So here're my thoughts on the govt's COVID-19 Response Spring 2021 plan.

This is a cynical bastard's take on the plan. For actual scientific information, please follow @dgurdasani1 @trishgreenhalgh @chrischirp @Dr2NisreenAlwan

Here goes:
- This is not a plan for controlling the pandemic.
- This is a plan for opening up the country, presumably to save the economy, hoping to get life back to normal, placating the COVID sceptics in your party.
- According to the plan, R will rise, cases will go up and there will be more deaths (the most conservative estimate is a further 30,000 deaths over the next 4 months). This is baked in.
- Rises in cases will be acceptable as long as NHS capacity is not overwhelmed i.e. it's ok if it is at breaking point as long as it does not break.
- All schools will reopen on the 8th of March with little in the way of mitigatory measures: R will rise significantly.
- The packaging is slicker, the language sounds more 'sciency' but the plan is very similar to last year. Most striking is the repeated msging around being guided by the data when the entire plan is timetabled by date till June. Has the feel of 'a suitable form of words'.
- There is the very clever use of the 'no earlier than X date' for each of the planned steps. Makes it sound cautious when actually each step represents a massive risk of increased transmission and is timetabled 5 weeks from the previous one.
- There are 4 tests to be met before moving to the next step:
1. Are we continuing to role out vaccines?
2. Are vaccines working well enough to reduce hospitalisations and deaths?
3. Is the NHS overwhelmed?
4. Any new variants that mean we should rethink plans? (7/12)
These tests have no specified cut-offs e.g. how well are we rolling out vaccines? What is unsustainable burden on the NHS? It's a bit like the government marking it's own test papers.
Further, the tests have no relation to cases. Even with skyrocketing cases you can pass all 4 tests because at least 3 and 4 will take a while to go red and you can be well into the next step before the consequences of the previous one start to show up.
- Another clever bit. The document has sections on all the key areas of concern: schools, test-trace-isolate, support for isolation, border controls. So in response to any concerns raised about these, the govt can always say, our plan covers that.
- That makes the plan great for press conferences and interviews. However if you look under the section headings, there's little meaningful content or change from what's already happening. The plan covers all these key areas but doesn't have much of a plan for them.
E.g. a year in, the plan talks about setting up a test-trace-isolate system for the future, including getting more private providers for tests.
-And here's the big kicker, the plan is based on continuing to live with COVID, not getting on top of it.

We're screwed.

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More from @HZiauddeen

19 Feb
Depression and anxiety disorders occur more frequently in women & girls compared to boys & men, with estimates as high as 2:1. I have been wondering how much of this difference is attributable to misogyny and sexism (working with @kate_manne's definitions here)
A few points up front. (1) I do not have any answers to offer, this is essentially me wondering out loud. (2) This is from a psychiatrist’s perspective. (3) I am not going to get into ascertainment issues i.e. are women more likely to be diagnosed with depression & anxiety
(4) Such differences in prevalence are nearly always multifactorial (biology & environment). I am wondering how much misogyny and sexism contribute to this multifactorial causation. Given this particular focus, hopefully we can avoid whataboutery
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26 Oct 20
@dgurdasani1 and I have just published this piece in the Byline times. Not going to talk about the whole piece in this thread but just wanted to focus on three key aspects
The first is the two false dichotomies that have seriously hampered our pandemic response and continue to do so. (2/n)
The second aspect is the lockdown strawman. Nobody wants or is advocating for lockdown because ltheyare very hard and have multiple costs. Having to lockdown is a point of extremis because it mean you've failed to control the pandemic. (3/n)
Read 7 tweets
21 Oct 20
Tweetpost: Power and discrimination

1. This is about how power operates in societies & systems across the hierarchies of caste, gender, sexuality, ableness and class. This is a distillation of the wisdom and insights of several brilliant women whose work I have read recently.
2. The specific works are:
@Isabelwilkerson's 'Caste',
@kate_manne's 'Down Girl' & Entitled,
@IjeomaOluo’s 'So You want to Talk about Race’,
Angela Saini's 'Inferior' and 'Superior'.
Any errors of fact or interpretation are my own.
3. I would highly recommend all of the above and also @AnandWrites 'Winners Take All' and @JYSexton's 'American Rule', both excellent books that have been tremendously helpful in shaping my thinking about this.
Read 111 tweets
9 Sep 20
Tweetpost: Functioning and its cost

1.This post is about functioning in psychiatry and mental illness but a lot of it will apply to most areas of health and medicine.
2.Here I’m going to talk about functioning for a given individual i.e. how well they are able to function in their own lives NOT about the expectations of the society or rabidly capitalistic system that they happen to be born into (more on that in next tweetpost)
3.Functioning for our present purposes can be thought of as: to what extent is the person able to manage what they need to and want to do in their life? Both ‘need to’ and ‘want to’ are important and we should consider as far as possible all aspects of their life.
Read 52 tweets
24 Jun 20
Using meritocracy as opposition to representation and equity:
A very predictable response to calls for greater representation and equity, is ‘the job/opportunity should go to the best person’.
Here’s a thread about this rather devious tactic.
This thread has been occasioned by a fair bit of ‘should go to the best person’ that I’ve seen recently, as in response to the #BLACK_LIVES_MATTER protests, several organisations have been trying (or seen to be trying) to improve their representation of BAME individuals.
One hears this whenever there is an attempt to meaningfully improve representation of any minority group (e.g. women, BAME) in any system. By meaningful representation, I mean sharing of power, from being part of the voices that are heard, to making actual decisions.
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26 Apr 20
Tweetpost: COVID planning in community mental health services
Here is a thread about some of the thinking that went into our service’s COVID planning. I’d be grateful for any comments and criticism as they would be a great help in revising plans as we go. (1/24)
So a couple of important points up front. (1) We’re an early intervention in psychosis service (2) This is a service level plan i.e. how we as a service best look after everyone under our care for at least the next 3-4 months and how we look after ourselves to ensure this. (2/24)
(3) Each individual should get (as far as is possible) the care/treatment that was planned/promised before COVID19 in addition to whatever else they need currently. (4) Delivery of both of the above will be affected by staff and/or their families becoming ill. (3/24)
Read 24 tweets

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