The UK is going to be making free rapid tests available to everyone. As you might imagine, I approve. However it should be remembered rapid tests are most effective when combined with other things. Short thread 1/n…
For a start, for tests to be useful they have to be used! It is not obvious to me that there is any incentive for that in the proposal. If people suspect they are infected, but don't want the risk of having to isolate, they're not likely to take a test 2/n
Then there's the perennial question of what happens in the event of a +ve test? If people actually isolate that's great, but that's not been universally the case in the pandemic so far, putting it mildly. Hopefully their behavior would change enough to make a difference 3/n
Which brings us to the question of support. People isolating need sick pay! Their contacts need to be encourage to test! Effective pandemic response needs all these things! 4/n
We should also encourage use among people who have recovered from infection. While reinfections are rare, they are expected to get more common as immunity wanes, and are almost certainly more likely with some variants 5/n
Likewise vaccinated individuals. The much-maligned AZ shot has clear efficacy against serious illness, but breakthrough infections are possible, even though it is not clear how likely they would be to transmit 6/n
Which brings me to the whole question of 'Covid status'. I can see all sorts of problems with the approach outlined in the article, but others are better placed to address those concerns, I think 7/n
I will say that for ages, I've argued that if you wanted to open eg movie theaters with minimal transmission risk, you could do it if you required a -ve rapid test before admission, and then everyone wore masks. The latter would mitigate transmission from any rare false -ves 8/n
Which brings me to the close. Yes more use of rapid tests is good, but there has never been a silver bullet. Interventions work in combination, and here we need to encourage uptake, ensure and support isolation, and continue to vaccinate. 9/end

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More from @BillHanage

26 Mar
Getting immunity from a vaccine is vastly safer than from infection, both as an individual because it avoids the negative consequences of infection AND for the community because unlike the virus, these vaccines don’t transmit
So I am quite pleased that a decent fraction of Fla residents have received at least one shot, the more the merrier
I predicted a few months ago that Fla would be quieter than other places over the winter because of larger number of contacts outside. I don’t know if that *was* the reason but the relative quietness did materialize even as variants have grown to a large proportion of cases
Read 6 tweets
18 Mar
Reading this, which looks like a pretty definitive take on the origins of the pandemic. Important conclusion: most zoonoses of this kind would go extinct of their own accord.…
That actually makes a lot of sense if you consider everything we know about the clustered nature of transmission. Like they say, we should do better at detecting zoonoses early on
Nice illustration of how a transmission chain could sputter along a bit before making it big. Note that what this means is that while the pandemic descends from the market in Wuhan, that's not necessarily where the index case occurred
Read 7 tweets
16 Mar
Absolutely right. The various aspects of the failure need more thorough unpacking in a medium that is probably not twitter, but it is actually striking to me how *much* we (meaning epidemiologists) knew a year ago about what this virus is capable of, and how little it has changed
Just as a for instance, the varying severity by age has been known pretty much since Jan 2020. And so has the potential for presymptomatic transmission, which is absolutely essential to the effort needed for control, and the importance of rapid testing
I was very aware of the potential for minimally symptomatic transmission because of my involvement in this (true story - I wrote my draft on an overnight flight at the end of feb. Then we all got slammed and it wasn't submitted for months)…
Read 9 tweets
13 Mar
There are a lot of think pieces going around about the pandemic one year on. This is one of the best, from @jameshamblin, because it is upfront about the difficulties we face handling uncertainty. That's relevant to then, and now. A short 🧵commenting on the issues raised
The first thing to remember is that uncertainty about precise numbers is not an excuse to avoid action. This is a common misunderstanding about how mathematical modeling results should be interpreted. Depending on your inputs, you can get all sorts of results...
The goal is not to forecast exact outcomes, because you hope you never experience the world in which nobody intervenes *at all*, but to understand how seriously to take the threat. Qualitatively right is not the same as exactly quantitatively right.
Read 16 tweets
1 Mar
A long sobering look at the pandemic in the UK. The success of the vaccine rollout should not obscure the way that leaders failed to heed the lessons of spring 2020 to an extent that beggars belief…
Look at the cumulative deaths. Around 40k in spring of last year. In other words ~2/3rds of the total are from the last few months (data from…)
While some of this is down to the emergence of B.1.1.7, it is mostly down to an attitude that resisted taking appropriate action, and ignored scientific advice. As many will know, I think 'led by the science' isn't the right way round - we should be led by those we elect. But...
Read 5 tweets
21 Feb
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
Read 11 tweets

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