Monday, December 5, 2022

Will Steffan on What a Four Degrees Temperature Rise Looks Like in the Age of Ecological Disorder

For a trifecta of depressing posts for this Monday morning, I want to save this video here. It's Will Steffan, an American chemist who became the executive director of the Australian National University Climate Change Institute, explaining back in 2018 that we only have two years to make a solid plan we all stick to 100% in order to keep the global temperature to just 2°C above pre-industrial times. Whoops! 

He explains that without a plan incorporated everywhere NOW, as we watch Ford destroys the greenbelt, we'll be on track to see a 4°C rise by the end of this century. The real shocker for me, that he does a great job of explaining, is that the difference between mean global temperatures now and the mean global temperatures during the last ice age, is just FOUR DEGREES!! People survived during the ice age, but didn't thrive and innovate until the weather became optimal. We're in this very tiny optimal place, but it won't last long. And who knows what a 4° rise will look like, but Steffan predicts it won't be survivable without air conditioning, and that might not be possible if we lose too many engineers and skilled labourers, etc. to the inhabitable conditions. That's just our bodies trying to survive. He didn't get into what will happen to the entire agricultural system. I'd hazard to guess we'll go hungry before we burn up. 

It's 50 minutes long, but the most important bit is from 30-37 minutes.


ETA: This article: Climate change isn't the main cause of a loss of biodiversity - which is another urgent issue. That can be blamed on "habitat fragmentation and loss, overhunting, over-exploitation, agricultural expansion, pollution, and industrial development." The problem comes when things like massive solar fields directly harm habitats:  

"There is at present no plan, in any country, anywhere, on a global or national scale, to address extinctions, biodiversity crash, and habitat loss. The dismal reality is that with a green build-out, we will be saving not the complex web of life on Earth but the particular way of life of one privileged domineering species that depends for its success on a nature-ravaging network of technological marvels. Only once this truth is understood can honest decisions be made about what kind of world humanity wishes to inhabit in the age of ecological disorder." 

Time for palliative care?

What Going on With Kids Today? This is What "No Mitigations" Looks Like

 Dr. Jeff Gilchrist's thread on what's going on with kids today. He does biomedical research. (I didn't indent it because it's long, but this is entirely his words:)

"This virus season has been like no other with high hospitalization rates from RSV, Influenza and now more children are dying from Strep A bacterial infections. This looks at what might be going on.

So far in the UK, five children have died in England under age 10 within a week of diagnosis of invasive group A strep (a bacterial infection) and one 7 year old child in Wales. The rates of invasive Strep A in children age 1-4 is 4.6x higher and age 5-9 is 3.7x higher than pre-pandemic 2017-2019 seasons according to the UKHSA. A 9 year old Canadian girl also recently died from a bacterial infection. 

Normally most infections cause mild illnesses but this bacteria can also cause scarlet fever and in rare occasions infect the lungs and bloodstream which needs urgent treatment and can be life-threatening. The bacteria can easily spread between people. This kind of infection is typically treated successfully with antibiotics but currently many places, including in Canada, are facing antibiotics shortages, so the necessary treatment may not be easily available. The UKHSA is advising people to call 911/999 or go to Emergency if your child is having difficulty breathing, there are pauses when your child breathes, your child's skin, tongue, or lips are blue, your child is floppy and will not wake up or stay awake. Why are serious Strep A bacterial infections worse this year than before the pandemic? Dr. David Fisman points out that surges in viral respiratory infections can lead to downstream surges in invasive bacterial disease. His group has demonstrated this with influenza and pneumococcal disease and also a 4.3x increased risk after RSV and 2x increased risk after influenza activity for meningococcal disease

Those Darn Hibernating Viruses!

Many viruses stay in the body, all sneaky-like, for years after a first infection.

Chicken pox, which spreads from contact with blisters or mucus, shows up with flu-like symptoms and characteristic spots. Then 30-70 years later, it can develop into shingles in about 10% of people, which is a painful skin condition. Luckily we have a vaccination for chicken pox AND a vaccination for shingles for anyone over 50 who had chicken pox in their life. It's two shots, and they're a couple hundred dollars each. They figured out the connection between chicken pox and shingles back in 1953, but didn't try to prevent chicken pox with a vaccine (or even warn parents to avoid it) until 2000, and the shingles vaccine wasn't developed until 2006.

Polio, which spreads from contact with bodily fluids (mucus or feces), first shows up with flu-like symptoms that most people make a full recovery from within a week or two, but less than 1% end up with paralysis of some type. Then 15-40 years later, people who just had mild symptoms can develop post-polio syndrome, characterized by progressive muscle weakness and atrophy, joint degeneration and pain, and skeletal deformities. Polio was around for centuries before Jonas Salk's vaccine in 1955. Luckily, vaccinations have almost completely eradicated polio here. So far.

Sunday, December 4, 2022

Five Questions for the Minister of Health

 Dr. Christopher Leighton, MD, FRCPC, wrote the following letter to the Minister of Health, and encourages other to do likewise in order to "document the gross negligence of our government. If they will not act, we should be doing more: Protesting, petitioning our local MPPs. Eventually there will be an Ontario Inquiry or Investigation." It's just five questions:

RE: The Failure of the Ontario Government to Respond to this Unprecedented Health Care Crisis

  1. Why does this government fail to acknowledge the most serious healthcare crisis facing Ontario hospitals in 70 years?
  2. Why hasn't this government formed an Emergency Response Team to formulate and implement immediate solutions to improve access to emergency service, pediatric critical care, cancer treatment and urgent surgical care (adult and paediatric)? 
  3. Why has this government failed to adopt ANY public health measures that will reduce the spread of COVID19 and influenza especially? 
  4. Why has this government removed the reporting of COVID19 infections by schools (contrary to the HPPA & the Education Act) when absentee rates are >= 30% in a number of schools & districts across the province? [PHO as of Nov. 21, 2022]: "Only 40% of children ages 5-11 have had a primary series (2 doses). Only 5% of children ages 6 months to 4 years have had a single dose of a mRNA vaccine." These numbers have barely changed over several months meanwhile, children are presenting to hospitals across Ontario "requiring critical care and [mechanical] ventilation." 
  5. Has the Premier, yourself, or the Chief Medical Officer of Health, directed in writing or verbally, or otherwise discouraged Medical Officers of Health from using their independent authority with the Health Protection and Promotion Act (HPPA) to make Section 22 Orders..." " require masking in schools for example?" "I personally cannot understand why preserving the health & welfare of all Ontarians is no longer a priority for this government. Shouldn't this be the ethical duty of every elected provincial and territorial government in Canada?" "Is it that this government values the lives of those who are predominantly dying from COVID19 differently from the rest of the population i.e. the elderly and persons with disabilities? This inaction leaves one with so many uncomfortable questions." 
 "These comments are my own"

