One way of reducing myocarditis from these mRNA and adenovirus vector COVID-19 vaccines would be to minimise the amount of vaccine which goes straight into circulation, rather than staying in the muscle as it is supposed to. This can be achieved to a significant degree by aspirating the needle, which is standard procedure with most intramuscular injections. This involves discarding vaccine and the syringe and needle if the aspiration results in blood being drawn back into the syringe. Links to the research concerning this is in a comment I wrote in:
Another way of reducing the myocarditis from these vaccines is to use them for only a subset of the population - those who are still likely to benefit from them, despite the non-trivial risks, due to characteristics of each such person which cannot be changed. These include the well-known comorbidities of obesity, hypertension, diabetes and using immunosuppressant drugs.
This would be relatively easy to do if the risks most people face from COVID-19 infection were greatly lowered by boosting their 25-hydroxyvitamin D levels to the 50ng/ml or more which their immune system needs to function properly. Without proper vitamin D3 supplementation, or recent extensive UV-B skin exposure, most people have only 5 to 10ng/ml 25-hydroxyvitamin D - so their innate and adaptive immune responses to pathogens are much weaker than they should be, and they are at a higher risk of the wildly dysregulated inflammatory immune responses which drive severe COVID-19.
This, combined with easy and immediate access to multiple early treatments is a much better way of protecting everyone from COVID-19, partly due to the direct reduction in severity and risk of hospitalisation, but mainly because average viral shedding is greatly reduced, reducing transmission and so reducing R0 below 1.0 and ending pandemic spread.
Still, with good 25-hydroxyvitmain D levels and other nutritional improvements and early treatment, some people with comorbidities - mainly those over 50 years - would benefit on average from vaccination to reduce the risk of severe disease.
The most important step towards protecting everyone from COVID-19 and other diseases is to boost 25-hydroxyvitamin D levels to at least 50ng/ml, with vitamin D3 supplement at about 0.125mg 5000IU / day for 70kg bodyweight. This takes a few months, so for early treatment ~1mg single dose oral calcifediol (pharma name for 25-hydroxvyvitamin D) will raise it in 4 hours, which is faster than bolus, such as 300,000IU D3, due to D3's need to be hydroxylated in the liver Without such supplementation most people have only 5 to 25ng/ml, 1/10th to 1/2 of the the 50ng/ml their immune system needs to function properly. Please see the research articles cited at: "What every MD, immunologist, virologist and epidemiologist should know about vitamin D and the immune system: https://vitamindstopscovid.info/05-mds/ .
It is all very interesting to speculate on the finer points of choice of vaccine and how to schedule the injections. Vaccines are glamorous, specifically directed, expensive, profitable, medically administered, solutions to a problem - and many people are attracted by these qualities.
However, their narrowness makes them of very little lasting value against rapidly proliferating variants (Omicron has already split into two mutationally distinct lineages: https://github.com/cov-lineages/pango-designation/issues/361). They take months to administer to entire populations in the very best of circumstances. They weaken immune responses for a while after the injection and they do nothing to solve the fundamental problem of weak and overly inflammatory immune responses due to inadequate 25-hydroxyvitamin D.
Vitamin D supplementation reduces the excessive inflammation which is the reason many people take immunosuppressant drugs, such as prednisone and dexamethasone. So the use of these pernicious drugs could be minimised or eliminated with vitamin D supplementation. These drugs do much more than reduce inflammatory responses. They reduce innate and adaptive responses too - and boost glucose levels.
It should be common-sense to get everyone's 25-hydroxyvitamin D levels up to 50ng/ml, but it is not so common among people who can't believe that anything so simple could be true. This common disbelief blinds these people to a proper understanding of health, and condemns many people to ill-health due to the avoidance of simple, good, approaches in favour of supposedly more sophisticated approaches which are more expensive, more dangerous and/or less effective.
I just am not in a position to listen to podcasts. Some of us never do, much as we regret hearing your sibilant tones. It would be good if you would put out a transcript (auto-transcription is imperfect but OK) of these things when you post them. At a minimum, a link to the preprint in the text would make it possible to at least understand the comments. Thanks.
Thanks, as always, for your thoughts and research. I wonder... how many cases of myocarditis are going unreported due to the tribalism of all-or-nothing vaccines? I personally know of two women, one 45 - slightly overweight, the other 63 with non small cell lung cancer and healthy weight, both with the Pfizer vaccine that experienced heart palpitations and abnormal heart rhythm after receiving their vaccines. I am not a doctor and no myocarditis was ever diagnosed with these women but I can't help but wonder if doctors and patients alike are finding other reasons for heart issues, rather than looking into whether or not the vaccine could have played a role. I wish there was a way to dig into this more.
