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Kashif Pirzada, MD Profile picture
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Dec 28, 2021 • 9 tweets • 3 min read
It must be bewildering to sort through the conflicting messaging out there now. Problem is everyone is:
- in a frenzy preparing for an Omicron wave, getting boosters out etc
- in deep shock about the rapidity of spread and what that implies
No one knows what lies next...
So part of the messaging you're seeing is accepting reality that it will be very difficult to avoid getting infected this round. Had we spent the last 2 years preparing to fight an airborne pathogen with ventilation, filtration and N95 masks, maybe most would have had a chance...
But this is likely one of many future rounds with this virus. SARS2 will win this one, and most cases will be mild; boosters will limit the damage, buy us 3-4 months of relative protection for most. The elderly, small children and of course the unvaxxed will be hit hard...
Boosters gives us time to prepare. The nightmare is if a new variant shows up that is immune evasive, deadlier and also super contagious. To prepare we can:
- Implement airborne precautions everywhere
- Mass produce antivirals
- Mass produce antibodies
- New vaccines
Whatever we do next has to take into account that immune memory to SARS2 is very short; the Israelis are trying to workaround this problem with serial boosters. We might have to do the same until we get better tools...
SARS2 'exhausts' the immune system - it has a 'super-antigen' that activates and depletes your T-cells. These effects are lasting months, maybe longer. Serial infections will keep adding to the damage. Each round depletes your ability to fight disease.
SARS also attacks your platelets, responsible for regulating blood clotting, and could explain why survivors have a high risk of blood clots post infection. Each subsequent round of infection brings more clotting risks, strokes, heart attacks...
All this points to a dark future, where many of the advances we've made in medicine are being reversed by this persistent and dangerous virus.
We have the means to avoid this fate, but it would take a massive effort to do so.
Our societies are just not built well to handle multi-year challenges, especially those that involve complex and uncertain science. We've expended all our hopes on vaccines, but these are falling short.
Ideas on what to do next are welcome, and tag anyone you think would help!

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More from @KashPrime

Kashif Pirzada, MD Profile picture
Jan 21
What I imagine a chief public health officer would write, but can't:
“Dear citizens, I write to explain some difficult realities. We are tired of fighting Covid-19. Our strategy was entirely based on vaccines, and though they are amazing, their benefits are proving fleeting...
"We could have built a strategy to supplement our vaccines with multiple mitigations, but we did not spend the time or the effort to do so despite having two years to plan and implement this...
"We ignored compelling evidence that the virus was airborne and highly dangerous in poorly ventilated indoor spaces. Instead, to avoid offending powerful personalities within our ranks, we stonewalled and now are completely unprepared to contain this virus...
Read 18 tweets
Kashif Pirzada, MD Profile picture
Jan 10
It is NOT inevitable that our kids will get Covid. The tools exist, including comfortable kid-sized N95 masks, HEPA filters, to prevent this.
Some opine that kids N95 masks are too hard to wear, are harmful, etc.
Let me ask you: do these kids look like they're uncomfortable?
This table from @masknerd shows excellent filtration from well-fitting masks; many are KF94 (N95 equivalent) masks from South Korea, where their use is routine and expected.
It is unfortunate that national media is platforming physicians who push the inevitability narrative. One of the key lessons I learned in medical school: you do not shrink from a problem because it is hard and difficult!
Read 8 tweets
Kashif Pirzada, MD Profile picture
Dec 26, 2021
After working several days in a row in the ER, can reasonably say a few things.
Omicron definitely is more mild... for the vaccinated. Unlucky folks on the older end or with comorbidities can get it more severely though.
For the unvaxxed, same deadly virus. No doubt about that.
The symptoms have changed as well.
Before the hallmarks were loss of taste and smell, severe body aches, chest pain and shortness of breath,
Now most (vaccinated) people present with a sore throat, runny nose, mild cough for a few days.
Last night, of around 45 PCR swabs we ordered,every single one was positive for Covid.
If you have cold or flu-like symptoms in Toronto now, you have to assume it is likely Covid regardless of what a rapid test or PCR tells you.
Read 11 tweets
Kashif Pirzada, MD Profile picture
Dec 13, 2021
I'm making rapid test 5-packs for my clinic patients. Also throwing in a KN95 mask to protect them from day-to-day airborne exposures. I figure if governments won't do it, it's up to all of us to jump in and protect each other this holiday season from Omicron.
I was fortunate to have a local business donate the tests. Was inspired by @LisaBarrettID's work in Halifax; 11 drops of the reagent in each vial, instructions, 5 test strips, and a mask in a sandwich bag. Feel free to do the same for your customers and patients!
This is the way it should be, and we don't have much time:
Read 7 tweets
Kashif Pirzada, MD Profile picture
Nov 19, 2021
Tomorrow vaccine approval is expected in Canada for kids 5-11. I believe so strongly in their benefits that I enrolled my own sons in a trial of @moderna_tx's vaccine for kids 6m to 5y. They have a 1/4 chance of getting a placebo, but🤞they have some chance at safety now. 🧵=>
The evidence thus far is that it is safe and effective for children. It reduces the risk of infection, and though death is rare, it still happens in 1/10k cases. Long Covid can happen in >1/50 cases. @EricTopol lays it out plainly here:
In this detailed thread @ENirenberg goes over data presented at recent FDA and CDC meetings. Myocarditis is thought to affect males pubertal age and above, and resolves quickly. The CDC advisory committee voted unanimously to recommend the vaccine:
Read 12 tweets
Kashif Pirzada, MD Profile picture
Nov 17, 2021
Covid is an airborne virus. What does that mean and how can you protect yourself from it? I go over some practical steps you can take to keep yourself safe this winter with @gilldeacon on @CBCHereandNow:
cbc.ca/listen/live-ra…
Step 1: Whenever you go in an indoor space, make sure you have the right protection. A well fitting N95 or similar mask is your superpower. It frees you from worrying if others are wearing their masks properly, and if they are vaccinated. I don't go indoors anywhere without one.
This is a guide to wear you can buy an N95 equivalent mask, typically $1 or so at major stores, and you can re-use them several times.
Read 8 tweets

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