Thread by @ewanbirney

COVID in Europe - my perspective this bright, sunny day in London. As ever, the main group I feel I am talking to here are journalists, who have to write about COVID because... it effects our lives so much.

Context: I am an expert in genetics/computational biology; I know of experts in viral evolution, clinical trials, immunology, infectious epidemiology and chit-chat with them regularly. I have a COI that I am long standing consultant to Oxford Nanopore which makes a COVID test.

Reminder: SARS_CoV_2 is an infectious human virus which causes a nasty disease in a subset of people; some people die (even with the best medical treatment); others suffer a long term disease we are trying to understand.

If we let the virus go through the population, not only would we accept these deaths and long term disease but also no healthcare system would be able to provide good healthcare during thing.

Amazingly, due to international collaboration and public/private partnerships we have at least 3 vaccines that work, 2 of which are now approved for use, 1 is actively being administered in a number of countries.

The strategy is therefore now clear - we need to safely and quickly vaccinate at least all the at risk people, and most likely the majority of our populations. This hideously complex in the logistics and delivery, but clearly doable. All wind to the sails of vaccine delivery

[A note to the people who will pick over decisions and debates over 2020 quite rightly; we *did* need a strategy that could activate if no vaccines work, but note just how many vaccines are in development - definitely worth trying them all before no-vaccine strategies]

Despite this long-term - mid-term even - hope we still have to navigate this winter. The vaccination levels will never be enough in even the fastest countries to make an appreciable difference this winter.

Quite simply, the combination of TTI (Test-Trace-Isolate) and NPIs ("Lockdowns", "Tiers", "Restrictions") needs to be in place to suppress transmission over the winter.

This is ... all about behaviours and operational details. It is the sort of thing which most people want to just "work" but making it work is super super hard. Armchair people who think this is easy, or they could guide the balance through themselves are ... kidding themselves.

There is also I think a very unthoughtful business of thinking that TTI is "not working". It's clearly working (NPIs are less than March; the R rates don't go to 3; many places in UK, France, German do have R ~1 or less...) it's just to work well enough everywhere.

Operational details get missed here probably because it is all about the details. I know the UK landscape best and feed on scraps of understanding for German, French, Spanish, Danish etc.

Broadly we're on top of testing across Europe - one can improve turn around times and local deployment, one needs to watch careful for demand surge and indeed many places are trying to work out how to leverage our command in testing to get other parts to work.

A good example of this is mass testing; Slovakia, Liverpool, French mass testing program. Testing *by itself* does nothing to change the pandemic (though it tells you where the virus is) - you need focus on behaviour change *post* testing as well - basically isolation support.

Isolation support (some people say compliance, but that seems a bad way to frame this) is a complex world between biology (how the virus works), sociology and behaviour, communication and economics.

Unsurprisingly given this it is ... complex and it is not as if we have tried and tested schemes for this to roll out on a population scale.

My own view is that we keep using ancedotes, instinct and broad policy statements with not enough laser like focus on "how do we make people with the virus or who are at high risk of having the virus stay isolated"

The other complication in most countries is that one has to accept a level of intra-household transmission; could we reduce this (how?). Lots and lots of fiddly stuff to work out.

Trace is also all about the details, and the long term push to get more Asian-country like backtracing I hope is coming through. One has to map things that have worked elsewhere to a UK, or French, or German context, but there is still headroom in making Trace work better.

For any given efficacy of TTI one then needs to add enough NPIs ("lockdown measures", or "tier restrictions") to keep R going down at high incidence or R ~1 at low incidence. Schemes which worked elsewhere have not worked in Saschen (Saxony) or Kent/East London/Essex

One thing is understanding why - one hypothesis is a new strain in the Thames Estuary which transmits faster which is being looked at hard by really good people (not me I should stress!) but the "why" here doesn't fundamentally change the "action".

The action needed is to improve TTI (not impossible - this is for example, mass testing with the right isolation support) and having a "stronger" NPI mix. This is not an either/or situation - it is a "both" situation.

When things are under control, then one can have this horrible Jenga like process of working out which NPIs one can remove where the TTI will hold at this level (which is feasible - for example, Cornwall, Schleiswig-Holstein).

Finally it is worth noting that NPIs don't work because No10 or the Elysee Palace or the Chancellory (or rather 16 Lander premier video conference call) say so. They work because people change behaviours.

This means this soft comms stuff of pulling together, everyone reducing the risk to look out for each other, clear rules that can be communicated well is surprisingly important.

Because this is all comms and societal stuff it *does* get wrapped up in politics - it has to. But ...please... this business of pulling together and delivering should be cross-party stuff in some fantasy world of getting each country through this.

This is probably howling in the wind, but we don't have so much longer to work through in this time. We need to ... double down, grit our teeth and get through this winter; modest Christmases, within guidelines, look after each other.

There is a far far better 2021 for us all. Let's get there together.