LONG THREAD (21 tweets): As schools return this week in England, am I optimistic or pessimistic about Covid right now?

TLDR: Both - but veering pessimistic. But the policy shifts to move me into optimism are NOT that big!

Let’s start with the optimism & end with the worries.
2. The vaccine roll out is going amazingly well. Over 30% of adult population in England has now been vaccinated and we are on track to offer everyone a first dose by July – and perhaps even earlier. Uptake has also been much higher than anticipated.
3. Not just that, but the vaccines work better than expected. They are not only v effective at preventing illness, hospitalisation & death but are also effective at reducing transmission – this means vaxxed much less likely to spread covid to others.

vox.com/future-perfect…
4. And after flattening a couple of weeks ago, cases are dropping faster again… Is this vaccines starting to combine with lockdown restrictions (esp care home & health care workers being several weeks out from first dose)?
5. Lockdown has also worked better than I was expecting – I was worried (as were others) that the restrictions & support for isolation & workplaces wouldn’t be enough to bring cases down quickly with the new more transmissible strain.
6. Indoor spaces are not opening up until mid April at the earliest according to the roadmap (EXCEPT schools – more of that later) with gyms, hairdressers, shops… and indoor household mixing, indoor pubs *potentially* 5 weeks later

bbc.co.uk/news/explainer…
7. IF (again more later) we can keep R down to 0.85-0.9 as we open (higher than now), we could be at 500-1000 confirmed cases a day by mid May & could keep cases reducing over summer w most adults vaxxed until we reach v low levels & stay there with minimal restrictions.
8. That's the optimistic scenario.

So what are the potential problems? Why am I hesitating to be optimistic?

(tip: Remember the a-d problems in next tweet!)
9. The optimistic scenario relies on: a) the vaccines doing almost all the heavy lifting of keeping cases as we open up; b) being able to open schools up AND keep cases reducing (R<1); c) no new variants popping up that resist the vaccines; d) on cases getting low everywhere
10. On a): Vaccines can do, and will do, a lot of heavy lifting. But even in Israel (which has same variant as us) where a high percentage of all adults have been vaxxed, cases are still relatively high & are plateauing at 4x their lowest numbers
11. On b): SAGE thinks opening schools all at once likely to push R over 1 (ie cases ⬆️). Other UK nations doing a phased opening. The big difference between this lockdown & November was schools. Cases rose in the SE last Nov. Most school staff & parents haven’t been vaxxed yet.
12. That said, Scotland doing well 2 weeks after primary schools opened & France has successfully kept its schools open whole time. But both are doing more mitigation than England – we can & must make schools safer. Ultimately we need to vax kids too.

osf.io/qg4bj/
13. On c): if we tolerate cases at current(ish) levels, then we DO risk new vax-resistant variants emerging here, esp while we are still rolling vax out & millions are on 1 dose. We are also at high risk of importing new variants – our border policies are nowhere strict enough
14. A year ago, over 1000 separate seeding events launched the pandemic here. Last summer, travel reseeded covid in places that were near max suppression like Ireland & Scotland. Selection pressure on covid is increasing rapidly. Our border policy is basically a big fat gamble
15. A new vax resistant variant risks a whole new wave, new lockdowns, waiting for updated vaccines and re-delivering them to people already vaxxed. It risks more stress for the NHS, more deaths, more people living with long Covid and another very difficult winter.
16. On d), last year we saw areas w stubbornly high cases. We’re seeing it again now (see this thread ). Basically, the inequalities that covid has so blatantly exposed risk Covid becoming a disease of poverty, like TB before it.

london.gov.uk/sites/default/…
17. A-D are SOLVABLE things, by supporting vax pgm with tried & tested public health measures such as excellent test & trace (particularly supported isolation), safer workspaces, safer schools, tackling poverty, addressing vaccine hesitancy & stricter border policy THIS year.
18. Vaccination makes many of these things EASIER, but not less important!

Tackling poverty & inequality obv much harder, but underlies the fundamentals of better public health, for covid and everything else.
19. So my pessimism comes from the fact that current gov strategy is relying almost entirely on vaccination. Basically, it’s leaving a route out of the pandemic this year to a lot of chance. The govt is crossing its fingers and hoping it’ll get away with it.
20. Maybe we'll get lucky. What I find so frustrating is that not that much more effort makes a route out of pandemic this year *so so much more likely*.

But without govt doing more to address those four issues A-D, I am veering towards pessimism.
21. So I am torn. We’ll know a lot more by end April: will vax pgm offset opening? But the importation of new variants is the big risk that we are just not doing enough about.

I hope we'll be lucky but I wish with all my heart that we weren't relying so much on luck. /END
PS Even under the most optimistic scenario, the NHS has been battered and needs time, understanding and funding to recover. The pressures are NOT over given the massive care backlogs that have accrued & hundreds of thousands of people living with long covid.
PPS I'm staying in the UK this year. Minimal foreign travel is best bet for 2021.

I'm not saying shut borders forever - I'm saying if we can prevent 3rd wave this year, we'll be in much better place next year with fully vaxxed pop (inc kids) & knowledge of emergent variants.

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More from @chrischirp

26 Feb
THREAD on COVID and DEPRIVATION:

As cases recede nationally, some areas remain stubbornly high. Many have been persistently high for months. Deprivation is an important aspect of this.

This is a tour of deprivation & covid & what it means

(21 tweets but pls read).
2. First, how is deprivation measured? Usually by the "Index of multiple Deprivation". This assigns a value to every neighbourhood (~7000 people) based on 7 domains of deprivation.

arcgis.com/apps/Cascade/i…
3. All neighbourhoods (technically MSOAs) are then ranked in order of deprivation and split into 5 equally sized groups ("quintiles"). Every person in population can then be assigned to one deprivation quintile from most deprived to least deprived based on where they live.
Read 21 tweets
23 Feb
1. LONG THREAD ON COVID, LOCKDOWN & THE ROADMAP:

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
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.
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. lrb.co.uk/the-paper/v43/…

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).
this section highlights the success of the UK vaccination programme so far
Read 5 tweets
21 Feb
THREAD ON LONG COVID & KIDS:

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

ONS Infection survey updated its estimates for Long Covid a couple of weeks ago.

assets.publishing.service.gov.uk/government/upl…
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.

BUT
Read 16 tweets
18 Feb
QUICK THREAD ON LATERAL FLOW DEVICE (LFD) TESTS:

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
THREAD ON UK VACCINATION PROGRAMME:

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

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