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14 Jan, 9 tweets, 3 min read
The UK has other problems for the next month or so, but this decision in my opinion hugely misses the point of rapid testing for schools or other places 1/n theguardian.com/world/2021/jan…
Imagine you only detect 75% of true cases of infection. Well, you just cut the risk of transmission in school by 75% and that's not nothing. What about the remaining 25%? Use masks as well. Anything that makes it through the rapid test now has to beat the mask 2/n
Two masks actually, if everyone is using them. This article with @j_g_allen and @jenkinshelen explains why this is important 3/n theguardian.com/commentisfree/…
I don't understand the damaging insistence that interventions be silver bullets capable of single handedly halting the pandemic, they work together as shown here 4/n nytimes.com/2020/12/05/hea…
Like I explain with @LeeKShaffer @baym in this (shortly in a journal near you) the perfect can be the enemy of the good. Let's think about reducing transmission enough through various interventions to get control 5/n dash.harvard.edu/handle/1/37363…
That paper 👆🏼 also incidentally considers the advantages of detecting *transmission* rather than cases, which is important for a thing that tends to spread in clusters, and can inform quarantine decisions 6/n
It is beyond bizarre is that this is in the UK, where until recently there was a parroting insistence that "schools are safe" instead of doing stuff to make them safe*er* 7/n
Testing (of all kinds) is an important part of that. One of the relative success stories of the last few months has been the way regular testing in colleges has restricted transmission in this age group bu.edu/healthway/comm… 8/n
Making this work, of course, requires clear honest messaging from trusted sources. Plus a consistent goal to keep transmission low across the board, not high in some groups and low in others.

Yeah, I know.

9/end

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More from @BillHanage

Bill Hanage Profile picture
16 Jan
My announcement that I was running with a mask got a LOT of comment (from all sides) earlier. It’s in response to changes in the state of the pandemic and the transmissibility of the virus. Worth unpacking 1/goodness knows
First I posted the photo after a couple of interviews this week in which mask use outside was discussed in the context of surging infections due to the variant B.1.1.7. Here's one
And then this with RTE where were talked about mask use in the context of the situation in the Republic of Ireland, where cases are surging. I commented that I run with a mask. Hence the tweet

Read 13 tweets
Bill Hanage Profile picture
15 Jan
I’ve thought long and hard about this. There is a constellation of circumstantial evidence around the most recently identified variant P.1, and what has been happening in Manaus, Brazil which makes me very seriously concerned. A thread 🧵
First Manaus has already been very hard hit by the pandemic. News reports in earlier stages told of rushed burials and bodies piling up reuters.com/article/us-hea…
The crucial thing was the rapid rates of transmission, not really mitigated by ‘flattening the curve’ any. total per capita mortality was not as high as might be expected elsewhere, but only because the age structure of the population in Manaus skews young citypopulation.de/en/brazil/amaz…
Read 13 tweets
Bill Hanage Profile picture
13 Jan
There is a new ‘variant’ clearly identified today, P.1. And it is worth saying a little about what we have learned about it, and from the variants we have identified so far virological.org/t/genomic-char… 1/quite_a_few
First these are not simple ‘mutants’. Mutations happen all the time and most mean nothing much and either persist at low levels or are removed by selection. The variants are characterized by *multiple* mutations – one of the reasons we call them variants and not mutants 2/n
Those multiple mutations are in parts of the genomes that are not exactly the same, but they overlap to a really pretty marked degree (esp the receptor binding domain). This looks like convergent evolution in which different lineages find the same solution by different routes 3/n
Read 15 tweets
Bill Hanage Profile picture
9 Jan
It has been a long tiring and, in many ways, terrifying week in the US. The events in DC have nevertheless obscured the growing public health crisis, which even with vaccines available can be expected to get WORSE over the short term - a thread
Where are we right now? Daily deaths cleared 4000 this week. That will get worse. How do I know? Because the deaths are the results of infections in the past, and infections got worse in the last few weeks. I'm so sorry, but it is coming
The amounts of infection now are so high, and the comparative vaccination rates so low, that we have to be prepared for a coming surge into healthcare across the nation. It is already going to be bad enough. It might well be worse given the threat of more transmissible variants
Read 10 tweets
Bill Hanage Profile picture
5 Jan
Everyone who thinks I just offer snark and the occasional bit of science. Let me please remind you how seriously I take this. People too close to me have died, too many of them. Too many have suffered the chronic nightmare of long covid
many more have treated the sick, and some have become infected. Some have been severely ill. Some still are
folks need to stop denying gravity and start seeing what is before their eyes. This virus is dangerous to *enough* that we need to take strong action to slow it down
Read 4 tweets
Bill Hanage Profile picture
5 Jan
This is relevant to the situation in the UK and elsewhere schools have been open with minimal infection control. Forget December, we knew *enough* in July to start preparing for the winter 1/n
You want schools open? Really? You have a few advantages, especially with younger kids who are less susceptible than older kids and adults. But that's not enough on its own. As in so many things here you see the advantage when you put multiple interventions together 2/n
You can improve ventilation. You can use masks. I know some of you don't *want* to wear masks but pick your battles for chrissakes. Test. Build confidence that you are doing everything to minimize transmission in schools and its consequences, instead of denying it happens 3/n
Read 6 tweets

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