1. To understand the navigation of an environment in which multiple and competing risks exist, a thought experiment - grounded in my own life - is useful. I am a recovered alcoholic, and my sobriety is the single most important element of my life. 2. If a genie was to appear before me and offer me lifelong and complete immunity to SARS-CoV-2 infection if I drank a single alcoholic drink, I would immediately refuse; the risk of jeopardising my sobriety vastly outweighs the risk of Covid-19.

1. Masks are tools used to mitigate the risk of infection by airborne pathogens, including, of course, SARS-CoV-2. The politicisation and the consequent symbolisation of masking has, overall, reduced their use. This is true whether you are anti or pro masking. 2. Increasing the symbolisation of masking is a guaranteed way to reduce their use even further. This is why I am adamant that my use of masks is purely for risk reduction. I make no statement by masking; I simply have no desire to get infected.

1. As I have mentioned several times before, the moment I learned that anosmia was a cardinal symptom of Covid-19 was the moment I decided I was going to do everything in my power to not get infected with SARS-CoV-2.

nature.com/articles/s4159… 2. I knew anosmia was a prodomal symptom for both Alzheimer's Disease (AD) and Parkinson's Disease (PD). I also knew that encephalitis lethargica - which in some cases developed into a form of PD - was the major sequela of the Spanish Flu.

1. From the linked article:

The pandemic has been blamed for a decline in school readiness among reception-aged children, but some teachers who took part in the annual poll *said the “Covid baby” explanation was starting to feel like an excuse*.
theguardian.com/education/2025… 2. From this recent article in Nature:

'In summary, children exposed to antenatal COVID-19 have higher frequencies of DD as compared to non-exposed controls. Risk factors for DD beyond maternal COVID-19 were not identified across sites; ...
nature.com/articles/s4159…

1. As I noted recently, science is inextricably nested within politics. Public health, epidemiology, virology and so on, all subject to the whims of politics. We are seeing this very clearly now. However, viruses are not nested within politics.

Viruses are molecular sharks. 2. We must be careful not to anthropomorphise viruses; they sit on the very edge of what we define as 'life'. However, the function of a virus is simple: replicate. To produce more viruses by hijacking animal or human cells.

1. I am of the firm belief that it is now impossible to get H5N1 out of the ecosystem of North America. Bluntly put, there is now simply too much virus present in wild birds and mammals to be able to contain it. There are also likely many more human cases than reported. 2. As such, it is vital that the new administration in the United States grips this problem, regardless, or in spite of, the views on vaccines held by some incoming senior health officials. Messaging to both agribusiness and the general public needs to be vastly improved.

1. Two very important points in this article. First, regardless of whether H5N1 mutates to allow for efficient human - human transmission, the extremely high prevalence of the virus in poultry and dairy cattle is having significant economic impact.

ctvnews.ca/world/article/… 2. In addition, unless a concerted effort is made to increase biosecurity in commercial poultry facilities and dairy farms, and / or to vaccinate poultry and cattle, this will continue to get worse. The high prevalence of the virus in wild birds guarantees it.

1. Tragically, NI is rapidly becoming a textbook example of how healthcare systems collapse. As I always note, the cause is multi-factorial, but one of those factors is low levels of vaccine uptake, specifically for influenza.

bbc.com/news/articles/… 2. Low influenza vaccine uptake is most likely due to vaccine hesitancy to Covid-19 vaccines generalising outwards to other vaccines. This then causes more people to require hospitalisation for flu, and more healthcare staff absences.

1. Never had Covid-19. How do I know? Because my late mother was in a nursing home from before the pandemic began until her death in September 2023, and I tested almost every single day. Always negative. Never had symptoms. Now I regularly test with NAAT. Again, always negative.

https://twitter.com/DrNeilStone/status/1875315271642312992

2. How do I remain uninfected after five years? I wear a respirator in all indoor spaces and test guests with NAAT before unmasking. That's it. A better question is *why* I go to this effort. I have been involved in biosecurity for many years, long before the pandemic.

1. This article is emblematic of two themes that dominate journalism regarding the Covid-19 pandemic. The first is an absolute lack of nuance; ideological thinking that is anathema to any competent analyst. Everything regarding Covid-19 is absolutist now:

https://twitter.com/timspector/status/1874712991834181894

2. In other words, it was *either* the virus *or* the lockdowns. This tribal approach absolutely fails to capture the complexity of the pandemic; the complex interplay between the pathogen, its acute and long-term effects, and our individual and societal responses to it.

1. Four years ago today, I was walking along the bank of the River Lagan in Belfast when my phone rang. It was the manager of my late mother's nursing home ringing to tell me my mum had contracted Covid-19. I remember it like it was yesterday. The fear. All-encompassing. 2. To add bitter irony to this, it was the very day she had been due to receive her first dose of vaccine. Other residents of the nursing home were infected, and some died. My mum had a moderate illness, but the infection caused delirium, which then caused dementia.

1. After my run this afternoon, I nipped into my local grocery shop to pick up a few things. In the checkout queue, I quickly noticed that the man in front of me was obviously in alcohol withdrawal. He bought a bottle of vodka, hands shaking, then took a slug in the car park. 2. There but for the grace of God go I, I thought. For some unknown reason, I became aware of my FFP2 - which was odd, because I always wear one in shops. Immediately a thought experiment popped into my mind:

1. Bioattribution, policy responses, and future countermeasure technology: 🧵

Outbreaks, epidemics, and pandemics can begin in three ways:

Natural
Accidental Release
Deliberate Release

Deliberate Release is further sub-divided into three categories: 2. These three categories of Deliberate Release are:

Biological Warfare
Bioterrorism
Biocrime

The process by which the origin of the occurrence of any infectious disease is determined is broadly referred to as bioattribution.

1. For obvious reasons, there is currently a considerable amount of discussion regarding the efficacy of lockdowns as public health measures. It's very important to be mindful of a few points regarding this media discourse. 2. First, lockdowns are brute-force public health measures that fundamentally represent a failure to control the transmission of a pathogen by other means. Their aim is to protect healthcare systems from being overwhelmed.

1. The reason that many experts in biodefense have backgrounds in political science is because the use of biological weapons by state or non-state actors is fundamentally a political issue. My own background is in security studies (a sub-field of political science). 2. Since 2020, it has been very obvious to me that this recognition of the importance of a deep understanding of politics has been noticeably absent from analysis of natural outbreak / pandemic response. Take the idea of, 'following the science' as an example.

1. As someone who has been sober for over 17 years, and obviously wishes to remain so, I understand the subtle, pernicious power of two phenomena all too well: normalisation and denial. Like many recovering alcoholics, I can spot them instantaneously in both myself and others. 2. People who haven't recovered from addiction really don't understand these phenomena with the same keenness as those of us who have (after all, my sobriety and my life depends on being on eternal guard for them in myself).

1. One of the problems I often encounter when discussing subjects like this is the absolute lack of nuance. Very basically put, people either concentrate entirely on the harms of lockdowns OR entirely on the harms of SARS-CoV-2 infection.

theguardian.com/society/articl… 2. The truth is that they are not mutually exclusive (a position very few people seem to understand, or wish to engage with). Of course lockdowns had the potential to harm children, but *so did exposure to the virus*.

1. This is an excellent question. To understand how Covid-19 has become a taboo subject, there are a number of factors that must be considered.

First, the dynamic that exists between governments, public health, the media, and healthcare professionals.

https://twitter.com/s0f0nisba/status/1822903610570834357

2. The relationship between government and public health is often seen as follows: governments taking advice from independent scientists and then following it. However, public health agencies are far from independent - they are nested within governmental structures.

1. Outstanding and hard-hitting piece from Tess Finch-Lees:

'Unless the HSE is testing all patients on admission, as well as staff, reinstating universal masking throughout healthcare, improving ventilation and filtration, expanding boosters for all...

https://twitter.com/Independent_ie/status/1808032971997262194

2. ... informing the public that we’re in the midst of a surge and how to protect ourselves, the claim it is doing everything to stop the virus spreading is unsubstantiated'.

Please click the pay walled link in the first tweet to let the Irish Independent know this is important.

1. When I wrote this - nearly a year ago now - I had no idea that only nine months later I would be asked whether commercial pasteurisation inactivates H5N1 in milk (thankfully, it appears to). My point is that this virus is behaving in an extraordinarily unpredictable fashion.

https://twitter.com/brownecfm/status/1668548714871267329

2. As such, we should *expect* highly atypical and unpredictable behaviour from this pathogen; nothing should be a surprise at this point.

The ongoing ability of this virus to infect both humans and a very wide range of animals, causing radically different levels of disease...

1. Many commentators on this platform have (rightfully) drawn attention to the Covid safety measures in place at the St. Petersburg International Economic Forum:

forumspb.com/en/covid-19-sa… 2. However, it is worth noting that this degree of Covid safety is absolutely not representative of other high-level international events, economic or otherwise. Once again, I assure you that political and economic elites are generally as careless about Covid as everyone else.