TLDR: I don't think we should ignore it.

ONS Infection survey updated its estimates for Long Covid a couple of weeks ago.…
It showed that 13% of under 11's and about 15% of 12-16 yr olds reported at least one symptom 5 weeks after confirmed Covid-19 infection.

ONS samples households randomly - so positive cases do not depend on having had symptoms & being tested.
Many have criticised this data because there is no comparator group of kids who had *not* tested positive for Covid and because some of the symptoms are common in childhood. (e.g. fever, cough)

These are perfectly valid criticisms and ideally we would have that.

ONS asks people *every week* for first 4 weeks and then every month after that. They measure duration of symptoms until *first* contact with no reported symptoms after first positive test. This reduces the chance that people are just reporting new colds etc for their kids...
But it is of course still possible. ONS lists the biases in the survey currently and some act to underestimate how common long covid is ("Downwards") and some act to overestimate it ("Upwards").
Another (not yet peer reviewed) study from Italy, specifically looking at long covid in kids, was published this week.…
It was based on 129 children diagnosed with Covid between March and Nov. 5% of the kids were hospitalised with Covid and 75% had had symptoms.

Parents were asked about *persisting* symptoms using the ISARIC Long Covid survey. The avg time after diagnosis was about 5 months.
35% of children still had 1 or 2 symptoms and 22.5% still had 3 or more symptoms. Overall 57% still had at least 1 symptom!

This table gives the breakdown by persisting symptom and severity of initial illness.
Also, for 35% of children, parents reported that the ongoing symptoms distress the child a little or quite a lot (11% said quite a lot).
Now this is a study based on kids diagnosed in a clinical setting (I think) and is only a small sample (unlike ONS) - so it's not clear how it would translate to the general population. It also doesn't have a control group which the authors acknowledge as a key limitation.
So what does this all mean? Well none of it conclusive. But it's becoming increasingly clear that long covid in adults is a real and serious problem.…

ONS in tweet 2 suggests (unsurprisingly) that is less common in kids than in adults. BUT NOT uncommon.
*Even if* ONS survey overestimates persistent covid symptoms in kids by a factor of 2 or 3, that is still thousands of kids since we know prevalence of infection has been higher among school age kids than general pop when covid common & schools open.
While our vaccination programme is rapidly vaccinating millions of adults, there is no licenced vaccine for kids & won't be until probably end 2021 /early 2022.

Yes the evidence of long covid in kids is uncertain, there is so much we don't know, not least actual impact.

As Rutter & @trishgreenhalgh said in this great BMJ piece… "Consider carefully whether to wait for definitive evidence or act on the evidence you have."

Consequences of being wrong about long covid in kids are huge *if* we let covid spread through kids.
So are the consequences of keeping schools shut long term.

But we *can* do all we can do make schools as safe as possible AND drive transmission very low in communities (lower than 10 cases / 100K people / week) and so minimise the number of cases in kids (and everyone!)
I believe this is the precautionary approach.

We *can* do it - all UK nations got to lower than that last summer. Vaccination of adults will make it easier.
It *will* mean keeping in many restrictions for longer to get cases below that threshold to protect schools & kids. END

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More from @chrischirp

23 Feb

TLDR: There’s a lot to like about the roadmap – but it could be & should be made much more effective.

Because this will be tying current situation to the roadmap, I’m concentrating on English data

Read on… (22 tweets - sorry)
2. Firstly, cases across England are falling. This is good news but the pace of reduction is slowing.

England has the highest case rate in the UK and the nations with lower case rates (on the order of 100 cases/100,000 pop/week) are plateauing even more ImageImage
3. The worry is that the more transmissible new strain + many people still out at work, often in non-Covid safe workplaces, means it might be hard to get much below 100/100K/wk , esp in deprived areas, even under current restrictions.

The new strain now dominant everywhere. Image
Read 23 tweets
22 Feb
This article by @bealelab explaining the different Covid variants, possible impacts on vaccine effectiveness & future of the pandemic is quite simply one of the best I've ever read.…

Some key bits highlighted below!!
This bit explains how vaccines tartget lots of different bits of Covid to provide protection - so that even if the virus gets better at one bit, vaccines can still work by stopping other bits. This is what the case with B117 (the Kent strain). Image
this section highlights the success of the UK vaccination programme so far Image
Read 5 tweets
18 Feb

LFD tests are mainly used for testing people without symptoms and PCR tests are used for those with (new) symptoms.

LFD tests now outnumber PCR tests every week. 1/4
Unsurprisingly positivity rates for PCR tests are much higher than for LFD tests. Reassuringly positivity rates are coming down in both cohorts.

BUT if we are relying more on more on LFD tests then we *must* use them carefully! 2/4
Firstly, they should NEVER be used as a "green light" to indicate no infection - only as a "red light" to indicate that you've got Covid and should isolate.

Do a confirmatory PCR for positive LFDs to minimise false positives & ENSURE support for isolation! 3/4
Read 5 tweets
15 Feb

TLDR: At 3 mill doses/week expect a big slowdown in *first* doses in April/May. But then summer ramp up to vaccinate all adults by early September.

Increasing to *6 mill/wk* for *6 wks* in April/May could vax everyone by mid July. 1/6
This is where we are now (latest weekly data to 7 Feb). Almost all vaccinations are first dose now.

Vaccination numbers levelling out at about 3 million a week.

But in early March we need to start giving 2nd doses... 2/6
*If* we stay at 3 mill/wk doses, by May ALL those 3 mill doses will be spent giving 2nd doses to people vaccinated in Feb.

In June 1st dose ramps up again & all adults offered 1st dose by end July. Using 3 mill/wk for 2nd doses means all offered 2 doses by early Sept

BUT 3/6
Read 8 tweets
12 Feb
1. THREAD on latest UK Covid Numbers:

A reasonably detailed dive into the latest numbers & (some) implications.

TLDR: things going in right direction but don't think unlocking will be easy.
2. Confirmed cases are still falling & we are back at levels last seen in early December. Positivity rates (accounting for changes in numbers of tests) are also falling in all 4 nations (and in all age groups).

ONS infection survey entirely consistent with this picture.
3. Cases and positivity rates also falling across all English regions & LAs. However, E. Mids, Yorks & Humber and N.East falling slowest.

Obviously falls are GOOD, BUT the green diamonds show where we were at the end of Aug last year.

There is a LONG way to go.
Read 20 tweets
9 Feb
MINI THREAD: One way in which the Kent (B117) variant might help us vs SA variant... Both are more transmissible that older variants & so quickly become dominant.

BUT SA not more transmissible than Kent (we think) - so Kent, already dominant in UK, should stay dominant. 1/2
This is good because all vaccines work well against Kent (B117) & it doesn't seem to be re-infecting people who've already had covid.

But SA can re-infect people & evade (somewhat) AZ vax. Unknown is how that might help SA over time as it has more people it can spread to. 2/2
Read 4 tweets

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