My longish thread on the Academy of Medical Science News Briefing with Sir Patrick Vallance and Prof Chris Whitty last night, and the London School of Hygiene and Tropical Medicine Global Health Lab chaired by Richard Horton and Prof Martin McKee. panopto.lshtm.ac.uk/Panopto/Pages/… (1)
The News briefing. Medics/scientists are used to robust debate. It should not descend into personal abuse. For example, I’m happy to be told I’m ‘utterly wrong’ and to debate about strategies. Debate is the essence of evaluation and finding a way forward. But no abuse.(2)
Chris Whitty and Patrick Vallance have an unenviable job, as do the 20 or so members of the SAGE (Scientific Advisory Group of Experts). They welcome debate and robust argument. They face extremely complex issues and difficult decisions. We must help them (3)
#COVID is a new virus which we still don’t understand well. We’re in a global pandemic and we don’t know its impact over the longer term. Even though China has damped down the epidemic they will have the challenge of how to protect non-immune people in future (4)
Chris Whitty made the important point that population testing, contact tracing and quarantine play an important role at the beginning and end of an epidemic, but are less valuable during peak transmission. (5)
Measuring the population immune response is critical for understanding how many people had the infection without symptoms, and the nature of that response. New tests are now available which we hope will be sensitive and specific. (6)
Younger people can become seriously ill after contracting COVID-19 although the risk is small. (7)
LSHTM online discussion chaired by Richard Horton and Martin McKee. Three speakers: David Heymann (DH): leader of the teams in Sudan and Congo that discovered the Ebola virus, advisor to WHO and UK government, one of the best epidemic experts in the world. (8)
Hayley McGregor (HM): medical doctor with Cambridge PhD in social anthropology. Adam Kucharski (AK): leader of the London School of Hygiene modelling team + author of ’The Rules of Contagion’. I acknowledge using some of his slides because they're beautifully illustrative (9)
Testing, contact tracing and quarantine is more successful with lower transmissibility of the virus and if clear symptoms emerge early in the infection. COVID is on the cusp, easier than flu and HIV, not as easy as smallpox or SARs. (10) 
This slide shows the current transmission dynamics across countries. Countries below the dotted line at R0=1 are controlling the epidemic for now. (11)
The Asian countries achieved rapid falls in infections. They epidemic more effectively than western countries w massive testing, contact, tracing quarantine (Korea is up to 40,000 tests per day. And strict social distancing. (12)
Here is the Singapore data (13)
Here is Hong Kong (14)
In Wuhan they had a huge crisis so they introduced a complete lockdown. This slide shows the effect. (15)
Even Italy is showing a gradual decline in the transmissibility but with much higher casualties, now more deaths than China(16)
The big question is how Asian countries will manage the future if their population remain non-immune. (New immune tests should reveal the scale or otherwise of asymptomatic infection) But they have a system in place to monitor outbreaks whereas Western states do not yet.(17)
Adam emphasised control will need to be in place in the longer term with possible intermittent lockdowns to keep outbreaks under control. My view is that large scale testing, tracing and quarantine systems will keep those outbreaks more quickly in check (18)
Adam Kucharski summarised some scenarios (19)
The importance of community participation+ empowerment was emphasised by DH. Fundamental to success in Ebola epidemics, in Singapore with COVID, in provinces outside Wuhan in China. Telling people what to do is not enough. The UK must build community engagement. (20)
Communication is important and difficult. We all make mistakes in communicating science. The consensus view was that introducing the idea of herd immunity had been an error because that was never the aim of the modellers or SAGE. (21)
Hayley felt that SAGE is insufficiently multidisciplinary: it needed more involvement of social science and community mobilisation, not just behavioural science, and to understand the political context of decisions.(21)
David Heymann is pessimistic that a vaccine will be ready for global roll-out in 18 months. We must find a good vaccine, test it for safety and efficacy, and produce enough to vaccinate the world. This could take more time than 18 months. (22)
Closure of public transport? Brief contact is much less significant than household contact. But DH pointed to 'super-spreaders' and explosive outbreaks in church communities +ski lodges. So we must be cautious on transport to maintain social distance if possible. (23)
We’re playing for time. Let us hope the immune testing shows more widespread immunity, that drug trials produce effective treatments for the sickest, and that voluntary social distancing strategies are able to flatten the peak of the epidemic to stop NHS overload. (24)
