Dr Satoshi Akima FRACP 『秋間聰』
@ToshiAkima
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Nephrology & Internal Medicine. Immunothrombosis incl DIC. @ISTH Member. No Conflicts of Interest. Views my own etc
Sydney, Australia
Joined September 2012
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Pinned Tweet
A lie oft repeated remains an abject lie. Nobody has ever produced a shred of evidence that a Cochrane review is a universally valid scientific “Gold Standard” applicable to all health outcome measures. Just repeating a lie is not enough.🧵
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1. I am hearing more and more stories of people catching COVID on a plane while wearing an N95 mask. There are numerous reasons for this and we'll go through them to help you avoid getting COVID
I got COVID. While wearing an N95 on a plane.
When I tell people, they respond with some version of, “That’s unfair! You’re more careful than anyone I know!”
And all I can think is, “Yeah. And I’ve been screaming from the rooftops that ‘individual responsibility’ isn’t enough.”
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There is now little doubt that SARS-CoV-2 is neurotrophic. It infects the brain: “neuroinflammation, microhemorrhages, brain hypoxia…including neuron degeneration and apoptosis [is] seen among animals that do not develop severe respiratory disease”
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Italian study shows ventilation can cut school COVID cases by 82% | Reuters
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This is why the Koch Bros got it right in seeing СОVΙD as a practice run for climate change. They’ve won. If you raise the alarm, you are “fearmongering”. The panic causes more harm than good. You’re not even allowed to suggest respirators now.
My friend took this photo. Why - WHY - is anyone sitting around outside in this horrendous air? People have lost all connection to reality and common sense responses to danger.
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4. By getting rid of the mask mandate, airlines are failing to provide a safe environment for their employees and customers. Apparently, turning planes into COVID Petri dishes is “good for business”. The industry solution is to deny it is happening. This enjoys union support🤡
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1. Qualitative fit test report on a surgical mask. Outcome: abject failure. The test failed within 5 seconds of a 7-minute OSHA fit test protocol (3M FT-10). In fact, it failed faster than I could start the timer. A record
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As a clinician, I've seen young patients die of sepsis from atypical organisms with lymphopoenia weeks after acute COVID. I've seen deaths from TB and endocarditis. I've treated multidermatomal shingles. I routinely look out for post-COVID lymphopoenia 🧵
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Large COVID autopsy study finds SARS-CoV-2 all over the human body
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Australia ends daily COVID reporting after deadliest month of the pandemic. The move is the latest stage in a protracted campaign to bury the ongoing coronavirus crisis and fraudulently depict it as a thing of the past
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A 🧵on
@3M
Aura N95/FFP2/FFP3 respirator models. The Aura is the standard go-to high-filtration respirator of the pandemic. It's kept countless healthcare workers safe. It's hard to go wrong with it. If in doubt when choosing a respirator, ditch the earloops and go for an Aura
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1. Now everyone can stop raising their eyebrows when I say that I exercise outdoors wearing an N95 mask. Omicron is a game-changer for transmissibility. BA.5 takes that to the next level. It's dead wrong to assume that outdoor transmission is insignificant
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The unspoken assumption of "living with COVID" is that it is in the economic best interests of the nation to allow the self-regulating forces of competition to liquidate the uncompetitive for the sake of net economic gain. Sacrificing lives to the gods reaps monetary rewards
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5. There is evidence that in such high-risk scenarios, N95 masks alone may be insufficient unless an air filtration system is operational. This means that when one-way masking on a plane, a P100 elastomeric is preferred
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N95 masks and HEPA filters for private schools, while public schools students are fed to the sharks by being told: “COVID is over”. This is class warfare at its purest
#SocialMurder
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12. All this could be avoided if there were mandates for filtration during boarding, taxi and takeoff, coupled with universal mask-wearing by staff and passengers. Two-way masking plus air filtration may mean P100 filters are no longer necessary. Until then, P100 filters stay on
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3. Due to worker absenteeism, there are delays in take-off, which means longer periods with stratospheric CO2 levels. This leads to more crew getting COVID and an increase in take-off delays. It's a vicious cycle
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1. So, where are the threads arguing that almost nobody dies OF cancer? Instead, people die WITH cancer! You can argue it's extremely difficult to die OF cancer if you really determine to minimise it
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People who tested COVID positive had a 3.5 times increased risk of being diagnosed with Alzheimer's disease, 2.6 times with Parkinson's disease, 2.7 times with ischaemic stroke and a 4.8 times increased with intracerebral haemorrhage.