One of your best posts yet, Vinay. Thank you and I hope a few people who might be in a position to act in response to this will read it. Our whole approach to this pandemic leaves me more and more hopeless regarding where we go from here. I love the information you give us in this and in other places but fear you are preaching to the choir. What can we as individuals do? The next election cycle is too far off.
A few key points from this paper: 1) the public health system in Ontario has committed to robust surveillance, standardization of reporting and treatment of myocarditis/pericarditis. Their focus on physician and hospital or clinic reporting to their vaccine safety surveillance system alone appears to be yielding better epidemiology data than that of the US. Provider reporting of adverse events is mandated in Canada, but not in the US. Layered on top of voluntary reporting the Canadian provincial public health surveillance data is likely far more accurate than VAERS or VSD. 2) The studies expected rates of myocarditis/pericarditis were based upon its own population rates by using data obtained from linked health administrative datalinks from between 2015-2019 and not derived from a meta-analysis of the existing literature on expected rates (BTW there is no adequate expected rate for myocarditis in the literature as per a CDC recent pre-print on AEs: https://www.medrxiv.org/content/10.1101/2021.08.31.21262919v1). The Ontario author's use of this database allowed for demographic specific expected rates to be calculated. 3) The comparison of heterologous and dose interval is very interesting. It is a good example of the use of adversomics within vaccinology. I would like to see what a lower dose (50mcg) of Moderna as a second dose would do to myocarditis rates . 4) Sadly, this study is yet another example of how the US (CDC Vaccine surveillance system) leads from behind in monitoring vaccine safety. No wonder there is vaccine hesitancy.
Unfortunately, at present, this type of study would be very difficult to do in the US due to the lack of regular VAERS reporting by providers, a patchwork of health information databases with their own limitations like VSD and an overall outdated system. We could achieve similar results to the Canadian system if we mandate and facilitated AE reporting by providers, clinics, and hospitals (ESP-VAERS) and if we use the Affordable Care Act mandated Electronic Health Records within a linked and central public health research access system.
I think this Ontario study is one of the most thoughtful studies on myocarditis/pericarditis to date. Thank you for discussing it.
One way of reducing myocarditis from these mRNA and adenovirus vector COVID-19 vaccines would be to minimise the amount of vaccine which goes straight into circulation, rather than staying in the muscle as it is supposed to. This can be achieved to a significant degree by aspirating the needle, which is standard procedure with most intramuscular injections. This involves discarding vaccine and the syringe and needle if the aspiration results in blood being drawn back into the syringe. Links to the research concerning this is in a comment I wrote in:
https://vinayprasadmdmph.substack.com/p/which-causes-more-myocarditis-covid19/comments
Another way of reducing the myocarditis from these vaccines is to use them for only a subset of the population - those who are still likely to benefit from them, despite the non-trivial risks, due to characteristics of each such person which cannot be changed. These include the well-known comorbidities of obesity, hypertension, diabetes and using immunosuppressant drugs.
This would be relatively easy to do if the risks most people face from COVID-19 infection were greatly lowered by boosting their 25-hydroxyvitamin D levels to the 50ng/ml or more which their immune system needs to function properly. Without proper vitamin D3 supplementation, or recent extensive UV-B skin exposure, most people have only 5 to 10ng/ml 25-hydroxyvitamin D - so their innate and adaptive immune responses to pathogens are much weaker than they should be, and they are at a higher risk of the wildly dysregulated inflammatory immune responses which drive severe COVID-19.
This, combined with easy and immediate access to multiple early treatments is a much better way of protecting everyone from COVID-19, partly due to the direct reduction in severity and risk of hospitalisation, but mainly because average viral shedding is greatly reduced, reducing transmission and so reducing R0 below 1.0 and ending pandemic spread.
Still, with good 25-hydroxyvitmain D levels and other nutritional improvements and early treatment, some people with comorbidities - mainly those over 50 years - would benefit on average from vaccination to reduce the risk of severe disease.
The most important step towards protecting everyone from COVID-19 and other diseases is to boost 25-hydroxyvitamin D levels to at least 50ng/ml, with vitamin D3 supplement at about 0.125mg 5000IU / day for 70kg bodyweight. This takes a few months, so for early treatment ~1mg single dose oral calcifediol (pharma name for 25-hydroxvyvitamin D) will raise it in 4 hours, which is faster than bolus, such as 300,000IU D3, due to D3's need to be hydroxylated in the liver Without such supplementation most people have only 5 to 25ng/ml, 1/10th to 1/2 of the the 50ng/ml their immune system needs to function properly. Please see the research articles cited at: "What every MD, immunologist, virologist and epidemiologist should know about vitamin D and the immune system: https://vitamindstopscovid.info/05-mds/ .
