Hello, welcome to my channel Medicine with Dr. Moran. The pandemic has now lasted two years
and a lot has been going on in terms of medical studies public health and a lot of other things.
Now what are the top 10 things that we could have done better with the current pandemic?
These are not listed in order of importance and depending on each person's situation
certain things will matter more than others. There are bookmarks for your convenience. There are
other things too but I've not mentioned them for obvious reasons. Let's go! Not allowing hospital
visits during the pandemic. Preventing family members or visitors from going to the hospital
to see their loved ones is very sad. Not being allowed to be there and comfort a sick or dying
loved one is very traumatic both for the patient and the family preventing loved ones from being
together at such times is detrimental and it does not help with the healing process. The power of
social support at the time of hospitalization is therapeutic. We physicians see this all the time.
An honorable mention has to go to harassment censorship of Covid researchers and physicians.
A recent survey of 510 Covid-19 researchers in the medical journal Science revealed that 385
reported at least one kind of harassment. Many of the researchers got personal insults, attacks
on their professional capabilities, as well as allegations of dishonesty, or corruption to name
a few. Attacks on social media were frequent and sad to see. There are even protests at hospitals
and this is not the way to treat health care workers or people scientists physicians people
like myself who are just trying to get across what's important in this pandemic. Protecting the
elderly in nursing and long-term care homes Proper mechanisms to protect the residents of these homes
basically to limit exposure to the virus weren't in place in many countries. Rapid testing for
health care workers at these homes would have been very beneficial. Also putting Covid patients into
these homes while still infectious was disastrous. Preventing spread in the homes is important due to
the extra vulnerability of the residents also allowing residents when possible to stay with
family members and not be at extra risk in the nursing homes would have been helpful.
There were nursing homes that didn't keep sick people separate from other residents. Number
three, not allowing vaccine choice Many countries only have one kind of vaccination that was an MRNA
vaccine. While this type of vaccine is very good at preventing severe disease there are many people
who for different reasons did not want to take this kind of vaccine but, they still wanted to
be vaccinated. Remember people like choice. My patients always like choice and in most aspects
of medicine there are different choices that we as physicians can present to patients with risks
and benefits so that the individual patient can choose a solution that best fits their need. Many
patients have wanted more traditional vaccines such as Novavax, Covaxin, or even AstraZeneca or
J & J, but those have not always been available for access in certain countries. Number four
Only instructing people to stay at home. Shelter-in-place instructions could have been much
better and during times of restrictions public health messaging should have been very pro-health
explaining to people that staying in your home can lead to eating more eating the wrong kind of
foods and of course leading to a lack of exercise. Many of my patients joked about their Covid-19 the
extra 19 pounds that they put on with the pandemic but it's not funny it obviously will lead to
things like high blood pressure diabetes and generally will reduce someone's health
and possibly even mobility depending on how much weight you put on. There were public health
broadcasts every day but I've never seen one where anyone taught people how to improve their immune
system and their overall health. They never even suggested things like exercise and eating healthy.
I think those were things that were important but were missed. Natural immunity not being accepted
Many countries ignored the protection of natural immunity for those who were fortunate enough to
survive the illness. Re-infections have been very uncommon and generally much less severe through
Delta. With Omicron things have changed there have been more re-infection in recovery patients
but we're also seeing a lot of infections in the vaccinated group as well. I've talked extensively
in a number of videos on this topic. Now in some countries healthcare workers were fired
leading to shortages in the pool of workers by not giving some credit to natural immunity.
Masking Again we're two years into the pandemic and there's only been two randomized masking
trials. I've talked about these on the channel in previous videos. Just to recap briefly one
study was in Denmark and it didn't show a statistically significant benefit of surgical
masks in preventing Covid. The numbers were 2.1% versus 1.8% although in fairness it may not have
had enough patients and had the power to detect those two numbers, a difference in those numbers.
Now the other study was from Bangladesh and they had over 300,000 participants and this did not
demonstrate any benefit of a three-ply cloth mask not the usual one you see on the street. It did
show an 11% reduction from a surgical mask which was statistically significant. Now we don't know
the benefits of masking young children if any in North America kids 2 and above were masked but
the WHO did not recommend masking for kids under the age of six. Better quality medical research
While there has been an enormous amount of high quality research some has been disappointing.
On the positive side the UK Recovery Trial has brought us four different medications which we
now use to treat Covid. The Together Trial which was a Canadian-Brazilian platform-based randomized
control trial using repurposed drugs found that Fluvoxamine was helpful as I previously reported.
