infectious disease doctor from Johns Hopkins Center for Health Security, Dr. Amesh Adalja, spoke with a reporter from Health, saying:⁵

“Fever screening can be one part of a wider system, but it’s still unclear how much marginal benefit there is. Prevention of infection with the new coronavirus is a multi-faceted task. Even with entry screening in place, it’s very important to still wash your hands and practice good hand hygiene throughout the day. For those at high risk, it will also be important that they continue to optimally social distance even when venues are open."

Data Show Smell and Taste Impairment Predicts COVID

There has not been a definitive study on the number of people with COVID-19 who also have a fever.⁶ New research published in JAMA offers a clue that fever may not be as common with the virus as originally believed.

Until more information is available, scientists are relying on data from the SARS epidemic in 2003 to assess COVID-19 patients. In one literature review published in 2009 following SARS, the researchers found that fever had a negative predictive value ranging from 86.1% to 99.7%.⁷

This means that those without a fever likely did not have SARS. However, the same cannot be said for COVID-19, as some people are contagious before they run a fever, and others may never get a fever. While temperature taking may only catch a small number of those with an infectious disease, some experts are suggesting that adding a smell test to screenings would be more effective.

It's also important to remember that you can run a fever for reasons other than COVID-19. There is a growing body of evidence to suggest that people with the virus have a higher rate of smell and taste dysfunction, including complete loss, which is called anosmia (loss of sense of smell) and ageusia (taste). Andrew Badley is a leader of a virus lab at Mayo Clinic. He spoke with a Stat News reporter, saying:⁸

"My impression is that anosmia is an earlier symptom of Covid-19 relative to fever, and some infected people can have anosmia and nothing else. So it's potentially a more sensitive screen for asymptomatic patients."

What Are the Numbers?

Badley and his colleagues published a study in April in which they evaluated the clinical notes of 77,167 patients who had undergone PCR testing for COVID-19.⁹ They compared those results to the patients’ electronic health records and found that 2,317 were positive and 74,850 were negative.

The team then identified and analyzed symptoms associated with COVID-19, including fever and chills, respiratory difficulty, cough, muscle pain, diarrhea and smell dysfunction. Those who tested positive were 27.1 times more likely to have smell and taste dysfunction than those who were negative.

This was significantly higher than any other symptom analyzed. The closest was fever and chills, which presented a 2.6 times greater likelihood that the person would have the virus. In a separate study published in the International Forum of Allergy and Rhinology, researchers did a retrospective review of patients who came to the San Diego Hospital system between March 3, 2020 and April 8, 2020.¹⁰

They included those with a confirmed positive infection who also had an evaluation of smell and taste function. There were 128 who met the criteria. Of those, 20.1% required hospitalization. In further analysis, the team demonstrated:¹¹ 

“Admission for COVID‐19 was associated with intact sense of smell and taste, increased age, diabetes, and subjective and objective parameters associated with respiratory failure. On adjusted analysis, anosmia was strongly and independently associated with outpatient care …”

Data gathered from 220 survey respondents across the U.S. showed the symptom of loss of smell or taste was even higher.¹² Of the respondents, 42% were COVID-19 positive and 58% were not. The loss or alteration in smell or taste as the first or sole symptom occurred in 37.7%.

Separately, a review of the literature was conducted to include 24 studies from 8,438 lab-confirmed positive COVID-19 patients across 13 countries.¹³ The researchers found smell dysfunction was found in 41% and taste dysfunction was present in 38.2% of the population.

Why Might Smell and Taste Be Affected?

Dr. Justin Turner from Vanderbilt University Medical Center believes the prevalence of anosmia in the population with COVID-19 is 25%, and it may be as high as 80%, based on patients’ subjective reports.¹⁴ He also hypothesized how it may happen. He believes the primary cause is an inflammatory reaction brought about by the virus inside the nasal cavity near the olfactory nerve. He explains:¹⁵

“In COVID-19, we believe smell loss is so prevalent because the receptors for COVID-19 that are expressed in human tissue are most commonly expressed in the nasal cavity and in the supporting cells of the olfactory tissue. These supporting cells surround the smell neurons and allow them to survive.”

Infection of the nasal epithelium also appears to be higher in adults. The authors of a study published in the Journal of the American Medical Association linked the low infection rate in children (less than 2%) with the hypothesis that they have a lower expression of ACE2 receptors than adults.

