Infection is disease. That thought has been continuing to emerge in my mind as I watch the attempts by the…

Infection is disease. That thought has been continuing to emerge in my mind as I watch the attempts by the smart few to stop mass infections. We need to understand that infection is bad, because the way the mass infection crowd get away with what they’re doing is by…/1 #COVID19

…appealing to lived experience of everyday infection, of everyday people. The colds and flus we all grew up with. (Back to them in a moment.) One thing I think needs saying is that the past century has been hugely skewed in our history of infectious disease. Antibiotics. /2

Prior to antibiotics, cut your hand in the garden, and you could be dead within a week. Everyday cuts and scratches could kill you. We were more intrinsically aware of and wary of infection. Vaccination preceded antibiotics, but together they transformed how we experience…/3

…and think about infectious disease. They illustrate an ongoing truth, that pharmaceuticals save lives, but also dull our senses. They encourage a set-and-forget mindset. As we also see in warfare, with constantly failed dreams of *the* ultimate weapon to end conflict. /4

Infectious disease is an ecological phenomenon, much more than it’s a medical phenomenon. Medicine is one ecological input to the ecosystems of microbes, of which disease pathogens and ourselves are parts. Antibiotic resistance and vaccine waning clear examples of how…/5

…the dance never ends. With that in mind, Paul Ewald’s work has always fascinated me. There are two aspects to it that are better-known, firstly his hypotheses on modulation of virulence using public health measures, based on a particular hypothesis from evolutionary theory. /6

I won’t explore that one here, evolutionary theory is a bit of a battle ground. Though I will say (having studied evolutionary theory in depth) that the idea it means ‘mutations occur randomly, and those that are most fit survive’, which passes for accepted wisdom, is…/7

…historically inaccurate, when you actually read Darwin (which few still do). It’s more a product of the modern synthesis, and has become a type of scientific slogan, a highly simplified caricature of what Darwin discovered and discussed. Upshot being, I think evolutionary…/8

…explanations have a lot more intrinsic power that can’t be tapped while we remain fixated on these caricatures of Darwin’s thought. But to get back to Ewald’s other line of thought that seems massively pertinent today, on *chronic infection*. Ewald feels, and I agree, that…/9

…our assumptions and thinking about infection are mired in our experience of acute infection. The infections that resolve themselves, or via vaccination and antibiotics. (Or *seem* to resolve, Ewald’s critical point.) Perhaps most of us now have come to think of infection…/10

…as a temporary, resolvable bump in life’s road. A medicinal view of infection. Ewald suggests that infections, even those we think of as acute, may in fact be chronic, and persist for years, if not our entire lives. We are aware of some chronic infections, HIV-1, measles…/11

…varicella-zoster, etc. But Ewald suggests many of our chronic ailments, such as cardiovascular disease, may in fact be the result of chronic infection. (Just recently we saw an example of this with MS: https://t.co/McZNiUtM2o) /12

This can be both ongoing presence of the infectious pathogen in our bodies, and/or the ongoing damage caused by earlier infection. In both cases infection is a possibly permanent shift to the ecological balance between ourselves and our surroundings. (Noting that…/13

…infection also plays a positive role in evolution, in driving biological change.). Just some of the research on possibly infectious causation of atherosclerosis here: https://t.co/t7RPJKpb3n /14

The important overall point is, take infection seriously. As those who study Long Covid know, infection with Covid may have lasting, even lifelong morbidity and mortality impacts. The deliberate mass infection of entire populations currently underway fails even basic…/15

…risk management process. Infection is not the inconvenience of a cold, we don’t even know for sure that those handful of regular infections we’ve all suffered are only acute, without chronic long-term effects. Recognising that our bodies fight infection using our immune…/16

…systems isn’t a reason to welcome infection itself. It’s like saying we have guns to defend ourselves, so let’s all start shooting. The past century is unique in human history, as above, because it’s the first time we’ve thought of infection as a minor, temporary thing. /17

In evolutionary time scales, and even in the timescales of human history, infection plays out across generations, even centuries and millennia. We’re still fighting TB, malaria and polio. Early victories have to be revisited, time and again. /18

Just to finish, recent hypotheses of the causal role of influenza infection with heart disease, and how flu vaccinations can possibly mitigate against that. ‘Just like the flu’ never seemed a dumber thing to say. /end https://t.co/iNVAoSqmCA