COVID-19 Q/A: Roger Seheult, MD & John Campbell, RN, PhD
Roger Seheult, MD and John Campbell, RN, PhD joined forces to answer your questions about COVID-19 prevention, treatment, future outcomes, and more.
In our recent Q & A, MedCram Co-Founder and Producer, Kyle Allred, moderated a hearty conversation with Dr. Campbell and MedCram’s own Professor Seheult. Between the two gentlemen, their YouTube updates on COVID-19 (and expansive libraries of videos and lectures on the whole spectrum of medical topics) have provided abundant, invaluable information to fellow medical professionals and the general population throughout the pandemic.
In this conversation, they look back on the pandemic thus far and talk about lessons learned, how to navigate information from research and the media, current national guidelines and available treatments, vitamin D, vaccines, and future developments.
Check out the video interview here, or read the full transcript below.
You can learn more about Dr. Campbell and watch more of his videos here.
Introducing Dr. Seheult and Dr. Campbell
Kyle Allred: Welcome! My name is Kyle Allred. I’m excited to be here with Dr. John Campbell and Dr. Roger Seheult. Both are outstanding medical educators who have worked tremendously hard over the past year to make sense of the relentless amount of COVID-19 information that has evolved over the past year, and both have shared their perspective with a large audience. You can read more about both of them in the video description below, and iIm excited to hear both of your perspectives on a wide range of COVID-19 related questions. Thank you to everyone who posted questions that we could use for this Q & A event, and before we get started I want to give you both a chance to say hello. So I’ll start with you Dr. Seheult in southern California. Good morning.
Dr. Seheult: Good morning, Kyle, and really a wonderful, big, good morning to Dr. John Campbell for joining us. John, it’s really something to have you on. I’ve been watching for a long time. You’ve been prolific. You’ve been one of the clear voices on the internet in terms of describing and keeping pace with COVID-19, so really, really privileged to be with you.
Dr. Campbell: And with you. I’ve been watching you for a long long time now, Roger. It’s just amazing to be able to talk in live time, and it’s good afternoon from me, and I’m seriously impressed that you guys must have been up at six o’clock this morning, had your breakfast, got dressed, brushed your teeth, and ready to go for seven o’clock. It’s impressive, so thank you.
Kyle: Dr. Seheult never sleeps. I’ve learned that by now working with him.
Dr. Campbell: I suspected this, yeah.
A Look Back at the Pandemic
Kyle: Well, I want to get started with a broad question for both of you, and Dr. Campbell, I’ll start with you on this one. As we’re into 2021 and we look back on 2020, what is one or two lessons that you hope that we can learn as a society from this pandemic?
Dr. Campbell: You know, I think one of the main issues all the way through this is that people have been reacting to circumstances as they came along rather than anticipating, rather than being proactive, and I think we’ve seen this in the level of international organizations. They didn’t really compute this concept that there could be a pandemic, because it hasn’t happened in people’s living experience. They kind of thought it couldn’t happen, whereas of course we know it’s happened before.
We know pandemics have come and gone throughout human history. 1918 pandemic as a big example, you know. The majority of the population of the Americas wiped out by smallpox and other communicable diseases with the arrival of Europeans, but people just didn’t seem to be able to conceptualize it, so they couldn’t think ahead.
So you know, even people like the World Health Organization, the government of the United States, the government of the United Kingdom, it seems to me that they will be reacting to things. So I think the big lesson is we need to anticipate potential problems because, you know, as well as the field of disease, you know that there could well be another pandemic, but there’s so many other problems for us as individual humans, groups of humans, and humanity, and I really just feel we need to be proactive, anticipate things, and not just wait for things to go wrong and then react to them, as really has been the pattern that I’ve seen over the past year in terms of people reacting to this pandemic.
Kyle: Excellent. Yeah, Dr. Seheult, what are your thoughts?
Dr. Seheult: Oh I totally agree with John; that is a very, very deep and profound thought. I mean, I also noticed that as well.
The other thought I had was just we could think, in the theoretical, we can think about, oh we need a vaccine, oh we need to do this, so we need to do that, but a lot of what has been left out of that equation, I think, is bringing people along and getting them to buy into those sorts of things.
So for instance, we have had a most amazing year in terms of vaccine development, probably we’ve never seen anything like this in terms of how rapidly we got so many different candidates to to market, but we see the problem in terms of the the misinformation out there and in terms of the thoughts in the population about whether or not they would want to actually have the vaccine.
You know, there’s been stories where these hospitals have received the vaccine. They finally have it and yet 50 sometimes even 60 of the healthcare workers that are targeted for vaccination refuse to even have the vaccination, and I think it’s because of misinformation. I think that’s where people like John and myself and a number of other points of light out there are really vital to educate in layman’s terms what it is that’s going on, so they can buy into this. The science is there but if people don’t buy into it, it’s not going to work.
Dr. Campbell: I agree completely. We’ve got to take people along with us, otherwise we’re just talking to ourselves and if people aren’t buying into wearing masks, vaccination, the appropriate behavior, then we’re not getting anywhere. It’s an excellent point.
Tips for Navigating COVID-19 Information & Media
Kyle: Absolutely, and speaking of sources of information and potential misinformation, both of you do so much educating and and put out a lot of informative videos. How do you decide what information sources are credible, and what’s your process for receiving new information about COVID-19? And Dr. Seheult, I’ll start with you on this one.
Dr. Seheult: Yeah, well, you know we’ve seen this in in the media, unfortunately way back in the days of Walter Cronkite — that’s a TV newscaster here in the United States — it was all about the questions of journalists — the when, where, who, what, all of that sort of stuff. That’s kind of gone away and we now have narrative journalism, where there’s a certain narrative.
They already know what the story is and they go out and find these these pieces to fit the narrative, and you know when we get into a pandemic like this where certainly a virus is at the center of that pandemic, and science describes what viruses do and the consequences of that, where do you go for that? I mean, you look on the network televisions here at least the United States and what you see is a drive-by type of snapshot and without any explanation, and so that just doesn’t do it for the type of information that we need.
So where do you go? Well the thing that tells you the who, when, where, and all of that in scientific journalism is papers. It’s scientific papers, and that’s not something that I learned until I went to medical school or, you know, or any kind of professional school. That’s where you learn how to critically appraise a topic, and that’s where you learn about the different levels of evidence with scientific journals.
And what is an observational study versus a randomized controlled trial? And why would one be weighed over the other? That’s not something that’s really intuitive to people in the general population and it’s not something that they necessarily need to learn, but they need to at least get their news sources from people who do understand that and who understand why that’s the case. And so when you’re getting your news sources now on coronavirus pandemic, things of that nature, make sure that it’s evidence-based; make sure the people that are telling you things are showing you the sources and you can read for yourself.
That’s why people like, you know, John and myself like to give the references for why we’re telling you these things. Don’t believe people, don’t believe us, if you want to depend on us to sort of figure out what the science is. You can do that, but also always remember that it’s got to be backed up by science
Kyle: Mhmm. Dr. Campbell.
Dr. Campbell: Absolutely, absolutely. We’re looking for, validity here is the key word .
Isn’t it, you know, what is actually doing, what it purports to do, so we need things to be research- based whenever possible, and as Roger said that the better the quality of that trial, the better — and our gold standard is the randomized, double-blind, control trial if we have it. We don’t always have this, so sometimes we have to use correlations that can tell us where to look.
So it’s knowing a bit about research and and research theory that really helps to take out the good bits of that and to differentiate the good bits from the bad bits, but as well as that, especially as clinicians, what we have to do is follow national guidelines. So in the UK, we have a few organizations that actually give national guidelines, and basically what they say is almost right by definition. Now the people advising on these national guidelines are very good experts and good clinicians, but we have to follow national guidelines as well.
And basically the main content and thrust between the national guidelines in the US and the UK is basically the same, because it’s based on people that understand this basic empirical science, and I think the other thing we do is, it’s surprising if we take the totality of medical knowledge. I don’t know what the latest figure is, but maybe about a quarter of that is research-based.
So you know actually with firm research findings behind that, a lot of it is more intuitive. It’s more of an art process, if you like, but very often what we have to do is look at what makes sense based on our basic understanding of how the body works — the physiology, the structure ,the anatomy, and how it goes wrong, the pathophysiological processes — and then we need to kind of make sense of what we’re doing in terms of those. So basically what we’re saying is we can say what we want as long as we’ve got a rationale, and ideally that rationale should be based on empirical, research-based evidence.
It can also be based on national guidelines, which is essentially the consensus of evidence, expert evidence, but also we need to base it on our understanding of the way the body works and the way the body goes wrong and the reassuring thing is if those three types of evidence agree, it’s really quite nice. So it gets a bit confusing when you might get uh an underpinning physiological rationale which would imply one thing and a research based paper which implies something else, but normally we find with time that the amount of harmony does grow, and it does increase.
So I think that they’re the three things, but we have to make sure it’s based on that. And of course, particularly, as people that, I suppose, popularize this, we need to give the evidence. We need to be transparent as to where we are getting the evidence from, so I don’t want anyone to listen to my opinion. I can’t give anything worse, you know, but if I’m someone who is filtering expert opinion, collective expert opinion, scientific rationales, and research papers and condensing those, that’s a completely different thing. But I do believe, as Roger said, the onus is on us to give the evidence and to make the evidence available.
Understanding the Current Research
Kyle: Both of you mentioned to some degree following, you know, national guidelines, favoring solid evidence, randomized, placebo-controlled trials when available you know. In a perfect world, of course, we’d have a randomized, placebo-controlled trial for everything and we just know what the best interventions are.
