Some early thoughts on today's briefing from the PM and scientific advisors. Is the govt strategy sensible? And is it truly 'following the data', or evidence led? 🧵
First- this is not a policy of pandemic control. The govts plan out of lockdown makes clear that the focus isn't on controlling transmission as long as NHS capacity isn't breached. R/case no.s are not one of the govts tests, as long as our NHS doesn't break.

Is this sensible?
No. This is exactly the same strategy that brought us ~150,000 deaths and 1.1 million estimated people living with long COVID. We know that hospitalisations can remain just 'within capacity' while leading to tens of thousands of deaths, and hundreds of thousands with long COVID
And of course the cost to the NHS also can't be overestimated - the NHS has remained 'within capacity' as defined by hospitals being able to treat COVID patients, but waiting lists are at the worst they have been in years. So not 'reaching NHS capacity' shouldn't be the aim.
SAGE modelling suggests that it is 'highly likely' we will see a 3rd wave, and there is uncertainty around whether this will reach hospital capacity or not, given the many unknowns. Shouldn't this in of itself be very concerning?
assets.publishing.service.gov.uk/government/upl…
Especially when we could be taking simple measures for pandemic control to pre-empt this.
What do the data show?
ONS data suggest increases in infection among school-age children - with prevalence highest across all age groups in England & scotland

It's important to note that this is just after a few wks of schools re-opening & *despite* staggered re-openings in Scotland. We know what happens next - Easter holidays will dampen this, but we can expect to see spread to other groups - including many not protected by vaccines.
A very high proportion of our population is now living with long COVID- with the vast majority having impact on their day to day functioning. This includes an estimated 43,000 children. The long term impact of this infection on them and others is unknown.

It's amazing to me that despite a report coming out last week that ~1.1M people in the UK are living with long COVID, there was no mention of this by the PM, government advisors, or even by media asking questions. How do the govt justify its current strategy in light of this?
Rises in transmission could lead to hundreds of thousands more living with long COVID- particularly since the ONS data show that it's young people, including many without any pre-existing conditions who are at risk - the same groups that are not fully vaccinated.
And what about variants?
The major variants of concern identified across the world are already within our community- because of our failed border policy - which is something scientists have warned about for months.
The numbers of the so-called South Africa variant, and the Manaus variant have been increasing - some of this will be travel, and some is possibly surge testing. Given our travel restrictions are not comprehensive, it's likely we're importing more.

These variants are now spread across the globe- it's impossible to predict where they may enter from. Yet, we have completely non-evidence based border policy where people from many places can enter the country and test & release in 5 days - which won't prevent entry of new VOCs.
We seem to be relying on our surveillance to contain these once they enter rather than preventing entry, despite clear evidence that shows that once these are in the community, identifying and stopping spread is almost impossible, even with excellent surveillance & surge testing.
Rather than strengthening our border policy, we're now introducing a traffic light system, that doesn't seem to be based on any evidence, given there is absolutely no way to predict where new variants may come from, and where they may arise next.
Another policy introduced without much thought appears to be the policy of 2x weekly testing for asymptomatic people. While regular testing might be an important adjunct to public health measures, introducing this, without addressing lack of support for isolation makes no sense.
Current data suggest that only 1 in 4 people who *have symptoms* get tested, and an even smaller number isolate. How many people with *no symptoms* will take this up unless the govt supports them with isolation? Our support for isolation in the UK, of the lowest in the OECD.
The Liverpool LFD pilot showed that those in groups most likely to be exposed were least likely to get tested. Those in most deprived areas had 2x the risk of infection but were half as likely to get tested. If the govt is following evidence, why haven't they revised policy?
It seems like false economy to invest billions in a testing system & then not support people to do be able to do what needs to be done to break transmission. Has anyone examined the cost-effectiveness of a system, where uptake is so poor because people can't afford to use it?
There is also a real risk that if not accompanied by the clear message that they are only for asymptomatic testing, and also not a green light test for people with symptoms, or contacts - they might be used in a way that might increase risk.

