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Kashif Pirzada, MD Profile picture
@KashPrime
Feb 20, 2022 • 72 tweets • 26 min read • Read on X
Why isn’t the pandemic over yet? Why did we require boosters? Authorities including the CDC are finally acknowledging that our vaccines provide protection for only 3-4 months at a time. I interview @fitterhappierAJ to go over possible reasons why.
I’ve been closely following @fitterhappierAJ’s takes on Covid and immunology. Initially I didn’t want to believe his predictions regarding T-cells, but they have stood the test of time and are now being confirmed by multiple lab studies
This is part of a lecture series by @masks4canada, to chart future directions of this pandemic. What can we do to change course, or at least ameliorate ill effects? Many of our political leaders want this to be over now, is this realistic? This is what we hope to address.
This is a simplified model of how our immune system works. We prevent infection with barriers like masks, and kill viruses when they get to our 2nd line of defence, our innate immunity and antibodies. If that fails, we have T-cells, which are efficient killers of infected cells. Image
What is the crux of Dr. AJ's arguments? We have been told that though the virus has mutated and is evading antibodies, our T-cells will save us. Problem is, these cells are themselves overactivated and damaged during infection, and start to damage you; the gets worse with age. Image
Papers that show continuing dysfunction in T-cells:
In Long Covid patients: nature.com/articles/s4159…
In severe Covid-19 disease: nature.com/articles/s4141…
Precipitates EBV reactivation:
doi.org/10.1016/j.cell…
Seen in lung damage on autopsy studies:
nature.com/articles/s4146…
The immune system depends on a fine balance and order to protect you. Invasion by a virus sets off your ‘innate immunity’ which sends signals, one of which is a chemical called Interferon, which ‘interferes’ with the virus. Your immune systems moves to quickly kill the invader. Image
Problem is, as @WmHaseltine explains in an excellent article series, that SARS2 is expert at hiding and preventing that signal from going out. Your cells are hijacked to create trillions of virus copies. T-cells go into overdrive to fight this.
forbes.com/sites/williamh…
SARS disables this essential early warning signal, Interferon. How severe a disease you get seems determined by how much this important early signal gets damaged.
nature.com/articles/s4159…
What happens is an overreaction; T-cells start killing healthy cells and each other, and you start depleting them, including your naive T-cells. Naive T-cells are a pool of cells that your body creates when you’re a child to handle future infections. Image
When these get depleted, it ages your immune system and likely leaves you open to future infections or cancers.
Low naive T-cells are associated with poor outcomes in this paper: pubmed.ncbi.nlm.nih.gov/33010815/ Image
This whole cascade seems to be prevented if you have antibodies circulating already that can sound the alarm on their own, which comes from recent infection or vaccination. Problem is your levels drop after 3-4 months. Maybe more boosters will keep them up longer.
This study from Singapore of Covid cases and close contacts shows that an antibody response was crucial in stopping infections:
doi.org/10.15252/emmm.… Image
A novel idea proposed by Dr. AJ is that naive T-cells act as a sink, a dampener on T-cell over-activation. He has a paper coming that will be explain in more detail, but this would go a long way to explain why age seems to the be predominant factor in death. Image
Younger people have more naive T-cells naturally, and if they act as a dampener on T-cell overactivation, would explain why those below 60 fare much better. The analogy is to carbon rods in stopping a nuclear chain reaction.
ncbi.nlm.nih.gov/labs/pmc/artic… Image
UK and US agencies are recently noticing the short duration of vaccine derived immunity:
cdc.gov/mmwr/volumes/7… Image
More and more papers are demonstrating poor long term outcomes post Covid infection. Many of these are in unvaccinated cohorts though, but the role of immune overactivation is becoming clearer and clearer Image
Image
Given the the risks to all age groups, especially the risk of death to those above 60, caused by T-cell overactivation and depletion, our leaders need to plan to prevent as many infections as possible. Image
I personally am planning to stay under circulating antibody protection as long as possible via boosters. Antibodies will allow your body to coordinate a defense against SARS2, prevent innate immunity evasion, and hopefully prevent Long Covid. Image
We need to build safe common spaces, ventilation upgrades, rapid tests and generally protecting as many as possible while restoring life to as close to near normal conditions as is possible. Image
This includes planning for surges and lulls in case numbers, where society can periodically recharge from high risk periods. Image
The alternative, where we do nothing and pretend things are over, is a dark future in which life expectancy is shortened, and many of us will not get to enjoy the fruits of our labours and a healthy old age
This is already being noticed by the insurance industry, where life insurance claims for those 18-64 are up 40%, an age group usually in good health.
thecentersquare.com/indiana/indian…
What is the solution? Improved vaccines are not far away, including intranasal vaccines. These have the benefit of being able to train your innate immunity, and the cells that line your nose and lungs to fight SARS2, and prevent it from evading immunity.
cell.com/cell/fulltext/… Image
I would caution against removing all pandemic protections. Much of the decision making is guided by political considerations and, in the case of Blue states, by focus group research, not sound science. It is not 'Mission Accomplished' unfortunately
nytimes.com/2022/02/10/pod… Image
Again, a link to the interview is here:
A transcript of the interview can be found here: docs.google.com/document/d/1-5…
A 32% increase in life insurance claims at Hartford Insurance Group:
Reupping this, sadly it looks like many places in the West are not preserving even basic measures. The results will be predictable, especially in those over 60 without regular boosters. Based on what you've learned in this thread, you now know better.
A fantastic thread discussing the value of Intranasal vaccines, mucosal immunity and long lived memory B cells:
An interesting treatment that could potentially reverse immune system aging: nature.com/articles/d4158…
#leonardiwasright
More verification:
And @fitterhappierAJ’s paper has just dropped! Hopefully will try to come up with a thread to explain it.
Some clarification:
Right on cue:
Reinfection leads to increased ICU admission in this study; immune system exhaustion would be a good explanation why:
More discussion on Superantigens and Superantigen-like motifs here:
Immune cell derangements and Long Covid:
Others are questioning if T-cells alone can fight off Covid without antibodies to help:
More evidence of viral suppression of immune activation and innate immunity that we reference in the video and this thread:
It doesn't take much to tip into exponential spread, when the R0 is close to 1...
A grand unified theory on the origins of MIS-C as well as severe Covid, featuring the Superantigen. Reinforces the point that we just can’t coexist safely with a super contagious superantigen carrying virus.
Links to earlier papers by @fitterhappierAJ that elaborate on this:
It's very important that @fitterhappierAJ be properly acknowledged for discovering this mechanism >2 years ago.
We have a sick scientific establishment that worships authority and pathologizes new ideas and directions. This is a centuries old problem.
Image
An older paper from China, in the pre-vaccine era, showing T cell depletion after infection. Could explain why they’ve been so adamant on controlling Covid infection. There are geopolitical stakes here, it seems, that leaders in the West are scarcely aware of.
More immunologists are speaking out about the serious derangement that happens with SARS2. This individual had 4 vaccines, and still developed acute Covid related cardiomyopathy and heart failure. This is simply not something you can endure 4x a year.
Wow! Public Health Ontario, in its latest assessment, strongly recommends bringing back public health measures in light of the prospect of recurrent, repeated SARS2 infections, and the prospect of immune system dysregulation. @fitterhappierAJ
Image
More evidence, as @fitterhappierAJ predicted, that your T cells don’t do well post SARS2 infection, especially if you’re older than 50:
Note the exhausted T-cells in this excellent study of Long Covid by @VirusesImmunity
Death-rate estimates from @MoriartyLab are consistent with @fitterhappierAJ's Naive T-cell hypothesis. If you're older than 50-60, your wisest strategy is to get boosted, avoid infection as much as possible, and advocate for masks/better indoor air quality
While a new study does not find Superantigenic activity from the spike protein itself, @fitterhappierAJ argues this activity could be coming from viral induced reactivation of latent viruses like EBV, explaining post-SARS2 T-cell exhaustion and depletion:
Great explanation of @fitterhappierAJ’s theory of age-related decline in T-cell effectiveness against SARS2 by @dr_kkjetelina. If you’re over 50, boosters are a good thing to get.

