Some people are *still* lumping "children" all together in talking about transmission, schools etc

That is a dumb thing to do

It doesn't take a paediatrician to tell you a 2yr old is different from a 17yr old

Case study using data from the @ONS

ons.gov.uk/peoplepopulati…

1/8
The @ONS performs large scale, *random* population testing via rt-PCR

People often complain test data in children is biased by lower symptom burden - that is not the case for this data

Hence, it is very informative (why aren't more countries doing this?!)

2/8
Here is a graph of the last few weeks modelled incidence by age group

Huge initial spike in 17 - 24yr olds
Up behind then followed 12 - 16yr olds
Then 25 - 34yr olds
Then 35 - 49yr olds
Then 50 - 69yr olds

Eventually the 2 - 11yr olds get dragged up behind

3/8
Here is the graph with just the children highlighted

The difference in the timing of the increase in cases is quite remarkable, and you can see the young children rates came up behind almost all adult cohorts

Why does this matter?

4/8
It shows the reservoir for the disease is young adults/adolescents, and transmission in this cohorts bleeds into surrounding age groups

Eventually it makes its way into young children

This is a stark contrast from influenza/other respiratory viruses - the reverse in fact

5/8
Note also the supposed blip in 12-16y prevalence during the school break (half term) some people were very excited about actually follows closely behind the fluctuation in prevalence in the young adults who aren't in school

But I digress...

6/8
The difference between age groups of "children" is highly significant when considering policy interventions and the effect they would have

e.g. targeting younger years care and education much lower yield than other interventions (and young children potentially more harmed)

7/8
Differences in older/younger children have been known for months

What we should see in the next weeks is cases declining in all children following the declines in young adults, even in spite of schools being open

This has happened in several other countries already

8/8

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More from @apsmunro

27 Nov
Really interesting pre print looking at school transmission in Northern Italy during the second surge

Suggests huge age dependant differences in risk of transmission in children in these settings (who would have guessed?!)

Let's take a look...

doi.org/10.1101/2020.1…

1/8
Detailed contact tracing of 43 cases
- 5 teachers
- 38 children

Whole classes tested regardless of symptoms, and swabbed a second time 10-14d later if the first was within 6 days of exposure

How much onward transmission?

2/8
Pre school (6 kids, 2 teachers) - 0/156 (0%)
Primary school (14 kids) - 1/266 (0.44%)
Secondary school (23 kids, 5 teachers) - 38/572 (6.64%)

Notice a pattern here?

3/8
Read 8 tweets
23 Nov
IT WORKS 🥳🎉

Great news from the Oxford/AZ vaccine phase III interim analysis today!

ovg.ox.ac.uk/news/oxford-un…

But if you thought you had questions after previous vaccine announcements, boy oh boy does this leave us wanting more!

Quick thread...

1/6
What are the interim results?

-131 cases in Brazil and the UK
-Overall efficacy 70% for the Oxford vaccine compare to control (MenACYW vaccine)
-No safety concerns identified

BUT

Split by dosing regime:
-2x high dose 62% effective
-Low dose then high dose 90% effective

2/6
That is a truly intriguing finding, and we'll need to see the breakdown of the data to understand the uncertainty around those estimates

I'll leave it for clever immunologists to theorise why a lower dose priming shot might be more effective

But wait, there's more...

3/6
Read 6 tweets
13 Nov
An absolute smorgasbord of data around children, schools and #COVID19 this week

We've got @PHE_uk , the @ONS survey, REACT study, and a new SAGE report!

Lets take a birds eye view of the key findings 🧵

1/17
First in @PHE_uk

Cases flattening in secondary age children after a sharp rise, rates still much lower in primary age

School outbreaks flat/declining (half term will have played a role here)

assets.publishing.service.gov.uk/government/upl…

2/17
Of course these tests are symptom based, and may miss cases due to lower symptom burden in children

Let's look at the UK's 2 big, random sample studies which overcome this issue!

3/17
Read 17 tweets
10 Nov
This is a phenomenal statement from @ADPHUK

One disheartening thing about some of the scientific communications during the pandemic has been a painfully narrow view

None of that here

A holistic, considered and progressive approach to management of the pandemic

1/5
First, focus on a combination strategy

Stop focussing on silver bullets or game changers and start getting the basics right. Promote good public health messages. Support test/trace/isolate.

Complex problems don't have simple one stop solutions

2/5
Second, win HEARTS and MINDS

Foster trust, goodwill and collaboration (hint; this is NOT achieved by punishment, shaming and fearmongering, no matter how many ❤️🔁 it gets)

**Protect communities**

Amazing document outlining these strategies here

adph.org.uk/wp-content/upl…

3/5
Read 5 tweets
9 Nov
This potentially incredibly good news

Twitter is about to be full of articles about "herd immunity" again, but now with words laced in honey rather than shouting and hissing

Some things we now need to consider...

1/6

statnews.com/2020/11/09/cov…
We need to see the data

I note it is a difference between arms of *symptomatic* infection - this might mean reduction in disease severity, but we need to know about transmission

Why is that important?

2/6
With only ~90 events there's no way we'll be able to see efficacy in the highest risk groups who we are trying to protect (and who we're most worried won't mount an effective immune response)

Nice to turn COVID into a cold for younger people, but not what we're aiming for

3/6
Read 6 tweets
6 Nov
A criticism of the data regarding children and #COVID19 from the first surge is that it was acquired with schools closed

Its now surge 2 and they're open

Let's look at the up to date info from @PHE_uk and @ONS infection survey and see what is going on

#schoolsreopening

1/10
After an initial surge, in the recent weeks of @PHE_uk data we have seen a decline in cases in the 10 - 19y age group

Otherwise lowest cases remain in the 0 - 10y ages, although still trending up

assets.publishing.service.gov.uk/government/upl…

2/10
What about school outbreaks?

They've been flat for the past several weeks despite rising prevalence in the community

Unfortunately doesn't tell us about how many cases involved or whether it's children or staff/teachers

assets.publishing.service.gov.uk/government/upl…

3/10
Read 10 tweets

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