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T. Ryan Gregory 🇨🇦 Profile picture
@TRyanGregory
Nov 24, 2022 • 24 tweets • 7 min read • Read on X
How could COVID be involved in the pediatric health crisis resulting from a surge in RSV and flu in various places (Canada, USA, Europe)? There are at least three ways. 🧵
First, let me get the "immunity debt" idea out of the way, so I can focus on the alternative (or, more likely, additional) explanations. I have already done some threads on this subject.

In short, the current patterns of infection -- when, how much, and where they are happening, and the number of severe cases -- does not seem to fit a simplistic "immunity debt" explanation. So, what else could be going on this year?
If (and we need more data here) it is NOT simply a matter of way more cases this year with the same percentage of them being very serious, then it would mean that either the severity of infections has increased for many patients. How could that be?
In simple terms, this would suggest that either the virus has changed, and/or we have changed, and/or there is some additional factor increasing the relative number of severe cases. So, what might be different this year? And how could COVID be implicated?
1. Co-infection.

COVID, RSV, and flu are all circulating right now. Being infected with more than one of them at the same time makes things worse.
Here are some papers about co-infection with COVID making RSV and flu infections more severe:

thelancet.com/journals/lance…

pubmed.ncbi.nlm.nih.gov/36112521/

ncbi.nlm.nih.gov/pmc/articles/P…

onlinelibrary.wiley.com/doi/10.1002/pp…
2. COVID infection during pregnancy affects fetal lung development.

thelancet.com/journals/lanre…
This doesn't cause respiratory distress by itself at birth, but it could become relevant when infected with respiratory viruses. "The absence of postna...
3. Immunity theft, in which COVID infection damages the ability of the immune system to fight off other infections.

How could this happen?
One mechanism is by COVID infection affecting dendritic cells.

journals.plos.org/plospathogens/…

frontiersin.org/articles/10.33…

Those cells are important in fighting RSV infections.

mdpi.com/1999-4915/12/1…
Some patients with long COVID show dysfunction in the immune system for at least 8 months post-infection even if the acute case was mild.

nature.com/articles/s4159…
There are other ways that COVID infection can affect immune function, including exhaustion of T cells. This article summarizes these and other ideas that have been discussed by @fitterhappier very well:

thetyee.ca/Analysis/2022/…
So, to summarize, there are three major ways that COVID could very plausibly be making this season much worse:

1. Co-infection with COVID and RSV or flu.
2. Infection during pregnancy affecting fetal lung development.
3. Immunity theft (several mechanisms).
A reduction in population level immunity and thus more susceptible hosts is obviously a factor (though, again, there was lots of RSV last year in many places). But it matters a great deal whether there are other factors.
A very large fraction of people, including children, were infected with Omicron variants over the past year. So, this would be the first season of RSV and flu in which this would be a major factor in most places. The season is starting early and many hospitals are overwhelmed.
It's worth noting that Sweden, which never had lockdowns, had a bad RSV surge last year.

From Nov 2021:

thelocal.se/20211105/rsv-w…
If COVID has made the severity of RSV and flu infections worse, then we need to mitigate the spread of these viruses now to protect children who are more vulnerable. We do not need to let them get infected to pay an immunity debt.
It is also important to consider what this would mean as more and more people get infected (or reinfected) with COVID. What about future seasons? Other viruses? Bacterial and fungal infections?

What we need is data, not assumptions.
One quick clarification. The claim is not that *all* RSV and flu infections are more severe. It's that more of the infections that occur will be severe because in *some* kids COVID has these effects. I don't want people misconstruing the claims made.
Another possible factor besides "immunity debt" or COVID is that the RSV or flu viruses in circulation this year are different and more virulent and/or transmissible. Here's a recent study on RSV variants that result in longer infection, for example.

academic.oup.com/jid/advance-ar…

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More from @TRyanGregory

T. Ryan Gregory 🇨🇦 Profile picture
Apr 29
Btw folks, what happened is that Québec saved us all from Poilievre. Bloc voters went Liberal this time to keep him out.