Of course, we’re in the midst of a pandemic and randomized controlled trials take time. They’re expensive, so in light of that, there has been an increase towards getting information from preprints, you know articles that haven’t been peer reviewed and have been posted on servers and very valuable information there, but also the potential downside that these aren’t peer-reviewed. What are your thoughts on the role of a pre-print server, you know pre-publication servers, for a way to access information for not only scientists and educators but also just the general public? And I’ll start with you, Dr. Seheult, on this question.
Dr. Seheult: Yeah, thanks, Kyle. So when it’s not peer-reviewed, you’re not getting as much input onto the possibilities of where the study could have gone wrong, where there could have been confounders, and so sometimes many heads are better — well, most of the time — many heads are better than one at picking that out and saying “this is what the study shows, but it may be showing this for a reason other than what the authors thought.”
You know, we live in echo chambers. We all do, and we all think about things and the same ideas. What’s good to do is get outside. People who are not, who haven’t been looking at the same thing for a year or two to say, you know what, “this makes sense, but have you thought about this? Have you thought about that?” And that’s really why the peer review process is so important. So when you don’t have the peer review process you lose out on that and there could be situations where you’re seeing something that is, quote, “published” or at least pre-printed that’s not published, that’s giving you an idea that really hasn’t gone through that filter. So realize that when you haven’t gone through the filter, you may be getting stuff that may be misleading or incorrect.
Dr. Campbell: No I agree completely. I mean, we have the expression, “sometimes you can’t see the wood through the trees.” When you’re actually in something, very often you can miss the obvious, and we have another principle here. It’s sometimes called the “tea lady principle,” where — there’s no degradation of tea ladies — but what it means is you could have an expert team who are working away on something, and they’re so into it, and they’re not seeing the totality of the picture. Then someone comes in with a cup of tea who’s not connected with the project and you say to them, “well, what do you think?” And they say, “well, why don’t you turn it upside down? You know, or something, you know, something basic like that, and they do that and then the experts say, “oh yeah, maybe that works.”
So, you know, we really need, as Roger said, that the more heads that are involved in this the better, and that to me, that involves expert heads of course, which is what peer review does. But it also it involves this kind of common sense review, which is important as well. But for a pre-print paper, we do need these at the moment, because things are changing so quickly and we’ve got to remember that human suffering and death is the consequence of doing nothing very often.
But there again we have to have good rationales for our interventions. So what what I tend to do, looking at a pre-print paper, is very often it will have been internally reviewed by a particular institution, and if that institution is of good quality, then I tend to think, “well that this peer review is not peer reviewed yet, not yet, but it’s been reviewed internally by the institution, that therefore it’s probably not too bad.” But as well as that, you’ve just got to put your own interpretation on it. Does it make sense to you? Does this seem to be following the basic science? Because, you know, basic scientific principles are contradicted, then there’s probably something wrong there. You know, if a paper comes out showing that homeopathy is an effective treatment, I would think, “well, I’m not sure that’s consistent with the basic science” and then that would be a problem.
Strategies for Treating Patients
Dr. Seheult: Yeah, I was just going to add to that too. I mean, look at the situation that we’re in right now. We’ve got, the FDA is approving things for COVID-19 on an emergency-use authorization basis and that tells you everything that you need to know. They’re willing to lower that bar.
For instance, convalescent plasma was approved without a control group and we have that today. And so the question is — and obviously that wasn’t a randomized, controlled trial. There was no control, so the people in the ivory towers, as we like to call them, they understand this. They understand that there’s a pandemic, and that the risk of not doing something is that people continue to die. But the risk of doing something risky is that more people die as well, and so there has to be struck a very fine balance about, how much evidence are you willing — how much evidence integrity are you willing to let go to get something out there faster, so that it can help more people?
Dr. Campbell: Yeah, any treatment is always a risk-benefit analysis, isn’t it? Any treatment that’s going to work or any surgery that’s going to work has got the possibility of side effects, because it’s having a physiological stroke, anatomical intervention on the human body, so there’s always that, always that risk of side effects. But while there’s that risk benefit analysis, I always feel very, very strongly that you know that the first principle that Hippocrates, way back in ancient Greece, you know, first do no harm, so if someone comes to me and this has happened, many, many times people have come to me for help, and I’ve been unable to help, and that’s a pity, but that happens. But if someone comes to me and I do harm, then that is really quite unconscionable, and I don’t know about — I mean, it’s not the sort of thing you might talk about publicly, but I could give you some instances where people have actually been worse off because I’ve treated it, and that is a really bad feeling, so we have to balance that the risk-benefit analysis, but we really don’t want to to cause someone harm by a clinical intervention
Dr. Seheult: Right, exactly. I’m reminded of a professor of mine in oncology saying, “you know, Roger, that they used to say, ‘don’t just stand there, do something.’ Well sometimes it’s actually ‘don’t just do something, stand there.'” And that’s the right thing to do.
Dr. Campbell: Yeah, I’ve been in a few first aid situations and as a professional who’s done trauma training in a first aid situation, very often my role as the professional is to stop first aiders doing first aid, you know, because the interventions would be potentially harmful, and you don’t want people moving unconscious patients. First aiders have learned first aid, so they feel you have to do it, and even professionals can be in that situation, as Roger said, very often the best thing to do is nothing or at least wait until we’re sure what to do.
Kyle: I want to ask a quick question on following the advice of our national institutions, whether it’s the CDC or FDA here in the United States. I assume it’s the national health service in the UK.
Dr. Campbell: Yeah, the National Institute for Clinical Excellence, yeah.
Understanding National Guidelines and Recommendations
Kyle: Perfect. This has been an evolving pandemic, and they’ve made recommendations that have been later revised. They’ve been slow to make certain recommendations. How can people have their trust restored or maintained in these organizations? And I’ll start with you, Dr. Campbell.
Dr. Campbell: Yeah, well we need these organizations because we do need a national guideline, because otherwise, you know, we do tend to have anarchy, and we don’t want that. So they’ve introduced these guidelines, and okay they haven’t always always been 100 percent correct, but all we can ever do, I mean when Roger goes into practice clinical medicine, it would be nice if he could use research findings that were found out next year and the year after and the year after, but of course he can’t, you know, can only go by what you know no, and current knowledge is always going to be limited, so as individuals and these groupings, they made decisions based on the best available knowledge now, and really that is all you can do. The key thing is to modify it or to change it or even to repeal it as new knowledge comes along because all we know is what we know now. Insight into the future would be pretty wonderful, but you know we can’t do that yet.
Dr. Seheult: Yeah and I would say this: everybody makes mistakes. That’s not in question. Everybody gets things wrong. What really stands out and makes people different in my mind is the willingness and open-mindedness to accept their mistakes and change their behavior once they find that out, and so to me, seeing seeing the fact that these organizations have changed their stance is not a black mark on their reputation, but rather one that’s showing that the science is working, that the process is working, and that people are updating what their recommendations are.
I think that it’s our job to educate the public. That’s the case when they see things changing. That’s a good sign that means that they’re looking at the science. They’re looking at the data, and they’re coming up with a different plan. Then the worst case scenario would be to get something wrong and be obstinate and not change. That would be the worst case scenario. There’s no way you’re going to ever have perfection and understand perfectly what it is that happens.
I mean, look at the example of estrogen replacement therapy. We had all of the studies that seem to show retrospectively that it was a good idea to replace all women with estrogen replacement after menopause, and with the women’s health study publication in 2002, when it showed that it actually increased the incidence of strokes, we made a reversal. We switched. Now there’s been some, you know, criticism and controversy that maybe if you keep women on estrogen replacement immediately after menopause that you don’t get some of those side effects, and that could be debated, but the point is is that when the studies were done, they made an about face and they changed their behavior.
Once we found out that masks seemed to help the recommendation, initially, was that mass didn’t help, and we made that switch. You know, initially the recommendation was to stay away from steroids, but the UK recovery trial proved that beyond the shadow of a doubt to be the wrong stance, and now dexamethasone is the cornerstone of treatment in COVID-19. So I think that’s good. The fact that things are changing shows that we’re willing to adapt. We’re willing to accept the science.
Dr. Campbell: And the human body is essentially infinitely complicated. We will never understand it. I mean maybe Roger could tell me how consciousness is generated, but I haven’t got a clue you know, and these are such fundamental things that we really don’t know. I mean the complexity inside a single cell is completely beyond comprehension. The way these molecular machines work. So we’re always going to be on a journey. We’re always going to be progressing, but I guess that’s what keeps us on our toes and keeps it interesting.
Current and Potential COVID-19 Treatment Practices
Kyle: Dr. Seheult, you mentioned steroids, dexamethasone, and I want to read a question from a viewer word for word, because I think it’s a great question. “Have there been any new promising treatments besides steroids and Remdesivir?” And the second part of the question is, “are doctors giving vitamin D to inpatients now?” So I’ll turn that over to you Dr. Seheult.
Dr. Seheult: Yeah so I love to talk about vitamin D, especially since we’ve got Dr. Campbell here, John, so I think there’s probably no treatment modality, and John can weigh in on this too, other than dexamethasone. There really hasn’t been any other treatment modality that has been studied as rigorously and has shown that steroids work. I mean there’s been a meta-analysis with different steroids, dexamethasone probably has the best number needed to treat and particularly it works best late in the course, so that’s another thing I think that we’ve found out the most.
Going back to your very first question, what are some of the lessons learned? The lesson that I’ve learned in terms of this is that COVID-19 is a two-part disease. There’s an early course where certain things seem to work very well, and there’s a late course where other things seem to work well, and those things that worked well early don’t work well late.
Dexamethasone is one of those treatments that works very well late in the course, but doesn’t seem to work very well early in the course, and that has to do with what’s going on pathophysiologically very early on. I believe there’s a suppression of the immune system, the innate immune system, suppression of of interferon response, and the key there at the early part of the course is to enhance immunity and to help out the immune system, whereas later in the course when the adaptive immune system kicks in and there’s this cytokine storm and pneumonia, it’s to suppress the immune system. I think dexamethasone is probably one of the best things for that. That’s dexamethasone.
