Cases have been climbing across the sunbelt. Healthcare is getting strained. Some thoughts – including an #optimismspa 1/n
First the increase is real. And while it is not possible to definitively tie it to any particular change or part of reopening that happened over the last couple months, it is stubbornly there 2/n
If haters gonna hate, then viruses gonna transmit given the chance. Duh. Those who have suggested the increases are only due to increased testing are wrong. These are real outbreaks of unknown dimensions. However -now for the optimism 3/n
We are capturing increases in the south earlier in the epidemic curve because in the spring, large outbreaks built up in the NE before any distancing happened, and they were concentrated in younger age groups. They were not detected because of current testing criteria 4/n
These then led to outbreaks in more vulnerable cohorts. It was disease and death in *those* groups that showed the scale of the problem. The doubling times across the South have been slower. That makes sense – contact rates are different 5/n
You can’t avoid an outbreak entirely without trying, but the outbreak will be different. It is slower. Some people including me even thought it might be 6/n
That means a window for action. Changes in multiple states over the last couple days are really welcome. But while they may take the foot off of the pandemic gas, we should be prepared to use the brake as well 7/n
(and if you are one of those people who seem to have decided it's inevitable, i *do* hope you checked with your constituents in advance that a certain amount of disease was acceptable) 8/n
If I had my way, we would have handled this very differently. Given that we are where we are, all we can do is work to stop it being worse. Hands to the pumps etc. Long road ahead 9-out

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More from @BillHanage

Jun 3, 2023
There is a super interesting quote from John Edmunds in this article on the brewing row over the UK’s Covid inquiry and it’s relevant way beyond that country. It concerns the use of scientific advice by politicians 1/n theguardian.com/business/2023/…
To start with I have to say “follow the science” has always been a slogan rather than a policy. Follow it where? That depends on what we want to achieve. Provided the goal is clear, then scientists can say whether a policy will likely help or hinder. And there’s more to it… 2/n
Even if the goal is unclear, you can still ask scientists what they think the likely consequences of a policy would be. And so this quote is key 3/n Image
Read 7 tweets
Apr 3, 2023
Finally returning to this, long after it has been digested by the twitterati. As someone who has worked on molecular epi, transmission, (meta)genomes etc it seems to me that the great majority of the commentary has spectacularly missed the point 1/n
This is not direct evidence of animals (raccoon dogs prominent among them, although far from the only possibility) being infected, but it is *exactly* what we would expect to find if they were 2/n
Had virus *only* been found in samples with human genetic material, it would be different. Even that would not allow us to rule out animals being infected too, just not among the samples collected. But we would not have evidence they *had* been exposed/infected 3/n
Read 11 tweets
Mar 10, 2023
This is a very interesting article, featuring a quote from yours truly about how many lives *could* have been lost in the US due to the pandemic before vaccines. This is my reasoning 1/n
washingtonpost.com/health/2023/03…
This figure from Jones et al JAMA 2021 shows estimates of how many Americans were infected by the time vaccines were available (the dotted line). As you can see, it is a little more than 10%. Maybe 13%. These are estimates from 1443519 blood donations collected over this time 2/n
In the spring of 2020, some people who really ought to know better had compared the threat of covid to the threat of flu. By dec 14th 2020, more than 300 thousand Americans had already lost their lives to this virus that only got a name in February 3/n
Read 10 tweets
Oct 27, 2022
When the local wastewater numbers go up, people often pay attention and get anxious - so worth noting that they just dropped *a lot*. What does that mean, and what's with this plateau since the summer? 1/n
first a little caution - as you can see these numbers can fluctuate quite a lot, and so the next sample might be up again. But that doesn't explain the plateau, and the fact we see similar in the south system makes me take it more seriously 2/n
In fact, this sort of pattern should not be considered very surprising at the moment. After all, the point when the virus was equally able to infect all of us is far in the past. Now there is a patchwork of immunity in the population, which makes it harder 3/n
Read 15 tweets
Aug 27, 2022
If you think mask use has insignificant benefits and is unjustified under all circumstances, you are wrong.

If you think that changing levels of immunity and available therapies don’t change the benefits of masks, you’re also wrong
If you choose to not wear a mask when asked to, I disagree strongly. It’s polite and kind to do so

Likewise masks can and should be used to mitigate transmission in high risk environments like healthcare
All masks are not alike. A fact which delights those who seek to weaponise them for political gain because they can always default to whichever most helps their point and riles up their base (compare - all masks are good, some masks are good, no masks are good)
Read 5 tweets
Aug 22, 2022
New paper in @JIDJournal from a great collaboration with @kar_jacobson among others (HT @SundermannAJ for putting it on my radar!)

Will attempt to summarize key points...

academic.oup.com/jid/advance-ar…
Genomic epidemiology is a wonderful new tool in our kit for detecting cases of transmission - but we always need to consider whether two independent cases might have very similar or even identical genomes by chance
this problem is especially acute early in outbreaks, when there has been insufficient time for the pathogen population to accumulate diversity, such that independent transmission chains are readily distinguished
Read 6 tweets

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