Thread by @ewanbirney

Yesterday I used the phrase "uptick in cases" about the REACT study - some people drew comfort here (upticks are small); other people were horrified I was giving false comfort. To be clear - the REACT study shows strong growth of Coronavirus infections in nearly all of England

I am definitely someone who has an optimism bias - it serves me well in many scenarios in science and life - and in this pandemic it is justified **in the mid to long term** : BUT *not* in the short term. Optimism biased people like me are not good decision makers in a pandemic

(we might be good data analysts; we might be good communicators; we might be good technologists in getting out of this; but optimism is a curse in the management of pandemics. I find the cross current on this really hard - the mindset that has served me well is not good here).

Back to the REACT study - like the ONS study this is the solid ground to stand on it is clear cut that transmission of the virus has grown in all areas across England, and has grown *strongly* in nearly all areas; as concerning is that the growth has moved to older age groups.

This obviously has impact on decisions. It means the current combination of high testing (testing capacity a positive in TTI system in the UK) and the Tier 2/Tier 3 scheme is not adequate in controlling the virus.

(one region, East of England, one might be able to convince yourself it is close to control, but thats 1 of 7, and given the other trajectories one *must* have a proper worst case scenario in mind where this is a timing issue.)

As well as optimism bias being a curse, the often used "keep something in your back pocket" and "see how the new things change" - or continuation bias if you prefer - is also a real issue in decision making.

For me this is as much because the risk/rewards are very asymmetrical. Downside risk here is further lack of control of the virus and *exponential* growth with a reasonable coefficient. It becomes uncontrollable (perhaps is already - one has to own all our mistakes here)

As Dr Fauci says, it is far better to be criticised for overreacting than under reacting in a pandemic.

Finally in this rather bleak thread I want to acknowledge the clear aspects that increased, population wide NPIs - call it higher Tiers, or more lockdown or whatever works to get it done - does not come "for free" - certainly not! They have serious, far reaching impacts.

It has serious consequences on lives and livelihoods and life in general. We have pretty good frameworks to navigate the awful decision tree ahead of us - whether it is Welfare economics and cost benefit analysis or "all in" health economics and QALYs.

Frustratingly we haven't done much public exploration of this decision tree probably because it is all a bit too bleak/lack of courage, +/- just higher priorities. One meta-thing to do right is to (a) have these bleak scenarios game planned in the abstract ahead of time and >>

(b) on any new pandemic have some strongly worded (perhaps even legislation?) triggers which force a future government to map out the decision tree in public.

My final two pleas after this thread. Firstly - do not envy either the people giving advice or making decisions. None of this is easy. If anyone provides an easy solution to this be very very skeptical.

Secondly - be kind and nice to the people around you - neighbours, friends, twitter followers and public. Assume best intent, even of the people you don't like or trust. It's hard I know, but this is a human vs virus thing, not left vs right, nor countries against each other.

We humans have to work as one team.