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Wes Pegden Profile picture
@WesPegden
Sep 17, 2020 • 8 tweets • 3 min read • Read on X
In our paper w/ @ChikinaLab we
1) account for preferential mixing in age groups
2) do not require perfect isolation of at risk groups
3) do not assume that we can "turn off transmission" (indeed, we assume transmission gradually reverts to normal levels)1/
Joel is also concerned that aged-care facilities could support an epidemic (not localized outbreaks at individual centers) on their own without any involvement of younger individuals (staff/doctors/etc). 2/8

An earlier discussion on this ended abruptly:
I think its fair to say this is an unusual viewpoint.

Threads like this which dismiss age-targeted strategies out of hand inevitably work with the most simplistic and absolutist version of an idea. I have not seen an argument that we cannot have a quantitative... 3/8
effect on relative transmission rates for different age groups (and yes I have given examples of how one can start to go about this👇, but there has also been not enough effort to generate these ideas because we think they are too dangerous!). 4/8

To be honest I found threads like this more compelling in March. Having seen what happened in places like FL, it should be clear that for every week we could have preferentially advanced the increase in social activity among younger people (even it was accompanied by a..
smaller timeshift in older transmission levels, since nothing is perfect!) we would have reduced mortality and morbidity substantially.

Note also that after younger groups peaked, their cases among much older individuals have also declined, and do not appear self-sustaining. 6/8 Image
In any location that will have an immunity-controlled epidemic, that epidemic will be be driven and ultimately controlled by high-contact low-risk groups.

Betting against the benefits of age-targeting is a bet that you will not have a large epidemic. 7/8

A few places have made this bet and won.

Many more have made this bet and lost.

And now we're going all in on the same bet, hoping we've suddenly been dealt a completely different hand. 8/8

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More from @WesPegden

Wes Pegden Profile picture
Sep 15, 2022
Our statistical re-analysis of the Bangladesh mask trial data with @ChikinaLab and @beenwrekt has been published in Trials (@MedicalEvidence).

1/4
trialsjournal.biomedcentral.com/articles/10.11…
The Bangladesh trial was a big lift and to date the only cluster randomized trial of masks to generate any publicly available data. Another pre-registered trial in Bangladesh by the same authors was suspended, and a pre-registered trial in Guinnea-Bissau never reported.
2/4
This unfortunately leaves us reading the tea leaves in this one completed study.

This paper is our read of the tea leaves.
3/4
Read 4 tweets
Wes Pegden Profile picture
May 16, 2022
The most pressing questions about the COVID pandemic don't come in the form "can X happen?".

I was surprised at how little quantitative information this article contains, especially when we actually do have high quality data on reinfections.

1/
The ONS survey tracks reinfections through surveillance testing among its random sample of participants. Even though the recent Omicron waves, the observed reinfection rate has been 1 per thousand or so days.

2/
ons.gov.uk/peoplepopulati… Image
These rates are no guarantee of the future, but science journalism should present the best data have, rather than relying on anecdotes.

In lieu of data like this, the article instead leans heavily on the feelings shared by expert commentators (every one of whom is on Twitter).3/
Read 8 tweets
Wes Pegden Profile picture
Feb 4, 2022
As a growing number of people criticize continued restrictions on children and young people, the responses hurdled back are not defenses of still concealing faces from weeks-old infants or making 6 year olds eat lunch silently and wear masks while they learn to read, but this:
1/
Some are pure-style assertions that "these people are bad, dying is bad, COVID is not over, I am on the other team".

Others have gone full-blown connect-the-dots conspiracy, trying to uncover the mystery of why people care about young people's day-to-day experiences.
2/6
What I have not seen from many in the past months is a full-throated defense of the specific policies that children (and babies) are being been subjected to.

Who's for it!? Anyone? Or are we all against it, but sure that some of us are bad people against it in the wrong way?
3/6
Read 9 tweets
Wes Pegden Profile picture
Feb 3, 2022
The pre-registration for the next phase of the Bangladesh mask trial (@Jabaluck etc) has been posted.

The good: it will probe a bias-resistant endpoint that should be much less dependent on subjective survey responses.

Two important criticisms follow:1/8
clinicaltrials.gov/ct2/show/NCT05…
1) The new phase of the trial still doesn't have any placebo intervention (like, say, education only).

One of the things our re-analysis of their previous study showed is that staff and participants were subject to big differences in study behavior.
2/8
 arxiv.org/abs/2112.01296
The study found much larger effects on physical distancing than on COVID; in general, it seems likely that intervention villages are considerably more "COVID aware".

If we really care whether masks are actually helping, comparing, masks+education to education would make sense!
/
Read 8 tweets
Wes Pegden Profile picture
Feb 1, 2022
In the pandemic's 1st year, failing to focus resources and attention on the oldest+most vulnerable in society meant young people faced excessive restrictions that were senseless from a public health perspective.

In the 2nd year, it meant inordinate levels of preventable death.
Commentators on here spend a lot of time talking about low-stakes controversial policies whose only merit is that they scratch a political itch.

Meanwhile the actual failure to vax and boost the oldest (and even LTC) populations goes largely unmentioned, except by "contrarians".
From the CDC:
cdc.gov/nhsn/covid19/l…

Vaccination rate among LTC residents: 87%
Booster rate *among vaccinated* LTC residents: leveling off at 67%

42% of LTC residents have fewer than 3 doses.

Look at the coverage maps.

A lot of "COVID-focused" states have <75% booster rates. ImageImageImageImage
Read 7 tweets
Wes Pegden Profile picture
Feb 1, 2022
This article is remarkable.

As it discusses, the trials for a 2 dose vaccine in 6 mos-5 year olds failed. But now the FDA seems keen to just grant emergency use authorization anyways, while data from trials of a 3-dose regimen are still a ways out.

1/
washingtonpost.com/nation/2022/01…
The next thing to watch for will be mandates for under 5's, for a vaccine under emergency use authorization in a low risk population whose only trial failed.

Meanwhile the US has some of the lowest vaccination and booster rates among the most vulnerable populations.

2/
I think it's a mistake to miss the connection between these.

We have confused people about risk, needlessly politicized our response, and tried to distract from crucial policy failures among high risk groups with policies aimed at children and young people.

3/
Read 4 tweets

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