I keep hearing that the UK should open up now... because Israel! There's seems to be a misunderstanding about what actually happened in Israel. Israel has had fairly strict mitigations in place & schools were opened only after 57% of the population was fully vaccinated. Thread
I keep hearing that because infections in Israel have declined during vaccination, this is a sign other countries can open up. What people forget is that Israel didn't follow a vaccine-only policy, but a multi-pronged strategy aimed at containing transmission during roll-out.
Here are a few examples:
Schools in Israel only opened on the 18th April after 57% of their population was *fully* vaccinated, and children wear masks in schools.

They had a mask mandate outdoors & indoors until very recently (much stricter than the UK)

While the outdoor mandate has been recently dropped, people still need to wear masks indoors.

There is a focus on maintaining ventilation, masking and social distancing in schools that opened only very recently when community transmission was very low.

This is not the situation in the UK at all. 19% of our population is fully vaccinated and 50% partially. We're still seeing >2000 confirmed positive cases/day. Our schools don't have many of the strict mitigations in Israel.
The DfE is considering doing away with mask wearing.
It's very clear that we saw increases in infection in schools after they opened, with declines during Easter break. These were also reflected in other age groups, consistent with spill over of transmission from schools into the wider community.
It's also worth looking at Chile, where 32% of the population has been *fully* vaccinated, and 42% have received one dose. Reassurance that vaccines would protect against rises in transmission led to early opening up - with devastating consequences.
It takes a large proportion of the population to be vaccinated to be able to prevent surges in infection. Vaccines + non-pharmaceutical interventions are needed to contain spread during roll-out. This also prevents virus adaptation, protecting our precious vaccine resources.
want to thank @chrischirp for discussions that helped me understand this and crystallise this into this thread.
Wanted to add a caveat here- thanks to @dolmenman1 for pointing this out - the scenario in Chile may not be completely applicable to the UK - given uncertainty regarding vaccine effectiveness with P.1, and potentially P.1. being more transmissible (B117 is our dominant variant).
Also, wanted to thank @fascinatorfun for pointing out that Israel also started vaccinating 16-21 yr olds much earlier on, targeting 'mixers' alongside 'vulnerable' groups, which would have a much greater impact on transmission compared with the UK vaccine strategy.

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More from @dgurdasani1

27 Apr
The govt has recently started trials in schools to replace 10 day quarantine for contacts with daily testing with rapid (LFD) tests for 7 days. The govt is using these as 'green light' tests contradicting both MHRA & CDC recommendations. 🧵

There is very little transparency around this - to my knowledge the govt has not released ethics documents. It's clear from the information sheets provided to parents that consent is being sought only from children/parents who are willing to substitute isolation with testing.
This doesn't make any sense from an ethical perspective because the entire bubble is exposed to risk when a child who's been exposed is not isolating and rather being tested with LFDs that are known to miss infections, which is why they are only recommended as 'red light tests'
Read 26 tweets
26 Apr
I was invited today to on @NickFerrariLBC to comment on the recent letter by 22 scientists on ending mask use in schools, and opening up the UK without masks & social distancing by June 21. I was *not* told that this would be a 'debate' with Anthony Brooks, one of the signatories
This is a letter that's been signed by Carl Heneghan, Sunetra Gupta, Karol Sikora - the architects of the pseudoscience & several debunked papers that led to the Great Barrington declaration - that caused untold damage to pandemic response across the world.
Both Heneghan and Gupta predicted there would be no 2nd wave. Gupta said early last year that 50% of the population was already immune, and we would reach 'herd immunity' soon. Both opposed pandemic control - & suggested we should let the virus spread through young people.
Read 19 tweets
24 Apr
Concerning that in India, not only is the cost of Covishield (Astra/Oxford) vaccine above the $3 max price set by Astra, but this cost is not being borne by govt, but rather by the public (esp for those <45 yrs). Current pricing is $5.3 and $8+ through state & private hospitals🧵
The Serum Institute is the manufacturer of Covishield in India, and originally sold 100 million doses to central govt for a price of $2 per dose. The govt has decided to split vaccine roll-out between central govt (50%) and state govt & private sector (totally 50%) from May.
This means that anyone over 18 can now access vaccination through the state & private sector - these are not free, though. People 18-45 yrs have to pay between $5.3-$8 for a dose, while vaccines are free for over 45s through the govt vaccine centres.
Read 8 tweets
24 Apr
The cases in India show no sign of peaking - and they will not, because no action is being taken to prevent this in most parts of India. Cases in all states rising exponentially now & nothing imposed except night/weeked curfews in most places. Why? 🧵
Here's the situation in India - every state has its own decision making capacity & what we're seeing now is exponential rises in *all* states. There is no part of India that is spared, but exponential rises have started at different time points - some later and some earlier.
What is absolutely clear is that even the places that are not where Delhi is will be there unless they do something to prevent this- because the rate of growth looks similar across all places - it's just at different points.
Unfortunately most state govts are not doing much.
Read 13 tweets
23 Apr
I've been avoiding writing about this because it feels too close to the bone at the moment. But important to discuss- so here goes. What's unfolding in India is absolutely tragic & horrific (and was preventable). Unfortunately, it's likely to get worse before it gets better. 🧵
We've been seeing rapid growth in the pandemic, which hit some parts of India (e.g. Maharashtra, W. Bengal, Delhi) earlier than others - but cases are now growing exponentially in every part of India. India has had >300K *reported* cases and >2000 *reported* deaths in 24 hrs.
Deaths & cases are being substantially underreported. The positivity rate in Delhi is 36% and testing isn't available for many. It's estimated that deaths are being underreported by ~10x, with level of underreporting varying from place to place.
Read 25 tweets
21 Apr
One of our government's 4 tests was not exceeding NHS capacity. An interesting discussion with @Kit_Yates_Maths recently with @OwenJones84, where he astutely pointed out that this hasn't been defined got me thinking about how we might go about defining this.

A few thoughts. 👇
So when is NHS capacity overwhelmed?
Is it when we run out of oxygen in hospitals?
Is it when we run out beds despite surge capacity?
Is it when we run out of ventilators?
Is it when we start creating surge capacity by using resources from other routine care settings?
Worth remembering surge capacity is often created at the cost of routine care - public & private. Also when we create surge capacity, the number of staff treating the patients are often still the same- it's just the no. of staff per patient has changed.
Read 12 tweets

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