Covid19_Vaccine_News

Covid19_Vaccine_News

 

  • Tyranny: UK Won’t Accelerate Re-Opening Despite COVID Deaths Being Below Road Accident Fatalities
  • HAFHAF April 21, 2021
  •  

    A mysterious blood-clotting complication is killing coronavirus patients

    Once thought a relatively straightforward respiratory virus, covid-19 is proving to be much more frightening

    https://inltv.co.uk/index.php/truth-about-vaccines

    Assembling the COVID-19 5G Bioweapon Kill Grid

    Evidence claims that Chinese Military discussed coronaviruses as a bio weapon Part 1

    http://youtubeexposed.com/index.php/china-s-usa-takeover

    ‘Don’t-underestimate-number-vested-interest-in-COVID-19's-longevity.mp4

    There is no evidence that Wholesale Lockdowns

    reduce sickness and deaths from the alleged Covid-19 Virus

    https://inltv.co.uk/index.php/covid-5g-killinggrid

     

     
    https://humansarefree.com/2021/04/tyranny-uk-wont-accelerate-re-opening-despite-covid-deaths-being-below-road-accident-fatalities.html
     

    Despite new figures showing the daily number of COVID-19 deaths in the UK dropping below those from road accidents, the government is still refusing to accelerate the lifting of lockdown restrictions.

    The average number of daily deaths now stands at 25 a day with COVID cases dropping 94 per cent from the peak. On Monday, the UK recorded just four total deaths.

    tyranny uk won’t accelerate re opening despite covid deaths being below road accident fatalities

    “By comparison, the UK records an average of around five deaths from road accidents daily,” reports the Telegraph.

    The government has continually insisted it will prioritize “data not dates” in deciding when the measures should be relaxed, although that argument seems to immediately dissipate when the data favors re-opening quicker.

     

    “We’ve been told regularly, that we are following the data, not the dates, but sadly, it seems to be the other way around,” said Conservative MP Pauline Latham.

    “Derbyshire there are huge swathes of villages and towns, that have no Covid whatsoever, and that’s repeated over all sorts of areas of the country.”

    “We do need to start getting businesses back to normal. We need to get hospitality businesses fully functioning, and using their indoor spaces,” she added.

    Last week, Prime Minister Boris Johnson claimed that lockdown restrictions and not vaccine rates were to thank for the country’s plummeting COVID cases, despite data showing cases were already falling before each successive lockdown.

    Many took this as a sign that Johnson will be pressured into placing the country on lockdown yet again in the Autumn if there is another wave of the virus.

    The government’s timetable for re-opening promises an end to all restrictions and social distancing measures on June 21, although events are already planned after this date that will require limited attendance, social distancing and masks.

     

    Many fear that the restrictions will never truly be lifted given that the precedent has now been set that the state can place the entire population under de facto house arrest at the drop of a hat.

    Source: Summit.news

 

 

While YouTube has a right to reject some videos that are posted, does YouTube they have a right to censor material?

http://www.wikipediaexposed.org/covid19_vaccine_dangers.html

http://inltv.co.uk/index.php/covid-fraud

Welcome to The Vaccines Revealed Community..

Dr. Patrick Gebtempo-CEO of Revealed Films

Click the below link to Join The Vaccines Revealed Community

https://upvir.al/ref/zi52632830

 

Some Possible Side Effects of the Covid-19 Vaccine

 
 
There are more and protests around the world with protestors holdings protest signs such as:
STOP The Censorship of Discussion about Mandatory Vacccines
WE WILL NOT LIVE IN FEAR
FREEDOM IS ESSENTIAL
WAKE ......UP........ PEOPLE!!!!!
NO Censorship to Fake Media
NO Mandatory Vaccines
NO 5G Tracing of People
NO MORE LIES ABOUT COVID
NO W.H.O.= Bill Gates Dictatorship
Also see:
Covid19_Vaccine_Dangers (wikipediaexposed.org)
http://www.wikipediaexposed.org/covid19_vaccine_dangers.html
 
Coronavirus_Planned_Manmade? (wikipediaexposed.org)
http://www.wikipediaexposed.org/coronavirus_planned_manmade-.html
 
COVID-19 (wikipediaexposed.org)
http://www.wikipediaexposed.org/covid-19.html
 
Coronavirus-COVID-19 (wikipediaexposed.org)
http://www.wikipediaexposed.org/coronavirus-covid-19.html
 
 Coronavirus_USA (wikipediaexposed.org)
http://www.wikipediaexposed.org/coronavirus_usa.html
 
Coronavirus_Australia (wikipediaexposed.org)
http://www.wikipediaexposed.org/coronavirus_australia.html
 
Covid-19_Fake_Pandemic (wikipediaexposed.org) 
 http://www.wikipediaexposed.org/covid-19_fake_pandemic.html
 
Covid-19_Updates (wikipediaexposed.org)
http://www.wikipediaexposed.org/covid-19_updates.html
 
Covid-19_Surveillance (wikipediaexposed.org)
http://www.wikipediaexposed.org/covid-19_surveillance.html
 
5G_HealthRisks (wikipediaexposed.org)
http://www.wikipediaexposed.org/5g_healthrisks.html
 
Covid_19_News (wikipediaexposed.org)
http://www.wikipediaexposed.org/covid_19_news.html
 
 
HE WORLD MUST UNITE TO STOP THIS
 
A Father Speaks About Wifi in Schools and His Children's Health
 
 
 
'Australians must know the truth - this virus is not a pandemic-Alan Jones
 
 
 
Alan Jones explains that Sanjeen Sabhlock, resigned from his position as an economist at the Australian Finance and Treasury so be could speak out about what he describes as ..." very heavy handed lockdown tactics by the Victorian Government and the Australian Government have been like using a sledge hammer to swat a fly. Sanjeen Sabhlock went on to say that ...."... the so called COvid-19 Pandemic can not be anyway compared to the 1918 Spanish Flue Pandemic which killed around 50 million people when the population of the world as around 1.8 billion people... for the so called Covid-19 Pandemic to be compared to the 1918 Spanish Flue .... around 200 million people will have to have died from Covid-19 .... when the reality the official claimed statistics claim around 2 million people have died after being tested positive of some type of Coronavirus...."
 
Discussion with Dr. Judy Mikovits and D. Rashid A. Buttar - Part 1 of 4

Dr Jeffrey I Barke Speaks Out On COVID 19 Madness

What if the experts are wrong?

Welcome to The Vaccines Revealed Community..

Dr. Patrick Gebtempo-CEO of Revealed Films

We have a very critical next step for you. Right now censorship of open discussion and debate about Covid-19 Coronavirus and the possible dangers and side effects of the Covid-19 Vaccines is at an unprecedented high level. Getting this information out is getting more and more difficult. We get cut off at every turn. There is the Big Tech Companies such as FaceBook. YouTube and Twitter that are conspiring to limit this information being freely available to the general public.

The only way we can get this information to the world is through you - the good old fashioned personal referral method through people who care about a subject who communicate with each other sharing information with each other.

So I have a very big ask here. I want you to join our every growing Vaccines Revealed Community and mission to help to share this information with the world. It is very simple for you to share this link

Click the below link to Join The Vaccines Revealed Community

https://upvir.al/ref/zi52632830

This is a major event. We are going to face many adversaries. The last time we tried to do this years ago we were shut down right on the launch time. They attacked our servers. They shut us down. Now we are trying to get these emails out and trying to host the videos ect. We will likely to be shut down as every turn by the big tech companies such as FaceBook, YouTube and Twitter.

You are the person who cares about this critical topic that can share this information.

I thank you in advance that you will register for this video and will share this important information with others. So welcome and thank you.

