“Immunity debt as an individual concept is not recognised in immunology”

A timely, elegant & well researched article that addresses an important piece of contemporary misinformation - so called 'immunity debt'

Quotes from article🧵

#SARSCoV2

ft.com/content/064000… "The discussion swirling around immunity debt shows how easy it is for a plausible-sounding theory to circulate as misinformation"

Via Prof Peter Doherty, Nobel laureate for his fundamental work on viruses and immunology

His explanation in a lecture last year that the reason #COVID19 can be so harmful is b/c it can enter almost every cell in the body, unlike most other viruses, was a lightbulb moment for me

https://twitter.com/ProfPCDoherty/status/1570203098009972736

For those interested, here is an article about the ACE2 receptor, which is what the covid spike protein uses to bind to & gain entry to the cell. It’s almost everywhere we’ve looked in the body which goes some way to explaining COVID’s many manifestations

frontiersin.org/articles/10.33…

My prediction on #COVID19 having been a doctor for almost 20 yrs & been deeply involved in the pandemic:

It will end, eventually, through slow adoption of NPIs + mucosal vax. BUT, if you have bad #longcovid by then we prob WON'T HAVE CURE in your lifetime. So avoid until then What does that mean?
- Get #COVID19 as few times as possible (none is best)
- Get lowest dose of virus if you do get it (masks, safe indoor air)
- Be as vaccinated as possible
- Recover properly

I believe that we will have treatments for #longcovid but not a total, one-off cure

Important clarification re. repeat #COVID19 infections

No doubt a repeat infection is worse than no repeat infection - EVERY time carries risk of bad outcome.

What is still debated is whether an infection makes bad outcome from future infection more or less likely. Brief🧵 The fact the second point is being debated should not distract you from the first. Even if you've been infected one or more times you should try to protect yourself from another.

The 5 Fs of getting effective masks on the faces of your loved ones for #COVID19 protection in the real world

1 - Filtration
2 - Fit
3 - Feel
4 - Fashion
5 - Finances 1, Filtration

Refers to the % of potential covid containing particles (i.e aerosols) the mask material filters out. Cloth & surgical masks are unrated, untested & unpredictable but let’s be generous & say they filter 50%

This should be a proper “oops” moment in our #COVID19 response, and quite possibly an “oh shit” one

Here is real world data confirming earlier predictions that the time between covid waves would progressively decrease

Why is this so concerning? 🧵

https://twitter.com/dgbassani/status/1542991378073935877

Briefly, waves grow when each infected person infects average > 1 person & end when each infects < 1 bc people got infected & either develop some immunity to that variant, die,or behaviour changes

Vax contribute to baseline immunity (that’s good) but prob too slow to affect wave

It's dawning on me we're no longer fighting #COVID19 - we're fighting innumerable covids that are evolving along uncountable parallel evolutionary paths from original Wuhan strain

My non-viral-evolution-expert thoughts:🧵

https://twitter.com/nextstrain/status/1532806352736690176?s=20&t=pvCilLcnmzEOWa-7iYF96Q

Human time is meaningless to the virus - it's all about:
1) the number of generations since the original strain AND
2) each innumerable branch of SARS-CoV-2 phylogenetic tree evolving independently

Parallel processing - why our human-speed responses keep falling short

Surely first time in history where 1-2% of such large, mobile, populations is getting infected with same virus EVERY WEEK

Given each infected person makes almost 1 trillion viral copies the opportunities for the virus to evolve are enormous & explain ongoing #COVID19 burden Viral copy numbers here

ncbi.nlm.nih.gov/pmc/articles/P…

Thread on 2 months of use of a discreet home made portable HEPA filter aka "Pram-PAPR" using unmodified off-the-shelf equipment to put a layer of #COVID19 protection around our 6 month old baby Despite some misinformed or misguided commentary earlier it is now apparent that #COVID19 is a potentially serious, even fatal, disease in all ages

Despite this, options to protect young children remain very limited

We have genuinely tried "living with covid" in highly vaxed pop & is proving unsustainable for health system & economy

Time to try "living w less covid?"

NOTHING in "vax only" strategy game changer in near term. Boosters marginal at pop level, better (mucosal) vax uncertain 🧵 Our strategy in face of unsustainable situation seems to be:
1. Doubling down on what's not working (vax, necessary but not sufficient)
2. Hoping better versions of (1) come soon &
3. Changing testing / reporting & a PR campaign to convince everyone that things are actually fine

"Vaccines only" #COVID19 strategy w removal of other protections makes perfect if you hold 6 beliefs

Each belief WAS reasonable in 2020, yet proved wrong w time. Now, to maintain the idea that things are OK, each of these 6 beliefs must be defended with ever more vigor 🧵 I am completely serious that each belief was reasonable to hold at the start of the pandemic, and I myself held most of them. As we have learned more, I have changed my view, however many people have not and each of these beliefs has become a frontline in its own right - why?

