Prof. Christina Pagel Profile picture
Jul 2, 2021 25 tweets 10 min read Read on X
THREAD: Where are we in UK with cases, where are we going and should we care?

TLDR: nowhere good, somewhere worse, absolutely yes.

1/24 (yes, I know, another long one. Still worth a read I hope!)
We are at almost 30,000 daily cases again - numbers last seen in mid December.

Cases are climbing steeply. 2/24 Image
They are climbing in all nations now - over the last week growth in all nations was about 70%.

This is clearer when looking at the same plot on a log scale (2nd chart).

It's not just testing- positivity is rising too (note that positivity chart only to 26 June) 3/24 ImageImageImage
What does this mean? 70% growth is about 9 day doubling time & 18 days left till 19 July.

Growth has accelerated recently but projecting forward at current 70% gives 90K 7 day average & over 100K cases a day by 19 July.

Charts show same thing on log and normal scales. 4/24 ImageImage
This may seem unbelievable - but we have about 25 million people likely still susceptible to covid (only 50% of pop fully vaxxed).

Schools have another 3 weeks of term.

Most things are open, inc pubs and each other's houses.

The football is on, England is winning. 5/24 Image
Vaccination will slow growth but unlikely to have massive impact in next 18 days.

Even if growth slows to 50% a week, that's still 80K daily cases by 19 July. To get to "only" 50K daily cases you'd need to suddenly slow down a lot.

Today's week on week rise is 74%. 6/24 ImageImage
So who is getting infected?

Well mainly younger people - particularly school age children and twentysomethings.

While cases are highest in 15-29 yr olds, they are rising fastest among 5-14 year olds. 7/24 ImageImageImage
In England, the number of school outbreaks is almost back to where we were last December and almost 400,000 children were off school due to Covid in week to 24 June.

There are still 3 weeks left of term in England. 8/24 ImageImage
In Scotland, cases are highest in 20-24 year olds and much lower in under 14s. School term has ended in Scotland which is a good thing.

Two thousand recent cases in Scotland were linked to football, particularly the England/Scotland match.
bbc.co.uk/news/uk-scotla… 9/24 Image
Covid is everywhere but cases are highest in Scotland and North of England (and Cornwall!).

Looking at regional English data, once again the North is disproportionately affected by covid.

But almost *every* local authority saw increases last week. 10/24 ImageImageImage
So that's where we are and where we are going over next 18 days.

And then on 19th July, we open a lot more. Will this matter?

What about hospitalisations & deaths? 11/24
The number of people in hospital is still low - much much lower than it would be without vaccination and compared to where we were in Nov with similar case rates.

But hospitalisations are rising - especially in Scotland and England and that growth is also increasing now. 12/24 ImageImage
In England, hospital admissions are rising in every region but are highest in the North. 13/24 Image
Daily reported deaths have started rising a bit but are still very low - much much lower than compared to last autumn with similar case numbers. This is a good thing and largely due to vaccines. 14/24 Image
So why should we care?

Many (inc govt) are saying infections don't matter any more, that the link between cases and hospitalisations / deaths is broken. That it's fine if kids & young people get it and we shouldn't worry about it.

I disagree. Strongly. Five reasons. 15/24 Image
1. Hospitalisations & deaths are far lower than they would be without vax. But they are rising - and if we get to over 100K cases a day, many will still get very sick and some will die.

Plus hospitals are already stressed and don't need more stress! 16/24 Image
2. Long covid. ONS reports 1 million people a year living with long covid, and 385K have had it for over a year. 634K said it adversely affected their daily lives.

Even 7-8% of 2-15 yr olds & 12% of 17-24 yr olds reported symptoms for over 12 weeks.
ons.gov.uk/peoplepopulati… 17/24 Image
Sooo... for every million new infections, we might expect 100K-200K (mostly young) people living with long covid.

Many will find their ability to work or study affected.

The longer term impact of covid on the organs are unknown - but we know covid can damage the body. 18/24 Image
3. Deprivation.

Cases are highest & vax rates lowest in deprived areas, and people more likely to need hospital and get long covid.

Children in deprived communities suffer more from education disruption.

Letting infection rates soar will exacerbate inequalities. 19/24 Image
4. Variants

Every new case provides chance for further mutation.

Delta went from 0% to over 90% of cases in 10 weeks.

As children get infected, any mutation that can better infect their vaxxed parents (and their parents' friends) will have a selection advantage. 20/24 Image
5. We can prevent cases!

We have safe & effective vaccines. Pfizer is approved for over 12s & vax for under 11s are being trialled.

We have an excellent vax programme, it *just isn't quite finished yet*.

We are letting things rip for the sake of a couple more months. 21/24 Image
We also need to support vaccines through public health measures *which govt is not doing*:
- excellent (rapid!) contact tracing
- support for isolation
- better ventilation
- better communication of symptoms, testing, isolation, vaccines 22/24
Instead, govt is planning to remove the few measures that we do have: social distancing, masks, isolation and allowing mass events & venues such as nightclubs without testing or other measures.