It is all very interesting to speculate on the finer points of choice of vaccine and how to schedule the injections. Vaccines are glamorous, specifically directed, expensive, profitable, medically administered, solutions to a problem - and many people are attracted by these qualities.
However, their narrowness makes them of very little lasting value against rapidly proliferating variants (Omicron has already split into two mutationally distinct lineages: https://github.com/cov-lineages/pango-designation/issues/361). They take months to administer to entire populations in the very best of circumstances. They weaken immune responses for a while after the injection and they do nothing to solve the fundamental problem of weak and overly inflammatory immune responses due to inadequate 25-hydroxyvitamin D.
Vitamin D supplementation reduces the excessive inflammation which is the reason many people take immunosuppressant drugs, such as prednisone and dexamethasone. So the use of these pernicious drugs could be minimised or eliminated with vitamin D supplementation. These drugs do much more than reduce inflammatory responses. They reduce innate and adaptive responses too - and boost glucose levels.
It should be common-sense to get everyone's 25-hydroxyvitamin D levels up to 50ng/ml, but it is not so common among people who can't believe that anything so simple could be true. This common disbelief blinds these people to a proper understanding of health, and condemns many people to ill-health due to the avoidance of simple, good, approaches in favour of supposedly more sophisticated approaches which are more expensive, more dangerous and/or less effective.
I just am not in a position to listen to podcasts. Some of us never do, much as we regret hearing your sibilant tones. It would be good if you would put out a transcript (auto-transcription is imperfect but OK) of these things when you post them. At a minimum, a link to the preprint in the text would make it possible to at least understand the comments. Thanks.
Thanks, as always, for your thoughts and research. I wonder... how many cases of myocarditis are going unreported due to the tribalism of all-or-nothing vaccines? I personally know of two women, one 45 - slightly overweight, the other 63 with non small cell lung cancer and healthy weight, both with the Pfizer vaccine that experienced heart palpitations and abnormal heart rhythm after receiving their vaccines. I am not a doctor and no myocarditis was ever diagnosed with these women but I can't help but wonder if doctors and patients alike are finding other reasons for heart issues, rather than looking into whether or not the vaccine could have played a role. I wish there was a way to dig into this more.
One of your best posts yet, Vinay. Thank you and I hope a few people who might be in a position to act in response to this will read it. Our whole approach to this pandemic leaves me more and more hopeless regarding where we go from here. I love the information you give us in this and in other places but fear you are preaching to the choir. What can we as individuals do? The next election cycle is too far off.
A few key points from this paper: 1) the public health system in Ontario has committed to robust surveillance, standardization of reporting and treatment of myocarditis/pericarditis. Their focus on physician and hospital or clinic reporting to their vaccine safety surveillance system alone appears to be yielding better epidemiology data than that of the US. Provider reporting of adverse events is mandated in Canada, but not in the US. Layered on top of voluntary reporting the Canadian provincial public health surveillance data is likely far more accurate than VAERS or VSD. 2) The studies expected rates of myocarditis/pericarditis were based upon its own population rates by using data obtained from linked health administrative datalinks from between 2015-2019 and not derived from a meta-analysis of the existing literature on expected rates (BTW there is no adequate expected rate for myocarditis in the literature as per a CDC recent pre-print on AEs: https://www.medrxiv.org/content/10.1101/2021.08.31.21262919v1). The Ontario author's use of this database allowed for demographic specific expected rates to be calculated. 3) The comparison of heterologous and dose interval is very interesting. It is a good example of the use of adversomics within vaccinology. I would like to see what a lower dose (50mcg) of Moderna as a second dose would do to myocarditis rates . 4) Sadly, this study is yet another example of how the US (CDC Vaccine surveillance system) leads from behind in monitoring vaccine safety. No wonder there is vaccine hesitancy.
Unfortunately, at present, this type of study would be very difficult to do in the US due to the lack of regular VAERS reporting by providers, a patchwork of health information databases with their own limitations like VSD and an overall outdated system. We could achieve similar results to the Canadian system if we mandate and facilitated AE reporting by providers, clinics, and hospitals (ESP-VAERS) and if we use the Affordable Care Act mandated Electronic Health Records within a linked and central public health research access system.
I think this Ontario study is one of the most thoughtful studies on myocarditis/pericarditis to date. Thank you for discussing it.