So growth rate and R number in the UK now over 1. Unsurprisingly given that Delta variant now dominant. A short thread on the next few weeks there, which will be (sorry) big on uncertainty… 1/n
That's quite a large increase. The caveat of course is that it is from a *very* low base indeed. And cases will not necessarily translate into severe illness, especially in vaccinated people 2/n
Unfortunately these too are up, from a low baseline. This should be treated with caution because when numbers are this low they can be impacted by unusual events like clusters of infection in vulnerable populations - although you'd hope such folks were vaccinated 3/n
This is a good total with one dose. But by my math that's nearly 60% not fully vaccinated, and 40% not at all. ~20% with one dose, which provides poor protection against symptomatic infection with the Delta variant. Several questions there... 4/n
What about vaccine specific efficacy of single dose? ie Pfizer vs AZ? What about breakdown by age (older and younger more likely to get Pfizer)? Crucially, what do vaccines, one dose or two, do to protect against serious illness due to Delta? I don't know the answer 5/n
I am certain the coming weeks will see more cases. What that means for severe illness, deaths and stress to healthcare in the UK will depend on the answer to my previous question. My opinion is that vaccines will still do a lot to help, exactly how much remains to be seen 6/n
We are in for a tense few weeks waiting to see what emerges. But we're not going to find out overnight. Sorry, I warned you there would be uncertainty. This might end up being anything from a bit bad but basically OK to really quite bad ('quite' in the US sense of 'very') 7/n
As it is the majority of the virus population in the UK is a more transmissible, probably more virulent variant that shows evasion of vaccine induced immunity from a single dose and *60%* of the population has received one or no doses of vaccine… 8/n
And for goodness sakes think about the many people who do not live in the UK (or US) and who are still awaiting any hope of vaccination at all. Delta is bad, but whatever happens in the UK won't be as bad as it might have been. Won't be as good either but that ship sailed 9/end

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More from @BillHanage

3 Jun
Have digested the latest excellent technical briefing from @PHE_uk on variants and Delta (the variant formerly known as B.1.617.2) in particular. as ever, all findings are context dependent and should be interpreted with care, but this is serious and deserves a wide audience 1/?
First, read all about it yourself (don't take my word for it!). Briefing here… and Risk Assessment… 2/?
This is from the risk assessment. Yes there is a lot of red. There is now very good evidence of increased transmissibility (will come back to that) compared with Alpha/B.1.1.7 (already quite transmissible). This is important. There is also... 3/?
Read 18 tweets
2 Jun
I read this article this morning and it made me uneasy, I've just figured out why. Not linking deliberately although easy enough to find if you really want to 1/n
The article admits that a definitive answer on the origins of the pandemic is probably never going to be available (I agree), and then proceeds as if it were. This is silly 2/n
If there will never be a definitive answer to the question, why act like there will be? In its absence people will pick sides based on pre-existing positions rather than accepting uncertainty. And the thing is we'll be better off in the future accepting that uncertainty 3/n
Read 6 tweets
27 May
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
Read 14 tweets
26 May
A few points about "Chicken Pox parties", and why they should never have been part of any serious discussion of pandemic management… 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… 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…
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*… 2/?
We knew it in the autumn too… 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…
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

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