The govt strategy on COVID-19 appears to be to “allow the disease to circulate in younger people where it’s not causing much harm” while protecting “the people who are really vulnerable” This should concern us all - outlined in this @BylineTimes piece by @NafeezAhmed 👇
Thread
The primary strategy of govt is vaccination of the vulnerable to reduce serious illness & death. While this is vital, there appears to be no plan to tackle transmission & no recognition of the harms to health & economy that would come with 'allowing the disease to circulate'
Once again, the govt have conflated SARS-CoV-2 with influenza - a mistake which has led us to almost 100,000 excess deaths in the UK. High levels of continuing transmission in the UK have created the conditions for viral mutation & adaptation.

SARS-CoV-2 isn't influenza.
10% of people with SARS-CoV-2 have persistent symptoms lasting >3 months - including people who have mild acute infection. The long term impact is not known but many studies suggest multi-organ dysfunction that can last at least for months- we don't yet know if this is reversible
Studies suggest long-term dysregulation of the immune system & development of auto-antibodies in some people with COVID-19. We know the virus can invade many organs & virus antigen can persist in the brain, and in the gut for many months.
medscape.com/viewarticle/93…
Why is our government happy to expose millions of people to a virus where the long term impact on health is simply not known. Esp when early studies suggest that the impact may be long-lasting & serious for at least a subset.
And why are we still drawing comparisons with flu?
Worse still, the govt seems fully aware that vaccinating a subset, or even most of the population may not prevent transmission. They cannot & do not rule out the need for further lockdowns.

Why, then, are there no plans to suppress & keep transmission down, to prevent this?
Why after repeated late action, & lack of adequate case finding, contact tracing & isolation which has led to three lockdowns,~90,000 deaths from COVID-19, and economic devastation are we still moving forward with a strategy which could result in more cases & a fourth lockdown?
The negligent strategy outlined by govt sounds suspiciously similar to the 'focused protection' ideology described by the Great Barrington Declaration that suggested shielding the vulnerable, while letting the virus spread through the population to develop herd immunity.
The voices behind the GBD were invited to brief the PM in autumn, despite the GBD being grounded in pseudoscience & their repeated predictions being proven incorrect. They advised the govt not to lockdown in Sept despite SAGE advice - leading to thousands of preventable deaths.
The govt now once again appears to have chosen a policy of pseudoscience & mass infection. After three late lockdowns that cost thousands of lives in the name of 'saving the economy', we are here yet again. Are we going to change course or keep repeating the same mistakes?
After 10 months, we still have no strategy to exit lockdown in a way that prevents yet another wave of infections, cases of long COVID & deaths, and a repeat of very recent history. The NHS is in crisis. We have a new variant of virus that transmits much more easily.
Continuing transmission also favours further virus adaptation (we've now seen at least three new concerning virus strains across the globe), leading to further risk of favourable adaptations, and escape mutations to vaccines.
Rather than focusing on elimination, which is the only way out of this, that doesn't end either in mass devastation or another lockdown - the govt has once again chosen a strategy of 'living with the virus' and 'tolerable deaths'. Govt & its advisors have ruled out elimination.
What would high levels of transmission mean?
We had >1 million cases of COVID-19 reported in last weeks ONS report. That means at least 100,000 people with debilitating symptoms lasting >3 months, >35,000 hospitalisations and ~10,000 deaths. That's just cases from *one week*.
Deaths may be lower depending on the speed of vaccine roll-out. But our health & economy would be devastated, if the virus was allowed to spread across the population.

And cases will rise again unless we put measures in place *now* to *keep* transmission down once cases are low
This means bringing cases down as fast, and as low as possible and not easing restrictions before cases fall to very low levels. This means doing everything possible to bring R down now. This means fixing our broken test,trace, isolate & support systems so we can keep cases low.
It means revising measures on social distancing & mask use in the light of the new variant & supporting the public with new measures as much as possible. It means reducing transmission in schools by supporting them with mitigatory measures.
It means better quarantine measures. Support with isolation. Financial support to those who are suffering the impact of lockdowns. Greater support for parents & carers & schools. Greater investment in mental health. Addressing structural inequities.
Pandemic control is multi-pronged. There is unfortunately no single silver bullet. It's half-way measures and late action that's brought us here. Unless we learn from these mistakes, we are doomed to repeat them again and again. At an unacceptable cost.
This graphic from the BBC shows how long it can take vaccine programmes to really have an impact on containing disease outbreaks (and these are for highly effective vaccines that do protect against transmission). It's completely dishonest to present these as a magic silver bullet

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More from @dgurdasani1

15 Jan
Extremely concerned by the quarantine and travel restriction policy in the UK - which is not based on evidence - and *still* doesn't go far enough, despite the really concerning new variants that are circulating in many parts of the world. Brief thread.
We have closed all travel corridors - this means that everyone now needs to follow quarantine restrictions. But let's look at these. Are these grounded in evidence?