Friday, December 2, 2022

History of Mask Controversy

 The New Journal of Medicine just posted a video of the history of mask wearing. It's just 12 minutes:

Unfortunately, they conclude that masks have always been controversial, so will likely always be controversial, and it's even worse in more atomistic, partisan, polarized countries that focus on the individual over the community. 

You can see more about the history of the Spanish Flu, which killed one in five people, here. One in five, and they still fought against wearing a mask!! 

Monday, November 28, 2022

All Natural Misinformation

This thread is from Dr. Kay M. Dingwell on her experience shifting from natural is necessarily best to incorporating some scientific research into her decision-making:

I used to be vaccine hesitant. Had my kids on a modified schedule and felt I was VERY educated. Here are posts I made in 2010 about visiting public health with Charlie, two months at the time:

When pregnant with Charlie, I was pretty resentful of 'unnatural ' obstetric care and was convinced I could do things better. I had 'done my research' and wanted an unassisted home birth. 

Thursday, November 24, 2022

On OCDSB's Mask Motion

The OCDSB motion to require masks in all schools but allow exemptions for anyone who finds masks to be a hardship was not passed tonight after a 6-6 tie. Both student trustees also opposed it, but their votes weren't counted in the official tally. Here are three arguments I heard from opposing voices, and my rebuttals: 

Telling people it's required but that they can avoid it by saying it's a hardship for them means it won't change anything. 

Although it was hard to watch concessions be made in the spirit of compromise and the original motion be whittled away bit by bit over two long evenings, it was worse to hear final arguments about it being too watered down to bother passing by the very people who chiseled away at it! Of course that was the plan. The idea of the exemptions was to take any enforcement off the plates of teachers and administrators, but people argued that it makes it no different than a strong recommendation. 

I believe it's not the case that everything will be the same if you require masks but allow people to remove them without penalty. We know that every little bit will help, and we can't let the perfect be the enemy of the good. Sure people who are anti-masks will still not wear them, but I'm hearing from many parents with kids who want to mask, but don't want to be feel weird. If it's stated that they're required unless there's a hardship, then it makes masking the default, and those kids who want to mask will put them back on. In my own classes, almost all my students kept their masks on after the mandates were lifted last April because I told them the risks and the current data, and I asked them to keep them on if possible. That's all it took to get compliance from 95% of them. When the message is, "Masking isn't mandatory, but please respect people's choice to continue masking if they want to," that messaging leaves NOT masking as the default, and then kids feel uncomfortable wearing a mask. The message makes a huge difference even if there's no penalty for non-compliance.

Wednesday, November 23, 2022

A 12 Step Solution to Fix Healthcare

This thread is from Dr. Raghu Venugopal, an emergency physician in Toronto explaining how to fix healthcare in Ontario:

1. Declare a crisis

2. Scrap bill 124.

3. Give nursing and allied staff a raise.

4. School masking to reduce spread (plus cleaning hands and ventilation).

5. Get provincial health ministers to agree to federal data request to get available federal funding.

6. Spend surplus on health staff and structures, not highways, car sticker rebates, and waste.

7. Robustly invest in family health teams.

8. Supercharge hospital bed capacity (including ICU), which we hugely lack.

9. Bipartisan flu vaccine promotion now.

10. Fair paid sick days.

I could go on. But the Ford administration is going to do none of this, I am sorry to say, except I do note they promise to build hospital beds.

Lastly, it's about publicly funded health care:

11. Yes to non-profit surgical facilities.

12. Scrap for-profit nursing homes with increased mortality. Most hospitals are general, so children fight with elderly for beds. Healthier seniors means more pediatric beds.

So simple, and so not going to happen!! 

A trustee in OCDSB (Ottawa/Carleton) last night, where they discussed a mask mandate at an intense meeting that required police intervention to keep the crowd at bay, asked, "Why, if the situation is so dire, have neither Moore nor Ottawa's Medical Officer of Health, Dr. Vera Etches, imposed mask mandates?" And many people are saying - Wow, great point!! 

Thursday, November 17, 2022

Science of Mask Efficiency

A thread from Dr. Leo Lam, who has a Ph.D. in Electrical Engineering, worked for over twenty years as a science advocate, and was co-founder of medical imaging software.

I'm tired of hearing the contrarians talking about how masks don't work as protective devices against respiratory diseases as our nation's pediatric hospitals are full of children sick with RSV/Flu and COVID continues to be the 3rd leading cause of death. The contrarians are WRONG. Some of them are already making attempts to take apart the excellent study done at the Boston School District with minor technicalities while ignoring a fundamental fact: the study is only a proxy. 

These contrarian physicians mistakenly believe that RCTs [randomized control trials] or observation of the secondary effects somehow make the gold standard for scientific evidence. It is NOT. Why? Because masks are mechanical devices that are physically measurable. And we have physical data. RCTs, by definition, are examining efficacy by proxy because the effect of drugs (and some medical devices) is not directly observable. You can't directly see how the chemicals interact with our cells/molecules or organs until we have nanobots with viewing capabilities. With masks, we can directly test and measure their efficacy via controlled particulate generators and sensors. This is the same for other physical objects, like seat belts, parachutes, and helmets. It would be absurd to run RCTs on them. Unethical, too. 

Tuesday, November 15, 2022

Where Does the Buck Stop on Mandates??

