Thread by @chrischirp

THREAD: I keep being asked when we can go "back to normal" or "like it was before". My personal thoughts:

We've added a new disease to our population, more infectious and more severe than flu.

The world pre 2020 no longer exists - we may want it to, but it just doesn't. 1/13

Vaccines are amazing but do wane - esp vs sympomatic infection. Immunity from infection wanes too.

Surely Omicron has proven that high levels of antibodies in your population are no guarantee against v high levels of illness & disruption. 2/13

We *could* act as we used to & accept millions of people getting sick once or twice a year. Yearly education, business disruption. And gradually, a slightly sicker pop'n. That seems to be the current plan in UK and e.g. US.

But that's NOT the *old normal* - it's worse 3/13

We *can't* go back - but we *can* go forward *if* we accept we need some adaptations - driven by what we have *learned*.

Learning:

1. Outdoors is pretty safe - so let's invest research and funding into making indoor air as much like the outdoors as possible 4/13

It's *not* easy, but it *is* possible - we did it with clean water, electricity infrastructure, CFCs, telephone and broadband...

The best thing about cleaner indoor air is it works against *any* airborne disease and also reduces e.g. allergies. 5/13

2. Vaccinate the world as soon as possible - and keep working towards vaccines that are longer lasting and more variant proof.

3. Invest in global infrastructure to support surveillance of new variants of Covid *and* other new infectious diseases. There will be more. 6/13

4. Add permanent surveillance of Covid infection rates in UK to existing programmes for flu, measles etc in public health

5. Invest in understanding & treating longer term clinical impacts of Covid, inc organ damage & Long Covid + treatments (eg antivirals) for acute phase. 7/13

6. We need to urgently increase funding and staffing for NHS if it is expected to cope with regular Covid surges *and* existing backlogs *and* years of understaffing and not enough money.

This includes *supporting* existing staff to stay..! 8/13

7. There *will* still be future surges. We need to have a plan to deal with these surges - as we do for other diseases.

A plan which is supported by the rapid outbreak identification & rapid understanding of virulence & transmission we've learned to do so well in the UK! 9/13

The plan might include (temp) reintroduction of large scale testing (inc better tests?), high quality masks in indoor spaces and - *if & only if* there is a serious threat from e.g. a new variant (or disease!) - further measures, such as targeted test, trace & isolate.

10/13

A plan should *not* mean long national lockdowns, which represent a failure of public health systems.

In fact, refusing to do the *learning* in "learning to live with Covid" is the biggest risk for such future lockdowns. 11/13

8. We also need to invest massively in reducing inequalities: in health, in housing, in workplaces, in sick pay, in education - this will make us more resilient to future outbreaks and reduce ill health and death - from Covid & everything else!

Both nationally & globally 12/13

Fundamentally, world is different now. Acting as if it isn't, which UK seems determined to do, may feel good in short term but will result in a new normal worse than the old one.

I prefer for us to build a new normal that's *better* than frequent sickness & disruption. 13/13