Things I should not have to explain in 2020 part 2:

- SARS-CoV-2 exists
- SARS-CoV-2 causes COVID-19

This time, a (long) thread
I think that when people make these claims- these absurd claims- it's not the result of taking a collection of premises, analyzing them, and drawing a parsimonious conclusion (setting aside the preposterousness of that conclusion).
There's this concept in psychology called "locus of control." It refers to the extent to which a person feels in control of what happens to them, as opposed to external forces beyond their influence.
I could think of few things could make our respective loci of control feel more external than this pandemic which has stolen over 1 million lives prematurely and permanently changed life for many more.

What if SARS-CoV-2 didn't exist?
We all crave that normalcy that predates this tempestuous time.

We miss not having to wear masks when we go out. We miss not having to worry about standing too close to people. We miss physical contact. We miss having plenty of surge capacity. We miss not feeling this way.
People need it to not be real.

But denying the existence of SARS-CoV-2, of this pandemic, its scale, its influence- it will only take us further from normalcy. It will only deepen the chasm between where we are and where we one day hope to be.
SARS-CoV-2 was first noticed on 12/31/19 when a cluster of pneumonia associated with Wuhan's Huanan Seafood Wholesale Market appeared.

On 01/09/20, the China CDC reported nCoV-2019 (later renamed SARS-CoV-2) was the cause and its genome was made publicly available.
A more comprehensive history of things can be found here:
ecdc.europa.eu/sites/default/…
And phylogenies can be constructed of isolates:
ncbi.nlm.nih.gov/pmc/articles/P…
pnas.org/content/pnas/1…
nextstrain.org/sars-cov-2/
And I offer this one for some good news:
pnas.org/content/pnas/1…
Some denialists have proposed that SARS-CoV-2 is no virus at all, rather it is an exosome.

Exosomes are extracellular vesicles made by cells to communicate with other cells. In principle, they resemble enveloped viruses. Except exosomes are not infectious. https://www.pnas.org/content/pnas/113/33/9155.full.pdf
The fact that inoculation of susceptible and permissive cell cultures with SARS-CoV-2 produces cytopathic effects (CPE) and the virus can be isolated and this can be repeated ad infinitum plainly refutes this (the CPE can be viewed in some links above).
Additionally, SARS-CoV-2 has been sequenced repeatedly. Its genome exhibits prototypical features common to coronaviruses and does not align with sequences present in our own genome, ruling out an endogenous origin. https://www.jbc.org/content/early/2020/07/13/jbc.REV120.0139
Some denialists also claim that SARS-CoV-2 is not the cause of COVID-19 because something something Koch's postulates (I have not heard a coherent statement of the canard so this is the best I can do in summarizing it).
Koch's postulates 4 conditions that can be used to determine which pathogen (and whether a pathogen) is responsible for a given disease.

However, as is eloquently explained here (virology.ws/2010/01/22/koc…) these conditions are imperfect and not readily applicable to viruses.
Nonetheless, the fact that COVID-19 occurs in patients who are infected with SARS-CoV-2 and does not occur in those not infected by it is about as iron-clad evidence as any that SARS-CoV-2 is the cause of COVID-19.
I am begging you- stop contributing to the misinfodemic we have at play. It is killing people.
Fact check claims put before you.
Listen to experts.

Wear your mask. Physically distance. Wash your hands.

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More from @ENirenberg

27 Sep
I'm seeing a lot of nonsense about boosting the immune system lately, so here's a far-too-long thread on what "boosting the immune system" really means and why 1) you can't and 2) it's not smart.
Classically we regard the immune system as being a network of molecules, cells, and organs responsible from protecting us against pathogens (disease-causing microbes). But how does it do that?
The immune system has to have a means of being able to tell apart self-antigens from nonself-antigens so that it doesn't respond to the wrong ones. This is called self-tolerance and it's much trickier than you may be aware.
Read 17 tweets
30 Aug
If this were merely about a vaccine getting EUA approval during a pandemic, assuming it genuinely did show very compelling data regarding its safety and efficacy, I would be willing to consider that case. The issue is... this decision seemingly rests ultimately with Hahn. /thread
Hahn has completely tarnished the integrity of the FDA's EUA stamp. First it was issued for HCQ based on essentially no good evidence, then had to be rescinded when there was high quality evidence of lack of efficacy and in some cases harm.
More recently we had the fiasco with convalescent plasma. There are no RCT data to base this on yet. What's more concerning is that the data from Mayo could be interpreted as showing that lower quantities of plasma HARM patients rather than high dose helps.
Read 7 tweets
8 Aug
Holy fuck.

We need to discuss this piece of malicious disinformation immediately.

(Long) thread time.
There is literally so much erroneous about this that I don't even know where to begin but the first sentence seems like a good starting point:
"Many countries either adopted or declined early treatment with HCQ, forming a large country-randomized controlled trial..." "
"with 2.0 billion people in the treatment group and 663 million to the control group."

If you read this sentence and still think anything that follows in this link has any credibility you have absolutely no business opining on the use of hydroxychloroquine. Why?
Read 21 tweets
4 Aug
Anyone who looks to this charlatan as a source of medical expertise or even as someone with anything resembling scruples is undertaking a fools errand. This is a textbook example of his dishonesty (thread).
People who read this article and support it have really zeroed in on the quote that says that HCQ can act as both a vaccine and a therapy. First of all, nowhere in the article is it described as such.
The article is an in vitro study of HCQ in Vero cells.
What is actually said is that it MAY have some therapeutic and prophylactic efficacy. In no way can this behave like a vaccine because that is fundamentally antithetical to the function of HCQ as it's immunosuppressive. But that's really the tip of the iceberg.
Read 18 tweets
2 Aug
With respect, this is a really bad idea (thread).
At this point, we only have Phase 1 data (ChAdOx did a hybrid Phase 1/2 trial) which is nowhere close to sufficient to determine whether or not the candidates we have are safe. It is furthermore in no way a demonstration of vaccine efficacy.
As a reminder, phase 1 of the clinical trial process for a vaccine is intended to rule out gross toxicities (i.e. the people who receive it don't immediately get some kind of horrifying SAE) and provide immunogenicity data.
ncbi.nlm.nih.gov/pmc/articles/P…
Read 19 tweets
25 Jul
This is utterly pathetic and infuriating. It does, however, offer a good opportunity to examine both the meaning of free speech and the folly of bothsidesism (false balance).
All free speech means it is not explicitly illegal to say any given thing. We should firstly note however that even this has limitations:
uscourts.gov/about-federal-…
Indeed, I would in fact go as far as saying that to amplify overt propaganda that has been debunked repeatedly to undermine the tireless labors of professionals who have ceaselessly striven to make Americans see sense...
Read 9 tweets

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