CON EP 65: What do New COVID-19 Studies Show?

CON EP 65: What do New COVID-19 Studies Show?

Update on COVID-19 Looking Into facts from U.K & Israel

A largest real-world study of COVID-19 vaccine safety published by Israel’s Clalit Research Institute in The New England Journal of Medicine

  • A total of 1,736,832 persons were eligible for inclusion in the vaccination cohort
  • The median age in the eligible cohort was 43 years 

Israel was the first country on Earth to fully vaccinate a majority of its citizens against COVID-19. As of August 2020, Israel has one of the world’s highest daily infection rates — an average of nearly 7,500 confirmed cases a day, double what it was two weeks ago. Nearly one in every 150 people in Israel today has the virus.

A major study, conducted in collaboration with researchers from Harvard University, examined data on over 2 million people in Israel.

The study compared rates of 25 adverse events (within 3 weeks) between vaccinated and unvaccinated individuals, and separately, between unvaccinated individuals infected and not infected with coronavirus: Findings show that the vaccine is safe, while coronavirus infection is associated with numerous serious adverse events.

Few adverse events were associated with the vaccine. Myocarditis, the most serious one, was associated with an excess of 2.7 cases per 100,000 vaccinated persons. In contrast, coronavirus infection in unvaccinated individuals was associated with an excess of 11 cases of myocarditis per 100,000 infected persons.

The vaccine was found to be safe: Out of 25 potential side effects examined, 4 were found to have a strong association with the vaccine.

Other adverse events moderately associated with vaccination were swelling of the lymph nodes, a mild side effect that is part of a standard immune response to vaccination, with 78 excess cases per 100,000, appendicitis with 5 excess cases per 100,000 (potentially as a result of swelling of lymph nodes around the appendix), and herpes zoster with 16 excess cases per 100,000.

As you can see, as of August 15, 2021, 58% of COVID patients admitted to the hospital who were over the age of 50 had actually received two doses of COVID injections and 10% had received one dose. So, partially or fully “vaccinated” individuals made up 68% of hospitalizations.

Only in the 50 and younger category were a majority, 64%, of hospitalizations among the unvaccinated. Whitty, however, completely neglected to differentiate between the age groups. The same applies to deaths. Unvaccinated only make up the majority of COVID deaths in the under-50 age group. In the over-50 group, the clear majority, 70%, are either partially or fully “vaccinated.”

Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections 

*This study is still under peer review* This is a retrospective observational study.

Overall, 673,676 MHS members 16 years and older were eligible for the study group of fully vaccinated SARS-CoV-2-naïve individuals; 62,883 were eligible for the study group of unvaccinated previously infected individuals and 42,099 individuals were eligible for the study group of previously infected and single-dose vaccines.

  • The researchers evaluated four outcomes: SARS-CoV-2 infection, symptomatic disease, COVID-19-related hospitalization, and death. The follow-up period of June 1 to August 14, 2021, when the Delta variant was dominant in Israel.
  • Vaccine-induced immunity was also associated with a 27-fold increased risk for symptomatic infection (95% CI 12.7-57.5) compared with symptomatic reinfection (P<0.001)
  • In a separate analysis that compared vaccine and natural immunity regardless of the time of infection, fully vaccinated patients had a higher risk of infection (OR 5.96, 95% CI 4.85-7.33) and symptomatic disease (OR 7.13, 95% CI 5.51-9.21).
  • When allowing the infection to occur at any time before vaccination (from March 2020 to February 2021), evidence of waning natural immunity was demonstrated, though SARS-CoV-2 naïve vaccinees had a 5.96-fold (95% CI, 4.85 to 7.33) increased risk for breakthrough infection and a 7.13-fold (95% CI, 5.51 to 9.21) increased risk for symptomatic disease.
  • SARS-CoV-2-naïve vaccinees had a 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection with the Delta variant compared to those previously infected.
  • For comorbidities, they found a statistically significant 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection as opposed to reinfection (P<0.001).
  • Conclusion of the study: This study demonstrated that natural immunity confers longer-lasting and stronger protection against infection, symptomatic disease, and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity. 

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

Disclaimer: “These studies should not be interpreted as saying, ‘if you have already been infected, don’t get vaccinated.'”

