Thread by @ewanbirney

A note for I think journalists about the "377 deaths under 60" being the cost for COVID for the UK. This a bonkers positioning statement and is definitely not something trying to shed light on the extremely nasty problem we have in front of us.

The main thing is that what has been aimed for throughout, from the start, is not having a catastrophic capacity demand on the NHS (or any healthcare service). Simply healthcare services cannot cope at some point and then, straightforwardly, many people die, for many reasons.

In this situation, one can aim to do this more rationally ("triage") or not (obviously, more rationally, better) but there is no magic bullet, or emergency button to press. Field hospitals are useful, but they have to be staffed. Healthcare capacity is a fragile thing.

So - the counterfactual here is "what would have happened if the NHS capacity limits were seriously breached" - and many people would have died or had serious disease, both from COVID and other things - and if we don't navigate Q1 2021 well this still *could* happen.

At this point, for me, the argument is settled, but just to have the other arguments lined up (a) there are plenty of very healthy and happy 60+ year olds with plenty of good years left in them; very very sadly some of these people have died from COVID.

(b) there is way more than death sadly as an outcome - spending months in hospital, in an ICU, is horrible and there is a complex disease (probably a collection of diseases, or a spectrum, etc) labelled LongCOVID, interestingly analogous to CFS/ME which is triggered by this virus

LongCOVID clearly happens with an earlier age range and at least more even sex bias. It is all a bit murky (at least from my perspective) and I suspect will take a while to work out (incidence, symptoms, spectrum criteria, treatments, outcomes).

In the extremely cold hearted, but necessary world of weighing lives for health economics (QALYs and the such) one can at least place into some framework "end of life cancer drugs" with "death from COVID" with "LongCOVID".

In these frameworks, it is likely that the long term debilitating diseases, such as LongCOVID, have a big impact. So every person prevented to have gotten LongCOVID is a win, just as much as every unnecessary death avoided.

(c) We would have been in a very different place if vaccines did not work. If vaccines did not work then we would be looking at managing the kinetics of healthcare delivery whilst trying to minimise QALYs lost in the system - hideous to think about and super complex. BUT>>

<<This is not the case. At least 3 vaccines work. There is every reasons to think they will work against new strains (as they have been trialed against a mixture anyway); in the absolute worst case scenario, as the 3 first vaccines are engineered, one can match them to the strain

So - now - we can prevent deaths and LongCOVID via vaccines (hurray! go for it!) and *all* of the health economics plus real economics point in the same direction - vaccinate as fast as possible.

In the UK we have an extra spectre of the new strain being that much more transmissible (I suspect other countries also, but they need to work out where they are) but I actually don't think this changes the strategy (vaccinate as fast as possible) but >>

It will change tactics about NPIs and TTI efficiency (though one should *never leave* any TTI efficiency on the table!) in Q1 2021. Basically, we will need more NPIs, perhaps a lot more; but this is now tactics to buy time for the strategic goal of vaccination.

I was musing about what commentators should kick up a fuss about - it is not the case that everything is unchallengeable or settled. So - here are some topics more worthy of debate:

1. How does economic recovery work across 2021 given that we do expect post COVID working / holiday practices changing? We need to think hard about this and lots of straightforward politics here to my naive eyes

2. COVID/ SARS_CoV_2 is a global not national problem. How do we get the whole planet into a happy place here - how do we do vaccinations, trade and travel during 2021?

3. A question I (and @emblebi) is interested in is how to do on-going global surveillance of SARS_CoV_2 and new pathogens - both during vaccination and also for the future - we should never, ever allow another virus to get the jump on us like this again.

(As all viruses have nucleic acids genomes, we can survey things without knowing what we're looking for; plenty of options here for us to get a jump on new viruses rather than the other way around)

4. A rather meta question, but nevertheless important; the UK has got to learn from the pandemic in terms of crisis response. The UK did some things badly (March, Care homes) and some things well (RECOVERY trial, let's hope vaccination). What do we learn from this - and how?

The rather "wissenschaft" question of how one sets up a system which actually learns from this I find interesting. Not my expertise.

The "scorecard" nature of thinking about this (could have done X better) is a necessary starting point, but this is not the endpoint, and there will be a huge picking over of decisions - sort of science/health/economics policy slo-mo VAR

Individuals will be involved in this. Some will have made bad decisions with good rationales; some bad decisions will have happened because no one even made a decision; operationalising decisions well will be I think a key issue; some people might have been negligent.

The meta-question is how to structure a discussion that gets through this and then gets to the "what structures do we need in crisis and with what types of people" and try to abstract things for the next time (as ... there will be a next time) and it wont be identical to this

There are other questions to get stuck into. Of course, I get that journalists and commentators can just rage - it sucks - this is definitely not something anyone wanted to happen. But I think rage is best employed to do something useful.