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Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
@ToshiAkima
Oct 17, 2021 • 13 tweets • 7 min read • Read on X
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Lockdowns are the crudest possible form of public health intervention. Far better is to identify the correct mechanism of spread for a pathogen and use that insight to control the infection at its source: just as we did with cholera in the 19th century Image
In London, cholera outbreaks in 1832 and 1849 killed a total of 14,137 people, because the Thames had become severely contaminated by overflow from sewerage. They'd got the mechanism of spread wrong, thinking it was spread in the air by "miasmas" en.wikipedia.org/wiki/1854_Broa… Image
The "miasma" theory is very archaic. "Malaria" for example means "bad air" in Italian. Medieval plague doctors wore respirators with aromatic scents in them to ward off the foul-smelling "miasmas" to avoid getting infected en.wikipedia.org/wiki/Plague_do… Image
It took a huge struggle to overcome the miasma theory of cholera spread before the waterborne theory was accepted. As with the idea that #COVIDisAirborne physicists took the lead. Michael Faraday wrote to @thetime in July 1855 about testing "the degree of opacity” vs. white paper Image
Like our aerosol physicists today, Faraday's warnings were ignored. In 1855, Dr John Snow published arguing it was a waterborne disease. It was universally ignored. Snow did not live to see the success of his theory which wasn't fully accepted until 1866 collections.nlm.nih.gov/ext/cholera/PD…
It was not until things got so bad with the Great Stink of London of 1858 that parliament finally took action. Led by engineer Joseph Bazalgette, a system of public sewerage was installed. As a result, cholera was eliminated from London theapricity.com/forum/showthre… ImageImage
City after city that emulated London in installing public sewerage systems eliminated cholera without antibiotics or vaccines. Snow and Faraday were right: cholera was waterborne, not airborne. Once they'd got the mechanism of spread right they could control it at its source Image
The problem with the idea that #COVIDisAirborne is that it sounded to opponents too much like the archaic miasma theory. The evidence for aerosol spread is now overwhelming compared to that for droplet theory. As with cholera, we now know how to control the disease at its source!
Just as cleansing the water eliminated cholera in the 19th C, then our task today is to clean the air. We have the technology to filter the air. We must mandate the use of these + high-grade masks (N95, KF94, KN95) for everyone until COVID is eliminated. Because #COVIDisAirborne Image
Lockdown is a crude tool that comes from the Middle Ages. Social distancing at 1.5m doesn't work against aerosols that travel distances and linger even after a person leaves a room. If you rely on these, you'll need longer/harder lockdowns to compensate
The moral of the story is that the model of lockdown/social distancing works poorly when #COVIDisAirborne because it fails at primary source control of the infection unless it is made so draconian people have zero contact with each other
In a cholera epidemic you wouldn't tell people it's fine to keep drinking faecally contaminated drinking water as long as you're vaccinated. So why say the same thing for an airborne virus? #COVISisAirborne
A more in-depth review of the history of the theory behind aerosol spread of disease, covering much the same territory poseidon01.ssrn.com/delivery.php?I…

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More from @ToshiAkima

Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Oct 19
I was always suspicious of the thousands of freshly minted clichéd Canadian trucker convoy and MAGA accounts pushing anti-vaxx propaganda. You'd block a thousand only to have a thousand more appear. They'd all repeat the same set of messages over and over.
We clinicians are naive. All we could do in reply to the misinformation campaign was quote some RCT as though it were a scientific debate, when really it was an act of war. Yes, a proxy war waged by atypical means, but a war nonetheless.
As they got the UK to shoot itself in the foot with Brexit, the troll farms politicised the bipartisan issue of vaccination. The result was a civil war waged with biological agents, causing an enormous mortality disparity between left and right.
Read 6 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 29
The paper is now out in @Nature after I tweeted on this oral presentation @ISTH 2023 by @AkassoglouLab. Fibrin/fibrinogen may be a therapeutic target in СОVΙD neuropathology. Link in next tweet.
“...results reveal a role for fibrinogen as a SARS-CoV-2 spike-binding protein accelerating the formation of abnormal clots with increased inflammatory activity”…“fibrin-targeting immunotherapy suppresses SARS-CoV-2 pathogenesis”.

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From an #immunothrombosis perspective, this paper now shows fibrinogen to be a far more critical player in this field than previously thought. We used to focus more on contact, TF, and thrombin but now must look further downstream in the fibrinogenesis/fibrinolysis pathways too.
Read 7 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 8
It's not so bad a comparison if you accept that to get a similar “depletion of the susceptibles” by a Darwinian evolutionary mechanism, you'd have to deplete 2-400M vulnerable pheno-/genotypes from the pool.
It's always assumed that “evolve to become milder” means that the virus evolves, when it is just as likely that humans are “evolving” via a survival mechanism involving “depletion of the susceptibles”, leaving only those less prone to a lethal outcome. This, too, is evolution.
GBD types would likely argue that intervention to halt the depletion of the susceptibles is a perversion of the natural selection process and a crime. By opposing it, we are simply prolonging the pandemic.
Read 11 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 5
And this week's Grand Rounds “just a cold” is another young patient with enterovirus-induced fulminant myocarditis needing intubation, ECMO, and an Impella LVAD. I've never seen so many severe post-infectious complications presented in my life.
Last week's Grand Round? Another “just a cold” with Mycoplasma in a paediatric patient who developed encephalopathy, needing IV pulse methylprednisolone and IVIg. It's like every week we see a new case of previously rare infectious complications in young patients.
Another Grand Rounds case. A pregnant woman with severe cardiomyopathy caused by a combined adenovirus and enterovirus infections. Required ECMO.
Read 4 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 3
Subjecting trial subjects to wearing surgical mаsks against an airborne virus is like running a bike helmet RCT with subjects in Tupperware helmets that weren't designed for that purpose. “But we don't know it doesn't work until we run an RCT” isn't good enough.
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“But there was a 30% reduction in head injuries in the Tupperware group vs. placebo.” Not good enough! In a high-risk scenario for major head injury, a Tupperware helmet won't do. The magnitude of risk test subjects were exposed to needs investigation and quantification. Image
Non-pharmaceutical physical protective devices are subject to engineering standards of proof of efficacy. In the case of helmets, that means crash testing in a lab to see how they fare in high-risk situations that live subjects can't be exposed to. helmet.beam.vt.edu/lab.html
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Read 7 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jul 31
A reminder that there was once a titanic struggle between contagionists vs miasmatists over the mechanism of transmission of cholera before the need to cleanse the water of waterborne pathogens was accepted. We are going through a similar struggle today, fighting for clean air. abc.net.au/news/2024-07-3…
If you want to read about how divisive the debates between the contagionists and miasmatists was, you should read “Death in Hamburg” by @RichardEvans36. They didn't need Twitter back then to be almost reduced to pistols at dawn.
Quoted in the article by @Hayley_Gleeson is our latter-day Professor Pettenkofer from Down Under: “I want to believe…”
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Read 4 tweets

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