THREAD: where we are with covid in UK, particularly England, right now ... inc schools and circuit breaks... based on my @IndependentSage briefing today (which you can watch here if you want )
Confirmed UK cases still going steadily up - doubling every 2 weeks or so - faster end of Sept and bit slower last 2 weeks. Of course reliant on testing so take with pinch of salt.
Cases continuing to increase in England, NI and Wales. 2 weeks into central belt restirction in Scotland and we're seeing a flattening. Remember impact on cases takes at least a week to show in case numbers. Keep an eye on NI next week and Wales in two weeks...
English regions still show NE, NW & Yorks with highest cases but some sign of slowing growth. But growth nonetheless. ONS social survey reports people going out less - will be helping to slow growth.
Removing highest three regions shows just how fast the rest of country is increasing - lower case numbers there are *not* cause for complacency! If growth does not stop, things will be significantly worse there in a few weeks.
What age are new cases? @ONS infection survey is good for this (since doesn't rely on testing behaviour or having symptoms, important cos kids much less likely to show symptoms). V. interesting data but note last data point is more uncertain. So what does it show?
Highest cases in last 2 school years & young adults - growing but growth slowing. Infection in secondary school pupils under 16 is coming down while primary school kids are shooting up! Not sure why, & wait for next week to confirm But top 3 age groups *all* include school yrs.
The @ONS social survey shows that parents of dependent kids are worried about kids getting covid, mental health impact & time off school. 8% said their child had been sent home due to outbreak and of remainder 41% said their school had an outbreak!
The Dept for Education said 46% of state secondary schools had one or more pupils self-isolating but only 16% of primary. Overall 4% (400K kids!) are off due to covid outbreaks. Attendance is much lower in hard hit cities. Covid in schools is a growing problem...
so what about hospital admissions? They are going up still - and close to 2 week doubling but perhaps slowing a bit (good). But almost back at March 23rd levels (bad).
again lots of regional variation with v high admissions in the North (at London 23rd March levels) and much lower elsewhere... but remove the North and you can see all regions have increasing admissions
Deaths will follow admissions... ONS registered deaths (gold standard but lagged) show steady 2 week doubling in the 8 weeks to 16th October. Same pattern in daily English deaths within 28 days of +ve test (more recent data)
Takes about 4 weeks from infection to death. So almost all people to die in next 4 weeks from covid, already infected. Given rough 2 wk doubling of cases & admissions, expect deaths to follow too (perhaps slowed a bit). Awful. BUT what we do now CAN change last 2 weeks of Nov.
This just projecting exponential growth onto current confirmed cases in England over next 8 weeks. Assuming tiers reduce R to 1.1, this will slow growth but it is still growing. Even if R goes to 1, that will maintain high persistent level. Few believe they will bring R below 1.
A 2 week circuit break now could reduce R to 0.65 (halving every 8 days) and dramatically reduce cases starting a week after the circuit break starts. Hosp adms will fall from 2 weeks after that and deaths from 4 weeks later. We could "reset", particularly in North & schools
A circuit breaker in 2 weeks or 4 weeks would still work but in the meantime there would be tens of thousands new infections and thousand hospitalisations and deaths. and might need to go for longer to get cases low enough. And would miss half term.
In those 2 weeks + 4 more weeks of restrictions sufficient to bring R below 1 but schools open, we *could* rebuild test and trace & other public health infrastructure, such as improved ventilation. Read our detailed blueprint! independentsage.org/blueprint-for-…
So... next few weeks will be crucial in assessing effectiveness of circuit breaks in NI & Wales, Scotland's new tiers and English tiers. A circuit break in England right now is best bet to rapidly reduce cases and will save thousands of lives by mid-December. /END
PS the moral is that exponential decay is our friend just as much as exponential growth is our enemy

