On a lighter note this weekend, let me tell you the story of a (not so secret) service dedicated to protecting the human population from aliens.
1/

(They don't usually dress like that btw with exception of maybe @antmikeg & @Smithkjj )
And by aliens I mean the bug kind...

(Sometimes real biology looks worse than our imagined extra-terrestrial invaders)

If you've not guessed yet I'm referring to Health Protection teams across the UK who deal with communicable diseases & environmental health threats.

2/
HP teams are made up of a diverse lot of professionals: communicable disease control consultants, nurses, practitioners, scientists, epidemiologists, microbiologists, analysts, emergency planners, etc.... that reflect the skill mix required.

3/
They do a lot of infectious disease surveillance that goes on in the background in normal times, looking out for the next outbreak, or forecasting changes in infection trends, or monitoring effect of vaccines etc. They're experts at making sense of all that surveillance data.
4/
And they do lots of investigative work to find out whodunit, kinda like outbreak/infectious disease detectives investigating a microbial crime scene. Where did it start? How did it start? Who got hurt? Where's it gone? Why did it happen? Etc...

5/
In this endeavour they're often supported by a diverse cast that includes colleagues from infectious diseases, virology, microbiology, environmental health, sexual health, animal/plant health, Health & Safety, immunology, vaccinology, public health, etc.

6/
They help coordinate outbreak investigations & response that involves an orchestra of different agencies from hospitals to clinics to local authorities etc...

7/
They make sense of the evidence base and help create guidance for partners and others so that responses are evidence-based, uptodate, proportionate & standardised.

8/

(Well done to @RenuBindra & team who've slogged thru the past year)
They're experts at assessing risk & managing uncertainty. Often people seek zero risk solutions that don't exist & it's a real tough task to find right balance between risks, harms, & ensuring proportionate responses. Not easy shouldering uncertainty.

9/
They're the national pandemic insurance / security blanket. When it all goes right, no one notices or cares (& in past decade there have been cuts to the service). But, when the brown stuff hits the cooling apparatus, they are who you need to help dig you out of it.

10/
ICYMI the last 2 decades has been eventful: SARS, swine flu, Ebola, MERS, avian flu, super-gonorrhoea, carbapenemase producing organisms, XDR TB, polonium, Novichok, anti-vaxxers, etc... As COVID has shown us, we're only a spillover or mutation away from the next epidemic.

11/
They bridge the science & operational end of public health for infectious disease control. It's a highly specialist field of public health whose practitioners have had years of training & prior experience from clinical medicine, infection control, environmental health, etc.

12/
Lastly I do feel health protection is one thing that the UK is good at and it remains to be seen what the new NIHP will bring.

Some good communicable disease control specialists to follow on social media include @doctorshaib & @petermbenglish

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More from @andrewleedr

18 Feb
Normally I enjoy the high standards of journalism in @guardian . Not today as disappointed with misleading headline that suggest infections are spreading fastest in children. It'll worry parents/teachers & I doubt most readers will unpick the headline.
1/
theguardian.com/world/2021/feb…
The latest REACT1 report shows prevalence of infection in ALL age groups has fallen, including children aged 5-12 from 1.59% in Round 8 to 0.86% in Round 9a. The authors of REACT1 report also (wisely) didn't try to interpret the prevalence figures.
2/
spiral.imperial.ac.uk/bitstream/1004…
If this were a research trial you wouldn't place much weight on the age differences in % prevalence because of the wide confidence intervals, i.e. differences weren't statistically significant.
3/
Read 16 tweets
3 Feb
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/
Read 6 tweets
3 Feb
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/
Read 11 tweets
17 Jan
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)
Read 16 tweets
10 Oct 20
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.
3/
Read 8 tweets
1 Oct 20
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.

Good article by @zeynep explaining the rationale.
theatlantic.com/health/archive…
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 Image
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!

2/n Image
Read 13 tweets

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