Alasdair Munro Profile picture
Sep 9, 2020 8 tweets 2 min read Read on X
I have the great privilege of working on the Oxford #COVID19 vaccine trials

Safety is the top concern in all vaccine trials, and we go to great lengths to ensure the vaccine is safe to use, and to keep our trial participants safe

Here are some of the ways we do that

1/8
First we have a dedicated phone number our participants can phone 24hrs a day, 365 days a year with ANY medical concerns that gets them straight to a study doctor

We provide advice, direct them to appropriate care, and record ALL symptoms/events in our participants

2/8
All participants have symptom diaries they complete in the period following vaccination

We receive alerts if any serious symptoms are recorded so we can follow up with them, check they're OK, and review if they were related to the vaccine (some mild side effects are normal)

3/8
We conduct frequent face to face reviews with the participants to check their diaries and ask them about anything they may have forgotten to tell us about

If they took paracetamol for a headache, it gets recorded

Antihistamine for sneezing, gets recorded

Everything

4/8
What if something serious happens?

If a patient is hospitalised FOR ANY REASON (fell down the stairs, anaphylaxis to a bee, hernia repair etc) we review ALL the details of the admission and speak directly to the study sponsor within 24hrs

5/8
Some stuff is totally obviously unrelated (e.g. car accident)

For other stuff, we speak to the medical specialists looking after the patient and the study sponsor to discuss any possibility it could be related to the vaccine

The majority of the time, it is *very* unlikely

6/8
If there are concerns it *could* be related, the studies STOP until their dedicated safety monitoring team can collect and review all the relevant information to ensure they are happy the study is safe to continue

These reviews are extremely rigorous

7/8
In a trial with 10's of 1000's of patients, it is common for them to pause for review of medical events which may have happened anyway, regardless of the participant being in the trial

But no one takes chances. Safety comes first, and we work hard to ensure it's safe.

8/8

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More from @apsmunro

Jul 28
Interesting rebuttal here from @VPrasadMDMPH to punches thrown initially by @adamcifu on the new masking RCT

Lots to like in this piece, but I believe Vinay is very wrong about something in a way that is difficult to see

The placebo effect

1/
open.substack.com/pub/sensibleme…
Vinay points correctly to the bias prone endpoint of self reported URTI symptoms and implies the entire difference between groups could be due to “the placebo effect”

The problem is, this is almost
certainly not a result of placebo

It’s detection or ascertainment bias

2/
Vinay describes as much in his piece, when he mentions different interpretations of vague symptoms between people with or without masks depending on their beliefs

Wear a mask and wake up tired? Probably nothing

Not been wearing a mask? Could be the start of something…

3/
Read 6 tweets
Jul 25
Incredible study 🇳🇴

RCT of surgical masks for reducing respiratory infections

Wearing a mask for 14d reduced onset of symptoms of respiratory infection (OR 0.71, 0.58-0.87)

Absolute risk difference of ~3%

What does this mean?

1/🧵
bmj.com/content/386/bm…
First, it shows RCTs of population implementation of interventions like masks is of course possible

In fact it is necessary and important to appropriately determine effect size

2/
Second, it shows surgical masks ARE effective at an individual level in the short term of reducing some respiratory infections

Excellent news - although we cannot delineate between respiratory viruses which may behave differently (long range aerosol vs contact etc)

3/
Read 5 tweets
Jun 10
New study of paxlovid for Post Acute Symptoms of Covid (PASC - also known as "long covid")

It's quite an interesting study actually

Here are my brief thoughts

1/🧵
jamanetwork.com/journals/jamai…
The rationale behind this is that some have postulated PASC could be due to viral persistence - SARS-CoV-2 hanging around when it should have been cleared

Anti-virals might help clear the virus and resolve symptoms

2/
The evidence base behind this theory is far from clear, but given the general mess of evidence in the field this seemed like a reasonable trial

It could also serve as possible therapeutic diagnosis (if it works, it gives evidence towards the possible cause)

3/
Read 9 tweets
Jan 11
A few interesting points of data which help us to evaluate some theories re Covid

1) RSV season is now ending in England with the most "normal" wave since the pandemic

Covid related immune problems causing more severe RSV is in the bin 🗑️

1/
assets.publishing.service.gov.uk/media/659fe802…
Image
2) Covid may be peaking (possibly plateauing) with the LOWEST prevalence (via mass testing survey) in all age groups being in school aged children

Schools being unsafe, children being disproportionately affected or spreaders of Covid is in the bin🗑️

2/
gov.uk/government/sta…
Image
3) Covid infection to hospitalisation rate by far the lowest we've seen during the pandemic

We can totally bin the idea Covid infections become increasingly severe, or of a meaningful increase in severity from current variants 🗑️🗑️🗑️

3/
Read 4 tweets
May 3, 2023
This article about masking and RCTs is extremely confused and appears to totally misunderstand everything about clinical trials

I will put to one side the dreadful title (which presumably the authors didn't choose) and explain some of the most important errors in thinking

1/ Image
First of all, the idea Science "couldn't" produce the answers we needed is false

We are perfectly capable of producing high quality, relevant clinical trials in this area

We just didn't

There are no excuses for this, it's a massive failure

2/ Image
Second, the idea that the RCTs asked questions they couldn't answer is also false

They set out to answer very specific questions, and they provided useful answers to those questions

If those are not the questions you WANT answered, then we need MORE trials to do that

3/ Image
Read 10 tweets
Jan 17, 2023
What's happening with GAS in the UK?

The surge has caused a great deal of anxiety and got a lot of attention

Quick update on the situation following new data and some great new analyses

1/🧵
alasdairmunro.substack.com/p/group-a-stre…
Updated data from UKHSA tells us a few things

Firstly, the data on scarlet fever is now not useful, as it basically just represents awareness

Probably massive overdiagnosis at the peak, no idea where it truly is now

2/
gov.uk/government/pub… Image
The data on invasive GAS (iGAS) is more useful as requires microbiological confirmation

Cases have been very high, but possibly flat or declining - difficult to know due to reporting lag, but this is the feeling on the ground

Case fatality still normal, most deaths >65y

3/ Image
Read 7 tweets

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