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Adrian Constantin #⃣🎵 Profile picture
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Mar 25 • 55 tweets • 18 min read
Understanding the science of the Sars-2 pandemic has been difficult enough (see 👇), but, my main interest, as a lay person, was on pandemic policies. While policies are informed by science, the relation between them isn't always straightforward.
1/🧵
2/ Let's get one thing out of the way: could we let the technocrats decide the pandemic policies?

Absolutely not!

How resources are allocated in a society, who benefits or suffers, who lives or dies as a consequence is ALWAYS a political decision.
3/ What science tells us about a topic:
* What we know today,
* What we don't know yet and which part of that looks interesting for future research (the known unknowns),
* What methods and tools we may use or invent to study the known unknowns.
4/ Given the knowns and unknowns, policy makers must figure out:
* What new info, tools and artifacts are needed.
* How urgently the info or artifacts are needed.
* How many resources (money, effort, etc.) will be spent.
* What to do until the new info or tools are available?
5/ In harmful situations, policy makers must assess the risks posed to the society:
* How severe is the harm, e.g. loss of life, of health, property, income, revenue.
* How many people are potentially affected?
* What are the possible risk reduction tools/measures?
6/ High precision isn't the goal, but you'd want a ballpark quantitative measure of the risks. Worst case scenarios are a common way of looking at risks.

A fuzzy, fluffy statement like "The effects are, generally, mild." or "Everything's gonna be fine." is not a risk assessment.
7/ Let's now look at Covid science and policies.

What we know today:
* The disease is caused by a coronavirus, transmitted between people thru aerosols. Aerosols are small particles that hang in the air, like dust, and are produced during breathing, speaking, coughing, etc.
8/ What we know today (cont.):
* Similar to other coronaviruses, the immunity produced by infections is short lived (~months) and leaky (a person re-infected with Sars-2 can transmit the virus to other people).
9/ Looking at risks: although the vaccines have, so far, offered protection against death and severe acute disease, Covid weekly death rate in Finland was aprox. 7 times higher in 2022 than in 2020-2021 (132 deaths/wk in 2022, 18.5 deaths/wk in 2020+2021).
sampo.thl.fi/pivot/prod/fi/…
10/ In US, Covid death rate was lower in 2022 than in 2020-2021, but remained high enough to make it the 3rd leading cause of death for the 3rd year in a row.
healthsystemtracker.org/brief/covid-19…
11/ Death due to acute Sars-2 infection is not the only risk with Sars-2. There's been plenty of evidence that Covid is linked to an increase in heart attacks.

jamanetwork.com/journals/jama-…
12/ Another study

cedars-sinai.org/newsroom/covid…
13/ Same info for those who prefer the movie version.
14/ More info, this time with a peek into one of the mechanisms that cause increased risk of sudden cardiac death.

journals.plos.org/plosone/articl…
15/ Covid affects the brain.
16/ Covid affects the gastro-intestinal system.

nature.com/articles/s4146…
17/ Covid affects the immune system.

whn.global/covid-19-and-i…
18/ Cardiovascular disease + general health decline can mean only one thing. You guessed it: erectile dysfunction.
verywellhealth.com/erectile-dysfu…
19/ Then there is the post Covid syndrome, aka Long Covid. For some patients, the symptoms of Covid-19 (fatigue, sleep problems, cognitive problems, etc) persist for months or even years after the acute infection. It affects adults and children.
canada.ca/en/public-heal…
20/ Do we have a quantitative assessment of these risks? Partly. We can already see the most severe effects in the excess deaths (XD) and life expectancy data.
In the EuroMoMo countries +1.2M XDs have been recorded in 2020-2022.
euromomo.eu/graphs-and-maps
21/ A similar figure has been recorded in the US.
ourworldindata.org/explorers/coro…
22/ The excess deaths closely track the Covid deaths. Most of the excess deaths are explained by the direct impact of Sars-2.

