Thread by @BillHanage

This from @devisridhar is the sort of grown up, admitting uncertainty, but science led take that’s exactly what you want in a pandemic. I have some comments specifically about the uk’s attitude to transmission in schools 1/? theguardian.com/commentisfree/…

The risk has literally evolved over the last 18 months. The founder virus was poor at infecting kids, especially younger ones (there has always been a big difference between the under tens and older) 2/?

I’ve heard smart people I trust say that the R in schools with the founder virus was below 1. That seems very plausible for that virus and the under 10s, less so for older age groups. Both are complicated by the fact that kids are less likely to have symptoms 3/?

However, younger folks can have high viral loads, as shown by this @c_drosten et al tour de force science.sciencemag.org/content/early/… 4/?

The whole problem with concluding kids are not major contributors to transmission is their tendency to have minimal symptoms. That means testing directed at symptoms will miss those infections/transmission events, even for the founder virus 5/?

And once alpha comes along that changes matters. Now those adolescent age groups are *definitely* hotbeds of transmission. This was probably a major factor in the rapid spread of alpha in the UK. Schools were practicing minimal infection control 6/?

And of course the result was *another* lockdown (made necessary by poor pandemic management). Together with an excellent vaccination campaign, that made a huge difference, although it could have been worse 7/?

take total pandemic deaths in the first wave and second waves, compared by percentage. We had it hard here in MA. Roughly 55:45 - most happened at the start. In the Uk the corresponding numbers are roughly 30:70. Spring 2020 was only the start and the alpha wave was terrible 8/?

Now, having gained some control through a couple decisions (vaccine plan and lockdown) that were genuinely good, the UK response to Delta repeated all the mistakes that should have been learned from - including this spectacularly poor piece of advice gov.uk/government/new… 9/?

This did not work out well. Please note that rates in younger kids seem low. This is good and should make people feel better about sending them to school, but the adolescents?! 10/?

The result was a surge, leading to yet another delay to a silly, predetermined end date. It didn't need to happen. Here we are vaccinating 12-18 year olds. If you're not doing that you can at least protect them with other interventions 11/?

If you don't protect them then you will get more infections, more transmissions to vulnerable folks, not all of whom will be vaccinated, and more cases of MIS-C than would have happened cdc.gov/mis/index.html 12/?

(sidebar if you want to use rapid tests in schools or indeed anywhere, you have to use them regularly on symptomatic and asymptomatic alike and act on the results, and it don't sound like that's been happening) 13/?

Opening schools should be a priority, but as I have been saying for the last year that means putting them ahead of other things, and it means working to keep them open. The UK approach of burying the head in the sand, again, is not prioritising schools. It's ignoring them 14/end