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Breaking! Omicron implicated as the cause of fulminant paediatric hepatitis. “High population burden of Omicron variant (B.1.1.529) is associated with the emergence of severe hepatitis of unknown etiology in children”. By
@nishiura
et al
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The Central Error of the Pandemic…
Is that of running pandemic management by laissez-faire socioeconomic principles.
If you grasp this, all the other errors fall into place as the inevitable consequence of following that line of thought. 🧵 1/x
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Myocarditis: a wee whiff of S1 spike poison from the vaxx is much better than a massive whack of the same poison from the virus.
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A harsh truth: The world economy not only never recovered from C19, the real socioeconomic contagion is just getting started. Because we wanted it to rip, and we get what we wished for—C19 has only just begun.
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2. During boarding, the air filtration system is usually not running. You know how stuffy it can get on board a plane on a hot day, when departure is delayed. Before take-off, the CO2 levels climb to eye-watering levels (it should be less than 700ppm)
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Today, a visitor to the hospital asked why I was wearing a PAPR respirator. “Isn’t СОVΙD-19 over? I saw it in the news.” I replied that we have more people in hospital than at the peak of the Delta wave.
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Onboard for my flight a couple of days ago to visit my father after an unexpected hospital admission. The look on the flight attendant’s face when I said “no meals or drinks for me”
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I wear my respie all day at work and then put one on to go to the gym after work. It's easy to stop the reaping. Just do it.
"You can't wear them [N95s] all day during work"
Prof Peter Collignon
Except I and many others do, and I have not had a single day's illness since the start of the pandemic. I don't see how this dogmatic statement is justified. I. AM. WEARING. ONE. NOW. FERCHRISSAKE.
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10. My first recommendation for P100 elastomerics is the
@DentecSafety
Comfort-Air NxMD (review coming). The GVS Ellipse P100 is popular. The Dräger X-plore 2100 is cost-effective. The 3M 6000 is widely available. The Sundström SR100 has a high pass-rate
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Not me. I'm not catching RSV, C19 or influenza. I wonder why?
Queensland: "Doctors are acquiring RSV, COVID and influenza in the state’s hospitals in rising numbers, sparking the state’s peak medical body to call for urgent action to better protect medics in an already struggling healthcare workforce."
@qldhealth
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The world economy is being kept alive and functional by the
#ZeroCOVID
economics and social policy of the Far East (JP, TW, SG, PRC). Without it, global supply chains and the world economy would just crumble and collapse tomorrow
I think most people don’t realize what would happen to global supply chains if China abandoned its zero COVID policy.
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Unbelievable. Japan with a 3rd shot vaxx rate barely above that of the Bahamas is on the verge of getting their Reff <1 and into exponential decline...just with universal masking/ventilation plus a reasonable double vaxx rate alone
だいぶ下がって来た！
あと少し！
あと少しで実効再生産数が1を切って、急速に感染収束していくフェーズに入る。
皆様、どうか油断せず、早期の感染収束を目指しましょう！
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Please note
@3M
@3MSafety
that black N95s are also an equity and safety issue. Darker-skinned women, in particular, are targeted because they stick out from the crowd wearing white respirators. It's NOT just about fashion! Black Auras will save lives.
Who wants a black
@3M
Aura? More would benefit from excellent protection if this respirator was available in black. We've written to the CEO of 3M to highlight this popular request. Retweet if you want to make safety stylish
@3MHealthCare
@3MSafety
@3MNews
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Unfortunately, history tells us that engineers have been more successful at infectious disease control than any infectious disease expert or microbiologist has ever been. It was how cholera epidemics were brought to an end.
This attitude represents a huge part of the reason most people still believe handwashing is the top way to stop the spread of a deadly airborne virus.
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Happy New Year! Ready or not, 2023 has arrived like a wave. I fear it's going to be a tumultuous and turbulent year in world history🧵
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7. Bottom line: do not wear surgical masks for respiratory virus protection because
#COVIDisAirborne
. They were not designed for this. The reason people aren't test fitted for surgical masks is that we know 100% of subjects will fail 100% of the time
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6. Another part of the problem identified in that paper is that most crew and passengers have not been fit-tested for their N95 masks. Elastomerics have a much higher pass rate on fit testing.
