Dr. Deepti Gurdasani Profile picture
Oct 22, 2020 22 tweets 8 min read Read on X
A thread on where we are with the COVID-19 pandemic in England, and what we need to do urgently based on current evidence. This thread also explores why the govt Tier 1-3 strategy is nothing but a distraction from the actual public health response needed. 1/N
As we know, the PHE data shows an exponential increase in daily confirmed cases of COVID-19. We are currently seeing between 25-30K daily cases. This is likely an underestimate as testing capacity has been reached. Moreover, increases are occurring across all of England. 2/N ImageImage
Predictably increase in case numbers have translated over time into increasing hospitalisations across all of England, with regions in the North likely to hit NHS capacity soon if we don't act. While increases in the South appear slower, these are only lagging 3-4 wks behind. 3/N ImageImage
We know that hospitalisations are doubling every 14 days in England (@IndependentSage)- with clear exponential rises. This is likely to translate into corresponding increases in deaths with a 2-3 wk time lag from increase in hospitalisations. 4/N Image
As there is a lag of ~4 wks from infection to death, even if we act now, we will sadly see increasing deaths over at least the next 4 wk period. We are likely to see ~2000 deaths in the next 2 wks, ~4000 in the 2 wks after, and ~8000 in the 2 wks after. 5/N
This means that many of those who will die from now to November have already been infected, and there is little we can do to prevent this. We can only manage these cases the best possible way in hospital. The most effective way to prevent deaths is to prevent infections. 6/N
This means we will inevitably now see ~6-10K deaths by December due to late action. But we can prevent more if we act quickly! What do we need to do to prevent these deaths, and more people being sick with Long COVID-19. 7/N
Cases are rising across all age groups, and across many different settings. Educational settings, including primary and secondary schools are important hubs of transmission. Using a piecemeal approach targeting only hospitality and households, as Tier1-3 do will not work. 8/N ImageImageImage
Experts, including SAGE, iSAGE, and the CMO all agree that we need a multi-pronged approach, rather than the Tier1-3 approach. There has been little to no impact of restrictions imposed in such a piecemeal manner. 9/N
There is agreement that we need an urgent circuit breaker to curb transmission. SAGE modelling shows that a 2 wk circuit breaker could have a huge impact on case numbers, hospitalisations and deaths if introduced now. The more effectively we reduce R, the more lives we save. 10/N ImageImageImage
But what does this mean for long-term strategy?

The idea of the March lockdown was to rapidly bring down cases, and buy time to develop good case finding systems (TTI) to enable us to then control local outbreaks effectively without needing nation-wide restrictions. 11/N
Despite having several months to prepare, we failed to develop an effective system. The slide here shows the stark contrast between the private (Serco) system, and the NHS test, trace system. If we invest in NHS based TTI, we can have effective test, trace & isolate. 12/N Image
It's important that such a system is backed by financial support for those who need to isolate/work from home/shield. Scaling up testing is not going to solve the problem if only 18-20% of those who need to isolate are able to (due to financial insecurity). 13/N
Important to note here, that the idea of some sort of a trade-off between COVID-19 control and the economy is a false one. The evidence overwhelmingly shows that countries that have invested in robust COVID-19 control have had less of an impact to their economies. 14/N Image
Similarly, the idea that COVID-19 control is divorced from providing routine healthcare to those with chronic conditions is also a false one. The more COVID-19 transmission is allowed to increase across the population, the more overwhelmed our health services will be. 15/N
The only way to protect the NHS, and enable it to provide routine care is to prevent COVID-19 infection, and prevent NHS services from being overwhelmed. Controlling COVID-19 is the only way to protect our health, and our economy. 16/N
Here is the advice by @IndependentSage. They suggest a 2 wk circuit breaker (similar to May) followed by lower level restrictions over another 3-4 wks. This period needs to be used to urgently reform the current TTI system, and provide financial support to those affected. 17/N ImageImage
It is crucial to utilise this period to put in place effective case detection strategies so we can rapidly identify and control outbreaks once nation-wide restrictions are lifted. Without this we will likely find ourselves in the same situation again. 18/N Image
Financial support is a key part of this. We also need clear public health communication that doesn't minimise the risk posed by COVID-19 or blame the public. We also need clear regulatory frameworks for education, workplaces & other settings with support for these from govt. 19/N
We are very near seeing a repeat of March, and we're sleepwalking into a situation where tens of thousands of deaths will occur. We need to act now. Every day we wait results in hundreds of excess deaths. Inaction by govt is costing lives. 20/N
Importantly, we need a long term strategy so we are not stuck in an endless cycle of late action related lockdowns. We need effective and robust FTTIS systems so we are rapidly controlling outbreaks, as many other countries have done, without the need to return to lockdown. 21/N
We need to prevent the fire, rather than fight it once it's accelerated beyond control. END

