Alasdair Munro Profile picture
Jun 25, 2021 9 tweets 4 min read Read on X
A very calm thread🧵

Waiting for data before frightening kids, parents and the general public about variants, children and schools is important. They deserve this.

It has not been well practiced across the board - and given todays @ONS data, it is particularly disappointing

1/ Image
Many will remember (feels like a lifetime ago) a lot of concern about the Alpha variant (prev known as B1.1.7) being very transmissible or more severe in children, disproportionate to its effects in adults

As it turns out, that was not the case

2/
When schools were about to open in March, some people were very clear this would be a catastrophe

This led to a lot of anxiety among children, parents and teachers

Fortunately, it was not a catastrophe

In fact, it was completely fine

3/
ons.gov.uk/peoplepopulati… Image
Now we have a new variant, Delta

It is more transmissible by everyone (including children) and may cause more severe disease

But once more, very early on we heard lots of stories on THIS variant being worse and more transmissible *particularly* in children, and schools

4/
Despite lots of anecdotes, there was no real data to support this issue

There were conspiracy theories about cover ups of terrifying data, accusations of public health officials, letters written galore, and general furore

5/
When PHE released some data, the analysts themselves were *very clear* that it could not point to the precise role of schools in wider community transmission due to the nature of how the data is collected

This has often been dismissed or ignored

6/
Time has passed, and it is quite clear now that as for Delta, as for all #SARSCoV2 before it

-Young adults transmission highest
-Teens transmission a bit more due to more mixing, but to a lesser extent
-Younger children transmission surprisingly low

7/ Image
In fact, let's just take a moment to admire the primary school aged data

This is the least vaccinated group, with among the highest amount of social mixing, in school with no facemasks for 3 months, whilst other respiratory viruses have run rampant

It is quite extraordinary

8/ Image
Anyway, this is an issue because the horse has bolted

Most people will never hear that it turned out there was nothing special about kids and this variant

They'll just remember the scare stories

It's very easy to terrify parents

It is very difficult to un-terrify them

9/

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More from @apsmunro

Jan 11
A few interesting points of data which help us to evaluate some theories re Covid

1) RSV season is now ending in England with the most "normal" wave since the pandemic

Covid related immune problems causing more severe RSV is in the bin 🗑️

1/
assets.publishing.service.gov.uk/media/659fe802…
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2) Covid may be peaking (possibly plateauing) with the LOWEST prevalence (via mass testing survey) in all age groups being in school aged children

Schools being unsafe, children being disproportionately affected or spreaders of Covid is in the bin🗑️

2/
gov.uk/government/sta…
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3) Covid infection to hospitalisation rate by far the lowest we've seen during the pandemic

We can totally bin the idea Covid infections become increasingly severe, or of a meaningful increase in severity from current variants 🗑️🗑️🗑️

3/
Read 4 tweets
May 3, 2023
This article about masking and RCTs is extremely confused and appears to totally misunderstand everything about clinical trials

I will put to one side the dreadful title (which presumably the authors didn't choose) and explain some of the most important errors in thinking

1/ Image
First of all, the idea Science "couldn't" produce the answers we needed is false

We are perfectly capable of producing high quality, relevant clinical trials in this area

We just didn't

There are no excuses for this, it's a massive failure

2/ Image
Second, the idea that the RCTs asked questions they couldn't answer is also false

They set out to answer very specific questions, and they provided useful answers to those questions

If those are not the questions you WANT answered, then we need MORE trials to do that

3/ Image
Read 10 tweets
Jan 17, 2023
What's happening with GAS in the UK?

The surge has caused a great deal of anxiety and got a lot of attention

Quick update on the situation following new data and some great new analyses

1/🧵
alasdairmunro.substack.com/p/group-a-stre…
Updated data from UKHSA tells us a few things

Firstly, the data on scarlet fever is now not useful, as it basically just represents awareness

Probably massive overdiagnosis at the peak, no idea where it truly is now

2/
gov.uk/government/pub… Image
The data on invasive GAS (iGAS) is more useful as requires microbiological confirmation

Cases have been very high, but possibly flat or declining - difficult to know due to reporting lag, but this is the feeling on the ground

Case fatality still normal, most deaths >65y

3/ Image
Read 7 tweets
Jan 8, 2023
It may seem ridiculous this is even necessary, but it actually cuts to the heart of some of the major issues with messaging around mask use

Clearly these persist even today, which is remarkable

1/
fullfact.org/health/5live-m…
Whilst the quality of the evidence around the impact of community mask use is really poor, it’s generally in favour of a modest impact

A *modest* impact

In fact, an impact which is generally imperceptible from statistical noise to the naked eye

2/
Claiming community masking would suddenly be the difference between vulnerable people being safe or unsafe is simply false

Whilst they may modestly impact population levels of infection, they have a negligible impact on any individuals absolute risk

3/
Read 4 tweets
Dec 13, 2022
With everything going on, it can feel difficult for parents to know when to get their poorly child checked out

My most important tip is to check the AMAZING healthier together website (or app)

what0-18.nhs.uk

What follows are some general tips I give parents in ED

1/
Firstly, it’s normal for them to not be normal when poorly - because they’re poorly!

As a reference, remember when you last had a flu like illness and how you felt

That’s probably how they feel! They will behave accordingly

You’re looking for signs out of keeping with this

2/
Fever can make children look extremely unwell

If they perk up when the fever recedes, then they probably looked so unwell because of the fever - not because they have a serious illness

This is a reassuring sign - still looking very unwell when temp normal is more concerning

3/
Read 8 tweets
Dec 4, 2022
Here is a totally uncontroversial thread about immunity to common pathogens as influenced by the pandemic

I will simply state facts

1. Rates of many commonly circulating pathogens almost completely vanished during the first 1 - 2y of the pandemic (eg Group A Strep)

1/ Image
2. The reason these pathogens almost vanished was because transmission was reduced by the measures which were introduced around the world to reduce transmission of #SARSCoV2

This coincidently also reduced transmission of other pathogens, often even more successfully

2/
3. Because these pathogens commonly circulate, there is usually a relatively stable amount of population immunity to them, acquired by infection

4. Vastly reduced rates of infection will therefore result in lower levels of population immunity than prior to the pandemic

3/
Read 4 tweets

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