1/I keep receiving over and over the same comments on EVALI. “The cases were too young to be COVID!” “It was caused by vitamin E acetate!” “It has nothing to do with COVID”! I demonstrated in my article that these arguments are not valid but it seems to be the time to make a 🧵
2/First of all, what is EVALI? The name (E-Cigarette, or Vaping Product, Use–Associated Lung Injury) was invented by the CDC to describe an epidemic of “severe lung disease” with most cases identified in the US.
3/Why was it associated to vaping? Because many patients reported the use of electronic cigarette, originating the speculation that vaping may be the causative agent for the acute lung injury.
4/When did it happen? In July 2019, large clusters of lung injury, previously never observed, were first reported in Wisconsin and Illinois and then in all US. There was an increase in emergency department visits throughout the summer of 2019 followed by a peak in September.
5/Case patients were defined from the beginning as persons who exhibited lung ground-glass opacities and reported the use of e-cigarette devices in the 3 months before symptom onset. What does this mean?
6/It means that patients who had severe pneumonia but did NOT vape were EXCLUDED from the EVALI reports. If a patient developed pneumonia and vaped as last time 3 months earlier, it was considered an EVALI case.
7/It is well known that vaping is done mostly by young people, so already the case definition may explain why cases affecting older people could have gone undetected. Can the onset of a pathology happen 3 months after exposure to the causative agent? 🤔
8/To identify cases previous to the outbreak a syndromic surveillance was performed, but ONLY among persons 14 to 30 years old, because more likely to vape.
Please keep this in mind before to comment again that EVALI cases were too young to be COVID 😊
9/Now, pathology. It is described in several articles that the pathology of EVALI largely overlaps with COVID, to such extent that a SARS-CoV-2 antibody test is considered necessary for the identification.
pubmed.ncbi.nlm.nih.gov/33817560/
10/If we consider MIS (multisystem inflammatory syndrome) the similarity with EVALI is even more impressive, because MIS affects mostly young people, it is caused by SARS2 but it is not infectious.
11/Do you still think that EVALI has nothing to do with COVID? 😉 More to come.
12/Now, coming to vitamin E acetate and THC (compound in cannabis). These additives have been blamed by the CDC as likely cause for the lung injury seen in EVALI and people keep repeating over and over what they heard in the news. It’s normal.
13/It is well known that some compounds added to e-cigarettes are irritant for the lungs and can worsen COVID - but they do not cause it without SARS2.
14/We also know that not all cases vaped those compounds. When all ages were considered, 30% vaped ONLY nicotine. We can also see that the risk factors for EVALI are the same as for COVID, like obesity.
15/During the EVALI epidemic in the US, there was also a smaller cluster of cases in Canada and none of them was associated to vitamin E acetate. How then can vitamin E acetate be the cause for EVALI?
canada.ca/en/public-heal…
16/That’s the reason why NIH concluded in this report published in September 2020
pubmed.ncbi.nlm.nih.gov/32243764/ that the causative agent for EVALI was NOT identified and it is NOT possible to exclude a viral origin. They call for an analysis of EVALI samples.
17/Some are wondering why after the pick in September 2019 there was a reduction of cases and since COVID is in the US very sporadic EVALI cases are reported. First, we need to keep in mind that the CDC stopped to count mild EVALI cases from December 2019
cdc.gov/tobacco/basic_…
18/Why? Because mild EVALI cases were confounded with the flu, which started earlier than usual in 2019.
19/In February 2020, short before the official introduction of SARS2 in the US, the CDC stopped to collect and report EVALI cases. Why? They claim to have identified the “primary cause” of EVALI but we know now that they did not.
20/We also know that the CDC director admitted in this interview that COVID cases were wrongly assigned to the flu.
21/As EVALI cases were assigned to the flu when it started and flu cases were proved to be caused by COVID, then we can’t exclude that EVALI cases were COVID 🤯
22/Lung injuries from vaping irritant compounds happened before EVALI and are still happening during COVID, but the cause of an epidemic of that proportion is hard to explain, as no compound was found that may have caused it.
23/The timing of the EVALI epidemic is also an incredible coincidence, if it wasn't COVID. We see a disease with the same pathology of COVID, few months before COVID but then it almost disappears when COVID is officially there. OK…
24/We should not think that the ancestral lineages were identical to what we saw ravaging in Wuhan in December 2019. We have indications that the lineage A was less pathogenic than B, which was found to be associated to the Huanan market
25/As SARS is not naturally present in the US or Europe, it is not surprising that it was not comprised in the viral panel used to test EVALI or flu cases and it may have circulated undetected for a while before to create a cluster of cases in Wuhan.
gh.bmj.com/content/7/3/e0…
26/ One day I was staring at the trees from @Ayjchan preprint and suddenly I got this idea
Lack of variability in the first genomes that were identified in Wuhan may be just the result of missing sampling of previous lineages!
27/”But in Wuhan there is the WIV! It would be a hell of a coincidence!”. I agree, but we need also to consider that in October 2019 Wuhan was the host city of the World Military Games, with thousands of participants. A perfect super-spreading event.
28/You can watch the opening ceremony here to better understand what I mean.
29/We know that many athletes from several countries reported COVID symptoms during the Games and an investigation was started in 2021, but so far, the results have not been shared.
washingtonpost.com/opinions/2021/…
30/I know, the possibility that EVALI may have been caused by SARS2 has been defined a “Chinese conspiracy theory” but we should keep in mind that it may be (as for a lab origin) just a trick to stop the investigations.
31/To make it looking even worse, it is often associated to an intentional release in Wuhan, not really necessary considering the possible role of the World Games as super-spreading event.
32/Many Americans are convinced that they had COVID in 2019, I keep receiving their comments all the time and this possibility has been reported for a while also in the media.
uncoverdc.com/2020/04/05/cou…
33/To conclude, if we want to find the #OriginOfCovid we need to leave no stone unturned and do not focus only on natural origin or one specific lab. We may never be able to find or prove its origin, if it is not where the light is on
34/I just want to make clear that I am not pretending to have demonstrated that EVALI is COVID, just that it is not a conspiracy theory and I hope that one day, not too late, it will be proved/disproved by analysing the samples for SARS2 antibodies.
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