This article, on the arrival of B.1.617 (et al) in the U.K. is important, but is missing some really important context. Notably, we expect clusters, even in vaccinated people. It’s how *many* there are when compared with unvaccinated that matters 1/n…
Look at this. No deaths. That’s not the usual story when it comes to this virus and care homes. I don’t want to draw strong positive conclusions from small numbers, but nor should we draw strong negative ones 2/n
It’s actually rather like this. Again an outbreak, but nowhere near as bad as we’d have expected in the absence of vaccination… 3/n
To be clear, the suggestion that public health communication has been delayed because of elections is really shocking. And it’s important to investigate clusters. But the fact of clusters or community spread is less important than whether or not there’s more than you’d expect 4/n
The U.K. has very low incidence right now largely as a result of hard work in the first three months of the year. However population immunity at present is not sufficient to avoid exponential growth following any return to ‘normal’ 5/n
The story of the next few months in the U.K. will be the virus growing back from a low base, slowed by vaccines and likely the weather, and whatever else can be put in its way. I suspect it might be quite slow and the worst consequences blunted by vaccines. I hope I’m right 6/end

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More from @BillHanage

1 May
The only thing more mind boggling than the fact this is happening, is the idea that it is a “test” that will provide useful data. It isn’t, period.
It is happening at a time of low prevalence, in this age group due to few contacts offer the last few months, which makes any findings of questionable relevance to circumstances with higher prevalence
Negative test before entry is good, but ‘urging’ people to get tests after (or before for that matter) is not follow up. It’s not even an adequate study.
Read 6 tweets
26 Apr
I am seeing a lot of anxiety around partial immunity through vaccination producing selection for escape variants. Here @colinrussell and I explain why we *don't* think that's likely 1/n…
It depends on the supply of the mutations that enable immune evasion. If we assume this happens during breakthrough cases in vaccinated people, there's not much time for it to make a difference, because transmission tends to happen early on in infection 2/n
And if breakthrough cases are less likely to transmit in general (as seems so in at least some cases) that makes it even more difficult 3/n…
Read 10 tweets
6 Apr
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
Read 9 tweets
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

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