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Dr Satoshi Akima Profile picture
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10 Dec, 8 tweets, 3 min read
Interpretation: the reason for the exponential surge in Omicron cases is due to breakthrough infections in those with prior vaxx/infection-induced immunity PLUS cases in those without previous immunity. But in breakthrough cases, some protection is retained, reducing severity
It is improbable that Omicron is any less severe in those lacking prior immunity. Just like Delta, Omicron will hunt down these immune naive individuals, producing surges large enough to overwhelm hospitals, then add to the burden by hitting those with prior immunity too
I can easily imagine that the vaccinated/previous infected cases will still progress to respiratory failure a bit more than they used to with Delta. But a significant proportion of them still won't progress and many will be able to be discharged to manage bed pressure
I sorely doubt that the immune naive patients will behave much differently to those infected with Delta. They will be just as likely to exhibit the dreaded slow "progression" towards respiratory support, irrespective of whether they have Delta or Omicron biorxiv.org/content/10.110…
A couple of tweets saying much the same as what I just did. Large numbers of cases due to breakthrough cases or reinfections
"Reduction in severity" is largely an artefact of the fact that the vaccinated and the reinfected retain some degree of protection against severe disease
There is absolutely no signal at all pointing us to the conclusion that Omicron is inherently either more or less severe than Delta in those immunologically naive to COVID
A more in-depth way of saying roughly what I said in the opening tweet about what we're seeing being explicable by increased rates of breakthrough infection but with reduced severity of outcomes vs immunologically naive

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More from @ToshiAkima

Dr Satoshi Akima Profile picture
29 Nov
There’s a lot of #Hopium being shared over #Omicron saying that because info is incomplete that therefore “it’s just a mild cold”, “viruses always become more harmless over time”, “let’s all get infected”. But we know more than many admit
Once again, alarm signals about increased transmissibility (in Delta this mean higher viral loads and increased hospitalisation rates). Lack of perfect evidence of harm is hardly grounds for Faith in #Omicron being the Saviour attenuated live viral vaccine some claim it is
Omicron already exhibits mutations that were predicted to increase infectivity through enhanced binding to ACE2. There are *NO* known genetic features predictive of it turning into a cuddly live attenuated viral vaccine against COVID (the virology equivalent of Santa)
Read 8 tweets
Dr Satoshi Akima Profile picture
28 Nov
It takes 3 shots to be fully vaxxed. If you’re double vaxxed, you’re only partially vaxxed. The EU won’t even let you in
If it takes 3 shots to be fully vaxxed, then Australia is only 1.6% fully vaxxed. We've already been overtaken by Canada, who announced their 3rd shot later. To avoid future lockdowns, we've got to get to +50% by winter. Table by @covidbaseau covidbaseau.com/vaccinations/ Image
The evidence is clear. If we get everyone triple jabbed by winter, we have an excellent chance of averting lockdown. Follow the Israeli example. DO IT NOW!—don't start after we end up in another lockdown crisis
Read 12 tweets
Dr Satoshi Akima Profile picture
20 Nov
Unsolicited Review: Castle Grade N98 respirator. This gets a recommendation from me. TGA approved making it suitable for HCWs. It is comfortable and reusable. Ideal for Australian HCWs who suffer PPE burns from N95 masks, while upgrading aerosol protection castlegrade.com.au
Initial concerns included that I am not fit-tested by work, but as soon as you put it on you can tell there is reduced air leakage around the mask edges vs. a fit-tested N95. That means ZERO fogging of glasses. The tight seal pushes the air through the front of the respiratory
The acid test is whether I'd wear it working on COVID duties despite not being fit-tested. The answer is YES. There is obvious reduction in air leakage around the mask edges. It would be difficult for work to object to me wearing a TGA approved N98 respiratory instead of an N95
Read 16 tweets
Dr Satoshi Akima Profile picture
20 Nov
Another cycling day today. 50km done wearing a KF94 mask all throughout the ride (only removed to drink water). The trick to avoiding having it fog up your glasses is to push it as high on the bridge of your nose as possible.
During my work N95 fit testing, I was instructed to push the N95 mask as high up as possible. A KF94 is smaller so it causes it to sit above your chin, but this encourages exhaled air to be expelled from the bottom—not the top, fogging up the glasses
I was also instructed to carefully mould the nose bridge wire so that it fits the contour of your face. It's best to do this in front of a mirror. This further improves the fit, reducing leaks of air upwards, fogging up your glasses.
Read 6 tweets
Dr Satoshi Akima Profile picture
19 Nov
The answer is that it doesn't matter. Masks, social distancing and lockdowns are NPIs not drugs. It's enough signal that everyone gets masked and the burden of proof is on those who want to demask to provide level 1 evidence it won't cause excess mortality/morbidity.
The burden of proof to come up with evidence to substantiate their position falls on those who propose the potentially unsafe course of action. With novel drugs, that falls on the prescriber/manufacturer of the drug. With NPIs it is the de-prescriber of precautionary measures
There is no level 1a+++ evidence for the efficacy of lockdowns, handwashing, or social distancing for COVID. That is not grounds for de-prescription of these precautionary NPIs. The burden of proof falls on those who wish to de-prescribe them to prove it won't increase mortality
Read 6 tweets
Dr Satoshi Akima Profile picture
19 Nov
If Australians wish to avoid further disruptive lockdowns, we must find alternative NPIs to take their place. The evidence is clear: universal mask mandates are the best solution. They probably work even better than lockdowns or social distancing while keeping the economy running
The only reason to reject masks is that we love lockdowns. That's what's going to happen if we don't find a better alternative. Now we know #COVIDisAirborne we can use this insight to find more mode-of-transmission specific NPIs other than crude lockdowns
Anyone who rejects masks is an agent of chaos who secretly wishes more lockdowns upon us for the purpose of stirring social unrest, then harnessing it for their crazed populist cause. Gallows and all Image
Read 6 tweets

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