In terms of Remdesivir, you know, that’s kind of a tale of two cities there. We’ve got American randomized controlled trial data that shows that Remdesivir works early in the course, but then you’ve got this WHO trial. What do you do with the data there that shows that really it didn’t help at all? But again that was a little bit more later in the course.
The real question, though, that you asked is there anything else? Vitamin D, I’m not gonna let John talk about vitamin D first since he was one of the first people on this back in February, but I certainly have a lot to say about vitamin D, but I really haven’t seen anything yet emerge other than monoclonal antibodies early in the course, in terms of the data that we have: randomized controlled data. So that would be, I think, another topic that we can talk about is getting people early in the course of the disease who are positive, who are at-risk, have risk factors for progression to get monoclonal antibodies, and there’s a couple of options out there, but I’ve already said a lot. I’ll hand it to John.
Dr. Campbell: Now I agree completely, Roger, the tight, the time criticality of the interventions are clear. I think we did a video recently on the monoclonal antibody therapy that it has to be given early before the virus kind of gets into the cell, so that you know the earlier that is given the better, but we know we know that steroids are massively anti-inflammatory. They will just stop inflammatory processes. They’re very powerful drugs and the immune response is tied in with that inflammatory response, so to give steroids when we have an active viral disease would be contraindicated. Exactly what we don’t want to do and yet and yet, as Roger says, later on in the course where we’re dealing with the bodies, what is essentially an immunological stroke or autoimmune reaction almost to the virus, then it’s essential to damp that down so the alveoli don’t fill up with these these inflammatory fluids, absolutely time critical, and the vitamin D1 of course is very interesting.
Now the Spanish study that both of us have covered — that they gave calcifediol, didn’t they? — which was the active form of vitamin D. So when I take my vitamin D3 tablet, it’s going to take days to a week to convert that into the active form So really the time to be taking vitamin D is when you’re healthy. When someone becomes ill, if we give them vitamin D2 or vitamin D3, that’s not going to build up into the active form, the calcifediol, in the blood for some days or even a week, and by that time the disease can kind of progress.
So, it’s you give them the calcifediol as the Spanish study did — they’re giving the active form already — so again, they’re kind of cutting out a few days of time, so that this time criticality is really vital, and it would be so nice if we had a very broad spectrum, very effective antiviral drugs, but I’m afraid it’s a major failure of human progress so far that we don’t have such a thing. We have them for bacterial infections, for antibiotics, but viruses are complicated and we don’t have good antiviral for some things. We have like herpes simplex, we have antiviral treatments for that, but generic antivirals I’m afraid we are still struggling on towards that and we’re not there yet by any means. But the monoclonal antibodies are very promising.
Kyle: A lot of people have asked about Ivermectin and wondered if this could be a potential therapeutic and have wondered about the evidence so far for it, and the second part of the question is should organizations and even governments look into this medication as a potential? And so I’ll start with you Dr. Seheult on this question.
Dr. Seheult: Yeah, so we covered Ivermectin fairly early many months ago and it was very preliminary, and we mentioned that there was some possibility about Ivermectin working. I think at the time the preponderant theory was that Ivermectin somehow inhibited proteins from going into the nucleus and causing the immune system to be shut down.
I think the current thinking is — and what sort of woke us up to this Ivermectin — was the Senate, the United States Senate hearing where Dr. Kory gave a testimony. That group that’s looking into Ivermectin, and that’s Paul Merrick’s group out of Eastern Virginia Medical School, and the group that they’ve put together believe that Ivermectin works in a completely different manner. It actually blocks the ability of the virus from hitting the ACE2 receptor almost like a monoclonal antibody. And so they believe that this may be beneficial in preventing and also in treating early SARS-CoV-2 COVID-19 infection.
So there’s a number of studies that have looked at this. Let’s talk about the research for this. What I would like to see, and iIm sure John as well, would be a large randomized, controlled trial, multi-center, that’s peer reviewed and published and conducted in the country where you want to actually have the treatment, because populations around the world are different, and you know one of the things that we’re seeing with this is there is randomized, controlled trial data — some of them are up to two, three, four hundred in size, which is good, but it hasn’t been peer reviewed, hasn’t been published as far as I can see, and the data is showing that — and these populations have, by the way, a higher incidence of parasitic infections and so they’re not exactly the same populations we see in the United States — the other interesting aspect about this, too, is that the mortality, at least in the United States, is higher than in some of these countries where they’re doing this, and so a lot of these studies where I’m looking at the mortality in both arms are very, very low, and so it’s hard to parse out. That enough to say is if we look at what the group that has raised the awareness of Ivermectin,
I think ivermectin is if, boy, if it works, it will be amazing. So I’m hoping that it works. If you look at that group that’s brought it up, what they’re asking for, which I think is perfectly reasonable, is for the NIH to look at the data to figure out what needs to be done to move forward, so that this could be potentially available in the United States. Look, Ivermectin either works or it doesn’t work, and it doesn’t matter who says it works or who doesn’t say it works. It either works or it doesn’t, and we know how to figure that out. We do that by large, multi-center, randomized, controlled trials, and I think that’s what needs to happen.
The good news is that I did see that there is a randomized, controlled trial that’s currently undergoing a trial at Temple University in Philadelphia. I don’t know when that’s gonna be completed or when we’re gonna have results on that, but I’m hoping that that happens fairly soon. And look, you know, the people that are proposing this aren’t quacks. These are well respected academics that have been working in critical care for quite a long time and have published a number of papers. What we need to do is have an open mind. Take it seriously, but again, remember that there are potential side effects in giving Ivermectin, so we have to make sure that what we’re doing is good and responsible.
Dr. Campbell: Yeah, the idea of having a drug which is is relatively inexpensive, which has got a known safety profile, which is generic — people can make it in very large amounts without any copyright issues on the drug — it is a great idea and that’s what happened with steroids, of course; these drugs are readily and freely available. We now know how to use them. It just seems a pity to me that drugs like Ivermectin and Hydroxychloroquine have got tangled up in politics to some extent, and I mean politics with a small p there, not really party politics. So it’s one of the things that we’re actually not entirely free to talk about at the moment, because there’s a lot of emotion around about and there’s a huge amount of disinformation around about it.
Now as Roger said, the people proposing this are very high quality people, so I spent an evening looking at it, and I read their information, and when you — and it all did kind of make sense — but when you actually look back to try and get the original trial data, as Roger said, I was really quite frustrated. So I studied, in Bangladesh, for example, that seemed to show efficacy, but we’ve got a different age profile there. We’ve got a different level of parasitic disease. We’ve got malaria. We’ve got so many other things that could be confusing the picture, so I’m not sure we can really take too much from that, so I didn’t really find any clinical trial that I felt I could report on reliably, so all I can say at the moment is we don’t really know.
It’s an interesting possibility. If it works, I would be absolutely delighted, the same as Roger. Because people know how to use it, it’s relatively inexpensive. It’s available all over the world. It’s on the World Health Organization list of essential drugs, but that’s for treating parasitic disease of course. This is re-labeling, repurposing, so the bottom line to that question, Kyle, at the moment is we don’t really know.
Kyle: So I think I know the answer to this, but just to clarify, you both have heard about reports of patients either attaining Ivermectin to take it prophylactically for COVID-19 or even attaining the veterinary form of Ivermectin, you know horse paste, I imagine neither of you think that’s a wise idea at this point with Ivermectin.
Dr. Campbell: Do nothing, take nothing that your own doctor does not prescribe.
Dr. Seheult: Yeah
Dr. Campbell: It’s as simple as that.
Dr. Seheult: Yeah. exactly.
Kyle: Exactly. I want to move on to the recent mutation that, Dr. Campbell, you’re in the thick of this in the UK and certainly it’s popped up here in the United States and it’s probably more widespread than we know at this point, but tell us your perspective on this mutation and, specifically, there’s concern from folks that, will this make the vaccine less effective? Will it make testing less effective? It could even make the treatments, the very few treatments that we have less effective.
Dr. Campbell: So this is a mutation. The virus is mutating all the time, of course, so really it’s a variant and there’s actually, there’s a cluster of mutations that tend to go together, so there’s a deletion of the amino acid 69 and 70 I think it is, and it’s B5O1Y, so there’s a change in an amino acid, and this cluster tends to go together.
But now there’s evidence, now we know, I think we can say we now know, this form is more transmissible, and it looks like from the data we have, it’s about 55 percent more transmissible, and what that means is that the level of interventions we were taking to prevent the spread of the disease that were working are now no longer sufficient, because we’re dealing with a more transmissible disease.
So to keep that r value below one, we have to be taking now more rigorous precautions than they were before, because of the increased transmissibility. Now the data we have from public health England shows definitely it’s more transmissible, but it’s not showing it’s making people sicker, which is a good thing. Now there is some question mark at the moment, and we don’t know this yet.
There’s an intimation in the data that it may be increasing the infectiousness and how quickly the disease is spreading through younger people, basically talking about the teenager group, the under 20 group, that there is some very, very early intimations that it might be making that younger group sicker. But we have no firm evidence on that yet, because what we found in the course of this pandemic over the past few months is that there’s been increased incidence in a particular demographic in younger people or older people, and it’s been a different time, so this could be a coincidence.
