Prof. Christina Pagel Profile picture
Oct 23, 2021 20 tweets 9 min read Read on X
THREAD: overview of where we are with Covid.

TLDR: Things aren't looking great, SW hit hard by the Immensa lab scandal, admissions climbing quite fast.

Half term should help a lot in the short term. Esp if we accelerate vax. Clear case for Vax Plus. 1/20
On vaccination, home nations between 65 and 71% fulle vaxxed. Good but behind many other high income countries now.

England v slow on 12-15 rollout - 18% vs 36% in Wales & 50% in Scotland.

16-18 yr old data shows vax works 2/20
On boosters - firstly looks like Pfizer booster works phenomenally well - much higher levels of antibodies after 3rd dose and 96% reduction in risk of catching covid after 3rd dose compared to just 1 dose.

So we def want to them in people - & case stronger for under 50s? 3/20
But although England is progressing (almost 50% of over 80s boosted), we are falling behind keeping up with eligible people (over 6 months out) - because we did so well in Jan/Feb, we are NOT keeping up now. An issue.

NB N Ireland has barely started!! 4/20
Note that while boosters are v important, as long as they are only in over 50s, won't nec help transmission that much which is concentrated in kids & their parents' generation.

Kids vax on the other hand will make a big difference (inc 5-11 yr olds when licenced!) 5/20
Overall, cases are very high - and they've been high for a long time.
We've recorded >4 million cases since 27 June which was last time we had fewer than 20K.
That's 4 months of constant drag on health & disruption to lives. 6/20
For the home nations, Wales is highest and increasing rapidly. England going up next fastest. NI high but flat and Scotland lower and flat (but positivity there is increasing).

ONS confirms Wales & England v high but puts NI lower than Scotland - lagged to a few weeks ago? 7/20
Deaths remain relatively high (given vaccination progress) - although far lower than January peak, we've still recorded over 11,000 deaths since 27th June.

ONS death registration confirms than 86% of deaths with Covid are *directly* due to Covid. 8/20
For hospitalisations, people in hospital are going up in Wales & England but down in NI & Scotland, broadly matching case trajectories.

In England hospital admissions have gone up sharply in recent days, 25% of current ICU patients are covid patients & NHS super stretched. 9/20
Let's dig into England data a bit more...

The SW is a clear anomaly both in case rates and positivity rates. The out of step drop in early Sept *should* have been picked up much quicker.

It's not the only region affected but is the worst affected. 10/20
And the SE has seen a rapid increase in hospital admissions 3 weeks since the testing problems began (2 Sep) - ie enough time for chains of transmission to start from people wrongly believing they were negative.

This scandal will have lasting health consequences. 11/20
The other noticeable things are low London levels (some due to prev infection & cities in general being lower right now). London seeing sharp recent hosp admissions - but also has a less vaxxed population.

NE & Yorks continue to have highest burden of severe Covid cases. 12/20
Looking at local authorities in the SW you can see some local authorities have been hit harder than others - Cornwall and South Devon least affected.

More transparency from UKHSA on which areas affected would be very helpful. 13/20
You can also see that the impact on the SW is across *all ages* - highest in school age kids & their parents' generation 14/20
Bu age, cases still by far highest in school age kids - particularly 10-14 year olds. Still rising too - but hopefully half term will provide a natural break.

But all age groups now rising again... 15/20
This chart by @PaulMainwood using ONS Infection Data modelled prevalence by year of age shows beautifully how rampant infection in kids spread to parents and most recently grandparent generation. 16/20
And we are seeing this now in hospital admissions. Rising in all age groups 17/20
So that's where we are. As latest SPI-M models show future is uncertain - boosters & kids vax will have a big impact but we need to speed up. Half term will help.

But winter is coming, NHS is struggling, there's AY.4.2

18/20
That why @IndependentSage is calling for a "Vaccine Plus" approach, as are the British Medical Association, NHS confederation, the Unions and other scientists. 19/20

And we need a lot more clarity about what happened with the Immensa lab scandal and what measures are being taken to ensure it can't happen again. 20/20

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More from @chrischirp

Oct 19
Important 🧵on our new peer-reviewed paper:

The pandemic is as bad as it ever was for babies - in year to Aug 2023, 6,300 babies under 1 were admitted to hospital wholly or partly BECAUSE of Covid.

They are ONLY age group where admissions have NOT gone down over time 1/17 Image
Our study, led by Prof @katebrown220, looked at all hospitalisations in England in children with a Covid diagnosis or positive test from Aug 2020-Aug 2023.
We then *excluded* all admissions where a Covid diagnosis was incidental (ie not why they were in hospital)
2/17 Image
Infants (babies under 1) are generally at higher risk from respiratory infections, plus they are the age group that, if infected, are overwhelmingly meeting the virus for the first time.

They are not vaccinated and have not had it before. 3/17
Read 18 tweets
Sep 26
Prof @Kevin_Fong giving the most devastating and moving testimony to the Covid Inquiry of visiting hospital intensive care units at the height of the second wave in late Dec 2020.

The unimaginable scale of death, the trauma, the loss of hope.
Please watch this 2min clip.
And here he breaks down while explaining the absolute trauma experienced by smaller hospitals in particular - the "healthier" ICU patients were transferred out, leaving them coping with so much death.

They felt so alone.
Here Prof Fong explains how every nurse he met was traumatised by watching patients die, being only able to hold up ipads to their relatives and how it went against their normal practice of trying to ensure a dignified death, with family there.
Read 5 tweets
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

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