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Dr Satoshi Akima Profile picture
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20 Oct, 5 tweets, 3 min read
There is only one possible explanation for why Japan had a lower case-fatality rate than Australia, despite Japan having an older population #COVIDisAirborne
Aerosol mitigation (including mask-wearing) means that even if you contract COVID, you get exposed to a lower dose of viral copies resulting in a milder illness. Because #COVIDisAirborne aerosol mitigation saves lives
Australian states must mandate the universal wearing of high filtration efficiency masks and other aerosol mitigations. Cleaning the air in COVID is like cleaning the drinking water in cholera. You can't just rely on vaccines #COVIDisAirborne
Some will argue that Japan currently has a higher vaxx rate. While that may be true now, at the time of the Delta peaks in Japan and Australia, they were very similar. COVID cases also occur predominantly in the unvaxxed. Vaxx rates don't explain the difference in mortality
Unlike AU where testing is free, there is a ~15$ PCR testing fee in JP. That means prevalence in JP was underreported and case-fatality even lower: "Tokyo data showed the positivity rate fell from 25% in late August". We got nowhere near 25%! cbc.ca/news/world/jap…

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More from @ToshiAkima

Dr Satoshi Akima Profile picture
18 Oct
Afterthought Nr 2 on this thread: I found myself using the term "primary source control". Why was I saying that?💡I teach my medical residents/registrars to always pursue "primary source control" of infections all the time instead of relying on antimicrobials
Primary source control of infection is a much more ancient, pre-antimicrobial era method of infection control. You drain the pus, debride or amputate the gangrenous limb, remove the foreign object/device/hardware/prosthesis
Even today if you don't achieve primary source control antibiotics won't be enough and you may lose your patient. Teaching point: Don't be overreliant on treating infections with pharmacological interventions
Read 5 tweets
Dr Satoshi Akima Profile picture
17 Oct
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
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…
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…
Read 11 tweets
Dr Satoshi Akima Profile picture
1 Sep
The unspoken assumption of "living with COVID" is that it is in the economic best interests of the nation to allow the self-regulating forces of competition to liquidate the uncompetitive for the sake of net economic gain. Sacrificing lives to the gods reaps monetary rewards
This is a form of Social Darwinism in that it assumes that the self-regulating force shaping society for the better is that of the principle of capitalism as the "survival of the fittest". One devalues the "wealth of nations" by interfering to stop it
The assumption comes along that allowing the weak to perish under natural forces of competition increase the "wealth of nations". Economic intervention to support the economy during lockdowns keeps non-viable entities alive in violation of the law of the survival of the fittest
Read 13 tweets
Dr Satoshi Akima Profile picture
31 Aug
Observations of a Tsunami. Last week I optimistically predicted that NSW would track more like Arizona but this week gives me cause to doubt that. We might be headed on a one-way trip to Florida instead
I predicted on the 21st that it would take 2 weeks to reach a daily case number of 1300. I was accused of scaremongering. We reached +1200 in about 8 days instead. This reflects NSW frontline staff's experience with a surge more vehement than anticipated
If we start on Monday 30/8/21 at 1200 cases/day with an exponential doubling time of 8 days then by next Tuesday we could be at 2400/day. In another 8 days, 4800/day. If the peak occurs in October there's plenty of time to squeeze in another exponential doubling to 9600/day
Read 11 tweets
Dr Satoshi Akima Profile picture
31 Aug
Dear Journalists. Please take note and hold politicians accountable by challenging their falsehoods. This is basic high-school level maths, not rocket science. In this thread, I will explain it in easy-to-grasp terms
This is what "linear growth" looks like. It goes 2-4-6-8-10-12 etc. It takes quite a few steps to get from 2 to 12. That means growth over time often tends to be slower in a linear growth model. The graph looks like this. Linear = straight line Image
With exponential growth, you get serial doublings. So if you start at 2, you go 2-4-8-16-32-64. Exponential growth allows you to get from 2-12 in far fewer steps than with linear growth. The curve looks like this Image
Read 14 tweets
Dr Satoshi Akima Profile picture
30 Aug
This needs to go viral in Australia. The story line being that it may not be possible to open up like the UK has done because we relied excessively on the Pfizer vaccine instead of AstraZeneca. The AU Pfizer based double-vaccination strategy now in flames
The reason for this might be because even though antibody levels falls with time for both Pfizer and AstraZeneca vaccines, the better T-cell mediated response from AZ might compensate for this thelancet.com/journals/lance…
The conclusion is that we cannot use the UK as a template for a vaccination strategy in Australia. We are forced to follow the Israeli model and forget whatever BoJo did or said. As the science changes, so the public policy must change with it
Read 4 tweets

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