They found that age was a risk factor based on the number of ACE2 receptors in the nasal cavity, “the first point of contact for SARS CoV-2 and the human body.”¹⁶ Your sense of taste is dependent on smell, so it makes sense that when smell is altered you also have an alteration in taste.

I also wonder how much zinc deficiency or insufficiency may have to do with the loss of smell. Data gathered for a study published in the International Forum of Allergy and Rhinology showed that those who were admitted with more severe disease had an intact sense of taste and smell. One of the symptoms of zinc deficiency is a loss of sense of smell.¹⁷

We know the body uses zinc intracellularly to stop viral replication and slow or stop the infection.¹⁸ Could it be that individuals who get more zinc into the cells and use it to slow the infection also demonstrate symptoms of zinc insufficiency or deficiency as their body uses the trace element to fight the virus?

How to Test for Zinc Deficiency

Zinc is important to all organs and cell types, which explains the varied symptoms associated with deficiency. It is required for approximately 100 enzymes and is crucial for your immune function, wound healing, cell division and growth and development. Researchers believe that zinc deficiency:¹⁹

“… is strikingly common, affecting up to a quarter of the population in developing countries, but also affecting distinct populations in the developed world as a result of lifestyle, age, and disease-mediated factors.”

In North America, overt deficiency is uncommon and related to inadequate intake, increased losses or requirements. For instance, bioavailability is lower with a plant-based diet and some have found that vegetarians need 50% more of the recommended daily allowance than those who eat meat.

However, it is not uncommon to have a mild or moderate zinc insufficiency. Since the trace element is important in the fight against viruses, including SARS-CoV-2, you may want to consider taking a simple zinc test at home to determine your status.

In the video below Dr. Donald Ozello demonstrates a simple taste test that can quickly tell you how insufficient or deficient in zinc you might be. Simply place two tablespoons of a solution of zinc at room temperature in your mouth and hold it. The results are based on what you taste after 10 seconds.

• Grade 1 — An immediate bad taste, meaning you have no deficiency
• Grade 2 — A moderately bad taste, indicating you have a mild deficiency
• Grade 3 — A slightly unpleasant taste or delayed taste, which means you are deficient
• Grade 4 — No taste, which means you are severely deficient

Combine Quercetin and Zinc for a Powerful Immune Boost

For zinc to work it must first get into the cell. Your body uses zinc ionophores, or substances that open the cell membrane for it to pass through. Drugs like chloroquine and hydroxychloroquine are zinc ionophores, which likely explains how they affect those with COVID-19 when the drugs are combined with zinc.

The good news is there are other substances that have the same action without the side effects. In a lab study published in 2014, scientists evaluated quercetin and epigallocatechin gallate (EGCG found in green tea) for the biological activity that may increase cellular zinc uptake. They concluded:²⁰

“The ionophore activity of dietary polyphenols may underlay the raising of labile zinc levels triggered in cells by polyphenols and thus many of their biological actions.”

Quercetin and EGCG also have the advantage of inhibiting an enzyme used by coronavirus to infect healthy cells.²¹ Adding to this, quercetin has potent antiviral activity in its own right.²² When considering supplementation, it's important to remember that excessive zinc may increase health risks. Acute side effects include nausea, vomiting, diarrhea, abdominal cramps and headaches.²³

Another important factor relating to immune health is the balance of copper and zinc; an increased intake of zinc may help. Chris Masterjohn writes this as little as 60 milligrams of zinc per day can introduce problems.²⁴ Essentially, copper lowers the activity of superoxide dismutase, sometimes called SOD. This is a crucial to your immune defense. He recommends:

“Zinc that is swallowed for the sake of reaching the lungs should be used preventatively rather than at the first sign of symptoms, because it takes a long time to enrich systemic stores of zinc.

I prefer to use 1-3 zinc lozenges per day preventatively so that the tissues of the nose and throat are rich in zinc as soon as they encounter the virus. Unlike swallowed zinc, however, lozenges designed to spread zinc through these tissues can be jacked up quickly in response to symptoms, because their ability to spread zinc through these tissues is not limited by intestinal zinc transporters.”

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Up to 7.8% of the U.S. adult population takes proton pump inhibitors (PPIs), medications that are prescribed for acid-related disorders like heartburn, gastroesophageal reflux (GERD) and chronic indigestion.¹ For years, the aggressively advertised medications have been a lucrative Big Pharma venture, but they’re also controversial because they are linked to many health risks.