But that’s my main concern at the moment, that this is more transmissible, and is it affecting younger people more? We don’t really know yet. Now in terms of the vaccine and indeed in terms of reinfection, so we’ve actually done studies in the UK; Public Health England have done retrospective analysis on this and they’ve looked at people that have definitely been infected, and they’re looking at how many people get re-infected, and there’s a very small proportion of people who get re-infected — very small proportion. Nearly all have asymptomatic illness, but that proportion is, there it’s perhaps less than one in a thousand, it’s a very small amount. And it’s been shown that with this new new mutation, it’s no more likely to cause reinfection than the old form of the virus, so what it’s looking like is when people make immunity to the virus, that immunity is active against the old form of the virus and this new variant of the virus, the immunity is what we would call cross-immunity.
It’s working for both types and the other thing about this is the protein structure of the virus. What we call the “proteome” of the virus, this new mutation has changed less than one percent of actually the protein structure in the virus. That means 99 percent of the protein structure in the virus is the same as it was and, of course, the immune system is primarily learning to recognize these foreign proteins, so even if it can’t recognize that one percent of the foreign protein, it makes sense that it can recognize the other 99, and that is what’s happening that people aren’t getting reinfected at a higher rate, and from that it is very rational, but very reasonable to extrapolate that the vaccines will also work.
Because if we take the Oxford vaccine, for example, it’s not producing one antibody. It’s a polyclonal response. It’s producing many different types of antibodies and it’s inducing natural killer cell activity. The NK cell activity, the large lymphocytes, now we used to think that they were non-specific, but we have recent data now that shows that they are specific, and they can be alerted to the presence of a particular type of virus.
The vaccines are also stimulating the small lymphocytes, the T cells and the B cells — the cytotoxic T cells that will kill virally infected cells, the B cells that will make the antibodies — and it’s also stimulating what we call the phagocytic cells. These are the cells that eat viral particles and eat virally infected cells that the macrophages and the neutrophils are also stimulated. So the immune response is not simple. The immune system is attacking from this way and this way and this way and this way and the idea that such a, basically, a simple mutation and a simple change in the proteome would dramatically affect that is not really a worry at the moment.
So I’m more than happy that the current vaccines will work and even even if there was a big shift, the vaccine manufacturers can change the the configuration of the vaccine for the RNA, for the messenger RNA vaccines quite readily, and also for the viral vector type vaccines, the Oxford type vaccine, could be changed if it needs to, but it doesn’t at the moment. So I’m not worried about that. Vaccination is still our way out of this.
Kyle: Dr. Seheult, what are your thoughts?
Dr. Seheult: Yeah, I mean I think John answered that better than I could have. He answered all of the points. He hit on all of the points that I think are relevant to that question.
Kyle: Excellent. Well, let’s move on to vaccines then, specifically. And, Dr. Seheult, you’ve had the vaccine, the Pfizer vaccine was offered at your hospital, and you were able to get that, what was it, two weeks ago now? Your first dose?
Dr. Seheult: Yeah, a little over two weeks.
COVID-19 Vaccines and Allergy Concerns
Kyle: So the question is, how concerned are you both about the reports of allergies in some people that have gotten vaccinated, short-term side effects, long-term side effects, just the overall safety and efficacy of these vaccines?
Dr. Seheult: Yeah, so I think if we add up all of the media accounts, I think that’s a very accurate way of finding out how many allergic reactions there are, because you know that every allergic reaction is going to be in the media.
We’re probably less than a one-in-a-hundred-thousand at this point, and you know, if you were to be giving out a big campaign and giving out peanuts, I think we probably have more allergic reactions to that than we would to the vaccine. So this is completely reasonable. This is completely with what I would expect there to be.
What we’re going to see, and I want to get people ready for this, is in about a month or so, maybe about a couple of weeks, we’re going to start to see people completing their second shot, and then seven days after that we’ll then have quote-unquote “immunity” based on the studies that we’ve been looking at, and then now get ready, because there are gonna be people that are gonna be coming down with COVID-19 even after the vaccine, and why is that?
Because it’s not a hundred percent effective. It’s 95 percent effective. That means five percent of the people, or yeah, five percent of the people that get vaccinated will potentially still be able to get coronavirus or COVID-19. And so don’t let that scare you into saying, “well look, the vaccine is not efficacious; it’s not worth getting.” Just like, “don’t worry about these allergic reactions that you shouldn’t get it because people are getting allergic reactions.”
Look, you have to look in the population and compare to the population. Any time you put a foreign substance, anything, into somebody, you’re going to get the potential of allergic reaction, so just be prepared. Put it in context. Look at the numbers. Make sense of the numbers, and think about this rationally, that nothing is a hundred percent.
The point here is that we’re trying to reduce the number of COVID-19. There’s good data that the RNA vaccines, both — at least we have data in Moderna, but probably also related to the Pfizer vaccine and probably also the Oxford; in fact we do have data in the Oxford vaccine — that shows that vaccination not only reduces COVID-19 but also reduces infectivity.
Dr. Campbell: The encouraging thing about the vaccines is — and with the Oxford vaccine — so far it’s looking like it’s 95 percent or higher that people who have had one dose of the vaccine, even though they can become infected, don’t get sick, and this is the key thing. We need to stop people getting sick and keep them out of hospitals.
So in the Oxford trial, no one who had the first dose of the vaccine went on to be hospitalized, and that is remarkably encouraging. And with the Pfizer, it’s looking like about 90 percent of people after the first dose don’t get sick, so again, you’ve got to think about the protection against infection in absolute terms, which of course we want, but we’ve got to think about the protection from getting sick, if we do get infected, and for both of them that’s looking quite promising, which is why the UK has gone on to this one-shot to regime to try and vaccinate as many people as we can.
And Roger’s absolutely right, if you hear if someone has an anaphylactic reaction, you’re bound to hear about. The news is going to pick that up. Now the Moderna and the Pfizer vaccine, people will know that this is based on a single strand of RNA, but RNA is basically water-soluble, so it won’t get into the cell.
So it’s necessary to surround that with a lipid-based capsule. So each piece of messenger RNA is in this lipid-based capsule, and the lipid-based capsule is actually different between the Moderna and the Pfizer vaccine. So the lipid-based capsule for the Pfizer vaccine, for example, needs to be kept at — what is it — minus 70, 80 degrees centigrade? Whereas, for the Moderna vaccine, that lipid capsule only needs to be kept at about minus 20 degrees centigrade. That’s where the difference comes in, and there is a chemical configuration in the vaccine of this lipid coating. It could be that one of those components is causing the allergic reaction, and the manufacturers are going to be able to take that out.
But having said that, the people that I have heard of having the allergic reactions are predisposed to having allergic reactions. We call these people “atopic.” They have allergic reactions to quite a few things. They produce these immunoglobulin types to things that they’re not supposed to, but produce them too, and they carry epipens already.
So these people know that. So for people that are prone to allergic reactions to have a very small incidence of allergy reactions, it doesn’t surprise me at all, and it doesn’t really concern me, because these people know if they’re getting vaccinated to get vaccinated in hospital. So I have no history of allergies, so iId be quite happy to get vaccinated in a sports center, for example, in a mass vaccination campaign.
But for people that are prone to allergic disease, we would vaccinate them in hospital, and if people have these allergic reactions in hospital, we are very good at treating them. They are eminently treatable, and okay, the person might feel pretty bad for a short period of time, but in the vast majority of cases they’re going to be absolutely fine, because we give the appropriate treatments. So as Roger said, 1 in 100,000 allergies doesn’t surprise me at all, doesn’t concern me. What is a pity is that the media pick up on this, and this is ammunition to the anti-vaxxers campaign. But as someone who’s been giving drugs and vaccines for many many years now, it doesn’t surprise me, it doesn’t concern me at all, to be quite honest.
Dr. Seheult: Yeah, Kyle, I would just add that people who get penicillin shots, it’s one in 8,000 that gets an allergic reaction, according to the current data. Here it’s one in 100,000 for the vaccine. If only the media would publish the 12 times that somebody got an allergic reaction from a penicillin shot than they did from a vaccination shot. Then we would have people being anti-antibiotic.
Dr. Campbell: Yeah, headline: “But vaccine causes 12 times less allergic reactions than an antibiotic.” I mean, as you said Roger, peanuts. I mean it’s about 1 in 71 and 80 kids in the UK have a level of allergy against nuts. It’s really high, all the simple non-steroidal anti-inflammatory drugs, the ibuprofen and things like that, that they have a very high incidence. Normal aspirin has a pretty high incidence of allergic reaction, so the latex gloves, you know, I’m sure there’s more people allergic to latex than there is to the new vaccine.
Dr. Seheult: Yeah
More About Vaccines
Kyle: What would you say to someone? I mean, you guys both mentioned how rare allergic reactions are with these vaccines and putting them in context with other things like penicillin, what would you say to someone that says, “well ,you know that’s fine, it’s only in 100,000 or so they get an allergic reaction. But I don’t know about long-term side effects with these vaccines, and I also, you know, I take really good care of myself. I have a strong immune system, I don’t get sick often. Why should I get the vaccine? If I get sick with COVID-19, I’ll just let my own immune system fight it off?” What would you say to that question? I’ll start with you Dr. Campbell on this one.
Dr. Campbell: Well you just never know if you’re the one that’s going to get sick. I’ve met so many people who said, “well I don’t know why this happened to me.” But it does. That’s the nature of disease. It does happen to people. And although we have recognized comorbidities, increasing severity with age, increasing severity with other comorbidities, that’s on a population level.
You know, if I get infected, although I have no particular comorbidities, I don’t know if it’s going to kill me or not. There’s always that possibility. We can’t predict all of these things, and it’s this ris- benefit analysis again, isn’t it? I’m pretty happy with the safety of the vaccines. I’m more than happy to get that. I don’t really want to get this disease, because there’s maybe a two percent chance, three percent chance, it’s going to kill me. That chance is always there.