So Dr. Kieran Moore, CMOH, claimed he doesn't have the authority to institute mandatory masking in schools, and that boards can "consult with their local medical officer of health." It was later clarified that the CMOH can order masking in schools, or local health units, and it's not up to individual school boards. The Ottawa Citizen reported, 

Several medical officers of health have said they would prefer the province bring in mandates. Although they have the power to do so themselves under provincial public health legislation, they say it is difficult to enforce and makes for uneven rules across the province. Ottawa's Medical Officer of Health, Dr. Vera Etches, has said she would support local businesses and organizations that bring in mask mandates--something the Ottawa-Carleton District School Board did earlier this year after provincial mandates were dropped. It is again set to debate the issue. . . . On Wednesday, OPH (Ottawa Public Health) posted a message on Twitter saying it would "fully support any business/organization that chooses to implement a mask wearing policy." That leaves schools and post-secondary institutions to make their own decisions.

But BOY is it tricky to find out where responsibility lies on this!

Monday, November 14, 2022

Moore on Masks: It's All on Families to Get Back to ALL of the Basics

I watched it so you don't have to! I've transcribed most of it, but left out repetitive information in places. I also added timestamps to some of the more pertinent bits. And I've added in my own responses here and there. Many reporters did an amazing job with persistent questioning, except that one guy in the front, who didn't write anything down and just lobbed softballs. 

TLDR - The reason kids are getting sick is because of their parent, siblings, and grandparents, who really need to do better. We're doing something really new and different today by urging people to wear masks specifically when they're around children four and under. And if we need mandates in daycare to save the children, we'll absolutely think about it.


The Polycrisis and Planetary Palliative Care

Dr. Thomas Homer-Dixon and Johan Rockström wrote about the "Cascade of Crises" we're experiencing right now. They discuss global hunger, people forced to moved, political authoritarianism, violations of human rights, violent demonstrations, ongoing conflict. They point to three things: the magnitude of consumption, "vastly greater connectivity among our economic and social systems, and risk synchronization. Since everyone is specialized, we don't have experts that can analyze all the connections. They advocate for creating a consortium for this. But can we do it fast enough?  

The two biggest issues right now, climate change and covid, are revealing an ongoing inability for our society to make wise decisions in the face of calamity, which may be leading us to a collapse of this civilization. But acknowledging that possibility doesn't mean giving up or hiding out. Perhaps if we accept (or just believe) that we're nearing the end, we can shift our priorities enough to usher in a more peaceful and equitable denouement.

Some recent climate change articles are painting a frighteningly bleak picture. At the Paris Agreement in 2015, countries around the world signed on to reduce greenhouse gases (GHGs) in order to cap warming at 1.5°C above pre-industrial levels by 2030. It's become clear that we won't be able to make it. 

Current pledges for action by 2030, if delivered in full, would mean a rise in global heating of about 2.5°C and catastrophic extreme weather around the world. . . . Global emissions must fall by almost 50% by that date to keep the 1.5°C target alive. . . . We had our chance to make incremental changes, but that time is over. 

The climate crisis has been a test of our ability to put long term collective needs over individual desires, and we failed miserably. It's no wonder we're not sufficiently mitigating SARS-CoV-2. Despite all our knowledge and technology and ability, we just don't want to be inconvenienced. 

Sunday, November 13, 2022

Viral about that Virus

I posted a mini thread yesterday that exploded:

It hit a million impressions in just 24 hours, and it's still going strong. I'm so glad I turned off comments early on after I got slaughtered by trolls on a different post yesterday - almost 500 random comments mainly from people with fewer than 10 followers and almost entirely American based, lots of gun-lovers. It's the wild west on Twitter since Musk fired most of the staff. 

Friday, November 11, 2022

Our Duty to Others IS Love

In my class recently, we were asked to get into groups to get a reading down to one key word. The passage was on Confucius, and it was about human-heartedness, taming unruly impulses, filial piety, benevolence, and justice. 

In my little group, I suggested it's all about love. My group disagreed. I pointed out that the word is mentioned several times in the reading because they were quite sure it wasn't mentioned at all. They countered that it's all about duty, order and control. It's trying to control us by making us do things for other people. They said that like it's a bad thing. One kept bring up the idea of that we can only control people by shaming them and making them feel horrible, so it's in essence a horrible theory. I kept rereading the passage to see where they were getting this idea. I thought I must have missed something crucial in the text. Then, when we went around the room to share ideas, I was heartened that many other groups came up with terms like love and virtue and service, so I wasn't losing my mind. The reading was full of love.

It reminded me of two things: First, it's a similar reaction to class discussions on Kant's deontological (duty-based) ethics. Any thought of a duty or obligation to others gets the shackles up on many teenagers who are in survival mode competing with one another for university slots. But, if I come at it from the other end, focusing on what would make for the most benevolent society, or even what would be the best way to solve a conundrum with a group of people you really care about, they tend to come up with the notion of doing for others even if it's not in our best interest. They will start to argue that we can't expect to get our own way all the time, and that we have to look at the bigger picture and do what's right even when it's not what's easy or what most benefits ourselves. If we want to have a good home life or a good society, we have to consider the effects of our actions. And then we can get into the nitty gritty of how to decide that. It sometimes takes a full class of thinking to get them on board with "duty" being useful to keep the peace because first you have to get them outside of their selves, outside of their personal striving against each other. 

We Need Mask Mandates Now!

Here's Dr. Joe Vipond on mask mandates:

Hey Canada, it's time we talked about mask mandates: What they do, why they're important, and what we've learned from the past.

A mask mandate simply means a law that requires universal mask use in a certain situation (schools, work, public spaces, etc.). It's usually coupled with some kind of penalty, the simplest being lack of entry, but could be fines or other penalty. The intent of a mandate is to increase the number of people wearing a mask. It essentially sets the social benchmark for what is deemed acceptable behaviour. We go from mask wearers being the exceptional citizens to non-mask wearers being the exceptional citizens. We saw this in Calgary. On August 1, 2020, the percentage of mask wearers went from around 15% to 85% overnight.

