On @BBCOS today discussing the tragedy of exceeding 100,000 COVID-19 deaths in the UK, and what led to this.

19:03 for a bit and then 19:23 onwards:

Also, a few thoughts in a thread below:
The PM said during the briefing today, that the govt did the best they could. He was 'deeply sorry' for every single death.

If every single death is a tragedy, then why didn't we treat every death as preventable?

Why did we repeatedly talk about 'tolerable deaths'?
How on earth can he say he did his best, when UK policy was almost never evidence based - and the govt invited proponents of the ideology of naturally acquired herd immunity to brief him on policy- at a point in time we urgently needed to act to prevent thousands of deaths?
When the UK was late in every single response -
Late to lockdown 3 times
Late to introduce policy on masks
Late to introduce quarantine
Late to introduce test, trace & isolate
Late to enact school closures
Almost no mitigation in schools
Shamefully low support for isolation
The tragedy of all this is, the govt, and it's key advisors still haven't learned.

Whitty said he today has learned so much in the past year.

If he has, why is he still talking about 'tolerable deaths' and 'living with the virus'?

When it's clear we can't afford this.
The science has advanced a lot, but did we need all this knowledge to mount a successful pandemic response? No.

Countries that did this successfully acted aggressively focusing on elimination with basic public health principles we know so well.

We never managed to apply these.
We treated it like the flu. Despite having the opportunity to learn from countries ahead of us on the pandemic curve, we embraced British exceptionalism. We knew better. Contact tracing was for low/middle income countries. Quarantine was not effective and didn't apply to us.
We were going to base our response on new world beating tests & technologies.
Millions of untried antibody tests
Ventilators made by Dyson
An exceptional digital contact tracing system
A world beating test, trace & isolate system
Operation Moonshot
Nightingale hospitals
We employed clever policies such as:
Eat out to Help out
Get back to work
Save Christmas!

We couldn't possibly treat our 'freedom loving' population to 'draconian' measures.

We wouldn't be like 'those' countries taking away people's liberties.
And we aren't.

Three lockdowns later we have the third highest mortality per population in the world.

*5000 times* higher than Taiwan
*500 times* higher than New-Zealand

What did these countries do? Recognise the seriousness of the pandemic and take aggressive measures early.
The measures in themselves weren't complicated- they were basic public health 101. And there is absolutely no reason, a well resourced country like the Uk couldn't have done this. If we failed, it's because we had a govt that repeatedly failed us.
A govt that never understood that we can't 'live with the virus'. This policy inevitably leads to surges, deaths, lockdowns. It devastates the economy. Paradoxically, our focus on liberties & the economy led us directly to losing our liberties & our livelihoods.
So, please don't tell me that we're unlucky, or our population is demographically or culturally different, or that our country is too connected geographically (we're an island!). These are excuses to abdicate responsibility from where it truly lies.
And please don't tell me this is down to the variant. We were well ahead in terms of our mortality even before this, during the 1st wave, and we acted late again in autumn (> 1 month after SAGE advised lockdown in Sept)- cases were surging before the variant was even dominant.
Of course the variant made matters worse. But why did we let transmission continue at high levels for such a long time - and produce conditions conducive for the virus to mutate and adapt? And why didn't we treat the variant as an emergency & prevent spread to other regions?
The govt saw risks too late, reacted rather than prevented, didn't have the courage to reflect on their mistakes, & learn from them. And for all the empty rhetoric, they still haven't. We will continue to see many many more deaths, unless our govt actually listen, watch & learn.

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More from @dgurdasani1

23 Jan
Thread on the recent report on the possible risk of increased death associated with the new UK variant (B117)- with a discussion of the evidence around this, and what this means.
First, there is strong evidence to support increased transmissibility of B117 - current estimates of increased transmissibility range between 30-70% - from epidemiological evidence examining the differential rate of growth of B117 with respect to other variants & increase in R
There is also evidence from PHE contact studies that the risk of transmission from those carrying the B117 variant is ~50% greater than with other non-B117 variants.
Read 27 tweets
19 Jan
Very concerning report - 47 cases of the 501Y.V2 (variant arisen from South Africa) reported in surveillance within the UK. This is the variant with the E484K mutation that has been associated with significant escape from antibodies in the laboratory. 🧵

More information on the variant here.Using plasma those infected in the 1st wave (with robust antibody responses) >90% showed reduced neutralisation with the variant and 48% showed complete escape. How this translates to vaccine response isn't clear yet.

Antibody neutralisation is only one part of the immune response. T cell adaptive responses are also important, but the early data on reduced neutralisation are concerning. We need to look carefully at vaccine effectiveness against this variant.
Read 7 tweets
18 Jan
But it isn't less from kids than adults!! That's the point. Where is the evidence to support that?

WE certainly have evidence to the contrary? Even from within England.
The evidence from England is actually the *opposite* that children were *more* likely to bring infection into the household, and when they did *more* likely to transmit. So this is just not correct. And it should be corrected, given this isn't evidence based at all.
The PHE contact tracing data isn't suitable to assess transmission for children. There's been so much written on this- symptom based testing underestimates susceptibility & transmission from children. The ONS data are available & much less biased- and do not back up this claim.
Read 4 tweets
18 Jan
This is flawed interpretation of data, and should be corrected. I see experts constantly read biased evidence on child transmission at face value, despite this being inconsistent with less biased studies even from the same context. My thread linked below:

Short summary: Symptom based contact tracing has always underestimated the secondary attack rates in children. Just compare contact tracing results even from the previous variant in England from the recent PHE report to the ONS household infection survey. Starkly different.
Why? Because symptom based contact tracing
1. Hugely underestimates children as index cases (less likely to be symptomatic)
2. Often mis-assigns *index caseness* to adults who are subsequently affected because the child was asymptomatic & not tested initially.
Read 9 tweets
17 Jan
Key work by @GuptaR_lab on neutralising antibody response to SARS-CoV-2 virus among people vaccinated with Pfizer 3 wks post-1st dose.

All <80s (8/8) but <50% (7/15) >80 yr olds neutralised the virus >50%.

So less potent response in >80s. No data on the booster response yet.
This is consistent with our understanding that immune responses among the elderly may be less potent. In light of this, we urgently need data on the elderly before considering delaying the 2nd dose, including data on post-2nd dose neutralisation & the impact of delayed booster.
Given our focus on protection of the vulnerable and elderly, to prevent deaths, it's crucial we understand the impact of policy on protection conferred among these groups. Data on overall efficacy may not be generalisable to the elderly as immune responses may be less potent.
Read 7 tweets
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?
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

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