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)

Tuesday, November 8, 2022

Sick Kids in Schools

Here's a curious story that happened long ego enough that I think it's finally okay to tell it. 

About 18 years ago I was cautiously pregnant. From the very beginning doctors and midwives kept telling me, "This one might not be viable." Add to that, at 39 I was really old to be having another kid. So, about five months along, I was shipped off to Toronto where they had a fancy machine to do some tests that would see whether or not the pregnancy should continue. They were worried about Edward's Syndrome, which has a 50% fatality rate within a week of birth. For those who make it past that first week, they might make it a few years with constant medical interventions. They'll have a short life full of suffering.   

At five months, you've already felt the baby move, so this was a very difficult day. Even worse, when they tried the test, the fetus was in a bad position. They needed it to roll over, so they gave me a chocolate bar and told me to run up and down the hallway to "wake it up." I had to rouse this tiny being for a test that was going to help me decide whether or not to "terminate" it. Yikes.

Long story short, the best they could do was to give me 50/50 odds, and I gambled and won. My little one is still going strong, except she's very very sick right now. She likely has Covid even though she keeps testing negative. She went to stay with her dad for a couple months, and they don't mask anymore, and there you go. I'm making my peace with that. 

But that's not the funny part. There's more

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. . . .