Thread by @Globalbiosec

Let's talk about the mystery epidemic of #hepatitis in children. It's most likely a complication of #COVID19 but may take a while to be adjudicated as such. The syndrome has been seen in children <17, mostly unvaccinated kids <5 years. A thread.

Hepatitis is a known presentation of #MISC onlinelibrary.wiley.com/doi/10.1111/ij… & MISC is a late complication, after the acute infection. So, the fact that PCR is negative is not surprising.

Also, kids do not have as robust an antibody response as adults so may be -ve on serology too. nature.com/articles/s4159…

Adenovirus is probably a red herring, as it is sometimes found incidentally in critically ill kids with other conditions, may occasionally cause nosocomial outbreaks ajicjournal.org/article/S0196-… & has not previously been associated with liver failure
bmjopen.bmj.com/content/10/7/e…

SARS-Cov-2 is tropic to the liver and commonly causes liver injury, so biological plausibility (one of the Bradford-Hill criteria for causation) is present. nature.com/articles/s4225…

When COVID cases are sky high, even a rare complication such as MISC-associated hepatitis, will be noticed because a small proportion of a huge number of cases will be clinically important.
Why then is there such a mystery, & why have standard epidemiologic tools not been used?

The Bradford-Hill Criteria for causation seem to be forgotten by epidemiologists. We used it for other recent mysteries that caused much pontification and mystery narrative, like EVD68 and polio-like syndrome. eurosurveillance.org/content/10.280…

Or like Zika virus and microcephaly, which also caused a lot of running around of experts pontificating without method. ncbi.nlm.nih.gov/pmc/articles/P…

And what about ideological reasons why there is a concerted effort to deny COVID as a cause and find another explanation. Any explanation. It;s called "escalating commitment to a failing proposition" and is a normal reaction to accruing evidence that a vested position is wrong.

Some countries and experts have invested in a narrative that COVID is trivial for kids, and even that mass infection of kids is desirable to create "herd immunity". nature.com/articles/s4159…

In the UK, children were denied vaccination for the longest time, and then belatedly and relucantly offered it. When countries and experts have invested in this position, and evidence accrues that it is a wrong position, we see escalating commitment to a failing proposition.

Perhaps this is why we have not seen a proper epidemiologic analysis of causation. Yet. Yes, it may be caused by something else. But in the midst of the pandemic, COVID is the most likely cause.