Nick Mark MD Profile picture
Jun 5, 2022 11 tweets 7 min read Read on X
Once again there is a wave of #misinformation about #ExcessMortality & #vaccines in the US.

A mysterious insurance report says “excess mortality is rising” could it be the vaccines?
No. Virtually all the excess mortality is associated with COVID infections!

A debunking 🧵.
1/ ImageImageImageImage
Every few months, a myth of “unexplained deaths not from COVID” resurfaces.
Last time they claimed “young people” were inexplicably dying. Looking at the actual data it was pretty clear that virtually all the excess deaths under 45 were due to COVID.

2/
In a later incarnation, this conspiracy theory revolved around a mysterious (and nameless) "insurance industry expert” & "former Wall Street analyst” who did his own analysis and “found an 84% increase in excess mortality."

This too has been debunked.
reuters.com/article/factch…
3/
Let’s look at the actual data:
If we look at weekly deaths of all cause, we can see five spikes above baseline in weekly deaths, each corresponding to a wave of the pandemic.
Source: CDC
cdc.gov/nchs/nvss/vsrr…
4/ Image
How much of the increase in mortality is due to COVID?
If we look at # of deaths/week, comparing weekly COVID deaths to total deaths. we can see the answer is almost all of it!
Example: Of the ~27k excess deaths in early 2021, ~26k were due to COVID!
cdc.gov/nchs/nvss/vsrr…
5/ ImageImageImageImage
But we don’t have to look just at correlations, because Doctors put the cause of death on death certificates.

Looking at COVID associated deaths🟦vs non COVID deaths 🟩, we can see that virtually all of the excess mortality can been attributed to COVID infection!
Source: CDC
6/ Image
This isn’t really surprising since COVID was the THIRD leading cause of death in the US in 2021.
cdc.gov/mmwr/volumes/7…
7/
Not only do mortality spikes correlate with surges in COVID infections, they do NOT correlate with vaccinations.
Compare 3 lines: weekly excess Mortality ⬛, COVID cases 🟥, & vaccinations🟦
The correlation (R²) is higher for mortality⬛ & cases🟥.
github.com/hmatejx/COVID_…
8/ ImageImage
If we look at that insurance report that Kory shared (and clearly didn’t read), we can see more evidence that vaccination *reduces* excess mortality.
Specifically excess mortality is HIGHEST in the places with the LOWEST vaccinations!
Source: soa.org/48ff80/globala…
9/ Image
This too isn't surprising, we know that at this point in the pandemic the vast majority of COVID mortality occurs among unvaccinated people.
Source: Our World in Data
ourworldindata.org/grapher/united…
10/ Image
Summary:
-there IS a significant increase in excess mortality...due to COVID infection
-there IS NOT a temporal association between vaccines & excess mortality. In fact, quite the opposite: states with the highest vaccination rates had the lowest mortality #VaccinesWork
11/

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More from @nickmmark

May 3
A slightly tricky blood gas case:

77 yo with respiratory distress, RR 30, SpO2 80% on non-rebreather at 15 lpm

CXR & TTE are unrevealing

pH 7.58 / PaCO2 24 / PaO2 >500 / HCO3 22

MetHb 0% CarboxyHb 0%

The ABG looks like this: Image
The answer is sulfhemoglobinemia.

Sulfhemoglobinemia is a *permanently* modified hemoglobin associated with exposure to TMP/SMX, dapsone, phenazopyridine, & other amino & nitro compounds.

It has an altered oxy-hemoglobin dissociation curve.

2/

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Sulfhemoglobinemia is easily confused with methemoglobinemia. Both have very dark colored blood & present with cyanosis. Diagnosis typically requires a specialized lab.

Spoiler: you may have heard that SulfHb is green. It isn’t really. You’re thinking of Vulcans’ blood.

3/
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Read 7 tweets
Apr 28
This story is absolutely shocking.

Philip Morris International (PMI) spent millions to influence medical education by buying a series of “CMEs” at Medscape!

How else has big tobacco tried to normalize vaping & influence the medical community?

🧵
1/
theexamination.org/articles/medsc…
Recently it was revealed that Philip Morris International (PMI) had SPONSORED CME materials about smokeless tobacco products on Medscape.

I had the opportunity to review these “CME” materials & they are pretty shocking!
2/

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One truly incredible thing about this “CME” was that it has NO DISCLOSURE SLIDE!

The fact that people teaching about vaping don’t disclose their financial ties to the tobacco industry is absolutely bonkers!

Why isn’t there a sunshine act for this?
3/
Read 19 tweets
Jan 27
Damn. Under Trump the White House Medical Unit was a pill-mill. Thousands of ambien & provigil per month.

Worse, for a clinic that doesn’t typically do procedures w/ moderate sedation they sure are they ordering prodigious quantities of morphine, fentanyl, versed, & ketamine…? Image
Honestly, this reminds me of Norman Ohler’s Blitzed.
The AG report was largely concerned with the enormous cost of prescribing these non-genetic meds.

It’s worth pointing out that dispensing prescription meds without documentation is malpractice. In the case of controlled substances it’s also likely a crime.
Read 8 tweets
Oct 28, 2023
It’s October - hockey season - so let’s talk about a hockey/pulmonary case:

A previously healthy 17yo presents with dyspnea, frothy sputum, & orthopnea that began after playing hockey.

In the ED he is tachycardic, tachypneic, mildly hypoxic. He has crackles bilaterally.

Dx?
1/ Image
Before we get to the diagnosis, Inhalation of which of the following could explain his symptoms?

2/
The answer is ZAMBONI DISEASE!

Poorly maintained combustion engines produce carbon monoxide (CO), nitrogen oxides (NO₂), & other volatile organic compounds.

These compounds are heavier than air.

To avoiding melting the ice, there is often minimal ventilation in ice rinks.
3/
Read 10 tweets
Jun 19, 2023
Lots of inane comments from Elon/Rohan bros that vaccines don’t prevent disease.

Let’s debunk these claims:
1. Polio - vaccine introduced 1957
ourworldindata.org/grapher/report…

2. Measles - vaccine introduced 1963
ourworldindata.org/grapher/measle… ImageImage
3. Tetanus - vaccine 1938
cdc.gov/vaccines/pubs/…

4. Diphtheria
researchgate.net/publication/32… ImageImage
5. Hepatitis A - 1996
cdc.gov/mmwr/volumes/6…

6. Hepatitis B - 1982
cdc.gov/mmwr/volumes/6… ImageImage
Read 6 tweets
Jun 8, 2023
The long awaited #COVIDOUT RCT is now in @TheLancet:
- high risk adults randomized to either metformin (MET), ivermectin (IVM), fluvoxamine (FLV) or placebo.
- MET reduced the risk of long COVID (6.3% vs 10.4%; NNT = 24)
- no benefit with IVM or FLV

thelancet.com/journals/lanin…
1/ ImageImageImageImage
COVID-OUT was a large blinded multicenter RCT looking at repurposed oral meds.

The primary outcome was severe COVID; this was one of the *MANY* negative RCTs of ivermectin. (See 🧵👇)

The current study is a planned secondary analysis, looking at the incidence of long COVID.
2/
COVID-OUT was a factorial design enabling efficient evaluation of multiple oral medications in various combinations.

After diagnosis, subjects received meds by next day mail. They were followed up to 300 days (10 months).

Diagnosis of long COVID was made by a synonym survey
3/ ImageImageImage
Read 9 tweets

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