Dr Shankara Chetty Aproach to Covid19

Iris Koh (Singapore) 

Vijay thank you so much. So now without further ado we like to invite dr Shankara Chetty. You know he's he has really made news around the world you know with this amazing protocols that has like zero deaths and zero hospitalizations in South Africa which is a lot less advanced than Singapore, so definitely we will be very interested to hear what you have to say you know so please take it away doctor Chetty. Welcome to Singapore

Dr Shankara Chetty (Port Edward, South Africa):

Thank you thank you for having me it's a pleasure being here and sharing my experience with you. I think I want to divide my presentation into two major segments early treatment and of course the vaccinations. I share very different respective from a lot of people and  medical practitioners around the world and that I haven't really been exposed to the mortality and morbidity that everyone else has seen and I've addressed this pandemic from the start, from the very first patient and I've seen the benefits of doing that from the start so I'm a very strong proponent of early treatment and early intervention in a pandemic. Our meaning is to prevent mortality and morbidity. That would …..aah,  our success in doing that with dictate everything else that follows and so I think the perspective that I have is very different from the rest of the world from the perspective of early treatment.  Very early on in the pandemic I realised the few new answers to this pandemic that would make a huge difference to how we actually managed it. I very early on noticed that we are dealing with the biphasic illness. We are dealing with almost two separate illnesses in covid infection or covid illness. The first is a viral infection which generally is self-limiting. A majority of patients find by the 5th or 6th day of illness, they start to improve, they start to notice that their symptoms are settling down they get their appetites back and what I notice that in concerned about the dyspnea around the world, was that every patient that presented backward dyspnea, did so on the 8th day exactly a week after the initiation of the first symptom and the first symptom being the day you started to feel unwell and so I interrogated that and what I found was that the 8th day seemed to be a trigger for a hypersensitivity kind of reaction. That hypersensitivity kind of reaction made me classify the illness from the 8th day rather than the first, based on severity. Some patients don't have this reaction on the eighth day, and some have mild some have moderate illness, and some have severe, and like any hypersensitivity reaction you want to be quick and aggressive to treating it to curb all what might transpire further on. Now if this is not timeously settled, then patients progress to inflammation and hyper inflammation by about day 12 and by day 14 we see the clotting setting in the coagulation problems. So, it became vitally important to treat these patients timeously and of course educate them about that eighth day. So, every patient in my practise came in early. I made myself available to them, so I took away the fear from society. Made sure that they are aware that they could come and see me early on and every patient that came in got his 8th day predicted from the interrogation of his first day. Now the treatment on that 8th day was relatively simple. We are dealing with a hypersensitivity trigger. I subsequently found that that trigger was the exposure to spike protein and spike protein being the allergen that seems to cause all the problems and so on the eighth day there is a release of chemical mediators due to mast cell degranulation, like in any allergic process and the mediators released are your histamines, leukotrienes, prostaglandins and of course platelet activating factor. So, the treatment followed that modality. The treatment for your histamine release was antihistamines, the first generation being the ones that are traditionally used in such severe reactions, so promethazine, cyproheptadine, hydroxyzine showed benefit. In mopping up all your leukotrienes, that was given to that add task was given to Montelukast which worked well in that setting and of course platelet activating factor required some sort of anticoagulation so, patients were put on aspirin. Steroids had to be quick and aggressive, and the dosage needed to be adjusted according to the severity of the reaction dependent on the patient and so, the first phase of the illness was treated relatively symptomatically. Patients were monitored.  We wanted to make sure that we prepared for that 8th day. We wanted them well recovered so that we didn't have an overlap of these two phases and that modality of treatment has brought me all the success. Nothing really changed in the second wave and the third, even though the change of variance arrived, the 8th day remained the same, the start of this reaction remained the same, however the different variants and the changes in their spike protein caused a difference in the severity of the reaction. We found when we talk about the notorious South African variants that had far higher mortality and mobility and that was due to a change in spike protein, which triggered a far more severe allergic response on the 8th day. So, the prediction of the 8th day became the most vital thing in being able to aggressively and timeously intervene with the others. So, I think the perspective rather than any medication is really far more important in the way we addressed the illness. Now there's a few things that vitally important in the understanding here and that is that be dealing with the hypersensitivity pneumonitis which is leading to the breathlessness and hospitalizations, rather than covid pneumonia and my medication that I use is completely on-label for a hypersensitivity pneumonitis so, any discussion of off label use is negated by the change in the label. So, I think it's vitally important to understand that we are dealing with an allergic process that spirals out of control and that's what's leading to all the mortality and morbidity.  I think it's vitally important to understand these immunologic processes that are happening in our body so that we can understand the public health interventions we need to take. The article that I wrote in the first wave predicted that people over 55 were rather aware likely to be sensitised to this allergen and so we're having this reaction patients below 55 were likely to not be sensitised because of not being exposed and the first wave would have been their first exposure and subsequent waves would have probably triggered a severe response and there was an expectation that younger people would die in the subsequent waves, seeing that they had developed the necessary immunoglobulins. We also have in my long covid patients have found the increase in immunoglobulin E, which has shown that this is an allergic process. Immunoglobulin E levels are a bit slow to show up, so I took the opportunity in long covid to actually assess that, and I found very high levels. So, from a management perspective of the pandemic without the mortality and morbidity, I've seen I would have hoped that we looked at this immunoglobulin E, found the necessary sub type specific to spike protein and that would have been the best way to actually assess risk in patients as to who would progress into the second phase and take the necessary steps to avert that. So, the success I've had is solely because of education of patients so that they could understand when to come in for further treatment and of course the understanding of the perspective and the fact that we are dealing with their hypersensitivity pneumonitis, rather than a covid pneumonia and so to institute quick early list of treatment on that particular day. As to the vaccination campaigns that have arisen over the world, my initial publication was controversial for one simple fact. I t brought to light the fact that if we could curb all the mortality and morbidity with early treatment, it would completely negate the need for vaccinations. Natural immunity would be the way to herd immunity so we would have to treat people that got sick and they would