We now see a similar trajectory towards a mask mandate in Canada, with Ottawa leading the way. Baseline mask use has probably (by my eye) been about 5%. We hope this will increase with increasing exhortations to wear a mask. So we'll go from "now you need to wear a mask," "no, really it's quite important," "goddamn it we're drowning here, will you for god sakes wear a mask," and maybe we'll boost the mask use to 20, 30, or even 45%. It simply won't be enough to bend the curve. If we know (and we know) that we'll eventually end up with a mask mandate (because exhortations don't work well enough), the earlier we do it in the curve, the better. So why not skip the "pretty please" steps and go right to what's worked in the past??

Thursday, November 10, 2022

If We Know What's Right, Will We Do What's Right?

The Toronto Star just quoted Kieran Moore,

I’m very loath, after 1,000 days of a pandemic, to put in a mandate. We know what works, and we can trust Ontarians to do the right things. 

Nope. If we could trust people to KNOW what's right with all the misinformation out there, and then to DO the right thing (i.e. wear an N95 completely covering mouth and nose at all times in all public places), then we wouldn't have kids being shipped to hospitals across the province because of overflow. It's even worse now that we have 112 Paediatric ICU beds in Ontario, and 122 patients in need of a bed. 

In Ontario, 19 children have died of Covid so far. How much worse does it have to be for people to understand the need to wear an N95 around others? Like many communicable diseases, Covid spreads through carriers - a third of cases have no symptoms, so we need to mask even when we feel perfectly healthy. We can't know we have it, and can't know if someone nearby will die or be permanently disabled from catching it from us. Vaccines help prevent severity, but don't significantly stop transmission. N95s are a painless and effective way to stop the spread. If public health had pushed masks over hand washing in the last few years, then I might trust Ontarians to "do the right thing," but PH comms has been a disaster. 

From a Socratic perspective -- he argued that if we know right, we'll do right -- the problem is that most people don't know in their hearts that walking around publicly without a mask is wrong. We often avoid doing wrong because we'll get in trouble, but when we really know wrong -- like if you were asked to kill an innocent child -- it doesn't matter whether or not you'd get in trouble because you wouldn't be able to betray your conscience to that extent. The problem with masks is that many people don't know it intellectually either. They don't get how Covid is transmitted and don't know what to believe about the effectiveness of masks, and they don't get the difference between an N95 that seals to the face and a flimsy bit of cloth or surgical mask. And then, once they get the right information, they have to make the connection between walking around the grocery store without a mask on and killing an innocent child, the one in the cart next to yours in the check-out line, or the one that the cashier has waiting at home for mum, in order to really know know that it's wrong. Only then can we trust them to do the right thing.

Please wear an N95 or better in public places, especially schools, healthcare facilities, transportation, grocery stores, and anywhere people NEED to be. If you think we need a mandate in order to save the lives of our children, let Ford know at 416-325-1941. 

Wednesday, November 9, 2022

Medical Officers of Health - Can't They Save the Day??

 The Peterborough Medical Officer of Health, Dr. Thomas Piggott, wrote, 

I would agree and add my voice to the numerous health system leaders who are concerned with capacity of the health system in the face of COVID and other respiratory viruses and have been calling for a return of masking in recent days. If we have not reached the threshold from a health system capacity impact to reinstate required masking in key indoor locations, we need to understand when exactly that would be. I have said before and I'll say again, a multi-layer approach is needed (especially we need to see improved COVID/influenza vaccination rates, and improvements in in indoor air quality/ventilation) but masking in indoor locations is a key effective strategy with no associated health harms. It should be the first preventive measure to be returned and the last to leave as we continue to learn to live with COVID, keep kids in school, keep businesses open, and prevent health system collapse. 

What we are seeing affecting paediatric hospitals and children is the sentinel event for more broad community transmission. We usually see transmission in younger first. In coming weeks, I anticipate other populations, including older adults, to be more severely affected as well. There is a broad, not localized crisis facing our health system. It should have a coordinated provincial, not local, response. This is needed for clarity of message and coordination/feasibility of implementing. I believe it will soon come, but I sincerely hope the decision on return of required masking comes before the worst period to prevent it, not when we've already reached that point.

Covid Club - Specially Made for Public Health and Media

The first rule of Covid Club is you do not talk about Covid.

The second rule of Covid Club is you DO NOT talk about Covid!

Third rule of Covid Club: someone starts coughing, sneezing, sore throat? It's just a cold.

Fourth rule: only hand sanitizer in classrooms.

Fifth rule: keep the windows closed, fellas.

Sixth rule: no masks, no RATS.

Seventh rule: Covid will go on as long as it has to.

And the eighth and final rule: if this is your first time at Covid Club, you have to spread Covid.

(Inspired by Michael Olesen's tweet - and Fight Club)

Monday, November 7, 2022

André Picard's "Kids are suffering from COVID in ways we never expected"

In a Globe & Mail article, Picard outlines the absolute crisis state health care is in right now, particularly for children:

Pediatricians, family physicians and emergency rooms are being slammed by a tri-demic: simultaneous outbreaks of respiratory syncytial virus (RSV), influenza and COVID-19, with cases of rhinovirus and enterovirus thrown in for good measure. To make matters worse, there is a grave shortage of children’s pain medication in pharmacies. Even antibiotics such as amoxicillin, used to treat the complications of these minor ailments, are in short supply. A winter surge of respiratory illness in children is to be expected, but this year it has come early and hit hard. The number of infants and toddlers needing hospitalization is unusually high. Because there are a limited number of beds (since the number of physicians, nurses and other health professionals who care for children are in limited supply) this has led to the postponement of surgeries. And, in year three of the pandemic, the backlog of surgeries for children is already significant. There is every indication that this troubling situation is going to get worse before it gets better. After all, winter cold and flu (and potentially COVID) season is only just beginning. Where will all the sick kids go? That is a question that should send chills down the spine of every parent.

He blasts the political mechanisms that allowed children to be put in harm's way:

Sunday, November 6, 2022

Community Debt and Empathy Debt (and Credibility Debt)

Thread by Dr. Christopher Leighton

Covid 19 didn't cause "immunity debt." It caused "community debt." 