Dr Rashid A Buttar, FAAPM, FACAM, FAAIM
www.AdvancedMedicine.com
This email address is being protected from spambots. You need JavaScript enabled to view it.
Center for Advanced Medicine, 170 Medical Park Road, Suite 210,
Mooresville, NC 28117, United States

Click the below link to Join The Vaccines Revealed Community

https://upvir.al/ref/zi52632830

 

5G Installer Finds Cov-19 Written On Inside Of 5G Circuitry

Plandemic_Documentary_Hidden Agenda-behind-COVID19-P1

DrJudyMikovits

Plandemic_Documentary_Hidden Agenda-behind-COVID19-P2

DrJudyMikovits

 

DR.A. RASHID BUTTAR EXPOSES FAKE NEWS-Part 1 of 3

Dr Aajonus Vonderplanitz talks viruses and swine flu

 

Covid19 Vaccine Not A Vaccine, DR. DAVID-MARTIN

 

The mRNA COVID Vaccine is NOT a Vaccine

The mRNA COVID Vaccine is NOT a Vaccine

Freedom Articles- January 14, 2021

By Makia Freeman

AT A GLANCE...

  • THE STORY:

The new mRNA COVID vaccine deployed by Moderna and Pfizer is not what you think. It's not a vaccine.

  • THE IMPLICATIONS:

These so-called vaccines are chemical devices that make you sick, operating systems that reprogram your DNA forever, and much more.

NOT a Vaccine: the mRNA COVID vax is a chemical pathogen production device and a technocratic, transhumanistic tool to reprogram you. Image credit: Jordan Henderson

 

 It’s NOT a vaccine. The mRNA COVID vaccine

now being militarily deployed in many nations around the world, is NOT a vaccine. I repeat: it is not a vaccine. It is many things indeed, but a vaccine is not one of them. We have to awaken to the fact that the COVID scamdemic has rapidly accelerated the technocratic and transhumanistic aspects of the New World Order (NWO) to the point where people are blindly lining up to get injected with a “treatment” which is also a chemical device, an operating system, a synthetic pathogen and chemical pathogen production device. As covered in previous articles, this new COVID vax is a completely new kind of technology, potentially even more dangerous than your average toxic vaccine. In this article, we will explore in more depth what this mRNA vaccine is.

Doctors David Martin and Judy Mikovits Expose How So-Called COVID Vaccine is Not a Vaccine

Listen to this short excerpt featuring doctors David Martin and Judy Mikovits (who have both been very outspoken thus far in exposing the COVID plandemic) who are speaking with Robert Kennedy Jr. and lawyer Rocco Galati, who is representing a Canadian freedom group suing the government for the entire COVID scam. David Martin makes some extremely important points about how we can’t accurately label the device Moderna and Pfizer are pushing as a vaccine, because both medically and legally, is not a vaccine:

“This is not a vaccine … using the term vaccine to sneak this thing under public health exemptions … This is a mRNA packaged in a fat envelope that is delivered to a cell. It is a medical device designed to stimulate the human cell into becoming a pathogen creator. It is not a vaccine! Vaccines actually are a legally defined term … under public health law … under CDC and FDA standards, a vaccine specifically has to stimulate both an immunity within the person receiving it, but it also has to disrupt transmission … They have been abundantly clear in saying that the mRNA strand that is going into the cell is not to stop transmission. It is a treatment. But if it was discussed as a treatment, it would not get the sympathetic ear of public health authorities, because then people would say “What other treatments are there?”

The use of the term vaccine is unconscionable … because it actually is the sucker punch to open and free discourse … Moderna was a started as a chemotherapy company for cancer, not a vaccine manufacturer for SARS … if we said we’re going to give people prophylactic chemo for the cancer they don’t have, you’d be laughed out of a room, because it’s a stupid idea. That’s exactly what this is! This is a mechanical device, in the form of a very small packet of technology, that is being inserted into the human system to activate the cell to become a pathogen manufacturing site.

The only reason why the term [vaccine] is being used is to abuse the 1905 Jacobsen case that has been misrepresented since it was written. If we were honest with this, we would actually call it what it is: it is a chemical pathogen device, that is actually meant to unleash a chemical pathogen production action within the cell. It is a medical device, not a drug, because it meets the CDRH [Center for Devices and Radiological Health] definition of a device.

It is made to make you sick … 80% of the people who are exposed to allegedly the virus [SARS-Cov-2] have no symptoms at all … 80% of people who get this injected into them have a clinical adverse event. You are getting injected with a chemical substance to induce illness, not to induce a[n] immuno-transmissive response. In other words, nothing about this is going to stop you transmitting anything. This is about getting you sick, and having your own cells be the thing that get you sick.”

Judy Mikovits also chips in with this:

“It’s a synthetic pathogen. They’ve literally injected this pathogenic part of the virus into every cell of the body … it can actually directly cause multiple sclerosis, Lou Gehrig’s disease, Alzheimer’s disease … it can cause accelerated cancer … that’s what the expression of that piece of virus … has been known to do for decades.”

The mRNA vaccine operating system “software of life”. Image credit: Moderna 

COVID Vaccine is an Operating System, Says Moderna

The COVID mRNA Vaccine is an operating system which can program your DNA, and therefore program you, at your core essential blueprint level. Is this an exaggeration? No it’s not. Moderna states on their website that their mRNA technology platform is a “software of life” and “functions very much like an operating system on a computer.” This is straight from their website:

“It is designed so that it can plug and play interchangeably with different programs. In our case, the “program” or “app” is our mRNA drug – the unique mRNA sequence that codes for a protein.”

The Game Plan: Making Every Human into a Digital Node on the Control Grid

We are fast moving into the world of transhumanism, where our natural biological bodies are hijacked and infiltrated with synthetic parts, starting at the nanoparticle level. The NWO controllers want to download some kind of Microsoft office system or software into your body and brain, and hook you up to the JEDI and/or Amazon-CIA cloud, so they can have direct access to your brain. Then, they can roll out “vaccines” which are not vaccines to continually update you, just like computer software gets regular updates. Viruses, real or not, and vaccines, real or not, are just means to achieve this goal.

Turning Humans into Commodities via Social Credit Currency

Alison McDowell sums up the current transhumanistic NWO path of highest probability below, which involves social credit, 5G, the Smart Grid and AI to induce planetary-wide compliance:

“Within the tech-no-logic system, total compliance will be demanded. Approved behavior becomes currency, tokenized on blockchain and monitored by sensors and AI. They are training us for a future where we compete with one another to see who is the best behaved, the most docile. Surviving will mean conforming to the strident terms of psychopathic financial agreements. To obtain the data needed to verify claims embedded in twisted “pay for success” deals, our mother, the earth, must be remade as a geo-fenced digital prison using 5G and satellite constellations. All of your data will be added to your “permanent record” to evaluate your value as human capital for investor portfolios. The billionaires envision a future where freedom is a privilege limited to themselves, their functionaries, and the robots they control. Be assured AI is already keeping tabs, and social credit scoring is well underway.”

It is a grim future, however it is not set in stone. I agree wholeheartedly with McDowell that we do NOT have to accept this as our fate or experience such a painful timeline IF we can wake up quickly and change. However, we must first accept this is the probable path we are on. Like it or not, this is the current trajectory. How do we change it? Firstly by looking within. To change ourselves, we must change our inner world and change our perception, and so therefore change our reality:

“This planned future, however, is NOT preordained. Totalitarian transhumanism is not a foregone conclusion. Trudell’s remedy? Change our perception of reality through active non-cooperation. Manifest in our hearts, minds, and actions the world we desire. Where they engineer disconnect, RECONNECT with intention; not only with one another, but with ALL our relations and the land and the spiritual beings that exist beyond our senses. We must synchronize to change the vibrational reality, and that power exists within us as children of the earth.”

This is not airy-fairy talk, but rather a realization that we are participating in co-creating a nightmare world by allowing our perception to be programmed to bring about the NWO. They are using our energy to do it! To reclaim our sovereignety, we must reclaim our perception by breaking down the programming that was inserted into us.

Final Thoughts: A Technocratic, Transhumanistic Tool

It is vital to know, and to tell others, that the current mRNA COVID vaccine is not a vaccine. This is not just because calling it a vaccine gives Big Pharma legal immunity from damages, but also for all the reasons listed above. These devices are designed to reprogram you at the fundamental level. They are not vaccines, they are not drugs, and in my opinion, they are not treatments or medicine. As scary as these terms are, I would go beyond just calling them chemical devices, operating systems, synthetic pathogens and chemical pathogen production devices, which are already illuminating terms and horrible enough. I would call them technocratic, transhumanistic tools to permanently change your genetics and transform you into a synthetic human. They are symbolic of just how swiftly the NWO agenda is being made manifest in our physical reality, and hopefully a wake-up call to everyone to strive harder to stop this dark, nefarious agenda while there is still time.

