Dr Noor Bari Profile picture
Oct 2, 2021 15 tweets 4 min read Read on X
CDC defines influenza as an epidemic disease. Even though it has been around for ages, and is never truly gone from the earth, it comes and goes in waves. COVID-19 will likely be similar.

Endemic illness stays at a constant level roughly.

cdc.gov/flu/about/inde…
I don’t think you can just decide to call something endemic at an arbitrary point in time… it has to show some characteristics of steady rate of disease.
I hope we don’t chose to allow COVID-19 to be at very high endemic levels, or have large epidemics. Would be better if it was sporadic outbreaks. Much safer.
In fact, even at high “endemic” levels there is evidence of epidemic outbreaks of different strains emerging and outcompeting each other…
Things endemic doesn’t mean…

Mild.
Everything will be alright.
You can’t control it.
Back to normal.
Malaria is an endemic disease.

There is an elimination program to control it.

Endemic does not mean “Do not eliminate.

who.int/teams/global-m…
“This vision will be achieved progressively by countries eliminating malaria from their territories and implementing effective measures to prevent re-establishment of transmission.”

Sound familiar?
End TB strategy.

Endemic to many parts of the world, according to WHO, TB should be eliminated.

who.int/teams/global-t…
Some thoughts on chicken pox, also endemic to many parts of the world, possibly slated for elimination.

medicalnewstoday.com/articles/23167…
Each of these diseases is different, and needs different strategies.

TB is airborne slow, latent, hidden, has animal reservoirs. Vaccine partially effective.

Malaria, insect borne but no animal reservoir.

Chicken pox, airborne but vaccine susceptible.
We have not let “endemic” get in the way of planning disease control before, and despite difficulties, infectious disease specialists haven’t thrown the towel in before.

The word endemic has been used inappropriately to mean the public should stop harassing the government.
COVID-19 is still an epidemic disease in most countries.

It is a serious multi system disease, and requires control.

Declaring it “endemic” makes absolutely no difference to that.
If your government or medical officer is telling you that your country/region has endemic SARS… just say “Yes, and what is the plan to control it?”

Because that’s the normal response to a serious endemic disease.
I am so glad that I am not the only one that can see this.

Endemic COVID-19 is a mess.

Just because a disease is endemic, does not mean you can forget about controlling it. It will mess up the economy whether you like it or not.

#TargetingZero🦠
#EndemicCOVID19 will eat your healthcare system and spit out the pips.

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More from @NjbBari3

Apr 25
I’m not saying the virus that fuses brain cells together did it… I’m just saying it might have had a part.

theguardian.com/education/2024…
I’m not saying being persistently unwell and absent from school due to COVID infections and secondary bacterial infections plus viral reactivations did it… I’m just saying they might have played a part.
I’m not saying teachers being off sick more frequently did it… I’m just saying it might have played a part.
Read 8 tweets
Apr 14
The playing field did change… between the pre vaccine and vaccine era… but after that?

Honestly, I don’t know.

Data erosion is so bad I can’t answer the question “Are things getting better?”

->
I have reason to suspect things aren’t getting better…

Reducing access to vaccines.

Not strain matching vaccines.

Reducing protections in hospitals, aged care and other communal facilities.

Accumulating infections…
So if you are thinking of relaxing your precautions because 5 years in and everyone hasn’t dropped down yet…

I’m not sure that anything has really changed. You’ll just be joining the train of deterioration a bit later…
Read 7 tweets
Apr 11
See what I mean about COVID being bad for your immune system…

If you are infecting the immune system itself… how far do you think you are going to get?
It’s not just macrophages in the lungs either… it’s monocytes too…

Monocytes are a bit like macrophages, but circulating around the body.

nature.com/articles/s4139…
Now the liver…

“the number of liver macrophages significantly increases according to the hyper-production of pro-inflammatory cytokines…….

(hepatic stem cells (HSCs) respond to this inflammatory load with transdifferentiation into collagen-producing myofibroblasts”
Read 18 tweets
Apr 10
When you become irreversibly unwell due to repeated COVID infections they will say…

“Well we did tell you to take personal responsibility for your health.”

“We did write guidance to ventilate and wear masks*.”

“You were told about long COVID.”
None of this is role modelled by leadership.
There is no fanfare, you won’t see it on ads.
Read 7 tweets
Apr 10
The more I think about subclinical infection conferring immune “strength” the more it doesn’t make sense.

Previous studies used to support the hybrid immunity theory also showed that the reduction in death and hospitalisation was related to the severity of the first infection.->
There’s also data showing that the group that have the least symptomatic infections… healthy kids… also had a large proportion that did not make a strong immune response in terms of antibodies…
So while variolation of SARS2 might be theoretically possible, I don’t think it’s actually going to give meaningful levels of protection.
Read 7 tweets
Mar 31
Ok… spent last night in ED again (cat 2 injury, not me) and oh boy did the waiting room look like fun.

50% coughing and fevers with surgical masks on. Other 50% vomiting (so no masks on).

What do you suppose the air soup would have contained?
Oh, and waiting room was full… while in the background the dulcet tones of MET codes being called.
All is well regarding injury this morning… except grumpy cos splinted… but cheerfully finding adaptations too.
Read 4 tweets

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