Communities lost members, young and old, healthy and frail. Death rates climbed in 2022 as leaders ditched masks. Communities lost health care dollars because Ford pocketed billions of federal aid money. Communities lost education funding because Lecce decided a few hundred dollars to each parent (> $380 million) would somehow improve learning better than investing that money into the curriculum, schools, or education workers. Isn't that what the Minister of Education does?

Communities lost nurses and access to care. Ford used the notwithstanding clause to prevent collective bargaining! Bill 124 restricted pay to 1% per year. Fatigued and over worked, many nurses left the profession or changed jobs. Communities lost public health measures. Communities lost regional approaches to public health interventions. Section 22 orders suddenly ceased, and Medical Officers of Health will not disclose why. 

Saturday, November 5, 2022

The Cult of Covid

I've been posting threads from health care professionals on here to save them as we watch whether or not Twitter will self-destruct. This one is from someone anon, @1goodtern who posts lots of fantastic info, but I have no idea what they do for a living. (ETA - they're a priest), The stats they share aren't too dissimilar from Canada's, and the post resonates crucially with my own experiences as someone screaming into the void about the very simple steps we could be taking to prevent the spread of a fatal virus. This could have been something I wrote if I were able to write this well! 

It's been a strange day today and a hard one. Time for a re-evaluation and update on where I stand with covid mitigations and why. I'm not up-to-date on international data and differing levels of protections anymore, so I'll be talking about the UK, but the principles should apply worldwide.

First, today, and a few observations:

Today I was at an event with 200 people, as part of my job, something I couldn't avoid. I was the only one in a mask FFP3, and today I wore my stoggles [sic] too. There were zero mitigations in place. Also zero sympathy, zero understanding, lots of strange looks, some aggression, lots of coughing, lots of people looking unwell. 

Friday, November 4, 2022

Immunity Debt is Not a Thing! (And a Bit on Lymphopenia and Similarities to HIV)

The term 'immunity debt' is causing problems because if it's the case that the immune system can lose function from a lack of illness after years of masking, then the solution is to expose kids to more illnesses. Health care professionals online are jumping all over this because it's SO wrong and leads people to this very dangerous conclusion. Why is this bullshit being spread right now? Maybe for some politicians and public health and other medical professionals to cover the fact that they've allowed a lot of children to be harmed by a situation that could have been prevented. 

Immunity debt isn't a thing! Getting sick doesn't make your immune system stronger, and avoiding illness doesn't harm it. If you think we need to be exposed to germs in our environment in order to better fight them by boosting our immune system, and you're avoiding an over-sanitized life of masks and hand-washing, you're thinking of bacteria, not viruses. Let your kids play in the dirt, but please put a mask on them when they go to school. 

And telling people to take off their mask so they don't risk a flu immunity debt is like telling people not to wear a condom so they don't risk an STI immunity debt. Nonsense, right?!

This is explained in greater detail by Dr. Kristen Panthagani in this thread. She explains that microbial exposure is important, but it means exposure to commensal microbes (i.e. the microbiome), not pathogenic microbes that make you sick. Just think about it for a minute. How often do new parents try to keep sick friends and family away from the baby?? It's for a good reason! Dr. Deepti Gurdasani also wrote a thread about the invented term 'immunity debt.' Ontario Public Health also clarified that immunity depletion (dysfunction/dysregulation) IS a thing .The more a person gets sick, the harder it can be for the immune system to keep fighting. It's the kids who had Covid already who are more susceptible to flu, and, according to this study in Nature immune dysfunction from Covid can persist for over eight months from the time of infection. 

Colin Furness says immunity debt fits a narrative of muscles that atrophy, except our immune system isn't a muscle. It's more like a photo collection that doesn't fade if we don't look at it. The photos just sit until they're needed. 

Dr. Papenberg recently responded in a forum on this issue: 

We would NEVER recommend any child purposefully getting infected with any respiratory virus, including CVOID-19. . . . There is no benefit to the individual child to get a respiratory infection earlier in life. 

On a Lighter Note: David Cross on Covid

David Cross tweeted this "partial list of things equal to or greater than the physical and mental pain and suffering experienced while wearing a mask while shopping" from his new show, I'm From the Future. I can't find it in a way that can be embedded, so it's just at this link. The list includes such tragedies as having a ladybug land on your shoulder. 

But here's another relevant bit from the show that's on YouTube:

Thursday, November 3, 2022

A Panel of Experts on Ending the Covid Public Health Threat

Several medical professionals that I follow on Twitter have excitedly announced the arrival of this joint article: A multinational Delphi consensus to end the COVID-19 public health threat, in Nature. The panel of 386 experts from 112 countries developed a set of 41 consensus statement and 57 recommendations, which have been further endorsed by 184 organizations globally. Steffen has a super short version:

So much of this has already been said, but the fact that there is consensus from so many gives it just that much more weight: We need to communicate effectively, strengthen health systems, emphasize vaccination but not exclusively so, promote preventative behaviours, expand treatments, and eliminate inequities. Their recommendations are to be implemented in the short term (months, not years) "to end COVID-19 as a public health threat. . . . Failure to use these approaches risks not only prolonging COVID-19 as a public health threat, but also further diversion of resources from efforts to achieve other extant public health goals." Below are some of the important bits.

Three of the highest-ranked recommendations call for the adoption of whole-of-society approaches, while maintaining proven prevention measures using a vaccines-plus approach [vax, mask, ventilate/filtrate]. . . . advise governments and other stakeholders to improve communication, rebuild public trust and engage communities in the management of pandemic responses. . . .

Pandemic fatigue threatens to undercut our vigilance and the effectiveness of our responses to ongoing and new pandemic-related challenges. . . . Highly transmissible variants continue to spread globally. . . . Reinfection risks are not fully understood. . . . Long COVID has emerged as a serious chronic condition that represents a considerable burden of disease and still lacks adequate understanding and appropriate preventive or curative solutions. In addition to its direct health consequences, COVID-19 has disrupted economic activity, social interactions and political processes, affected civil liberties and interrupted education at all levels. Although many government and individuals no longer have the same level of concern as earlier in the pandemic, many public health leaders, including members of this panel, continue to regard COVID-19 as a persistent and dangerous health threat. . . . 