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More from @chrischirp

15 Oct
THREAD: personal thoughts on tiers, circuit breakers, restrictions, R (ENGLAND)

My calcs based on SAGE notes (bit.ly/3lTraqv) & SpiM paper on circuit breaker (bit.ly/2T0p6AA)

TLDR: 2 week circuit breaker NOW, then enough restrictions/FTTIS to keep R below 1
Cases are rising across England. SAGE estimate R i s1.2 -1.5 & not below 1.2 anywhere. Although North highest (1), everywhere rising. Plotting each region with start point at first week with over 20 cases/ 100K people/week shows that trajectories similar (2) - all on same course
All charts below assume simple exponential growth or decay (based on R) till end Nov. V v simple but illustrate point! I use hospital admissions as not dependent on testing. Back of envelope, don't take numbers literally.

Overall, doubling rate currently about 2 weeks (R=1.3).
Read 14 tweets
8 Oct
THREAD: My thoughts on pubs FWIW.

At current growth, covid hospital admissions in North of England less than a week away from levels London had on lockdown day in March (per population)
Covid loves us socialising indoors (pubs & homes) and laughing, chatting over a table for hours... I think right now closing indoor pub service in hard hit areas & restricting household mixing is right thing to do BUT we need to work immediately on plan to reopen inc
Fixing test & trace (e.g. in England, currently works least well where needed most). This inc supporting isolation - financially (£500/2 wks less than minimum wage!), practically (caring responsibilities, grocery, accommodation...) (govt SAGE said same bit.ly/2SBpfKP
Read 6 tweets
3 Oct
THREAD: many of us in healthcare have seen new IT systems hailed as gamechangers. Many don't live up to their promise. Often failure is at final step of implementation - I interviewed people at 4 hospitals who all implemented the same IT system & developed these cartoons...
The hope is that they capture typical stories of what pitfalls happen in real life - and gives tips for how to avoid them! The full cartoons (and a downloadable booklet) are freely available from @nejmcatalyst catalyst.nejm.org/doi/full/10.10… but here are some with real quotes :-)
"Because it involved IT, even tho the CMO had signed off & we had his blessing & the promised resources & the contract, then we had to go through what we call the IT gov committee. Which is not a quick process, so we had to formally present this…and that took another 6 mnths"
Read 8 tweets
3 Oct
SHORT THREAD: Some interesting (if unsurprising) data in NHS test and trace this week on age profile & positivity rates - particularly for kids & young adults. 1/4
Firstly, MASSIVE increase in school-age kids getting tests in September. Stark to see how much extra capacity was needed - not surprising and should have been anticipated! Also surprising that 20-29 yr olds NOT getting more tests even though age group with most infections. 2/4
BUT, no increase in cases among under 10s and only modest increase in 10-19s. Biggest increase in cases by among 20-29 years olds. This age group should really be getting more tests. 3/4
Read 5 tweets
2 Oct
THREAD: what happened with COVID in September and where are we now? It's been an eventful month and there is good news and bad news... read on to find out which is which!

NB: Longish thread (18 tweets) but hopefully informative with lots of pretty charts...

@IndependentSage
Confirmed cases have continued to rise, but hard to interpret cos of ongoing problems with testing. But let's go with this for now - where are the confirmed cases?
All the nations have seen steep increases over September but Wales and N Ireland doing rising less steeply than England and Scotland... Let's dig a bit further into England
Read 18 tweets
27 Sep
THREAD: as requested by absolutely noone here are some thoughts on COVID-19, the UK and exponential growth... (it's a positive thread though!) 1/11
Infectious diseases by their nature have exponential growth while lots of susceptible people are around (still case in UK) as each person infects others. Left to its own devices, COVID-19 cases would double every 4 days or so. With knock on increases for hospital admissions 2/11
But we've not left COVID-19 to its own devices. We've done lots of things to slow the spread (social distancing, masks, rule of 6 etc). This slows down the *doubling time* (how long it takes for cases to double) - effectively giving us longer to bring down transmission. 3/11
Read 11 tweets

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