Thread by @adamhamdy

1. Over the past few months I've worked and corresponded with researchers, human coronavirus (HCoV) specialists, medics, epidemiologists and scientists around the world, trying to understand the challenge we face in #COVID19

2. It's frustrating to see myths perpetuated not only by ill-informed commentators and politicians, but also by other scientists. In February I was asked to prepare a paper on the risks of COVID-19 by a former Cabinet Minister.

3. I sent drafts of that paper to a number of scientists, some of whom I knew from a previous career in medical consulting, others who were simply kind enough to respond to a request to review. One prominent medic replied saying he strongly disagreed with my recommendations.

4. I'd suggested a 4-week preemptive shutdown of airports, schools and high risk workplaces in order to tool up for a test, trace, isolate response. The professor (who I'm not going to name) said my recommendation would result in a 50% reduction in GDP over those 4 weeks.

5. As such it was too expensive to justify given the risks of catching #SARSCoV2 🤔

A 4-week shutdown with a largely healthy population in order to tool up for testing looks pretty cheap in comparison with what we now face.

6. Another professor at the Pasteur Institute in Paris rejected the suggestion #SARSCoV2 might persist in privileged immune sites. He said it's impossible for a virus to perist in the presence of neutralising antibodies. Completely untrue, but he's a professor, so he must know...

7. Persistence of HCoVs in the presence of Abs is established science. Dr Marc Desforges and his team have done extensive work on HCoV persistence in the central nervous system. This is a good review of what they've found: ncbi.nlm.nih.gov/pubmed/31861926

8. Other medics and academics were highly supportive of my analysis & recommendations, which went to Matt Hancock. They formed the basis of this post. freemarketconservatives.org/the-government…

9. It's also disappointing to see the biggest public health and economic challenge of our lifetimes being turned into a political football. Perhaps most sad is the situation with children and schools.

10. @cyclingkev, @MaryBoustedNEU & others are rightly questioning the government on its scientific advice. The emergence of Pims-TS, a paediatric inflammatory sydrome that seems to be linked to SARS-CoV-2 infection should concern us all. thelancet.com/journals/lance…

11. The government's response has been to downplay the risk. Both these statements cannot simultaneously be true:

A) Children do not transmit the virus effectively (suggesting a low rate of infection among children)

B) Pims-TS is a rare complication.

12. Either children are efficient transmitters of SARS-CoV-2 and Pims-TS is rare, or children are not efficient transmitters and Pims-TS is a worryingly frequent complication. It is not the job of unions or teachers to prove or disprove risk. It is up to the government.

13. As our understanding increases, it seems children are just as likely to be infected as adults. Per this study of the infection rate in Geneva; "No differences in seroprevalence between children and middle age adults are observed."

medrxiv.org/content/10.110…

14. Rather than the usual political bunfights based on vague statements and ambitions, we need to be using facts and figures to guide policy. The government needs to articulate specific risk. What does it believe the infection frequency is among children?

15. How many children per 100,000 does the government expect will suffer Pims-TS complications? Once it has given specific numbers, backed by scientific evidence, parents, teachers (and the government itself) can make a proper assessment of how to move forward.

16. We now live in a world in which we all need to understand risk. If you think risk=likelihood, you might want to talk to an insurance underwriter. Put simply, risk= likelihood x severity. If the likelihood is low, but the consequence very severe, the risk can still be high.

17. The overall risk of dying from #COVIDー19 is low, but it's a pretty severe outcome. And many of us know people who've survived infection but have experienced prolonged recovery and relapses. Less severe, but still unpleasant consequences.

nytimes.com/2020/05/10/wor…

18. Some (perhaps many) will adapt their behaviour in light of their perception of risk. Is the benefit of my proposed activity worth the risk?

Others will adapt their behaviour in light of the friction caused by infection controls.

https://twitter.com/laurelchor/status/1260784481159442434?s=20

19. There is unlikely to be a V-shaped economic recovery while a significant proportion of the population exercises the right to take precautions in relation to health. Instead of peddling the myth that we can go back to the way things were...

20. ...governments need to help define what the new normal looks like. Yesterday, Angela Merkel said #COVIDー19 is likely to be with us for some time.

dw.com/en/coronavirus…

21. The @WHO made a similar statement yesterday. People are being lulled into a false sense of security by talk of vaccines and cures. Even at their quickest, these things take time.
cnbc.com/2020/04/22/wor…

22. And anyone who is an expert in HCoVs will freely admit there is much we don't know about them, and about SARS-CoV-2 in particular. We still don't understand immunity. This recent study found symptomatic reactivations in patients with antibodies.
medrxiv.org/content/10.110…

23. I'm an optimist and I believe we will ultimately overcome this challenge, but we won't do it with Punch & Judy politics, false hope & vague assumptions. Science is the only way through this crisis. Science that informs good clinical practice & public health response.

24. Science that's underpinned by evidence. This isn't a time for propaganda, bluster or unfounded beliefs. We need to put aside our political, social & religious differences and adopt a scientific approach. This means using high quality evidence to reach conclusions.

25. It also means being willing to admit our knowledge has limitations and that we need time to develop a better understanding. We need to kick the now, now, now habit. That world is gone.

26. It may be scary and it might not be convenient, but the alternative is to accept a much higher rate of ill health and mortality than any of us have been used to, and, frankly, I don't see us having a fully functional economy until the vast majority of people feel safe.

27. Poking holes in an epidemiological model, or sharing a skeptical hot take by a ill-informed commentator isn't going to change the reality that confronts us all.

28. We need to remember the precautionary principle of public health and give scientists and medics time to get a better understanding of what we're up against before carelessly opening up and putting lives and livelihoods at risk.