* [1] This video credit:link here

 

COVID: The Virus That Isn’t There: The Root Fraud Expose

https://www.lewrockwell.com/2020/10/jon-rappoport/covid-the-virus-that-isnt-there-the-root-fraud-exposed/
LewRockwell.comanti-state•anti-war•pro-market

 

Science is not assumptions.

The pandemic is a fraud, down to the root of the poisonous tree.

Reprinted with permission from Jon Rappoport’s blog.

Codex Alimentarius Nutricide

Criminalizing Natural Health, Vitamins, and Herbs

May 14, 2009

This is the first part of a series of talks by Dr. Rima Laibow MD

exposing the serious dangers of The Codex Alimentarius, or "Food Code" created by the World Health Organisation (WHO)

 


 

This is the second part of a series of talks by Dr. Rima Laibow MD

exposing the serious dangers of The Codex Alimentarius, or "Food Code" created by the World Health Organisation (WHO)

 

 

This is the third part of a series of talks by Dr. Rima Laibow MD

exposing the serious dangers of The Codex Alimentarius, or "Food Code" created by the World Health Organisation (WHO)
 

This is the fourth part of a series of talks by Dr. Rima Laibow MD

exposing the serious dangers of The Codex Alimentarius, or "Food Code" created by the World Health Organisation (WHO)
 

This is part five of a series of talks by Dr. Rima Laibow MD

exposing the serious dangers of The Codex Alimentarius, or "Food Code" created by the World Health Organisation (WHO)
 
 
 

The Codex Alimentarius is a threat to the freedom of people to choose natural healing and alternative medicine and nutrition. Ratified by the World Health Organization, and going into Law in the United States in 2009, the threat to health freedom has never been greater. This is the first part of a series of talks by Dr. Rima Laibow MD, available on DVD from the Natural Solutions Foundation, an non-profit organization dedicated to educating people about how to stop Codex Alimentarius from taking away our right to freely choose nutritional health

 

http://inlnews.com/CodexAlimentarius.html

 

Meet Rima E. Laibow, M.D. :: Dr. Rima Truth Reports

drrimatruthreports.com/aboutus/meet-rima-e-laibow-md

Meet Rima E. Laibow, M.D. Rima E. Laibow, M.D. is the Medical Director of the Natural Solutions Foundation. She is a graduate of Albert Einstein College of Medicine (1970) who believes passionately in the right every American to choose a personal health path that is free of government or corporate interference. The Dr. Rima Network for The Dr ...

The Codex Alimentarius is a threat to the freedom of people to choose natural healing and alternative medicine and nutrition. Ratified by the World Health Organization, and going into Law in the United States in 2009, the threat to health freedom has never been greater. This is the first part of a series of talks by Dr. Rima Laibow MD, available on DVD from the Natural Solutions Foundation, an non-profit organization dedicated to educating people about how to stop Codex Alimentarius from taking away our right to freely choose nutritional health

http://inlnews.com/CodexAlimentarius.html

 

'Australians must know the truth - this virus is not a pandemic-Alan Jones

 

 Dr. Cameron Kyle-Sidell, a Brooklyn doctor, and other doctors have suggested, in some cases, conventional ventilator protocols may be doing more harm than good.
The wrongful use of ventilators may cause death of a patient rather than saving the life of a patient, 70-80% of people put on ventilators die. 
 
Thank You Andrew!
I first came across this video of Cameron yesterday when a scientist and good friend of mine sent me the link. I was so impressed with Cameron’s point of view that I posted here on Medium earlier today, then I did a search on Medium for Cameron’s name and saw your post.
 

COVID-19 treatment changes

Andrew T

Andrew T - Apr 19, 2020

Dr. Cameron Kyle-Sidell, a Brooklyn doctor, and other doctors have suggested, in some cases, conventional ventilator protocols may be doing more harm than good. Several media outlets (WLNYNYTDaily Mail) have reported on this. These changes are beginning to be adopted but they are not widely accepted and challenge current medical conventions. I will try to explain the changes in lay terms.

COVID-19, in serious cases, causes pneumonia (an infection that inflames lungs) and can lead to ARDS (acute respiratory distress syndrome). ARDS is not a disease. It’s a syndrome that is a collection of symptoms that occur together. One of the symptoms of ARDS is hypoxemia (low levels of oxygen in the blood). Since your organs require oxygenated blood, hypoxemia can lead to death.

Several doctors have observed that COVID-19 doesn’t cause typical ARDS. In typical ARDS, patients with very low blood oxygen levels are often put on ventilators. The ventilator uses pressure to force oxygen into the lungs and bloodstream. This is done because the lung muscles have or will tire out from labored breathing (tachypnea). However COVID-19 patients with severe hypoxemia often have lung muscles that are functioning and compliant, which is atypical. Putting a patient on a ventilator has always been considered a last resort because it can cause lung damage. However, the change is what is considered a last resort. Hypoxemia (very low blood oxygen level) is typically considered a signal that the patient is in need of a ventilator. That is the convention that is being challenged. The change is to delay putting the patients on a ventilator with extremely low levels of oxygen in their blood. Then use other existing ARDS treatments, such as giving them oxygen and proning (lying the patient face down). The intuition and anecdotal evidence is that patients that might have been intubated from following conventional protocols are recovering from hypoxemia without being intubated.

Another change is if a patient does require being put on a ventilator that they use lower pressure and more oxygen. The concern is that the pressure is causing lung injury. It is widely reported that most COVID-19 patients that go on ventilators die.

There are other doctors that have made some of the same observations including Dr. David Farcy, the President of AAEM (American Academy of Emergency Medicine) and Dr. Gattinoni, an authoritative ARDS researcher. In a recently published editorial Gattinoni states:

However, the patients with Covid-19 pneumonia, fulfilling the Berlin criteria of ARDS, present an atypical form of the syndrome. Indeed, the primary characteristics we are observing (confirmed by colleagues in other hospitals), is the dissociation between their relatively well preserved lung mechanics and the severity of hypoxemia.

Gattinoni recently gave further guidance on treating COVID-19 and reasserted:

COVID-19 pneumonia is a specific disease with peculiar phenotypes. Its main characteristic is the dissociation between the severity of the hypoxemia and the maintenance of relatively good respiratory mechanics.

The changes to ventilator protocols are controversial because they challenge existing medical thinking and are not backed by clinical trials.

 

Health, Hope, Healing…

http://drrimainstitute.com/

Rima E. Laibow, M.D. is a graduate of Albert Einstein College of Medicine (1970) who believes passionately in the right of Americans to choose their own health paths. She has practiced drug-free, natural medicine for over 40 years by seeking the underlying cause of every illness and ailment and treating that root cause.

She believes in using nutrients and other natural options to find, define and treat the problems which underlie degenerative, chronic diseases and poor aging while supporting the immune and other crucial systems. She has enjoyed remarkable success with a wide assortment of cataclysmic problems.

Dr. Laibow is the Founding and past President of the NeuroTherapy Certification Board, which she helped establish, in order to strengthen and develop the field of NeuroBioFeedback and bring it into wide-spread use as a powerful, non-toxic tool for modern medicine.

Because of Dr. Laibow’s awareness of the powerful natural, non-toxic options available to treat the underlying cause of disease she is focused on maintaining these choices for all Americans. Based on her understanding of the impact of poor nutrition and chemical/pesticide toxicity on the declining health of America, Dr. Laibow is determined to help Americans maintain the choices that allow them to protect themselves from disease and toxic harm.

Dr. Rima E. Laibow, MD
International Medical Director


The Dr. Rima Institute serves people seeking robust well-being and dynamic health.  Our patients come from all over the world.  We provide unique, drug-free protocols to deliver information, nutrients and energy to assist in gaining, or regaining health. 

