New paper led by @SarahESeaton from the @DEPICT_Study team - we analysed over 9,000 transports of critically sick children from local hospitals to paediatric intensive care units...

DEPICT, led by @pic_pram , has been such a great study to work on. 1/6
There are two main ways you can do this: "scoop and run" where you get the child to PICU as fast as possible or "stabilise first" where you spend some time (often hours) at the local hospital treating the child there before transport. 2/6
Of course it's not quite that simple - for very sick children you just *have* to stabilise at the local hospital before transport, so patients with longer stabilisation times tend to be sicker.

Once you account for that there is no significant difference in mortality 3/6
We also looked at whether the leader of team sent to the retrieve the child makes any difference - lead could be a consultant, junior doc or an advanced nurse practitioner. Consultants tend to go out to most serious cases.
Once that is adjusted for, again no difference. 4/6
The final thing we looked at was whether a critical incident happend during the transport. Unsurprisingly perhaps, a critical incident involving the child was associated with higher mortality.

But not - thankfully - incidents with equipment or the ambulance. 5/6
Overall this means that the different and dynamic ways transport services have had to adapt to serve their patients have not, using this national data, impacted the survival outcomes of critically ill children.

full BMC Paediatrics paper here:…

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More from @chrischirp

5 May
The Maldives have similar vax rates to us & the Seychelles much higher (full) vaccination rates

Below is fully vaccinated & then at least one dose of vaccine.
Both Maldives & Seychelles are using a mix of the Chinese vaccine (Sinopharm) and Astrozeneca.
Israel used Pfizer. ImageImage
Both Seychelles and Maldives are currently experiencing huge Covid surges.

The Seychelles has just locked down for two weeks.… Image
I don't know why the Seychelles experience is so different from Israel.

One difference is that Israel has had longer with a high percentage of fully vaxxed people. It also used a different vaccine.
Read 4 tweets
4 May
THREAD on B1617 from COG data:

Yesterday I did some tweets about the growth of B1617 ("India") and its subtypes in the community using data from the Sanger Inst (England only).

Here is the recent data from England from COG (genetics consortium for covid)
2.This includes data from travellers & surge testing

BUT overall picture is the same as for community cases from Sanger yesterday.

B1617 growing very fast & has overtaken all other variants of concern / under investigation (except B117 ("Kent") which is still >90% of cases).
3.Look at the number each week, you can see that the other main variants are hardly growing. B117 cases ("Kent") are also going down (which is why our overall case numbers are falling).

But this variant, B1617 ("India"), is still shooting up.
Read 7 tweets
3 May
Update on B.1.617 ("India") variant in England using latest data from the Sanger institute.

This data *excludes* sequenced cases from travellers & surge testing so "should be an approximately random sample of positive tests in the community"

TLDR: warning signs! 1/10
Data is available up to week ending 17th April.

Firstly raw counts (excluding B.1.1.7 ("Kent") which is dominant) shows rapid growth of B.1.617 ("India") over last 4 weeks.

S Africa (B.1.351) and B.1.525 variants are not growing in absolute numbers. 2/10
Looking at each variant as a proportion of all sequenced cases the rapid rise of B.1.617 ("India") is crystal clear. Remember this data *excludes* traveller and surge test data.

In week to 17 April it was almost 4% of all sequenced cases! 3/10
Read 11 tweets
30 Apr
how about some positivity?

Here's a brief overview of state of Covid in UK right now.

TLDR: pretty good, couple of things to keep an eye on. 1/13
Case rates are below 50/100,000 people/week in all nations (orange), dropping from prev week (grey) and approaching levels last seen Sept 1 last year (green). 2/13
England is the flattest in terms of case rates and this is reflected regionally (orange and grey dots close together). Yorks & Humber still highest region, confirmed by the ONS infection survey too. 3/13
Read 13 tweets
29 Apr
THREAD update on variants:

Today PHE released more variant data (& split the B1617 ("Indian") variant into 3 subtypes).

Big increase with 400 overall cases in UK - closing in on B1351 (S.African variant).

Guardian article:…

The COVID-19 Genomics UK Consortium (COG) release specimen data by date of test taken - so we can track numbers over time.

NOTE: COG specimen data contain some duplicates (ie. more than 1 test per person) but nums consistent w PHE & trends still evident. England data only below
655 spotted tests of S.African & 497 of Indian variant(s) - but clear v rapid increase in Indian variant in 3 wks to 17 Apr

Most are travellers (PHE), but each carries a risk of onward transmission if traveller infects houshold or doesn't isolate…
Read 9 tweets
27 Apr
Short THREAD on Covid-19 Variants in ENGLAND:

The Sanger Institute has just released webpages that let you explore genomes that they sequences every week...

I had a look - two variants are currently growing "S Africa" and "India" but v small numbers. 1/7
This chart show the numbers of potentially worrying variants sequenced each week.

The recent rapid growth of the India variant (B1617) & the highish, steadier, numbers of S African variant (B1351) are clear (not great).

Brazil variant (P1) almost negligible (good!). 2/7
These are small numbers.

But S African & Indian variants are growing in the context of overall numbers going down. So the *proportion* of sequenced cases that are these two variants is going *up* - and for the Indian variant - going up A LOT.

Should we be worried? 3/7
Read 9 tweets

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