This is a deliberate choice to allow millions of young people to get infected. 23/24
With our excellent vax programme + better public health measures we can vaccinate instead of infect - and avoid the negative consequences of infection.

Instead govt has given up and plan is to "live with" soaring infections.

It's a terrible plan. 24/24
PS thank you to Bob Hawkins for his help in preparing the charts as ever!

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More from @chrischirp

Aug 28
THREAD: I asked what the point of Public Inquiries is for @bmj_latest

We've spent hundreds of millions of £ on Inquiries over last decades, generating deep understanding of failures & 1000s of recommendations.

But v few recommendations get implemented!
What is going on?

1/12 Image
E.g. Covid-19 Inquiry has cost £94 million so far - and is projected to cost over £200m by its end (it still has years to go).

1st report published (out of at least 9) found major flaws and proposed 10 recommendations.

Chances are low that they will be implemented :-( 2/12


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Inst for Government looked at 68 Inquiries from 1990-2017.
The Inquiries cost over £630 million and made 2,625 recommendations.

Only 6/68 Inquiries have received full scrutiny by a parliamentary select committee on implementation of recommendations. 3/12 Image
Read 12 tweets
Aug 9
🧵War causes direct civilian deaths but also indirect deaths over the following years.

Recent paper estimates eventual total direct & indirect deaths in Gaza attributable to the war - 10% of entire pop'n.

I want to explain these estimates and why deaths must be counted. 1/13 Image
Why count casualties from war anyway? For moral, legal and strategic reasons.

1 - owe it to those who have died
2 - International law says must count & identify dead as far as possible
3 - monitor progress of war & learn from tactics

2/13 Image
There are direct and indirect casualties of war. Direct deaths include those who killed by fighting or bombs.

Indirect deaths are those that die when they would otherwise have lived because of one or more of: lack of food, healthcare, housing, sanitation, income, hope. 3/13 Image
Read 14 tweets
Aug 1
THREAD: the summer Covid wave in the UK continues.
Basically, there is a LOT of Covid around and not a lot of other respiratory viruses.

If you have cold or flu symptoms, it's probably Covid.

The latest hospital data from England shows steady, quite high levels. 1/8 Image
But admissions don't tell us how much virus is circulating more generally. The best (but imperfect) measure we have is wasterwater measurements, and only in Scotland and not England.

Scotland's wastewater is showing a huge July peak - highest since Omicron's 1st yr in 2022 2/8 Image
Because different people shed different amounts of virus and variants can matter too, you can't for sure infer how many people were infected between different wasterwater peaks. BUT given the size, I'd say it's pretty likely this is the largest peak since 2022 in Scotland 3/8
Read 8 tweets
Jul 23
THREAD:
I wrote about Baroness Hallett's Inquiry Module 1 report for @bmj_latest .

She found that there was *never* a plan to keep a pandemic death toll down - I discuss this and what it means going foward.

Main points below: 1/14 Image
The headline most seen is that the UK planned for the wrong pandemic.

While it is true that was far too narrow a focus on a flu pandemic, that is not the most telling bit.

To me the most telling bit, is what the plan did NOT do 2/14


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The issue is less the wrong disease, but that there was never a plan to prevent one at all – of any disease type.

The plan was *never* about reducing the number of pandemic deaths. 3/14 Image
Read 14 tweets
Jul 19
Quick thread on current Covid situation in England and Long Covid.

I have Thoughts about the Inquiry Report published yesterday but am still trying to organise them.

TLDR: high Covid levels remain, Long Covid remains 1/11
This wave is not over. While the number of admissions with Covid remains lower than the autumn/winter waves, it has now remained highsh for several weeks.

This means there are a lot of people out there getting sick - and having their work, plans and holidays disrupted. 2/11 Image
Scottish wastewater data to 9 July shows a sharp decrease, suggesting that prevalence might be on its way down.

Obviously Scotland and England can have different dynamics, but it’s the best we’ve got as long as England refuses to analyse its own wastwater. 3/11 Image
Read 12 tweets
Jul 3
THREAD: Given tomorrow's election, I've been thinking about our nation's (poor) health, the wider determinants of health and how these have worsened and what it means for policy....

TLDR: worrying only about NHS & social care is missing the point

let's dive in... 1/25
The UK has a health problem. After steady gains in life expectancy for decades, it flatlined during the austerity years and fell for the first time this century with the Covid pandemic.

The number of people out of work for long term sickness is near record levels. 2/25
There are huge inequalities between rich & poor. Boys born in the most deprived areas can expect to die almost 10 years earlier than their peers in the least deprived areas.

Even worse, they can expect to spend 18 fewer years of their life in good health (52 vs 70 years) 3/25 Image
Read 38 tweets

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