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:

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. 

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. 

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:

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. . . . 

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 the 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.

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. 

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. 

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 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. 

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. 

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. 

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.

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!

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. 

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!):

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? 

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.  

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."