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A reminder that if you purchase 3M products from Amazon, make sure they are BOTH sold AND shipped by Amazon (a 3M authorised seller). NOT from a third party (unless you are CERTAIN they are an authorised seller). Shipped by Amazon is NOT good enough.
I just found out due to this thread that the 3M Aura masks I ordered from Amazon and have been wearing are counterfeit. I have been wearing these in busy hospitals…
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My whole team of junior staff have called in sick this week. I am just about the last one left standing. It's a mystery why.
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I've been quiet for a few days. I wish I could tell you why but my contract includes gag clauses. You prefer not to see me. Take care you don't. N95/KF94 or at least KN95 masks all around because
#COVIDisAirborne
. Get triple vaxxed NOW! Brace hard. This is your captain speaking😥
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The 3M Aura (9322+ P2) N95 mask with expiration valve. Your best choice for outdoor exercise. Another mask review…🧵
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7. You can also do a home qualitative fittest if you really want to make sure you have a proper seal on your elastomeric mask. This thread shows you how to set up a testing system at home
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1. There is now a term for this phenomenon where inflammation drives thrombosis. Pre-COVID, we suspected other infections drove this and that it may even be a microbial clearance mechanism. That term is “immunothrombosis” (or “thromboinflammation”)
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1. A reminder to everyone that earloop respirators are generally not much better than surgical masks. Please upgrade to N95 (or better) and abandon using KN95/KF94 mask (like you gave up bandanas and scarves in 2021)
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Antiviral nose spray that kills 99.9% of viruses begins production in Israel via
@timesofisrael
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Hi, I'm Toshi, and I mask as I'm Anxious we'll become a world in which we don't Care for each other, our vulnerable, my patients, as we deem them expendable. The Anxiety called Care means I break the chains of transmission to protect Others.
Join me in never ceasing to Care.
@RaffyFlynnArt
Hi I'm Dave,
This is what I do to protect myself and those for whom I care. I too wish to suppress infections and reinfections. They should not be inevitable and are definitely not benign 🙏🏻🙏🏻
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The troll/bots are saying NPIs like respirators aren’t needed against an endemic infection. They don't realise that mosquito nets are endemic in malaria zones. Ditto for condoms with HIV. Endemic means NPIs forever. So learn to love it. .
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8. The minimum is a negative pressure test. Cover the filter with both hands and sharp inhale to see if there are leaks. Repeat with head up-down, left-right. See how far you can open your mouth before a leak develops (all masks have their limit)
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1. A full review of the Flo Mask Pro respirator
@flo_mask
. Fully *independent* verdict: it's a winner. A discreet elastomeric you can wear and forget about. It “disappears”, even when worn for extended periods
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If you're wondering why I am quiet. Family health issues. But the hospital has gone berserk. My PCRs are all turning positive. So wear your respirator: protect yourself to protect others. СОVID has only just begun!
1. If you think that COVID is over, then it is a sure sign that COVID has only just begun for you. Because you let down your guard and decided to let it walk over you like a doormat. Not just once, but over and over again. You've been fooled.
#COVIDhasOnlyStarted
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I am a zero HIV zealot, a zero TB zealot, a zero syphilis zealot. And to boot, also a zero COVID zealot. It's a badge I wear with pride. We have the technological capacity to achieve this. As Keynes said: “Anything we can actually do, we can afford”
Zero is an ideal to aim for. Like zero tolerance for sexism/racism, it sadly doesn't mean we actually get to absolute zero overnight. We don't have absolute zero cases of HIV yet. But we don't say “never mind, just learn to live with millions of cases—it's the new normal”
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I've heard colleagues saying they are starting to intubate COVID cases again. BA.5 has the same mutation as Delta that made it pathogenic/nasty while having the immune escape typical of the Omicron line. If you've had Omicron Mark I or II (BA.1 or BA.2), you can get BA.5
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I've had thousands of encounters with SAR-CoV-2+ patients and never caught it once. I wonder why?
#COVIDisAirborne
something…something…?
Their own data:"About '70 to 80pc' of Victorian healthcare workers with COVID-19 caught it at work, Government reveals" Aug 2020👇
We don't need to keep reinventing the wheel. In 2020 HCWs were eventually provided N95s to arrest the nosocomial infections.