develop natural immunity and as this spread,  we'd reach herd immunity and this virus would become endemic, and that would have been the ideal public health strategy but unfortunately vaccines have taken centre stage and I think they need to be put into context with all the work that's been going on around the globe and all the results and data that has been collected. Each country has started its vaccination campaigns at different points in time so we should look back at those who started early on and see how it is panned out and I think it's a good predictor for the future of those that have started late, and we should be very considerate of what we're trying to achieve with vaccinations itself. Now just to put into context vaccinations. Vaccines are to prevent infection and prevent transmission prevent being the most important word there, not decrease. So, the prevention of infection and transmission gives it a population or a group benefit so, if someone takes the vaccine and doesn't get infected or doesn't have the ability to transmit it, then they protect me by doing that. Now we've seen from around the world at the vaccines haven't been successful in preventing infection and transmission, and so we have yet to prove a group or population benefit to these vaccines. Now the claim around the world has been that the vaccine seemed to prevent Sevilla illness and death the prevention of severe illness and it is not a vaccine benefit, it is a therapeutic benefit and the medication or the medical intervention to a sick patient also prevents severe illness and death and so if we going to say that vaccines prevent severeness in death, they should be compared to treatment interventions not to vaccines, and the prevention of severe illness and death has not been proven by randomised clinical trials and that is something that we've seen has waned over the period following vaccinations. Now as well the prevention of severe illness and death, being a therapeutic intervention, we tend to use treatment strategies only on sick patients and so sick patients are the only ones exposed to side effects of such treatment interventions, however if the vaccine claims to prevent severe illness the data as a therapeutic intervention, that is exposing an entire population that's not unwell to the same side effects, and so, that that can be disastrous if we haven't really taken the time to understand those side effects in the long term effects of these vaccines but,  more importantly from a public health perspective, the prevention of severe illness and death if that occurs is an individual benefit, it has no group benefit, so if someone takes a vaccine, they supposedly will not get severely ill or die but, that has no benefit to me. That is an individual benefit and so being an individual benefits I don't see why I should be forced to take the vaccine to protect someone else. I don't see how that benefit is transferable so, I think the public health interventions in the mandating of vaccines don't make any sense. There is an illogic there that needs to be addressed. To put that into a layman's perspective to highlight what an individual benefit actually is, I think the analogy with skydiving is appropriate. When you skydive you take a risk, and you will get the benefit of that and of course it is your choice, and it does not have a benefit transferable to anyone around you. So, the risk and benefit are individual and so the choice should be individual. Now with the vaccines I've been told to skydive for the benefit of humanity or the person next to me so the community at large is asking how? How does this benefit the person next to me? I have a vested interest in the people around me and if I had someone could show me a benefit I would probably take the risk in skydive, because, it would benefit someone but please show me how it does this? Now that science has not come to the pool. What has transpired is that they've offered me a bear and a doughnut to jump. I don't need to be around or not I want to know how this works? Now we're getting to the point where I'm being threatened that I'll be pushed out of the plane if I don't jump. So unfortunately I've had to look very closely at what's being done and from looking closely at what's being done, the parachute on being provided doesn't look very safe, It's got a few more holes than I'd like to like to see in a parachute and of course when I look at the plane I see a few people having survived this jump and there are few dead bodies on the ground and when I enquire about it, I'm told not to look at it or they probably asleep. So, I think if I put you at the edge of a an aeroplane and gave you a leaky parachute with a few dead bodies on the ground, you two would be hesitant. So, I think the term Vaccines hesitancy is very well warranted and I think people need to be better educated and the people that punt these vaccines need to be willing to answer the questions around there. As far as the prevention of severe illness and deaths from what I've seen with my patients, we've got two things happening here. We've gotten exposure to spike protein supposedly, one thing to stimulate an immune response which will hold you in good stead when you expose to this virus, but of course spike protein is the allergen implicated in the hypersensitivity pneumonitis, and I think that the exposure to vaccines, rather than building him in decent immune response, is developing a measure of tolerance in the host. So like desensitizing to an allergen, vaccines are desensitizing us to the allergic invective spike protein and so when you are eventually exposed to spike protein through an infection you do not get severely ill or die, because you have a measure of desensitization because of exposure to this spike protein through the vaccine itself, however that exposure to the vaccine does not last and the desensitization does not last, so we’ve seen that over a period of  three of four months that claim of prevention of severe illness and death actually starts to wane and so booster comes necessary like you would in desensitization exposing your patient repeatedly to the same allergen to maintain that level of tolerance and so, we need to understand how these vaccines are working and use them appropriately. Is the measure of tolerance that it gives you worth the risk of the side effects that we would see and is this going to be something long term without any long-term data on safety and efficacy? So, I think the perspective of vaccination needs to be understood clearly and so we need to bring everyone to the table, and I have an open debate, understanding about what we're trying to achieve from a public health measure. So, the discrimination between vaccinated and un-vaccinated people is wholly logical and I think this has caused a lot of problems in society. It's going to be divisive, and we've got to look at the ethics around this.  From my perspective, I simply find that the travesty that occurs from a lack of informed consent is vitally important in this that is where all the human rights stem from and of course part of the informed consent is being told what you are giving and made to understand what you are giving, so if I had to look at this very broadly, due to the patents, no one knows what's in the vaccine and if you are not told what's in the vaccine every single person around the globe that's been vaccinated has had the informed consent violated, simply because they weren't informed about what was being injected into them. So, I think there's a legal aspect to this. There is agendas to this, but the science needs to come to the fore and the signs and the logic is what should drive us to the solution to this pandemic. I hope that calmness ensues, and logic ensues and a shine some light on where we go with this. I think that we've overestimated the pandemic and underestimate  the control by governments and other governing bodies and that needs to be readdressed there will be a silver lining in this cloud if we stand and stand for our rights and stand for the science to be explained and I think that's where we are as humanity on the brink of something new, hopefully something good for the future thank you for having me.

