Thread by @jadenozzz

NOW - Science and Technology Committee @CommonsSTC: UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks...

https://twitter.com/jadenozzz/status/1305265291216257026

Witnesses: @carlheneghan, Professor of Evidence-Based Medicine & Director, @CebmOxford, University of Oxford;

Dr Thomas Waite, Director,Joint Biosecurity Centre;

Professor Sylvia Richardson, Director, MRC Biostatistics Unit, Cambridge Institute of Public Health

Prof Richardson: increase is being seen in infections, but must be interpreted with caution because of sampling characteristics (i.e. selection of those coming forward for testing). ONS and REACT studies may have less bias, but also have smaller sample sizes

Chair asks about changing fatality rates since March

Dr Waite: deaths & hospitalisations are lagged data (wait two weeks etc). We wouldn't expect to see an uptick based on the people we're seeing getting infected at the moment

Heneghan: increase in detected cases on Sept 2nd. Right around bank holiday (he means delay processing tests), and right after Eat Out to help Out (may have increased cases). Then, in Sept, 50% increase in consultations for acute respiratory infection...

... This is highly predictable for going back to school, back to work, etc. Many people are coming forward fr medical care with COVID alongside other respiratory pathogens.

Heneghan on Oldham: no matter what we've done, cases (have remained about the same). If you go into acute care numbers, we're not seeing its impact in hospitals and deaths. A slight increase, but nothing like what we saw in March and April

... we have to question what Govt's strategy is.. are we accepting that the virus is endemic, and will circulate freely between young people in the summer

We also have to be mindful not to push the disease into the winter, when immunity etc is poorer...

Between now and xmas we will see a 4x increase in general practice attendance in a good year, 8x in an epidemic year. We will see a 50% increase in deaths until January. This is important context.

Heneghan: exponential rise is incorrect - we're seeing a linear increase in line with other respiratory pathogens for this time of year

Also - role of increasing testing in hotspot areas - leading to the view that 'it's going up', but actually it's just 'picking up what's there'

Chair asks about govt assessment of 30,000 cases a day (about 10x the number testing positive a day)

Waite: models are useful, but that 'doesn't sound right today'

He also confirms CMO did not say about 2 week lockdown

Q about Bolton: is it likely nearby areas have similar rates, just not being picked up?

Heneghan: infections and epidemics, 400 per 100,000 consulting constitutes an epidemic, and that's symptomatic people...

... When we talk about 200/250, you're still in the ballpark of a seasonal virus. And you also need to know how many have symptoms... we need the data so that we can say more than just 'it's going up', and then panic

Chair asks whether the figures (graphs) being used to show daily cases to look as if they're going back up to the April level is misleading, as there's no context (lack of testing at the peak means peak was hugely underestimated)

Waite agrees context is essential.

Q asks about transparency without context - Manchester evening news panics people with big red lines going up, is this right?

Waite: as much data presented together as possible is best. Need to also specify who's being tested and why

Heneghan: shift in debate from protect NHS to cases. People in Bolton will want to know what the impact is on healthcare. Need a clinical definition of cases. If we're going to react and have restrictive measures, this has to be based on the impact of the disease (i.e. not cases)

Q about tripling of France hospitalisations?

Heneghan: data in France and Spain starting to flatline, not exponential. Testing through description in France, and private incentivising hospital beds (could be benefical esp for elderly, i.e. we may want more having treatment)

... when a place has had a hard lockdown, there could be very low levels of immunity in those areas (might be happening in France)

Waite: we are seeing increases in hospitalisations in the north west, albeit from a very low base

Q about what the Joint Biosecurity Centre and what it does

Waite: use NHS test and trace to identify COVID transmission chains and stop the spread of the virus, bringing together experts to inform local and national decision making

[impossible surely?]

Q about Oldham, what can we infer from steady rate there?

Heneghan: test and trace is having an impact, but problem is government keep intervening and confusing the policiy - what's the point in test and trace if it then leads to lockdown. We need to keep a eye on hospital data

Heneghan now talking about cycle threshold in testing, that using a specific threshold stops us picking up people who had the infection in the past (which is what's happening at the moment)

Questioner - you are critical of PCR?

Heneghan: PCR is helpful, but needs a strategy, otherwise identify too many false positives

***A cycle threshold >35 generally are people who aren't infectious***

NHS currently use threshold of 45, identifying people who are not infectious

Questioner asks what can be done about false positives?

Heneghan: we've got more marketing than science at the moment - statements like 'moonshot' aren't helping. We need a strategy for the sustainable use of tests over long term. At the moment, it's not sustainable.

Heneghan: we can't test our way out of this pandemic, random testing of the population will pick up dead virus, we can isolate RNA fragments up to 90 days after infections.

If you randomly test in schools, you might as well shut them all down now.

... we must think about harms and social consequences.

Right now, when a single Yr13 student is possibly positive for coronavirus, whole year group sent home, because no one is thinking through how we;re using these tests appropriately.

Waite agrees, testing won't stop you getting the virus, people with the virus need to isolate

Q about guidance for schools

Waite: there is guidance about what to do, when to isolate etc for schools. Guidance needs to be followed because the education of our children is really really important

Heneghan: if you accept we have an endemic seasonal pathogen and want to keep schools open, we have to have a strategy to reduce those risks. People are so terrified by the language and rhetoric that they're going beyond the guidance through fear of what's coming next

Heneghan: "it is utter chaos" in schools right now because of the 50% increase in other respiratory pathogens circulating in children (and adults' responses to this)

Part 2, mostly on Test and Trace

Witnesses: Baroness Harding of Winscombe, Interim Executive Chair, National Institute for Health Protection

Simon Thompson, Managing Director of the NHS COVID-19 App, NHS Test and Trace

Dr Susan Hopkins, Chief Medical Advisor, NHS Test & Trace

'COMFORT BREAK'

27% of people registering for a test report NO SYMPTOMS, but having been 'in contact with someone who had tested positive - Dido Harding

Chair - 27% of people lied?

Harding: no, some people can just walk up because they're worried, it's totally understandable.

Chair - but they wouldn't be allocated a test then if they didn't have symptoms?

Harding - they will get a test.

[so basically even if you admit at the test centre you don't have symptoms, you'll still get a test]

Harding on increase in demand - entirely human to be scared and worried and to think the answer is to get a test

With children going back to school, a marked increase (doubling) in children <17, especially aged 5-9, seeking a test

Chair asks, considering 500,000 people a day will have coronavirus-relevant symptoms now and going into winter, your testing capacity will only just reach that by end of October, without considering the additional strain from coronavirus?

50% of the testing capacity will go on NHS patients and workers, and social care workers. Testing 100 people per 100,000 in local areas

@BBCFergusWalsh @iansample @hannahdev @sarahknapton @whippletom @shaungw

@Madz_Grant @allisonpearson

I'm done with this session now. If you want to continue to watch ramblings on contact tracing and the app, the live and re-wind-able feed is here: parliamentlive.tv/Event/Index/52…

Correction: 'to me', not 'today'

Correction: 'prescription', not 'description'