We help detoxify the body, return the body to normal structure and function and detoxify recent or long-term toxins which are reducing optimal function. We use a variety of modalities, all of which are non-toxic, drug-free, to support robust, vigorous heath and function. Health restoration, rejuvenation and preventive protocols are areas of significant focus for us – and for our patients.

Our practitioners are experienced, sensitive and true healers, chosen for their ability to bring health and healing to our patients.  The Dr. Rima Institute offers advanced, world class therapies that may benefit both the client’s short- and long-term quality of health, life and well-being. The Institute’s Advanced Health Care Consulting Service allows people world-wide to benefit from Dr. Rima’s expertise as a world-class environmental physician and psychiatrist.

Our services are available, as appropriate, through internet consultation and in person when in Santiago de Chile.
 
Facilities offering top quality care for the management and cure of life-threatening illnesses, rejuvenation and longevity, and for preventive care, are rare. Where they exist, however, they provide significant opportunities for practitioners, for patients and for investors.


No first class destination medical/dental tourism facilities exist in Chile and very few exist in the rest of South and Central America.

The Big Picture ? "The end goal is to get everybody chipped, to control the whole society, to have the bankers and the elite people control the world."Nick Rockefeller quoted by Aaron Russo in this interview.

It's not about more power, it's not about more money, it's about the survival of the elite pyramid

Several years ago, after his popular video Mad As Hell was released and he began his campaign to become Governor of Nevada, Russo was noticed by Rockefeller and introduced to him by a female attorney. Seeing Russo's passion and ability to affect change, Rockefeller set about on a subtle mission to recruit Russo into the elite's CFR (Council of Foreign Relation) organization. Aaron Russo, the famous Film Maker of Trading Places starring Eddy Murphy, also made a film called "America: Freedom To Fascism"

http://inlnews.com/CodexAlimentarius.html

Codex Alimentarius Commission (CAC)

http://www.fao.org/fao-who-codexalimentarius/committees/cac/about/en/

The Codex Alimentarius Commission or CAC is the body responsible for all matters regarding the implementation of the Joint FAO/WHO Food Standards Programme. Membership of the Commission is open to all Member Nations and Associate Members of FAO and WHO which are interested in international food standards.

The Commission meets in regular session once a year alternating between Geneva and Rome.

The programme of work of the Commission is funded through the regular budgets of WHO and FAO with all work subject to approval of the two governing bodies of the parent organizations. 

The Commission works in the six UN official languages.

Copied in the 5th century, Codex Alexandrinus is one of the three early Greek manuscripts that preserve both the Old and the New Testaments together. Its name ('Book from Alexandria') derives from the city of Alexandria in Egypt, where it was preserved before the Greek Patriarch of Alexandria, Cyril Lucar (d.

The 18th session of the Codex Alimentarius Commission, held in 1989, agreed to establish a new Coordinating Committee for North America and the South West Pacific, bringing together, in the words of the New Zealand delegation "far flung countries ... which have many common interests".

CCNASWP is a remarkably diverse region combining fully mature economies such as the USA, Canada, Australia and New Zealand with 10 small island states. The largest of these is Papua New Guinea (population over 7 million) and the smallest, the Cook Islands and Nauru with populations of around 10 000.

The regional coordinator is based within the Fijian Ministry of Agriculture.

Fiji looks forward to applying standards at the national level and supporting all countries in the region, especially the small island developing states, to establish a sound policy framework for food safety. These initiatives will support improvements in public health, ensure that imported food is safe and of the expected quality and develop increased access to international markets.

The regional coordinator will continue supporting work on regional standards and seeks to strengthen participation of the region in Codex in general. This can be achieved by continuing to develop capacity at the national level by enhancing the role of national coordinators and contact points for increased and effective participation in Codex

The Codex Alexandrinus (London, British Library, Royal MS 1. D. V-VIII; Gregory-Aland no. A or 02, Soden δ 4) is a fifth-century Christian manuscript of a Greek Bible, containing the majority of the Greek Old Testament and the Greek New Testament. It is one of the four Great uncial codices…..

The Codex Alexandrinus (London, British Library, Royal MS 1. D. V-VIII; Gregory-Aland no. A or 02Soden δ 4) is a fifth-century Christian manuscript of a Greek Bible, containing the majority of the Greek Old Testament and the Greek New Testament. It is one of the four Great uncial codices. Along with the Codex Sinaiticus and the Vaticanus, it is one of the earliest and most complete manuscripts of the BibleBrian Walton assigned Alexandrinus the capital Latin letter A in the Polyglot Bible of 1657. This designation was maintained when the system was standardized by Wettstein in 1751. Thus, Alexandrinus held the first position in the manuscript list.[4]

It derives its name from Alexandria where it resided for a number of years before it was brought by the Eastern Orthodox Patriarch Cyril Lucaris from Alexandria to Constantinople. It was given to Charles I of England in the 17th century. Until the later purchase of Codex Sinaiticus, it was the best manuscript of the Greek Bible deposited in Britain. Today, it rests along with Codex Sinaiticus in one of the showcases in the Sir John Ritblat Gallery of the British Library. A full photographic reproduction of the New Testament volume (Royal MS 1 D. viii) is available on the British Library's website. As the text came from several different traditions, different parts of the codex are not of equal textual value.

 

FLOURIDE AND DEMOCRACY

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    The history of the fluoridation of water supplies and the dental benefits are open to much scrutiny.According to the Independent newspaper in Hervey Bay on 24/1/13,a leading doctor for the state of Queensland stated

“it is the safest and most effective way of improving the dental health of Queenslanders”.

I would like to challenge this assertion with a litteny of facts which raise concerns for not only the dental health benefits,but health in general as a direct result of fluoridation.

Fluoride comes in many forms,and is in fact not registered on the periodic table which classifies chemical substances.The “name” fluoride,can refer to many various substances-calcium fluoride,sodium fluoride,hydrogen fluoride,lead fluoride,aluminium fluoride, but to name a few.The important thing to remember is that in whatever form a substance takes to use the term fluoride,it is a combination of chemical compounds and substances.

The only naurally occurring fluoride is calcium fluoride(CaF2),which occurs naturally in water but is not soluble.It is not added to our drinking water,and in fact it is illegal to do so.      

Sodium Fluoride is the name given to  inorganic chemical compounds(NaF).This is what is added to our water.It is soluble and therefore dilutes in water.The additive in our water in Hervey Bay is Sodium Fluoride in the form of “fluorosilicic acid”.

Just to clarify further,Sodium Flouride can be in two forms-Pharmaceutical grade,and Industrial grade.As you would expect,Pharmaceutical grade refers to a controlled combination of substances.Think of men in white coats,beakers,bunson burners and the like.

Industrial grade Sodium Flouride is another matter.As flourosilisic acid(H2SiF6),this industrial grade of sodium fluoride is what we are drinking.Where does it come from?It comes from industry as a bi-product(waste) from several industries-Fertilizer,Aluminium,and Weapon manufacturing to name a few!It is not treated/sterilized/processed before being added to our water.

This additive comes from an industrial process which results in a waste product that is then sold to municipal councils so it can be disposed of in-wait for it-HUMAN BODIES!! The majority of fluoride ends up down our drains,on our garden,and in our food production.

“Fluoride” is a misnomer-there is no such substance listed in the periodic tables as stated earlier,instead we find a gas called Fluorine.The use of this gas in various industries listed above results in certain toxic byproducts which are created in these processes.One such toxic byproduct is called Sodium Fluoride,and it has to be one of the most remarkable substances ever produced.Here are some of its applications-

*Major additive in rat and cockroach poisons

*active ingredient in toothpaste

*ingredient in anesthetics, and hypnotic, psychiatric drugs such as Prozac

* ingredient in sarin nerve gas

*additive in drinking water to alleviate tooth decay

 

Getting interesting,isn’t it!

Fluorine gas is one of the most active,most aggressive,reactive elements in the periodic table.In other words,it is a very dangerous,toxic substance.

Fluoursilisic acid therefore is a chemical cocktail from industrial manufacturing processes which originate from a gas that is extremely dangerous and toxic.