U.S DATA on COVID-19

Unfortunately, we cannot rely on U.S. data to get a clear idea of how the COVID shots are working, as the U.S. Centers for Disease Control and Prevention has chosen not to track all breakthrough cases. As reported by ProPublica on May 1, 2021, the CDC stopped tracking and reporting all breakthrough cases, opting to log only those that result in hospitalization and/or death. It also prevents us from understanding how variants are spreading and whether those who have received the jab can still develop so-called “long-haul syndrome.” As of Today, CDC is only tracking “most severe cases”

Trends in Internal Medicine Study

  1. Bart Classen, MD. published a study in August 2021 disputing the COVID 19 shots claims. The study titled “U.S. COVID-19 Vaccines Proven to Cause More Harm than Good Based on Pivotal Clinical Trial Data Analyzed Using the Proper Scientific Endpoint, ‘All-Cause Severe Morbidity.”

Dr. Classen disputes the primary endpoint “severe infections.” This, Classen says, “has been proven dangerously misleading,” and many fields of medicine have stopped using disease-specific endpoints in clinical trials and have adopted “all-cause mortality and morbidity” instead.

The reason for this is because if a person dies from the treatment or is severely injured by it, even if the treatment helped block the progression of the disease they’re being treated for, the end result is still a negative one.

To offer an extreme example of what you can do with a disease-specific endpoint, you could make the claim that shooting people in the head is a cure for cancer because no one who got the treatment — who got shot in the head — died from cancer.

When reanalyzing the clinical trial data from these COVID shots using “all-cause severe morbidity” as the primary endpoint, the data reveal they actually cause far more harm than good.

The proper endpoint was calculated by adding together all severe events reported in the trials, not just COVID-19 but also all other serious adverse events. By doing this, severe COVID-19 infection gets the same weight as other adverse events of equivalent severity. According to Classen: Scientific principles dictate that the mass immunization with COVID-19 vaccines must be halted immediately because we face a looming vaccine-induced public health catastrophe.”

“Results prove that none of the vaccines provide a health benefit and all pivotal trials show a statistically significant increase in ‘all-cause severe morbidity’ in the vaccinated group compared to the placebo group.

Janssen claims that their vaccine prevents 6 cases of severe COVID-19 requiring medical attention out of 19,630 immunized; Pfizer claims their vaccine prevents 8 cases of severe COVID-19 out of 21,720 immunized; Moderna claims its vaccine prevents 30 cases of severe COVID-19 out of 15,210 immunized.

https://www.scivisionpub.com/pdfs/us-covid19-vaccines-proven-to-cause-more-harm-than-good-based-on-pivotal-clinical-trial-data-analyzed-using-the-proper-scientific–1811.pdf

US COVID-19 Vaccines Proven to Cause More Harm than Good Based on Pivotal Clinical Trial Data Analyzed Using the Proper Scientif

Update Aug. 24, 2021: With evidence of seriously-waning immunity at the five- to the six-month mark, CDC is now recommending a third “booster” shot. In highly-vaccinated Israel, recognizing that vaccination likely does not confer protection beyond a few months, the country has reimagined its vaccine passports. They will only apply to people who have had three shots, and only be good for a six-month period of time.

A 10 year Navy Surgeon speaks out on mandates in the military. In 2020, only 20 deaths of COVID-19 in the US military. Currently, they have 80 cases of Myocarditis. 

In 31 years of the VAERS, there were 317 cases of myocarditis. This year there are 1,113 cases of myocarditis. 

Facts on myocarditis. Non-fulminant active myocarditis has a mortality rate of 25% to 56% within 3 to 10 years, owing to progressive heart failure and sudden cardiac death, especially if symptomatic heart failure manifests early. 

“When death is an adverse effect and that is viewed as selfish for not getting it. We’re being gaslighted. 

CON EP 64: Petrodollar and What Affects Gas Prices

CON EP 64: Petrodollar and What Affects Gas Prices

Petrodollar and Gas Prices

Not many people have heard of the petrodollar and just as many people don’t know what affects gas prices. Gas is one of the only necessities that we allow for such drastic price fluctuations. The petrodollar is a system that the majority of the world uses to buy crude oil. Gas prices are determined by many factors including supply and demand as well as crude oil prices. 

