Thread by @ewanbirney

It is somewhat hard to know which strand on England's November lockdown to pick apart - a large number of people in the press (and twitter) are commenting ("hot takes" in the US parlance) - most heat and not so much light.

Yesterday, before the announcement, I tweeted on this here:

https://twitter.com/ewanbirney/status/1322509291060891648

I'd also recommend @AdamJKucharski's tweet thread on this

https://twitter.com/AdamJKucharski/status/1322634517920755715?s=20

and @JeremyFarrar's here

https://twitter.com/JeremyFarrar/status/1322863128208617472?s=20

I can feel quite a few people processing this, and those people in media positions, via their public personas. It's unsurprising there is concern, angst and questions, even though if you had been following the numbers, SAGE and other debates it was well sign posted

So - in this tweet thread I want to remind people why this is different to March - it *really* is, and then I will do a second thread on things that people bring up which I think are not good arguments

Why is November Lockdown or more restrictions not like March in England?

The first, and most practical, is that hospitals will stay open for non-COVID procedures if at all possible + schools being open is the next highest priority (that's what I infer). Both of these are clearly about minimising the health and life impact aspects of more restrictions.

The second is that our situational awareness - how much of the virus transmitting, and where - and knowledge of the virus (incubation period, disease profile at least for acute disease) is in a completely different space - we really know stuff.

Just knowing where and how doesn't mean we can change things, but it is a good thing. It allow us to forecast and model with confidence; it allows us to understand where to focus.

The third thing is that worldwide clinical research - of which some of the best has happened in the UK in particular the excellent RECOVERY trial - means less people die who are infected. Both single big things (knowing which drugs work) and thousands of little things here.

Frustratingly our increased knowledge does mean we now have a fuzzy view of a nasty long term follow on disease ("Long COVID") which we still need to get into focus more as it will be important to understand.

The fourth big thing is that although the mixture of TTI and restrictions in October was not enough to prevent growth, it *did* slow growth alot from the R ~2.5 to 3 in March vs 1.5-1.2 in October. We're not that far away from reasonable control of the virus transmission.

This deserves the Dickensian quote again: "Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery". Much the same with growth vs shrinkage here.

One "card in our favour" is that at lower incidence levels some aspects of TTI - in particular Trace - just work better (or should work better - it is super complex to operationalise this stuff). This means lower incidence gives us a chance to have less restrictions and control.

The fifth big thing is that we have real confidence that there will many vaccine trials reporting end of this year / beginning of next, and if one or more is successful, this will likely change many aspects of the epidemic.

Vaccines are best not thought of as a fairy tale ending to this pandemic, but they are potent tools when they work (how potent we wont know until the Phase III trials are in). Past the early vaccine results there is the Spring and less favourable weather for the virus.

So - although this is not a nice place to be, the horizon is definitely better looking forward. And although the weather in England is always pretty foul I hope this lockdown is far sharper, shorter and easier than March (fingers crossed!)