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Infectious Disease Ethics Profile picture
Infectious Disease Ethics
@ID_ethics
Bioethicist | Doctor | Own views, with data Personal account @_euzebiusz_
Apr 4, 2023 • 4 tweets • 2 min read
🧵Two key findings of UK study below regarding cardiac deaths after covid vaccines

1. Significant risk of death for females after 1st dose AstraZeneca vaccine ("not mRNA" below)

This is 1 death for every ~16,000 females aged 12-29 after their first dose

1/4 Image Second key finding regarding cardiac deaths after covid19 vaccines

2. Non-significant risk of death for males after 2nd dose of mRNA vaccines

If validated, this would be 1 death for every ~350,000 males aged 12-29 after their 2nd dose of mRNA

2/4 Image
Jan 27, 2023 • 5 tweets • 3 min read
2015 BMJ article:

"The US CDC is generally thought to be free of industry bias"

The CDC Foundation: $12m from corporations in 2014

Example donations:
@RochePharmaUK $600k
@JanssenGlobal $1.5m
@sanofi $600k + $762k via Genzyme
@AbbottNews $550k

bmj.com/content/350/bm… After criticism of the CDC for allowing influenza anti-viral manufacturer Roche to fund their "Take 3 flu campaign"

"The CDC cited observational and industry funded [antiviral] studies, including one it described as “independent” but was funded by Roche"

bmj.com/content/350/bm… Image
Oct 2, 2022 • 7 tweets • 6 min read
📰I edited a special issue of Monash Bioethics Review on pandemic public health ethics

For background, read my paper in link below

For the excellent contributions by @pgodfreysmith @DiegoSilvaPhD @ShamikDasgupta1 and other non-twitter stars, see next 🧵

link.springer.com/article/10.100… 2/ Covid heterodoxy in three layers by @pgodfreysmith @Sydney_Uni

One of the first and most cogent philosophical critiques of covid19 policy

- Harms vs. benefits
- Excessive liberty restrictions
- Effects on young people and what gives life meaning

link.springer.com/article/10.100…
Dec 28, 2021 • 4 tweets • 2 min read
🧵Some implications of the inevitability of SARS-CoV-2 infection:

1. It may be better to have your first infection sooner rather than later

- severity increases with age
- vaccine protection wanes over time

So delaying first infections may increase average severity 2. Post-vaccination infections (and re-infections) will help to:

- increase herd immunity to current variants,
- stabilise epidemic transmission into an endemic equilibrium,
- reduce long-term public health risks (provided they remain mild)

Nov 19, 2021 • 16 tweets • 6 min read
🧵Neil Ferguson (below):

Many covid19 cases in UK summer 2021 will likely:

-reduce winter disease burden &
-perhaps prevent another UK lockdown

The key concepts here are:

Herd immunity + seasonality

Next, a thread on how these should guide policy

newschainonline.com/news/covid-pro… In northern summer 2021, I called this:

"Probably the most important message for highly vaccinated populations in the northern hemisphere"

Oct 4, 2021 • 18 tweets • 4 min read
🧵 Moral panic and infectious diseases

1830s: The English were praised for not surrounding a cholera outbreak with troops, a public health measure which:

"would have been ineffectual and would have produced a moral panic far more fatal than the disease"

(more below) According to the article below, this 1830s quote is the first English use of the term "moral panic" in its modern sense (although note that it was quoting a French physician)

If you know of an earlier use, please reply below!

HT @JobbingLeftieH

mdpi.com/2076-0760/7/4/…
Aug 10, 2021 • 13 tweets • 5 min read
🧵I am teaching a class on research ethics at the moment, so it is a good time to discuss whether a randomized controlled trial (RCT) of community masking would be ethical

TL;DR: almost certainly yes

1/ 2/ The standard idea of clinical equipoise is that research (or an RCT) is ethical when there is “no consensus within the expert clinical community about the comparative merits of the alternatives being tested”

1987 reference below:

nejm.org/doi/10.1056/NE…
Jul 21, 2021 • 10 tweets • 4 min read
🧵RSV rebound epidemic mega-thread

TL;DR: Public health measures for #covid19 disrupted herd immunity to other viruses which are now rebounding - putting pressure on health systems worldwide.