Petrodollar

Before we clarify what the petrodollar is we need to understand some history regarding currencies and economics. 

  • In current society, there is no gold backing of the US dollar. We have a fiat currency, money without any backing by any kind of reserves. 
  • Post-WWI with a war-torn Europe the US had the most gold and a strong currency. Roughly before WWII money was backed by gold. In 1944 a conference of 44 countries was held in New Hampshire to discuss currencies. 
  • The decision was then made to back currencies by the stable US dollar and then have the US dollar be backed by gold.
  • Imports and exports all over the world were bought and sold basically using the US dollar. Which gives the US a lot of power through sanctions. In 1971 Nixon proclaimed that the US dollar will not be backed by gold. 
  • The Vietnam war was completely financed and funded by debt. When Nixon broke away from the gold as the reserve the dollar dropped in value making it hard to pay off debt, and shooting crude oil prices from $2 a barrel to $12 over 2 years. 
  • To save the US, Nixon and his Secretary of State and National Security Advisor Henry Kissinger came up with a plan. Treasury Secretary William Simon was sent to Saudi Arabia. 
  • Their idea was the petrodollar. 
  • This was the concept of having the US dollar be used in exchange for oil. With that agreement, Saudi Arabia would get military and economic support. 

The petrodollar is the agreement between the US and Saudi Arabia to sell its oil in dollars. The most valuable resource is oil. This allows the USD to be the most dominant currency and a hedge for countries.  

https://bitcoinmagazine.com/culture/the-hidden-costs-of-the-petrodollar 

https://en.wikipedia.org/wiki/Petrocurrency 

https://www.thebalance.com/what-is-a-petrodollar-3306358

What determines gas prices

The first thing that affects oil cost is crude oil. Starting with the quality, there are different types of oil depending on where it comes from. There is a grading system for oil. Oil supply by their largest manufacturers is regulated by OPEC. 

  • Crude oil has the biggest influence on price. Crude oil cost is determined by supply and demand. This includes the resources it takes for exploration, to remove it from the ground, and transport it to where it needs to go. Demand is higher in the summer months and lowers in the winter, the price follows demand. Some countries also store gasoline to drive demand. 
  • Tax is another influencer on gas prices, federal and state taxes are also pushed on the consumer. In July 2019, the federal, state, and local taxes on a gallon of gasoline totaled an average of 18% of the total price. Federal tax made up 18.4 cents, while state tax made up 29.66 cents. Marketing and distribution costs are also pushed on the consumer. You’re not only paying for the gas but also the cost of advertisements and everything in between.

The top five sources of U.S. total petroleum (including crude oil) imports by share of total petroleum imports in 2020 were

  1. Canada 52%
  2. Mexico 11%
  3. Russia 7%
  4. Saudi Arabia 7%
  5. Colombia 4%

https://www.investopedia.com/articles/economics/08/gas-prices.asp

https://en.wikipedia.org/wiki/Gasoline_and_diesel_usage_and_pricing 

EP 129: Things Only Nurses Understand

EP 129: Things Only Nurses Understand

Things only nurses will relate to

Every career has its own insider information and moments only coworkers can relate to. Nursing is the same way. We have ur acronyms and struggles but there is a lot of funny aspects to being a nurse. Nursing can be so stressful sometimes all you can really do is laugh.

    1. Code Browns

      1. Sometimes as nurses we are the bowel movement supervisors. A code brown is different from other codes but is definitely the smelliest one. Every nurse will experience a code brown. A code brown is a situation that all nurses will find themselves in, it is a situation where a patient has made a large fecal mess in the bed. A code brown usually calls for a clean-up crew. Don’t deal with a code brown alone, get your coworkers involved, they’ll love it. 
  • Tips on feeling with a code brown
      1. Double mask
      2. Vics vaporub
      3. Mouth breathing
  1. The Q word

    1. No one is allowed to say it, we don’t even like saying it at home. The Q word is worse than swearing and no one is to mention it. The Q word puts negative energy in the air and usually curses the unit. Everyone knows remembers who said it and what has come of it. It’s a weird nursing superstition that unfortunately comes true more often than you like. Nurses are not supposed to mention a slow shift. I think it is a yin and yang thing, stillness and chaos, one comes with the other. 
  2. LOLs