Hi @edu_sagov @SAHealth -this press release contains dangerous misunderstanding of role of HEPA air purifiers in reducing #COVID19 transmission

Purifiers DO NOT remove CO2, so this trial says nothing about their ability to remove virus, which they can do

education.sa.gov.au/department/med… @edu_sagov @SAHealth

https://twitter.com/drgregkelly/status/1486493490674425859?s=20

"Science has defanged Covid, time to get on with our lives"

This, by usually reasonable Devi Sridhar, is a huge worry because it is almost entirely disconnected from the current reality that the pandemic is far from over and buys into a HUGE fallacy

🧵

theguardian.com/commentisfree/… Fallacy is this - we should relax about #COVID19 b/c then we "treat...this virus like we do other infectious disease threats"

Reality is that if we treated covid like we do other threats and STOPPED NORMALISING CATASTROPHE we would do MORE, not less

The most dangerous idea in Australia right now is that, somehow, our #COVID19 experience could have / should have been much better

Objectively we have done better than almost anywhere w low deaths AND good economy yet we are about to throw it all away because it's really hard 🧵 It's done without any coherent strategic thought about where we're headed

New style is just to pick and choose bits we like from Western countries at certain times w/out seeing how their strategy fits together or how it unfolds. Eg Denmark looked awesome 3m ago let's be them!

I'm increasingly thinking that the main Q we need to ask ourselves in highly vaccinated countries is:

Do we want the pandemic to continue or do we want to start wearing high quality masks in public?

Brief 🧵 Mencken said that for every complex problem there's an answer that is clear, simple & wrong

However, caution re. oversimplification shouldn't obscure the fact that transmission of SARS-CoV-2 IS simple

It can ONLY be transmitted from an infected person to an uninfected person

Honoured to appear at the Senate Select Committee on #COVID19 alongside Prof Raina MacIntyre on behalf of @RealOzSAGE - specifically discussing COVID and kids

Chaired by Senator Gallagher @SenKatyG

⬇️🧵on my comments below

Appears to be controversy on COVID & kids:

- Experts saying less severe in kids than adults, only 2% hospital admission, death v rare

- Overwhelmed paediatric hospitals in US & now Canada

Both are true, if we understand why we can avoid worst of #COVID19 in Australia, again

Why we formed OzSAGE @RealOzSAGE, who we are and why we're promoting:

- Living with occasional outbreaks, not widespread #COVID19 disease
- Ventilation & #vaccinesplus
- No one left behind
- Protecting the health system

🧵 Australia has many world class institutes, universities, etc. We know because we represent many of them!

Yet #COVID19 challenges us because it cuts across every silo of expertise. Virology to sociology. ICU to IT. So we gathered 50+ ppl from the largest relevant breadth we could

Some clarity post Vic #COVID19 news today

Next few mths NSW/Vic won't see big change of restrictions due to health system overwhelm

REAL CHOICE is after that, do we aim for:

"Let it rip (vaccine edition)" aka #COVIDeveryone, or

"Maximal suppression" aka #COVIDelimination? Degree of freedom that NSW gov has in next few mths very limited as the health system is already SEVERELY strained - of course gov knows this

We're in lockdown for the next few mths, aside from some minor relaxations like picnics, small weddings, etc to enhance tolerability

Those who argue that #COVID19 is not a concern in children because it only rarely causes serious illness and death might be surprised to learn that there are whole fields of medicine devoted to preventing kids getting sick and dying from other rare conditions We also need to understand that even though the risk per infection is very low, if a very large number of kids are infected, that becomes important. Even a tiny percentage of a very large number is a large number.

I think much of the incoherence & backflips in #COVID19 response, esp in rich countries, came about b/c ppl don't understand who ICU teams are & what they do

I'm an intensive care specialist who did an MBA to try & understand this better myself, here goes at an explanation: 🧵⬇️ Firstly, it's TOTALLY MEANINGLESS to talk about death or mortality rates in a pandemic without talking about ICU teams

If you are in a rich country with a functioning health system there is ALWAYS an ICU team standing between you & a potentially avoidable premature death

Democracy is messy. Australia's #COVID19 response worked because ppl at the top, Nick Coatsworth & Morrison included, were able to bend to pressure when needed. That's something to be proud of

Yes, things happened slowly & avoidable harms occurred Therefore attacking ppl that made success possible tarnishes legacy & reputation rather than defending it. Few direct points:

1. Advocating at risk to career, employment & reputation is not a feature of narcissism

Being thin skinned and offended by challenges to authority is