1/6
Thread by @Dr_D_Robertson: The Home Secretary has suggested that police should get higher priority in vaccinations. There is an article in the @guardian where this is clarified JCVI has set out their recommendation...… threadreaderapp.com/thread/1351848…
2/6
Of course, there's a traditional way of rationalising these decisions. Risk is product of bad event, and likelihood of event happening. Some occupations - people providing necessary services where contact with large numbers is unavoidable, will be at higher risk.
3/6
They include HCWs, teachers, transport workers, teachers…

Their risk will be raised, compared to other people of the same age, sex, and health, because their exposure, their risk of being infected, is higher.
4/6
Similarly, people in the "clinically extremely vulnerable" (CEV) category will be at higher exposure risk - by virtue of having to spend time, regularly, in those high risk settings, hospitals and clinic waiting rooms.
5/6
We can quantify the likelihood, for people of different ages and risk factors, of various bad outcomes if infected. The chance of dying (the infection fatality rate). Of hospital admission. Of needing some form of supplementary oxygen CPAP, or ventilation.
6/6
If you can also quantify the risk of becoming infected, then you can multiply the risks of infection, & of bad outcomes, and use this risk assessment to identify those most at overall risk… - or to rank them, eg to decide how to prioritise vaccination or other interventions.

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More from @petermbenglish

5 Jan
How big a hurdle is it to get a license for a slightly modified version of a licensed vaccine?
1/6
One of the advantages of the genomic-driven development of mRNA and vector vaccines is that it is relatively straightforward to modify the base sequences to keep up with pathogen mutations.
2/6
In this 10 tweet thread, @DrEricDing discusses concerns that evolution of SARS-CoV-2 might lead to variants which are not recognised (as effectively) by the immune system following previous infection or vaccination. threadreaderapp.com/thread/1346241…
3/6
Read 6 tweets
4 Dec 20
@sweetanimo @patricia_stoop @abcdiagnosis I have seen some of your conversation on Twitter about the use of Covid-19 vaccines in people who are immune-suppressed, and thought I might be able to help.
1/11
First, the UK guidance, including on contraindications etc., is conveniently all in one place - in the public domain - in the "Green Book", via gov.uk/government/pub…
2/11
But first, let's consider how and why immunosuppression might be an issues with a vaccine.
3/11
Read 13 tweets
3 Dec 20
Thisk, on lateral flow testing "false positives" is from DH guidance, and strikes me as extremely stupid. assets.publishing.service.gov.uk/government/upl…
@deeksj @jackiecassell

1/4
It says the test is "99.6% specificity (meaning four false positives per thousand tests)". (It doesn't mean that actually: it's four false positives per thousand tests that should have been positive - not the same thing at all. Confusing sensitivity and predictive values.)
2/4
But that isn't the stupidest thing.

It then says you can use a test with sensitivity of <70% (in the real world >30% of true positive cases give a false negative result) as a confirmatory test, and cease isolation if the second test is negative.
3/4
Read 4 tweets
1 Dec 20
Hi @ScienceShared and @mugevic!

Let's say the reproduction interval is about 4 days. That's the interval between the onset of symptoms in case 1 and the onset in case 2 (on average).
1/10
Patients are most infectious before the onset of symptoms. So, if case 1 develops symptoms, they will probably already have infected at least half of the secondary cases.

And some of them will already be infectious and have infected tertiary cases.
2/10
Few people will get tested on the day of onset of symptoms. Most of the time the onset of symptoms is identified retrospectively. After all, symptoms are mostly common to many other minor viral infections.
3/10
Read 10 tweets
30 Nov 20
We keep banging on about "test and trace" for #Covid-19.

But it's pointless.

With a reproduction interval of only 4-6 days, if you wait for a test result before isolating contacts, you will do it too late. They will already have spread the infection.
1/2
And many cases are asymptomatic, so you'll miss them, anyway.

Testing is too unreliable. Too many false negatives, and too short a time from infection to infectiousness.

The only thing which works is keeping people apart so they can't transmit it.
2/2
"given the
potential delays in isolation of patients, even the early
detection and isolation strategy might not be fully effective
in containing SARS-CoV-2."

thelancet.com/journals/lanmi…

@mugecevik et al
Read 4 tweets
30 Nov 20
I seem to have been saying this internally within @PHE_uk and predecessor organisations forever.

Every time there's a major event and they ask for feedback, we tell them "Email does not work. It gets /we get overwhelmed. We can't keep up and feel guilty. It's stressful."
1/6
We frequently get the same message once from the original sender, and then four more times from people concerned we might have missed it; and then we have to try to work out if we're looking at an updated version...
2/6
And sometimes the delays mean that we receive older versions after newer ones... It is a disaster!
3/6
Read 6 tweets

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