(THREAD) Here is my understanding of the UK's Covid situation, and why we need a circuit breaker NOW.
Whether we call it a circuit breaker or a lockdown, some dramatic cessation of normal activity is inevitable fairly soon. If we just carry on at the present rate, we should expect to be up to around 2000 deaths a day by the end of the year.
In fact, that’s probably optimistic, as the collapse of a number of local hospital systems by that point will mean a greatly increased case fatality rate and/or an increase in ordinarily preventable non-COVID deaths. It’s hard to predict exactly when it’ll happen, but ...
there must surely come some point when the public will not accept this level of mortality, and will demand that the government imposes the necessary measures to reduce it. Any delay in commencing this cessation will only extend the time for which it needs to run.
My understanding is that the goal of a circuit break is to get transmission down to the point where contact tracing can be effective. As such, it can be distinguished from longer lockdowns that seek to eliminate community transmission altogether, a la New Zealand or Victoria.
People often refer to circuit breakers as being for a fixed duration (e.g., 2-3 weeks). But the stopping point needs to be epidemiological rather than temporal. Perhaps it could’ve been only 2-3 weeks had we implemented it when Sage recommended, but now it’ll need to be longer.
Contact tracing hasn’t been going well, but it’s probably not reasonable to expect it to be able to cope with the volume of cases we currently have. The virus is out of control. Around 20,000 cases a day and an R rate of ~1.5 means that ...
there are just too many contacts for the system to handle (even a “world beating” system like ours). If we had only 1000 cases a day, for example (as was true back in August), it’s feasible that the tracers could be contacting more than 90% of those who need to self isolate.
In addition to its epidemiological effects, a circuit break could have powerful psychological effects. It would send a clear message that This Is Serious Now, which is critical for improving compliance with self isolation (without which our contact tracing system is pointless).
And a national circuit breaker might help to restore some of the “We’re all in it together” community spirit that was evident during the initial lockdown, which is also essential for compliance (this is one reason why I’m sceptical about regional approaches).
The lockdown until #ZeroCOVID option is still my preference, for what it’s worth. That option would be very costly (we’d need to make the rich pay for it!), although I suspect it’d still be cheaper in the long run, and would save many more lives. One can only look at NZ with envy
Either way, the current approach of tinkering at the margins and squabbling over paying for the necessary public health measures is wasting precious time. It will impose a terrible cost in lives, in addition to its economic cost.
A couple of addenda prompted by comments I’ve received. I’ll use graphs to make both points. One of them is quite positive, the other rather less so.
I’ll start with the gloomy one. When I said “around 2000 deaths a day by the end of the year”, that wasn’t a figure plucked from the air to be alarmist. It was the most optimistic I could be. Deaths per day is growing exponentially: plotted on a log scale it looks like this.
That trend line running through the data has an R^2 of 94%. If we stay on that line we'll get to 2000 deaths a day BEFORE December.
Anyone who thinks that there’s some reason why deaths won’t continue to follow the trendline on a log plot should go back and take a look at the plots that @bristoliver has been making for about 2 months of deaths in the NW.
But here’s a positive graph, showing progress on track and trace. Prior to mid-August there was never a week in which tracers contacted >5000 people within 24 hrs. Since then there’s been a huge increase: tracers are now beating the 24 hr contact threshold for >5000 people a day.
That increase hasn’t been enough to keep pace with the spread of infection, obviously. But with a circuit break we could get to a point where the caseload is manageable.

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More from @ProfColinDavis

30 Sep
At today’s press briefing, Chris #Whitty asserted that rates of #COVID19 are not increasing in school-age children, based on a graph showing the rate of test positivity has not increased in the 5-10 or 11-14 year old age groups. 1/n
However, the test positivity rate isn’t very illuminating. We know there are other viruses in circulation that have symptoms that overlap with COVID. The test positivity rate conflates the increase in COVID cases with the increase in these other viruses. 2/n
It would be of interest to look at the rate of increase of positive cases across age groups (I’ve not seen these data). However, these data would also be problematic to interpret, because:

a) Maybe 40% of infected children are asymptomatic, and won’t be tested; and ... 3/n
Read 15 tweets
20 Sep
Text on the left is from UK government guidance to higher education. Text on the right is from UK government guidance to schools (updated 17 Sept). Why the difference? Is it something to do with the magic protective bubbles they have in schools? @Parents_Utd @ConcernedofBri1 ImageImage
Here's a good illustration of the magic bubbles that are apparently going to minimise transmission (except in practice many of the bubbles will have a hundred or more individuals).
And here's why masks are necessary in indoor spaces (including schools).
Read 5 tweets
17 Sep
Seeing as the UK #testing system is broken, one can examine NHS Pathways data (digital.nhs.uk/dashboards/nhs…) which report 111, 999 and online assessments categorised as potential #COVID_19. Here are data from Bristol and NE Somerset. Current rate: doubling every 7 days. @Bristol_C19 Image
Here are data from SW London (doubling every six days): Image
Here are data from Hertfordshire @Mike_Page (doubling every seven days): Image
Read 5 tweets
27 May
The UK government continues to claim that its pandemic response is science-led. A key aspect of this science is the behavioural science. Let’s review how that's played out. The government:
1. Delayed lockdown, costing thousands of lives, while briefing journalists that this delay policy was based on behavioural science -- specifically, a phenomenon called "behavioural fatigue" that doesn’t seem to exist in the scientific literature.
2. Accompanied its message about the importance of handwashing with anecdotes from the PM about shaking hands with all of the Covid patients he met.
Read 9 tweets
4 May
If you're not a politician, there’s no need to say “sadly died”. We all know it's sad. Even a psychopath doesn't need to be told what the socially appropriate emotion is when his fellow citizens die of an infectious disease.
No grieving person says, “my husband sadly died yesterday” or “my daughter sadly died before I saw her”.
This linguistic styling is, quite transparently, an exercise in image management ("You can tell I am a person who cares, because I said ‘sadly died’").
No doubt the comms people have instructed ministers on the approved language. You can picture the prepping immediately before the daily press conference: "Remember that you care about the people who sadly died. It might help to picture them as party donors”.
Read 6 tweets
23 Apr
Toby Young and Carl Heneghan and other “lockdown sceptics” have been making strong claims about how they can show lockdown has had no impact on the epidemic, based on simple maths. But there’s a problem with their argument. [THREAD]
Understanding the problem with this argument is important, because -- taken at face value -- it could lead us to end lockdown on spurious grounds. It’s been getting a lot of coverage both on TV (here’s Carl Heneghan on Newsnight)
Read 17 tweets

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