Why aren't we fixing our test, trace, isolate and support system- a system that forms the central backbone of surveillance, and pandemic control. We seem to have abandoned this, after investing billions in private companies who failed to deliver on this 'world beating system'
While vaccine roll-out has been an amazing success of our strategy, which will have a major impact on reducing hospitalisations and deaths- we simply cannot rely on this alone. We have 7% of our population fully vaccinated, and ~46% received 1 dose.
This level of vaccination is not sufficient to contain transmission in of itself, and it's vitally important to contain transmission alongside vaccination- an aim that doesn't seem to be part of our strategy at all. Rising transmission even with vaccination can cause damage.
We don't need to look at hypotheticals here. We can look at what's happening in other countries. People often point to Israel, but there are other countries like Chile, ahead of us on vaccination, where healthcare systems are still being overwhelmed.
We need a comprehensive public health strategy alongside vaccine roll-out with:
1. Effective test, trace, isolate & *support* systems
2. Effective border restrictions & quarantine
3. Safety measures in schools and workplaces
4. Good public health communication and engagement
Such a strategy has been notably absent from government discussions around roadmap out of lockdown. It's vital we keep transmission low as roll-out continues- this is also an important step to prevent further virus adaptation that could really threaten vaccine strategy.

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More from @dgurdasani1

7 Apr
Important study out from @TheLancetPsych on neurological & psychiatric manifestations across 236,379 people with 6 months follow up after COVID-19 in the US- examined using electronic health records.

What did it find?
thelancet.com/journals/lanps…
Important to note first that the study only included survivors- so people who had survived for at least 6 months following infection were included.

Several neurological and psychiatric outcomes were examined in electronic health record data from health-care facilities.
Healthcare facilities data were collected from including primary care facilities, hospitals, specialist units, ICUs. It's unclear from the study how representative these are of infection across the general population (i.e. who would have ended up in the study if infected)
Read 12 tweets
7 Apr
It's been rather disconcerting to have had false claims made about my conduct by someone I've never engaged with directly. I wrote about this earlier & bizarrely, since, even more false claims have been made.

While the claims are false, the targeting has been very real. 🧵
In the thread above I addressed a false claim made about me by another scientist @sailorooscout - the claim being I had engaged in 'name-calling' and 'degrading' conduct against them - when I hadn't engaged with them at all. I reasonably asked that this be corrected by them.
It became very clear that I didn't engage in the behaviour claimed by @sailorooscout
Rather than acknowledging the claim was incorrect, they suggested I 'forget quickly', linking to a tweet that hadn't been written/liked by me. It seems to have been by one of their followers. Image
Read 8 tweets
6 Apr
I'm seeing very concerning attacks against scientists seeking to provide accurate information around vaccine efficacy- especially in the context of new variants, or legitimately discussing the recent reports of thrombotic events associated with Astrazeneca. Short thread.
I'm sure many saw an exchange a few weeks ago, that was also platformed in the Spectator, which is quite odd given the context. In this exchange, a scientist urging pandemic control due to concerns about low efficacy of vaccines against the B.1.351 variant was met with attacks. Image
The account suggesting @devisridhar tweet was misleading complained they were blocked by her after the interaction. This was picked up by the Spectator & presented in negative light. This seems odd as this account has pre-emptively blocked me & others.

spectator.co.uk/article/scotti…
Read 14 tweets
5 Apr
Sadly it did. Prevalence among school age children *doubled* in Scotland since schools opened - as per the ONS data (the most accurate data we have on infection), and is the highest across all age groups. Why does the media consistently get this wrong?

thetimes.co.uk/article/return…
Can anyone look at this graph, and suggest that school openings in scotland didn't contribute to transmission? Yet, our media has consistently said this - despite the very clear evidence we have to the contrary. What is going on?
This isn't the only piece I've seen that claims this- several pieces over the past week make this completely false claim. This is the sort of misinformation that's entrenched in our media- and I honestly don't know how we address this.

thetimes.co.uk/article/return…
Read 4 tweets
2 Apr
I'm hearing worrying rhetoric from scientists suggesting that children don't suffer from 'severe illness' so may not need vaccination. Let's look at the evidence around this. How severe in SARS-CoV-2 in children, and what are the impacts of transmission occurring among children?
We've heard repeatedly, even from scientists that children are less susceptible to infection or transmission- a narrative that seems to suggest children are less likely to get infected. We know now that this is simply not the case.
Indeed, as this point in time, young children have highest positivity rates in England & Scotland (shown below), with rises having occurred soon after school re-openings in both regions. We also know that infection rates were highest in primary & secondary age groups in December.
Read 20 tweets
1 Apr
ONS survey data out today- looking at the pandemic by age paints a heterogenous picture. We appear to be having two different pandemics- one accelerating among young children since schools re-opened, alongside declines in older age groups possibly due to vaccination/lockdown 🧵
Infection prevalence appears to have decreased slightly in England, level in Wales, with increases in Northern Ireland, and slight decrease in Scotland after increases the last few weeks.
Infection rates appear highest, and rising among primary school children, followed by secondary school children & 35-49 yr olds. While this is a general population, survey data, it seems consistent with what we're seeing in symptom-based case data from PHE as well (discuss later)
Read 13 tweets

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