To add to @larrybrilliant's caution against dismissing the possibility of respiratory transmission of MPXV, #mpox is caused by an orthopoxvirus, closely related to #variola, the cause of #smallpox. Both are respiratory viruses. Smallpox was highly airborne 🧵mdpi.com/1999-4915/12/1… In fact, variola could transmit across great distances through the air. Even Clade IIb MPXV has been detected in ambient air in the clinic setting link.springer.com/article/10.100…

Information warfare has been part of medicine and science forever. The heliocentric theory of the universe; smoking being harmful to health; h. pylori and stomach ulcers; the Sverdlovsk anthrax leak; climate change; vioxx, the list goes on. unsw.press/books/dark-win… A lab leak of weaponised anthrax from a biolab in #Sverdlovsk was denied by the Soviets, who blamed animals in the markets. US experts agreed and published high impact papers "proving" it was natural. 12 years later, after the fall of the Soviet Union, Yeltsin confessed it was a lab leak. Truth came via a confession, not science.

Our new paper on #influenza #vaccine for 50-64 year olds to prevent sudden cardiac arrest (SCA). We have long known that flu can trigger heart attacks, strokes and other cardiovascular events. ~20% of 1st presentations of heart attack is SCA. 🧵sciencedirect.com/science/articl… Survival from heart attack has dramatically increased since I was a med student in the 1980s, due to advances in rapid revascularisation of coronary arteries. Survival from SCA, not as much, as many occur in the community.

This paper is a tour de force in understanding recent changes in highly pathogenic #AvianInfluenza and why the risk of a human pandemic is higher than ever- here is my simple explainer 1/7: 🧵
nature.com/articles/s4158… phylogeographical analysis confirms there have seen major ecological changes in HPAI since 2016, and esp since 2021. Since HPAI began infecting domestic birds in 1996, we have seen a pattern of epidemic waves that subside between waves, and with mass culling of birds. 2/7

The government’s take on long Covid - the problem is, the medical community needs to go back a few steps and accept that 1. COVID is not a cold, but an illness that can result in serious chronic illness due to multi-organ effects. 🧵thesaturdaypaper.com.au/news/health/20… via @SatPaper The term was coined by patients, but fatigue may be due to heart failure, respiratory damage, immunological effects or a range of other genuine pathologies. The virus may persist in the body ilong after the infection. This may cause immunopathology nature.com/articles/s4158…

Some key quotes from this brilliant piece: "Hegemony refers 2 the dominance maintained by those in power to ensure that their preferred worldview is seen as natural, inevitable and beneficial to all, largely by manufacturing the consent of the people." 1/6
croakey.org/rethinking-cov… COVID Hegemony (is) normalisation of widespread infection achieved by .. coercive persuasion, to gain our consent and even approval. Divorced from realities of widespread transmission, the media, politicians & experts push 4 “return to normal”, “live with COVID”. 2/6

Finally RAT neg on day 12 of #SARSCoV2 infection despite having antivirals. Daily testing allowed me to protect others in the household. Five day iso with daily testing unaffordable to most will not help the economy. We need widespread equitable access to testing and treatment. I wore N95 in common areas, used HEPA filtered air purifiers, open windows and isolated for 12 days. Did have rebound too - from RAT neg at day 5 to RAT pos again on day 7. But maintained the 7 day iso & kept testing to make sure I was not putting others at risk.

The Sydney Q station is worth a visit. It is where ships and incoming passengers were quarantined during pandemics such as the 1918 influenza pandemic. Many haunting reminders carved into the rock. Giant autoclaves for the luggage

AHPRA's made a serious mistake in trying to silence Dr David Berger - Medical Observer - #AusDoc ausdoc.com.au/opinion/ahpras…

I and another family member had COVID last week despite being fully vaxxed, and was worried about a vulnerable family member that I am sole carer for. I protected them from infection by universal #N95 use at home, windows open (brrrr) and air purifiers running 24/7. 1/2 I also checked my RAT daily to monitor how infectious I was (a negative RAT is a good indicator u r not infectious). I also had a private prescription for AVs which cost $1200. All these things were expensive - the air purifiers, the N95s, the RATs.

Mousepox, caused by orthopoxvirus ectromelia virus, closely related to #smallpox only infects mice. In mice it causes a mild illness. In 2001 Australian scientists were developing a contraceptive vaccine for mice. But it killed all the mice. (Thread) newscientist.com/article/dn311-… The vaccine was to help control mouse breeding and reduce agricultural damage . They used ectromelia virus as a vector to carry mouse egg proteins so the mice would develop antibodies to their own eggs and thereby become infertile.

MPX is an orthopoxvirus closely related to #smallpox. It has 2 clades- the milder one has a fatality rate similar to #SARSCoV2 - the other, closer to SARS1 at 10%. UK outbreak caused by the milder clade. #monkeypox has surged since 2017 due to (thread) wwwnc.cdc.gov/eid/article/27… A combination of waning immunity from smallpox vaccines - mass vaccination stopped by 1980, when SPX declared eradicated; population growth and ecological factors as we explored wwwnc.cdc.gov/eid/article/27…

Let's talk about the mystery epidemic of #hepatitis in children. It's most likely a complication of #COVID19 but may take a while to be adjudicated as such. The syndrome has been seen in children <17, mostly unvaccinated kids <5 years. A thread. Hepatitis is a known presentation of #MISC onlinelibrary.wiley.com/doi/10.1111/ij… & MISC is a late complication, after the acute infection. So, the fact that PCR is negative is not surprising.

A lot of defeatist chatter about the small 4th dose trial published in @NEJM. A thread on interpretation. 3rd dose protection wanes substantially. Note, the Y axis is a log scale, so small differences are actually large differences. 1/5 nejm.org/doi/full/10.10… The 4th dose restored waned immunity to the same level or higher than early after dose 3. That's good, because without dose 4, there is little protection. The VE against symptomatic infection was 31-43%. On a population level, this is important. 2/5

NSW should immediately reinstate mask mandates, QR codes, contact tracing, and 3 day home isolation for international travellers. Abandoning everything while Omicron takes over and cases surge to unprecedented levels is more than a mistake. It is reckless. 1/3 Data not clear that Omicron is less severe and still emerging. See

https://twitter.com/EricTopol/status/1471839260068093953

Even if Omicron less severe, 25K cases a day means the health system will collapse if even a small % need hospitalisation. Loss of protection of 2 doses of vax will negate ↓ severity

Reality check: #SARSCoV2 will never be endemic. It is an epidemic disease, and always will be. This means it will find unvaccinated or under-vaccinated people and spread rapidly in those groups. It will display the typical waxing and waning pattern of epidemic diseases 1/5. Cases rise rapidly over days or weeks. No truly endemic disease does this. This is the reason governments prepare for pandemics - the propensity for epidemics to grow rapidly can stress the health system in a very short time. Here is the pattern, classic epidemic. 2/5