yourlocalepidemiologist.substack.com/p/why-older-pe… Image
As predicted, subsequent infections of SARS2 results in greater, cumulative pathology along nearly every body system. And remember, these are survivors, as the most susceptible have already died.
Excellent and detailed profile of @fitterhappierAJ‘s work in @TheTyee. You may need to read it 3-4X but you’ll never take SARS2 lightly again once you do:

thetyee.ca/Analysis/2022/…
easychair.substack.com/p/immune-dysre…

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More from @KashPrime

Kashif Pirzada, MD Profile picture
Mar 6
Wanted to share with you something near and dear to my heart.
Today my colleagues and I are proud to launch the Canadian Covid Society. @CanCovSoc

Covid-19 is thankfully not the threat it once was, but there are still significant issues with having a new disease roughly 4x as bad as Flu (and much more contagious) floating around, which also disables a lot of people as well.

In Canada it was the 3rd leading cause of death 2020, 2021 and 2022. We have the Canadian Cancer Society, and Heart and Stroke foundation for the 1st and 2nd causes, it's time we have one for the 3rd leading cause of death.

It is perfectly natural to not want to deal with this issue anymore. But that's part of the problem isn't it?
Many of us have a visceral aversion to discussing it, perhaps a natural reaction to memories of the most traumatizing days of the pandemic. But the fact remains that it's still out there, that it will continue to cause strain on our health systems, disable people, and shorten life for many of us.