PPIs have been overprescribed, wrongly prescribed and over-advertised. For example, 46% to 63% of patients seen in ambulatory care settings who were taking PPIs had no gastrointestinal (GI) complaint or "documented indication for anti-secretory therapy," according to an article in Clinical Correlations, the NYU Langone Online Journal of Medicine.² They are also routinely used in intensive care unit (ICU) settings.³

Though PPIs were designed to be taken for no more than eight weeks when first approved by the FDA, they are often used long-term despite their well-documented risks.⁴ According to Clinical Correlations, PPIs:⁵

"… are inappropriately continued long-term, leading to significant overuse of this medication class. PPIs therefore represent an important target for physicians to reduce unnecessary medication use and lower the risks associated with polypharmacy."

Further, PPIs are habit-forming and difficult to quit. Now, scientists writing in the American Journal of Gastroenterology have added another layer to the recognized risks of these drugs: They have found links between taking PPIs and the risk of developing COVID-19.⁶

Increased Risk of COVID-19 Seen With PPI Use

In the study, of 86,602 eligible survey respondents, 53,130 (61.3%) listed "prior abdominal pain or discomfort, acid reflux, heartburn or regurgitation" on their surveys. They were asked about their use of PPIs and H2 receptor antagonist (H2RA) drugs, which are also prescribed for acid-related disorders.⁷ Of that group, 3,386 (6.4%) participants reported that they had tested positive for COVID-19.⁸

Upon analyzing the data, the researchers found that people taking PPIs once a day had more than two times the risk of contracting COVID-19 than those who didn’t.⁹ For people taking PPIs twice a day, it was even worse: They had more than three times the risk of contracting COVID-19 than those not on the drugs.¹⁰ People on H2RAs did not have an elevated risk.¹¹

To rule out confounding data, people who had taken PPIs for less than a month, possibly for COVID-19-like symptoms, were classified as nonusers.¹² In their analysis, the study’s authors did not find that taking PPIs increased the odds for reporting such symptoms. Based on the results, the researchers warned:¹³

"Since meta-analysis reveals that twice daily PPIs do not offer clinically meaningful benefits over once daily dosing for gastroesophageal reflux disease, our findings further emphasize that PPIs should only be used when clinically indicated at the lowest effective dose."

What Explains the Increased Risk of COVID-19?

From their observations in the medical setting, the researchers arrived at the theory that PPIs may increase COVID-19. “We developed this hypothesis at the beginning of the COVID-19 pandemic when we started to see a high incidence of GI symptoms and learned that the virus sheds into saliva, and thus can be swallowed into the stomach," said Dr. Christopher V. Almario, the study's lead author.¹⁴

The basis of the findings is likely PPIs' induction of a condition called hypochlorhydria, a low level of stomach acid, say the researchers. Hypochlorhydria impairs the body’s ability to defend against ingested bacteria and viruses. In one study, once-daily PPI use "increased the odds for enteric infection by 33%."

Since it is known that pH ≤3 impairs the infectivity of a virus similar to COVID-19 (SARS-CoV-1), though its effect on COVID-19 is not yet known, the researchers wrote:¹⁵

"As SARS-CoV-2 employs the angiotensin-converting enzyme-2 receptor to rapidly invade and replicate within enterocytes, increases in stomach pH >3 from PPI use might allow it to gain entry into the GI tract more easily, leading to enteritis, colitis, and systemic spread to other organs, including the lungs.

… there is biological plausibility for our findings as the similar SARS-CoV-1 is pH-sensitive and remains infective at a pH >3; twice daily PPI use can lead to 24-hour median intragastric pH >6 and sustain pH >4 for more than 20 hours.

We also found evidence of a dose-response relationship as those using PPIs twice daily have higher odds for COVID-19 positivity when compared to those taking lower-dose PPIs or those not using PPIs at all. Moreover, individuals taking the less potent H2RAs are not at increased risk."

The Researchers Discuss the Study

Upon hearing the results of the study, some who are taking PPIs may want to abruptly stop. But Dr. Brennan Spiegel, one of the study authors, cautions against it.¹⁶

"This study does not mean that people on PPIs should just stop their medicines … As always, the decision about whether, when, and how to modify PPI dosing should be based on a thoughtful assessment of the risk-benefit ratio for individual patients.

