Thread by @ewanbirney

There are debates - important debates - to have in these COVID times, but there are some either stupid debates or misguided in my view debates. Here's my list with brief rejoinders.

1. False positives on tests are grossly inflating the number of cases. Straightforwardly they are not; the system understands false positives, goes to a lot of length to prevent them, and, acknowledging that they can never be 0, carefully models them in analysis.

2. "Hard" Stratify and Shield (or segmentation) is a solution. By "Hard" I mean placing all the at risk people in entirely COVID "safe" environments (extremely low risk of infection) and then having the remaining people at low risk live normal lives, and get the infection.

There is a case for "soft" stratification (I will come back to this) and of course a whole range from very hard to really quite soft, but this is no deus ex machina approach for "solving" the epidemic.

The first issue is the sheer number of at risk people for the acute, lethal disease. It is the majority of people over 65 and that's a lot of people (many many people over 65 are either obese or hypertensive, and of course ~50% are male).

The practicalities of creating and managing very low risk COVID infection environments for this number of people when they will need many things - from shopping to healthcare is eye-watering and basically when people I trust have looked at this, impossible.

(I am not a large scale logistics expert!)

The second thing is that this long term follow on disease from COVID infection ("Long COVID") clearly happens at some rate at earlier ages, and is less male biased, indeed might be female biased.

We don't understand this well enough to map this out, but it definitely means there is both far more people at risk and most importantly, it is harder for us to identify this group.

3. We should shut schools to reduce transmission. Not unless we *really* have to as (a) children are not at increased risk of bad outcomes and (b) the transmission rates between children look similar to elsewhere (or less) and (c) closing schools really impacts children's lives

In addition, home schooling does reduce the effectiveness of working from home considerably for the majority of adults with children (I might be... understating this).

4. We should only act once the NHS capacity limits are reached. This is a mad argument. Firstly there is a huge amount of momentum in this system; acting now only changes hospitalisations in ~4weeks best case as it goes transmission->incubation->early viral infection->COVID

Secondly as soon as one can be confident that one can't control viral transmission one should act. A big error in the management of the Israeli 2nd wave was trying to manage to hospital capacity.

Hospital capacity gives you wiggle room and space for us to make mistakes and recover, but it is not a solution with growing transmission.

So - you might ask what are the debates to be had?

The first is realising that lockdowns are *really* not good - they are not good for mental health, for other health, for livelihoods and for the economy. The economy can socialise debt and spread it over future years, but these are future years we and our children will inhabit

As such, it is *really* important to work out the way to do this with the least restrictions and the least economic pain. This is complex - its still has lots of unknowns on the transmission side (eg why precisely does super-spreading happen?) >>

<< but in addition it feels like this is economic + political policy on steroids, made fast - what outcomes do we want to optimise for (or minimise against)- what is fair and equitable in this compressed decision space with such weird thing (please remove these things not others)

Some of these things feel mundane and petty - should golf courses stay open given the fact that golf is famously a way to wreck a good walk between two people. If we let people walk, why not golf? ( I posit this as an example - I don't want to get into this debate!).

Other things are really complex and more live policy and politics. Working from home works fine for many jobs, but for a variety of the key jobs for the functioning lockdown economy it does not (delivery drivers to nurses).

This goes to the far broader differential between quite a bit of public sector jobs (many of which one can work from home, no furlough needed) compared to private sector (how should support and furlough work).

Another debate goes to some hard truths, present in frameworks but super-charged; for example we recognise that the death of someone in their 80s is different from their 60s or 40s (in the UK this is in the QALY framework for the NHS) but how do we use this differential?

The other debate is less for columnists or opinion writers but just as important - how much better can we make Test-Trace-Isolate? What are the easy wins operationally here? These are details, details and details but really important.

As followers will know, I know that tweeting about making operational improvements to TTI is easy - actually getting it to work is far harder.