A thread on how to stay safe from measles and two on why you should keep testing for Covid.
The first, on measles, from Jeff Gilchrist (I didn't block quote it all because it's so long - but it stops at the three asterisks and the vaccination poll.)
Increased Measles in Canada - Are you Protected?
As Public Health crumbles and too few people are getting vaccinated for measles, our herd immunity levels have dropped too much, and now many people are at risk for a disease we almost eradicated in Canada. There has been a huge surge in measles cases around the world including cases in the UK and USA. The government is strongly advising everyone in Canada to be vaccinated with two doses of measles vaccine, especially before travelling. Popular March break destinations like Florida are having measles outbreaks, and the Florida Surgeon General is no longer requiring children who are unvaccinated to remain home from schools where measles cases are circulating, which means cases will continue to surge there.
Measles is one of the most contagious viruses that infect humans, spreads through the air, and requires such a small dose to become infected that 90% of people who are not immune will become infected if exposed. Aerosols can remain airborne for hours so even walking into an empty room where a contagious person had been two hours previously can be enough to continue infecting people.
Initial symptoms include fever, red watery eyes, runny nose, cough, followed by a rash that starts on the face and then moves to the rest of the body. Small white (Koplik) spots may also appear in the mouth or back of the throat and usually one day before the onset of rash. Symptoms may develop 7-21 days after exposure; the rash typically appears 3-7 days after symptoms start and lasts 4-7 days; symptoms can last 1-2 weeks. People can be contagious days before the rash (which is not itchy) and also days after the rash is gone, so just because you feel better doesn't mean you can't infect others.
Since measles is airborne, cleaning the air (ventilation, filtration) and wearing a respirator can prevent infection. . . . More and more of these almost eradicated or less common diseases are returning including things like scarlet fever. We really should be investing in infrastructure improvements to clean the air like we did for drinking water considering they all spread through the air. The measles vaccine is also highly effective. Before the introduction of the vaccine in 1963, major measles epidemics occurred every 2-3 years killing an estimated 2.6 million people each year. "Measles is among the leading causes of morbidity and mortality worldwide during childhood, particularly in developing countries." This is why there was a concerted effort to eradicate measles and why it is still important for people to get vaccinated for it. Parents should ensure their children and adolescents actually received both of their measles vaccines. These are usually given as a combo MMR (Measles-Mumps-Rubella) vaccine at 12 months and a second dose at 18 months or 4-6 years of age. Infants can receive a dose as early as 6 months if travelling to a high risk area. In Ontario, measles vaccination rates in 7 year olds were only 59% for the 2021-2022 school year where we need closer to 95% to protect the community (herd immunity), so a lot of children will not be protected. Adults also need to double check their vaccination history as some may have only received one dose decades ago. If you are unsure, speak to your healthcare provider about a potential MMR booster dose or getting a blood test to see if they are already immune to measles. Vaccines can also be obtained at walk-in clinics and travel clinics. The MMR booster vaccines are the same ones given to both adults and children.
Most of us have never experienced measles or even know someone who had it so we do not understand how serious infection can be. Measles infection can lead to brain damage and death in 2-3 of every 1000 cases. If you are pregnant, older than 20, a child < 5, or immunocompromised you are at higher risk of complications. Measles can also cause deafness, blindness, severe diarrhoea and related dehydration, ear infections, and severe breathing problems including pneumonia:
"All children or adults with measles should receive two doses of vitamin A supplements, given 24 hours apart. This restores low vitamin A levels that occur even in well-nourished children. It can help prevent eye damage and blindness. Vitamin A supplements may also reduce the number of measles deaths."
Unfortunately infection from measles can also cause damage to your immune system and eliminates pre existing immune memory from previous infections. Epidemiological evidence found people who had been infected with measles had increased morbidity and mortality for up to five years after infection. Measles may have accounted for up to 50% of all childhood deaths from infectious disease mostly from non-measles infections that children could no longer fight off. Testing before and after infection they found children lost 33% (median) of their total pre-existing pathogen-specific antibody repertoires in mild measles infections and 40% (median) in severe infections while controls retained 90% over similar or longer durations. The study also looked at measles vaccination which confirmed that the vaccine does not impair the immune repertoire like an infection does.
