Re-opening schools & increasing wider social activity is going to increase transmission, & possibly may push R above 1.

This may lead to a surge in younger people (including in many over 50s), poss leading to great stress on NHS again.

We are not at all out of the woods yet.
Understandably, everyone is focussed on what date they can see their friends & family, get their kids back in school, or do x activity again.

But more important than lifting or imposing restrictions for sustainable pandemic control is proper Public Health policies & resources.
Rather than just asking about restrictions (or the lifting of them), it is important to continue asking about resources...

We can't just rely on vaccination alone - coverage is not nearly high enough to prevent a sig surge.

So what resources are government going to provide...?
As well as vaccination, the government seem set on mass testing (screening), including of schools, as the way out of the pandemic.

But the usefulness of screening tests is determined by the effectiveness of the intervention they trigger...
What interventions can justify covid-19 screening tests, given the barriers to self-isolation faced by those at highest risk of a positive result?

The UK's level of support to isolate is quite simply not up to the job currently.
Vaccination shifts the burden of self-isolation even further onto key workers & socioeconomically disadvantaged groups.
These communities will continue to be hit harder by the virus & the associated restrictions.
(Good blog on this by @jackiecassell here).
jackiecassell.com/self-isolation…
Providing support to isolate would increase test uptake, self-isolation rates, and the number of contacts given - All of which facilitate greater control of transmission.

It could be the difference between keeping R≤1 for many more weeks, therefore preventing a spring surge...
For more info on why support for self-isolation is so important, what kind of support people need, and some examples of successful support schemes, we wrote about it in our @bmj_latest piece here 👇

#ResourcesBeforeRestrictions #SupportToIsolate.

bmj.com/content/372/bm…

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More from @ScienceShared

20 Feb
Interesting study on test-to-release for contacts in school settings.

Study shows a PCR test of school contacts on day 9 can reduce total time-off school (reduced loss of instruction compared to 14 day quarantine of all contacts).

1/

jamanetwork.com/journals/jama/…
Obviously caveat for UK needed as in UK policy for contacts is now a 10 not 14 day quarantine, so test-to-release on day 9 may not really be worth it (similar to a q asked by one of the responses to the article, in Figure below).

2/
But other (real-world) studies suggest PCR test-to-release on day 5-7 may be as effective.

bmj.com/content/372/bm…

Modelling also suggests daily LFD for 5-7 days may work too (awaiting pilot data).

thelancet.com/journals/lanpu…

3/
Read 5 tweets
16 Feb
The @ONS have (rightfully) received a lot of praise throughout the pandemic.

But the publishing of Long COVID data without a comparator group is poor use of statistics - Floating data points without denominators are not particularly helpful or useful.
ons.gov.uk/peoplepopulati…
1/
See here for why LongCOVID data presented without comparator groups can result in misguided interpretations of data.

2/

Unfortunately, these data are now being readily broadcast by high profile scientists and some politicians, and are understandably causing some panic among parents & the public.

3/
Read 6 tweets
11 Feb
#COVIDUNKNOWNS webinar on testing was brilliant.

Such a wide range of experts discussing such an important but complex topic 👍

Would really recommend watching if you want to learn more about testing and COVID-19 responses.

@drphilhammond takeaway...

Since the landmark principles of a population screening test were first set out in 1968, it has been accepted that the usefulness of screening tests is determined by the effectiveness of the intervention they trigger.

@mugecevik @jackiecassell @sdbaral

bmj.com/content/372/bm…
What interventions can justify covid-19 screening tests, given the barriers to self-isolation faced by those at highest risk of a positive result?
Read 4 tweets
9 Feb
"Over 500 hotels are waiting to accept homeless, covid positive patients needing step-down care, NHS staff looking to distance safely from family while working, & those who have been asked to self-isolate but would find it difficult to do so from home."

bmj.com/content/372/bm…
"5000 rooms could be prepared within 72 hours of being asked. The hotels are fully insured to handle patients and staff, and hotel workers have been trained to clean and work in a way that minimises risk of spread. The whole enterprise is charged at cost with no profit made..." Image
"The UK government’s response to the proposal has been muted, however. Hotel isolation is being implemented but only for a small number of international travellers arriving in the UK from certain countries where cases are high..."

3/ Image
Read 11 tweets
3 Feb
Our new @bmj_latest paper 'Put to the test: use of rapid testing technologies for Covid-19' analyses how new technologies can be most appropriately used to support different testing strategies & examines the benefits and risks.

A Twitter summary 👇

1/
bmj.com/content/372/bm…
In this paper, we first explain why the transmission dynamics of SARS-CoV-2 mean testing turnaround time is crucial if testing is to have an impact on transmission, before summarising the problems of false positives, false negatives, and test result interpretation.

2/
We then go on to describe novel tests, focussing in particular on rapid antigen lateral flow tests.

Lateral flow tests aim to detect only infectious cases, can be scaled up quickly for decentralised testing, do not require laboratories, and provide results rapidly.

3/
Read 15 tweets
2 Feb
Again, lots of clamour to close the borders or have mandatory hotel quarantine, and Scotland now implementing managed quarantine for all itl arrivals.

But the latest PHE report and other analysis suggests E484K mutation was acquired independently in the UK...
All evidence suggests that what you do at the borders is largely irrelevant if you're not controlling cases in community.

Latest PHE report adds to this, showing that as much as ppl want to believe problem is 'foreign,' mutations can & will arise in UK.

mirror.co.uk/news/uk-news/b…
Hotel quarantine of international arrivals, but not of cases in the community, is, to me at least, a very odd policy to back.

UK has possibly lower than 20% adherence to self-isolation.

Where is the clamour to offer hotel accommodation to community cases..?
Read 5 tweets

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