I HAVE ONLY ONE QUESTION-WHAT IS IT DOING IN OUR WATER SUPPLIES!!

Amongst the chemicals found in Fluorocilicic acid,we find the following:

*Cadmium

*Arsenic

*Mercury

*Lead

*Sulfates

*Phosphates

*Radionulides(radioactive particles)

How did this substance ever get to be added to our drinking water?Lets get a history lesson which will clarify the matter.After the second world war aluminium production took off in a big way in America.But this  industry had many problems.One of these was an increasing number of health problems from people living near these plants.Fluorine emissions in particular caused many people to lodge court cases against these plants(Alcoa),and most of these were settled out of court.An Alcoa chemist,Gerald J Cox,proposed that Fluoride waste helps dental health and it should be added to drinking water.This was in 1939.Studies conducted to investigate a relationship between dental health and fluoride were financed by the fluoride producing industries.It is not surprising then that a favourable relationship was established. America started fluoridation of its water supplies with waste chemicals from industry!Fluorosilicic acid is composed of tetrafluorosilicate gas and other species of fluorine gases captured in pollution scrubbers and concentrated into a 23% solution during wet process phosphate fertilizer manufacture.Generally,the acid is stored in outdoor cooling ponds before being shipped to local councils to artificially fluoridate drinking water.Fluoridating drinking water with recovered pollution is a cost effective means of disposing of toxic waste.The fluorosilicic acid would otherwise be classified as a hazardous toxic waste on the Superfund Priorities List(USA) of toxic substances that pose the most significant risk to human health and the greatest potential liability for manufacturers.During the 1960s,there became a shortage of sodium fluoride from the aluminium industry,and with the help of the EPA(Environmental Protection Agency) in America,fluorosilicic acid was transformed from a concentrated toxic waste and a liability into a “proven cavity fighter”.The EPA and the US Public Health Service waived all testing procedures and-with the help of the American Dental Association(ADA)-encouraged cities to add the radioactive concentrate into America’s drinking water as an “improved” form of fluoride!We here in Australia are upholding this HERE IN HERVEY BAY!!The first three cities to be fluoridated in America were Grand Rapids,Michigan,Newburgh,NY,and Evanstan,Illinois in 1950.

What is the process in Australia?Well it appears we the people have no say in the fluoridation,or mass medication through our water supplies.Local councils are informed by state governments that fluoridation is to occur.No consultation whatsoever is sought between you and I as to whether we would like to be medicated.State governments advise councils that on a certain date fluoride will commence,and that all the infrastructure necessary to implement this will be installed at the water treatment plant by this date.The only choice open to a council is who will pay for this installation?Accept the state governments offer,and there will be no expence incurred to local council.If a council rejects the proposal,the state government will install this infrastructure anyway,then bill that council for the cost.There is absolutely no discussion on the merits of fluoridation,just an acceptance that this practice is beneficial to ones dental health.Recent changes have been implemented in Australia that now give local councils the ability to repel fluoridation ,and therefore remove it from our water supplies.Cairns have acted on this change in policy,and have decided to cease fluoridation.Hervey Bay Council has announced it is to continue fluoridation,once again doing so with no consultation with you and I.Read on to see why we should all be concerned with there decision.It should be noted that ALL maintenance to fluoridate our water supply is at the expence of the Hervey Bay council,and ultimately,ratepayers!

 

       HEALTH CONCERNS FOR FLUORIDATION OF WATER SUPPLIES

As is all the information herein,none of this information is based on my opinions only,they are all based on freely available FACTS.Do your own research and then make your own mind up as to the course of action you and your family are willing to take.From hereon,I will refer to our fluoride additive in Hervey Bays water(fluorosilicic acid) as SF.

The two ways we apply SF :

SYSTEMIC refers to ingestion through water,and

TOPICAL,as in external application from toothpaste.

The Centers for Disease Control and Prevention(USA) has now acknowledged that the mechanism of fluoride’s benefits are mainly topical,not systemic.There is no need whatsoever,therefore to swallow fluoride to protect teeth.  

If you look into toothpaste with SF,there is a warning about ingesting toothpaste,particularly for the young.

Ingesting SF is a practise that has spawned a pandoras box of cricisim which governments and most dental practitioners ignore.

 

*SF, when ingested at ANY LEVEL acts as a neurotoxin which directly affects the pineal gland in the brain as well as the central nervous system.The Pineal gland is a pine cone shaped gland of the endocrine system.It is situated near the center of the brain,between the two hemispheres.It is also known as the third eye.Functions of this gland include-secretion of the hormone melatonin

                             -regulation of endocrine functions

                             -conversion of nervous system-endocrine system signals

                             -causes feeling of sleepiness

                             -influences sexual development

SF has been proven to infiltrate the blood-brain barrier,and therefore affects and accumulates in the pineal gland.It causes calcification of this gland.Brain studies indicate SF can lower IQ’s,promote lethargy,apathy,and in addition it directly has a negative affect on our thyroid gland.If you look up treatment for hypothyroidism(over active thyroid),you will find one treatment is to administer fluoride tablets!In other words,this treatment verifies that SF reduces the thyroid production of hormones.

Dr Pyyllis Mullenix,an EPA toxicologist in a review in 1995 noted that fluoride has been listed among 100 chemicals for which there is “substantial”evidence of developmental neurotoxicity.In total,there have now been over 100 animal experiments showing that fluoride can damage the brain and impact learning behaviour.Dr Mullenix was fired from her position as Chair of Toxicology at Forsythe Dental Center for publishing her findings on fluoride and the brain.

                                                   

*SF is a great concern when you ingest as heated or boiled water.As water is boiled,steam is produced,which therefore increases the proportionate amount of SF in the water.Every time you make a cup of tea or coffee for example,you are receiving additional parts per million of SF through the water.The major concern with this fact is in bottle fed babies-baby formula made with fluoridated tap water.Mothers milk has 0.004% fluoride which occurs naturally .When a mother makes her baby formula with fluoridated water,300% more fluoride is consumed by that baby .The American Dental Association distributed a November 6,2006 email alert to its members recommending that parents be advised that baby formula should be made with “low or no fluoridated water” due to findings that it would cause dental fluorosis later in life!!Unfortunately,the ADA has done little to get this information into the hands of parents.WE HAVE DONE THE SAME HERE IN AUSTRALIA.

*The EPA(Environmental Protection Agency)in America warns to keep toothpaste away from children under 6 years of age.If swallowed,they recommend to contact the poison control center,or seek medical advise.

*There are links to bone cancers,athsma,kidney damage and brain damage as stated previously-In 2000 the senior vice president of the EPA in America recommended a study be done “to investigate the cancer link between water fluoridation by the addition of fluorosilicic acid or sodium silicoflouride(another additive from industry) in the water.He recommended toxicity studies be undertaken.This has not been implemented.

*Two reasons given for fluoridation are the reductions of both tooth decay and fluorosis(pitting or discoloration of tooth enamel).It is a fact that both these major reasons are false.The rates of fluorosis have increased in every area that fluoridation has been done.In America 41% have fluorosis,NZ 30%.Tooth decay has not reduced as a result of this process.Without getting into a discussion into the merits of this assertion,I will point out a few facts :

      -The WHO(world health authority)statistics report that the rates of tooth decay       

        have been declining between 1970-2010  at the SAME RATE in               

        fluoridated or unfluoridated countries.In other words,there is no evidence that

        fluoridation is effective in lowering tooth decay!

      -Information from Colgate states that fluoride “is a naturally occurring element

        that strengthens teeth”,and that “fluoride that is swallowed enters the

        bloodstream and becomes part of the permanent teeth as they develop”.Why

        then have we not seen a decrease in dental cavities and fluorosis in fluoridated

        area’s that surpass the unfluoridated area’s?

*The Center for disease control in America reported in 2005 that fluoridation caused irreversible discoloured teeth in 33% of children

*National academy of sciences USA reported that fluoridation is:

      -a potent hormone disruptor which affects teeth,bones,thyroid,lowers IQ,

       especially in children.

