THREAD on cases in the UK:

TLDR things going in right direction overall but some areas of concern for deprived communities & in schools. 1/19
Overall cases in the UK have fallen over last week after a long flat period. Note that tests have fallen too though (mainly lateral flow device (LFD) tests as schools are on holiday). 2/19
The ONS infection survey with data to 3 April - which tests random sample every week - reports new cases going *up* in England, flat in Wales and NI & going *down* in Scotland. 3/19
Cases are now 6-7 times lower than they were at January peak - back to where we were in mid-September last year.

But we're still almost 10x higher than in July last year (our lowest point). 4/19
There is also a difference regionally. The REACT study which tests about 100K people each month, found that while all regions decreased a lot since Feb, Northern regions have the highest rates (2x higher than the South) 5/19
And that difference in cases is also seen in hospital admissions - yes all regions have much reduced admissions (good) but the North has distinctly more than the South. 6/19
Part of the reason the North might be seeing higher cases is that it has more deprived regions than the South.

The most deprived communities have almost 3x as many cases as the least deprived as we leave lockdown. 7/19
I am worried about inequalities getting worse as we emerge from lockdown, with larger, more serious outbreaks in more deprived areas and concentrated in the North. 8/19
If we look at schools, ONS infection survey released modelled rates of Covid by year of age for each nation.
data here:
ons.gov.uk/peoplepopulati…

Let's look at Scotland which open schools first. 9/19
On 20th February, cases were mostly in working age adults.

On 22nd Feb, Scotland had a phased return to primary schools. 10/19
The ONS modelled estimates for 6th March (yellow), a couple of weeks later, show that while cases drop in older age groups, they have risen in younger ones. 11/19
And by 20th March (red), the modelled estimates are much higher again in younger people while among adults cases keep falling.

Now for some pros and cons... 12/19
Firstly pros: ONS is a random weekly sample so does not rely on people coming forward for testing or whether you have classic covid symptoms (important for kids). It's the best population indicator we have. 13/19
Cons: Number of people sampled in Scotland is not that high and there are quite large uncertainties attached. Plus the following week, ONS shows drops but the most recent week is usually an underestimate in ONS (& they flag it as more uncertain) so I've left it out here. 14/19
Also, ONS infection survey today shows overall cases in Scotland decreasing. This could be cos decreases in adults are offsetting increases in children or inaccuracies in the model or a combo of both 15/19
The confirmed case data in Scotland by age (dependent on testing behaviour and symptoms (in primary school kids)) does show increase in kids after schools open but with a flat trend in late March and declines over Easter holidays (as we'd expect) 16/19
In England, where all schools open on 8 March, ONS sees some increase in children and then a decrease in most recent week in primary school. 17/19
The REACT study shows a clear shift in most cases being in 5-12 year old children in the last two weeks of March in England. 18/19
Cases are likely to decrease during holidays. But by May, with schools open and shops, hairdressers, gyms etc opening we should expect increases. The question is: by how much? in which age groups? are deprived communities going to be hit harder? How much increase is "ok"?! 19/19

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More from @chrischirp

Oct 19
Important 🧵on our new peer-reviewed paper:

The pandemic is as bad as it ever was for babies - in year to Aug 2023, 6,300 babies under 1 were admitted to hospital wholly or partly BECAUSE of Covid.

They are ONLY age group where admissions have NOT gone down over time 1/17 Image
Our study, led by Prof @katebrown220, looked at all hospitalisations in England in children with a Covid diagnosis or positive test from Aug 2020-Aug 2023.
We then *excluded* all admissions where a Covid diagnosis was incidental (ie not why they were in hospital)
2/17 Image
Infants (babies under 1) are generally at higher risk from respiratory infections, plus they are the age group that, if infected, are overwhelmingly meeting the virus for the first time.

They are not vaccinated and have not had it before. 3/17
Read 18 tweets
Sep 26
Prof @Kevin_Fong giving the most devastating and moving testimony to the Covid Inquiry of visiting hospital intensive care units at the height of the second wave in late Dec 2020.

The unimaginable scale of death, the trauma, the loss of hope.
Please watch this 2min clip.
And here he breaks down while explaining the absolute trauma experienced by smaller hospitals in particular - the "healthier" ICU patients were transferred out, leaving them coping with so much death.

They felt so alone.
Here Prof Fong explains how every nurse he met was traumatised by watching patients die, being only able to hold up ipads to their relatives and how it went against their normal practice of trying to ensure a dignified death, with family there.
Read 5 tweets
Aug 28
THREAD: I asked what the point of Public Inquiries is for @bmj_latest

We've spent hundreds of millions of £ on Inquiries over last decades, generating deep understanding of failures & 1000s of recommendations.

But v few recommendations get implemented!
What is going on?

1/12 Image
E.g. Covid-19 Inquiry has cost £94 million so far - and is projected to cost over £200m by its end (it still has years to go).

1st report published (out of at least 9) found major flaws and proposed 10 recommendations.

Chances are low that they will be implemented :-( 2/12


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Inst for Government looked at 68 Inquiries from 1990-2017.
The Inquiries cost over £630 million and made 2,625 recommendations.

Only 6/68 Inquiries have received full scrutiny by a parliamentary select committee on implementation of recommendations. 3/12 Image
Read 12 tweets
Aug 9
🧵War causes direct civilian deaths but also indirect deaths over the following years.

Recent paper estimates eventual total direct & indirect deaths in Gaza attributable to the war - 10% of entire pop'n.

I want to explain these estimates and why deaths must be counted. 1/13 Image
Why count casualties from war anyway? For moral, legal and strategic reasons.

1 - owe it to those who have died
2 - International law says must count & identify dead as far as possible
3 - monitor progress of war & learn from tactics

2/13 Image
There are direct and indirect casualties of war. Direct deaths include those who killed by fighting or bombs.

Indirect deaths are those that die when they would otherwise have lived because of one or more of: lack of food, healthcare, housing, sanitation, income, hope. 3/13 Image
Read 14 tweets
Aug 1
THREAD: the summer Covid wave in the UK continues.
Basically, there is a LOT of Covid around and not a lot of other respiratory viruses.

If you have cold or flu symptoms, it's probably Covid.

The latest hospital data from England shows steady, quite high levels. 1/8 Image
But admissions don't tell us how much virus is circulating more generally. The best (but imperfect) measure we have is wasterwater measurements, and only in Scotland and not England.

Scotland's wastewater is showing a huge July peak - highest since Omicron's 1st yr in 2022 2/8 Image
Because different people shed different amounts of virus and variants can matter too, you can't for sure infer how many people were infected between different wasterwater peaks. BUT given the size, I'd say it's pretty likely this is the largest peak since 2022 in Scotland 3/8
Read 8 tweets
Jul 23
THREAD:
I wrote about Baroness Hallett's Inquiry Module 1 report for @bmj_latest .

She found that there was *never* a plan to keep a pandemic death toll down - I discuss this and what it means going foward.

Main points below: 1/14 Image
The headline most seen is that the UK planned for the wrong pandemic.

While it is true that was far too narrow a focus on a flu pandemic, that is not the most telling bit.

To me the most telling bit, is what the plan did NOT do 2/14


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The issue is less the wrong disease, but that there was never a plan to prevent one at all – of any disease type.

The plan was *never* about reducing the number of pandemic deaths. 3/14 Image
Read 14 tweets

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