As with any medication, the lowest effective dose should be used when clinically indicated, and, when appropriate and consistent with best-practice guidelines, H2RAs may also be considered as an alternative treatment for acid-related conditions."

H2RAs, medications like Pepcid, Tagamet and Zantac, generally available over the counter, are not linked to contracting COVID-19 in the research. They are considered safer than PPIs and their use is suggested as a way to discontinue PPIs by tapering off treatment.¹⁷

However, one H2RA, Zantac, has a red flag of its own. In 2019, the FDA said tests revealed the presence of the carcinogen N-nitrosodimethylamine (NDMA) in Zantac, whose generic name is ranitidine. According to Harvard Health Publishing:¹⁸

"NDMA is an environmental contaminant that is found in water and foods, including dairy products, vegetables, and grilled meats. Its classification as a probable carcinogen is based on studies in animals; studies in humans are very limited."

In April 2020, the FDA requested manufacturers to withdraw all prescription and over-the-counter Zantac drugs from the market.¹⁹

PPIs Are Dangerous Regardless of COVID-19 Links

PPIs are designed to reduce acid in the stomach, yet hydrochloric acid, along with pepsin, is necessary to break down protein in your intestinal tract. That means a reduction in acid from the use of PPIs changes nutrient absorption and digestion for the worse.

Without adequate breakdown of protein, you increase the risk of experiencing dysbiosis,²⁰ or an imbalance in the gut microbiome between pathogenic bacteria and friendly bacteria. This condition opens the door for a host of other problems like candida, Helicobacter pylori (H. pylori), C. difficile and leaky gut.

Moreover, when people suffer from heartburn, GERD and chronic indigestion, the problem is rarely caused by too much acid. Patients with these ailments are usually suffering from other stomach issues that can be addressed with a healthy diet and natural treatments. Unless an endoscopy has confirmed high levels of stomach acid, it's actually more likely that you don't have enough.

PPIs Have Serious Side Effects and Limited Uses

According to gastroenterologist Dr. Mitchell Katz, PPIs are warranted for only a few conditions, including:²¹

• Ulcerative esophagitis
• GERD
• Zollinger-Ellison syndrome
• H. pylori

Prescribing PPIs for other conditions is irresponsible because they are linked to many concerning conditions, as I’ve noted. According to The New York Times:²²

“Several studies also have shown an increased risk of bone fractures from osteoporosis in patients taking P.P.I.’s, though the results aren’t consistent. Possibly the change in stomach acidity reduces the body’s ability to absorb calcium.”

PPIs are especially problematic for seniors, wrote the Times. Dr. Ian Logan, a Scottish physician, said:²³

“When patients were admitted to our geriatric wards, a lot of them didn’t have clear indications for taking these drugs … And they’d remained on them for a lot longer than they should have … They do have significant side effects, especially in older patients.”

Among the side effects often seen are increased risk of pneumonia, gastrointestinal infections and severe diarrhea. Here are more scientifically documented risks of PPIs:

Increased risk of heart attack24	Serious allergic reactions25
Kidney problems26	Stevens-Johnson syndrome27
Increased risk of fractures28	Increased risk of pneumonia29
Pancreatitis30	Increased risk of C. difficile31
Reduced liver function32	Iron and B12 deficiencies33

How to Wean Off PPIs

If you’re already taking a PPI, you'll want to get on a lower dose than you're on now, if possible, and then gradually decrease your dose even further. Once you get down to the lowest dose of the PPI, you can start substituting with an over-the-counter H2 blocker like Tagamet or Cimetidine, but not Zantac or ranitidine.

Then, gradually wean off the H2 blocker over the next several weeks while implementing the lifestyle strategies addressed below. As always, be sure to check with your doctor before starting any new medications or making changes to the ones you’re currently taking.

Safe, Natural Alternatives for Heartburn, Acid Reflux and Indigestion

Consume Enough Probiotics — This will help balance your bowel flora, which can help eliminate helicobacter bacteria naturally.

Eliminate Food Triggers — Food allergies can be a problem, so you'll want to completely eliminate items such as caffeine, alcohol and all nicotine products.

Increase Your Body's Natural Production of Stomach Acid — Start with high-quality sea salt (unprocessed salt) such as Himalayan salt.

Take a Hydrochloric Acid Supplement — Try a betaine hydrochloric supplement, which is available in health food stores without prescription.

