Senior Clinical Research Fellow in Paediatric Infectious Diseases | Clinical trials | Vaccines | on Threads @apsmunro | Husband and dad
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Jan 11 • 4 tweets • 2 min read
A few interesting points of data which help us to evaluate some theories re Covid
1) RSV season is now ending in England with the most "normal" wave since the pandemic
Covid related immune problems causing more severe RSV is in the bin 🗑️
1/ assets.publishing.service.gov.uk/media/659fe802… 2) Covid may be peaking (possibly plateauing) with the LOWEST prevalence (via mass testing survey) in all age groups being in school aged children
Schools being unsafe, children being disproportionately affected or spreaders of Covid is in the bin🗑️
It may seem ridiculous this is even necessary, but it actually cuts to the heart of some of the major issues with messaging around mask use
Clearly these persist even today, which is remarkable
1/ fullfact.org/health/5live-m…
Whilst the quality of the evidence around the impact of community mask use is really poor, it’s generally in favour of a modest impact
A *modest* impact
In fact, an impact which is generally imperceptible from statistical noise to the naked eye
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Dec 13, 2022 • 8 tweets • 2 min read
With everything going on, it can feel difficult for parents to know when to get their poorly child checked out
My most important tip is to check the AMAZING healthier together website (or app)
What follows are some general tips I give parents in ED
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Firstly, it’s normal for them to not be normal when poorly - because they’re poorly!
As a reference, remember when you last had a flu like illness and how you felt
That’s probably how they feel! They will behave accordingly
You’re looking for signs out of keeping with this
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Dec 4, 2022 • 4 tweets • 2 min read
Here is a totally uncontroversial thread about immunity to common pathogens as influenced by the pandemic
I will simply state facts
1. Rates of many commonly circulating pathogens almost completely vanished during the first 1 - 2y of the pandemic (eg Group A Strep)
1/ 2. The reason these pathogens almost vanished was because transmission was reduced by the measures which were introduced around the world to reduce transmission of #SARSCoV2
This coincidently also reduced transmission of other pathogens, often even more successfully
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Nov 20, 2022 • 8 tweets • 3 min read
Interesting comment here
As a matter of fact, the data suggest this is completely wrong
Let’s look at a few studies comparing protection from covid vaccination vs infection
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Because this is twitter, I of course need to start by saying I am not suggesting it is good to get infected
Merely pointing out protection from infection is excellent, and comparable to vaccination
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Nov 18, 2022 • 5 tweets • 1 min read
Is the immune system like a muscle? 🤔
Yes actually, in many ways it is 💪
EXCEPT it's not one big "general" muscle
You have specific muscles for each different pathogen, and each of them is a bit different in how quickly/easily it gets stronger or weaker🏋️♂️
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For some bugs, once you've fought it once, your muscles are so strong against it they may never need another work out to fend it off (e.g. measles, smallpox)
For others, they get weak quite quickly, but get stronger again each time you fight it (e.g. RSV, Covid)
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Nov 14, 2022 • 7 tweets • 3 min read
Many are aware of the current high rates of RSV admissions to hospital/PICU
You may not be aware that a substantial number of these are in very young babies, only a few weeks old
The reason why many think this is happening might not seem obvious at first...
1/🧵
Clearly this has nothing to do with covid infections, as the babies are far too young
Also nothing to do with them not having been exposed during the pandemic - they're post pandemic babies
In fact, it's not much to do with *their* immune systems
Face masks for young children (<12) should be avoided in view of lack of evidence of utility and potential harms
1/ adc.bmj.com/content/early/…
Most existing evidence used to suggest efficacy of masks in young children is irreparably biased by systematic differences in masked vs unmasked populations
In some studies this is actually explicit, which makes it remarkable people consider it useful evidence
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Nov 5, 2022 • 8 tweets • 3 min read
Immunity debt is not a "made up term"
Here is a list of references about immunity debt (also known as Immunity Gap) to share with those who may be confused regarding this term
A request that before tweeting about “immunity debt” that you spent a few minutes reading *ANYTHING* published about it (your friends tweets don’t count)
Most people arguing about it are completely wrong about the basic premise
Let’s explain
1/ open.substack.com/pub/alasdairmu…
It has nothing to do with individual immune systems being generally weaker due to lack of exposure to generic pathogens
It is about total, population immunity to specific pathogens
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Nov 4, 2022 • 5 tweets • 2 min read
If you read medical research, the 95% confidence interval is one of the most important results to understand
Chances are, everything you know about it is wrong
There is NOT a 95% chance the true effect lies within any given 95% CI
Some very niche, but very loud parts of twitter claiming the extraordinary surges in childhood RSV are somehow caused by covid
In reality, this phenomenon was first observed in countries which had experienced negligible levels of covid infections, so this is nonsense
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Here we have New Zealand
Whilst there has been an understandable focus on air quality for SARS-CoV-2, the idea that this is obviously transferrable to other respiratory viruses is not necessarily true
For example, lets look at RSV
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Studies on hospital transmission of RSV found substantial reductions with the use of glove and gown PPE
Despite the surprising bad press over hand hygeine, guess what?
It's kinda important for many different bugs (and there are more than just covid!)
Someone has emailed the whole directorate by accident, immediately recalled the email, yet here is the flood of confused "Reply All" emails asking what is happening or asking to be removed from the trail
It is 2022
My email is pinging with these every 40 seconds
Excellent
THERE IS NO TRAIL IF YOU ALL STOP EMAILING EACH OTHER ASKING TO BE REMOVED FROM THE TRAIL
Sep 29, 2022 • 7 tweets • 2 min read
Whilst working in ED over the weekend, we got into a discussion about the drug codeine, an opiate used for analgesia
Unfortunately, codeine is awful
Here is why I don't prescribe codeine, and you probably shouldn't either
Except the codeine molecule itself doesn't actually exert any analgesic effects
To work, codeine needs to be converted in your body into a different drug - one you might have heard of
Morphine
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Aug 5, 2022 • 6 tweets • 2 min read
The new EHR mining paper from the CDC on post covid conditions in children is a good lesson on bad causal inference
The results are meaningless
@VPrasadMDMPH does a nice breakdown here, but I would like to point out a few key lessons
1/ vinayprasadmdmph.substack.com/p/another-bad-…
Because children who get tested for Covid are systematically different to those who don't, we can infer almost nothing from this paper at all
Where the study finds an "association", we cannot determine whether this associated is *causation* or merely confounding
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Aug 1, 2022 • 7 tweets • 3 min read
I am absolutely howling that anyone could share this pre-print on mask wearing
I pray they simply didn't bother reading it before promoting it, as that is genuinely the least worrying explanation
A new low for covid twitter
1/ doi.org/10.1101/2022.0…
Whilst calling itself a systematic review, it provides no explanation for the "criteria" or the "for reasons"(?!) given why such an immense number of studies were excluded, especially given the woeful quality of many studies which were kept in
2/
Jul 25, 2022 • 7 tweets • 3 min read
Looks like a pretty major breakthrough in the investigation of paediatric hepatitis with unknown cause
Adeno-associated virus 2 (AAV2) detected in the plasma of all 9 cases (and liver of the 4 available to test), and in zero matched controls
1/ bbc.co.uk/news/health-61…
This virus needs *another* type of virus to be present in order for it to replicate - either a normal human adenovirus or a herpesvirus