Thinking about the uncertain situation w B.1.617.2 in the UK as the country opens up, this is very good (no surprise, it's @adamhfinn answering the questions). I have a few additional points and a mild point of disagreement 1/n theguardian.com/world/2021/may…
The additional point - it's really not clear what is going on with 617.2. It has certainly been growing, but that doesn't necessarily mean it is (much) more transmissible. It may have merely had more opportunities 2/n
As more contacts and opportunities for transmission arise in the UK, we can expect them to result in more cases. Having said that of course, we need to ask why one lineage rather than another is lucky enough to take those opportunities - maybe it's more than luck 3/n
So it will be important to examine the proportion of tests coming back with spike gene target failures in coming weeks, because this will tell us more about reductions in proportions of B.1.1.7. However there are still some things about B.1.617.2 that are frankly weird 4/n
as @erikmvolz and @arambaut have pointed out, the clade is quite old (est origin ~9/20), which is hard to square with a huge transmission advantage or we'd expect to have heard about it sooner. That said, our sampling hasn't been great. So might that be a factor? 5/n
Now for my point of disagreement. I am not sure things will become much clearer in the coming few weeks. Note that we are still struggling to nail down the properties of P.1 months after we learned about it. And there are other reasons 6/n
The incidence in the UK is *really* low at the moment. Yes we can expect that to increase for the reasons stated in the article, but that is against a background of not only immunization but also the summer (or what counts as a summer) 7/n
Last year it took quite a time for transmission to build up again after the great pub reopening (among other things) on July 4th. It may well be that something similar happens here. And then there's that thing about exponential growth - the exponent doesn't have to be large 8/n
So if Rt is >1 but not by a lot, it might take a while to show up in doubling times. And of course the consequences in terms of severe illness and worse will take longer to become clear and are uncertain because of immunization 9/n
Of course, things might move quicker, this isn't a forecast. My concern is more that small changes over the next few weeks are not interpreted as being out of the woods, because we expect more transmission in the cooler months and a lot of people still need their shots 10/n
So closing - we (here and in the UK) are in a MUCH better place than we were. Of course huge swaths of the world are not and need help. We should do all we can to supply it, while keeping a weather eye on the evolving (pun intended) situation 11/end

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More from @BillHanage

16 May
Upon seeing this I had to go look for what prompted it. Although that might not have been the intent of the original post, I’m glad I did 1/n
Here’s the preprint. It’s not clear why MIT should feel ‘shame’ (isn’t academic freedom a good thing?) or what it has to do with the prolific aforementioned scientist. arxiv.org/pdf/2101.07993… 2/n
If nothing else, we need to accept that preprints happen, that sometimes they are less good than regularly published work and sometimes they are better. They have a special role in a rapidly changing situation like this 3/n
Read 4 tweets
10 May
There will be a lot of people answering this the obvious way, but what strikes me is that *even now* there’s not enough immunity from prior infection in Sweden to stop this happening.
Whatever else that means, it suggests that population protection through infection induced immunity is not going to happen without bad consequences. The idea might have been defensible at the start when we were more uncertain about severity, it hasn’t been for some time
If people compare per capita mortality in Sweden with elsewhere note that an appropriate comparison is the other Nordic countries, all of which took a very different route, rather than other European countries with their own stories
Read 4 tweets
8 May
It’s great that public health has been getting some recognition. Many 🙏🏼. If you’d like to donate to help this work, which is mostly done by really underpaid and devoted people, here are some ideas. @MSF_USA @CEPIvaccines @PIH @NFIDvaccines for a start 1/n
If you want to help public health donating to established non profits is better than say, someone from twitter on patreon, for a bunch of reasons. For a start there’s oversight of where your $ go and an existing system of governance, hopefully with accountability! 2/n
I don’t want to deter donations to new initiatives like @crisisreadiness, but just to point out that if you really want to help, think about the best way to help 3/3
Read 5 tweets
7 May
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 theguardian.com/world/2021/may…
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 cdc.gov/mmwr/volumes/7… 3/n
Read 6 tweets
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 science.sciencemag.org/content/372/65…
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 papers.ssrn.com/sol3/papers.cf…
Read 10 tweets

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