Tyler Black, MD Profile picture
Feb 6, 2022 10 tweets 4 min read Read on X
"COVID isn't that bad for kids."

To April '21, the estimate of orphanhood is 1.1M, and undoubtedly this number has grown (especially with avg age of death decreasing)

"1.1M orphans? What? That's not possible!"

Let's take a look at this.

Thread:
/1

thelancet.com/journals/lance…
People think of *orphanages* when they think of orphans. This leads to the common belief that an orphan is someone with no parental-role relatives.

And commonly, orphans refer to such children.

However, @UNICEF uses a standard international definition, which I too prefer.
/2
There are many configurations of parenthood. In some cultures, it's the "nuclear family" (mom+dad+kids), in some cultures it's an extended family (including grandparents, for example), and within cultures there are variations (raised by aunt, grandma does the raising, etc)

/3
A *primary* caregiver is someone who has shared but crucial role in supervision, safety, security, and basic needs. A *secondary* caregiver is someone who is regularly tasked by the primary caregiver to fill caregiving roles.

/4
Of course, all of these people are crucial to the development, care, security, and emotional connection to children.

The loss of any of these people, from a regularly babysitting aunt to a full-time caregiving grandparent to a mother or father, is devastating to children.

/5
So using the @UNICEF definition, an orphan is someone who lost a primary caregiver.

Deaths due to COVID have created 1.1M such orphans, and that's before omicron or delta waves.

Realistically, this number is likely 2M as of today and not slowing down.

/6
The estimate of loss of secondary caregivers is about 1.6M such orphans (realistically 3M today).

All children who lose a primary or secondary caregiver experience significant suffering and harm.

/7
Survey after survey of kids tells us that their top concerns, distresses, or challenges are the fear of a loss of a loved one, teacher, caregiver, or parent. And they are worried about the adults' in their lives health. They too, understand they are relatively protected.

/8
But they know what we all know, if they lose a caregiver and experience orphanhood, it is a pain and stress that will change their lives forever.

so please, keep the awful, repugnant phrase "covid isn't that bad for kids" out of your brain.

/fin
(all images are stock photos to the best of my knowledge, and i licensed 3 myself for these tweets as well as using free sites, i hopefully did not publicly use a child's expression of grief at a funeral)

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More from @tylerblack32

Jul 2
Since Trump took office:

* Elon net worth is $980B (+$500B)
* Donald Trump's family ~$10B, up about $7B
* Top 15 billionaires: up 33%

And USAID was cut 6 billion, resulting in hundreds of thousands of or the poorest people needlessly dying and suffering.

/1
Since Trump was elected:

* $5-700M on white house renovations
* $132B for the war in Iran
* $930M for the refurbishment of the "gifted Qatari jet"
* $102M for Trump's golf trips every weekend (at his properties, which profit)
* $40M for a military parade

/2
Since Trump was elected:

* $500B in lost IRS revenue
* $135B in benefits obligations and costs due to DOGE retirements

/3
Read 4 tweets
May 13
OK @joannamoncrieff ,lets do this.

POINT BY POINT
🔽🔽

/2 Image
Point 1: "Disease-targeting" is an invented criterion

1a. You demand drugs show "disease-targeting effects" or be presumed harmful. This is never necessary. The actual claim: reliable symptom change across replicated RCTs.

/2
Point 1: "Disease-targeting" is an invented criterion

1b. Cardiology doesn't know the molecular lesion driving most post-MI mortality benefit from beta-blockers. We use them anyway because they work. "No known mechanism, therefore presume harm" would gut most of medicine.

/3
Read 14 tweets
May 5
RFK is no better at psychiatric medications than he is about vaccines.

RFK's "overmedicalization crisis" thread is a master class in using true-ish numbers to imply a false conclusion. Let's go through it. 🧵

/1
The core trick: he treats prescription prevalence as self-evidently bad. But high rates only signal a problem if the meds don't work, are given to people who don't need them, or cause net harm. He establishes none of this. He just gestures at numbers.

/2
The same rhetorical structure would indict insulin prescribing, or asthma inhalers. Prevalence is not pathology. The question is whether treatment matches need — and whether the alternative (untreated illness) is better or worse.

/3
Read 20 tweets
May 4
Disabled people should not live in poverty.

It makes no sense the way we treat our people with disabilities in Canada. Canada has the full apparatus to implement adjusted payments, yet we typically support disabled people WELL under the poverty line.

/1 Image
Canada has an official poverty line: the Market Basket Measure. It's regionally calibrated, methodologically sound, and updated by StatCan.



A single person on BC PWD receives ~$18.4k/year. The Vancouver MBM is ~$29k.

/2www150.statcan.gc.ca/t1/tbl1/en/tv.…
That's not a rounding error. It's a structural choice.

PWD recipients in Vancouver sit at roughly 47% of the poverty line and below the Deep Income Poverty threshold (75% of MBM), which is the level StatCan uses to flag the worst material deprivation in the country.

/3
Read 10 tweets
May 2
Quick thread: "How do SSRI's work" 🧵

I've had a few patients ask me how SSRI's work.

To be clear, my first answer is "well we know they are supposed to block serotonin reuptake, but it's not that simple and we don't really know."

But, if you want the best 2026 science...

/1Image
For a few particularly science-interested patients, I walk them through what we currently have for the 'best evidence' even though we're still not sure.

This is the "best story" I can tell about SSRI's right now.

(nb, this is NOT locked in, this is MY best synthesis)

/2
1) SSRIs BLOCK the Serotonin Transporter
The protein that pulls serotonin back into the neuron after its released is blocked. Serotonin lingers longer in the synapse, the gap where neurons signal each other.

This is very well established, & how SSRIs were designed.

/3Image
Read 15 tweets
May 2
The Ihben story is making the rounds. "Judge forced 18 vaccines, child got autism." It's being treated as a smoking gun. It is not a smoking gun. It is barely a story.

/1
Sourcing: one father, one advocacy org (CHD), one GiveSendGo. Records sealed. No filings. No named physicians. Every outlet repeating it cites the same Defender article. This is a closed loop, not corroboration.

/2
"18 vaccines in one day" is not a thing. That number counts antigens as doses to make the headline scream. Real catch-up schedules don't work this way and you can verify that in five minutes on the CDC site.

/3
Read 10 tweets

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