A few thoughts on the pandemic and 'protecting healthcare', prompted by this heartfelt and urgent article about what it is like to actually work in healthcare during a pandemic theguardian.com/commentisfree/… 1/n
firstly we should note that healthcare is either stretched or close to it in many places at the moment, and we have yet to see the effects of the Christmas holiday or (in most places) any impact of more transmissible variants 2/n
When we talk about ‘protecting healthcare’ what does that mean? Does it mean preserving ICU beds? If so how many ICU beds are enough to handle the regular requirements of the non-pandemic part of healthcare? 3/n
Or do we protect healthcare by not allowing community transmission to rise such a level that other parts of healthcare suffer either because of a lack of resources, or a lack of staff 4/n
If drafting in staff from elsewhere in the system to care for pandemic patients, what happens to those parts of healthcare? Does it mean not having to cancel elective procedures? Or not having to postpone potentially lifesaving surgery because you can’t rely on a bed 5/n
Not everybody gets to know what is actually going on inside hospitals. And in some places Drs and nurses are heavily discouraged from talking to the media, which allows disgraceful misinformation about what is really happening to take hold. Remember the early days in Wuhan? 6/n
This puts more barriers between those of us who spend their days and nights thinking about and working to help stop the worst of the pandemic, and those who are being asked to upend their lives without really being told why 7/n
Finally ‘protecting healthcare’ was the language of flattening the curve, to avert catastrophic damage from an unmitigated out-of-control epidemic. That was then. After that we were supposed to not go back there. It is horrifying so many places have 8/end
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Very interesting preprint on epidemiology of B.1.1.7 (or the 'Variant of concern' - VOC) in SE England. Have not fully digested but there are some important take homes 1/n cmmid.github.io/topics/covid19…
Some have argued B.1.1.7's sudden rise is a 'founder effect' reflecting the VOC getting into a more densely connected network of hosts, and a number of superspreading events. This seems unlikely to me because there were lots of more common lineages available to be amplified 2/n
the preprint agrees. First, here is the increase in the proportion of cases due to the VOC in the SE (pink) compared with the rest of England (these are detected btw through characteristics of the test result). The gray box is the 2nd national 'lockdown' (👈🏼hate that word) 3/n
As might have been expected the UK is reintroducing more intense restrictions over the Christmas period. This may be tied to the 'new variant' common in the SE of the country, but should not obscure the fact that the relaxation in early December will have had an impact 1/n
There are several reasons to think this is an important variant, but notably it has increased extremely rapidly since emerging in mid sept (maybe a little earlier)
Unlike the earliest stages of the pandemic, this variant has been competing with existing and established lineages, and it is against that backdrop that the increase has occurred, strongly suggesting IMO it is more transmissible 3/n
I've been getting questions from friends about what to do if their child gets sent from home to quarantine, after a case is identified in their class or 'bubble' (or whatever is the local term) 1/n
First point, be pleased that the exposure was detected. Imagine if it had not been. The information is power which helps you and others avoid infection, that is what the quarantine is for 2/n
the alternative (not testing) means undetected transmission in schools could introduce the virus to many households. Younger children *are* less likely to become infected and suffer severe illness, but they can transmit 3/n
Will not be time for many of these and please understand may well be distracted so will miss put too many but given the thanksgiving holiday would like to should out to those like @ImpactMovie who have been admirable friends for months. Happy thanksgiving to you and yours!
I would add @SFDukie happy thanksgiving to you and yours - hopefully in a non generation mixing setting
Or the extraordinary @EIDGeek - this had been a bad year. Getting to know you better has been one of the better parts. Look forward to meeting in person, one day
First this is good news in that it shows yet more evidence efficacy can be achieved, and in a vaccine setup we understand better than mRNA vaccines - no disrespect to any platform, but having more weapons in our arsenal is always going to be better
But what’s bad is the relentless media focus on the “up to 90% efficacy” which makes me irritable. This was a result from a mistake in the vaccine trial regarding dosage. Vaccine trials are not the sort of places you want to make mistakes
A comment (to complement some parallel threads from @michaelmina_lab) on the value of rapid testing, even if it is imperfect. So how do you re open say... movie theaters in the midst of a pandemic where anyone could be infected, and many are at risk of fatal outcomes? 1/n
So bad things are that most movies theaters are indoors, probably poorly ventilated. Crowds. Lots of opportunities for close contact. A person at the peak of infectiousness could kick off a Superspreader event 2/n
If you could present reliable evidence you have been -ve in the last 24 hrs, well that would obviously be transformative. But wait - what if that test result is a false negative and there is a resulting false sense of security? That’s where the masks come in 3/n