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.

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More from @Globalbiosec

Mar 17
A lot of defeatist chatter about the small 4th dose trial published in @NEJM. A thread on interpretation. 3rd dose protection wanes substantially. Note, the Y axis is a log scale, so small differences are actually large differences. 1/5 nejm.org/doi/full/10.10…
The 4th dose restored waned immunity to the same level or higher than early after dose 3. That's good, because without dose 4, there is little protection. The VE against symptomatic infection was 31-43%. On a population level, this is important. 2/5
The 11-30% VE against any infection will make a substantial impact on transmission at a population level. The impact of vaccines is a function of VE, coverage and incidence of infection. When incidence is high, even a vaccine of modest VE can have a major population impact. 3/5
Read 8 tweets
Dec 17, 2021
NSW should immediately reinstate mask mandates, QR codes, contact tracing, and 3 day home isolation for international travellers. Abandoning everything while Omicron takes over and cases surge to unprecedented levels is more than a mistake. It is reckless. 1/3
Data not clear that Omicron is less severe and still emerging. See Even if Omicron less severe, 25K cases a day means the health system will collapse if even a small % need hospitalisation. Loss of protection of 2 doses of vax will negate ↓ severity
Those who got AZ are most at risk because protection against symptomatic infection drops to 5.9% after 2 doses according to UK data. About 34% for Pfizer. khub.net/documents/1359…
Read 7 tweets
Nov 15, 2021
Reality check: #SARSCoV2 will never be endemic. It is an epidemic disease, and always will be. This means it will find unvaccinated or under-vaccinated people and spread rapidly in those groups. It will display the typical waxing and waning pattern of epidemic diseases 1/5. Image
Cases rise rapidly over days or weeks. No truly endemic disease does this. This is the reason governments prepare for pandemics - the propensity for epidemics to grow rapidly can stress the health system in a very short time. Here is the pattern, classic epidemic. 2/5 Image
Every epidemic infection follows this pattern unless eliminated by vaccination or mitigated by non-pharmaceutical measures. Natural infection NEVER eliminated any infection. Not smallpox, which displayed the same pattern over 100s of years. 3/5 Image
Read 5 tweets

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