I was wondering earlier today if change was afoot in the UK due to B.1.617.2, but @jburnmurdoch's thread is better than anything I could put together. It deserves your time. I do think it misses something out however. Hospitalizations are climbing much earlier than I'd expect 1/n
First it certainly looks like B.1.617.2 has become readily established, and is sweeping in multiple different places suggesting that it is more transmissible even than B.1.1.7, itself no slouch. IMO we can't put this down to founder effects/networks 2/n
(I still don't understand why given what *looks* like high transmissibility it has an MRCA so far back, but it's clearly capable of causing outbreaks like these. That's enough to take it seriously) 3/n
One thing @jburnmurdoch rightly emphasizes is that vaccination will make this round with the virus unlike prior ones. Huge numbers of people are protected already. But importantly not everyone, with younger age groups still to receive shots 4/n
That's why I am surprised, frankly, to see hospitalizations ticking up already. Previously we saw cases climb in younger age groups, often for a while, before the virus got into older networks and hospitalizations ticked up. At the moment they're close to lockstep 5/n
Numbers are small and the situation may change. But I am still surprised. I cautioned less than two weeks ago that it might take a while for the situation to become clear. While it's still not perfectly so, it's much clearer 6/n
Now the UK has had a pretty fine vaccine rollout. The great decline in cases since the winter has been chalked up to that. But that is wrong. Vaccines have protected many older age groups from more severe disease, but the case numbers have been coming down due to NPIs 7/n
This is why, given recent relaxation of NPIs, an uptick was expected. The UK Health Secretary is quite correct here. However the part later on when he says that vaccines 'sever the link between cases and hospitalisations and deaths' is exaggerated 8/n bbc.com/news/uk-572752…
This is a modeling paper, based on the properties of B.1.1.7, which suggests the consequences in the UK of removing all NPIs even with higher levels of vaccination than this could be quite grim 9/n thelancet.com/journals/lanin…
Intuition for how that might be the case is that vaccine uptake is imperfect. As we've surely learned by now truly uncontrolled outbreaks can infect lots of people quickly. And the *vast majority will be fine* but a small fraction of a very large number can be a large number 10/n
If you'd asked me what I expected a few weeks ago, I'd have said a mild outbreak in which seasonality and vaccination combined to limit the impact of relaxing NPIs. Now I am not so sure. I want to be clear that I *don't* think we are back in Dec 2020 11/n
And yes, it looks like vaccine efficacy is maintained. So getting shots into younger arms will help 12/n
I'm not going to speculate on what might explain the increases. Surely some combination of transmissibility, active case finding, shifting contact networks and the changing nature of disease in different age groups but one thing is clear 13/n
It's not over. The future *is* brighter than the past in places with vaccination (too few), but we need to remain aware and be ready with other interventions, to prevent a bump in the road becoming a serious sting in the tail 14/end

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More from @BillHanage

26 May
A few points about "Chicken Pox parties", and why they should never have been part of any serious discussion of pandemic management thejournal.ie/dominic-cummin… 1/n
Like Covid, chicken pox is more likely to lead to severe illness and complications the older you are when you are first exposed. In the UK in the 1990s about 25 people died every year of the infection, 80% being adults ncbi.nlm.nih.gov/pmc/articles/P… 2/n
It is generally thought that on recovery from chicken pox immunity is lifelong. As a result in the 70s and 80s some people would arrange for their kids to be infected at an age they would be at lower risk of complications. This is not a good idea 3/n infectioncontrol.tips/2015/12/18/its…
Read 8 tweets
25 May
How to start on the problems with this? Herd immunity to SARS-CoV-2 through unmitigated outbreaks comes at an abysmal cost in deaths, and chronic outcomes of infection. Ok we know that now but... 1/?
We knew that *then* theguardian.com/commentisfree/… 2/?
We knew it in the autumn too theguardian.com/commentisfree/… 3/?
Read 8 tweets
16 May
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
Read 11 tweets
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

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