Alasdair Munro Profile picture
Sep 25, 2020 8 tweets 3 min read Read on X
🔥Hot off the press🔥

New article in @JAMAPediatrics from me and @SaulFaust

"The education and well-being of the current generation of children and young people should be the highest priority in any national strategy to reopen society."

jamanetwork.com/journals/jamap…

1/8
Children have been spared the worst of disease from the pandemic, even considering the extremely rare post-COVID-19 hyperinflammatory syndrome

But school closures have been harming children, so the question regarding their role in transmission has loomed large

2/8
A new study from brings us a step closer to understanding

In a meta analysis of contact tracing studies, children acquire the infection less than adults. Looking at household transmission specifically, by less than half (OR 0.41, 95%CI 0.22 - 0.76)

jamanetwork.com/journals/jamap…

3/8
Differences much stronger for young children (<12-14y) than older teens

This is supported by seroprevalence data which have generally found lower levels of infection in children (especially in the largest, population representative studies)

4/8
Assessing infectivity has been difficult, as has assessing direction of transmission in studies within schools

Thankfully, the vast majority of studies of COVID-19 within schools have found very limited evidence of transmission, with most cases remaining isolated

5/8
Importantly - the time has come to put polarisation and reductionism of the debate aside

Our children's futures are too precious for them to be used as a political football

Decisions on precise actions taken to make schooling happen need to consider a number of things

6/8
-Community transmission rates

-Resources available for infection prevention

-Social/cultural acceptability of different interventions

-Needs and viewpoints of the CHILDREN and their families whose futures may be irreparably damaged by long term school absence

7/8
It's not as simple as "Kids don't transmit", or, "Schools will propagate a second wave"

They can't be opened with impunity with high prevalence, or remained closed indefinitely

But children MUST be at the forefront of all national strategies to reopen society

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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