Saturday, October 29, 2022

Portable UV Sanitation: a Pricey Solution

If you could avoid Covid with greater certainty for less than $500, would you?? 

I've been looking into portable UV light. From the beginning of Covid, people have talked about Upper Room UVGI (UltraViolet Germicidal Irradiation) that can be installed near the ceiling of a room, necessarily, to ensure nobody looks directly at it. It kills viruses, but, with a wavelength of 254 nanometres, it also harms people's (and pets') skin and eyes. More information from a Harvard slideshow, the CDC, the Center for Global Health Delivery, and a fun Naomi Wu video. 

BUT last Wednesday, research published in Nature found that UV light with a wavelength of 222 nm, 

doesn't reach beyond the layer of dead cells on the surface of the skin or the film of tears on the surface of the eye. Because bacteria and viruses are much smaller than those layers, Brenner and his colleagues reasoned that far-UV radiation could destroy the pathogens without damaging the skin and the eyes. . . . 

In a 2018 study, the investigators showed that more than 95% of influenza viruses in teh air were inactivated when they floated past a low-power far-UV lamp. Brenner's group had already shown that cells in a 3D human skin model and in mice were basically unaffected by such low doses, and other researchers found no evidence of eye damage from 22 nm radiation in rats.

Friday, October 28, 2022

The John Snow Project on Spooky Masks

The John Snow Project has the singular goal of cleaning the air in public buildings the way its namesake demonstrated the link between cholera and contaminated drinking water, and eventually was able to convince the government to clean water for public consumption. Cholera was one of the deadliest diseases in 19th century Britain, so this was a big deal. 

Covid is currently one of the deadliest diseases right now, but we're still in the place where some people think it spreads by magic or happenstance or that people are getting sick from the vaccines, not the virus, or they throw up their hands at the lunacy of suggesting we can actually prevent transmission. We're right where John Snow was when he just turned off the contaminated tap himself to prove that there's a link. Our situation isn't hard to prove, but it's hard to be believed. In Future of an Illusion Freud talked about the difficulty of convincing people that God isn't real -- people will kill you if you take away a belief they need to manage their lives. So it is with Covid. People get angry if you try to tell them it's not over. 

Thursday, October 27, 2022

Mask Court Case in Alberta

Families of five immunocompromised kids in Alberta fought the lifting of mask mandates by the government, and, long story short, Justice Grant Dunlop said the cabinet can't do that, as reported by CBC:

The order was unreasonable because it was based on an interpretation of the Public Health Act as giving final authority over public health orders to elected officials. . . . While Minister LaGrange's statement on its face appears to prohibit school boards from imposing mask mandates, it does not do so, because the minister can only do that through a regulation, and the statement was not a regulation. . . . The application argues the abrupt end of the masking mandate infringed on the charter rights of the immunocompromised children who were forced to choose between their education and their health. . . . They said the decision to remove mask mandates in Alberta schools was not consistent with public health advice and instead was made by government officials for political reasons, including "quelling protests" that were taking place at the Coutts border crossing. . . . The applicants' legal team argued the children at the centre of this court case suffered segregation, alienation and bullying as a result of having to stay home from school or, in other cases, because they were the only ones at their schools who wore masks.

Covid is a Stealthy Enemy; Our Body its Battlefield -- Shore up Your Defences, and Fight to Keep it at Bay!

Dr. Uppity (@MeddygLou), an NHS GP in Wales, wrote an excellent thread, beautifully written, explaining how Covid works with some battlefield imagery to help. I have nothing to add:

Since Covid hit the UK I’ve been reading compulsively, like how you can’t help looking as you drive past a car crash. There’s a lot still to research, but I’ve made a rough working model in my mind of how Covid attacks the body, and what the main issues can be. Covid virus travels through the air, a bit like invisible smoke. Covid is airborne. It’s also in droplets of spit & mucus in air or on surfaces, but that’s not the main way it transmits. Wash your hands & stick up a screen if you like, but improving indoor air quality & masks will do far more to protect you from infection. 

Once you breathe in air with the virus in it, the virus attaches itself to the cells that line your nose, throat, voice box, windpipe & lungs. It gets into the cells using ACE2 receptors as a “door.” ACE2 receptors are also found in the lining of the gut, the lining of your blood vessels, and many other organs, giving Covid easy access to these areas. In the lungs there’s just a thin layer of cells between the air & the bloodstream. The virus gets into a lung cell using the ACE2 “door,” then hijacks the cell’s factory area to make rough copies of itself. Lots and lots of copies! It may also turn up secretion production, so on one side the cell starts releasing mucus full of new viruses into the lungs. These can either infect more lung cells or get breathed out into the air to maybe infect someone else. On the other side is the bloodstream, where more new viruses are released. The lining of the blood vessels, the vascular endothelium, also has ACE2 “doors.” Now the virus can infect the lining of the blood vessels in the lungs, AND travel round the entire body, infecting any bit of blood vessel wall as it goes. 

Wednesday, October 26, 2022

Covid and Kids

I feel like I'm "cheating" just copying threads instead of writing, but so much work on social media needs to be acknowledged and saved in a more searchable manner. Here's a thread from @MeetJess. She's the go-to for long threads chronicling sudden deaths of teens and young adults - picked up by Fortune magazine even, but today she focused on the lies we've been told about children. She discusses BC specifically, but this is the case in many parts of Canada. I flushed it out a bit in places for clarity:

Covid "doesn't affect kids" was one of the very first lies that was one of the very first lies that was fed to the public: Kids didn't get sick, kids can't transmit the virus, kids won't have lasting effects. Kids are being sent into unsafe schools, repeatedly infected. 

One thousand B.C. kids were hospitalized, thousands left with Long Covid. A study has shown that kids who have special immunodeficiency illnesses are at a higher mortality rate due to Covid-19 complications. Some kids and teens have long-term lung damage after Covid-19. Covid-19 neurological complications, long-term complications ["7% have seizures, brain damage].  Children hospitalized with Covid-19 can have lingering health issues months later. Your kid's school needs better ventilation to help keep Covid-19 in check. 