And as well as that, the thing with the vaccine is even if you could guarantee — which of course you never can — you could guarantee, I’m going to be safe, am I going to pass it on to other people? There’s this social responsibility. So vaccines for me are just this win-win situation. It protects me, which I’m pretty happy about, but it also protects those around me and contributes towards herd immunity. So it’s a win-win situation. I’m so jealous of Roger having had this. I really am. I haven’t had mine yet. I’m really looking forward to it.
Dr. Seheult: Well, I hope you get it soon. I’m going to be getting my second shot later this week, and I heard the second shot’s a little worse, so we’ll see how it goes.
Dr. Campbell: It kind of makes sense, because you’ve already developed some immunity to that, and then when you introduce the antigen again, you’re going to get more of an inflammatory reaction. And as you know, the inflammatory reaction can be localized, but you also get this systemic inflammatory reaction, which is what makes you feel bad. So you know you need to book a day off work, and just take it easy for a day or two after the vaccine. That is a price well worth paying for not getting this disease, taking away the risk of dying, and taking away you as someone who could potentially spread it to someone else. To me, it’s a small price to pay, and I’m more than happy to pay it.
Dr. Seheult: And yeah, Kyle, I totally agree with John’s assessment there of that question. I don’t really have much to add. Absolutely the same points.
What to Expect In Terms of Forthcoming Vaccine Information
Kyle: Another potential consequence of COVID-19, I mean, Dr. Campbell, you mentioned the risk of, of course, dying or having a severe infection. Another potential risk is this long COVID syndrome or long-haulers. And so, I’m curious what both of your thoughts are about that. But certainly people that have experienced that, some of them have been very vocal. We need more recognition for this and more awareness around the post-COVID infection effect. So I’ll start with you, Dr. Seheult, just general thoughts on that.
Dr. Seheult: Well, they’re absolutely right. We do need more, and we are getting more information, because as this pandemic goes on, that information is going to come in. A lot of people see this as a black and white issue. You’re either dead or you’re not, and unfortunately it’s not that way. It’s a gradient. There are people who’ve survived it who are alive and yet are experiencing daily debilitating symptoms. The recent study came out showing that in healthy athletes who have come down with the COVID-19 and recovered, 60 percent of them had signs of myocarditis or inflammation of the heart tissue. That’s very concerning. It’s concerning to me in terms of what are we going to see down the line?
We all remember way back learning about in school about these people who had infections, never got antibiotics, and started to get conditions of rheumatic heart disease, mitral stenosis, and we don’t see that anymore, because we have antibiotics. But what are we going to see now because of this post-inflammatory type of syndrome? We don’t have the answer to that.
What I suspect is going on is that when you get infected with the virus, you know the immune system is ripping it apart and presenting different antigens, and epitopes to your immune system, different parts of different body parts, if you will, of the virus. And that is going to generate a wide and broad antibody and immune response against many epitopes.
When that happens, the chances of you getting an autoimmune condition like Guillain-Barre-like narcolepsy things that have happened before in in post-viral states goes up, whereas if you get the vaccination, you’re getting a very specific epitope, very specific protein, and you’re making a very specific response against that virus. It seems to me that the chances of getting a post-vaccination issue is going to be smaller than getting a post-infectious viral syndrome.
Dr. Campbell: I think the whole issue of post-viral syndromes and post-viral fatigue is
under-recognized. I know two or three people just from personal contacts who’ve never been quite right from viral infections from quite a long time ago. I mean, Roger said something there that really concerns me.
Actually, you mentioned myocarditis and this is inflammation of the myocardium, the heart muscle itself. And if people have that, it’s absolutely essential that they rest, so if people are not recovered from this illness, it really is important, I think that they don’t go and play squash. They don’t go jogging, they don’t go out cycling, they really take it easy until the doctors are very happy that they’ve made a good recovery. I’ve actually seen people who’ve had relatively minor viral infections go out do some vigorous exercise, and they’ve gone into fatal cardiac dysrhythmias that can happen so post-viral syndromes are underrated anyway.
Now I think it’s gonna turn out to be two types. There’s going to be this specific post-COVID syndrome, which I’m hopeful is going to resolve. Now there is studies on this, you know, more people resolve after three months than one month, and people do get gradually better over time. But what is really concerning is in some people, the virus is going to damage tissues and if you damage, like, heart muscle tissue, if you damage the structure of the lungs, if you damage the structure of the kidneys, then the ability of those organs to recover is limited if the actual architecture of those organs is damaged. So there could be a residual long-term organ damage from that, and we don’t know that yet.
So in the United Kingdom the health service is actually recruiting in combination with academics a group of 60,000 people that are currently being followed up and are going to be followed up long term. And they’re going to be seen regularly at clinics. So there’s going to be a long COVID follow-up program in the UK, so data will be forthcoming on that.
But I’m hopeful that most of the people that get this fatigue, get the prolonged fever, a very common report that people have given to me is they get very fast heart rate. The heart rate goes up to about 130, 140 with even very minor exercise. I’m hopeful that will resolve over a period of time, but we could well have this core of people that are left with long term damage. And we have seen this in previous pandemics. This did happen somewhat after the 1918 pandemic that there was a condition called post-encephalitic parkinsonism, where people were left with damage to the to the basal ganglia of the brain and long life parkinsonism as a result of the acute viral infection caused by caused by actual tissue damage. So we’re just hoping that this is going to be small, but we can’t put numbers on it yet.
Dr. Seheult: Yeah and I was just going to add, Kyle, I mean that doesn’t say that,
that doesn’t mean that there aren’t long-term complications to the vaccine, which I think gets the original question, but generally speaking, and if you look back, there have been long-term complications from vaccines in general. If you look at narcolepsy for instance was one of the issues back in the vaccination for the flu back in 2009, but usually we see those things within a few months of a vaccination so it’s not like we’re going to be having to wait two to five years to see the results of that. We usually see those pretty quickly, and so I think we should have some data on that. Once that goes, there really isn’t a reason, and again, it’s not like you’re choosing between complete normal health and taking a vaccine which may have complications. You’re choosing between, in a pandemic, having the post-viral effects of getting the virus versus the post-effects of getting the vaccine .
Dr. Campbell: I know which I’d choose, I’d go with the vaccine risk rather than the infection risk, that is for sure. No, I agree completely that the idea that something is going to drop out of the ceiling in 18 months time and hit us when we weren’t expecting it, I think the chances of that are pretty close to zero
Kyle: And to your point, Dr. Seheult, I think it’s important to also point out some of these complications or side effects that arise during a trial, during a vaccine trial, like Guillain-Barre Syndrome, which is a scary thing, you know. It’s a nerve syndrome where there’s a temporary paralysis, potentially, or worse. But comparing the importance of, comparing that to also background how many people experience something like that — Guillain-Barre or Bell’s Palsy — without a vaccine or with a typical infection. So I think that’s something, again from my vantage point, that’s lost with media reports. It’s like, “hey look, this person was in the vaccine arm of a trial and they got this Bell’s Palsy, this facial paralysis,” but turns out there’s a proportion of people that get that regardless. We call that background, and sometimes that’s lost in these news reports.
Dr. Campbell: We had this with the MMR a few years ago in the UK. People were saying there was autism after the measles-mumps-rubella vaccine, and there was a report on the news where a child had had the MMR vaccine, they went to visit him next month, and he developed autism. They took one case completely out of context. It turns out there is no correlation here at all. This was completely bogus science.
And for example, in the Oxford vaccine when they were doing the trials in Brazil, there was actually three deaths from trauma. One person was actually murdered, one died in a row traffic accident, and one died from blunt trauma to the head. And of course that’s nothing to do with the vaccine at all. It’s just, if you’re taking large numbers of people, then things can happen. You know, living human life is dangerous. It’s not risk-free.
Kyle: There’s one thing I wanted to point out about that myocarditis study that you mentioned, Dr. Seheult, one potential limitation just for people to be aware of from my understanding. And correct me if I’m wrong, Dr. Seheult is that study looked at athletes, but there wasn’t really, they didn’t have a before and after for them. So there was some concern, maybe the radiologist overread a potential myocarditis there, so there wasn’t a true control group. But just something for people to look into, I think.
Dr. Seheult: And that’s the purpose of peer review and critical appraisal, absolutely. But, again, we’re going to have more data that’s going to come out. It’s going to be if this causes significant long-term comorbidities, we’re going to find out about it.
Dr. Campbell: I mean, I think there is some pathological data, unfortunately, from post-mortem studies that does show the virus has directly damaged the lungs, the myocardium, the brain, and the kidneys. And I think there’s this post-mortem data on that now, but we’re just hoping. But of course the post-mortem data, thankfully, is self-selecting data. These are the people that had most severe disease. We don’t do post-mortems on the on the vast majority of people that thankfully survived, so we don’t have that data yet. But we know, what we’re saying is we know this tissue damage can happen. We just believe it to be at a very low rate.
Vitamin D and Looking Ahead
Kyle: Absolutely. Well neither of you are in the business of predicting the future, but as as we’re in a new year now, and we’re we’re looking ahead and there’s a, you know, for some people maybe a sense of hope that we made it through the year 2020, what do you anticipate over the next three months, six months, over the next year? What are some of your predictions as you look ahead for how things will go with this pandemic? And the second part of the question is, do you anticipate another pandemic coming down the pike? Do you think this is something that’s going to happen, unfortunately, more more frequently? I’ll start with you, Dr. Seheult on this one.
Dr. Seheult: Well, I think that right now that the spike that we’re going through is going to eventually subside, I’m hoping, in February or March for a couple of reasons. Number one, we’re not having as many get-togethers, holiday get-togethers, as we have had in the last month or two.
