Thread by @ewanbirney

My perspective on the COVID world, this cold November night in London

Context: I am an expert at genetics + computational biology. I know experts in viral testing, clinical trials, infectious epidemiology, immunology and cell biology of viruses. I have a COI in that I am a long established paid consultant to Oxford Nanopore which makes a COVID test

A reminder. SARS-CoV-2 is an infectious virus which causes a serious disease, COVID19, in a subset of people (more likely in people who are older, male, overweight) often leading to death. If we left the virus to move through the population many people would die quickly.

Due to remarkable speed of research, we have 3 vaccine candidates that look like (from the early brief results programmed in to assess efficacy) that they are safe and they will work (though we have yet to pin down how well).

As well as these three vaccines being very likely useful, it bodes well for the over 30 (!!) other vaccines being developed, coming in over next year at different points.

Research on both drugs and clinical pathways has also meant that we can halve the rate of death in hospital with this disease; this is great, but not enough to change the outcome of allowing the virus to move through the population.

As such, all countries are now "building a bridge" to a population wide vaccinated future. That bridge means controlling infection levels to cope with the transmission with low mortality and critically not overwhelming health care.

Frustratingly for Europe and North America, the transmissibility of the virus in the winter is higher (as with all Coronaviruses); the individual Test, Trace, Isolate schemes (best exemplar being Germany) could not contain transmission in Europe alone.

Most countries have now instituted some layer of population wide restrictions (NPIs in the lingo) as well as TTI to reduce transmission. This is broadly working (eg France, UK, Spain, Italy, Ireland, Netherlands) or holding (Germany, lighter lockdown now).

Sadly they have not held well in some countries (Belgium) or applied late in other previously well performing countries on TTI (Austria); these have had to institute more drastic restrictions to achieve control and prevent healthcare system melting.

There are numerous details, many operational, which differ, and numerous aspects to improve in operations of TTI (there is basically no level of TTI which one should not aim to improve on).

Even more testing is one; better use of App information is another; plenty are in the rather simple sounding but critical "support of isolation" and exploiting the overdispersion of transmission of this virus (backtracing protocols from Japan).

It is worth noting that Asian countries, often with comparable(ish) winter temperature (South Korea, Japan) still have their TTI schemes, coupled with hygiene and population compliance on rules giving good results. It is achievable.

Back to the bridge to the vaccine - the bridge has to last to the spring, when it seems very likely that nearly all the at risk population (who want to be in most developed nations) would be vaccinated, and the weather should also turn in our favour.

(Vaccination logistics is going to be complex and a real operational thing that could screw up; We will need to have good teams at national, regional and local levels to deliver)

But I suspect we can be more optimistic than spring for our everyday lives improving in small ways. I do think improvement in TTI (across Europe) will allow less NPIs to be present for maintaining suppression of the virus

In a UK context, this means I hope more downward movement of regions through the Tier structure; the Tier structure is set up to have this. We will all be in a Tier until spring, but that could be Tier 1 (here's hoping) for us.

We need good data feeding good "nowcast" models feeding good decision making to move NPIs up and down - thankfully (again now in a UK setting) the data, modelling and decision process has improved.

(I appreciate that a lot of people want to rage against this; personally I can see huge improvement in all of the components from Sept. The rage seems misplaced in the context when we're building a bridge to a vaccinated world; if this was not the case, it would be a different)

Furthermore when the Healthcare workers get vaccinated, one major operational risk of having simply not enough healthcare workers will have reduced significantly, and then each level of vaccination will work in our favour - allowing us to ratched down NPIs.

In the UK context, this means more likely that transmission drops (R much less than 1) in Tier 2; it should always drop in Tier 3 (that's Tier 3's goal; let's hope it works) meaning the country slowly moves to Tier 1.

Other European countries have regionality programmed in (Länder in Germany, Autonomous Regions in Spain etc) so this is as much "coordinated regional decisions to a common goal" as "moving through Tiers".

Broadly I can see a way out of this. There are many things that can go wrong now, and thousands of people in healthcare, testing, tracing, local health teams, national health teams working their hearts out to achieve this.

In the meantime we need to hold our nerve, working with these teams to lower transmission - follow rules, wear masks, have Apps on, take advice from health protection teams.

I have no idea whether one describes this as optimistic or not (I have learnt that optimism is a curse in a pandemic) but it is important to stress that we are on the start of this bridge now, and this bridge has an end in a better place for all of us.