I have been inadvertently quiet here for months. A few reasons for that, some fun, some not.

But I'm now 3 weeks into my sabbatical, clearing room for more thinking time.

This includes reflecting on what I'm actually trying to accomplish in the late pandemic era.

1/5 Having been a public epidemiologist since 2020, I think I can boil it down to a need to analyze and talk about things that need to be said, but that aren't being said.

In the first three years, that totaled nearly than 3,000 interviews with journalists.

Yes, I counted.

2/5

This brief thread has a VERY targeted audience: faculty and librarians at the University of Toronto.

If you are one of the thousands in the U of T Faculty Association, and if you generally support what I stand for, please read on.

It's about the current UTFA election.

1/5 I have been beyond disturbed at the rhetoric in this election.

Full disclosure: the incumbent, Terezia Zoric, is a mentor of mine. I'm biased, yes, but I also know her WELL.

She has done a Really. Great. Job.

2/5

This brief thread is very specifically for journalists: some follow me & maybe still drop in?

We need to talk about how COVID burden/outcome measures are reported.

Counting hospital admissions & deaths WAS appropriate in 2020-21.

Now those stats badly misinform. Why?

1/6 Until Omicron, our frame was a respiratory virus that infected & killed rapidly.

Low population immunity and limited understanding of what the virus does to the body, meant that incidence rate, ICU capacity, and deaths told us when things were better or worse.

Not now.

2/6

A cathartic thread about the perils of doing public science communication during a pandemic.

Yesterday, I was notified that I have been granted the teaching stream equivalent of tenure at the University of Toronto where I teach.

This is on my list of major life events.

1/10 I'm thrilled, of course. But this thread isn't about that, it's about the danger of being blunt while precarious, and being unable to properly defend myself.

COVID did *not* make promotion easier. (It did influence my pedagogy narrative, and delayed my review by a year.)

2/10

We have TWO big problems here.

The FIRST problem is that in missing what the REAL Long COVID problem is, this Star article misinforms.

The SECOND (real) problem is that we actually don't understand Long COVID prevalence at all.

1/19

thestar.com/news/over-3-mi… The first part of this thread is about Why.

Why there is no uniform case definition for Long COVID.

Why we use a variable symptom laundry list, many of which are non-specific.

The second part of this thread considers the negative consequences of this knowledge deficit.

2/19

An expansive musing thread on mask non-use, which I am now calling "mask akinesia".

Every class I teach, I walk in with my mask and my Aranet4 CO2 detector, to measure air quality. I'm lucky: the rooms I teach in are always below 800ppm and often below 700ppm.

1/20 I make a show of measuring air quality with my mask on.

I often remind them that the air is excellent but that doesn't lower the risk from people sitting immediately around them.

~4% of my students wear masks. ~30% have missed class because of COVID, some cough in class.

2/20

Lost: one public health system.

@TOPublicHealth data show that only 4% of primary school kids have the new XBB COVID vaccine, the variant currently ripping through schools.

Adults aren't much better, tbh. Even the 70+ group is only 28%.

Hmmm ...

1/8

toronto.ca/community-peop… It seems pretty hard to have vaccine conversations these days. I do anyway.

There is a whole ton of misunderstanding out there. Even among people I know who are smart and usually aware.

Public misunderstanding happens when public health stops communicating.

2/8

What is going to happen with COVID this fall? Well, here's a worried thread ...

First, I do not believe we are seeing anything seasonal about COVID at all. Wastewater signals were elevated but not climbing all summer. Hot weather and being outdoors helped a bit, I'm sure.

1/15 But it's important to understand why respiratory viruses are seasonal in the first place, and why COVID is different.

Flu, colds (etc) have a basic reproduction number ("R0") only slightly higher than 1. Remember that R0>1 means sustained transmission; R0<1 fizzles out.

2/15

Having recently finished the largest single deliverable of my life, I'm heading out tomorrow on my first actual vacation in 4+ years: scuba in the Caribbean!

Yes, I'm psyched. (Also indescribably exhausted.)

How will I handle COVID safety?

1/7 Well ... literally 100% of COVID cases known personally to me since May have been acquired through travel.

This is because travel is high risk and almost nobody is taking even basic precautions ...

2/7

"Sherpabody" is my new favorite word, thanks to a research team at the University of Helsinki. They have designed a very handy anti-viral molecule that could become a highly potent, variant-proof, COVID-cancelling nasal spray, And it could be taken before OR after exposure.

1/5 A sherpabody is a lot like an antibody - a particle that attaches to virus, gumming it up so it can't infect.

This sherpabody attaches to a distal part of the spike where very little mutation happens, and causes the spike to change its shape, causing dysfunction.

2/5

A short update thread on my COVID-19 infection. I tested NEGATIVE yesterday evening and again this morning (day 14). Yay!

What does this really mean, though? To misapply Churchill, this could be the beginning of the end, or the end of the beginning...

1/8 My respiratory phase is clearly winding down, with no detectable viral load in my nose or throat. That doesn't mean ZERO virus, it means a low & diminishing viral load.

