Conversation

Notices

1. Embed this notice
   Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Sunday, 03-Aug-2025 21:26:25 JST Ian M. Mackay, PhD (he/him)

   • Auscandoc
   • Infoseepage

   @Infoseepage @auscandoc Excessive repetition. Scaling back was smart. We're seeing what we need.

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Sunday, 03-Aug-2025 08:18:35 JST Ian M. Mackay, PhD (he/him)

     Why don't we name and follow the evolution of every influenza virus variant? Or RSV variant? Or measles virus variant? Etc.
     Why are so many studies published investigating *JUST* SARS-CoV-2 & sign/symptom/disease X, when other viruses have yet to get this level of intense attention?

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Sunday, 03-Aug-2025 10:48:41 JST Ian M. Mackay, PhD (he/him)

     • Infoseepage

     @Infoseepage I agree with your point that 'there's a sense that'. I think that sense fails to grasp that we haven't done nearly as much and as diverse a range of highly technical research into these viruses we live with. So our sense could be quite biased into thinking SC2 is the devil, when in fact it's just one of many demons

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Sunday, 03-Aug-2025 19:02:47 JST Ian M. Mackay, PhD (he/him)

     in reply to

     • Auscandoc
     • Infoseepage

     @auscandoc @Infoseepage Sure. Actually a great example of why we need to be comparing new virus findings alongside 'old' viruses to be sure there aren't other changes to our understanding that we're missing by focussing on just one. I'm not implying don't research SARS-CoV-2 btw. I'm stating, be better at checking if that scary feature is actually unique to SC2 or not.

   • Embed this notice
     Auscandoc (auscandoc@med-mastodon.com)'s status on Sunday, 03-Aug-2025 19:02:48 JST Auscandoc

     • Infoseepage

     @Infoseepage @mackayim2022 I would add that the word “variant” wasn’t even in the (public and general medical) lexicon prior to COVID.

     In fact it wasn’t even there in early COVID. I distinctly recall the debate as to whether the UK variant was in fact such or was a founder effect.

     And I also recall an infamous minimizer saying “Variants shmariants”.

   • Embed this notice
     Bryan (they/them) (blackqueeriroh@terra.incognita.net)'s status on Monday, 04-Aug-2025 02:46:42 JST Bryan (they/them)

     in reply to

     • Auscandoc
     • Infoseepage

     @mackayim2022 @Infoseepage @auscandoc what gives you the confidence that we’re seeing what we need or that there isn’t more to see with SC2?

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Monday, 04-Aug-2025 06:32:32 JST Ian M. Mackay, PhD (he/him)

     • Auscandoc
     • Infoseepage
     • Bryan (they/them)

     @Infoseepage @blackqueeriroh @auscandoc What makes you think sequencing efforts are scattershot?
     Sequencing a portion of positives is all that's needed to monitor variant emergence. That detail isn't needed for patient management, is slow, costly and resource intensive. That's being done worldwide at the moment anyway. Not every country, but enough to see emerging variants. Not that we react to new variants other than for vaccine updates.

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Monday, 04-Aug-2025 07:58:53 JST Ian M. Mackay, PhD (he/him)

     • Auscandoc
     • Infoseepage
     • Bryan (they/them)

     @Infoseepage @blackqueeriroh @auscandoc
     Few things.
     🔴Good luck getting that funded.
     🔴MANY places -not just CHN, NLD & DEN- use PCR screening of sick people as an ongoing tool. Its the standard.
     🔴POCT Dx, 'PCR screening' and WGS are three distinct items.
     🔴I agree-more & better tetsing would be fantastic. But I'm realistic. And it shodulnt be limited to H5 or future threats that may never eventuate. We haven't yet got that in place for current viruses..

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Monday, 04-Aug-2025 08:06:42 JST Ian M. Mackay, PhD (he/him)

     in reply to

     • Auscandoc
     • Infoseepage
     • Bryan (they/them)

     @Infoseepage @blackqueeriroh @auscandoc
     ...We still require special investigations when the few frontline tests are negative for a case of special interest to a Doctor. You may not grasp how little laboratory testing regimes are standardised or systematic.

