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Amanda Kvalsvig Profile picture
@AmandaKvalsvig
Mar 29 • 4 tweets • 2 min read • Read on X
It's time to shift the burden of proof.
If someone wants to claim that Covid-19 or Long Covid will be less harmful in future, they must provide evidence showing why multiple infections are better for you than one or zero.
You can't choose to have only a 3rd infection.
1/4
The cumulative infections are what matter and around the world they are ticking up.
The evidence is compelling. It shows multiple longer-term harms to individuals, sectors, & societies from this virus.
This week we called for a country-level response:

2/4phcc.org.nz/briefing/long-…
This Briefing began as an evidence review but it quickly became a call to action.
The evidence will continue to develop at pace, bringing new treatments and solutions, but what we already know is enough to get moving.
We must get case numbers down. We have the technology.
3/4
Hopeful but unevidenced opinions are damaging our future health, and we haven't time to listen.
We've lots to do. We can start by cleaning our indoor air - a well-evidenced & transformative change that will have multiple health and wellbeing benefits.
4/4
 iris.who.int/bitstream/hand…

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More from @AmandaKvalsvig

Amanda Kvalsvig Profile picture
Mar 27
For those interested in the source for our statement that teaching is a high-risk occupation for Covid-19 and Long Covid in Aotearoa New Zealand, a short 🧵

1/5
 rnz.co.nz/news/national/…
In 2022 when NZ was experiencing widespread Covid-19 cases for the first time, an internal NZ Government memo (later OIA'd) included a graph of Covid-19 case rates by occupation. Teaching was at the top of the ranking.

Link to the full memo:


2/5 fyi.org.nz/request/20877/…

Image
Image
In 2024 NZ is seeing the consequences of this failure to protect teachers.
It was entirely predictable and predicted that Covid-19 would spread widely in schools but Government chose a policy of 'business as usual'. I argued in vain for a protective approach in January 2022.
3/5
Read 6 tweets
Amanda Kvalsvig Profile picture
Dec 2, 2023
If some propose that children's immune systems were harmed in 2020 by spending time in minimal/no contact with others, they should apply testable hypotheses and data in support.
eg, Children have always lived on remote islands & farms, isolated for weeks/months at a time.
1/5
1. What types of immune dysfunction are they at risk of and how do these effects manifest in health data? The list from AlKhater shows what you would measure.
And ask the flying doctors. Are country children known for being particularly sickly?

2/5 ncbi.nlm.nih.gov/pmc/articles/P…
Table from AlKhater et al. Features suspicious of an underlying primary or secondary immunodeficiency: 6 or more new infections in 12 months 2 or more serious sinus infections or pneumonias within 1 year 2 or more episodes of sepsis or meningitis 2 or more months of antibiotics with little effect Need for IV antibiotics and/or hospitalisation to clear infection Failure to gain weight or grow normally Resistant superficial or oral candidiasis Recurrent tissue or organ abscesses Infection with opportunistic organism such Pneumocystis jiroveci pneumonia Complications from a live vaccine Family...
2. If remote children move to a town/mainland (eg, for schooling) they encounter infections that are new to them. Do they suddenly start getting more serious illness than other children? How many years would you expect the immunity debt to continue? Again, measurable in data.
3/5
Read 5 tweets
Amanda Kvalsvig Profile picture
Nov 19, 2022
This analogy isn't just incorrect, it’s actively harmful. The immune system is nothing like a muscle.
Immunity isn't the goal: health is the goal. There's no net benefit to health post infection, & ++ potential harms. Aiming for immunity at the expense of health is indefensible.
Alongside infection-generated immunity to pathogens, well-described health impacts include death, multiple organ damage, autoimmunity, cancers, lower immunity to other infections, birth defects, disruption of microbiome and gut barrier, viral persistence/reactivation and more.
I don’t know why measles was used as an example in the pictured tweet. Measles is a devastating epidemic pathogen that famously causes immune amnesia, ie, previously-acquired immunity is lost, increasing the risk of further infections. The immune system is not a muscle.
Read 6 tweets
Amanda Kvalsvig Profile picture
Sep 25, 2022
It's hard to wrap one's brain around the idea of a new, serious, common disease.
One reaction is to see plain statements of risk as fear-mongering. Another is not to see yourself in statements of risk, because after all, you've never lost anyone or died from a pandemic before.
You can see this brain wrinkle in statements intended to reassure, eg "Most children will be fine". The statement is true, but is it grounds for permitting infection to spread? Only if you subconsciously assume that the children you care about will always be in that "most" group.
That's why one of the jobs of public health is to advocate for protection for all:
- those who are high risk & experience 'reassurance' like the above as explicit proof that their lives are not valued, &
- those who are low risk & will be blindsided when the unthinkable happens.
Read 4 tweets
Amanda Kvalsvig Profile picture
Aug 6, 2022
This article is a v good explanation about Covid-19 immunity. It’s also (inadvertently) a v good explanation of why it’s vital to pick the right strategic goals. If you make immunity your strategic goal instead of population health, logic will walk you to some strange places.
1/
NZ no longer has a well-defined pandemic strategy - a key policy gap. I’ve put down some ideas about why it’s critical to choose the right goal - & why hybrid immunity doesn’t make the grade.
(I’m certain the author and commentators are all clearly aware of this fact, btw).
2/
Why ‘immunity’ is not a coherent or defensible strategic goal in a pandemic: a🧵
The images in this tweet are a 2-page text for those who prefer - but the thread will have the complete text (slightly shortened).
3/ This image is a pdf of the text in the thread.This image is a pdf version of text in the thread.
Read 16 tweets
Amanda Kvalsvig Profile picture
Apr 2, 2022
It's an interesting question, how you assess potential harms from a new pathogen. My own approach with Covid and children has been:
1. All major childhood infections have potential for post-acute impacts so the question was 'what and how much' not 'whether' there would be impacts
2. Rule 1, 2, and 3 in paeds is 'listen to parents'; lived experience is a very important early signal. New health problems may go under the health system radar for a long time because they sit outside usual disease frameworks and the health system is v busy with acute illness.
3. I find that understanding the immunopathology of an infectious disease is v valuable to get a sense of what type of problems may occur. Early evidence about immune and microvascular pathology in Covid rang some big alarm bells for me wrt potential for hidden harms to children.
Read 5 tweets

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