Modify Your Diet — Eat a lot of vegetables and high-quality, organic, biodynamic, locally grown foods.

Optimize Your Vitamin D levels — Vitamin D helps fight infectious diseases.

There Are Many Safe Alternatives to PPIs

In summary, PPIs are linked to many serious side effects for which the 7.8% of the U.S. adult population who take them may be at risk. Yet, the painful, acid-based conditions that people take PPIs for can often be relieved by making relatively simple lifestyle changes. These changes are especially important with the reported links between PPIs and COVID-19.

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British scientists at the University of Oxford have successfully conducted phase one of their trials and anticipate the vaccine to be distributed in bulk by December, if future testing goes to plan. 

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Researchers have created a virus in the lab that infects cells and interacts with antibodies just like the COVID-19 virus, but lacks the ability to cause severe disease. This safer virus makes it possible for scientists who do not have access to high-level biosafety facilities to join the effort to find drugs or vaccines for COVID-19.

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As the world reels from illnesses and deaths due to COVID-19, the race is on for a safe, effective, long-lasting vaccine to help the body block the novel coronavirus SARS-CoV-2. The three vaccine approaches discussed here are among the first to be tested clinically in the United States.

How vaccines induce immunity: The starting line

In 1796, in a pastoral corner of England, and during a far more feudal and ethically less enlightened time, Edward Jenner, an English country surgeon, inoculated James Phipps, his gardener’s eight-year-old son, with cowpox pustules obtained from the arm of a milkmaid. It was widely believed at the time that once milkmaids became ill with cowpox, a relatively mild disease, they were no longer susceptible to smallpox. The young boy became quite ill, but recovered in about a week. Jenner then injected James with material from a smallpox pustule and observed that nothing untoward happened. A new scientific approach to disease prevention was born.

A century later, it became clear that vaccination — a term Jenner coined from the Latin name for cowpox, Vaccinae variolae — worked because vaccines induce protective immune responses. We now know that vaccines can generate neutralizing antibodies by activating immune cells called B lymphocytes that secrete those molecules. Antibodies specifically recognize a shape on a virus or a toxin and bind to it, much like a key that tightly fits into a lock. They can then block the virus or toxin from binding to our own cells, effectively disarming it.

However, in order for these antibodies to bind strongly to viruses or bacteria and to last a very long time, the body has to be tricked into believing it is responding to an infection. When that happens, immune cells called T lymphocytes are activated and can help B lymphocytes make better, long-lived antibodies.

Seeking long-lasting immunity: Fragments and targets

Many weakened (attenuated) live viruses have been used as vaccines. These tend to provide long-lasting immunity even after a single dose. The yellow fever vaccine, for instance, generates immunity that can last a lifetime. Other examples include measles, mumps, and rubella combined (MMR), rotavirus, smallpox, and chickenpox vaccines.

Some vaccines are just killed versions of the whole virus. Immunity in response to such vaccines is not that long-lasting, and several booster shots are needed to enhance immune memory and prolong protection. The injected flu vaccine — a combination of strains of influenza most likely to circulate in a given year — is an example of a killed virus vaccine. Given as a single injection, it only offers protection for about three months. Other killed virus vaccines include those for rabies and the injected polio vaccine; both induce long-lasting immunity only when multiple doses are administered.

Many vaccines are made up of a piece, or a modified version, of the target virus or bacteria. Their effectiveness can vary, and booster shots are generally necessary to achieve relatively long-lasting immunity. For instance, the modified versions of the toxins released by the bacteria that cause tetanus and diphtheria given in the Td vaccine can generate protection for about 10 years. One current vaccine for pneumonia offers protection for four or five years.

Creating vaccines for COVID-19: mRNA and hybrid approaches

Unfortunately, research shows not all COVID-19 patients make natural antibodies against the novel coronavirus. Even in those who do, antibody amounts tend to decline about two months after the initial diagnosis. Therefore, natural infection is unlikely to create herd immunity (the slowing of the spread of a pathogen when a large proportion of a community acquires immunity against it). So, effective vaccines are desperately needed.

There are over 100 different COVID-19 vaccines in various stages of testing and development: preclinical work using animal models, followed by Phase 1 (safety), Phase 2 (optimal dose, schedule, and proof of concept), and Phase 3 (effectiveness, side effects) trials in humans.