    1. Sometimes Little Old Ladies will make you laugh out loud. Only nurses will believe you when you tell them how your 87-year-old female patient weighing in at 45 kg tried to take on the whole unit. It is always the little old grandmas that cause the most destruction. These innocent ladies can be their loving selves during the day but once it starts to get dark, their minds may follow. The hardest sundowning patients we’ve dealt with have been little old grandmas.
  3. The only compliment a nurse will give

    1. Nurses don’t complement their patients often but the one compliment you’ll hear is “nice veins”. Nurses love good veins because it makes their lives a lot easier. Sometimes we just place a peripheral IV because we can. It’s also a compliment you’ll only hear in the hospital and we do mean it. 
  4. Magical powers on micropore tape

    1. Just like Frank’s red hot nurses put micropore tape on everything. Securing limbs for line placements, holding dressings in place, taping foleys, and everything in between. We use micropore tape for everything.
  5. Full moon

    1. When a full moon is present every nurse is on stand by. This is one of those times where you are not just expecting one patient to go nuts it’ll be a portion of the unit. Somehow the bright light of a full moon wakes up the worst in our patients. Make sure to pack some extra snacks or extra coffee because it’s going to be a long shift. 
  6. Mysterious frequent fliers

    1. This will forever be a mystery. We cannot understand how patients keep coming back with the same problems and we offer the same solutions. A patient comes in, we fix their problem, give them instructions on how to move forward, tell them exactly what made them sick, and still, they come back. We don’t get it, do people not want to live?
  7. Shift swap curse

    1. For some reason when nurses adjust their schedule and swap shifts, they end up getting the short end of the stick. No one knows why it happens but for some reason when you try to accommodate for your social life you end up paying for it. This is why it is important to choose your schedule wisely and try to not switch it once it is finalized. 
EP 128:  Gender Dysphoria & Gender-Affirming Surgeries With Shannon Whittington

EP 128: Gender Dysphoria & Gender-Affirming Surgeries With Shannon Whittington

In this episode, we’d like to welcome Shannon Whittington. Shannon is a speaker and best-selling author of her book LGBTQ ABC’s for Grownups. She is a clinical nurse expert in gender-affirming surgeries for transgender and nonbinary patients. She is an advocate of the LGBTQ community.

Shannon answers the following questions for the viewers:

  1. How much education did you receive in LGBTQ+?
  2. What do transgender and binary mean and what are gender-affirming surgeries?
  3. What are some struggles and barriers the LGBTQ community faces
  4. What is gender dysphoria? What age does it start?
  5. At what age can people be put on hormones or get surgery?
  6. Can you tell us why people switch sexes? What seems to be the main reason?
  7. What are some things we need to be conscious of when providing care to the  LGBTQ population? 
  8. How can I be an ally to the LGBTQ+ pop?
EP 127: Central Lines in Nursing

EP 127: Central Lines in Nursing

Central Lines

Central lines are any line that is placed into the larger vessels of the heart. Any catheter that is inserted and sitting in the superior or inferior vena cava is considered a central line.

Central line insertions

It is an invasive and sterile procedure that requires consent. The pt will be draped and the nurses and physicians will gown up their sterile gowns. When catheters are placed the patient is lying flat and given a numbing medication called lidocaine and pain medication. Make sure to have some sterile flushes handy in case you need to flush the line. Your job as a nurse will be to assist the person placing the line which can be an NP, MD, PA, and also monitoring vitals. Then the line is being advanced you may see some ectopy on the monitor, this usually happens when the tip of the catheter hits the right atrium (atrial tickle). If there is some ectopy let the physician know so they can pull back on the catheter. Once placed it is then sutured and anchored in place.

Some common central lines are PowerPICC, Hickman, Broviac, Groshong.

PICC lines

A PICC is a peripherally inserted central catheter. 

PICCs are narrow flexible catheters usually inserted through a vein in the peripheral region. It is slid through until the tip reaches a large vessel in the heart called the superior vena cava. Usually placed in the upper arm.

Central lines can be inserted through:

  • internal jugular vein
  • common femoral vein
  • subclavian veins
  • basilic vein
  • brachial vein
  • cephalic vein

The major benefit to PICCs is that they allow for the administration of drugs that would not be able to be given through a peripheral line. They also give the patients the ability to have a long-term catheter for continuous use, for chemo, hemodialysis, etc…

Central line uses

Central lines can have multiple lumens or be single. The most common ones are a single lumen, double, and triple lumen.

