More on the shocking resistance of western public health authorities to accept that diseases can be airborne.

Why? Unknowingly, are they are still fighting the centuries old battle about whether diseases spread through miasma (putrid air) or contact?
/1


en.m.wikipedia.org/wiki/Miasma_th…
A big battle in the 19th century was whether doctors infected their patients through touch, and should therefore wash their hands.

Semmelweis was ridiculed by senior doctors for encouraging hand washing. Everyone knew disease was spread by miasma.

en.m.wikipedia.org/wiki/Ignaz_Sem….
The eventual victory of the contact theory of disease spread - and the importance of washing hands - transformed health.

But it meant the 20th century public health establishment refused to tolerate criticism from those who argued disease is spread through the air.

/3
The current debate about whether COVID might be airborne was infected by this 100+ year old battle about whether disease is spread by miasma (putrid air) or contact.

Hence we were told to wash hands not wear masks and WHO told us it was fake news to say COVID is airborne.
/4
The sad irony is that the current public health establishment showed itself to be just as blind to evidence as it's predecessors in the 19th century who refused to acknowledge Semmelweis's data showing that hand washing could dramatically reduce deaths of mothers giving birth.
/5

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More from @CDlbcl

15 May
Once again medicines regulations are becoming politically charged in the UK. Late last year it was rapid / hasty (depending in your view) MHRA authorization of COVID vaccines. Now it is about cancer treatments.

Brief thread on regulatory approval and market access.
/1
For your doctor to prescribe you a medicine, two things must be true (outside a clinical trial)

1. The medicine can legally be sold in the place you live (regulatory marketing authorization)
2. Someone (hopefully by you) is willing to pay for that medicine (reimbursement)

/2
The regulators make sure that medicines are only sold if there is strong evidence that the balance of benefit to risk is favourable. Their goal is to stop companies marketing medicines that are unsafe or don't work.

The "label" on a medicine is key.

/3
Read 19 tweets
13 Mar 20
Tough choices for governments in managing COVID-19.

With apologies to @olivierveran here are some sketches which I think illustrate options. We are plotting number of cases on y against time on x.

Firstly the do nothing option is the blue curve in this graph.
The reason that is so bad is that at peak the number if cases would be well above the capacity - red line - of the healthcare system to cope. Insufficent ventilators, beds and staff would lead to higher proportion of cases dying than would otherwise be the case.
/2
Govs want to "flatten the curve" so cases develop like the green curve. Even if the total number of cases were the same as in the blue curve, the fatality rate would be lower as hospitals could cope better: the max number of cases never exceeds healthcare capacity red line).
/3
Read 10 tweets

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