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Tyler Black, MD Profile picture
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Feb 8 • 4 tweets • 2 min read
I was quite sure that there were major Ontario hospitals like SickKids and McMaster claiming things like "300% increases in hospitalization" and "200% increases in suicidal presentations" to their ERs in 2020 and early 2021...

why I always say: look for the data
I'll be doing a thread about this amazing study that shows us the detail that Ray et al couldn't, but arrives to the same conclusions, in the coming days.

jamanetwork.com/journals/jamap…
This is such a great and nuanced conclusion that shows us that the most dire of conclusions about mental health decreased, and outpatient care increased (8% overall, 26% adolescent female), nowhere near the "doubling" or "tripling" claims of non-experts.
There is lots to say about this and you can be sure the thread will be epic, but check out these press releases by McMaster, CHEO, and SickKids from the end of the study date:

The data to March did not support these proclamations in Ontario

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More from @tylerblack32

Tyler Black, MD Profile picture
Feb 9
even the surgeon general @vivek_murthy ..

abcnews.go.com/Politics/surge…

Though expression of concern is always OK, let us not be swept up by one-sided and biased narratives of what the evidence is showing.

/1
We have significant evidence emerging that many of the dire outcomes decreased, and there are nuanced changes (not devastatingly huge) both positive and negative. An excellent review of the evidence and its problems here.

ncbi.nlm.nih.gov/pmc/articles/P…
add in this incredibly detailed data from Ontario (canada's largest nation; generally strict school closure measures) shows some changes up and down (-50% to 28%) in various measures.

/3
jamanetwork.com/journals/jamap…
Read 8 tweets
Tyler Black, MD Profile picture
Feb 9
A well balanced, expert review of quality of evidence limitations, the mixed nature of results we're seeing, and the implications of all of this as it pertains to "Covid-19 impacts on youth mental health."

/1
"Longitudinal findings paint a more nuanced picture than some cross-sectional studies from the early stages of the pandemic, though there is reason to believe that there could be long-term impacts on youth mental health, especially in more vulnerable youth."

/2
Compared to some very one-sided evidence reviews from the Canadian Paediatric Society and the Royal Society of Canada, and the awful #urgencyofnormal document, this review highlights the complexities and nuances.

/3
Read 6 tweets
Tyler Black, MD Profile picture
Feb 9
Update for @politico

A group of non-mental-health credentialed doctors makes statements about mental health that are not supported by the bulk of our evidence.
For example, in Massachusetts out in @JAMA_current , new referrals for child mental health issues decreased sharply early on, and increased (about the same) later on, but this would not be by anyone's stretch a "dramatic increase." Image
You can certainly see how selectively grabbing March 2021, for example, might allow that statement, but not the bulk of the evidence, including Mar-Jun 2020 and Jan-Jun 2021 combined.

(note: Mar-Jun 2021 every jurisdiction in MA open school) Image
Read 4 tweets
Tyler Black, MD Profile picture
Feb 8
Folks @NewsHour @PBS presenting #UrgencyOfNormal / Lucy McBride relatively uncritically, without mentioning all the errors and lack of expertise in children's development and mental health they have. Please let them know how important it is to have mental health experts.
Literally an entire segment in which Lucy McBride, a private internist with zero child mental health, speech development, or child developmental expertise, was asked questions about MH/development impacts by @IAmAmnaNawaz .

Expertise matters.
Please media, stop giving non-experts "mental health of kids" expertise cred or even credibility.

There is no reason that a private practice internist should be speaking on national television in her white coat about pediatric development or mental health.
Read 4 tweets
Tyler Black, MD Profile picture
Feb 6
"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
Read 10 tweets
Tyler Black, MD Profile picture
Feb 5
Why yes, selective-article grabber, I did thoroughly read the BBC news article about children and NHS referrals, and I have a few comments.

#schoolclosures #UKPolitics #ENGLAND

/1
First, it's important to note that I did what any normal human and not a data robot does when they read an infographic, I faithfully transcribed it using machine-reading software to translate it into Excel. If anyone can find the raw data, thanks.

/2
I then sourced school closures directly from gov.uk

This allowed me to create two lockdown periods (<30% school attendance) and open school periods (>75% attendance)

/3
Read 18 tweets

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