Alasdair Munro Profile picture
Sep 14, 2020 6 tweets 2 min read Read on X
I've almost given up on any balanced discourse about children, #COVID19 and schools, as everyone seems intent on either pretending children are not affected at all, or becoming borderline hysterical over the point

Case study: US daycares

1/6
This study from daycares in Utah has been amplified by high profile figures on twitter as a "big deal"

12 children infected (by staff) with 12 secondary cases, all in their homes, with no mention of transmission in the facility

A "big deal" 🤯

cdc.gov/mmwr/volumes/6…

2/6
That study is 3 days old and has an altmetric score of over 4000

That is insane

12 children with 12 secondary cases in over 3 months

How is this even newsworthy?

3/6
Oh look, another study of daycares in the US (Rhode Island)

In facilities catering for up to 19,000 children, 30 cases in children found

Of 20/29 facilities with cases, there were no secondary infections associated

Altmetric 640 🥱

cdc.gov/mmwr/volumes/6…

4/6
Both of these studies show basically the same thing; children can catch it and transmit, but the rate seems pretty low

The way they've been packaged is different: one is balanced and says, "with careful measures, this seems ok"

The other: "OMG CHILDREN TRANSMIT"

5/6
Children need us to move past this slightly hysterical, polarised way of talking about the risks of schooling, how we can mitigate against them, and how these are weighed up against the harms of lack of education. Particularly where it's become political

We can do better

6/6

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More from @apsmunro

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…
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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…
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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
Jan 8, 2023
It may seem ridiculous this is even necessary, but it actually cuts to the heart of some of the major issues with messaging around mask use

Clearly these persist even today, which is remarkable

1/
fullfact.org/health/5live-m…
Whilst the quality of the evidence around the impact of community mask use is really poor, it’s generally in favour of a modest impact

A *modest* impact

In fact, an impact which is generally imperceptible from statistical noise to the naked eye

2/
Claiming community masking would suddenly be the difference between vulnerable people being safe or unsafe is simply false

Whilst they may modestly impact population levels of infection, they have a negligible impact on any individuals absolute risk

3/
Read 4 tweets
Dec 13, 2022
With everything going on, it can feel difficult for parents to know when to get their poorly child checked out

My most important tip is to check the AMAZING healthier together website (or app)

what0-18.nhs.uk

What follows are some general tips I give parents in ED

1/
Firstly, it’s normal for them to not be normal when poorly - because they’re poorly!

As a reference, remember when you last had a flu like illness and how you felt

That’s probably how they feel! They will behave accordingly

You’re looking for signs out of keeping with this

2/
Fever can make children look extremely unwell

If they perk up when the fever recedes, then they probably looked so unwell because of the fever - not because they have a serious illness

This is a reassuring sign - still looking very unwell when temp normal is more concerning

3/
Read 8 tweets
Dec 4, 2022
Here is a totally uncontroversial thread about immunity to common pathogens as influenced by the pandemic

I will simply state facts

1. Rates of many commonly circulating pathogens almost completely vanished during the first 1 - 2y of the pandemic (eg Group A Strep)

1/ Image
2. The reason these pathogens almost vanished was because transmission was reduced by the measures which were introduced around the world to reduce transmission of #SARSCoV2

This coincidently also reduced transmission of other pathogens, often even more successfully

2/
3. Because these pathogens commonly circulate, there is usually a relatively stable amount of population immunity to them, acquired by infection

4. Vastly reduced rates of infection will therefore result in lower levels of population immunity than prior to the pandemic

3/
Read 4 tweets

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