Conor Browne Profile picture
Feb 13 9 tweets 2 min read Read on X
1. Assessing health risks: 🧵

A mantra in my analysis work is this: *risk mitigation can create new risks*.

A non-Covid related example: in general, soldiers only wear armour on their head and torso (helmet and Kevlar vest). Why aren't they equipped with leg / arm armour?
2. The answer is fundamentally this: extra armour on arms and legs would offer marginal extra protection at the expense of mobility and speed (body armour is heavy). As such, the effect of extra protection would actually be *negative*: moving very slow makes you an easy target.
3. As such, increased mitigation against one specific risk (in this example, protection from shrapnel injuries on the arms and legs) actually *creates* a much larger risk - the vastly reduced speed of the soldier makes injury / death much more likely on the battlefield.
4. This example serves to illustrate how people need to think about health risks. It is absolutely understandable that many people reading this are laser-focussed on not getting Covid, but the fact is there are, obviously, a huge multitude of other serious health risks to people.
5. As such, and I cannot stress this enough, avoiding healthcare is a very bad idea. By mitigating your risk of getting Covid to the point of completely avoiding healthcare settings, people are creating a new and serious risk to their own health.
6. Now, that is not to say that one cannot attempt to mitigate one's own risk in a healthcare setting by doing all the usual stuff - wearing a respirator, using a portable HEPA, asking staff to mask (although I'm well aware some may not) - but...
7. not attending healthcare at all is a very bad idea from a risk calculus point of view. Unless you're a medical professional, the unknowns are too great.

Any infection can kill.

Detecting and treating cancer early massively improves survival chances.
8. Detecting and treating chronic illness early improves outcomes.

The great danger of focussing entirely on one threat is you develop tunnel vision. This tunnel vision is, in itself, a significant risk.

Example: that red rash on your leg could be cellulitis.
9. Without assessment and treatment, that cellulitis could lead to sepsis, which could easily kill you.

This is an independent risk. It would be true whether it was 2019 or now.

/end

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More from @brownecfm

Feb 2
1. This is both an excellent and difficult question, but I'll attempt to answer it. When I'm asked to forecast by corporate clients, I usually give three scenarios: base-case, best-case, worst-case.
2. Base-case: deployment of 2nd generation vaccines (higher efficacy, not sterilising) by first quarter of 2025, low uptake. As such, continual waves of acute infection and attendant sequelae. Those who can avail of 2nd gen vaccines will have ⬆️ protection from infection.
3. Increased use and availability of therapeutics, and protocols for ⬇️ risk of Long Covid and other sequelae. Some adoption of indoor air cleaning, thus ⬇️ transmission in those areas.
Read 7 tweets
Jan 29
1. This is a point I've been making for well over two years. Historical comparisons with other pandemics - especially the Spanish Flu - fail to take into account the fact that the global population now has a significant percentage of immunocompromised people.
2. This was not the case in the early 20th century, because people with primary immunodeficiencies tended to not live until adulthood (no antibiotics or antivirals) and there were no people on immunosuppressant medication (because corticosteroids hadn't been invented then).
3. In addition, HIV did not exist at the time of the Spanish Flu. As such, we now live in a world more well-suited to viruses, because - apart from all the obvious like air travel etc - the global population contains one component it didn't before:
Read 5 tweets
Jan 20
1. It *is* infuriating, but, as always, the fault is the lack of messaging from governmental public health organisations. In my experience, the general public understands the concept of Long Covid (albeit in a very basic and binary manner), but don't understand other sequelae.
2. I say 'basic' and 'binary' because most people I know think of Long Covid as a *rare* occurrence, and tend to equate it with *very severe* cases. As a representative example, a friend completely lost his sense of smell and taste for nearly six months after an infection.
3. This persistent anosmia caused my friend to suffer significant and absolutely unwanted weight loss, because when he tried to eat, everything tasted utterly unpalatable. He then went on to suffer all the negative health effects one would expect with nutritional deficits.
Read 6 tweets
Jan 16
1. At the very beginning of the pandemic, when case numbers were minuscule in Northern Ireland, I used social media networks - specifically Facebook - as an analogy to explain to friends how they would witness exponential growth of infections in their own social circle.
2. First, they would hear that friends of friends had caught it, the threat still seeming distant, then acquaintances, then closer friends or work colleagues. The point was that social media networks would illustrate what appeared an ever-closing concentric circle of infection.
3. A circle centred on the person I was talking to. The sense of the virus 'getting closer' was, of course, indicative of the nature and speed of exponential growth in the community.
Read 6 tweets
Jan 12
1. The results of this study are, sadly, not at all surprising. I would only add that its findings should be placed in the broader research context of the risks of SARS-CoV-2 re-infections (see @zalaly 's work on this), and the recent survey by @StatCan_eng showing an...
2... increasing risk of developing Long Covid with each subsequent (re) infection. Taking this body of research as a whole, it should be blatantly obvious that - in the absence of better vaccines and / or therapeutics, and without any real non-pharmaceutical interventions, we...
3... are inexorably heading towards a world in which the majority of people will soon be suffering from either a significant sequelae of SARS-CoV-2 infection, Long Covid, or both.

Let me be clear: the majority of health systems globally will be unable to cope with such an...
Read 5 tweets
Jan 9
1. My late father spent a considerable amount of his adult life in the military. One of my earliest memories as a child was playing with my Action Men dolls (GI Joe in the US) along with all the other kids in the neighborhood. We were playing in my parents' back garden...
2... when my dad came out of the house, surveyed the skirmish being set up by my childhood friends and I, looked at my Bren gunner Action Man, and said, 'move him a bit left, over there - better position for suppressing fire', then went back inside.
3. Anyway, his favourite military expression - which he applied to almost everything in his life - was 'never reinforce failure'. In other words, don't keep doing something over and over again that spectacularly failed the first time.
Read 4 tweets

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