Coronavirus

Reports of spike protein shedding.

Urinary shedding of spike protein in COVID-19 patients

COVID VACCINE DEATHS

David Cooley (59)
died on May 28, 2021
10 days after his second Moderna dose

Dan Kaminsky (42), April 23, 2021
second dose of Pfizer on Apr. 12

Joel Kallman

Larry King

Midwin

Hank Aaron

Marvin Hagler

Ashley Taylor Gerren (30)
April 2021
(lupus; “died in sleep”)

DMX

Duke of Edinburgh

Midwin Charles (47)

Benjamin G. Goodman
March 23, 2021

Vivek

Desiree R. Penrod

Sara J. Holub

Alber Elbaz

Karen Hudson-Samuels (68), February 16, 2021
“stroke”
https://nypost.com/2021/02/18/former-news-anchor-dead-one-day-after-receiving-covid-19-vaccine/

Daniel Thayne Simpson (90), February 4, 2021
first dose of the Moderna vaccine on Feb. 3.
“natural death” – no autopsy

Among the 27 Michiganders who died after getting a jab in the arm, the average age was 78. The majority had underlying health conditions such as diabetes, cancer, heart or lung disease, Alzheimer’s disease and even COVID-19. Most of those who died were residents of long-term care facilities; some were in hospice care.

Continuous Renal Replacement Therapies (CRRT) are dialysis treatments that are provided as a continuous 24 hour per day therapy.

GiViTI COVID19 MEETING 10 March 2020 – ICU PATIENTS

Patient Characteristics

• The average age of patients is about 70 years old.
• The most frequent co-morbidity is OBESITY.
• A clear majority of patients are males.
• On admission PaO₂/FiO₂ < 100.
• CXR on presentation usually bilateral interstitial pneumonitis (can be asymmetric if co-infections).
• Beware of swab results as they may be negative initially. Clinical impression is more reliable. Confirmation often comes only later via BAL, as pulmonary involvement is lower.

Hematochemistry

• Pro-calcitonin (PCT) = 0 (in the absence of co-infections).
• High CRP.
• High LDH.
• Elevated liver enzymes (from virus +/- medications).
• High CK especially in younger patients (who usually have high fever, chills etc.).
• Extreme elevation of, and difficult to control blood glucose levels, often causes ketoacidosis.
• Low albumin (collected in the lungs??).
• Lymphopenia (low CD4).
• BNP normal.

Pharmacologic Therapy

• Lopinavir/ritonavir (KALETRA) 200/50 mg po BID.
• Chloroquine 500 mg po BID or hydroxychloroquine 200 mg po BID.
• Prophylactic antibiotics (variable according to local practice: piperacillin/tazobactam, ceftriaxone, TMP/SMX, antifungals (the use of azithromycin has been abandoned).
• Acetylcysteine 300 mg po TID (secretions not abundant, but dense when present).
• Steroids? Only in cases with fibrosis (do not use prematurely).
• Tocilizumab? IL-6 receptor inhibitor. Rationale is vast inflammation BUT use must be evaluated in setting of lymphopenia. At the moment NO indication for routine use and NO precocious use.

Intensive Therapy

• Profound sedation.
• Paralysis
• Fluid balance net NEGATIVE: the lungs act like sponges due to inflammation.
• Protective ventilation (require high PEEP, even > 15 cm H₂0, monitor carefully for possible complications such as subcutaneous emphysema, PNX – tolerate pH up to 7.3 – in contrast to classical ARDS, patients usually have good compliance and can be ventilated without high driving pressure).
• PRONE POSITION (18-24 hour duration – fundamental principle of management = extremely effective – require up to 7 rotations – do not trust initial improvement and continue this therapy at least until clear signs of progress with therapy).
• Tracheostomy often within 7 days allows for earlier and safer weaning attempts (high risk of relapse).
• CRRT? Reserve for patients with greatest chance of favorable outcome for the following reasons: increases labor burden on nursing staff, greater difficulties with prone position, creates problem of disposal of infected bags/waste.
• Nitric Oxide: have not seen significant beneficial effects, but can be useful in gaining time for the most critical patients (extreme therapy).
• ECMO: rarely necessary, because patients are very responsive to adequate ventilation. Indicated in cases of patients not responsive to therapy and extreme hypoxia.

Monitoring

• CXR to define clinical presentation. May be repeated but imaging does not correlate strictly with clinical condition.
• CT Chest NOT indicated because great difficulty of transport, great risk of spreading contagion
• U/S Chest highly indicated for daily assessment of pulmonary condition (PATTERN 1: diffuse B lines, PEEP responder – PATTERN 2: anterior zone clear, posterior zone consolidation, responsive to prone position) – useful in evaluating complications from high PEEP and recruiting maneuvers.
• Echocardiography: look out for dyskinesia (myocarditis?).

Weaninig

• Afebrile.
• Decrease in inflammatory parameters (CRP, LDH).
• Euvolemia.
• PEEP < 12 cm H₂
• PaO₂/FiO₂ > 150.
• FiO₂ ≤ 50%.
• Do not trust initial improvement, because patients may experience early relapse.

COVID Vaccine Deaths