  • Prolonged IV antibiotic use
  • Long Term medication infusions
  • Multiple access was obtained with one line.
  • TPN, Chemo
  • Long-term inotropic therapy, vasopressors
  • Home and sub-acute discharge
  • Blood draws

Hemodialysis Catheter

Thicker than a PICC and temporarily used for hemodialysis or CRRT. a fistula is preferred over this method. It can be tunneled or temporary and should only be used for dialysis but can be used in emergent situations for medications. 

Tunneled vs non-tunneled catheters

Tunneled catheters are placed for longer-term use and many times patients can be sent home with them. Tunneled catheters are passed under the skin and then fed into a large vein. Tunneled catheters also have something called a cuff which facilitates tissue growth to anchor it in place. 

Ports

Also used for long-term treatment. It is implanted so that it sits underneath the skin usually in the upper chest. They need an occasional flush but otherwise don’t require much care. They can also be multiple.

Risks and Complications 

Central lines are great; they provide critical access during critical times however there is some risk associated with central lines.

Air embolism

Rare but can occur during insertion and when giving medications. 

Air bubbles enter the bloodstream and can travel to the brain, heart or lungs causing a MI, stroke, or respiratory failure. 

Signs and Symptoms

  • difficulty breathing or respiratory failure
  • chest pain or heart failure
  • muscle or joint pains
  • stroke
  • mental status changes, such as confusion or loss of consciousness
  • low blood pressure
  • blue skin hue

Infection

Infections leading to sepsis can happen during the insertion period and after if proper maintenance isn’t done. 

Signs and Symptoms

  • Fever
  • Chills
  • Tachycardia
  • Fatigue
  • Hypotension
  • Redness or swelling on site
  • Purulent drainage
  • Elevated WBCs

Phlebitis

Inflammation of the vein where the catheter is inserted.

Signs and Symptoms

  • Redness, pain, or drainage at the site
  • Streak formation along the vein

Thrombus formation

Any catheter that is inserted will be at risk for thrombus formation and then embolism.

Maintenance

  • After insertion, you will need to get an x-ray to confirm placement. Daily x-rays are not needed unless you are having problems with the catheter. One thing that can happen is catheter malposition, which will be revealed on the x-ray. 
  • A central line can be pulled back if it migrates but should not be pushed further in.
  • Dressing changes are sterile procedures. Dressings need to be kept dry and changed if wet. 
  • The dressing should be changed per hospital policy, some places change them weekly and some every 72 hours. Keep in mind that every time you do a dressing change you expose the line to infection so they should not be done whenever.
  • Some catheters need to be flushed with heparin.
  • Keep lumens patent by flushing at least once a shift or keep a KVO going.
  • Clean lumens with alcohol before using or keep caps on them.
  • Using a 10 ml syringe generates the proper intra lumen pressure. 
  • Catheters that have clamps require heparin flushes, if clamps are not present it is a saline-only catheter. 
  • Avoid blood pressures on the side of the line.
  • Always protect the catheter from tugging. 

According to healthypeople.gov the most common HAIs include:

  1. Catheter-associated urinary tract infections
  2. Surgical site infections
  3. Bloodstream infections
  4. Pneumonia
  5. C. diff

CLABSI or Central Line-Associated Bloodstream Infections account for thousands of deaths a year and million dollars in added costs to the healthcare system. 

https://www.cpc.mednet.ucla.edu/sites/default/files/Refresher131112/Day1/Transition/LinesTubesPorts.pdf

https://www.google.com/search?q=how+often+should+you+change+a+central+dressing&rlz=1C5CHFA_enUS947US948&oq=how+often+should+you+change+a+central+dressing&aqs=chrome..69i57j0i22i30j0i390.9250j0j4&sourceid=chrome&ie=UTF-8

https://www.jointcommission.org/-/media/tjc/documents/resources/health-services-research/clabsi-toolkit/clabsi_toolkit_tool_1-3_pictures_of_central_venous_catheters_fpdf.pdf 

https://www.azuravascularcare.com/infodialysisaccess/difference-between-cvc-and-picc/ 

https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections