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.

1. Dr. Levinson is quite correct here. In common with the development of societal resilience to the threat of any natural disaster, the key, of course, is preparedness. Sadly, the response to Covid-19 in many countries has rendered us *less* prepared for another pandemic.

https://twitter.com/DrCharlesL/status/1793226866372890772

2. Although rapid development of effective vaccines for Covid-19 had to be the first priority in response, we neglected to accelerate and deploy technology on a widespread basis that could mitigate the transmission of SARS-CoV-2 and other future pandemic-potential pathogens.

1. About me (2024 update): 🧵

In my professional role I advise both commercial entities and individuals on the current and future risks posed by pathogens, including, but not limited to, SARS-CoV-2. This predominantly takes the form of bespoke analysis,.. 2... forecasting / horizon scanning, and the identification of positive risks / market opportunities. 

I consider it vital that we reduce the transmission of SARS-CoV-2 globally. As such, I am primarily concerned with the acceleration and adoption of technologies to...

1. Thank you for your good wishes, Dr. Stephens. Your comment has made me reflect on the effects of how I've altered my life since March 2020 have been so far. The alteration in question has essentially been this: wearing a respirator (FFP2 minimum) in all public indoor spaces.

https://twitter.com/onehorseblind/status/1791198306892492861

2. Note I say, 'public', because I don't wear a respirator amongst people when everyone I'm sharing air with has tested. I also almost never wear a respirator outdoors. The most pertinent effect is that - to the best of my knowledge - I've never had Covid-19.

1. 'They detected portions of viral RNA for up to two years after infection, although there was no evidence that the person had become reinfected. They found it in the connective tissue where immune cells are located, suggesting that the viral fragments were causing the...

https://twitter.com/DrInfoSec/status/1780403515807928828

2. ... immune system to attack. In some of the samples, the researchers found that the virus could be active'.

This phenomenon of viral persistence is obviously no surprise to the many extremely talented researchers who have been mooting it for years.

1. What this patient experienced is emblematic of the fact that both emergency care and GP services are in a state of collapse in Northern Ireland.

BBC News - Altnagelvin: Patient spent nine days in 'staff locker room' - BBC News
bbc.co.uk/news/articles/… 2. There are a couple of points to be made about this. First, Northern Ireland is very much the canary in the coal mine for the rest of the UK; without intervention, what is happening in NI now is likely to happen to these services in the rest of the UK in the next few years.

1. I am 17 years sober today. My sobriety is the single most important thing in my life. In fact, it defines my life. Without my sobriety, I would not be alive to write this. If I had kept drinking as I was drinking when I made the decision to put down the bottle, I would have... 2... died long, long before the Covid-19 pandemic began. In my own experience, and speaking purely for myself here, there are two crucial elements to sobriety: leaning into that which is uncomfortable, and recognising the arbitrary nature of societal norms.

1. It is important to remember that the ongoing attempt by certain scientists, media, and governments to erase Long Covid is a perfectly logical extension of their already-successful efforts to normalise acute Covid-19 disease. 2. Acute Covid-19 was normalised by force-fitting SARS-CoV-2 infection into a category I can best describe as summed up by the phrase, 'like any other respiratory virus'. This simple - but false - idea now permeates infection control practices, testing etc.

1. Sometimes I find it difficult to remain professional and measured on this platform. This is one of those occasions, as I watch politicians seemingly unable to grasp the fact that with Covid in a state of constant and unmitigated transmission, children will be sick more often.. 2. ... and hence absent from school more often. Why? Because when a new virus is in circulation, along with all the other pathogens that were circulating pre-pandemic, children will get infected by pathogens more often and hence become sick more often.

1. A consequence of 'normalising' Covid-19 (which, let's face it, is actually in many cases a concerted effort to *erase* discussion about the disease), is that it tacitly creates a false binary between living healthily and avoiding infection. 2. I've seen a few examples of this false binary lately, and generally they take the form of an earnest (and sincere) concentration on living and aging as healthily as possible without mentioning that SARS-CoV-2 infection is a risk factor for new-onset chronic illnesses.

1. The reason the pandemic is uniquely dangerous is because of its pace. That is to say, the changes it is causing in society (highly stressed healthcare systems, workforce issues etc) and the long-term effects of infection are accumulating slowly enough to be normalised. 2. This phenomenon - familiar to climate scientists - is effectively the tale of the boiling frog. It is both insidious and pernicious.

For a good description, see here:

washingtonpost.com/weather/2019/0…

1. I place tremendous value on my health - physical, mental, and cognitive. Since getting sober, over 16 years ago now, I have taken a fierce joy in both hard, challenging exercise, and tackling complex analysis at speed.

I am very aware how easily I could lose all of this. 2. I am 52 years old, and can run a half-marathon with essentially no warm-up and no recovery time. I can hike over rough terrain all day with a heavy rucksack moving at a steady three miles per hour pace. This level of fitness places me squarely in the top 5% of my age group.

1. 'However, additional provisional data indicate that cases of tuberculosis (TB) in England rose by *10.7%* in 2023 compared to 2022 (4,850 compared to 4,380). The rise signals a rebound of TB cases to above the pre-COVID-19-pandemic numbers...

).gov.uk/government/new… 2. ...While England remains a low incidence country for TB, the current trajectory takes the UK further from the pathway to meet WHO 2035 elimination targets. **UKHSA is working with partners to investigate the reasons behind the increase in TB**'

** my emphasis.

1. I absolutely get where @1goodtern is going with this thought experiment, but let me offer an alternative scenario.

First, 14.4 million people would be dead who otherwise didn't need to die.

thelancet.com/journals/lanin…

https://twitter.com/1goodtern/status/1757833385202823234

2. In the European Region, 1.4 million people are alive today who otherwise wouldn't be:

who.int/europe/news/it…

1. Assessing health risks: 🧵

A mantra in my analysis work is this: *risk mitigation can create new risks*.

A non-Covid related example: in general, soldiers only wear armour on their head and torso (helmet and Kevlar vest). Why aren't they equipped with leg / arm armour? 2. The answer is fundamentally this: extra armour on arms and legs would offer marginal extra protection at the expense of mobility and speed (body armour is heavy). As such, the effect of extra protection would actually be *negative*: moving very slow makes you an easy target.

1. This is both an excellent and difficult question, but I'll attempt to answer it. When I'm asked to forecast by corporate clients, I usually give three scenarios: base-case, best-case, worst-case.

https://twitter.com/starhavenn/status/1752682697699271026

2. Base-case: deployment of 2nd generation vaccines (higher efficacy, not sterilising) by first quarter of 2025, low uptake. As such, continual waves of acute infection and attendant sequelae. Those who can avail of 2nd gen vaccines will have ⬆️ protection from infection.

1. This is a point I've been making for well over two years. Historical comparisons with other pandemics - especially the Spanish Flu - fail to take into account the fact that the global population now has a significant percentage of immunocompromised people.

https://twitter.com/u01rar/status/1751878478834577839

2. This was not the case in the early 20th century, because people with primary immunodeficiencies tended to not live until adulthood (no antibiotics or antivirals) and there were no people on immunosuppressant medication (because corticosteroids hadn't been invented then).

1. It *is* infuriating, but, as always, the fault is the lack of messaging from governmental public health organisations. In my experience, the general public understands the concept of Long Covid (albeit in a very basic and binary manner), but don't understand other sequelae.

https://twitter.com/CovidSolidarit1/status/1748663191847006493

2. I say 'basic' and 'binary' because most people I know think of Long Covid as a *rare* occurrence, and tend to equate it with *very severe* cases. As a representative example, a friend completely lost his sense of smell and taste for nearly six months after an infection.

1. At the very beginning of the pandemic, when case numbers were minuscule in Northern Ireland, I used social media networks - specifically Facebook - as an analogy to explain to friends how they would witness exponential growth of infections in their own social circle. 2. First, they would hear that friends of friends had caught it, the threat still seeming distant, then acquaintances, then closer friends or work colleagues. The point was that social media networks would illustrate what appeared an ever-closing concentric circle of infection.