elifesciences.org/articles/77562
23/ The changes in life expectancy support the excess mortality data. Life expectancy has dropped across the world since 2020.
ourworldindata.org/grapher/life-e…
24/ In the US life expectancy has fallen to its lowest level since 1996.
statnews.com/2022/08/31/u-s…
25/ Life expectancy has fallen in Finland also.
yle.fi/a/74-20014835
26/ We know that, for a number of adverse outcomes, more infections means higher hazard risk.
nature.com/articles/s4159…
27/ The incidence of Long Covid after an infection is less well quantified, with estimates ranging between 0.5% to 15% of those infected, depending on when they were done and what is counted.
28/ Canada's Public Health Agency estimates that "14.8% of adults with a confirmed or suspected infection, experienced longer-term COVID-19 symptoms", and 3% "said that their symptoms often or always limited their daily activities".
canada.ca/en/public-heal…
29/ In 🇫🇮, the Public Health and Wellbeing Institute (THL) claims that Long Covid is excluded from its responsibilities on pandemic response policies. Why one of the most dire consequences of the pandemic is not within its responsibility remains a mystery.
30/ The lack of decent statistics on Long Covid is scandalous. Quantifying the long term morbidity risks caused by Sars2 infections should be high priority for policy makers. All we get, instead, are vague statements about "mildness" and "natural boosters".
31/ It's notable that we got the first serious attempts of quantifying Long Covid risk came from the economics papers. With public health focused on the economy, I guess it's only fair that economists would now focus on population health.
32/ On policies, we know that certain policies that can significantly slow down the spread of the disease, without shutting down the society.
33/ We know that old technologies like quarantines and isolation work and are even more effective when combined new technologies like vaccines.
34/ We know that face masks work in slowing down the spread of the virus and that better masks (respirators) work even better.
bbc.com/news/health-57…
35/ Given the airborne transmission mode, we have good reasons to believe that clean indoor air slows down transmission. This means air ventilation, filtration, possibly upper room upper-room germicidal irradiation.
#DavosSafe
36/ The rich and powerful already apply those technologies for their benefit.
#DavosSafe
forbes.com/sites/brucelee…
37/ Given all the data available, given that it has become the 3rd leading death cause, why is this disease called mild? Should we also call Alzheimer, strokes and diabetes "mild conditions"? How about cancer and heart disease?
38/ Why do public health offices refuse to acknowledge that Covid is airborne and that respirators help reduce the virus transmission? Why do some physicians argue against clean air the same way their 19th century counterparts argued against clean water?
39/ I mentioned that policies are always political. @jmcrookston argues that science is also political, always. I begrudgingly came to agree with that view.
40/ The politicization of science comes in many forms. A combination of dogmatism and public show of force played big a role in the denial of airborne transmission of SarsCov2, as @jljcolorado et al. explain in this well documented, well written article.
41/ Power+pride has been a strong combination in preserving disproven dogmas.What could Pope Urban do, when he found out that his arguments against heliocentrism were voiced, in one of Galilei's books, by a doofus (Simplicio)? Resort to reason? God forbid!
en.wikipedia.org/wiki/Galileo_a…
42/ Combined with the desire of the Church to maintain a monopoly on scientific thought, it sealed Galilei's fate. It may have also drastically downgraded the role the Italian peninsula and Catholic Europe played in the upcoming scientific revolution.
43/ Sometimes the reasons for science or policy going astray are simpler and more prosaic: money.

"In the 1960s, the sugar industry funded research that downplayed the risks of sugar and highlighted the hazards of fat."
npr.org/sections/thetw…
44/ Not the only such example in nutrion science.
"[The] findings were touted even though one of its authors didn’t seem to think much of it.

“We’re hoping they can do something with it — it’s thin and clearly padded,” a professor wrote to her coauthor"
statnews.com/2016/06/02/can…
45/ Would anyone have "fiscally responsible eugenics" on their list of policy motivations?

Somebody tell these simpletons how costly cancer or Long Covid treatments are, in monetary and non-monetary terms, for patients, their families and society.
Section of David Nutt’s book ‘Alcohol Explained’, descSection of David Nutt’s book ‘Alcohol Explained’, desc
46/ There are instances, like the Tuskegee Experiment, when policy decisions defy logical, sociological or political explanations.

The Tuskegee study, ran between 1932-1972 and enrolled "600 impoverished, [male] African-American sharecroppers."
en.wikipedia.org/wiki/Tuskegee_…
47/ "399 had latent syphilis, with a control group of 201 men who were not infected. The men were promised free medical care, but were deceived by the US Public Health Service, who never informed subjects of their diagnosis"
48/ "Throughout, participants remained ignorant of the study clinicians' true purpose, which was to observe the natural course of untreated syphilis. Scientists prevented participants from accessing syphilis treatment programs available to other residents in the area."
49/ "None of the infected men were treated with penicillin despite the fact that, by 1947, the antibiotic was widely available and had become the standard treatment for syphilis."
50/ By 1972, "28 patients had died directly from syphilis, 100 died from complications related to syphilis, 40 of the patients' wives were infected with syphilis, and 19 children were born with congenital syphilis."
51/ Although the experiment had no scientific value, in 1966 "the CDC, which by then controlled the study, reaffirmed the need to continue the study until completion; i.e. until all subjects had died and been autopsied."
en.wikipedia.org/wiki/Tuskegee_…
52/ No dirty money or political benefits were earned from the Tuskegee Experiment, yet it was stopped only in 1972, when Peter Buxtun made the details public, through the Washington Star.

Outside the Nazi world, one can rarely find such examples of systemic sadism.
53/ Of all the models above, of science and policy gone badly wrong, which one would explain the ineptitude of the Covid pandemic policies? Give me the "all of the above" option.
54/ And remember: all policies are political, always!