Sunday, October 23, 2022

The Price One Pays: Liquidation of the Uncompetitive

I'm saving this excellent thread by Dr. Satoshi Akima FRACP. It's tongue-in-cheek, but of course some are sharing bits of it as proof that we need to let 'er rip! missing the point that this is what it looks like to bring some inane views to fruition. The unmistakable tip off that he's satirizing the policies of our day is his final screenshot from the introduction to Architects of Annihilation: Auschwitz and the Logic of Destruction, by Götz Aly and Susanne Heim. 

At the heart of Covid minimisation lies a Social Darwinist assault on medicine. It emanates from the implicit neo-Darwinism lying at the core of neoliberalism, which assumes all societal progress is driven by unfettered market competition. 

Government intervention in the natural competitive order undermines market competition, destroying society by propping up uncompetitive entities that ought to be permitted to be liquidated by natural attrition. We cannot repeat the mistakes of the Soviet block and its unnatural state interference in capitalist competitive marketplaces. A state lead moonshot approach to solving the Covid crisis will see the West suffer a downfall like the Soviet Union. While liquidation of the uncompetitive is painful short term, it will be for the betterment of society in the long run: it is "creative destruction." Costly interventions such as lockdowns, masks, air filtration and next-gen vaccines must be opposed for being violations of Nature. Unnatural interventions put the state in debt while creating immunity debt. It is better to get the creative destruction by the liquidation of the uncompetitive done upfront than suffer such dept-creating interventions that prolong pandemics, thus aggravating suffering long-term. 

Saturday, October 22, 2022

Gonsalves' The Death Eaters

Gregg Gonsalves' article in The Nation explains how Camilo José Vergara's The Pandemic Diary clarified for him, and now us, that there are two pandemics: one lived by the professional class who order groceries online, and another lived by people who can't afford to miss work and aren't able to work from home. He quotes Keeanga-Yamahtta Taylor

If you don't know anyone who has died from the virus, then you may conclude that Covid is not a big deal and that our kids should really be in school. If you know people that have died and been hospitalized, and if the size of your apartment does not allow you to be socially distant from your mother, who lives with you and has Type 2 diabetes, then you may have a different attitude toward sending your child back into a school building. 

Gonsalves points out the problem that our policies "have largely been based on taking the social realities of the well-off as the neutral, default setting." We're throwing the disabled, poor, racialized, and/or otherwise marginalized peoples under a bus. People crafting policy are thinking of their own and finding solutions that would work for their own nearest and dearest instead of using a more inclusive lens to protect the most vulnerable. Gonsalves writes,

Public health is not about trickle-down, with benefits given to those with means and privilege flowing down, eventually, to all--because we know that doesn't happen. To sit back and watch, even to offer data sets and statistical analyses is not enough; this technical aspect of our work may be necessary, but it is not sufficient to lift all of us up.

Absolutely. We need to make sure that the most vulnerable in our society is safe - mask mandates can help do that. 

Thursday, October 20, 2022

Campaigning on Covid

As you might know, if you're a frequent reader here, I'm running for an elected position: school board trustee. It's a little position, so there's no budget or staff. There's also no speeches or debates, just lawn signs and fliers. Campaigning is like an expensive two-month long job interview that requires a daily walking and stairs regimen that goes on for hours. Recently, some well-meaning friends who are trying to help me win (by heeding the noise of the loudest voices) cautioned me to limit any writing or posting about Covid. It turns people off and will cost me votes. I agreed, but then I had second thoughts the following day, and tweeted this:
I've been cautioned not to tweet so much about covid because it could cost me votes. But we're sleepwalking through a crisis that could be averted if we can just open our eyes to it. Hospitalizations and deaths are way higher now than this time in the previous two years.

Wednesday, October 19, 2022

The Breath of Fools

Another thread to save - this time from author Alisa Lynn Valdés. Warning: Lots of swears in this one!

The mechanism of SARS2? Endothelial damage. In plain English? Covid-19 fucks up the lining of your blood vessels. All 60,000 miles of it. Blood vessels lack nerves. You feel okay as it eats your arteries. Doesn't mean it's mild. It means the endothelium isn't innervated. So what happens when the endothelium is damaged? Well, the first thing to go are your capillaries and arterioles. They're the smallest blood vessels. One endothelial cell thick. If the endothelium is damaged, they can disappear, get clogged, leak. This won't show up on X-ray. What happens when your microvessels get fucked up? Microvessels are where all the exchanges that keep you alive take place. Oxygen gets from your lungs to your blood there. Nutrients get from your intestines to your blood there. The bad stuff is filtered out there.  So now imagine that those processes can't happen. Or can't happen like they used to. Your skin starves. Your kidneys get polluted. Your labs look normal. Your brain dies a little. Your eyes go bad. You don't die. Your government tells you you're fine. It was mild!

Saturday, October 15, 2022

The New Wave

Barry Hunt, an engineer in Ontario, explains the difference with this next wave of Covid. Full disclosure, he works at Prescientx in the manufacturing and distribution of respirators, CO2 monitors, etc. to pay the bills. That doesn't change the truth of what he writes: 

I know this wave, Wave 8, seems like the same old same old, but this time it's different. 

We used to have a respite between waves during the summer for people and hospitals to recharge and regroup prior to the fall and winter onslaught. This time we didn't. We used to finish a wave before we started the next one. This time we're starting a new wave on top of the current wave. We used to start a new wave with <1000 daily cases (in Ontario). This time we're starting with 40,000. We used to start a wave with a single dominant variant. This time we have variant soup. We used to be confident our new monoclonal antibodies would be effective against a new dominant variant. This time we aren't. We used to be confident one more vaccine boost would overcome immune evasion. This time we're not. We used to have low hospital occupancy and spare hospital capacity at the start of a wave. This time we don't. 

Thursday, October 13, 2022

77 Things to Hate About Covid

Caroline Dew, an ICU Critical Care nurse in Australia, wrote this thread that I want to save. My only criticism is that it's written in the past tense. You can see from these graphs of hospitalizations that the pandemic hasn't ended. Canada has a bigger population, but it's currently in a worse position than Australia. Sylvia Jones says our health care system isn't in crisis despite the unprecedented closures of hospital emergency wards, and I'm terrified to find out what she thinks a crisis looks like.