We don't know average days to get to ZERO, nor whether any lingering virions are actually active.

2/8

A follow-up thread to the one I posted two days ago about my COVID infection, specifically about vaccination and nasal anti-viral spray.

(Day 11 today: I have some nasal congestion but otherwise I continue to feel good. My positive test was faint for the first time.)

1/8 A few were disappointed I didn't mention vaccination. (And some expressed glee that vaccines don't work.)

I am maximally vaxxed/boosted. We know the vaccine doesn't prevent infection, but does protect against serious illness. I would seem to fit that description perfectly.

2/8

As my colleagues and students already know, I contracted COVID-19 last week. It was from someone who visited my home for a few hours immediately before developing severe symptoms themselves.

There was masking and HEPA filters, but clearly not enough of each. In fact ...

1/8 I erred taking my mask off after they left without opening windows and venting the house.

The first two days I had mild fever + sore throat, unpleasantness that soon resolved, with no new symptoms.

O2 sats ~98%.

However, I'm still testing clearly positive on day 9.

2/8

A week ago I uttered a thread exploring anti-viral nasal sprays (see below).

Great conversations in the replies!

I thought I would summarize some of the things I have gleaned from these.

1/12

https://twitter.com/FurnessColin/status/1626999352639070209

I had talked about a particular (expensive) nitric oxide "[NO]" spray procured from Israel ("Enovid") but marketed in Canada as "saNOtize".

It is in fact a Canadian product that simply hasn't been approved for use by Health Canada yet. Maybe soon.

2/12

Maybe you'll like this; maybe it will get up your nose.

A promising thread on a promising anti-viral nasal spray that uses nitric oxide [NO].

The activity of [NO] in the respiratory tract is astonishingly complicated, I have discovered.

But I like what I have found.

1/13 Respiratory tract cells make and use a lot of [NO] for a lot of purposes. As a reactive free-radical molecule (a bit like having velcro all over it), [NO] is only around for milliseconds before attaching to something.

2/13

@ASPphysician OK, let's do this one at a time, and then I think I can identify the underlying issue here: your epistemology is calibrated for clinical practice guidelines. A large n study, meta-analysis, and the like.

Mine is to make sense of emerging data, it's a different way of knowing... @ASPphysician So, liver damage. The low n spate of kids with severe liver failure has been attributed by some to adenovirus.

But there is evidence going back to 2020 from India about liver damage from COVID.
d
More recently, a small n pediatric descriptive study: pubmed.ncbi.nlm.nih.gov/35687535/
...

Some like to blame mask wearing last year for a grotesque spike in severe child illness this year.

That view is entirely wrong. But regardless, BC had no protections to blame. No masks or HEPA filters at school. Unsurprisingly, they had record levels of RSV last year.

1/5

https://twitter.com/PennyDaflos/status/1595254858525061125

So let's be really clear here. You can't blame non-existent protections (while also completely misunderstanding the immune system) to explain this.

Only one theory can explain what's happening in pediatric hospitals now. And it's frankly scary, tbh.

2/5

A word on the idiocy known as "immunity debt". How did such a nonsensical idea take hold?

Simple. The obvious mental model for our immune system is a muscle: use it or lose it. Muscles atrophy when we don't use them. The same mental model works for our memories & skills.

1/19 So it shouldn't be surprising that a satisfying narrative emerges, using this same mental model, while simultaneously vilifying lock-downs and masks, which nobody liked anyway.

But here's the thing. The immune system isn't anything like a muscle. It's a photo collection.

2/19

This Thanksgiving is different from the past two under COVID.

1. This year, the virus is way more prevalent, AND more way more immune escaping (from vax as well as past infection).

2. This year, our hospitals are overwhelmed for those unlucky enough to become very ill.

1/8 3. This year, no gov't or public health leadership safety advice. (Many WILL act IF they hear it.)

4. The media have also been deadly quiet about how to stay safe. Unhelpful.

Despite all these differences, staying safe simply requires the SAME vigilance as last year.

2/8

A Long COVID plan?! Sounds great!! But...

Long COVID isn't one thing, it's a collection of collateral harms.

And I'd bet big $ that the case definition is going to be cruelly narrow.

Why? Because the cost to treat is going to be sky-high.

1/15

cp24.com/news/long-covi… There's autoimmune Long COVID, and that does seem treatable and reversible from what I'm told.

Then there's vascular damage COVID where people can't work anymore. That's expensive when it's permanent.

Then there is Long COVID diabetes. Definitely permanent & expensive.

2/15

I've been studying the BC COVID seroprevalence study, co-authored by Bonnie Henry, who until recently had insisted that schools were safe. And now we know that most children (more than adults) have been infected.

It's presented as good news: robust "hybrid immunity!!"

1/17 But it's better understood as a horror show, IMO.

First, parents didn't consent to this, they were actively misled. Second, immunity to COVID is temporary, but some Long COVID symptoms, like diabetes and death, aren't. Hybrid immunity is a lousy deal.

2/17