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/

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/

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/

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. Here's a commentary on the work.

leeds.ac.uk/main-index/new…

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/

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/

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/

https://twitter.com/ANUmedia/status/1663454452865462272

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/

While this sends the wrong message, I suspect it will mean little. What WHO was doing in the emergency response was no longer making a difference in most places. The battle to take CVID as seriously as it deserves to be was lost a long time ago. 1/

who.int/director-gener… Fact is, we have a major ongoing new cause of death that is in the range of 5-10% more people dying than previously, & chronic conditions that WHO itself just said last week is in the order of hundreds of millions of people, 1 in every 10 infections 2/

https://twitter.com/smpwrgr/status/1651433967575515136?s=42&t=3mABp02NbFW-0yI-r0B_AQ

As testing declines, & we understand more about delayed COVID mortality, important to look at XS deaths to measure the ongoing mortality impact of COVID-19. Here's two dramatic examples of the widening gulf bw C19 & XS deaths, but it's true everywhere as I've shown previously.

https://twitter.com/CrabbBrendan/status/1620556751363006464?s=20

Please please don’t think you’re bullet proof if you’ve been infected before. Far from it, please consider yourself as susceptible as anyone else no matter what your prior exposure. 1/

abc.net.au/news/2023-01-0… Yes, immunity to infection is real. The reason you get better after being infected, the reason waves disappear, & indeed a key reason new variants arise is because infection confers a degree of immune protection - it’s a powerful force, no argument there. 2/

A reminder of where to focus our COVID attention. Australia currently likely has 0.4-1.1m people with COVID, some 4-10x the actual case numbers. This means virtually every family will be effected in this wave. 1/

https://twitter.com/CaseyBriggs/status/1608197267407925248?s=20&t=SmTbI3DI1yOfgdn2oZQGiw

Current wave is comparable to the previous 3 faced in 2022. Our hospitals under serious strain, many emergency depts esp, ~4,000 in hospital for COVID (previous peak 5,500), death toll large (likely ~50+ per day but won’t know for sure for months), LC likely in 5% cases 2/

COVID is killing thousands of Australians who would have otherwise lived, likely to be 20-30,000 by year's end. This fig shows that, after saving lives in 2020 (another story), once this line crossed the zero in late 2021, we were in ‘excess’ territory. 1/ Only shown to June 26, this ABS report has more recent data showing that XS deaths continue unabated abs.gov.au/statistics/hea…

We had 2,500 XS deaths in July alone. 2/

For those wondering, data is accumulating that 4-5% of omicron cases in triple vaccinated people experience #LongCOVID - see

thelancet.com/journals/lance…

ons.gov.uk/peoplepopulati…

1/

https://twitter.com/PatsKarvelas/status/1582634213056315392

And understand that self reporting is incredible accurate - @VirusesImmunity estimates it to be 94% in her and @PutrinoLab 's landmark biomarker work. 2/

medrxiv.org/content/10.110…

The scale is breathtaking, as is our nonchalance towards it. Key points:
(1) On track for 20-30,000 deaths more than usual in 2022
(2) COVID causing ~50%, the rest also likely COVID as in Singapore
(3) Last wave our worst
(4) These are true XS, ie, no 'catch up' on previous years

https://twitter.com/COVID19actuary/status/1583478761886224384

A national day of mourning in their honour is necessary.

Grateful to Peter Shergold & his 3 colleagues for their COVID review "Fault Lines" released today. I have only just seen the report & so am not yet in a position to comment in detail. But I do love the 'dedication' & wish we were hearing more like that. 1/
independentcovidreview.com At a glance, although there are some key conclusions I have some issue with, I do acknowledge it's impossible in a report like this to satisfy everyone. Most importantly, it's difficult not to be impressed by this list of recommendations. 2/

Imp. paper. Imprinting is not new but powerfully shown here. Means that not only does SARS-Cov-2 continue to evolve to escape protective antibodies, newer variants are less effective at generating broad-based protective antibodies, making life easier for the next variant. 1/

https://twitter.com/yunlong_cao/status/1570922875590414336

They conclude "Together, our results suggest herd immunity established by natural infection could hardly stop RBD (receptor binding domain) evolution & end the pandemic, & vaccine boosters using BA.5 may not provide sufficiently broad protection against emerging sub-variants 2/

I’m relieved & moved by what I see of the new federal govt; vision, strength openness, empathy, respect have returned. Which makes the tolerance of COVID’s phenomenal impact, that especially targets our most vulnerable people, all the harder to reconcile. #COVI19Aus. 1/ It’s not that nothing is happening. HM Butler, a person I respect greatly, has put COVID on the agenda, the AHPPC published a strong update & it was terrific to have intervention on isolation payments. But COVID is still treated nowhere near the national emergency it is. 2/

A thread on easing of public health interventions. In short, debating individual public health measures is not where to start the conversation. It is not very meaningful if the overall strategy is unclear. Most importantly, how much value do we put on reducing transmission? 1/ Clearly it’s good for health to have less COVID but what about the operations of aged care, health care, business in general, retail, travel, hospitality, schools? Are more or less infected people good for their operation? 2/

The notion that there’s nothing we can do as the Qld CHO & many other advocate - that everyone getting infected, regularly & repeatedly, is ok & desirable so some magically benign endemicity will be achieved - is flawed. It is not scientifically sound. 1/ It’s not just untrue (COVID transmission can be reduced with vax, high-quality masks, airborne mitigation & iso of infected people & close contacts) but dangerous; esp. to huge numbers of vulnerable people & unvaccinated kids, & also to acute & long-term health of everyone. 2/

Brilliant analysis on the death toll for the pandemic's first 2 years. As thought, excess deaths ~3x more than confirmed COVID deaths at 18.2 million people. Greater than the effect of the BIG 3 (HIV, TB and malaria combined). Still ongoing of course. 1/

thelancet.com/journals/lance… Tragic as it is for the world, from a parochial Oz point of view this highlights an extraordinary success over this period. For example, had we had the same rate as the US (~1.2m people died there), Australia would have had ~100,000 additional deaths 2/

I do understand wrestling with mask mandates in various settings, & for different mask strategies in times of lower transmission vs times of higher threat. But in the midst of a pandemic as we still are, reducing requirement for their use is nothing to celebrate. 1/ There will be more transmission as a result, and so more illness & death. I have said before that we may have a longer term baseline COVID mortality (ie, not counting peaks with new variants) of 40 or so per day given what is being tolerated in other comparable countries. 2/