Iris Koh (Singapore) 

Thank you so much doctor chatty at really to have usually share your wide knowledge on this topic and so basically and think you're here are clearly like drifting there was any basis that actually, un-vaccinated people have 20 times more likely to spread the infection. Do you think that's so?

Dr Shankara Chetty: (Port Edward, South Africa)

No, I think that is very misleading when we talk of transmission and infection. These are broad topics that have a variety of factors that influence them, whether you have a high viral load or not, it is irrelevant if you are standing across the road from me. You can have a low viral load and be living in the same house and that will increase your ability to transmit this, so there's a wide diversity of factors that play a part in infection and transmission and that needs to be looked at in completion and so when judging vaccination, we shouldn't talk about decreases. Decreases doesn't matter it is only one factor. It is either you prevent it, or you don't, so decreasing transmission and decreasing infection actually means nothing. The aim is to prevent infection and prevent transmission not to decrease it. If you look at transmission, the ability of an infected person to transmit a virus is dependent on their viral load which initially rises to a peak and then as the immunity sets in, it decrease is so, the transmissibility is dependent on viral load and changes during the course of the illness so how do you gauge transmission of the virus when it changes constantly even in a single patient through the evolution of the illness itself. So, this is all or nothing there's no decrease in transmissibility. That occurs naturally once your immunities sets in and so it's dependent on when you actually gauge that transmissibility. So, it's either you able to transmit or you not. So, if you want to gauge the efficacy of a vaccine it is all or nothing. It cannot decrease the transmissibility of a virus that lends it to a lot of manipulation dependent on when you test the transmissibility or that decrease in transmissibility. So, I think the science needs to prevail, the people that are making these statements need to be called out and need to be willing to sit in a debate and justify what they are saying. I made a comment to the article that was published saying that a half-truth can be as dangerous as an outright lie from a social perspective so those tasked with informing the public need to speak the full truth and be willing to have all angles tested and all angles debated so that we get a good understanding of what we're trying to achieve here.

Iris Koh (Singapore) 

Thank you so much doctor Chetty