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More from @dgurdasani1

Mar 24
A brief 🧵on recent experience with possible MCAS (Mast Cell Activating Syndrome) as part of long COVID. Hoping this thread may help others who have symptoms of MCAS post-COVID who may not have been diagnosed, or have considered this possibility & may be untreated as a result
Some background- I have had hypermobility, GERD, auto-immune disease (UC) & mild POTS before COVID. After COVID, the POTS, GERD worsened & I developed fatigue, brain fog & PEM. To those who know about MCAS, none of this will be surprising, as all these are associated with MCAS.
I recently had a wk long episode of gastro-enteritis, and was very puzzled as to what was going on. I hadn't eaten out & no one else at home was ill. I am on treatments that could cause this as a side effect, but I'd never had these effects with the doses I was using before.
Read 18 tweets
Mar 15
The media won't cover high quality peer reviewed published evidence on the long-term impacts of COVID-19 on every single organ system, but rushes to cover 'expert opinion' on an unpublished non-peer reviewed abstract that contradicts everything we know about LC so far.🧵
And of course no one can really critique because we know nothing about the actual nitty gritty of the study, as it doesn't exist, even as a preprint. How does one deal with a system like this?
It would be like if there was a whole body of empirical evidence that supported the earth being spherical, but one person conducted a study that they say showed the earth was flat (unpublished), but asked us on the basis of that to stop referring to the earth being a globe...
Read 11 tweets
Mar 14
Using TV shows to support the hegemony of normalising COVID by dismissing those taking precautions as having 'post-covid anxiety'. These shows, like MSM serve to maintain the status quo by dismissing anyone whose actions may threaten this normalisation as 'anxious'.
This is how a one normalises mass infection with an illness with serious long-term consequences. First, they call it 'mild' and suggest it's like the 'flu'. Then they talk about how mitigations like masks are harmful (they're not) & onerous, & how 'people don't want to continue'
Then they try to minimise the long-term impacts saying they either don't exist, are all in the head, or are *rarer* with vaccination and current variants. Relativism is used here- i.e. 'the situation is better', although absolute risk at population level is still unacceptable
Read 5 tweets
Mar 12
This is such an abelist way to framing of how long COVID affects a whole family. Rather than highlighting the systemic issues that lead to CV families lives becoming smaller, it frames the risk aversion of an LC affected person as 'anxiety'
npr.org/2024/03/11/123…
Here the partner/spouse of the person suggests that a 'compromise' is needed, where the 'compromise' is basically the person with LC taking risks that could disable them forever if they get re-infected. 'Eating in a restaurant' for example is presented as a reasonable compromise
As someone suffering with LC (and extremely grateful for a spouse on exactly the same page as me), I would never compromise on this- because I know that this could very easily lead to me ending up with even greater disability- which would impact our family massively.
Read 13 tweets
Mar 8
The public health situation in Gaza is dire -
>1/2 million at risk of famine.
16% of children <2 are malnourished- 70% have had diarrhoea in the past 2 wks
>300,000 cases of resp infection & >200,000 with diarrhoea (1/2 in children under 5)
reliefweb.int/report/occupie…
This is entirely man-made- forced starvation and lack of clean water, crowding - all imposed by Israel with support from our govts. Please please speak up. We cannot be silent. Every day more children are dying. And this will continue until Israel is forced to stop.
We cannot as public health professionals remain silent in the face of one of the worst public health crises - entirely preventable, and deliberately imposed on an entire population by Israel and our leaders.
Read 5 tweets
Feb 26
As govts take aim at Muslims & immigrants with blatant racism, your regular reminder that the most dangerous entities responsible for the most suffering and death are capitalism, capitalist hegemony, austerity, fascism, and ecocide (all of which are linked with white supremacy).
It's odd that all those who speak about the 'impacts of immigration' or 'multiculturalism', never speak about the huge impacts of capitalism, colonialism and white supremacy on the world- it's hard to imagine anything that has had greater impact on humans & their environment.
I speak to people who talk about authoritarian countries and dictatorships, grateful that they live in 'democracies' with absolutely no concept that they are also controlled by hegemony rather than dictatorship- and that their democracies have not been functional for a long time.
Read 7 tweets

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