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T. Ryan Gregory Profile picture
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Nov 20 • 14 tweets • 8 min read
Someone asked for a collection of my COVID threads in advance of (US) Thanksgiving in case they want to share some info with family members. Here you go (links to Twitter thread and Threadreader). 🧵
On RSV rates in Canada over the past several years, as it relates to so-called "immunity debt":



threadreaderapp.com/thread/1592688…
On "immunity debt" vs. "immunity theft":



threadreaderapp.com/thread/1591764…
On the two meanings of "immunity debt" and why this new term is not good:



threadreaderapp.com/thread/1589786…
On November 2021 vs. November 2022 and premature predictions that the pandemic is over:



threadreaderapp.com/thread/1588519…
On whether any major new variant that would get a new Greek letter name can evolve:



threadreaderapp.com/thread/1587862…
On variant names:



threadreaderapp.com/thread/1576945…
On what it means to have a cloud (or soup or swarm) of variants:



threadreaderapp.com/thread/1582324…
On why recent variant evolution in SARS-CoV-2 is something new:



threadreaderapp.com/thread/1577617…
On Omicron not being mild, with Canada as an example:



threadreaderapp.com/thread/1563519…
On phylogenetics, monophyly, clades, paraphyly, and taxonomy:



threadreaderapp.com/thread/1582762…
On Evolution 101:



threadreaderapp.com/thread/1477332…
And finally, a collection of images you may find useful:

(Sources: @dfocosi, nextstrain.org) Figure depicting the relati...Evolutionary tree showing t...Comparison of evolutionary ...
More useful images:

(Sources: @RajlabN and nextstrain.org) Mutations versus time for S...Spike mutations versus time...Scatter plot of immune esca...

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More from @TRyanGregory

T. Ryan Gregory Profile picture
Nov 21
The ABC (anything but COVID) approach dismisses the possibility that COVID can be implicated in the fact that pediatric hospitals in Canada and the US are overwhelmed with respiratory virus infections including RSV and flu.

BUT... 🧵
As already noted, the actual patterns of infection and hospitalization this year are not consistent with a simplistic version of so-called "immunity debt".

We need more data like this on RSV and flu rates and hospitalizations for the past several years in multiple countries/states/provinces, alongside information on which mitigations were in place and when they were ended. Without this, it's just conjecture and assumption.
Read 10 tweets
T. Ryan Gregory Profile picture
Nov 16
I noted recently that claims about exceptionally high rates of RSV this year, caused by "immunity debt" and explaining the high number of children in hospital, is an empirical claim that requires data. Well, we now have this for Canada thanks to @Wikisteff (follow him btw!). 🧵
Here is a plot of RSV rates since winter 2013/2014. As you can see, it's a very regular seasonal pattern for all the years up to the start of the COVID pandemic. There was essentially no RSV two years ago when schools were closed (winter 2020/2021). Rates of RSV in Canada from...
And it's not just RSV. There was almost no flu or colds caused by other coronaviruses (not SARS2) two years ago either.

Read 20 tweets
T. Ryan Gregory Profile picture
Nov 15
Some real data on RSV in Canada, thanks to @Wikisteff! Pretty typical pattern 2013-2019. No RSV two years ago (winter 2020/2021), then bad *last year* (winter 2021/2022). This year another bad/early season but already many in hospital. *Both* "immunity debt" and "immunity theft"?
So @FurnessColin was correct and Dr. McGeer's claim that we had 2 years without RSV and now we're experiencing 3 years' worth of RSV all at once is inaccurate.

Read 5 tweets
T. Ryan Gregory Profile picture
Nov 15
The most important voices on the topic of long COVID are survivor-advocates who speak from lived experience. I haven't done enough to amplify them. Please give a follow to folks like @calirunnerdoc, @elisaperego78, @loscharlos.
theguardian.com/world/commenti…
sfchronicle.com/opinion/openfo…
Read 4 tweets
T. Ryan Gregory Profile picture
Nov 15
This discussion was amazing and is exactly what we need right now. A thoughtful, nuanced conversation among open-minded experts. Not either-or, and data will determine which or how much of each effect is involved. Big thank you to all four guests and guest host.
Super well done, @fitterhappierAJ, @FurnessColin, @MsMacrophage (and Allison McGeer who is not on Twitter I think).

And very deftly moderated by @JeyanTVO
Read 4 tweets
T. Ryan Gregory Profile picture
Nov 14
*IF* there aren't actually atypically high rates of RSV in kids this year but there are far more hospitalizations, it seems there would be a few different hypotheses to consider (ASAP). 🧵
First, note that I am not seriously considering the individual-level, immune system is a muscle version of "immunity debt" here. It's nonsense.

Maybe there's a way to fit the population-level version of immunity debt to higher hospitalizations without more cases, though?
I think the two most plausible explanations would be that either the virus has changed and/or its hosts have changed. Specifically, virulence has increased (but not transmissibility), and/or host immunity has decreased/vulnerability to severe infection has increased.
Read 5 tweets

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