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Monday, 04-Aug-2025 08:06:42 JST Ian M. Mackay, PhD (he/him)

     in reply to

     • Auscandoc
     • Infoseepage
     • Bryan (they/them)

     @Infoseepage @blackqueeriroh @auscandoc
     And as a sidenote, when we introduced RATs, we severely undermined the quality and value of our results. We didn't just introduce "choice" - we empowered diagnostic failure.
     But we learned that quite a lot of people were happy with a poorly sensitive, poor quality, poorly controlled and unreported result. They didn't want to actually know the correct result, just *a* result.

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Monday, 04-Aug-2025 08:16:10 JST Ian M. Mackay, PhD (he/him)

     • Auscandoc
     • Infoseepage
     • Bryan (they/them)

     @Infoseepage @blackqueeriroh @auscandoc
     You also have to look at this in terms of value for the money *provided*. Yes, an unlimited budget would be great.
     I'd like to see that used for much more housing, poverty, mental health services, reducing alcoholism and domestic violence support, well before unnecessary pathology testing.

     Instead, many high-income countries are..

   • Embed this notice
     Auscandoc (auscandoc@med-mastodon.com)'s status on Monday, 04-Aug-2025 23:22:07 JST Auscandoc

     in reply to

     • Infoseepage

     @mackayim2022 @Infoseepage Yes and no. Yes there is a private lab service (LifeLabs just bought out by USA.. so whole other issue there) and hospital/provincial lab services.

     Province relatively tightly controls who can order what type of lab and what is covered by provincial finances. Viral PCR is provincial lab.

     TLDR is that Family Doctors aren’t allowed.

     I can tell you the whole long back story of my fight to have A1c put on the provincial lab form. 🙃

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Monday, 04-Aug-2025 23:22:08 JST Ian M. Mackay, PhD (he/him)

     in reply to

     • Auscandoc
     • Infoseepage

     @auscandoc @Infoseepage Such is life! We have bug private, high-throughput quality (in the sense of adhering to our national quality standards for pathology labs) commercial labs here that GPs sends stuff to via local collection sites. Is that not the case in Canada?

   • Embed this notice
     Ian M. Mackay, PhD (he/him) (mackayim2022@mastodon.social)'s status on Monday, 04-Aug-2025 23:22:09 JST Ian M. Mackay, PhD (he/him)

     in reply to

     • Auscandoc
     • Infoseepage

     @auscandoc @Infoseepage You don't have access to a respiratory panel? Or do you mean you want to tell your patient what variant they have? Heartless I know, but their health doesn't need to know that & there is significant extra cost, time & resources required to provide full genome detail. But no specific treatment.
     Careful pathology stewardship dictates its not cost effective.
     I wish we could get all tests on every patient but over the years have been disabused of that because reality

   • Embed this notice
     Auscandoc (auscandoc@med-mastodon.com)'s status on Monday, 04-Aug-2025 23:22:09 JST Auscandoc

     in reply to

     • Infoseepage

     @mackayim2022 @Infoseepage No we don’t get access to a respiratory panel in community

     Only hospitals.

     I (perhaps naively) believe that it would improve antibiotic stewardship.

     However, disabusing me of that utopian ideal was the recent experience of the patient with a negative rapid strep and a negative culture given two different antibiotics who was seeing me because they were “no better”. 🤦♂️

   • Embed this notice
     Auscandoc (auscandoc@med-mastodon.com)'s status on Monday, 04-Aug-2025 23:22:10 JST Auscandoc

     in reply to

     • Infoseepage

     @mackayim2022 @Infoseepage Not what I feel I need. Nor my patients.

     I’m back to having to say “this is going around”.

     I’d rather be saying “you have this virus” (because the test indicated such).