And number two, you know as, John, as a believer — I’m a believer that vitamin D is actually playing a role in this — and as the as the sun starts to come back up to the equator and hopefully toward the the tropic of cancer, we’re going to see more sunlight ,more ultraviolet B radiation, that means more vitamin D in our bodies, and so hopefully that’s going to help and knock down the infection rate. I suspect that the effect of vaccination is really not going to be seen on this pandemic until we get later in the year, and hopefully with the campaigns like we’re seeing in the UK and in the United States, we’ll hopefully have a better winter season next year, if things pan out. I’d like to hear what John has to say, especially about where we’re going to go with vitamin D this year.
Dr. Campbell: Well, you know, I go to the supermarket now from time to time when I can’t avoid it, and if I go in the afternoon, the vitamin D shelf is always sold out. So the message is getting through. Now we’re where our government is actually giving out vitamin D to vulnerable people between December and March. For four months, they’re going to give them a free supply, but as far as we know, they’re still arguing about the dose.
Now the Scottish government’s doing this, but it’s only at the 400 international unit levels, which is 10 micrograms. It’s nothing. There’s nothing, so I’m really hoping that the government are going to sort of increase their thinking on that and give a realistic dose, which would probably be something like 50 micrograms, which is 2,000 international units.
And as well as that, the other big factor as well as vitamin D, which Roger completely accurately says of course, but people are just not ventilating enough, because we don’t like being cold. So when we’re in public areas, a really good idea in public areas would be to have carbon dioxide meters, and if the carbon dioxide goes up in public areas, then it’s reasonable to assume that the the expired droplets and aerosolized water droplets in the air would also be increased.
Because I go into supermarkets now and other places, and really they’re just not well ventilated. So as the weather gets warmer, we ventilate more. We really need to dilute that viral load. That’s what masks are doing. They’re diluting the viral load. That’s what good ventilation is doing. We’ll dilute the viral load, but we’re just not getting that right yet. So as Roger said, spring will increase ventilation but we need to get that message out quicker.
Now as regards to what’s going to happen over the next few weeks in the UK, it’s not good. It’s not good. We have escalating cases. We know that there was more interaction over Christmas. We know there’s more cases coming down the pipeline, and we know that two weeks after that there’s going to be people getting sick and hospitalizations.
Now hospitals in the UK are already more full than they were at the peak of the first wave in April, the 12th of April, 2020. We’re already beyond that point, and we’ve got these high infection numbers now. I think it was about 57,000 new cases per day in the UK, and we know in two weeks time, a percentage of those are going to need to be hospitalized. And it’s still increasing and the level of restriction that we’re now implying, although we’ve got what we call tier four over many parts of the country, it’s looking like that may well not be enough because of the increased transmissibility of this new variant.
Now with the old variant, that would have been enough. The r value would have been below one and things would be getting better, but we’ve got this extra complete burden of this new variant. Now so cases are going to keep increasing for some time, and even if we get stopped, the case is increasing. We’ve still got the hospitalizations. We’ve got this expression now in the UK, it’s “baked in” so there’s so many hospitalizations, and tragically, so many deaths already baked into the figures.
So in the UK for the forthcoming months it’s going to be really, really quite difficult, and there are going to be more cases and deaths and as I read the data in the States, it’s similar. It varies in different parts of the States, of course, but the trend is up. The death trend is up and unfortunately that’s going to carry on, because the herd immunity effect is not going to really kick in with any significant effect on transmission realistically until March, April. That kind of time frame. So we just have to keep emphasizing over and over again, we need the hands, face, space, ventilate message. That’s not going to go away until really getting towards the end of 2021.
If then in terms of another pandemic, there’s two views about this SARS-coronavirus-2. Some people think we can eradicate it as we did with SARS-coronavirus-1 back in 2003. Other people think it’s going to become endemic. My thinking is it could be with us for a few seasons, but as long as the vaccine uptake is high enough, I’m pretty confident we can eradicate this virus, so you know we could be sitting here in five years time, and the SARS-coronavirus-2 may not exist in the wild. That is my hope. It’s possible.
As regards another pandemic, I’ve actually been teaching my students for about 30 years now, there’ll be another pandemic, and not that I worked that out for myself, I got that from the virologists. You know that they’ve always been saying this: there will be another pandemic. I’d suspected it would be a genetic shift in the influenza, but it’s not. It’s turned out to be this coronavirus that we weren’t expecting, but you know, Kyle, I think it sounds absurd to say this from where we are now. I think we’ve actually been quite lucky, because this is a viral pandemic that’s got thankfully a relatively low death rate. It’s not as transmissible as the measles virus or other viruses, so we could have had a virus that made that zoonotic spill over leap from the animal reservoir or from the, you know, the outside there there’s about 10 to the 23, 24 viral types, you know, more than we can possibly imagine.
We could have had a virus that infected people that was as transmissible as measles and as deadly as whatever you want to take. Take ebola, or take the middle east respite syndrome, you know, we could have had a virus that had those characteristics. So if this pandemic with relatively low death rates — terrible but relatively low compared to what it could have been and relatively low transmissible still enough to cause a pandemic but lower than it could have been — if we’ve learned from that, that pandemics form a real existential threat to the future of humanity, then maybe we’ve got off lightly. Maybe that’s a good thing.
Kyle: If the death rate was higher with this. If it was as deadly as, let’s say, ebola, would that then make the spread less possible though? I mean, is it…
Dr. Campbell: No. No, it would probably still spread in the same way it depends. It depends. The reason really that we have this pandemic now is with SARS- coronavirus-2 that people are most transmissible, shed most virus immediately before they get sick and immediately after they get sick.
So, for example, the Middle East Respiratory Syndrome. We still get the odd case of that, mostly in Arabia, from camels. It’s another coronavirus but the reason that didn’t become a pandemic, I think this was first identified in 2008-2009, something like that. But the reason this didn’t become a pandemic is not because it’s not transmissible, but because the people shed their highest viral load when they were at their sickest. So when people first got ill, if they isolated at that point they were shedding a remarkably low viral load, then a week later when they were very sick they were shedding high viral loads.
So what happened when Middle East Respiratory Syndrome first came along is quite a few healthcare professionals died who were actually looking after these patients when they were shedding high viral load. But because you can say that person is really sick, therefore that person needs isolated, then it was containable and we didn’t have a pandemic. The whole problem with this is that people are transmitting it when they’re feeling fine. That is the issue when they’re just a bit pre-drawn or just starting to feel ill. So we could have had a virus which was really deadly and really quite transmissible as well.
We’ve been, I still think we’ve been fortunate.
Dr. Seheult: Yeah, I was going to say that that’s exactly the reason why they were able to contain MERS and SARS is because of the lack of pre-symptomatic transmission. But I didn’t answer that question about whether or not this could be another pandemic. The answer is yes, it’s not a matter of “if,” it’s a matter of “when is the next pandemic?”
I mean, there are so many coronaviruses in bats. There are so many possibilities of the flu, and if you are sitting back and looking at this from the last year and thinking, “wow, how poorly did our government act and and get in terms of helping and getting things rolled around. That should be an impetus to every single person listening to this to look at their own lives and say “what is it that I can do to make sure that my immune system is in tip-top shape and ready to meet this next pandemic whenever it happens?”
And not just to do it for the pandemic, because here’s the great thing: it’s redundancy. The things that you can do to improve your immune system to handle the next pandemic are exactly the same things that you can do to have a more healthy and longer and less symptomatic life on this planet. And it all boils around just having the right dietary choices, exercising, doing all these things. It’s amazing that everything lines up in the same direction.
For some people it’s been a wake-up call, and they’ve made those those changes They become more interested in their own health care and in the things that they can do, And here’s the key, I think one of the big things for 2020, Kyle, to answer that very first question is people are learning that preventative medicine lifestyle changes now can have a big impact down the line
and be a benefit in multiple different ways.
Dr. Campbell: It’s amazing, things that are good for the individual in the short term are good in the long term and also pretty well are good for the planet, you know. Eat food, not too much, mostly plants, sort of philosophy.
And on that point, slightly border point, Kyle, but I really do think we need to rethink our relationship with animals. Because you know the viruses, because we’re animals, the viruses we are most prone to getting. You know, we’re not likely to get sick with bacteriophages — they’re viruses that specialize in infecting bacteria — we’re not so likely to get sick with viruses that affect plants or fungi. They are specialists to those organisms. The ones that are going to spill over into us are from animals, and, you know, the obvious example is the wild animal trade-in in Asia, for example, which is still going on at quite a level, but the huge, what you could call, monoculture, that we have. You know we will breed up millions of cows or pigs or chickens with very little genetic diversity between them, and that really is a potential recipe for new emerging viruses, so I really think we just need to rethink our whole ecological relationship with the planet and with animals in particular to prevent this happening again.
Dr. Seheult and Dr. Campbell’s Pandemic Best Practices
Kyle: Well I think that’s a good segue into maybe both of you sharing a little bit about some of your own personal choices, as far as your routine to stay safe from COVID-19 or lifestyle,
things that you participate in or supplements. And, you know, I know we could spend another hour on this, so let’s try to be brief with this answer, but I’ll start with you, Dr. Seheult on this one, some highlights of your own strategies for that.
Dr. Seheult: Yeah, so I look back on this very early in the pandemic when I really didn’t have a lot of choices for my patients, because things hadn’t come down. We didn’t even know about steroids, and the first question I had was “what did we do back in 1919 when we had this?” You know, we didn’t have oxygen in the hospitals at that time. They wore masks — they knew that — but a lot of the things that I saw looking back before the advent of antibiotics and medications, FDA trials, and randomized controlled treatments and trials and things of that nature. Was this, basically, focus on adapting and improving the immune system, the person’s own immune system, to deal with what it was that they were dealing with and this dichotomy came about?
