This episode will make a great companion for a long drive.
Dr. Seheult shares his first-hand experience treating patients with COVID-19 in the intensive care unit. Since the emergence of the Delta variant he has treated more people in their 30s without comorbidities most of whom are unvaccinated. As older adults get vaccinated, monthly hospitalization rates are trending younger. Some people worry about vaccine side effects, but studies show that the relative risk of these same outcomes is greater if the person is infected with SARS-CoV-2. In some states with low vaccination rates, critical care units are overwhelmed and health care is being rationed. Dr. Seheult states that a young person facing the Delta variant is more likely to be infected and more likely to be hospitalized than with a prior variant. In this clip, Dr. Roger Seheult shares his experience caring for young unvaccinated COVID-19 patients in the hospital.
Kyle: I've heard some people say that COVID vaccines aren't necessary for relatively young people who are in good shape and don't have medical problems. What are your thoughts on this?
Dr. Seheult: Well, Kyle, as you may know, I'm a critical care intensivist, and I take care of patients in the hospital. I work in a one ICU hospital in a one hospital town. So, anything bad that happens, it comes to me in the intensive care unit. I'm the one that is there when they put the endotracheal tube in. I put the chest tubes in, the central lines, and holding the patient's hands. And so for me, in the last couple of weeks, this has become really personal for me because what I've seen in the last couple of weeks in our hospital is like nothing else that I've seen even with the prior wave going back to February and January of this year. So, what is it that I'm seeing? I'm seeing patients in their 30s, patients even in their 20s coming in with very few comorbidities, maybe just a little bit overweight, and they are ending up on the ventilator. I've seen fathers in their 60s coming in crying, asking me to do everything that we can for their sons who are in their 30s, newly married with small children. We didn't see that back in February. And so, to get to the root of your question, is what do people who are younger have to be concerned about? I think it's a very good question because all of the things that we have learned about COVID-19 in the past is now being rewritten by the Delta variant. So, if you look at some of this data, this is data from Virginia, and you can see here on the left hand side of the screen in January is a graph that we're all very familiar with. This is basically the monthly hospitalization rate by age group. And what you can see there is on the right side of that first graph is it's a very high number for the elderly, and it goes down very precipitously for the young. And that's because the young were not being hospitalized. But as we go across this screen, you can see here that when we end up in August, a very ominous sign is occurring. What we're seeing is that the younger population are being hospitalized at almost the same rate. Maybe, instead of, you know, a 20th or a 10th, it's maybe half of the rate of the elderly. And so why is that happening? Well, we know that there's a very high vaccination rate in the elderly and a relatively low vaccination rate in the young. Even look at the...you can barely see it, but the yellow boxes are describing what's happening to pediatric cases. Pediatric cases, of course, those less than 12 years of age who can't get vaccinated are skyrocketing. And so this is the concern that I have.
We look at some of these other issues. For instance, this idea of the 99% survival rate. That's something that they say. Hey, 99% survival, and I really don't need to be concerned about it. So if you look at this data, and we compare it to something that we know very well like the flu virus, you'll see here that the hospitalization rate for the flu virus in young people is about 0.01%. If you look at the pre-Delta COVID-19 data, it's about 0.2%. It's almost 20-fold higher for COVID-19 in the young than it is for the flu. Now, if you think about the 1% number, you'll start to see very clearly that if you start to think about there's only the 1% that are going to be affected, that won't affect me, what we are seeing right now in this country, especially in states like Florida and Texas and specifically Idaho, is an overwhelming of the critical care hospital health care delivery system. Think about this. The population of the United States is 331 million people. If just 1% are going to die, that's 3.3 million people, and that's just the people who are dying. Let's talk about the people who are sick and need to be hospitalized because they can't breathe because of oxygenation. We only have under a million acute care beds in the United States, and so as a result of that, you are going to quickly overwhelm the healthcare system if you have a problem with an overwhelming infection. Let's take the state of Idaho. It has a 39.7% fully vaccinated rate, and what we're seeing there, as of yesterday, the governor has declared that hospitals now because they're overwhelmed are going to start to deliver basically rationed care. You should not expect the same standards of care that you're used to expecting in the health care delivery system because they're just not able to give it. Let me give you some specific examples. Instead of having one intensive care nurse for two patients, it's now going to be one intensive care nurse for six patients with some help from non-ICU nurses. Because they're overwhelmed, you cannot transfer patients to higher level of care for things that they need to get done if they have very advanced cancers, for instance, because those hospitals don't have room. If you need elective surgery, their elective surgeries are being canceled. Traumas are still happening. Babies are still being born. These are the problems that we're having in a situation where you may think that because you're healthy and strong and young, you're not going to be affected. But if you were to get into a car accident, or you wanted...know somebody that wants to deliver a baby and has a complication, it's going to be difficult for those things to happen. And so this is the thing that's occurring. And going back to my experience in the last couple of weeks, every single one of those patients in the hospital that were there in their 30s, their 40s were not vaccinated. And it's based on information that's coming out that you're making decisions based on whether or not you should get the vaccine because you hear about side effects, or you hear about things, for instance, about myocarditis. Well, here's an article from the new England journal of medicine, peer