Thread by @Dr_D_Robertson

Commentary on the Government's Covid autumn and winter plan 2021

A thread🧵

To put this in perspective, here is a history of the Government's planning on Covid.

https://twitter.com/Dr_D_Robertson/status/1321518534724358147

First of all, it is good to see that there *is* a plan, particularly after the removal of restrictions after Step 4 of the Government's earlier Roadmap.

As with previous plans, there are no numbers - no thresholds on cases, hospitalizations, or deaths.

It is more difficult now to set simple Covid thresholds as there are many factors involved - vaccines, immunity levels, variants...

... plus non-Covid hospital backlogs, and other critical uncertainties such as influenza over the winter. High levels of Covid and high levels of flu combined would be very bad.

However, thresholds *could* have been set on *overall* hospital demand.

It also how the 'risk of the NHS being overwhelmed'. If you *define* the NHS as something that is an emergency service / something that will always cope, then these thresholds become even more vague.

So, looking in detail at the autumn/winter plan.

An acknowledgement that there was (in Scotland) an impact from the return to schools and workplaces ... and an expectation that there will be further upward pressure on case numbers

There is a restatement that the link between cases, hospitalisations, and deaths has weakened significantly since the start of the pandemic. It is true that the proportion of cases hospitalized or that result in death has decreased significantly.

There is (thankfully) no talk of the link being 'severed'. Cases and hospitalizations and deaths are however linked, and the risk is that an increase in cases follows through to hospitalizations and deaths - albeit at a lower proportion

Here are the points of 'Plan A' - heavy reliance on vaccines

A good statement of the *risks*
- vaccination levels
- immunity waning
- society contact levels (schools/workplaces)
- new variants

And flu being a significant risk

'The Government will remain vigilant and monitor the data closely' - although with no public metrics as to thresholds for action

A chart on 'safer behaviors and actions'

On to contingency planning. Mention of SPI-M modelling for Step 4. Will be interesting to see if new modelling is presented this evening.

"SAGE and SPI-M modellers now deem the most pessimistic scenarios in the step 4 modelling to be unlikely **except in the case of a new dangerous Variant of Concern or significant waning immunity**.

(so this infers that they are possible)

It would be useful to see latest models.

Plan B
- communication
- mandatory vaccine-only Covid status certification (vaccine passports)
- face coverings becoming mandated in certain settings

- and working from home

So, there we have it. Full text here.

gov.uk/government/pub…

A relatively light-touch plan, with possible contingency plans.

As ever, not imposing low-impact measures now increases the risk of having to impose high-impact measures later on.

A real risk remains of Covid variants, waning immunity, and high levels of flu combined with Covid

Addendum: SPI-M (modelling) consensus statement
gov.uk/government/pub…

Commentary on the SPI-M modelling paper

https://twitter.com/Dr_D_Robertson/status/1437767815008825356