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2 COVID experts say they are wearing masks outside when it's crowded as the highly infectious Omicron BA.5 variant spreads via
@thisisinsider
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Not wild but a deliberate attempt to undermine public health. If public health mitigates against the wrong mechanism of spread, it is instantly neutralised. But that precisely was the aim of those who wanted to spread herd immunity faster as a way of ending the pandemic faster.🧵
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Prediction. From the ranks of rapidly emergent novel variants will emerge a catastrophic new wave of mass death on a large scale. It's not a matter of if but when. Act now to save lives. Else start writing more “we could never have predicted this” speeches today
Well, Omicron variant evolution is officially off the chart in terms of number of mutations.
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I recently had a COVID patient laugh at my PAPR respirator as I went in to explain that we are going to have to start dialysis due to COVID induced acute kidney failure (previous normal kidney function, no risk factors). The laughter did not last long
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There has been a lot of talk about microthrombosis (“microclots”) in
#LongCOVID
, along with the usual knee-jerk reactions about anticoagulation. But that may be mistaking effects for causes. A thread
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The GVS N31000 Segre Folded. My new favourite disposable non-elastomeric N99 (FFP3) mask with 99.9% filtration efficiency. A review
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If you look up Google Maps in Japan using the search terms “restaurant CO2 concentration monitor”, you can pick your restaurant based on the availability of real-time indoor CO2 monitor levels. And there are many choices
@jljcolorado
@ToshiAkima
@nikomer75
@Co2Covid
@ToshiAkima
関連してなのですが日本のGoogleマップで「レストラン CO2濃度測定」で検索するとCO2モニターをおいているレストランを検索することができます。どうも日本のGoogleがコロナ対策の情報を整理して検索できるようにしているようです。お試しください :-)
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Stop belittling influenza. If there is one thing the Spanish flu should have taught us and which we need to relearn from our own lived experience, it's that you should never say “just the flu”. It is a serious and often deadly disease. 1/2
@rebelwitacauz
You do know that the flu kills tens of thousands yearly? And that we’ve always advised people to take precautions against it, including vaccinations?
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Our mortality and morbidity meetings are full of cases of young patients dying of sepsis shortly after a COVID infection. Irrespective of what the underlying mechanism is, post-COVID immunosuppression is a phenomenon readily observable to the clinician.
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I've had people mention rising case numbers in Japan and South Korea. But let's really put that rise into perspective. Nations that have early accepted that
#COVIDisAirborne
simply fair better
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Decoding the “immunity debt” propaganda. It means that if there is a surfeit of infection, this can only have resulted from there previously having been insufficient infections. The solution to excess infections is always more infections.🧵
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Paediatric care in Okinawa decimated… As most predicted, the 9th wave is putting children most at risk: … The situation is terrible: … 'Although the number of severely ill paediatric patients, including those with C19, is increasing, the government has announced plans to stop
沖縄の小児医療が壊滅してる……
大方の予想通り第9波は小児が最も危険に晒されている……
酷い状況だ……
『コロナを含む小児の重症患者が増えているものの、医師不足で医療体制が維持できない恐れがあるとして、近日中に小児の夜間救急を止める方針を明らかにした。』
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Word is that “everyone in the White House” (don't ask me how I know) has CОVID. Yet instead of fully protecting him with a respirator, they gave him a crappy mask instead with barely better than zero protection.
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Recommending surgical masks instead of respirators is like recommending cling wrap instead of a condom against HIV. No, you don’t need a RCT to say that.
Surgical masks do NOT block aerosols which leak out the gaps. This has been shown in many publications. It is unacceptable for the
@CDCgov
to continue to spread this misinformation.
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No, I am not wearing a helmet because I am afraid. No, I am not wearing UV-blocking glasses because I am afraid. No, I do not wear sunscreen because I am afraid. No, I do not have brakes on my bike because I am afraid.
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Japan to downgrade COVID-19 from a level 2 to level 5 pathogen (the same level as seasonal influenza) as of spring to unleash restrictions on escalating death rates
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8. Running a fit test on a surgical mask is thus like testing a sieve for water tightness. It's just an absurdity that anyone thought recommending them during a respiratory virus pandemic might be a smart idea. It's not. Get a proper filtering respirator.