We can't go hiding behind "technocratic" patriarchs and matriarchs when we decide, as a society, that children can't have clean indoor air in schools, or when we decide that life has no value beyond the age of employment.
55/55 Are we going to let the technocratic class run the Covid experiment until completion?

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More from @adriancjr

Adrian Constantin #⃣🎵 Profile picture
Dec 17, 2022
My lack of expertise in infectious diseases, epidemiology or virology meant that I had to rely on other people's expertise during the Sars2 pandemic. However, from the beginning, experts had different views on the pandemic, so I had to decide which experts I should trust.
1/🧵
If you haven't suffered from the same problem, but want to understand it, imagine that your and your family's lives suddenly depended on your knowledge of farming snakes and the credentialed experts express contradictory opinions on the topic. Which experts will you trust?
2/
It sounds like an intractable problem, but there were a few basic principles that I could use to decide what information to trust.
3/
Read 16 tweets
Adrian Constantin #⃣🎵 Profile picture
Oct 30, 2022
The loss of freedom has been my main concern regarding the laissez-faire response to the ongoing Sars2 pandemic. I view freedom as a collective, as explained 👇

Let's see how the failure to get rid of a dangerous pathogen violates our freedoms.

1/🧵
First, the obvious: outside the realm of macabre cults, being killed prematurely is seen as a severe restriction of freedom. Excess deaths (EDs) are a common statistical measure of untimely death, comparing the count of currents deaths to an average of previous years.
2/
A number of countries publish ED statistics through EuroMoMO project. +1 million EDs have been recorded in the EuroMoMo countries from 2020 until today. It affects all ages, incl. an ⬆️ in EDs in the 0-14 y.o. group, starting in the 2nd half of 2021
3/
 euromomo.eu/graphs-and-map… Image
Read 13 tweets
Adrian Constantin #⃣🎵 Profile picture
Sep 18, 2022
Notice that Prof. Doherty actually explains, in terms accessible to a lay person why Covid is not like the flu and why Covid is a more complex disease than the flu. He doesn't use his credentials, he doesn't say "I'm a Nobel laureate, therefore I'm right!"
1/
He's done the same, but in more details in the video 👇.
2/
Prof. Doherty's research has focused on the immune system, in particular how the immune system fights against viruses. He shared the 1996 Nobel in Medicine and Physiology for "discoveries concerning the specificity of the cell mediated immune defence".
3/
Read 4 tweets
Adrian Constantin #⃣🎵 Profile picture
May 26, 2022
🇫🇮 Defense vs Health Policies

How Finland handled, politically, the security threat posed by the SARS2 pandemic and the security threat posed by Russia's invasion of 🇺🇦 and its aggressive stance toward neighbors could very well be the tale of two different countries.

1/🧵
When Russia attacked Ukraine in Feb. 2022, the entire political class reacted to the event and NATO membership was immediately put on the table. Two civic initiatives on the topic gathered enough signatures in record time.
2/
Media reflected the variety of opinions, from including the pro-NATO majority view, the anti-NATO minority view, and even the incoherent ramblings of the Finns party. All the parties organized internal meetings in which the party's position was discussed and voted on.
3/
Read 18 tweets
Adrian Constantin #⃣🎵 Profile picture
Jan 15, 2022
A comment I hear often in private, from my friends, is that we should just listen to the public health experts. Folks like me, who've never worked in public health should stay in their lane. I explain👇when and why we have a duty to speak, esp. for the benefit of our friends.
🧵
2/ Public health (PH) is a big umbrella, which covers many domains of expertise. Those domains are studied and taught by a wide range of professionals. For some of them, the expertise outside the medical fields may be much deeper and further developed. Let's see some examples.
3/ Common sense. In the spring of 2020 China locked down Wuhan and shutdown traffic to/from few other big cities. Soon after N. Italy hospitals lost all control, under pressure from an exceptionally high number of patients infected by a novel virus.
Read 19 tweets
Adrian Constantin #⃣🎵 Profile picture
Jan 9, 2022
The past year, like the year before, it has been hard to find clear, coherent and truthful info about the C19 pandemic. I wish to express my deep gratitude to all who, as primary sources and/or skillful aggregators of information, have helped me navigate these crazy times.
1/
I found some of them in the first year of the pandemic:
@nntaleb, @yaneerbaryam, @mlipsitch, @DrZoeHyde, @jburnmurdoch, @jljcolorado, @michaelmina_lab, @eppe, @DellAnnaLuca, @zin_zah.
2/
Others are more recent encounters: @MartinScheininF, @jantunen_matti, @MaaritLeinonen, @PirtaHotulainen, @OksanenLotta, @x2IndSpeculator, @fitterhappierAJ, @hjelle_brian.
3/
Read 4 tweets

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