Thread by @_ppmv

Beautiful storytelling. (1) Do people know #TheLastOfUs isn't just about love and zombies? Some viral and many bacterial infections can lead to encephalitis. E patients are walking brain-dead. Happens often in hospitals.

Note masks on set: the SARS pandemic isn't over in Canada.

https://twitter.com/TheLastofUsHBO/status/1620836878940344334

Rabies takes weeks to months to lead to encephalitis. Rapid onset would make outbreaks self-limiting. Long incubation times would allow a global zombie epidemic IF rabies acquired the immune evasion superpower of SARS-CoV-2 (Orf8).

@Neil_Druckmann stretches reality—but not much.

@Neil_Druckmann Superpowers: Orf3a Orf7a Orf6 pnas.org/doi/10.1073/pn…
Complement Orf8-C3b complex jbc.org/article/S0021-…
journals.plos.org/plospathogens/…
Nucleocapsid tandfonline.com/doi/full/10.10…
virologyj.biomedcentral.com/articles/10.11…
Cytokine storm academic.oup.com/intimm/article…
Convergent evolution HIV-1 mdpi.com/1422-0067/24/3…

@Neil_Druckmann Patients with encephalitis in hospital can be extremely violent (then typically euthanized by their doctor).

Cause of death (COD) is always
Primary-encephalitis
Secondary-whatever pathogen infection.

Never the double tap used to stop the patient’s heart.
encephalitis.info/at-the-bedside

@Neil_Druckmann Test & trace is easy for animal rabies due to bite/scratch marks. The vaccine works well during the acute phase.

But rabies is airborne; an immune evasive version with human-to-human tranmission would be unnoticed for months. This would be your real zombie world. #TheLastOfUsHBO

@Neil_Druckmann (2) Here the public policy problem gets interesting as we head for a high burden of neurodegenerative diseases (NDD). Like HAND in HIV-1, SARS-acquired neurocognitive disorder (SAND) comes in 3 flavors: asymptomatic, mild, dementia.
frontiersin.org/articles/10.33…

https://twitter.com/_ppmv/status/1581164028310605825

@Neil_Druckmann Assume most who test SARS+ positive - or who don't test but likely were infected - now live with neurocognitive damage. Here 70% who met HAND criteria reported no symptoms. High-functioning individuals may compensate; low-functioning ones may never notice.

https://twitter.com/dbdugger/status/1597385890695122944

@Neil_Druckmann Unlike in this charming Canadian dreamscape, in the real world a virus, bacteria or fungus will self-eradicate unless the incubation is extended or acute phase mild or asymptomatic.

Reality is a lot scarier than any zombie movie, isn't it?

Learn to Mask with #TheLastOfUsHBO. 👍

@Neil_Druckmann SARS pathogenesis in the peripheral and central nervous system follows the life cycle of viral replication in neurons and host response to NS damage. N symptoms and severe pathologies like encephalopathy, encephalitis and necrotizing hemorrhagic encephalopathy have been reported.

@Neil_Druckmann While media and policymakers gaslight the public into stopping masking, producers require masks on set, indoors as well as outdoors.

#DavosStandard └|😷|┐

You'd be wise to follow us and learn fast if any of this was surprising. sciopen.com/article/10.265…

https://twitter.com/_ppmv/status/1621805979938471936

@Neil_Druckmann Kind people ask: there is no treatment for SARS-acquired neurocognitive decline (SAND). Nor even for HIV (HAND), a different virus, but same basic mechanism, after 40 years of research!

The trick is not to get infected.

It's why we're big on prevention.

https://twitter.com/_ppmv/status/1621870640830595078

@Neil_Druckmann @RealCheckMarker made strong claims. Let me reality-check her via this Danish study of HIV/SARS coinfection: No higher mortality risk in PLH despite doubled risk of hospital acquired SARS infection and higher risk of severe outcome! ingentaconnect.com/content/wk/aid…

https://twitter.com/RealCheckMarker/status/1621763082170032128

Forgot to mention Orf10, my bad

https://twitter.com/_ppmv/status/1621984649181380609