#COVIDisAirborne
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The use of RCTs to test non-pharmacological physico-engineering-based preventative physical devices like respirators is virtually unheard of and sets an outrageous and dangerous precedent. 🧵
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I am surprised there are no laws against holding measles, COVID, or chickenpox parties involving minors. Parents are not entitled to expose children to risk. It's no different to failing to use a child safety seat, saying they don't believe in them.
@ELHopkins
We have been contacted by three separate groups of parents who are planning a 'measles party' so their children can catch measles and get 'natural immunity' to it and 'boost their health resistance'. We've obviously recommended MMR but 'they don't trust vaccines'.
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I recently had a patient in their 50s die of multiorgan failure from infective endocarditis from a rare organism the ID physician, nor I had ever heard of before. A bit like an immunocompromised patient. Sure enough, there was lymphopoenia at presentation 3 weeks post-COVID
🧵1/My sister caught Covid when she visited the UK 8 weeks ago. Since returning to Australia she&the kids have had:
-tonsillitis
-Then another virus
-The kids then got hand,foot&mouth
-Now they all have metapneumovirus. Respiratory centres in oz are doing viral swabs for these…
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Breaking! Japanese newspaper
@mainichi
reports that as of November, the Chinese government has BANNED genomic sequencing of new COVID variants. About 250 million people, or about 18% of the population, have been infected in China between December 1–20.
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I agree wholeheartedly with the criticism of the way the Conly Cochrane meta-analysis dismissive of masks has been conducted. But—sorry, team—I need to add some wee quibbles from a philosophy of science perspective. 🧵
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At the heart of COVID minimisation lies a Social Darwinist assault on medicine. It emanates from the implicit neo-Darwinian lying at the core of neoliberalism, which assumes all societal progress is driven by unfettered market competition.🧵
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A little reminder to always buy N95 respirators with head straps. Avoid ones with earloops (unless you've passed a fit test in it— there is an approximately 50% failure rate). There's no such thing as an N95 with earloops
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11. The non plus ultra solution is a
@cleanspacehc
Halo PAPR, here modelled with and without an exhalation filter. But it is rather expensive despite its recent price drop. If you want the first-class option, this is it.
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Bumped into an old colleague, a cardiologist, on ward rounds yesterday—wearing a surgical mask. I was in my Halo PAPR (
@cleanspacehc
). “What's that mask for?” he asks. He nearly copped a lecture. The ACE2 binding of SARS2 makes for a far worse cardiovascular toxin than cigarettes
If you’re an MD that spends time counseling patients to exercise + quit smoking in order to reduce their risk of a heart attack or stroke, and you haven’t yet added “avoid covid” to your ‘cardiovascular risk factors’ counseling speech — you may want to re-evaluate that oversight.
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1. There is only one reason to reduce the isolation period to 5 days. And that is because you want to kill more people, while accelerating spread in the workplace, thus exacerbating worker absenteeism to undermine the economy
If you want to promote spread, you'd use a 5-day isolation plan without rapid tests when the majority of people are still virus culture + and infectious
And continue to promote a deceptive metric that 40% of Americans are in high-risk spread zones, when it's 90%
(links in oped)
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One misconception about Japan's political response to COVID is that it is a lovey-dovey response that's all about caring for the people. Nothing could be further from the truth
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It's good to see the teal 3M 1860S taking off in popularity. It's a nice colour too and a pleasant change from boring white. It has one of the highest fit test pass rates in women among all N95s. Even higher than the Aura.
I wasn't the only one masking at a work event - 3 others in respirators too, including 1 in a teal one just like mine 🙌🏼
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Strokes, heart attacks, sudden deaths: Does America understand the long-term risks of catching COVID?
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This study corroborates human pathological studies that show viral persistence up to 230 days following symptom onset in subjects who had recovered from acute illness. It is not just in animal studies
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This business of passing off SARS-CoV-2 infections as a more socially acceptable case of “just a bit of RSV” or “just the flu” is nothing new. 🧵
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If not my patients, then friends spontaneously ask me why they get unrelenting non-COVID viral infections and UTIs etc they have never previously had soon after a COVID infection. Like other COVID-cautious people who have never had COVID, I do not experience this.
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“We also encourage you to wear a high-quality, well-fitting mask to prevent the spread of respiratory illnesses,” said Walensky. Note, what
@CDCDirector
wears is neither high-quality nor well-fitting. It hasn't even been approved as an N95 by the CDC/NIOSH!
