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Jan 19 16 tweets 4 min read
I think the vaccine/COVID myocarditis issue in kids really shows the difference between those reasonably weighing up costs and benefits and those who are either dishonest or not very good at epidemiology 1/n
2/n We know two things with a great deal of certainty for younger people:

1. myocarditis following vaccination is rare
2. myocarditis following COVID-19 is rare
3/n This is probably not a surprise, because myocarditis is rare in younger people regardless of the situation. Here's a study that found an incidence of 2 cases per 100,000 kids each year…
4/n Now, the issue is, we aren't quite sure which of these rare events (vaccine or COVID-induced myocarditis) is more common. Some studies say COVID, some indicate the vaccine (particularly Moderna)
5/n And, if we were totally incompetent, we might argue that, since some studies observe myocarditis at a slightly higher rate in younger people after vaccination, this means that the vaccine is causing harm

But that's a very bad argument
6/n Why? Well, while myocarditis is the main serious issue identified in young people post-vaccine, COVID-19 causes any number of serious, harmful problems
7/n Just look at the Nature Medicine paper that has sparked so much of this nonsense. Myocarditis in people <40 years is higher with Moderna than the virus!
8/n Except, look at pericarditis and arrythmias. Basically no risk from the vaccines, HUGE increased risk from the virus (the graphs are only for all ages, but from the supplement the virus increases the risk of arrythmias by >30x in under 40s)
9/n And those are just cardiac complications! If we take the gold standard of dividing hospitalizations by number of infections based on serology, COVID-19 causes hospitalization for about 1 in 1,000 children. WAY higher than the vaccine…
9.5/n On top of this, we've got the risks from long COVID. One study found that 1 in 5 adolescents report anosmia 3 months after COVID infection (this may be inflated by various biases, but is still something to consider)…
10/n Now, it's true that we don't know what the marginal benefit of second/third doses is on reducing these higher risks from COVID vs the increased risk from some vaccines of myocarditis
11/n This is a complex question that almost certainly has a complex answer, and I can see why some people have recommended against boosters for teen boys in this context
12/n That being said, if someone presents only the risk of myocarditis for COVID-19 vs vaccines, it's just a poorly-done piece of work that doesn't address the issues we care about much, if at all
13/n (It should be noted that this is NOT a criticism of the Nature Med paper, which didn't actually make this claim because they seem to be quite good at epidemiology and weighing risks and benefits)
14/n It's been pointed out that I should've been more clear - yes, the primary risk is for young men aged 11-29 receiving their 2nd dose of mRNA vaccines, and this is where most of the complexity I alluded to above lies
15/n Current evidence appears to indicate that the risk for younger children is negligible, and girls are also at a much lower risk at all ages…

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More from @GidMK

Jan 19
One thing I don't think people realize about 'endemic' COVID, where we have regular seasonal outbreaks that wax and wane, is how damaging THAT situation will probably be
It's hard to estimate the death/severe disease rate for COVID at this point, due to prior infection, vaccination, and better medication use (e.g. fluvoxamine), but we could say that for someone who's been vaccinated/infected, the risk is probably similar to seasonal influenza
But...influenza kills A LOT of people each year. We may not shut down society because of it, but one study found that eliminating seasonal influenza may reduce total mortality in a country by 3-6%…
Read 4 tweets
Jan 19
The new viral claim is that cannabis can help with COVID-19, due to a few lab-bench studies

I'm interested to know what people think the likelihood of this panning out is (poll in next tweet)
On average, what proportion of compounds that are found to do something in the lab end up having a benefit in actual clinical trials of human beings?
Now, this is a complex question, but it's also enlightening, because the real answer is that it kind of depends
Read 10 tweets
Jan 17
I don't think weird right-wing people from overseas who pretend to care about borders only when it's convenient to them realize how deeply unpopular Djokovic was here in Australia
This is polling by @theage, as mainstream as media gets here, showing that in a reasonably representative sample the anti-vaccine tennis twat had virtually no support at all. 6 out of 7 voters either didn't care or thought he should fuck off
Problem is, most Australians are very pro-vaccine, hate tall poppies, are a bit touchy about borders, have had a hard time of travelling during the pandemic, and feel very strongly about following rules (especially COVID rules)
Read 7 tweets
Jan 5
One of the more fascinating things when looking at the story of the pandemic is how tribal most arguments have become
Take lockdowns, for example. We have ample evidence that various non-pharmaceutical interventions were not as harmful as initial predictions suggested. It's just not correct at this point to argue that lockdowns have caused enormous death tolls…
We might expect that at some point in the future places that locked down will do worse on some metrics, but based on evidence we also might not. It's very uncertain, because large COVID-19 outbreaks also cause bad things to happen
Read 11 tweets
Dec 29, 2021
I thought I'd put together a short list of terms that, while they may have some formal definition, tell you more about the person using them than conveying any actual meaning in conversation

First up, "cancel culture". Means basically nothing
My perennial favourite, "nanny state". It's only used when people consider a govt intervention to be overreach, but what defines overreach is entirely subjective
Btw, feel free to add your own examples to this list, there are SO MANY
Read 8 tweets
Dec 16, 2021
I think the tales of hydroxychloroquine, ivermectin, and fluvoxamine are such fascinating examples of the problem with accepting low-quality evidence for drugs
The argument for use of HCQ and IVM has always been that they are reasonably safe (true) and so the plausible benefit outweighs any harms. Conversely, until the positive RCTs of fluvox came in, it was FAR less popular because it does have quite a few side-effects
But it appears, at least in the case of HCQ, that there is definitely no benefit and there is a reasonable chance of modest harm. In this case, using the drug has almost certainly caused unnecessary deaths
Read 8 tweets

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