reviewed published September 16th, 2001 looking at the Israeli data with almost a million subjects in each arm. So what we have here plotted in yellow is the risk difference per a hundred thousand persons infected with SARS-CoV-2, and in blue is the risk difference per hundred thousand persons who received the Pfizer BioNTech vaccine. First, let's take a look at SARS-CoV-2, or COVID-19. We see big risks here for acute kidney injury, for arrhythmia, for deep venous thrombosis, for pulmonary embolism, and for myocardial infarction. And again, notice that there is a small signal here in terms of COVID-19 for myocarditis and pericarditis. Clearly, there is a small signal there with post vaccination myocarditis, and pericarditis, but actually the data here on these from Israel is showing that it's more likely to get myocarditis and pericarditis post SARS-CoV-2 infection. But in terms of the relative risks for the vaccine, which is in blue, notice that the biggest one here at 78 is lymphadenopathy, which is a normal response to the vaccine. Now there's been a couple of papers that are in the peer review process, but have been published to a medical archive server. And again, the peer review process is where the paper is submitted to experts in the field that review it looking for possible bias or things that were not taken into consideration. And this pre-print non-peer reviewed article using electronic records in the United States, also agreed with the Israeli data that was published in the new England journal of medicine and came to the conclusion that young males infected with the virus are up to six times more likely to develop myocarditis as those who received the vaccine. Another pre-print, which is still currently in the process of being peer reviewed, made headlines in a number of papers in the UK and also in the United States. And it showed the opposite that the incidents of post-vaccine myocarditis had a higher incidents than hospitalization in pediatric patients from COVID-19. However, the article glean most of its data from the VAERS, which as you know, is a reporting system and raw data based on reports that could be made by anyone and often contain incomplete descriptions and chart notes that require additional investigation, removal of confounding variables and comparison to background levels of medical problems to become useful. Now, we'll talk about the VAERS here just a bit, but as you'll see various data, doesn't allow you to really conclude anything. VAERS can use to generate hypotheses, but not to test them directly. So in summary, I think it's good for researchers to generate hypothesis from VAERS data, but it's a problem when newspapers turn hypotheses of observational data that haven't been peer reviewed yet and turn them into headlines. So it'll be interesting to see what issues the peer review process points out in these papers and if they go on to be published. So to answer your question Kyle it's, it's, there's a lot of information there. Um, but for a young person now, today facing the Delta variant and maybe future variants, it's not the same type of virus that we were dealing with back earlier in 2021. Yes. Now they are more susceptible to getting the infection and now the risk of them being hospitalized is higher.
An infectious disease caused by the novel coronavirus SARS-CoV-2. COVID-19, or coronavirus disease 2019, was first identified in Wuhan, China, in late 2019. The disease manifests primarily as a lower respiratory illness, but it can affect multiple organ systems, including the cardiovascular, neurological, gastrointestinal, and renal systems. Symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste. Some infected persons, especially children, are asymptomatic. Severe complications of COVID-19 include pneumonia, sepsis, acute respiratory distress syndrome, kidney failure, multiple organ dysfunction syndrome, and cytokine storm. Treatments currently involve symptom management and supportive care. Mortality varies by country and region, but approximately 6 percent of people living in the United States who are diagnosed with COVID-19 expire.[1] 1
An essential mineral present in many foods. Iron participates in many physiological functions and is a critical component of hemoglobin. Iron deficiency can cause anemia, fatigue, shortness of breath, and heart arrhythmias.
A chemical that causes Parkinson's disease-like symptoms. MPTP undergoes enzymatic modification in the brain to form MPP+, a neurotoxic compound that interrupts the electron transport system of dopaminergic neurons. MPTP is chemically related to rotenone and paraquat, pesticides that can produce parkinsonian features in animals.
A study in which people are randomly allocated to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control may be a standard practice, a placebo, or no intervention at all.
The virus that causes severe acute respiratory syndrome, or SARS. First identified in China in 2002, SARS-CoV-2 is a type of coronavirus. It was responsible for an epidemic that killed nearly 800 people worldwide.
The virus that causes COVID-19. SARS-CoV-2 is one of seven coronaviruses known to infect humans. Others include SARS-CoV-1 (which causes severe acute respiratory syndrome, or SARS) and MERS-CoV (which causes Middle East respiratory syndrome, or MERS). SARS-CoV2 exploits the angiotensin-converting enzyme 2, or ACE2, receptor to gain entry into cells. The ACE2 receptor is widely distributed among the body's tissues but is particularly abundant in lung alveolar epithelial cells and small intestine enterocytes. SARS-CoV-2 binds to a cell's ACE2 receptor and injects its genetic material (RNA) into the cytosol. Once inside, the viral RNA molecules are translated to produce RNA-dependent RNA polymerase, also known as replicase, the enzyme critical for the reproduction of RNA viruses. The viral RNA is then packaged into infective virion particles and released from the cell to infect neighboring cells.
An antibody that plays key roles in immunity. Secretory IgA is the most abundant antibody in the mucosal immune system, accounting for nearly 20 percent of serum immunoglobulin. It is crucial in protecting the intestinal epithelium from toxins and pathogenic microorganisms.
A condition in which a clot forms in a blood vessel. Thrombosis can occur in veins or arteries and can cause damage to the tissues supplied by the affected vessel. Symptoms include pain, swelling, chest pain, numbness or weakness, and altered mental state.
The highest level of intake of a given nutrient likely to pose no adverse health effects for nearly all healthy people. As intake increases above the upper intake level, the risk of adverse effects increases.
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