We talked about this on a number of our MedCram updates. Dr. Jauregg, who was an Austrian psychiatrist, to use the fever of malaria to treat his neurosyphilis patients. We started to research a little bit about, what does hyperthermia do to the body? You know, it’s one of those natural systems of the body to cause a fever when you have a viral infection, and we saw that increasing the body temperature, whether it be through saunas, hot water baths, things of this nature can improve interferon, which is one of those things that we found out pretty early on that’s lacking in the early part of COVID-19.
And so just as a personal choice, I didn’t have any randomized controlled data, but I certainly wanted to take something that wasn’t very risky at all and apply it to my own life. Doing something like contrast showers where I take a hot shower and then followed by a cold shower. That’s been shown to improve the immune system.
There’s even a technique of hydrotherapy where you can place hot towels on the body to warm up and increase core body temperature. Going into a sauna. Going to spa. We looked at Finland early on. So these are things that I’ve done as well if I feel like I’m coming down with something. I don’t know if it’s COVID-19 or just a regular cold, I’ll do this. You know, I’ve supplemented with vitamin D. We’ve talked about that. I’ve noticed that I used to get catch a pretty bad flu every year, even though I’d get the flu vaccine, and I still recommend doing that.
And this is not a cure-all. This is not something that’s going to protect me 100 percent. The vaccine doesn’t even protect 100 percent, so I still do social distancing, I still do wear masks when I go to the hospital. I do all of those things. But in addition to all of that, I’ve been going into the sauna or the spa, doing contrast showers. If somebody calls me, they’ve had COVID-19, or they have it, I’ll tell them to do all of the standard stuff, but I’ll also say “hey try this as well,” so long as there’s no contraindications to it.
So I think about this: if it does turn out to work, and I think randomized controlled trials are definitely needed for hydrotherapy and COVID-19 — but if it works, this is something that somebody could do in their own home while they’re waiting to see whether or not they get sick enough to be admitted to the hospital. It’s not costly, nobody needs to write a prescription, it can come out of the the bath, and you can do it right there, so I think it’s pretty low risk. So long as they don’t burn themselves or they don’t have issues with arrhythmias with hyperthermia.
Kyle: And it’s important.
Dr. Campbell: I’m really glad you brought up that point about fever. I’ve been trying to teach this for a long, long time. The reason that the body has a fever in response to a bacterial or a viral infection. It’s not a mistake. It’s not the body getting it wrong, you know. There are specific pyrogens, fever-inducing cytokines, that are highly specific, that fit into totally specific receptors in the hypothalamus that trigger detailed prostaglandin-based mechanisms right in the brain that that adjust the fever mechanism and put the temperature set point up, so the body warms up to it. This is not a mistake. It’s a beautiful detailed piece of physiology. And then for me to come along with some paracetamol or Tylenol and just get rid of it, to me was just the height of arrogance, as if we know better.
It really is important to differentiate between symptomatic treatments and causal treatments. So if I have a splinter, I could pull that splinter out and take away the pain. That would be a causal treatment. Or I could give myself intravenous diamorphine and take away the pain, which would be a symptomatic treatment. We really need to look at what is causing and go with the causal stuff, and fever is basically when you’re at home, when you actually get an infection, fever really in that day is your only defense. That is what is helping you.
Now, I agree with Roger 100 percent. We need to optimize this. We need good nutrition. The vitamin D, I wish we were just monitoring vitamin D routine. You might; my GP won’t. My general practitioner won’t do my vitamin D levels. It’s not done as standard. Why aren’t we doing this?
Now it’s not that you’re going to make your immune system better if your immune system card is working perfectly and you look sort of young and fit and healthy, I’m sure it is.
What I can’t do is make your immune system better. I can’t improve that. I can’t improve your optimized physiology, but there’s so many things can reduce the efficiency of your immune system, like lack of vitamin D, which is an immunomodulator. Lack of protein, for example, is going to — we know for a long time that people with protein deficiency are more prone to infections, because they can’t make the antibodies. So there’s so many things that can reduce the efficiency of the immune system. If you smoke cigarettes, that’s going to paralyze the cilia in your respiratory system. So what we want to do is optimize the efficiency of your immune system, and that’s what we do. We can’t make it better, so there’s no such thing as a “tonic” or a “booster.” We can just make it as good as the physiology allows it to be.
Kyle: Well, Dr. Campbell, Dr. Seheult has talked about — well, first of all, Dr. Seheult made it very clear this is not about giving medical advice and any stuff —
Dr. Campbell: Absolutely —
Kyle: Medication should be discussed with one’s own medical professional. That said, Dr. Seheult has shared the level of vitamin D he’s taking. You’re up in northern northern England. There it is. There’s your Vitamin D. [Laughter] So two questions, if you’re comfortable sharing it. No problem if you’re not. What dose do you take and do you take it all year?
Dr. Campbell: Yeah, right, good question. One of my hobbies is growing plants, so in England we have a plot of land called an allotment which you rent off the council, so it’s not — this is unpleasant and I wouldn’t normally share it — but I take my shirt off and get plenty of sun exposure during the summer. Now you’re gonna make vitamin D when the sun is is 45 degrees or higher in the sky, and you’re going to make — if you’re in your shorts, for example, and you’ve got your torso and your legs exposed to vitamin D,
in half the time it takes you to get sunburned. So if it takes you two hours to get sunburned on a particular day, if you are out for an hour, in that time you’re going to make about 20,000 units of vitamin D.
Dr. Campbell: And we know that of course that is if you’re the same color as me. It’s a really important point. Darker colored skin people are going to make it more slowly. So and this is big; studies have been done on this in the States. African Americans have much lower vitamin D levels than White Americans. Hispanic Americans have lower levels of vitamin D.
And what have we seen in the differential of the severity of the COVID and indeed of the death rates, so for me I’m gonna make vitamin D about 20,000 units. We know we can store vitamin D, and we know that the fat soluble vitamins are adequate A, D, E and K.And when I was learning this, and it’s probably the same for Roger and for you Kyle, if it was drummed into our heads that you can get fat soluble vitamin, hypervitaminosis and you can overdose on A, D, E, and K, this was kind of drummed into people, and I think this is part of the problem. But it turns out that people aren’t storing vitamin D over winter. They’re not storing it for long enough.
So when I get the sun more than 45 degrees, and I get some overall body exposure, in medicine, we have this thing called the “rule of nine.” It’s how much body surface area you expose. So an arm is nine, an arm is nine, the front of the leg is nine, back of the front of the leg, back of the leg is nine each. So a leg is 18, torso is 18, back is 18. So it’s how much of that surface area you’re exposing. So I kind of build that up, and then I kind of guess how much vitamin D that’s made.
Now the great thing about sun exposure, if you’re exposed to the sun for longer — yes, it’s bad for the skin and you’ve got risks of melanoma and things like that — but you homeostatically stop producing higher amounts of vitamin D. It will get to a higher and higher level then it will stop, whereas when you take supplements that’s not the case. So most guidelines will say don’t take more than 4,000 international units of vitamin D a day. That’s kind of the guidelines in the UK, is the top amount, And that’s 100. That’s 100 micrograms.
So what I’ve been doing since — uh let me see — since September when the sun is no longer at 45 degrees in the sky, because I live pretty far north, I’ve been taking 2,000 units a day, which is 50 micrograms. It probably, I probably i’m going to increase that now a bit, because now it’s completely, pretty well completely dark all day. So I’m probably going to go up to 75 micrograms a day, which is 3,000 international units. And the other important thing, it is a fat soluble vitamin, so take it with fatty food. It will be absorbed — I have no evidence for this — but I believe it will be absorbed more efficiently if you take it with meals. So the short answer to your question, Kyle, is 2,000 international units a day, which is 50 micrograms.
Kyle: And so when the shirt stays on while you’re gardening, that’s your cue to start taking the vitamin D supplements.
Dr. Campbell: Pretty well. When you’re when your shadow is longer than you are, you know the 45 degree thing in the sky, you’re not making very much, and you know human beings are tropical creatures. We’re not supposed to live as far north. You guys, you live in California.That’s a much more sensible approach to life. But I live way way in the north, and basically we’re only making vitamin D for probably four or five months of the year.
Dr. Seheult: Yeah, and you’d be surprised at how many people even in southern California are vitamin D deficient. We are creatures that live inside. There was a recent survey that was done in the United States. I think seven percent of our waking hours are outside. We like to go in buildings, and the paradox isis that we recently had an outbreak here in the United States,
increase in the cases in the early part of the summer in Arizona and in Texas and in Florida, places that you would not expect to see that based on what we’ve just talked about. But you realize that people are going inside because it’s hot outside and they’re staying out of the sun on purpose, and you’ve got air conditioning that’s blowing the virus around inside and not doing a lot of ventilation with new air. So all of this can be explained pretty easily.
Dr. Campbell: Absolutely. It’s cheaper not to cool more air, or when it’s cold, it’s cheaper not to heat more air. So they tend to recycle more, and of course that’s going to recycle the aerosolized droplets and the droplets from the infection. Now, I’d just say one more thing, Kyle, that the thing that really convinced me about vitamin D was they dug up a skeleton in my country in a place called Cheddar Gorge that was 15,000 years old, and they looked at the DNA in this skeleton, and from that they could tell that this guy — and it was a man — they could tell he had blue eyes and really quite dark colored skin.
So the English had dark colored skin 15,000 years ago, and the advantage to being white is you make more vitamin D more quickly. So the original humans would all have dark-colored skin. We are tropical creatures, so the original evolution of humans — or if you believe in creation, Adam and Eve — they would be dark-colored. The adaptive advantage, as we go further north to allow us to colonize further north, is that we make more vitamin D.
