In the past 15+ yrs I've worked as a GP in some of the poorest parts of Sheffield with all the social ills of poverty: debts, joblessness/job insecurity, crime, abuse, domestic violence, mental ill health, disrupted lives, chronic diseases, alcoholism, early deaths, etc... 1/
For many of my patients, poverty isn't an abstract concept you read about. It's their lived experience. It's real. It's pervasive. It wears you down. It kills your hopes & dreams. And they're trapped in a repeating cycle across generations. 2/
COVID has been really bad for them. Difficult to lockdown in rubbish housing, little greenspace, nowhere to go, nothing to do. Having debts & insecure work forces you to work. I feel most for the kids, many who went to school with my kids, but lack the opportunities mine have. 3/
Education is a key to better life opportunities for them & better lives. But even that's now denied. How do you home school/learn at home if you have no wifi/laptop, squashed with others in a 2 room terrace, with minimal teacher input? 4/
Many have missed so much school this year & probably only been in 2-3 months out of 12. The loss of learning will scar this generation, & these disadvantaged families, & their future families, for generations to come. This is real, not imagined. 5/
I'm disappointed by those who clamour for school closures on flimsy evidence. Yes the evidence isn't perfect, but it is good enough to know nurseries & primary schools can be run fairly safely. No zero risk solution. Let's not lose sight of the kids in all of this.
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Our @ScHARRSheffield MPH disaster management class recently looked at the topic of post-disaster recovery. Several key points that will be relevant as we look ahead to the coming months. (I know we are in the thick of pandemic response, but never too early to look ahead!) 1/
It needs to be a managed process that starts the moment an incident has occurred. Not just about rebuilding and recovery, but also has to incorporate prevention/risk reduction measures & preparedness for potential further crisis. 2/
Key to this will be the need for multi-sectoral rapid needs assessments. The population's needs will have changed considerably between pre-disaster and post-disaster. So NHS/LA need to start thinking about doing these RNAs to guide next steps. 3/
I tweeted last week the link to @ECDC_EU evidence review of EU & international evidence on: COVID-19 in children and the role of school settings in transmission. Just finished reading it in full & it's balanced & comprehensive. (1) ecdc.europa.eu/en/publication…
Reiterates finding that children are very unlikely to have severe illness with COVID19 infection. (2)
Shedding of viral RNA thru upper respiratory tract may be of shorter duration in children than in adults. Associated with age, although doesn't appear to be significant difference in levels of viral RNA detected in nasopharyngeal swabs between the two. (3)
The number of COVID19 cases in UK continues to rise, with a trajectory that is worryingly becoming steeper. Hospitalisations up. ICU admissions up. Community transmission & outbreaks widespread. Clearly control of the epidemic in the UK is deteriorating. Deaths will follow. 1/
Worth revisiting @acmedsci 's report in July for their predictions. acmedsci.ac.uk/file-download/…
Their predicted real worst case scenario is looking more likely.
Give or take a few weeks, we're in for a difficult winter. What's less clear is just how bad is going to get... 2/
The UK gov has thrown £billions at the problem, hired loads of private consultants & consultancy firms, been given lots of good scientific advice, done national lockdown plus local variants of lockdown lite. Yet it's not working.
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The key to better control of the #covid19 pandemic may be in identifying & preventing #superspreading, through backward tracing to identify clusters. Need to rethink our approach.
Contact tracing seeks out where the infection has come from (look for source) & where it is going (contacts of the index who may be susceptible). An assumption is that all infections are equal (i.e. every infected person has a similar chance of infecting someone else).
1/n
So with COVID19, we assume with R0=2.6, 1 infected person infects 2.6 others. But this is an erroneous assumption if superspreading is a key mode of transmission. Some infected persons are more infective!
The problem I think with the current approach to COVID19 is we are approaching it the wrong way round, from the wrong end of the telescope.
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COVID19 is a public health problem that requires a public health approach & solution. Trouble is, we often try to solve public health problems with healthcare solutions from a healthcare perspective.
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If you had cancer, it would be nice to have the best cancer diagnostics & treatments. But wouldn’t it be better not to have had cancer in the first place? What if we eliminated smoking & in doing so prevented thousands of cancers?
Similarly, COVID19 is a preventable disease.
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#Masstesting especially of asymptomatic individuals for #COVID19 is NOT a magic bullet solution.
There seems to be a lot of clamour for it but we need to consider not just the utility of testing but also the issues with it.
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A few months back a team of public health researchers @FionaBell19@lliandme@ScHARRSheffield carried out a rapid evidence review on #masstesting. We found the evidence from around the world to be mixed, patchy and limited.
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NO TEST IS PERFECT. PCR tests for COVID19 can’t always tell if it is current infection or past infection, or whether the individual is still infectious or not. Here's where clinical interpretation and judgment is key.
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