RSV is particularly dangerous to young children.

I will update slowly with new data Could rebound epidemics have been predicted?

It was difficult to know how much #covid19 public health measures (& viral interference) would suppress endemic viruses like RSV

But once we knew they were suppressed, rebound epidemics were inevitable

Jun 29, 2021 • 25 tweets • 9 min read
🧵What happens when infectious disease modellers model the benefit of vaccines and don't take potential harms to healthy children seriously?

The public health crisis created by a vaccine for dengue has important lessons for #covid19 vaccines

wellcomeopenresearch.org/articles/6-154 A reminder of why potential vaccine-related harms to healthy children are important now:

The @CDCgov director has downplayed mRNA vaccine-related myocarditis in healthy children

Jun 8, 2021 • 14 tweets • 6 min read
🧵Let me make this uncomfortable truth loud and clear:

Healthy children and adolescents likely face higher risks from some (perhaps all) #covid19 vaccines than from natural infection

I.e., the risks of vaccination likely outweigh the direct individual benefits To take the most obvious example, multiple high-income country regulators have restricted the use of the AstraZeneca vaccine in children and young adults

This is because the risks outweigh the direct individual benefits

Jun 8, 2021 • 9 tweets • 3 min read
🧵New York's plan to run concerts with vaccinated and vaccinated sections

Raises some interesting issues (supposing spread of covid at such a concert, which is unlikely outdoors)

Should public health encourage the spread of #covid19 among the intentionally unvaccinated?

1/ One response, as below, is that we should mix vaccinated and unvaccinated in order to reduce the probability of infection in the latter (i.e., indirect protection or herd immunity)

2/
Apr 29, 2021 • 16 tweets • 23 min read
@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden Regarding India, I first noted in July 2020 that we would eventually see bad news due to comorbidites (in the context of poverty and inequality), but that overall deaths per capita would be limited by the low population age - similar to current events

@COVID_questions @bergerbell @pgodfreysmith @NahasNewman @WesPegden It is a tragedy, in the sense of the "remorseless working" of well-understood factors underlying public health in general, e.g. poverty

India spends <$30 AUD per capita on health

Australia spends >$7000 per capita
Mar 2, 2021 • 4 tweets • 2 min read
1/ We reviewed Australian medical guidelines:

Some medical decisions are evidence-based, but many are not - and this varies by specialty

E.g., Australian antibiotic guidelines do not state the level of evidence for recommendations (which is often low)

onlinelibrary.wiley.com/doi/full/10.11… 2/ Previous reviews of American Infectious Diseases Guidelines found that only 14% of recommendations were based on the highest level of evidence

jamanetwork.com/journals/jamai…
Feb 25, 2021 • 6 tweets • 6 min read
Post-lockdown rebound of infectious diseases:

RSV is back in Australia with a vengeance - current cases in red below, usual incidence in black

Note that #RSV is far more dangerous to infants & young children than #covid19

academic.oup.com/cid/advance-ar… To get a sense of #RSV vs. #covid19 in children:

In the UK:

- #RSV : usually kills 28-79 children per year

- #covid19 : a total of 7 children had died in paediatric intensive care up to November 2020

RSV data: jech.bmj.com/content/59/7/5…
covid19 data: picanet.org.uk/covid-19/
Feb 23, 2021 • 5 tweets • 3 min read
Article title: coronavirus immunity is "short-lasting"

Article figure: median time to re-infection ~ 2.5 years

(Median = black vertical line below)

Most people would be happy with >2 years to reinfection, especially with reduced clinical severity...

nature.com/articles/s4159… The above is an example of how scientists and journal editors could better communicate findings and risks

The widespread and baseless fears that there would not be immunity to #covid19 could have been reduced, rather than increased, by more careful reporting of the same data
Jan 26, 2021 • 10 tweets • 3 min read
Terminology thread:

rate ≠ risk
infection ≠ disease
quarantine ≠ isolation
social distancing ≠ physical distancing
prolonged PCR positivity ≠ shedding
virulence ≠ transmissibility

References to follow 1/ rate ≠ risk

A risk is a probability of a harm (of a given magnitude)

A rate is something that varies over time

journals.lww.com/epidem/Fulltex…