Ontario, not so much. Big gains for the Cons.

BC was where the NDP did best last election, and this time it went Lib and Con.
So, we essentially traded a Liberal minority with progressive parties being very influential to a Liberal minority with a huge Conservative opposition and minimal progressive representation.

The fact that 41.4% voted Con (vs. 43.5% Lib) isn't a good sign either.
Yes, I'm relieved that it's not Poilievre as PM and I'm glad he lost his seat. But beyond that, we're not in a very good place overall. The major rightward shift isn't going to be good, especially when the Liberals eventually lose to the Conservatives.
Read 4 tweets
T. Ryan Gregory 🇨🇦 Profile picture
Apr 1
It's very important to be clear about what is happening in the Canadian election and how progressives need to approach it. 🧵

The LPC surge toward a majority is due primarily to a collapse of support for the NDP and Bloc, and much less so a drop in support for the CPC.

1/ Vote and seat projections for Canada.
Vote and seat projections for Ontario.
Vote and seat projections for Québec.
This means that the Libs are mostly picking up progressive voters who are planning to vote strategically to stop the Cons. They are not picking up huge numbers of "moderate conservatives".

Cons support is generally committed but Libs support isn't.



2/angusreid.org/canadian-elect…
The *winning strategy* for Libs is to make strategic voting by progressives as painless as possible by leaning *leftward*.

The winning approach for progressive voters is to make it clear they cannot be taken for granted and do not agree with rightward drift.

3/
Read 6 tweets
T. Ryan Gregory 🇨🇦 Profile picture
Mar 19
Thoughts on pandemics, inclusion, annexation, Indigenous issues, climate, genocide, and more and the connections I see among them. I fully acknowledge that I am writing this from a position of substantial intersectional privilege.

🧵

1/
I really hoped that the (ongoing) SARS-CoV-2 pandemic would inspire us to make meaningful, positive changes in society. Indeed, early on it seemed like privileged people finally understood what it was like to lack access to things we otherwise take for granted.

2/
Sadly, but perhaps predictably, we instead rushed back to the status quo as quickly as we could. If anything, things are worse now in terms of public health, accessibility and inclusion, and global health equity. Infectious disease has been actively normalized.

3/
Read 10 tweets
T. Ryan Gregory 🇨🇦 Profile picture
Mar 8
Please, stop making these terrible arguments in order to dismiss threats of annexation by the US. 🧵

1. "He's just joking, trolling, negotiating, or being Donald."

Clearly not. Stop it.

1/
2. "Trump can't just declare war on Canada."

He wouldn't bother and he doesn't need to. The last time the US formally declared war was 1942. See every US invasion or occupation since WW2.

2/
3. "The US can't invade because of the constitution / international law."

He doesn't care about either of those things. See everything he's currently doing.

3/
Read 10 tweets
T. Ryan Gregory 🇨🇦 Profile picture
Feb 17
I'm sure infectious disease minimizers are attributing the record-shattering surge of severe flu this year to "immunity debt". Let's think this through, shall we?

🧵

1/
1. Serious mitigations ended more than 4 years ago. Why would immunity debt only kick in now? And why wasn't 4 flu seasons without mitigations enough to repay whatever "debt" there was?

2/
We wrote this more than 2 years ago.

calgaryherald.com/opinion/column…
Read 12 tweets
T. Ryan Gregory 🇨🇦 Profile picture
Feb 16
🧵

Just to recap what is happening, since public health has gone AWOL:

* This is the worst flu season in 15 years. Not just number of cases but number of *severe* cases.

1/
* H5N1 ("avian flu") is getting further out of control in the US. It is getting closer and closer to a human-to-human transmission outbreak.

* Measles is resurgent thanks to low vaccination rates.

* Tuberculosis is making a comeback.

* Many norovirus outbreaks.

2/
* COVID rates are lower than in past winters, but a) they're still way too high to ignore, and b) that's because there was a surge in summer (it's not seasonal) and the next major lineage of variants has not arrived yet.

3/
Read 4 tweets

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