Current quarantine rules in the UK are isolation for 10 days, *but* early release if testing -ve at 5 days.
Is this sufficient to ensure infections are not imported?
No.
Many reasons:
1. The incubation period of virus (infection to symptoms) can be up to 14 days.
2. Testing at 5 days may not pick up infection - people can become test positive & transmit after 5 days of exposure.
Read 7 tweets
15 Jan
If true, this is seriously concerning. Using lateral flow tests as a replacement for isolation of contacts is negligent. This goes against current CDC recommendations as to how these tests should be used, as well as the MHRA, which has rejected them being used for this purpose.🧵
The main purpose of lateral flow tests is to identify *new* cases through rapid testing that we hadn't identified before. The low sensitivity of the tests means that we cannot use them to *rule out* infection - important especially when we're dealing with high-risk contexts.
Current CDC recommendations below. Contacts need to isolate even with a *negative* rapid test - simply because these tests cannot be used to *rule out* infection. Their sensitivity is low & specificity is high - so +ve test rules in but -ve test *does not* rule out. Image
Read 6 tweets
15 Jan
The past months have seen several new concerning variants identified in regions across the globe. A thread about the new variants we're seeing in different parts of the world, what we know about them, their spread, what this means for the future & for urgent policy right now.👇
Starting with the B.1.1.7 variant in the UK, first seen in Sept. It has since become dominant across most of the UK, with evidence suggesting 40-75% increase in transmissibility by different estimates. There are many lines of evidence now to support this:
What about spread? Many warned early on that urgent travel restrictions & active surveillance & aggressive management outbreaks were needed to contain spread. This variant can get established within the community & become dominant within weeks, so the window for control is short.
Read 29 tweets
15 Jan
Lateral flow tests can be useful for identifying *new* cases we wouldn't have identified before.

They should *not* be used as a replacement for isolation among contacts, as they cannot rule out infection. Glad to see the MHRA take a stand against this:

theguardian.com/world/2021/jan…
It's rather shameful that the govt has considered such dangerous policiesm in the first place- these have been criticised by many scientists & are against the CDC recommendations for how rapid antigen tests should be used. We're at the point where the MHRA has had to reject this.
It's clear these policies were never grounded in evidence. Thankfully, approvals in this context are under the remit of the MHRA, but what about the numerous other policies of govt that are not grounded in evidence that are putting people at risk every day?
Read 4 tweets
14 Jan
The Great Barrington declaration, a dangerous ideology grounded in pseudoscience promoted by libertarians with vested interests has now embraced the government's policy as the 'focused protection' strategy they outlined.

We should be *very* worried.
I wrote about this yesterday, when a piece in the @BylineTimes by @NafeezAhmed reported on this. Our govt is actively following a strategy that has been widely debunked scientifically and called out as unethical and dangerous by the scientific community.

The John Snow memo signed by ~7000 world-leading scientists highlighted the dangerous flaws inherent to this ideology - including the huge risks for public health.

Read 8 tweets
8 Jan
Thoughts on where we are in the UK right now with cases, and the new variant, and what this likely means for the future. And the focus of government solely on vaccination of vulnerable individuals- rather than mitigating transmission. This is short-sighted, and dangerous. Thread
Let's review where we are first. We have ~58K daily cases in the UK (7 day average) at the moment, and numbers are still rising. Hospitalisations are now 50% higher than the April peak, with deaths at ~600/day. We are now in a national lockdown with schools moving remote.
The govts plan for the lockdown appears to be roll-out of vaccines to ~13 million vulnerable people in the top 4 priority categories. The idea appears to be to vaccinate rapidly to reduce symptomatic and severe disease in these groups- reducing hospitalisations & deaths.
Read 33 tweets

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