How does measles do this? It seems that measles can infect 20-70% of immune memory cells including B cells, T cells, and plasma cells in the lymphoid tissue and peripheral blood during the first 3-10 days after infection. T cell immunity may also diminish after measles infection and explain why cutaneous tuberculosis tests no longer test positive and remission of autoimmune related disorders are more common. You can read more about how measles wipes out the body's immune memory here and here. When measles vaccination rates are reduced and outbreaks occur, herd immunity for secondary infectious disease can also be lost due to this destruction of immune memory from measles infections. Protecting against measles also provides added benefits of protecting against other diseases as well. It was expected that people with two doses of measles vaccines may be protected for life, but a study in Brazil found seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose:
"The high rate of seronegative individuals in adequately vaccinated populations raises concerns about the potential role of a third dose of the MMR vaccine, particularly during outbreaks. Our data revealed that 67.3% of young adults considered adequately vaccinated had apparently non-protective IgG antibody titers, which may render them susceptible to measles."
Low or undetectable levels of antibodies does not guarantee lack of protection with virus exposure, but it is possible that cellular immune responses that were not measurable at the time may still provide some protection:
"The measles-containing vaccine (MCV) is highly effective, but a small number of two dose-vaccinated people (around 3%) exposed to the virus contract measles. In Spain, from 2003 to 2014, around 3.5% of confirmed cases had received two doses of MMR vaccine, most of them having received the second dose more than 10 years prior."
There are already signals that measles may be quietly spreading in Canada with at least nine confirmed infections in 2024 after two months compared to 12 cases for all of 2023. Two recent cases identified in Quebec and Ontario were not tied to prior travel or came into contact with any known measles cases suggesting they were infected within their community. One case hadn't been vaccinated and the other was a vaccinated man in his 30s who still had a breakthrough infection with milder symptoms. People previously vaccinated for measles who still get infected can have clinical presentations from mild to an illness that meets the full case definition so can make identification more difficult.
Cleaning the air isn't just important for measles, but TB, COVID, and respiratory viruses also transmit through the air via aerosols. For some reason Public Health will easily say that Measles and TB is airborne, but they aren't educating the public that other viruses and bacteria use the exact same transportation network (aerosols) to spread in the air. TB bacteria, which can be as long as 7000 nm, use the same aerosol transportation as the 47x smaller measles virus (150 nm), and the even smaller Covid virus (90 nm). While it is important to wash your hands in general, protecting your airways is where the focus and biggest investments should be made. The risk of contact transmission via hands from Covid in a community setting is extremely rare. This study tested 925 swabs and found only 0.32% had any viral RNA detected, and of those, none of the samples contained viable viruses so unable to infect.
Had Public Health and governments started investing in upgrading the infrastructure for clean indoor air early in the pandemic when it became obvious that Covid and respiratory viruses also spread via aerosols, we would be in a much better position today to deal with outbreaks of other viruses and increasing wildfire smoke pollution
***
"If people are choosing not to vaccinate themselves or vaccinate their children, it's goig to come to no ones surprise that we see teh resurgence of vaccine-preventable illnesses, even here in Canada. . . . The virus spreads easily through the air, transmits before people even show symptoms, and can linger inside enclosed spaces for up to two hours. . . . It also has a long incubation period -- usually between 10 and 14 days -- and, in some cases, can lead to life-threatening complications, including pneumonia, brain swelling, or death. Yet health officials stress the two-dose vaccine regimen against measles is more than 95% effective at preventing infection."
Sound familiar??
Some people online are chatting about the idea of "Informed Refusal" for kids in school whose families are opposed to vaccinations. It wouldn't affect their choice to vaccinate or not; it would just necessitate attending an information session and acknowledging that they understand the short term and long term effects of measles, that herd immunity is possible with measles vaccines, that the rate of serious longterm side-effects of the vaccines is extremely small, and that we need to get over 95% vaccinated for everyone to be protected or else we'll start seeing a lot of "breakthrough" cases (cases in vaccinated people). I'd love to see something similar with Covid!! You're free to never wear an N95 or get any vaccination, but first you have to listen and be quizzed on the facts around the condition, short term and long term effects of Covid, how N95s work, why N95s are better than surgical or cloth masks, why we should monitor CO2 in rooms and open windows when it's over 500ppm, and that vaccinations don't work with herd immunity for Covid because of the speed of mutation of the virus, so vaccinations are needed every six months at the minimum! AND that you can be contagious even after all your symptoms clear up!!