*Bob Canton,a former EPA scientist in USA stated Fluoride  “is a cumulative

  poison”,which leeches into our bones and pineal gland in particular.

*Since 1994,six studies have shown adverse affects on the brain from fluoridation in drinking water,even at optimal levels of 1 part per million.Symptoms found included hyperactivity,autism,ADHD to name but a few.

*In 1990,Dr William Marcus,senior scientist at EPA(US),was fired for exposing a coverup in a government study showing clear evidence that fluoride causes cancer.

In 1992 Dr Marcus was vindicated when an Administrative court Judge, David A Clark ordered the EPA to give him back his job-EPA then shredded all documents relating to the information which Dr Marcus exposed.

*Paul Connett PhD,is a noted advocate of the anti fluoride movement.He states that fluoride is a poor medical practise in that you cannot control the amount of SF which individuals may ingest.He also states that there is no such thing as a LACK OF FLUORIDE.No doctors monitor us for fluoride levels,and they are certainly not trained to look for any symptoms of fluoride toxicity.Due to the method governments use when adding fluoride to our water,we are deprived of our right to INFORMED CONSENT TO MEDICATION.No government should force medications on populations,especially for a NON-CONTAGIOUS,NON-LIFE THREATENING DISEASE!!!

*Going back to the article in the Independent Newspaper,we were told that there was “no evidence to show fluoride,in the amounts used in water supplies has any detrimental health effects”.This I absolutely agree with.The reason why I agree is because in all countries who fluoridate their drinking water there has never been a study done regarding health effects from ingesting industrial grade SF.All countries that fluoridate have never done any testing on SF,except for Pharmaceutical grade,WHICH IS NOT PERMITTED BY LAW TO BE PUT IN OUR WATER!!

 

*Put simply,SF is not necessary.Most industrialized countries have rejected water fluoridation,but have nevertheless experienced the same decline in childhood dental decay as fluoridated countries.(once again-according to WHO).

 

*                             THE WORLD AND FUORIDATION

-97% of Western Europe has rejected,banned or stopped fluoridation

-Only 5% of the worlds population is fluoridated

-The Danish Minister of Environment recommended against fluoridation in 1977

  because ‘no adequate studies had been carried out on its long-term effects on

  human organ systems other than teeth and because not enough studies had been

  done on the effects of fluoride discharges on freshwater ecosystems’.Here are just

  some of other countries fluoridation stances:

-China         Banned‘not allowed’.

-Austria       Rejected:Toxic fluorides not added

-Belgium     Rejected:encourages self-determination,those who want fluoride

                     should get it themselves

-Finland      Stopped-do not favour or recommend fluoridation of drinking water.

                    A recent study found no evidence that cavities are increasing

-Germany    Stopped.Study has found no evidence of cavity increases

-Denmark    Rejected-toxic fluorides have never been added to the public water

                    supplies in Denmark

-Norway      Rejected-drinking water should not be fluoridated

-Sweden      Banned-not allowed.No safety data available

-Japan         Rejected-may cause health problems…the o.8-1.5mg level is for

                  calcium-fluoride,not the hazardous waste by-product which is added

                  with artificial fluoridation.

-America   66% of America is fluoridated.This amounts to 50% of the worlds

                  people who are fluoridated.

*The main countries that have large amounts of calcium fluoride occurring naturally in their water are China and India.The health problems as a result are catastrophic,and they actually have a programme to REMOVE calcium fluoride before letting people consume this water.Just because a substance is NATURAL does not mean it is good.Lead,arsenic and mercury are also natural.

 

(6)HOW DID A TOXIC WASTE PRODUCT GET IN OUR WATER?

Starting in America,the Industries involved in producing this industrial grade waste were able to dispose of their waste at a huge profit instead of spending a huge amout of money to safely dispose a waste that their EPA rates at the highest level of toxicity.This was achieved by proposing they sell their waste to local councils for inclusion in that areas drinking water.By selling this waste,it then becomes a PRODUCT,and any product in the marketplace is not subject to any environmental laws governing disposal of toxic or hazardous materials!!!You can see now why the push to fluoridation was generated not by dental and health concerns,but by industrial and economic factors.We should investigate whether Australia follows suit with this strategy,and owing to the huge fertilizer and alumunium producers located here,I cannot see any reason to doubt that we too follow suit.

(7)For a thorough understanding of the fraud that is fluoridation,I recommend the following two documentaries as a start-

            *The fluoride deception –Christopher Bryson

            *Firewaterfilm               -Australian doco

Please watch them in the order they appear.Find out the history of this practise first,then in firewaterfilm you will see first hand some of the results and practices in Australia of fluoridation.

IN CONCLUSION,WE CAN SEE THAT:

We are being medicated against our will with a toxic industrial waste byproduct for a health disease that is neither life threatening or contagious, for a benefit that is patently non existent.There is no way of controlling the doses consumed,and most scientific estimates say we have 8-10ppm being ingested through all the foods we consume which are also laced with fluoride as SF.Until local councils can produce evidence that conclusively prove the dental and health benefits from this practise,we should demand an immediate halt to fluoridation.Long live Democracy,its good to know that our opinions and concerns are important with decision makers in local councils,state and federal governments.

Oh yeah,I almost forgot-remember the three cities in America that were the first to receive fluoridation back in 1950?Well,recent statistics available now show that the number of dentists per 10,000 people in America are as follows :

                       UNFLUORIDATED CITIES…………..52 Dentists

                       FLUORIDATED CITIES………………76 Dentists

                     GRAND RAPIDS,NEWBURGH,

                     AND EVANSTAN,USA………………..122 Dentists!!!!!!

If when reading this article you find it difficult to follow or understand,or if you couldn’t care less,and you believe what authorities tell you,maybe,just maybe,you already suffer from fluoride toxicity and have become the good citizen that proponents of fluoridation want as a result of this practise.(THIS COMMENT IS MY OWN PERSONAL OPINION,AND IT SHOULD NOT BE LABLED AS FACT,UNLIKE EVERYTHING ELSE PRESENTED ABOVE)

 

“YOU CAN FOOL SOME OF THE PEOPLE SOME OF THE TIME,BUT IF YOU SAY IT OFTEN ENOUGH YOU WILL FOOL MOST OF THE PEOPLE MOST OF THE TIME”(Anon)

GET OFF YOUR COMBINED BACKSIDES AND MAKE A STAND.TELL EVERYONE YOU CAN TO STUDY WHAT FLUORIDATION IS ,AND LOBBY OUR LOCAL COUNCIL MEMBERS TO CEASE THIS PRACTISE IMMEDIATELY.

SO,IN CONCLUSION,WHAT DO WE DO?

*Send this information to as many people as possible

*Organize a demonstration outside Hervey Bay council chambers,where we

  should object to this mass medication,and demand immediate removal

  from our water supplies.

*Once this date is organized,all who receive this email will be informed

REMEMBER,50 PEOPLE DEMONSTRATED OUTSIDE CAIRNS MP OFFICE PROTESTING AGAINST FLUORIDATION OF CAIRNS WATER SUPPLY.

IT IS GETTING REMOVED THIS MONTH(Feb 2013)   

 

COVID: The Virus That Isn’t There: The Root Fraud Expose

 
 
 
 
REBEL Cast Ep79: COVID-19 - Trying Not to Intubate Early & Why ARDSnet may be the Wrong Ventilator Paradigm - REBEL EM - Emergency Medicine Blog

David A. Farcy MD, FAAEM, FACEP, FCCM
President of the American Academy of Emergency Medicine
Chairman, Department of Emergency Medicine
Director, Emergency Medicine Critical Care
Mount Sinai Medical Center
Miami Beach, FL
Twitter: @DFarcy

Evie Marcolini, MD, FAAEM, FACEP, FCCM
Associate Professor of Emergency Medicine and Neurocritical Care
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
Board of Directors, American Academy of Emergency Medicine
Twitter: @EvieMarcolini

Cameron Kyle-Sidell, MD
Critical Care Medicine
Emergency Medicine
Maimonides Medical Center
Brooklyn, NY
Twitter: @cameronks

Ashika Jain, MD, RDMS, FACEP, FAAEM
Associate Professor
Trauma Critical Care
Emergency Ultrasound
Ronald O Perelman Department of Emergency Medicine
New York University/Bellevue Hospital Center, NY
Twitter: @4shikajain

 

 

This podcast is longer than we typically do on REBEL Cast (1hr 30min), however there is lots of information that is critical in the treatment of COVID-19 patients with pneumonia.  The questions we tackled were as follows:

  • Many of us have been working under the paradigm that COVID-19 PNA eventually develops into ARDS in the sickest patients. It appears to me that these patients don’t fit into this paradigm.  Many have normal to high compliance and there are certainly reports of patients not showing any signs of distress.  What are you seeing clinically?
 