So I know of two biological advantages to being white, because it’s a stupid idea because you get sunburned, but the advantages are you make vitamin D more quickly and we also make, uh i think, is it nitric oxide? I think, Roger, that reduces blood pressure and dilates? So the photochemical effects on the skin. But the main one is vitamin D, so that is why we change, our ancestors change from being dark color to being light-colored. That’s how important it is to get enough vitamin D.
Dr. Seheult: Well and then we also know that just sun exposure itself tends to have more melanin in the skin. But the other thing I thought was interesting is those cultures that tend to do sauna bathing, et cetera, are typically northern latitude cultures, like the Finns, the Swedes, the Germans.
Dr. Campbell: Yeah, and heating the body temperature up and helping the immune system that way, absolutely. Yeah.
Do We Need to Pair Other Vitamins with Vitamin D?
Kyle: One other point on vitamin D, since we’ve talked quite a bit about vitamin D, is potential vitamins to take with it. And I know there’s not a lot of data on this, but I’ve looked at the data and I’ve been convinced to take vitamin K2 and some magnesium along with my vitamin D when I take it. And Dr. Seheult talked about this recently in videos. What are your thoughts on that, Dr. Campbell.
Dr. Campbell: Yeah, I don’t know a lot about that, but the problem is, if you take a huge amount of vitamin D — and you’d have to work pretty hard at this — but it can increase your blood calcium. And then from the blood, it can go and you can calcify tissues. So in some people, you can get this, like, calcification of tissues, which is a bad idea. You don’t want to calcify your your heart muscle, for example. And my understanding is that the vitamin K2 helps to keep it out of the tissues, but I don’t really have any detailed knowledge on that. But I think you’d have to take pretty large doses of vitamin D for that to be a problem, whereas vitamin K deficiency it’s not something we really hear about. A normal balanced diet will give you enough vitamin K.
Kyle: Excellent. Well we are about at the, let’s see, hour and a half mark.
Dr. Campbell: Wow, really? Wow.
Dr. Seheult: John, it’s just so neat. It’s so nice. I feel like I’m in your living room and we’re sipping a cup of tea, and…
Dr. Campbell: You are.
Dr. Seheult: …we’re just talking.
Dr. Campbell: Absolutely.
Kyle: Well next time we should have a cup of whiskey.
Dr. Campbell: Afterwards, Kyle. Yeah, I’ll go for that.
Kyle: I think there’s some anti-viral effect to that…
Dr. Campbell: In high concentrations above 60 percent, yeah.
Alcohol and Viral Transmission
Dr. Seheult: But there’s some evidence, actually, that alcohol actually could increase the risk of a viral transmission at least in the mucosa, the upper mucosa, but anyway.
Kyle: Always the voice of reason.
Dr. Campbell: There is actually a serious point there, people, and I’ve been talking — I don’t know if you’ve seen any of the videos– but I talked to a professor of immunology in Baghdad, and she’s got friends in Iran, and that they were actually drinking methanol toxic alcohol. So they thought that because you have a 60 percent of solution of alcohol that cleans your hands, obviously to drink it, they thought would be better. And there’s been fatalities. It’s just absolutely, you know, the need for clear information is just so overwhelming, you know. So just to clarify, let’s keep the alcohol on the hands and not drink too much. But in terms of antivirals.
Kyle: Yeah, agree.
Dr. Seheult: Yeah and I would just say as a comment, Kyle and John, that if anybody in a medical authority in the UK is listening, please, please, please prioritize giving the vaccine here to Dr. John Campbell, because he is a national treasure, and we need more and more people like him all around the world that are saying the same message. And hopefully it’ll increase the validity and the believability of what we’re saying — which is true — and people start to listen and hopefully we’ll make some progress.
Dr. Campbell: Thank you for that, Roger. I guarantee that’ll fall on deaf ears, but I am delighted you’ve had yours.
Dr. Seheult: Thank you.
Kyle: There is one more question I had written down that I want to ask you both, and we’ll wrap this up, and it’s just about testing. So looking back at the year 2020, what lessons can we learn from testing for COVID-19, and what developments do you hope to see moving forward in 2021 for COVID-19 testing? Because we’re not out of the woods yet. As you both have pointed out, the vaccine uptake is going to take some time, and we have no guarantees that the vaccine, how long it’s going to work for. We hope very long, but we don’t know that for sure. So what are your thoughts on testing? I’ll start with you, Dr. Seheult.
Dr. Seheult: So one of the things that was perplexing to me early on was that everybody was coming up with their own tests, and it was taking such a long time. I think the US took 46- 47 days to develop their own test, whereas the Asians had their own test already. Why did we have to go and waste all of that time and why are we now a year later still having issues with testing availability not getting results back within 24 hours? I think that the term that summarizes it is that “the good is not the enemy of the perfect.”
We wanted perfection, and because of that, we were basically a mile wide and an inch deep. Whereas if we thought this more rationally, looking at antigen testing you know, we’ve had Dr. Michael Mina on to talk about the possibility of using daily antigen testing at least three times a week, antigen testing to find out whether someone is infectious. This may be the answer to opening up schools, and I think that’s really where we need to go in terms of this. Hopefully they don’t get their act together before the whole pandemic’s over, hopefully the pandemic becomes over very shortly. But if it doesn’t, I think a lesson to be learned there is to not treat this like a laboratory diagnostic test, but rather a epidemiological tool to get this thing under control.
Dr. Campbell: Now, I agree completely. I don’t know if you’ve got the saying there, but in England we say, “why reinvent the wheel?” It’s already been invented once and the World Health Organization have made a few things that we might question in this pandemic, but one of the good things they did way back in the early days — this would be in January — they put together a kit and an instruction manual on how to produce simple tests.
And the authorities in Thailand, they delayed by almost 20 hours while they made this test. You know, they literally did it the next day. It was fantastic, and they were testing people in Thailand, I think, on the 23rd of January. It was really really quite early. The CDC wanted to go their own way, as Roger said, 43-44 day delay, and that’s when the pandemic took root in the United States. It was such a tremendously unfortunate wasted opportunity that happened, so I think one of the big morals here is if someone invents something good, let’s just copy that, let’s just follow that.
So the Pfizer, Moderna vaccines are brilliant. They were developed in the States. I’ll have that. You know the Oxford-AstraZeneca vaccine was developed in in the UK. They’re spreading that out now in India. The Indians are planning to vaccinate 300 million people in the next few months, and I think they’re going to do it, I really do. But they’re using, basically, they’re using partly a British vaccine, but they’re not saying “oh that’s British, we’ll make our own Indian one.” They have made their own Indian one, as well, but they’re using both. Let’s use anything we’ve got here, and let’s just have so much more international communication. We’ve been teaching, speaking the same language of science here. We understand each other.
There’s no reason why this shouldn’t be done much more internationally altogether. Schools probably a slightly different one. In the UK, they’re talking about mass rollout of the lateral flow tests for schools here, which of course are are less reliable and there is some early data from Liverpool where in the UK where they did mass screening, and on lateral flow tests that people were changing their behavior, because they got a negative result.
So as Roger said, as an epidemiological tool, yes, this is absolutely vital. We can’t — if you haven’t got an epidemiological tool to make this invisible virus visible, then we’re fighting an invisible enemy, which is is a bit tricky. But it did concern me that people in Liverpool were getting this negative test. There is a lot of false negatives. And then there were visiting elderly relatives, for example, which is not a good thing.
So I’m not quite sure that it can work in practice in schools and as well as that, you could have a negative test that was a genuine negative test and then literally 10 minutes later, you could be infected.
So yeah, I’m not quite sure if that’s the way to go. I think we’ve got some pretty hard decisions to make over this just next two or three months while we’re waiting for the virus to kick in, but any tool we’ve got, let’s use it. Absolutely.
Wrapping Up the Conversation
Kyle: Let’s, uh, this has been a great discussion. Thank you both so much, and any parting words before we we wrap it up, Dr. Campbell?
Dr. Campbell: No, I can’t believe it’s been so long. Really, really interesting to talk to you, gentlemen. I really appreciate the opportunity, and I’m curious to see if anyone watches this video. We’ll see.
Kyle: Well, if you’ve made it until now in the interview, congratulations. Stuck with us.
Dr. Campbell: Yeah, oh, well, yeah. Should we have an award or something? Print out a certificate or something.
Dr. Seheult: That’s right. Again, John, thank you so much for joining us. I hope that we do this again soon, especially if there’s new updates and things as they progress.
This has gone so well, and I really appreciate you joining us, and it was a pleasure to be here.
Dr. Campbell: Yeah and the other thing, Kyle, that a lot of people don’t realize is that Roger and myself have a large back catalogue of videos from from pre-COVID days, which are somewhat neglected now.
Dr. Campbell: So, if you’re bored one evening, there’s no reason to not be stimulated.
Dr. Seheult: That’s correct.
Kyle: Well, thank you to everyone watching. Thanks for joining us. Thanks again for submitting questions for this. We really appreciate it, and we hope to do this again and see you all soon.
Dr. Campbell: Thank you
Dr. Seheult: And I would just say, have everyone look at both of our channels here. We both have channels on YouTube, and there’s a lot of information on both these channels that are not redundant, but rather supplementary and complementary.
Dr. Campbell: Absolutely, yeah.
Kyle: Absolutely yep. And you can also check out our website, MedCram.com. Dr. Campbell, do you have a website or is it primarily…?
Dr. Campbell: Not at the moment, no. I had technical problems with that. I often have technical problems. That’s just one of them.
Kyle: I doubt that, since you’re putting videos out daily. I’m sure you’ve got them pretty well dialed in by now.
Dr. Campbell: Not really.
Dr. Seheult: Well you’re very humble and a gentleman. Thank you so much.
Dr. Campbell: Thank you for having me. I really appreciate it.