If you've followed along with Covid news, so much of the information about measles is similar. Time will tell if the quest to prevent measles has a beneficial effect on Covid cases OR if the corollary happens, and our lackadaisical attitude towards Covid has a disastrous effect on measles cases. Measles is far more infectious, but Covid is sneakier, with a lot more asymptomatic spread. I'm going to try avoiding both with my trusty N95s!! (Check out one Toronto ER doctor's experience with Covid.) Two much shorter threads:
Kelly explains why we really need to keep testing for Covid at any sign of illness in ourselves or after contact with anyone else who gets sick:
“Why should I bother testing for Covid? If I’m sick I’m sick. Knowing it’s Covid doesn’t change anything.”
Actually - it does. If you know it’s Covid there are things you can and should be doing differently - despite what the CDC or other people want you to believe.
First off - stay home. If it’s at all possible for you to isolate please do so. These guidelines that suggest you can go back into the world as long as your fever is gone or symptoms are improving make ZERO sense. If you’re testing positive - you’re contagious.
Second - if you share a home with others (yes this includes pets) isolate away from them. Ideally in a room with an open window and HEPA filters. Wear a respirator whenever you go into other areas of the house.
Third - if you can’t stay home then please for the sake of your fellow human beings PUT ON A MASK. The best mask you can afford that fits your face. Headstrap respirators are the most effective. Try and have minimal contact with others.
Fourth - REST. Radical rest is important when you have Covid. Some studies suggest you should be resting for a minimum four weeks after infection (yes even if you feel “all better”). Rebound is a concern, and Long Covid risk appears to increase when people don’t slow down.
Fifth - keep a record of your infection. Long Covid is not rare and it’s not mild. If you become disabled and you need social supports, medical care, disability etc? Guess what? If you can’t prove you HAD Covid you will have a much harder time.
I’m sure there will be people saying “but you should do all these things for other respiratory viruses,” and I don’t disagree. I think we would all be healthier if people would stay home when sick and wear a mask IF they have to go out. But covid is NOT another respiratory virus. It’s a multi system virus that has proven vascular, neurological and immune system damaging capabilities. It disables 1 in 10 people and the risk of disability increases with each infection. It’s been downplayed for economic and political reasons, but the science is clear. You don’t want to keep getting Covid, and any person who cares a whit about others shouldn’t want to spread it to anyone. If we cared more about who we potentially infect - perhaps we would take more precautions. I’ve had friends say to me “I’m so glad I didn’t visit you because I’m so sick it would have killed you,” and yet they don’t stay home or mask. It doesn’t make sense. Just because you don’t personally KNOW the vulnerable person you infect doesn’t mean you should stop caring.
So please - keep testing to see if it’s Covid. Don’t buy into the idea that it’s “just another flu”. And if you’re positive take steps to mitigate contagion risk for others and Long Covid risk for yourself. If we do these simple things we would drastically lower transmission.
Then later Kelly added:
"I'm shocked - just shocked - that the White House has more stringent guidelines in place for Covid. Shocked! It's almost as though they realize the very serious risk of reinfections and don't want the President and staff exposed. But sure - one day isolation is fine for the plebs."
"It is NOT OK to breech H&SWA and encourage pupils and teachers to repeatedly be reinfected with a BSL3 pathogen that will overtly disable some, and may cause covert damage to brain, blood vessels and immune systems in others. These are our CHILDREN! If you care about our children’s education as you say you do, please protect their health! Sick children can’t learn! Children disabled with long covid - many are too sick to access school. CEV children are too high risk to access school if you keep encouraging schools to be a Petrie dish of Covid, flu, RSV, measles etc! Covid is NOT “just another respiratory virus” - it is a vascular virus via ACE2 infection of endothelial cells and increases risks of future long term chronic diseases and brain changes. If you really want to protect the learning of our children please stop encouraging reinfecting with SARS2 that causes cognitive damage! Children with cognitive impairment will also struggle to learn. Please stop trying to boost attendance figures by forcing infectious kids into unmitigated classrooms to infect everyone else! Forcing infectious sick kids to school with no testing = more kids get infected and sick, some will become disabled by LC = school attendance gets worse not better! Please stop using unscientific PH campaigns as a short term band aid trying to cover over a gaping and growing abdominal wound! It won’t work and you will and are doing real harm to children’s health. Please instead address the CAUSE of the ABSENCE rates. 2/3 due to children sickness!!! Please sort hybrid options so infectious sick kids, can work from home if well enough until non infectious, and please CLEAN THE AIR in schools! Please help BREAK THE CYCLE OF INFECTION rather than perpetuate it. This really isn’t rocket science. Please, you are risking our children and their families' long term health with your current policies."
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