Thread by @ewanbirney

This weekend is a festival of sport in the UK - Premier League action (sadly - Arsenal lost); Start of Rugby's 6 nations; Superbowl - against a background of a COVID still whipping around us. Some thoughts from sport-heavy London:

Reminder: SARS-CoV-2 is an infectious virus which causes a nasty disease (COVID) in a subset of people (more likely if older; male; overweight) and sadly a proportion of people die who get the disease.

If we let the virus follow its natural course in populations our health care systems would be overwhelmed; far more people would die both due to the virus and other things and it would be near catastrophic for the function of modern society

Many things have gone better than expected - most notably we have a large number of vaccines that work and additional treatments and clinical refinement have substantially improved treating the disease.

There have been some expected but against us moves - a number of mutations have occurred in different locations that have made the virus more transmissible and sometimes able to partially escape previous immunity.

(Both UK - England specifically - and now Portugal have gotten close to healthcare melt down in this B117 wave, and it seems clear that Europe as a whole - probably the world - will have to navigate B.1.1.7 / B1.351 / P.1 - and likely more changes in the future).

The exciting news though is vaccines - they work; we have a number of them. Most heartening is that Israel, which has had an excellent vaccine deployment shows clear impacts in reduction to mortality and hospitalisations due to vaccination

This primarily the Pfzier/BioNTech vaccine. The Ox/AZ vaccine (which I am on one of the trials) looks clear that a "long" 12 week dosing works if anything better than shorter (certainly not worse); I look forward to seeing real world data similar to Israel's from the UK.

Vaccines are brilliant, but they take time to just supply and deliver into people (there are a lot of people!) and time to take effect. Israel is only seeing its effects now and it vaccinated over twice as fast as nearly anyone else.

It's notable to me that Israel has not (yet) relaxed it's lockdown (though I think the debate is raging there). In one sense one has metrics of both cases and hospitalisations to be able to know if more transmission could be tolerated - not yet in Israel.

(One needs to work back 3 weeks from now to know what level one might have to hit for efficacy. My naive view is that 3 weeks ago Israel was ~25-30% vaccinated - so one has to wait to at this level, presumably further).

There is an unhelpful debate certainly in the UK about pitching scientists/modellers/healthcare leaders as risk adverse lockdown lovers with from my perspective very little desire to think this through.

to them: (a) we need to watch Israel, watch when they relax and what happens. We should learn from them and (b) don't forget that every week probably another 3 million people will be vaccinated in the UK, ie extending time here should simply buy us certainty of health+economy

It feels pretty bonkers (but that seems sometimes normal for COVID times) to discuss when UK is relaxing it's NPIs when Israel has not yet; Israel's reluctance is not being risk adverse, it is just ... complex and a long road from "vaccines work" to "vaccines means lower NPIs"

(Meta comment: one failure in the UK setting at least, if not worldwide is not merging technical science/healthcare scenario planning with technical economy planning. The end result is that it feels we do science+economy in the political arena without a joint understanding >>

<< this is bad; it's bad science and from my amateur economics side, bad economics. To stress - there are many decisions which must be made by elected officials across a complex and frankly really unattractive scenario landscape;

but by not fusing the technical advice we've ended up making the scenario landscape far mushier and messed up for politicians to see their way through it. Post pandemic we must have stronger economy+science policy schemes, thinking, "war games" etc)

Looking at Europe besides the UK, the complexity of securing vaccine supply with much high politics and complications is going to constrain EU for a while (as the German health minister has pointed out, at least a tight 10 weeks).

This is frustrating as every week is a week one could be vaccinating; however, I am sure the vaccine supply will be sorted out, and once that has happened the vaccine deployment and application rate must be as fast as possible.

Quite a lot of this sort of process is about rates above all, and one has to anticipate solving the current rate limiting step (supply) and thus ensure the downstream rates are good.

Across the developed nations (US, EU, UK, Canada etc) have over capacity in vaccine production will be good because... the real unit for vaccination in the world.

Here the cheap price, unfussy licensing and exponential growth as a (harmless, modified) virus itself of the Ox/AZ vaccine is brilliant; The 5 million doses delivered in India and 3 million in Brazil is a start along a very long road.

Rugby has started. I am ... optimistic, but 2021 is going to be a long road. It will get an easier road to walk.