Thread by @drgregkelly

"Vaccines only" #COVID19 strategy w removal of other protections makes perfect if you hold 6 beliefs

Each belief WAS reasonable in 2020, yet proved wrong w time. Now, to maintain the idea that things are OK, each of these 6 beliefs must be defended with ever more vigor 🧵

I am completely serious that each belief was reasonable to hold at the start of the pandemic, and I myself held most of them. As we have learned more, I have changed my view, however many people have not and each of these beliefs has become a frontline in its own right - why?

I believe that cognitive dissonance explains a lot

...It is hard for us to admit we were wrong because this causes dissonance in our minds "I am a good person vs. I caused harm / I was wrong"

It is cognitively easier to change facts than to resolve the cognitive dissonance

This leads to "positive feedback loops of action and self-deception by which slight differences between people's attitudes become polarized" - exactly what we are seeing in our community

So here are the 6 beliefs and attempts to reinforce them

1. "It's mostly mild"

Prominent since the start & us. taken to mean 'not hospitalised'

Yet for many, even 3X vaxed, this 'mild' illness is the worst viral infection they get in years. When considering the ++high likelihood of infection in certain contexts (NYE party anyone?)

AND the fact that many people can expect to get #COVID19 more than once per year this "mostly mild" illness starts to cause enormous disruption to individuals, workplaces and communities

news.sky.com/story/easyjet-…

We've seen numerous reinforcements of the "mostly mild" belief, even as the virus has ⬆️ virulence at times:
"mild except for old"
"except for pre exisiting conditions"

& my personal favourite - the "incredibly encouraging mild hospitalisation of babies"

https://twitter.com/drgregkelly/status/1482107696858169345?s=20&t=vbHsEd8k3pZ_rwwnPqhL-g

2. Immunity is perfectly effective against severe illness & persists (one and done)

I definitely believed this - I remember getting my first vax shot and thinking "checkmate #COVID19, my personal pandemic is over"

The other part of this belief is that immunity, whether acquired through vaccines or infection, is perfectly protective against severe illness or death - thus converting all cases to the "mild" category (which we know is a misnomer anyway)

Reinforcements of this belief:
-people insisting it's only unvaccinated who have anything to fear
- changing of data reporting goalposts to minimise the apparent number of reinfections
- downplaying calls for boosters (if perfect, why need booster?)

3. #LongCovid isn't real

I knew that post intensive care syndrome was well documented, if little known, and that survivors of CRITICAL #COVID19 would have problems

But I was extremely sceptical of long covid after non critical illness, rarely mentioning or amplifying news

Two things changed that - listening to voices of the #LongCovid community and some really terrifying science with good controls, like the Oxford brain scan study showing brain changes in survivors

https://twitter.com/PeterHotez/status/1510736533669748739?s=20&t=J3lD_TZ-0HLKBi0zA-PIgg

The minimising of #LongCovid has been extraordinary - even while clinics are being set up and then immediately swamped it rarely rates a mention. It is truly an inconvenient truth

4. Kids are not affected

Another one I believed / that was true. I conducted a shattering interview w 2 Italian intensivists in Mar2020. On call mostly dedicated #pedsICU docs - and all we talked about were the sick adults bc sick kids were non issue

https://twitter.com/PedsIntensiva/status/1238769442378711040?s=20&t=J3lD_TZ-0HLKBi0zA-PIgg

That has changed & #COVID19 has become important cause of death of kids, & cause of more illness (both short & possibly long term #LongCovidKids

Yes, children are definitely at LESS risk than adults, but children rarely get sick or die from anything

medpagetoday.com/opinion/second…

Re. #COVID19 & kids "Don't panic about INDIVIDUAL risk. DO act on COMMUNITY risk"

is message we need (kudos @ChandyJohnLab) but completely drowned out by increasingly strident calls to remove remaining protections like masks for the largest unvaxed pop

https://twitter.com/ChandyJohnLab/status/1476982077027495936?s=20&t=J3lD_TZ-0HLKBi0zA-PIgg

Part of insistence that kids are OK is that there isn't vax available <5yo

This has lead to strange scenes where the same people will say certain age kids don't need vax, then that they do but there's no hurry then wonder out loud why vax rates are low

5. I / we / my country are separate

The "vulnerable" are an unfortunate few that regrettably have to shield away in this brave new #COVID19 world

As long as my family / country has high vax rates we are ok, we can get back to "normal" life

Again not true. Firstly, these beliefs are inherently ableist, classist and racist and run against important measures we have made and must continue to make our societies fairer and more accessible

Secondly, huge proportions of the pop. have pre existing conditions. WE ARE THEM

The very same people that are supposed to shield themselves away are the ones whose deaths are minimised due to those same conditions - it just doesn't work

smh.com.au/national/under…

Thirdly, from a purely self interested viewpoint it's counterproductive

Variants repeatedly arise in countries with massive case numbers - almost everywhere now

There is emerging evidence that variants arise WITHIN immunosuppressed people who maintain chronic infections

i.e. within "vulnerable" people

news-medical.net/news/20210805/…

Yet discourse always about OUR national vax rates, OUR want of 'normal'

Inconvenient truth- EVERY infected person makes almost a TRILLION SARS-CoV-2 copies, a trillion chances for another variant to emerge

No one is safe until everyone is safe

#COVID19

ncbi.nlm.nih.gov/pmc/articles/P…

6. NPIs (non pharmaceutical interventions) don't work

If NPIs (masks, #SafeIndoorAir) etc. don't work then it's no point doing them, any money spent on them is wasted and any perceived restrictions (e.g. with masks) are government over reach

Of course no NPI works perfectly, which is why need layers of them

We hear there is no "high level evidence" of, e.g masks. Often unclear what is meant but it usually means "holy grail" (I use ironically) of medical research, the individual patient randomised controlled trial

This ignores few truths:

Whenever we study one thing in isolation in a COMPLEX environment, e.g. ICU, we almost always find a negative result

This doesn't mean that our interventions don't work, just that they are one of many & the effect of each is small. Hence, layers of NPIs

Further, many ways to find scientific truth that aren't pt level RCT. There is already a cluster RCT of masks that shows benefit, & numerous observational studies

In fact, the evidence for masks is already FAR greater than for most other safety measures we readily accept in our daily lives like seatbelts or tobacco restrictions NONE of which have been subject to any patient level RCT

"perfect sense"