The thing is that much of this article could have been written at multiple points over the last year. Viruses are not influenced by bluster. Fortunately they are impacted by vaccine induced immunity. A few thoughts... 1/n…
Cases are falling quickly in the UK and elsewhere, which is great. The reasons are not clear, but it is reasonable to think that some of it is down to the comparatively rapid and effective vaccine roll out *together with* current numbers of contacts 2/n
If those numbers of contacts and opportunities for transmission increase, then we can expect cases to increase too. That is why caution is merited. The more people are protected by vaccination, the more contacts can happen, and there is something else... 3/n
As the weather improves and more contacts can take place outside, we can expect seasonality to have an impact. The regular coronaviruses peak in January, and so some of what we’re seeing (in the US too) may reflect that, including a spike following the holidays 4/n
(In passing, it is extraordinary the range of different US states that saw a peak around that time, speaking to the importance of the contacts made over the holidays) 5/n
So we expect based on this and the experience of last year that cases will drop over the later spring and summer, but it is important to remember that the virus won’t go away on its own. More vaccination will help, as will parallel but hopefully loosening restrictions 6/n
Why ‘hopefully’? Well there are still important areas of uncertainty when it comes to the later trajectory of the pandemic. Here are a few - how much of the reduction is vaccine, vs infection induced immunity, vs seasonality and non-pharmaceutical interventions? 7/n
The vaccines are not all the same. They are good at preventing severe outcomes of infection, but to get the population rather than the individual benefit they need to arrest transmission. And it is less clear how good they are at that 8/n
And then there is the issue of variants. These are NOT escape mutants (for a start they have arisen in the absence of large scale vaccination) but they may be better able to transmit among vaccinated or previously infected individuals 9/n
The upshot is the potential for transmission to tick up again, especially among unvaccinated individuals. Even if the age group in question is less likely to require hospitalization, some of them will, and more will be left with chronic post-covid symptoms 10/n
However *when* this would happen depends a lot on all the moving parts I mentioned earlier - vaccination, seasonality, variants, contact patterns. Whatever happens over the next few months we will need to keep paying attention, especially come the fall 11/end

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More from @BillHanage

2 Feb
I think it is fair to say now that B.1.1.7 is definitely more transmissible, and possibly more virulent. This also reports cases that have acquired E484K, a mutation found in the other variants. This is concerning, but not reason to go crazy. A thread 1/n…
First let's put to bed any suggestion that overdispersion in transmission explains B.1.1.7's rise. Consider data from Denmark, Ireland and now LA to mention only a few. It's behaving as we expect 2/n
This is the weekly increase in England documented in the linked report since early October. It's quite interesting that it's not taken over completely but don't want to speculate why 3/n
Read 15 tweets
1 Feb
I am all for large amounts of testing, but I doubt this will be sufficient to do more than slow things down (good in its own right of course). There's also not much in here on what will be done in the event of a positive test.…
That's what people forget. If a positive test does not lead to action that stops transmission, meaning support to allow isolation and quarantine of contacts, you're really only keeping score for the virus
Read 4 tweets
23 Jan
Some recent credible studies from the UK suggest that the variant B.1.1.7 which was first detected there is not only more transmissible but associated with greater severity, measured by deaths. A thread 1/n
The studies on which this is based are summarized in this document. Notably, it is not founded on one study, but several. They incorporate different data, methods and different biases and they are all imperfect, but they point in the same direction.… 2/n
The upshot is that people infected with B.1.1.7 are about one third more likely to die than similar people infected with the pre-existing viral lineages. There is a LOT of uncertainty around that number. For a lot of reasons. But some increase (even if small) seems legit 3/n
Read 11 tweets
16 Jan
My announcement that I was running with a mask got a LOT of comment (from all sides) earlier. It’s in response to changes in the state of the pandemic and the transmissibility of the virus. Worth unpacking 1/goodness knows
First I posted the photo after a couple of interviews this week in which mask use outside was discussed in the context of surging infections due to the variant B.1.1.7. Here's one
And then this with RTE where were talked about mask use in the context of the situation in the Republic of Ireland, where cases are surging. I commented that I run with a mask. Hence the tweet

Read 13 tweets
15 Jan
I’ve thought long and hard about this. There is a constellation of circumstantial evidence around the most recently identified variant P.1, and what has been happening in Manaus, Brazil which makes me very seriously concerned. A thread 🧵
First Manaus has already been very hard hit by the pandemic. News reports in earlier stages told of rushed burials and bodies piling up…
The crucial thing was the rapid rates of transmission, not really mitigated by ‘flattening the curve’ any. total per capita mortality was not as high as might be expected elsewhere, but only because the age structure of the population in Manaus skews young…
Read 13 tweets
14 Jan
The UK has other problems for the next month or so, but this decision in my opinion hugely misses the point of rapid testing for schools or other places 1/n…
Imagine you only detect 75% of true cases of infection. Well, you just cut the risk of transmission in school by 75% and that's not nothing. What about the remaining 25%? Use masks as well. Anything that makes it through the rapid test now has to beat the mask 2/n
Two masks actually, if everyone is using them. This article with @j_g_allen and @jenkinshelen explains why this is important 3/n…
Read 9 tweets

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