Darren Markland Profile picture
Aug 7, 2021 14 tweets 4 min read Read on X
I am amazed by how much and how quickly we have learned about this perfect parasite. This article gives us insight into the nuts and bolts of how mutational refinements have made delta so infectious. #covid nature.com/articles/d4158…
First: It’s spike proteins are far more dexterous and literally able to probe the surface of our cells for the ACE2 receptor to unlock the door and gain entry.
Second, the virus as perfected a method that literally catapults in into its host cell at high velocity smooshing it into a coalescent hybrid.
Once inside, the virus deactivates cellular alarm systems, which hide it from the immune system. It shuts down all cellular activity and diverts it to viral reproduction only.
Fourth, it reformats cells, reorganizing their production facilities for maximum short term efficiency, literally redlining our cellular engines. Meanwhile merging multiple infected cells into a multinuculated mega cell that withstands brute force immune attacks.
Finally, as it entered a cell, it has perfected a technique not only to rapidly eject itself from its dying cell, but to rearm its spike proteins with greater efficiency than previous variants. Delta has 3 times the number of “keys” to gain entry to your cells.
This is why it’s infectious before testing becomes positive. Instead of a gradual crescendo of virons streaming out of us, delta is more like lightning followed by thunder. It also explains why it is so easy to catch. The virus is efficient. It takes far fewer of them to succeed.
This knowledge gives us insights into therapeutics and allow me to reassure you the vaccines still are incredibly effective at reducing infections and importantly severe disease, but ….
Certain laws of immunity remain.
🔹With a virus this good we need higher vax rates. 85% at least.
🔹Masks remain essential for because of the very high rate of asymptotic transmission, both in newly infected people, and sadly even in the double vaxed.
Yes, you can get and spread delta if you are completely vaccinated. You’re going to avoid the complications and still live your best life, but it can happen. Trust me on this. Being double vaxed is you doing the right thing for everyone.

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More from @drdagly

Dec 14
I looked into the room to see him pacing around the bed, guarding her. She was pale, and if not for the monitors I would have been worried she wasn’t breathing. My colleague had admitted her to the ICU in the early hours of the day.
“He’s adamant we do everything.”
I scanned the chart. She had been sick for years, in and out of hospitals for complications of long battled conditions. Things however were crescendoing. She was spending more & more time in hospital and each fight drained her more and more. This time it was a bladder infection.
She’d been stabilized over night, but there were things that needed to be done. Lines inserted, tubes adjusted, wounds probed. Hands laid. I must admit, it seemed daunting, and the mood in the room was heavy and still.
Read 16 tweets
Jul 20
Today my HVAC guy taught me how to be a better physician. As you know, it’s stinking hot in Edmonton right now, and though the heat doesn’t bother me much, we are a family of Vikings and it’s my job to help my ginger spawn survive. Cue the ominous silence from our AC unit.
I perform my due diligence. Thermostat, on batteries fresh, settings correct. Furnace blower fan, operational. Condenser coil, clean and intact. Exterior unit, not blocked by dead porcupine. Breakers reset and on. Still nothing. Now I’m faced with call the poor HVAC guy.
I’ve used the same guy for years. He’s just an honest good guy. I know he’s gonna be insanely busy, but Mr Hobbes is already in the basement and panting so I make the call. It rings forever and goes to voice mail. Dammit. I am considering dropping the dog off @slav_metalurges.
Read 15 tweets
Dec 13, 2023
I get asked a lot about how to fix medicine. There are many people out there who are far better equipped to answer that question, but I think we need to acknowledge some fundamental truths.

Medicine evolved out of our capacity to care for those outside of our immediate family.
It required compassion but also an inherent understanding that collective well being is beneficial for us all. In that sense it is indelibly connected with social structure. Disparities in wealth & justice distribution are huge social determinants & drive heath care consumption.
TLDR: Education, taxation, reconciliation, and justice reform are crucial players in improving health. All longterm things. What are short term solutions? Risk reduction through guaranteed income and housing.
Read 11 tweets
Sep 12, 2023
So here’s what you need to know about E. coli, in an easily digestible thread. Image
It a common bacteria, that resides in our guts and those of most animals. We live in harmony with it, but it’s always looking for an advantage. It wants to travel beyond the colon, but fortunately a combination of physical and immunological barriers keep the pickle in the jar.
As an ICU doc I see what happens when bacteria escapes the colon. Pop an appendix, perforate a diverticulum, or get sucker punched in the belly and leak. Stool in the abdomen leads to abdominal sepsis and without surgery it can be lethal . But that’s not what happening here.
Read 23 tweets
Feb 12, 2023
I get the call from the emergency department.
“He’s was near death, but we stabilized him.”
They start reciting the story. It’s a well worn script we both know all to well.
“Unhoused,
Addictions,
Lost to follow up”
I feel it. That blend of anger & frustration I must control.
“He’s pretty unkempt, but his beard is immaculate.”
And at that point my heart softens.
“We don’t have a name yet. We think he had a seizure.”
“Does he have a tattoo over his heart?”
Pause
“Yes”
“Is it a church bell.”
“Y-yes”
Sigh.
“I’ll be right down.”
It’s Ted*
I’ve known him for at least a decade.
“He needs dialysis.”
I remember the scarred inscription from when I put his line in 4 years ago.
“Don’t fuck with my salvation!”
“I promise you, I won’t go near it.”
“It’s a god damned masterpiece.”
“It’s the Mona Lisa’s smile.”
Read 15 tweets
Jan 6, 2023
Some difficult truths when looking at our struggling medical system. We are failing because we are the safety net before the brick wall. When social systems like education, mental health supports, disability services and fair taxation are purposely dismantled this is the fallout.
Our hospitals are full of patients with complex medical issues who no longer have the social supports to survive anywhere outside of the hospital environment. Many are homeless, frail or suffering from complications of addiction. These issues have not occurred overnight.
COVID has been a major player. Many of our frailest patients have become so directly as a result of the damage this virus can do. It was as if we “promoted” a significant fraction of our population into dependency over the past three years.
Read 10 tweets

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