Now these kind of randomized double-blinded trials are the best kind of medical research
where we randomly allocate patients who meet entry criteria to either the active intervention or drug
versus no intervention or placebo and we enroll enough patients so that we can be confident
whether the intervention is helpful or not. Now the Together Trial did look at Ivermectin in a
randomized fashion and failed to show benefit from Ivermectin. This is unpublished data still. I've
talked about many observational studies on this channel which have serious limitations.
Typically they're looking at two groups that they're trying to compare and the two groups
are often not the same and so the results at the end of the study can't be believed.
Many studies have significant bias within them and it's a key to try to spot that
and it's something that we've seen during this pandemic these sorts of bias trials
for example. Recently there were two observational Ivermectin studies that had significant
limitations because the group of people getting Ivermectin were very different from the group that
didn't receive Ivermectin. Thus the conclusions in these two recent studies or papers that I looked
at weren't worth reading and they're obviously not practice changing. Quite a few preprints
have been questioned as to their validity also. The Surgisphere database early in the pandemic was utilized in positive Ivermectin studies and that database
was questioned and was ultimately found to be inaccurate. Several peer-reviewed studies
which were published in well-respected medical journals were actually subsequently retracted.
Now this is why medical research needs to be critically appraised and not just
accepted at face value like it has been during this pandemic. It then gets picked up by the
media or the internet and suddenly it's accepted as fact even though the studies not practice
changing. Now there's still some trials two years into the pandemic that are yet to be completed
including a number of Ivermectin studies. Many on social media with large followings continue to
promote Ivermectin and state that it's the biggest pandemic mistake that this drug has not been used
more widely. Now the overwhelming majority of doctors do not prescribe this and in fact many
would lose their license if they were to. Frankly the best research with the least amount of bias
has shown no benefit with Ivermectin and we will know soon as there are about to be released some
randomized studies on this medication. I do think it's highly unlikely that Ivermectin
will be shown to have any benefit and that's why I've not talked about this on my channel.
Now remember when you don't know whether a medication is going to work in medicine what you
need to do study it quickly in a randomized trial rather than just prescribe it. We need answers and
we'd answers quickly and that's something that was a mistake in this pandemic. Next
number eight Hoarding vaccines and letting doses of vaccines expire. Many first world countries
have had large amounts of vaccines on hand so that people can get three or even four shots
before many people at risk in other countries even have a chance to get their first vaccination.
The more people around the world who are protected the less variants we're going to see and the less
global deaths. Many doses of vaccines have expired without being sent to other countries in need.
If you can shop online and get delivery within 24 hours of what you've just paid for why can't
these doses be sent to countries in need within days? Not spacing vaccine doses to an optimal
time frame Some countries including Canada and the UK tried to vaccinate as many people in high-risk
categories with a single dose before starting over again with the second dose and they did this when
vaccine quantities were at a very low amount. Now the first dose provided just over 80% protection
against infection and the second brought it up to 95% Other countries like the U.S. did not do this
and they went with a three week or a four week spacing between their two doses of MRNA vaccines.
Now spacing the dose out further would have saved many more lives because spacing out the vaccine
makes the vaccine more effective and lowers the side effect profile. I've talked extensively on
the channel about this. An eight-week interval between the first and second injections appears
to be optimal. It was also shown in Canada to reduce the uncommon side effect of Myocarditis.
Myocarditis was more common after the second dose and more common when the Moderna MRNA vaccine was
given and it's on the order of 1 in 2,500 in young males after their second Moderna dose.
Many countries have not been using Moderna for people under 30 because of that reason.
Recently I must say the CDC in the U.S. did change their guidance on vaccine intervals
to bring it more in line with the rest of the world. and the number one mistake during this
pandemic is to simply get healthy or if you are stay healthy. People in good health are
much more likely to successfully survive Covid-19 with fewer symptoms and less duration of illness.
It's a time where people really should have been trying to optimize their health and reverse their
comorbidities if they have any. I have had a number of my patients who have successfully lost
large amounts of weight and improved their blood pressure, and sugar control,
and cholesterol during this time. Even with the restrictions people should have tried to get
three to five hours of modern intensity exercise a week. For some people this can be done inside
even if it's in the winter and 30 below or you can go outside by simply walking or doing other
activities. People's health has gone down due to the pandemic with weight gain, reduced glucose,
and poor blood pressure control amongst other things. Many people have struggled with their
mental health that has been one of the most problematic parts of the whole pandemic. I think
an increasing number of people have had a lot of these long Covid symptoms but actually have never
had Covid and what I mean by that is that people who have never had Covid often feel fatigued,
depressed, find difficult to concentrate, have brain fog, and so on and that's simply because
of the pandemic. It's been a very challenging time for many people. Thanks for joining me
today on Medicine with Dr. Moran. I'm Dr. Keith Moran and remember get healthy and stay healthy.