Alasdair Munro Profile picture
Nov 18 5 tweets 1 min read
Is the immune system like a muscle? 🤔

Yes actually, in many ways it is 💪

EXCEPT it's not one big "general" muscle

You have specific muscles for each different pathogen, and each of them is a bit different in how quickly/easily it gets stronger or weaker🏋️‍♂️

1/
For some bugs, once you've fought it once, your muscles are so strong against it they may never need another work out to fend it off (e.g. measles, smallpox)

For others, they get weak quite quickly, but get stronger again each time you fight it (e.g. RSV, Covid)

2/
The good news is, for many bugs you don't need to fight them at all to get stronger

That's what going to the gym is for 🏋️‍♂️

Vaccination! 💉

Your immune system gets practice fighting the bug, but without risk of you getting injured by it

3/
Does this mean you should go looking for fights?

No!

But it does mean if you (or many people) haven't fought a particular bug for a long time, your immune system might not be as ready to fight it off so quickly

Best bet is to head to the gym if you can

4/
Usual disclaimer that all our models of immunology are huge simplifications of an extraordinarily complex system we don't fully understand and there are always caveats etc

But as a simple model, the immune system as lots of muscles is actually surprisingly good

5/

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More from @apsmunro

Nov 14
Many are aware of the current high rates of RSV admissions to hospital/PICU

You may not be aware that a substantial number of these are in very young babies, only a few weeks old

The reason why many think this is happening might not seem obvious at first...

1/🧵
Clearly this has nothing to do with covid infections, as the babies are far too young

Also nothing to do with them not having been exposed during the pandemic - they're post pandemic babies

In fact, it's not much to do with *their* immune systems

It's their mums

2/
Antibodies from mums are transferred to babies during the third trimester (specifically IgG antibodies)

Whatever mum has - baby gets!

If breast feeding, babies also get antibodies from breast milk too

This is why studies are targeting mums for RSV vaccines!

3/
Read 7 tweets
Nov 7
New from me and @R_Hughes1 in @ADC_BMJ

Face masks for young children (<12) should be avoided in view of lack of evidence of utility and potential harms

1/
adc.bmj.com/content/early/…
Most existing evidence used to suggest efficacy of masks in young children is irreparably biased by systematic differences in masked vs unmasked populations

In some studies this is actually explicit, which makes it remarkable people consider it useful evidence

2/
The only study which controlled for regional differences was the preschool vs primary school study from Catalonia

The only difference was age, and no significant difference was found in masked vs unmasked cohorts suggesting lack of clinically relevant efficacy

3/
Read 7 tweets
Nov 5
Immunity debt is not a "made up term"

Here is a list of references about immunity debt (also known as Immunity Gap) to share with those who may be confused regarding this term

1/
pubmed.ncbi.nlm.nih.gov/36193913/
Read 8 tweets
Nov 5
A request that before tweeting about “immunity debt” that you spent a few minutes reading *ANYTHING* published about it (your friends tweets don’t count)

Most people arguing about it are completely wrong about the basic premise

Let’s explain

1/
open.substack.com/pub/alasdairmu…
It has nothing to do with individual immune systems being generally weaker due to lack of exposure to generic pathogens

It is about total, population immunity to specific pathogens

2/
While fewer viruses were circulating during the pandemic, people got exposed less than they usually would

Some children never got exposed at all who normally would have

The *population difference* between exposure during the pandemic vs normal is the immunity debt/gap

3/
Read 8 tweets
Nov 4
If you read medical research, the 95% confidence interval is one of the most important results to understand

Chances are, everything you know about it is wrong

There is NOT a 95% chance the true effect lies within any given 95% CI

Why?

1/
open.substack.com/pub/alasdairmu…
This characteristic of a 95% CI is based on the frequentist understanding of probability

That means, when repeated over and over again, 95% of them will contain the true effect (under idealised conditions)

So why isn't it true for any given 95% CI?

2/
alasdairmunro.substack.com/p/95-confident…
Because that is a Bayesian, subjective probability statement reflecting our *belief* that it contains the true effect

Once it exists, it either does or it doesn't - frequentist probability no longer applies!

Confused? An example...

3/
alasdairmunro.substack.com/p/95-confident…
Read 5 tweets
Nov 4
Some very niche, but very loud parts of twitter claiming the extraordinary surges in childhood RSV are somehow caused by covid

In reality, this phenomenon was first observed in countries which had experienced negligible levels of covid infections, so this is nonsense

1/
Here we have New Zealand

2/
ncbi.nlm.nih.gov/pmc/articles/P…
West Australia 2020

3/
ncbi.nlm.nih.gov/pmc/articles/P…
Read 5 tweets

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