@EMNerd_ @emupdates @CriticalCareNow @ThinkingCC @srrezaie @Turtle1doc @PulmCrit STOP INTUBATING COVID PATIENTS FOR HYPOXEMIA!!! This is a tracing of a cirrhotic w COVID. Sat does not reflect organ arterial tissue saturation. They do not get tachycardic pic.twitter.com/vSwWkaCeY8

— Cameron Kyle-Sidell, MD (@cameronks) March 27, 2020

 

    • In New York:
      • Intubation is a primary intervention
      • We know intubated patients have a mortality rate between 50-80%
      • Initially, some patients are not displaying respiratory distress which makes calling this ARDS confusing
      • Patients are neither living nor dying from respiratory fatigue, rather a pure hypoxemic condition
      • The lungs we see in a high compliance state do not display any characteristics resembling ARDS right after being placed on a vent

      In New Hamphsire:

      • Not in surge yet, but preparing and using simulations
      • Currently waiting longer to intubate patients such as those with sats near 70% while utilizing other techniques such as high-flow nasal cannula
      • In the beginning, we discussed intubating early for patients, but also to protect the clinicians as you are at the highest risk for aerosolization
      • If we can stave off ventilation such as using high flow nasal cannula, awake proning, or even CPAP, patients will spend less time on the ventilator

      In Miami:

      • The dogma where we look at a patient and see they are hypoxic, or they will tire out and we need to intubate early
      • If not intubated early, there will be a crash intubation, however we have not seen this
      • We have a similar experience to New York: not resembling ARDS
        • I was arguing with a patient who’s O2 sats were low because he was refusing intubation. As an ER physician I felt he did not have the mental capacity to sign out AMA because he was hypoxic, however, he was making more sense than I was and was not in distress.
      • A fear with non-invasive ventilation and highflow nasal cannula is aerosolization as this is a real risk
      • Anyone who is dealing with these patients should be in full PPE
      • Risk should be minimal if we are using these strategies
  • One of the big fears with using NIV/HFNC is aerosolization. This is a real risk, but for many we are in full PPE which should make this risk minimal.  What are your thoughts on NIV/HFNC as an intermediary step for some patients in terms of staff safety and the patients in front of us?
    • My initial deterrence toward intubation is an ARDSnet strict protocol for a high compliance disease
    • However, patients are not going into respiratory fatigue, they simply get extremely hypoxemic and bradycardic and they die
      • This does not appear to be a death by ARDS and seems out of the ordinary
    • Need to develop a more successful ventilator strategy that would better fit the disease
      • Possibly turn it into a CPAP machine to simulate high flow
      • You do not want to put someone on a ventilator who can survive without it, but you also do not want to not put someone on a ventilator who will not survive without it
      • We have seen multiple patients in different groups
        • A patient satting 61% room air with a heart rate of 135, and tachypneic. He was talking and sitting up, signing consent to let us take pictures. We proned him and started high-flow. 2 hours later, his sats were in the 90s
        • Take time to see your patient
      • The fear of contamination makes it that we cannot treat people as well as we want to
      • When we work in the ER and ICU we are exposed to patients with covid, however when we walk into a hospital and open the door, we could be walking into it as well
      • There are a few trials where there is a reduction of aerosol when you use a mask over the patients face
      • It has been a struggle as appropriate PPE is difficult to come by
        • When you wear the same PPE for 14 hours, is it actually PPE? This is the state of how things are in New York City.
    • A lot of us associated this with HAPE syndrome (high-altitude pulmonary edema)
    • Looking at HAPE the mechanism is really hydrostatic pulmonary edema caused by hypoxemia
    • At high altitude, the pulmonary artery pressure increases because of alveolar hypoxia which leads to arterial vasoconstriction that is patchy and not homogenous
    • Comparing a HAPE chest x-ray to covid, it appears similar.
    • One of my attendings who actually suffered HAPE in Aspen said he was walking around, talking, with a heart rate of 130 and an O2 sat of 39%
  • In my reading of available evidence, patients with COVID-19 PNA who get intubated have a mortality rate of anywhere from 50 – 90%. Many studies reporting in the 80% range.  This is not a causation of intubation and mechanical ventilation but an association as most of these reports are observational and retrospective.  In other words, maybe the patients were just so sick they were going to have a high mortality anyways.  On the flip side this higher mortality may also be the fact that we are intubating patients early and using the ARDSnet protocol. What are you currently using to manage patients on the ventilator?
    • Typically in ARDS whether its infiltrate, fluid, or proteinaceous material usually the lungs are getting thicker, harder to move air into it which is creating fatigue
      • Is it possible, rather than the lungs becoming “thicker”, are they actually getting thinner?
      • Is it possible we have a disease with a higher compliance than normal, in which case is it possible that the PEEP we are using in order to get the sats that we want is causing lung injury?
      • I have seen palliative care patients who pass in that fashion without respiratory distress and without hypotension and yet could it be possible that what we are trying to do with our primary intervention by trying to get their sats to a certain level we typically see as functional, we are using pressure that is causing severe lung injury?
      • Even if true, we may have to cause lung injury to help people survive
    • There is speculation of 2 different phases: a high compliance that goes into a low compliance where there is a transition
    • What I suggest is to separate the patients between high and low compliance and figure out different respiratory strategies for each
      • For a covid patient with high compliance, leave their FiO2 at 100% until the viral replication has stopped and provide only enough PEEP to achieve a sat of 80%
      • Provide either narcotics or sedatives to keep their respiratory rate under 20
      • If unable to achieve this or if there is any dyssynchrony you can then possibly paralyze
      • The paradigm is difficult because it goes against everything we’ve done and what we believe when we choose to not intubate despite the patient’s sats
    • Give the patient a chance, and try not to put every single patient into a “box”
    • In ER medicine we tend to try to make people “fit”. We have to titrate and take things slow, maybe try to customize care
    • The patient will teach us about the disease, but we have to really listen and watch to see how he responds to treatments
    • 1 or 2 wks from now, if we find that what we’re doing is not working, we may be able to pivot
    • Some hospitals setting up protocols such as
      • Covid positive on CT or exam
      • Saturating less than 90% on 6 L nasal cannula
      • Early intubation followed by ARDSnet strategy
      • It is possible that this is referring to what may be hundreds of thousands of people, which is concerning
    • Study out of NYC [6]
      • Cross-sectional analysis of patients with COVID-19
        • Hospitalized: 1,999 (48.7%)
          • Predictors of Hospitalization: Age >65years, BMI >40, Hx of Heart Failure
          • Predictors of Critical Illness: Admit O2 <88%, D-dimer >2500ng/mL, CRP > 200mg/L
      • Outcomes:
        • Invasive Mechanical Ventilation: 445/1999 (22.6%)
        • Extubated: 38/445 (8.5%)
        • Still Intubated: 245/445 (55%)
        • Death or Hospice: 292/1999 (14.6%)
      • As many patients still hospitalized, numbers above may be underestimation
  • In my mind patients present into one of 4 clinical categories and I want to go over these one at a time…
    • Suspected or confirmed COVID-19 with minimal symptoms. These patients can most likely go home, but one big concern is how do we follow them up.  What are you using to decide who can go home and who can’t?  How are you following them up?
      • In New Hampshire:
        • If the patient is good enough to walk and talk and is not symptomatic, will discharge home with preprinted set of instructions that ask them to quarantine
        • Have a system in place where PAs will follow-up on the tests and call the patient with results.
      • In Miami:
        • If a patient is satting at 100%, we stress them
          • If they are able to do 3 mins of walking (sitting/standing for elderly) and their O2 sat remains above 96% we swab them and send them home
        • If their sats drop below 96%, then they have imaging and we quantify them based on what kind of therapy we will send them home with
        • If a patient comes in hypoxic, they go directly to the back for treatment and testing
        • If we send home a patient with O2 sats in the 90s, they are given a prescription for an oxygen compressor and we try to have case management organize them for delivery
      • In New York:
        • We have faced more obstacles with regards to sending people home as the ED has essentially turned into a full covid unit
        • The threshold for sending people home has gone down, because our hospitals are simply more full
        • There is a possibility that many of these people that we send home will come back which I don’t feel there is any way to prevent
        • There are all sorts of discharge issues. Possibly the largest concern are those that have no supervision, live by themselves, especially if they are older or are obese.
        • I do not think that someone that we send home and returns should be seen as a failure, but rather organizing their ability to return should be seen as a success.