Dew's thread is a response to the Australian Herald Sun article "The 77 things we hated about the Covid response." (It's behind a paywall so thick I can't even link to it!):

Sunday, October 9, 2022

On Being a Bad Person

I forgot to post this from last month - my monthly posting at 3 Quarks Daily

A student asked, "How many bad actions does a good person have to do before becoming a bad person?"

The notion of good and bad people raises the image of final judgment at the pearly gates. We have a scale somewhere with our actions added incrementally to one side or the other until there's a tipping point, or sometimes there's just that one unspeakable act that slams one pan to the ground requiring an inconceivable effort to budge it.

It's possible that an infinite number of bad actions doesn't make a person bad. I like to think that we're all greater than the sum of our worst actions. We're all just works in progress doing our best in this world, and it's never too late to change our path. It sounds nice. But then I started to consider some real people who appear to have unlimited selfishness as well as a cold indifference to the suffering they cause to others. Can we call them bad people until we see some movement towards redemption? 

Friday, September 23, 2022

Pandemic vs Endemic

Why Covid is now being called endemic instead of pandemic, and why that's even worse

TL/DR: Endemic means we've plateaued instead of having sudden waves of cases over and over. BUT we're plateauing at a very high rate. It means that it might not go up much, but it also means, without some serious immediate protections in place (mask, vax, and ventilate!), it also won't go down. Our current health care system cannot manage current caseload levels. 

Dr. David Fisman (check out his credentials here!) was on the Re-Sisters a couple days ago. It's an amazing podcast, and Dr. Nili Kaplan-Myrth was also on, so do give it a listen, but I'm just going to focus on Dr. Fisman's explanation of endemic here:

I actually don't disagree with Joe Biden's statement that the pandemic as a pandemic is over. I think if you look at the data in terms of deaths qualitatively, globally, we've been in a very different place for about the last 3-4 months, and I think that's great. You know, pandemics have beginning, middle and end. I think the difficulty is when a president says the pandemic's over. Everybody's eager to be done with this thing and go and time child back to 2019, and I think that's mostly how that's interpreted.


But you can't go back to 2019, and I think that's the difficulty as we now have a highly virulent, highly transmissible virus that infects blood vessels, that's an endemic threat. It's everywhere in the world, and it's infecting people at high, stable levels. So it's not causing these huge, massive waves.  

Wednesday, September 21, 2022

Personal Troubles and Public Issues

"People do not usually define the troubles they endure in terms of historical change and institutional contradiction." Developing a sociological imagination is necessary so that, "By such means the personal uneasiness of individuals is focused upon explicit troubles and the indifference of publics is transformed into involvement with public issues....To understand the changes of many personal milieux we are required to look beyond them."        ~ C. Wright Mills in "The Promise"

"It is no measure of health to be well adjusted to a profoundly sick society"        ~ attributed to Jiddu Krishnamurti in Mark Vonnegut's The Eden Express

There was an excellent op ed on mental health, by Danielle Carr, in the New York Times yesterday. I'm saving pieces here. She looks at how we treat mental illness, and how futile some efforts have been. Many have been led to believe the problem is a matter of access to care, but she goes down a different road.

Are we really in a mental health crisis? A crisis that affects mental health is not the same as a crisis of mental health. To be sure, symptoms of crisis abound. But in order to come up with effective solutions, we first have to ask: a crisis of what?

It's politics. She uses the term "reification" to explain the institutional gaslighting in which political problems are spun as personal problems which conveniently "abracadabras" away any nosy questions about who started it and who benefits from it. 

It's how, for example, the effects of unregulated tech oligopolies become 'social media addiction,' how climate catastrophe caused by corporate greed becomes a 'heat wave'--and, by the way, how the effect of struggles between labor and corporations combines with high energy prices to become 'inflation.'

In medicine, it's called "medicalization," which focuses on an individual's body while ignoring the social system that's often at the root of the problem. Like with the mental health issues arising from Covid. Incidents of depression and anxiety have increased dramatically, but that's not surprising given the circumstances: "feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health." Looking at the data, economic security is the biggest predictor of a mental illness during a crisis: "it's not simply a question of the numbers on your bank statement - although that is a major predictor of outcomes - but of whether you live in a society where the social fabric has been destroyed."

Monday, September 19, 2022

Campaign Video

 I was asked for an "at the door" video of myself. Here it is!

Teachable Moments: Should Schools Teach About Covid?

 I've been talking with parents who are trying desperately to keep their kids safe in the classroom. It sounds like most staff and students are unmasked despite higher Covid numbers in the hospital and higher fatality rates than last year at this time. It doesn't have to be like this.

A big part of the problem is the type of messaging that says something like this: "Please understand and be tolerant of classmates who are still wearing masks." It makes it clear, subversively, that NOT wearing a mask is the normal thing to do. But shouldn't schools be teaching the facts about Covid?? We should expect students to come home educated about what's happening in the world around them as it affects them. When recycling was brought in to our cities, they targeted kids in grades 2-5 to bring the message home to parents, and it worked! In some science classes, people are learning how Corsi-Rosenthal boxes work, but they're still not allowed in our board. But here are some other options for lessons in the classroom to develop an educated populous.

First, kids need to understand a bit about how politics works and why Biden might suggest the pandemic's over despite averaging 500 deaths/day in the U.S. right now, which is more than a 9/11 tragedy every week.

Sunday, September 18, 2022

What To Do If Our Classrooms Aren't Safe

I'm getting these types of questions over and over: What should I do if other students and the teachers won't wear masks? What do I do if my child gets Covid? It's the hardest question to answer because there isn't a clear solution when people in charge are ignoring or oblivious to a harmful virus being allowed full reign in classrooms. Public health strongly encourages wearing a mask in indoor public places, but stops short of mandates, possibly to avoid a backlash from the loudest protesters, some with a menacing presence. We have to be louder.

Here are a few suggestions that might work for some parents and in some schools. I understand the privilege some of these measures require, so if you've got it, use it to help the rest of the class! It's frustrating and discouraging that I don't have a better answer, and I'm sorry for that.