My final thread of the year - a brief review of the current situation and why I think the govt. is right to resist calls for another national lockdown.

Throughout this pandemic I have tried to stress the twin dangers of fear and complacency -
– excessive fear harms our mental (and overall) health and led to the deaths of thousands in the first wave who were too scared to seek medical help when they needed it. And complacency about the real risks of COVID leads to riskier behavior and increased spread of the virus.
Many recent headlines highlight record numbers of cases and increasing deaths with calls for another national lockdown. And of course it is true that the situation is getting worse but it is important not to panic people by exaggerating the threat but to give the true picture.
i.e. that cases are increasing but they are not at the level they were in March – when we had over 100,000 cases a day in the week leading up to the first lockdown. And that deaths are not increasing yet – and are thankfully still much lower than at the peak of the first wave:
but they are not falling either & have stabilised at around 400 a day. And more people are dying than usual for this time of year - and the leading cause of death is currently COVID. It also true that the no. of COVID patients in hospital is approaching the first peak nationally
and that in the regions most affected by the new variant (London, South East & East) admissions are increasing rapidly this is already causing elective work to be cancelled – and so harming non-COVID patients.
(Pls my earlier thread for more on impact of new variant.)
But there is significant regional variation as the graphs above and below show:
And that is why it is right to continue with the tiered approach with the measures being targeted where admissions/pressure on the NHS is highest. A blanket national lockdown unnecessarily harms those areas with the lowest admissions/pressure- without clear evidence of benefit.
It's also important to see what the impact of the new tiers is first – we saw on previous occasions when infections/admissions/deaths were rising rapidly (in March and Oct.) that people’s behaviour changed – & led to infections falling before lockdowns. conservativehome.com/thecolumnists/…
As I have said many times before, the govt. needs to ensure that measures to deal with COVID are proportionate to the threat and don’t cause more harm than benefit.

And the NHS needs to keep hospital acquired infections down and increase capacity to reduce the pressure.
Doctors/nurses/frontline staff will do our best too - but everyone of us can help by being careful when meeting people over Christmas and beyond - particularly with those at higher risk - because COVID is a preventable cause of hospital admission but most other causes are not.
Finally, I hope you all enjoy the Christmas break as best you can (even if, like me, you are in Tier 4) and that, although the coming weeks will be difficult - with the increasing rollout of the vaccine in the New Year - you share my optimism that 2021 will be better than 2020.

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More from @drraghibali

24 Dec
A thread on some early evidence on the impact of the new COVID variant - increasing cases, increasing hospital admissions but not yet the expected increase in deaths.

Is the new variant less deadly?
Generally, over the course of the second wave, we have seen a pattern of cases rising overall and then in the over 60s - which is then followed by hospital admissions rising with a 1-2 week lag, and then deaths with a 1-2 week lag.
However, as shown in the figure below, that pattern seems to have changed since cases linked to the new variant started increasing rapidly at the end of November with admissions increasing as expected, but not deaths.
Read 8 tweets
30 Oct
Plan B:
Why Sweden provides a potential model for us to follow - but not for the reasons most people think - and only if we learn from their mistakes.

And why - whichever plan is chosen - we need to build consensus. And how that could be done.
No country has received more attention for its approach to dealing with COVID than Sweden but there continue to be widespread misunderstandings of its strategy - with many thinking they followed the approach outlined in the Great Barrington Declaration.
However, the actual, official Swedish government strategy is ‘to limit the spread of infection in the country and by doing so, to relieve pressure on the health care system and protect people’s lives, health and jobs.’

And as its Chief Epidemiologist, Dr Tegnell has said,
Read 18 tweets
29 Oct
A brief review of where we are - & why we need a plan B.

In general, I think the current government strategy of suppression to keep cases low enough to maintain NHS services and minimise non-COVID health harms while protecting education and jobs is a reasonable compromise.
Furthermore, if virus levels get too high, fear increases and people don’t come to hospital, don’t go out and the economy suffers, etc. I also understand the governments rationale of not wanting to reintroduce shielding due to the mental (and other) health harms it would cause.
I also support the targeting of restrictions based on the local level of cases as opposed to blanket national ones. I find it hard to understand how it can be possibly be fairer to destroy jobs and businesses all over the country including in areas where hospitalisations are low
Read 12 tweets
29 Oct
Why I haven't signed the Great Barrington Declaration (GBD) or John Snow memorandum (JSM):

Having consistently highlighted the health harms of lockdown, I did of course welcome the GBD’s emphasis on the many harms of lockdown – particularly in countries without welfare states
– where lockdowns are even more likely to cause overall health harm. However, a declaration is not a policy and there are still too many unanswered questions. Although I fully agree on the need to focus protection on care homes & hospitals, I am not convinced that it is
feasible to shield the very large numbers of vulnerable people in the community when COVID transmission is high (esp. for those who live in multigenerational households). Also, the number of ‘non-vulnerable’ who would be symptomatic and hospitalised in the coming 3 to 6 months
Read 18 tweets
14 Oct
This series on COVID tries to analyse data objectively and aims to avoid the twin dangers of fear & complacency; prevent a large second wave & a second lockdown.

No 7. Is the NHS in the same position now as it was on March 23rd? And does that mean we need another lockdown?
Over the last few days, much has been said and written about the fact that there are now more patients in hospital with COVID than there were on ‘lockdown day,’ March 23rd, and some are claiming this justifies a second national lockdown to prevent the NHS being overwhelmed. .
While it is true that that there are more patients in hospital with COVID now (3332) than there were on March 23 (3160), the trajectory is very different (as I explained it would be 4 weeks ago - due to social distancing, isolation, masks, etc.)
Read 15 tweets
13 Oct
Thanks to @IainDale for inviting me on to @LBC to explain why a national 'circuit-breaker' lockdown is not justified. There is not enough evidence that the benefits of this policy would outweigh its harms - which must be the benchmark - especially in areas where cases are low.
However we must also continue to keep hospital admissions low enough to enable all NHS services to keep running; and also low so that people are not scared of going to hospital, school, shops, restaurants, etc. as happened first time around - but this should be achieved through
measures that minimise overall harm i.e. social distancing, self-isolation, reducing social contacts indoors, masks, etc. - which remains the best way to prevent a second national lockdown.
Read 4 tweets

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