Three promising vaccines (there are many others) are discussed below, because they will be the earliest to be tested in the United States through clinical trials:

• A vaccine created by Moderna in Cambridge, Massachusetts, uses a type of molecule called messenger RNA (mRNA) that can be mass-manufactured very rapidly. In this vaccine, mRNA induces human cells to make a molecule called the spike protein, which studs the surface of the coronavirus and enables it to enter human cells. The vaccine then triggers the immune system to make antibodies against the spike protein. Phase 1 human trials were started in March 2020 by the NIH. Initial results have shown the vaccine is safe and generates high levels of neutralizing antibodies. The vaccine is expected to enter Phase 3 clinical trials in July 2020.
• A hybrid vaccine uses a modified, harmless form of a chimpanzee common-cold adenovirus as a capsule, or vector, to deliver the coronavirus spike protein into the body and to stimulate immune response. This platform was developed at the Jenner Institute at Oxford University in collaboration with AstraZeneca. Already in clinical trials in many parts of the world, this vaccine is expected to enter clinical trials in the United States in August 2020.
• Another hybrid vaccine uses a human common-cold adenovirus to deliver the coronavirus spike protein into the body. That platform was developed by Harvard Medical School scientists in collaboration with Johnson and Johnson. This vaccine is expected to enter Phase 1 clinical trials in September 2020.

In animal models, all three vaccines provide protective immunity against SARS-CoV-2. Upcoming trials will help establish their long-term effectiveness and potential side effects. A central question will be how long protection might last. Based on information from trials for other diseases, it’s likely that hybrid adenovirus vector vaccines will protect individuals for at least one or two years, and probably longer.

Many are wondering when a vaccine will be available. If all goes well for at least one of these vaccine candidates, it may be as soon as the first quarter of 2021. Much hinges on results from the larger trials ramping up this summer.

Join @MassCPR researchers and physician-scientists for an update on the state of COVID-19 vaccine development, with a focus on vaccine trials in humans underway and others expected to launch soon. To register for this event click here.

For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.

The post Vaccines for COVID-19 moving closer appeared first on Harvard Health Blog.

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Lego could be used as a practical tool to train doctors in anaesthetic skills according to new research that has shown a simple task using the building bricks can help improve technical skills - a finding that could improve medical training and patient safety.

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A new study confirms that SARS-CoV-2, which causes COVID-19, cannot be transmitted to people by mosquitoes.

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Researchers have developed an ultrasensitive biosensing method that could dramatically shorten the amount of time required to verify the presence of the COVID-19 virus in a sample.

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Research shows European countries need to work together when lifting lockdown measures, to prevent COVID-19 cases rising again on the continent.

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Researchers have determined how the pandemic coronavirus SARS-CoV-2 inhibits the synthesis of proteins in infected cells and shown that it effectively disarms the body's innate immune system.

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Devices commonly implanted for chronic pain could expand patient access to prosthetic arms that ''feel.''

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A phase 2 randomized controlled trial of a recombinant adenovirus type-5-vectored COVID-19 vaccine (Ad5-vectored COVID-19 vaccine) was conducted in China in April 2020 and involved more than 500 people. The primary objective of the study was to evaluate the immune response and safety of the vaccine, and to determine the most suitable dose for a phase 3 trial. Phase 3 trials are needed to confirm whether the vaccine candidate effectively protects against SARS-CoV-2 infection.

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A phase 1/2 trial involving 1,077 healthy adults found that the vaccine induced strong antibody and T cell immune responses up to day 56 of the ongoing trial. These responses may be even greater after a second dose, according to a sub-group study of 10 participants. Compared to the control group (given a meningitis vaccine), the SARS-CoV-2 vaccine caused minor side effects more frequently, but some of these could be reduced by taking paracetamol. There were no serious adverse events from the vaccine. Based on their results, the authors say that further clinical studies, including in older adults, should be done with this vaccine. The current results focus on the immune response measured in the laboratory, and further testing is needed to confirm whether the vaccine effectively protects against infection.

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Continuing routine immunizations during the pandemic could save around 702,000 child lives from vaccine-preventable diseases, far exceeding the potential risks of COVID-19 transmission to older family members from visiting clinics, according to experts.

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International model, personal trainer, former tradie and recent inmate of the Big Brother house Chad Hurst reveals how he has managed to stay fit in even the toughest of lockdown conditions.

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