I'm finding these takes quite bizarre. Let's be clear- the VA study *did not* show that re-infections were more severe than primary infections. It *did show* that impact of re-infections was cumulative - i.e. acute+long-term sequelae worse if you have 2,3,4 vs 1 infection only.
I don't get why we'd only be worried about re-infections if they were worse than primary infections? Wouldn't we be worried even if they weren't worse but had a cumulative impact - given the number of times we're likely to be exposed in a lifetime?
Isn't this just basic public health? You don't need your 2nd, 3rd, 4th risk to be higher than the 1st to affect your health if each one holds cumulative risk, and you'll be infected repeatedly in your lifetime. Cumulative risks still v. concerning- because they add up!
There is no inconsistency between the recent Qatar study and the VA study, so not sure why its being presented like this. The Qatar study doesn't look at long term sequelae- it just shows that pre-omicron protection against re-infection was reasonably good. We know this.
The VA study showed that even with vaccination, impacts of re-infection are cumulative. So even if your 2nd infection is likely to be less severe than the 1st, each infection still adds risk over your lifetime, so it matters. So we should try to prevent this.

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More from @dgurdasani1

Jul 9
Question- I keep hearing that BA.5 has similar severity to previous omicron variants (lab studies suggest otherwise)-
my question is how will we actually assess this epidemiologically if we aren't testing? We can't actually assess severity against previous variants, can we?
Sure the ONS provides prevalence estimates - but we can't really separate out the impact of vaccination, past infection- all of which requires individual level data, and good surveillance via testing throughout. We've scuppered our ability to even understand new variant phenotype
How do we actually understand the intrinsic severity of each emerging variant without basic data on cases?
Read 5 tweets
Jul 8
True. Even when people talk about 'uncertainty' around long COVID, I feel like saying- there's uncertainty, but what we know so far already makes it pretty clear that long-term impacts are significant. And the course of action is not uncertain (i.e. prevent infection!)🧵
Also those who talk about uncertainty to dismiss things like long COVID (uncertainty shouldn't be cause for dismissal even if it does exist!) seem pretty certain that masks/ventilation or any other mitigation isn't needed, and that vaccines/therapies alone are more than enough.
Also many in the 'uncertainty' crowd are quite certain (without much evidence) that the virus will become 'mild' and 'endemic'. So uncertainty only seems to apply to dismiss harms, rather than encourage caution - and is always only interpreted optimistically -
Read 9 tweets
Jul 8
Another bit of hopium from the Guardian with no mention of the potential impact of the current BA.5 wave on long COVID (only hosps/ICU admissions/deaths discussed) - attributing the alarming increase in excess deaths to 'measures against the pandemic'🤦‍♀️

theguardian.com/world/2022/jul…
What do you think is impacting the NHS more? The lockdown in Jan 2021 that prevented it being overwhelmed, or perhaps SARS2 spread that hasn't dropped below 1 in 70 this yr, and 3 surges in a span of 6 months? Any guesses?
Also do you know why 'measures' were in place? To *prevent* the NHS getting overwhelmed. So these measures have prevented NHS disruption as well as caused it? Can we acknowledge that the pandemic (rather than mitigations) has had the largest impacts on the NHS?
Read 6 tweets
Jul 8
So close but yet so far. Recognising that isolation is important- but blaming people for not isolating with symptoms, when testing & support for isolation has been taken away. Blaming people for not taking up the booster, when they've been told it's 'mild' & like the flu.
It's not the fault of the public, when public health bodies have failed them so badly in providing the most basic information. I heard this entire interview with no mention of the chronic multi-system disease that affects many who have even mild acute infection.
If you don't inform people of their risks, you can't expect them to respond to mitigate them. It's as simple as that. If you've spent your messaging telling people it's now 'mild' and 'like the flu' don't blame them for not taking precautions. That's not on them. It's on you.
Read 5 tweets
Jul 7
Good to see a discussion of this hypothesis entering the 'centrist mainstream'. Worth acknowledging scientists who have been suggesting this may be the case since 2020. In many ways this isn't a new hypothesis. But acceptance of hypothesis often depends on who supports them.
Would've liked to see more explicit acknowledgement of earlier opinion pieces, and scientists who put these hypothesis forward in this paper.
I'm not an immunologist, so not the right person to comment on how this hypothesis fits with current evidence. An observation that this hypothesis put forward by scientists who were vilified for it is now being discussed, but without explicit acknowledgement of where it came from
Read 5 tweets
Jul 7
As expected, since mitigations and testing dropped, we've seen continuous excesses in mortality since mid-April in England- with between 1000-1,800/wk for the 3 wks leading up to 24th June. A large proportion of this is being driven by increase in mortality at home.🧵
So, I'm looking at the UKHSA data here, because the baseline used is pre-pandemic (2015-2019), although even the ONS which uses 2016-2019 & 2021 shows similar excesses to what I'm describing here. You can find the ONS report here:
ons.gov.uk/peoplepopulati…
So, what's causing this? If we look at the excess by cause, the excess is driven by deaths due to cardiovascular disease, heart failure, diabetes and liver disease as the underlying causes. COVID seems to be contributing to only a small proportion as a direct underlying cause.
Read 15 tweets

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