We need a national body that will keep advocating for things like updated vaccines and therapies, as well as common-sense fixes that prevent the spread of disease, like cleaner indoor air (which could have been very useful stopping this nasty measles outbreak we're having).

We need a national strategy to support and improve access to care for Long Covid sufferers, many of whom are simply unable to access any care for a devastatingly disabling condition. 2 out of the 3 Long Covid advocates we approached for our launch event were not able to attend due to illness, which should tell you something! There's no way to predict who will get it, when they'll get it, and there is no cure, yet.

We are organizing a virtual press conference for 1pm (ET) today, Wednesday March 6, 2024. A video stream will begin on Youtube, and this url will forward you there: . Journalists who wish to ask questions please send me a DM and I will send you instructions to join.

Our website is up at

You'll hear more from us as we grow the range of activities offered by the Society. We would love to share resources and help like-minded groups start national societies in their own countries. Would love to see and collaborate with an American Covid Society, a British Covid Society etc.

It is time that we create a permanent effort to fight this disease, and not have these efforts subject to political whims or a societal wish to indulge in denial.covidsociety.com
covidsociety.caImage
Image
Image
As a national society, we will be bilingual and our launch event will be in both French and English
lapresse.ca/dialogue/opini…
Read 8 tweets
Kashif Pirzada, MD Profile picture
Nov 28, 2023
Life expectancy drops for a third year in a row

C19 is the third leading cause of death, behind heart disease and cancer, ahead of accidents/trauma.

Mortality overall is up 13% across all age groups compared to 2019, and increasing every year

This should be a huge scandal! Image
We are being robbed of precious life years, for no good reason except to maintain an unsustainable status quo. We are losing time with our loved ones, the economy is losing out on workers in their prime years, and there must be a better way.

Media article:
Statscan source:
and
Does this look like a trend that's slowing down?
Not to me Image
Read 6 tweets
Kashif Pirzada, MD Profile picture
Jun 13, 2023
So much truth in this one graphic.
True story, on a recent shift, I had to run and help a patient who had collapsed on our waiting room floor, short of breath. Hypoxemic. The family was diligent, and tested before coming, and lo-and-behold, they were positive. With some help, got… twitter.com/i/web/status/1… Image
I asked ChatGPT to summarize my feelings in verse, and it did an astonishing job:

In sorrow do I witness suffering's reign,
The public's decline, inflicted by this bane,
The young struck by blood clots, strokes untold,
Life's flame grows dimmer, as the years unfold.
Alas,… twitter.com/i/web/status/1…
Thanks to @RobbieMeriales for the illustration:
Read 5 tweets
Kashif Pirzada, MD Profile picture
Jun 7, 2023
Today wore an N95 mask outside for the first time ever, and found it really helpful for throat irritation and that annoying choking feeling. Doesn't help for eye irritation though. Would highly recommend.
If you've upgraded your home, workplace or school with enhanced ventilation and filtration to fight airborne illnesses, you're in luck: staying indoors will protect you. If not, you can jerry-rig some filters using commonly available parts:
If you've spent time in any congested Asian or African city, the feeling is both routine and hard to forget. Even more reason to push hard the energy transition away from polluting and global-warming contributing fuels around the world.
Read 6 tweets
Kashif Pirzada, MD Profile picture
Apr 3, 2023
Had the chance to speak to Katie Dangerfield of @globalnews about Covid-19 boosters and the lack of clarity and guidelines from our advisory bodies.

I'll explain some of my reasoning why I think regular (every 6-12m) boosters are a good idea for all age groups:

1) It's always… twitter.com/i/web/status/1…
The article on Global News:
globalnews.ca/news/9592598/c…
This post really speaks to the incoherence of national policy. As doctors we have to hold two very different ideas in our heads. Covid is 'over' and 'just a flu' has to live in the same meatspace as 'omg why is this young person with zero risk factors having a stroke', or 'why… twitter.com/i/web/status/1…
Read 4 tweets
Kashif Pirzada, MD Profile picture
Mar 31, 2023
The unprovoked death of an innocent 16 year old boy in Toronto's subway system needs to lead to radical changes to the way in which we handle criminal behaviour, and address the chronic neglect of the most vulnerable in our society.

I will go over some solutions here.

I served… twitter.com/i/web/status/1…
The homeless population roughly breaks into 4 groups, which often overlap with each other. We often lump it all together, but each individual requires targeted supports depending on what factor is keeping them homeless.
Poverty is the 'easiest' to fix, just build more housing… twitter.com/i/web/status/1…
Mental health - the vast vast majority of mentally ill patients are non violent and do very well with treatment. They live, work and contribute positively to their communities. There is a subset of those who suffer severe psychotic illnesses, like cbc.ca/news/canada/ma…… twitter.com/i/web/status/1…
Read 7 tweets

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