#Fail
⚠️AT LAST—
@CDCgov
finally encourages people to wear masks to help reduce the spread of respiratory illnesses as Covid, flu and RSV expand—hospitals are overloaded. ➡️Ironically
@CDCDirector
says "One need not wait on CDC action in order to put a mask on”!
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I'm the crazy one who does Darth Vader cosplay at work in my PAPR respirator until they come down with severe acute or long COVID. Then I get the same people crawling back to me asking for help and advice. I say: now you see why I say prevention is better than cure. Too late
Commentators online: Don’t worry about Covid! If you’re healthy & vaccinated it’s just a little flu!
Actual people I know: It’s day 14, still testing positive, fever is worse, can barely move, feel like death… [2 months later] still fatigued with brain fog but can jog sorta…
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Mask wearing with shared air may end up being the new normal after COVID, as condom wearing with shared body fluid is the new normal after HIV. There may be no going back. Relax—you'll soon get used to it
#UrgencyOfANewNormal
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Therefore, the single biggest failure during the COVID pandemic has been to achieve consensus over the principle mode of transmission of SARS-CoV-2. The failure to recognise that
#COVIDisAirborne
, and to act on this insight, has cost millions of lives
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1. A review of the 3M VFlex N95 respirator. The 3M Aura fits 65-93% of wearers on formal testing, but if the one-size Aura is too small or big for you, the VFlex comes in a small or large (though 3M calls it “regular/large”) option.
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A little reminder that it's true: mаsks don't work. Only respirators do. Respirators are to COVID, what condoms are to HIV. Washing your hands won't protect you from COVID any more than it will from HIV. Removing your N95 to talk is like removing your condom to have sex.
It's time for me to come out of the closet and declare myself an anti-màsker. Get rid of màsks! Wear respirators instead. Join me, and with our combined strength, we can end this destructive conflict [PAPR respirator hisses].😉 🧵
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SARS-2 could make itself at home in the intestinal mucosa, as it is more “permissive” in immune terms. Other viruses, such as HIV, also use this escape strategy. SARS-2 could persist in the intestine, with the immune system unable to eliminate it.
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France is moving to mandate CO2 monitoring indoors with stipulated maximum tolerable safety levels indoors. Bravo France. The Anglophone world must rapidly follow their example! Because
#COVIDisAirborne
En 🇫🇷 : rappelons que le gouvernement et plusieurs ministères ont maintenant clairement indiqué des taux de CO2 à ne pas dépasser dans les lieux clos. Ce ne sont encore que des recommandations sans plans opérationnels.
Retrouvez tous les textes sur
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@Alan_CtV
When the CO2 hits 5000+ppm and there's an unmasked passenger with a dodgy cough sitting right next to me (a real-life story), you couldn't pay me enough money to swap my P100 for an N99 filter. It's a higher risk scenario than me seeing COVID cases in hospital
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9. Also do a positive pressure test by covering the filters with both hands and exhale. This is demonstrated in this video of the Dräger X-plore 2100. Repeat with head up-down, left-right, plus with mouth a little open as when speaking
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This is a tale of two earloop respirators. The Q100 is from Canada, and its antipodean twin, the AMD T4, harks from Australia. They are almost identical in look, feel, and fit test results.🧵
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4. A report card outlining the test result was issued based on the 3M template for fit testers. If anyone tries to make me remove my Halo PAPR respirator
@cleanspacehc
to swap into a surgical mask, the report will be produced showing the fit test failure
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Business owners in Japan are advertising the fact that they monitor CO2 levels in-store (keeping levels below 1000ppm) to encourage customers to visit their stores. They've even found a way to upload real-time store CO2 levels on Google Maps!
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How mild can smoking be? If my obese/hypertensive/diabetic packet-a-day smoker patient dies of a heart attack, do I write they died “WITH tobacco use” or “OF tobacco use”? The Big Cigarette mildologists wants you to know they died “WITH” it! Because it's just gotta be mild
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If you see non-clinicians decry post-COVID immunosuppression as a “conspiracy theory”, ask yourself why they're the same lot who've spent years pushing mass infection propaganda—herd/hybrid immunity, children-don't-spread-COVID…and now “immunity debt”.
Decoding the “immunity debt” propaganda. It means that if there is a surfeit of infection, this can only have resulted from there previously having been insufficient infections. The solution to excess infections is always more infections.🧵
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