Health Nerd Profile picture
25 Jan, 5 tweets, 1 min read
The entire field of epidemiology is about balancing cost and benefit, risk and reward. There is no choice without consequences, even the seemingly trivial ones
Most Master of Public Health courses (MPH) have a health economics unit for precisely this reason. Enacting a policy in one place invariably (at best) takes away resources that you would otherwise use somewhere else
This is a big part of the reason I spend so much time trying to convey nuance. There is no decision we can make for public health that is purely good

There are no silver bullets
These are things that every epidemiologist knows, and as a field we have been trying to convey since the start of the pandemic

Risk, and reward

Cost, and benefit

Everything is a trade-off
Government restrictions to prevent COVID-19 have benefits

They have costs

Deciding NOT to prevent COVID-19 is precisely the same

Which decision is better? That is where the evidence comes in

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More from @GidMK

14 Jan
It's likely that the marginal benefit - the additional improvement on top of other things - of very restrictive COVID-19 interventions like stay-at-home orders may be quite small

However, this is probably equally true of the COST of these interventions
It's something that I've seen completely ignored by most anti-restriction campaigners, but I think it's an important point that we should consider
Yes, if you've already limited how much people can go out to restaurants etc then closing them entirely might not reduce transmission all that much

But it also won't have the same negative impact either!
Read 4 tweets
13 Jan
A new paper has been published by John Ioannidis and Jay "Great Barrington Declaration" Bhattacharya on "lockdowns" as a COVID-19 preventative measure

Let's do some twitter peer-review! 1/n
2/n The paper is here, and it's an interesting read:

onlinelibrary.wiley.com/doi/epdf/10.11…
3/n The paper takes 10 countries' worth of data, and compares their COVID-19 case numbers against the restrictions they had in place in early 2020, comparing those with less-restrictive non-pharmaceutical interventions (lrNPIs) with more-restrictive NPIs (mrNPIs) Image
Read 26 tweets
11 Jan
One thing that's quite funny to note about the awful @JAMANetworkOpen study that has recently been incompletely corrected is that it implies that school holidays are killing people
See, the authors assume that, in the US, every additional year of schooling reduces your risk of death by ~46% across the entire lifespan, and that any/all days missed in terms of school are precisely equivalent to missing schooling
This is not some vague sidepoint, but a central assumption underlying the entire model. Every day missed from school is precisely equivalent to missing lifetime schooling by a fixed amount per child
Read 8 tweets
11 Jan
I do find it quite remarkable that people who have been making testable predictions that have completely failed to come through every day for MONTHS are still being given so much air
For example, a testable prediction made by Sunetra Gupta, Anders Tegnell, and others was that areas most impacted by COVID-19 in March/April would be substantially protected from any resurgence. This has proven largely wrong
This was, in part, based on the prediction by Gupta that the UK (and others) had already reached "herd immunity", or were close to it

Also wrong
Read 4 tweets
11 Jan
Some movement to announce here: JAMA Open have now corrected this paper 2 months after it was published

Unfortunately, it has gone from an error-filled useless analysis to a slightly less error-filled useless analysis

Some more peer-review on twitter 1/n
2/n The updated paper is here jamanetwork.com/journals/jaman…

And you can read @ikashnitsky and my original commentary on the paper here

osf.io/9yqxw/
2.5/n Important to note that this is a very influential paper. It has been in >100 news stories, and has been cited by the EU and WHO (!)

Worrying that until recently it was openly wrong
Read 33 tweets
10 Jan
GETTING SICK IS NOT A MORAL FAILING
Yes, this applies to COVID-19 as well. Stop blaming people for being sick
"But they didn't wear a mask" lots of people who DID wear a mask got COVID-19, it's not perfect protection, you can't apply morality to something that is largely out of your control
Read 4 tweets

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