Our household has COVID, primary school the likely source. We work hard to avoid it but this reflects that once again our community is awash with this virus, the 2nd-3rd major spike this year without any very ‘low’ period in between. Every infection/re-infection does damage so the short story - please do your best to minimise the spread of the virus, to protect yourself & others. This not another common ‘cold’ to be shrugged off. 1/
Longer story - I say this because of its effect on both: (1) the individual (unlike many respiratory viruses it’s a virus that has an effect throughout your whole body & as a consequence causes broader symptoms & damage to organs such as the brain, heart and immune system that can last for months to years - did you know for example that high-quality evidence says that even a mild acute infection can lead to a small drop in IQ, larger falls seen following severe disease & in long COVID patients. This is because ‘brain fog’ is actually a form of brain damage that causes cognition and memory problems), or… 2/
… (2) populations as a whole where its impact is way larger than any other infectious disease in this country. In the coming summer (yes summer) months - by analogy with previous waves this and last year and noting wastewater & (what is in effect sentinel) aged care data, it is likely several million Australians will get infected with all the well known implications for normal functioning of society. A thousand or more will likely die (5,000-10,000 more people will die more than usual in 2024 largely bc of COVID), & some 50x that number (in a younger age cohort) will suffer chronic form of the disease adding to an already large community long COVID caseload. 3/
So what can we do to reduce that impact, both individually and for society? See my pinned tweet for how we will be trying to protect the rest of the household (so far so good even for the sibling who shares a bedroom, see left hand image), & for what you too can do. But in brief it’s simply this: keep up to date with vaccinations (I do know that current eligibility restrictions are frustrating for many of us but do what you can here), breathe clean air indoors - based around monitoring air quality & then using ventilation/filtration & N95 masks when air quality poor and/or in a crowded space indoors - & test to get treated if you can & to keep others safe. 4/
In short, the best way to reduce the impact of COVID is to not get COVID in the first place, the second best way is to reduce the number of times you get COVID (yes, each infection carries a similar risk of damage/complications as the previous infection), and the third best way is to reduce the infective dose that you receive as there is evidence that, like most infections, COVID’s impact has a dose-dependent element to it. This last point is not well known, and I hope prevents many who try hard to avoid infection from despairing when they do get infected - everything you do to reduce transmission has likely made things better for yourself and for those around you. 5/
I post this as a community note because it is clearly not popular at the moment to speak plainly about this disease & its ongoing impact through official channels. We are at the ‘boiling our own water’ stage of public health control of airborne infections although there are encouraging signs in places that public health interventions in this space will become more mainstream - most especially in my home state of Victoria. Clean indoor air mainstreaming can’t come fast enough as the benefits go way beyond COVID, pandemic readiness just one additional advantage amongst many others. In the meantime, please look out for yourself, those close to you, and for the wider community. Lots of individual action = collective action. And as our story shows, individual action is worthwhile but does not make you bullet proof. It’s community-wide action that offers far better protection. The story of public health is widespread imperfect action by many is far superior to perfect action by only a few. And for that we need leadership. 6/end
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Thread on my routine for personal risk assessment for airborne infections. A surprise at the end, that provides a compelling additional reason to monitor CO2. 1/
During last week’s regional @WorldHealthSmt conference, @DrBronKing and I traveled on a bus for a 15 minute trip with 30 or so other delegates. As the reading on the CO2 monitor shows, this was high risk for COVID/flu transmission. It was an easy risk assessment; we both wore our N95s masks. But, despite being COVID-conscious, I don’t always wear my N95 indoors. How do I decide when to do so? 2/
I always carry with me the two core tools of personal protection; a CO2 monitor and an N95 mask. I wear an N95 mask if CO2 readings are higher than 1,000 (I’m in the process of revising that down to 800ppm for reasons I will explain another day), or if someone around me is unwell regardless of the CO2 reading. Most days there are situations where I wear an N95 mask. Instead of always double checking that I have my wallet and keys when I leave the house, I now include a pocket sized CO2 monitor and an N95 mask. It’s that routine. That is a personal approach, others do it differently (& prob better). 3/
This from @WHO @CERN, together with the landmark publication yesterday on mandating indoor air quality standards (), is game-changing both for the here & now & for pandemic preparedness where it is the lowest handing fruit for protection. The #PandemicAccord process should not ignore it. 1/science.org/doi/10.1126/sc…
By and large, the pandemic was not, and is not, treated as an airborne disease. This mattered a great deal. Everything from inadequate personal protection of those on the front-line, to little attention to poor ventilation in aged-care, schools, daycare centers, restaurants, businesses and even our homes. 2/
We are here now, and have to look forward to how this breakthrough consensus position can be used effectively and practical solutions adopted with a sense of urgency. Although no longer an emergency, we are still in a pandemic according to @WHO, having just experienced another very large wave, where the chronic impacts are especially concerning. 3/
This is a landmark paper on the path to better indoor air quality. Outdoor air, the water we drink and food we eat is regulated by standards that protect us from harms. This is not the case for the air we breathe indoors where we spend 90% of our time. This is the most definitive blueprint for change yet. The time to act is now. In doing so, we will be healthier now, and we will better prepared for future airborne pandemics.
Bouhaddou et al is a tour de force; a major advance in understanding how SARS-CoV2 evolves to do so well in humans. 1/
SARS-CoV-2 variants evolve convergent strategies to remodel the host response: Cell cell.com/cell/fulltext/…
While it's well established well SARS-CoV-2 evolves its spike protein to avoid antibody-based immunity, this shows how it also evolves changes in other viral proteins to avoid an earlier, less specific, but crucial arm of our immune defenses; the ‘innate’ immune response. 2/
The ‘step-change’ mutants we know at ‘variants of concern’ (alpha, beta, gamma, delta) appear to have independently evolved from the original ‘Wuhan’ virus to have similar mechanisms to modulate innate immune responses. 3/
As we watch all watch highly divergent BA.2.86 closely (will it take off and be a new variant of concern, the first since omicron? It is looking quite possible) there’s a regular line being used with all new lineages about ‘no evidence of increased virulence’, 1/
...which implies comfort with the current severity of omicron, and also with the power of ‘hybrid’ immunity (a mixture of vaccine- & infection-based immunity) keeping things at bay. It is true that things could be worse, but to me at least they are not good as they are. 2/
Omicron lineages have been big killers (eg, in Australia, a country of 26m people, we are closing in on 30,000 excess deaths mostly from the 18 months of omicron), and hybrid-immunity is not working anywhere near well enough. 3/
Here's a twitter A to the Q in the headline. First, with testing low, hospitalization figures are the best indicator. These are on the increase, & concerning is that this is off a high base. In short, we look to be facing a similar C0VID burden now to other bad stages. 1/
Second, it's not a 'winter' disease, we had 3-4 waves in 2022. That said, there is reason to be extra concerned when spending more time in shared indoor spaces. With other respiratory infections also on the rise (see @MackayIM), it looks a rough few months ahead. 2/
Third, I should emphasise (as the graph in my first tweet in this thread shows), there is no low time, just 'lower' times that are still in fact very high case burdens. This is not how it is for influenza for example. 3/