b'remaining localized at the injection site in19 vaccination, many appear to do wellprotein in a setting of generalized increased ordertoprovoketheimmuneresponseand feel completely fine after their vacci- oxidative stress throughout the body (Lewi and nothing more, spike-protein presencenations. Is this an assurance that no harmandClarke,1954;RamsayandLerman, has been detected throughout the body ofwas done, nor will be done, by the vaccine2015). As such, it can never be dismissed some vaccinated individuals. Furthermore,in such individuals? Some striking anec- as an incidental and insignificant finding, it appears that some of the circulating spikedotal evidence suggests otherwise, whileespecially in the setting of a symptom-free proteins simply bind the ACE2 receptorsalso indicating that there exist good optionsindividual, post-vaccination, appearing to without entering the cell, inducing an au- for optimal protection against side effects inbe normal and presumably free of body-toimmune response to the entire cell-spikeboth the short- and long-term. wide increased inflammation and oxida-protein entity. Depending on the cell typeUnder conditions of inflammation andtive stress. States of advanced degrees of that binds the spike protein, any of a num- systemicallyincreasedoxidativestress,increased systemic oxidative stress, as is ber of autoimmune medical conditions canRBCs can aggregate to varying degrees,often seen in cancer patients, can also dis-result. sometimesstickingtogetherlikestacksplay rouleaux formation among circulating While the underlying pathology remainsof coins with branching of the stacks seenneoplastic cells and not just the RBCs (Cho, to be completely defined, one explanationwhenthestickinessismaximal.Thisis2011).for the problems with thrombotic tenden- known as rouleaux formation of the RBCs cies and other symptomatology seen with(Samsel and Perelson, 1984). When this rou- Rouleaux Formation,chronicCOVID-19andpost-vaccinationleaux formation is pronounced, increasedPost-COVID-19 Vaccinationpatients relates directly to the persistentbloodviscosity(thickness)isseen,andThe dark field blood examinations shown presence of the spike protein part of thethere is increased resistance to the normal,below come from a 62-year-old female who coronavirus. Some reports assert that theunimpeded flow of blood, especially in thehadreceivedtheCOVID-19vaccination spike protein can continue to be producedmicrocirculation(SevickandJain,1989;roughly 60 days earlier. [Case 1] The first after the initial binding to the ACE2 recep- Kesmarky et al., 2008; Barshtein et al., 2020;picturerevealsmildrouleauxformation tors and enter into some of the cells thatSloop et al., 2020). of the blood. After a sequence of six ozone it initially targets. The clinical pictures ofWithregardtothesmallestcapillar- autohemotherapy passes (ozone autohe-chronic COVID-19 and post-vaccine toxicityies through which the blood must pass, itmotherapy), the second picture shows a appear very similar, and both are likely dueneeds to be noted that individual RBCs lit- completely normal appearance of the RBCs. to this continued presence, and body-wideerally need to fold slightly to pass from the dissemination, of the spike protein (Men- arterial to the venous side, as the capillary delson et al., 2020; Aucott and Rebman,diameter at its narrowest point is actually 2021; Levy, 2021; Raveendran, 2021). less than the diameter of a normal RBC, or Although they are found on many dif- erythrocyte. It is clear that any aggregation ferent types of cells throughout the body,of the RBCs, as is seen with rouleaux for-the ACE2 receptors on the epithelial cellsmation, will increase resistance to normal lining the airways are the first targets ofblood flow, and it will be more pronounced[Case 1]the COVID-19 virus upon initial encoun- as the caliber of the blood vessel decreases.A second patient, a young adult male ter when inhaled (Hoffman et al., 2020).Not surprisingly, rouleaux formation of thewho received his vaccination 15 days earlier Furthermore,theconcentrationoftheseRBCs is also associated with an impairedwithout any side effects noted and feeling receptors is especially high on lung alveo- ability of the blood to optimally transportcompletely well at the time, had the dark lar epithelial cells, further causing the lungoxygen, which notably is another feature offield examination of his blood performed. tissue to be disproportionately targeted byCOVID-19 spike-protein impact (Cicco and[Case 2] This first examination seen below the virus (Alifano et al., 2020). Unchecked,Pirrelli, 1999). Increased RBC aggregationrevealed severe rouleaux formations of the the avid receptor binding and subsequenthas been observed in a number of differentRBCs with extensive branching, appearing viral replication inside the lung cells leadmicrocirculatory disorders, and it appearsto literally involve all of the RBCs visualized directly to low blood oxygen levels and theto be linked to the pathophysiology in thesein an extensive review of multiple different acute respiratory distress syndrome (ARDS)disorders. microscopic fields. He then received one 400 (Batah and Fabro, 2021). Eventually, there isRouleaux formation is easily visualizedml ozonated saline infusion followed by a a surge of intracellular oxidation known asdirectly with dark field microscopy. When15,000 mg infusion of Vitamin C. The sec-the cytokine storm, and death from respira- available, the feedback is immediate, andond picture reveals a complete and imme-tory failure may result (Perrotta et al., 2020;there is no need to wait for a laboratorydiate resolution of the rouleaux formation Saponaro et al., 2020; Hu et al., 2021). to process a test specimen. It is a reliableseen on the first examination. Furthermore, indicator of abnormal RBC stickiness andthe normal appearance of the RBCs was still COVID-19, Vaccination, andincreasedbloodviscosity,typicallyele- seen 15 days later, giving some reassurance Oxidative Stress vating the erythrocyte sedimentation ratethat the therapeutic infusions had some du-Although some people have prompt andtest (ESR), an acute phase reactant test thatrability, and possibly permanency, in their clear-cut negative side effects after COVID- consistently elevates along with C-reactivepositive impact.22 H ealtHF reedomN ews /F all2021'