    • Silent Hypoxemia (“Happy Hypoxemia”): These patients often have low O2 sats but have no external signs of respiratory distress, AMS, or lack of perfusion. In my mind these patients are prime candidates for NIV/HFNC and awake proning.  Are any of you using awake proning? Any logistical issues with this?
      • Ideally, all these patients should have as much oxygen as possible
      • At some point, hypoxemia worsens hypoxemia and these are the perfect patients to put on high flow
      • In New York, we are at a point where we need to ensure our oxygen supply is okay because high flow uses a tremendous amount of oxygen, more than a ventilator
      • Perhaps high flow may even be more gentle than CPAP.
      • The patients sent to the floor on high flow will become entirely dependent on oxygen if you take them far enough such as on 80% and 50L
      • A patient in the ED on high-flow kept insisting on going home. I informed him if the system falls off his face, he will die.
      • My reservation with CPAP is it is not something people can keep on for 3-4 days
      • As far as proning, you will typically see a remarkably improved O2 saturation as well as blood gas
      • If someone is saturating in their 60s and you prone them and they are now 92, this recruitment does not appear to be sustained unless the viral replication slows down.
      • A higher change is observed when on their side; this is true with obese patients as well

First draft of a PROPOSED pathway for identify 'happy hypoxic' #COVID19 patients at triage, and giving them a chance NOT to get intubated. Work in progress. Very interested to hear from anyone with something similar/better in place. No experience of these patients yet pic.twitter.com/gFp5JsMd6V

— Cliff Reid (@cliffreid) April 7, 2020

 

    • Intermediate Hypoxemia: These patients often have low O2 sats but have some mild symptoms of respiratory distress such as tachypnea and tachycardia. These patients may require intubation but may also benefit from NIV/HFNC + Awake proning. What is your threshold to consider intubation?
      • Largely dependent on the patient and the environment
      • Initially if the patient required high-flow at 80% 50L to achieve a sat of 88-90%, this was the time for intubation
        • However our next patient had no distress. We did everything we could to not intubate which let us know even more this disease is nothing like we have dealt with before
        • As a guide, we try to get patients on high-flow and do not send them to the floors anymore
        • If the patient requires FiO2 of 90% high flow to achieve a sat of 88-90 and you are in distress which is predominately tachypnea and anxiety, then it is time to intubate
        • We are limiting the amount of people going into the room as well such as attending and resident, no RT or nurse
      • New Hampshire has not had a surge: we have time, ventilators, and negative pressure rooms with resources
        • Will probably have a lower threshold because that is what we are comfortable with and we have the resources
        • Still simulating throughout the day to make sure it is safe for the patient and for us so we will probably intubate earlier
      • Addendum (04/25/2020): Cabrini Respiratory Strain Score (CAB-RSS) [Link is HERE]
        • Not yet validated, but can be used as a marker of severity and potentially a decision tool for progressing to a higher level of ventilatory support

    • Respiratory Distress: These patients require intubation and are too far gone in my opinion to test NIV/HFNC.  Many of these patients will have high pulmonary compliance with hypoxic vasoconstriction in the lungs.  It seems increasing PEEP and prone positioning may be of minimal help with recruitment of collapsed lungs (i.e ARDSnet).  High PEEP (>15cmH20) may also compromise cardiac filling.  What ventilation strategies do you recommend in these patients with the limited information we have thus far?
    • ARDSnet trial discusses starting at low tidal volume 4-6 mL/kg
    • Titrating PEEP to maintain FiO2 above 90 with PEEPs as high as 18-20cmH20
    • Recommend not bagging patients: take them directly off high flow to intubation If they drop from 60s down to the 40s, you have 30 seconds to intubate
    • Right after intubating in the ED, they will be in a high compliant state and are tolerating volume and do not have the damage that happens with ARDS
    • Start the patient with 8-10 cc/kg of tidal volume (ideal body weight) based on mean airway pressures and plateau pressures to evaluate compliance
    • Put on 100% O2, start PEEP at 5
      • You will have to tolerate a lower sat because after intubating, the sats will drop, however they will go up slowly
    • Maintain a PEEP 8-10cmH20 and lower if possible
    • Use an oxygen first, pressure last strategy
      • Know there is a possibility that with each increasing pressure, you risk damaging some lung
      • If you need better sats, be more liberable with the tidal volumes
      • If the patient is hypotensive, try to decrease the PEEP if you can
    • I do not feel there is a way to achieve sats above 92% in this hypoxemic, progressive disease by increasing the PEEP
  • Evie I would like to ask you a few questions specifically in regard to neurological concerns:
    • How are you handling patients with stroke symptoms and suspected COVID-19. Imaging, systemic thrombolysis, endovascular therapy?
      • We are not doing anything different except that we are donning PPE
        • Patients are screened appropriately and we move forward
      • There is some emerging data from Italy and China that covid-19 patients have a blood clotting disorder that may be contributing to their respiratory failure
        • Microthrombi possibly forming in the vessels of the lungs
        • Patients may have inflammation-linked tissue damage that contribute to clot formation
        • Maybe tPA would help?
    • There appear to be lots of reports of headache and AMS as a common symptom. I am unaware of CSF studies to date, but should we be concerned about encephalitis?  Do these patients need LPs? Do we have any idea about the mechanism or prognosis of these patients?
      • We know from previous coronavirus, there are a couple of different ways the virus can get into the nervous system
        • Dissemination from systemic circulation, which makes sense
        • Moving across the cribriform plate of the ethmoid.
          • What is the mechanism?
          • The virus and previous viruses latch on to ACE2 receptors
          • When the coronavirus latches, that is how we might see symptoms
          • You can get retrograde axonal transport in the olfactory, trigeminal, glossopharyngeal, the vagus or even peripheral nerves

 

 

Thinking Critical Care Webinar – COVID-19 Respiratory Management – A Physiological Approach (Video Time: 1:34:28)

 

 

Critical Care Management via JAMA Network with Derek Angus (Video Time: 47:50)

References:

  1. ARDS Definition Task Force. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA 2012. PMID: 22797452
  2. Grasso S et al. ARDSnet Ventilatory Protocol and Alveolar Hyperinflation: Role of Positive End-Expiratory Pressure. Am J Resp Crit Care Med 2007. PMID: 17656676
  3. Chorin E et al. Assessment of Respiratory Distress by the Roth Score. Clin Cardiol 2016. PMID: 27701750
  4. Gattinoni L. Preliminary Observations on the Ventilatory Management of ICU COVID-19 Patients. SFAR 2020. [Epub Ahead of Print]
  5. Gattinoni L et al. COVID-19 Does not Lead to a “Typical” Acute Respiratory Distress Syndrome. ATS 2020. [Epub Ahead of Print]
  6. Petrilli CM et al. Factors Associated with Hospitalization and Critical Illness Among 4,103 Patients with COVID-19 Disease in New York City. MedRxiv Preprint 2020. [Epub Ahead of Print]
  7. Gattinoni L et al. COVID-19 Pneumonia: ARDS or Not? Critical Care 2020. [Epub Ahead of Print]

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Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @E