We can compare the UK experience to other similar countries to understand the role of public health rules in limiting disease.

Here I choose the Netherlands for comparison since it is close geographically, has similar vaccine rates, and had an initial Delta surge of similar size
As apparent from the graph above, UK doesn't come out too well. But first let's establish the conditions. Vaccination rates are similar between UK and Netherlands
Age structure is similar with the Netherlands having slightly more people in age segments >50yo
Urbanization is similar
So UK and Netherlands are pretty good pair of countries to compare. There may even be some cultural similarities around enthusiasm for football, bars, and nightclubs, but I'm not an expert there and will let others comment.
UK famously dropped all legal requirements for indoor masks and business density on July 19. Masks were still encouraged on public transport, but actual mask usage was less than 50%
Netherlands had dropped indoor mask requirements in June but kept public transport mask requirements, and in Amsterdam masking remained common (it was still required in city buildings for example)
On July 9, the Netherlands reintroduced density restrictions and a curfew, in response to data that most infections were in nightlife settings, so that's essentially the opposite of UK moving from restrictions to none on July 19
The Netherlands started requiring vaccine proof to enter restaurants, bars, concerts etc on September 25 in lieu of capacity restrictions, whereas UK still has neither
So overall we can consider the Netherlands restrictions as quite liberal (it wasn't universal indoor masking or a ban on indoor dining) and expect them to allow a certain level of disease, but we'd expect the UK's complete lack of restrictions to allow even more disease.
And that's what we see. The difference between the UK and the Netherlands in August is quite noticeable. It's not black and white, but it's significant. We can look at other countries, and UK continues to be an outlier, although other countries have bigger societal differences.
On first glance, if one doesn't think about the time lag between an infection event and when it gets diagnosed, or the ramp-up time in behavioral changes, it would seem that the drop in UK cases after July 21 was due to *removing* restrictions, but logic says that's not likely
Likewise a naive person would say adding restrictions on July 7 caused a rise in infections over the next week, but again we'd expect those cases to have occurred prior to the restrictions being implemented.
In practice we tend to see a 2-week lag between a new policy and expected effects. Not sure why. Maybe policy implementation takes a week, or maybe testing behavior is "sticky": when cases are rising, people may be fast to test; when cases are dropping they may be slow to test.
This seems to have tripped up the Economist, who declared victory in UK at exactly the wrong time: just 3 days before cases began rising again.
However the laws of biology do not dissipate just because people want them too. There are some mysteries to the virus, but its ability to infect unvaccinated people with high efficiency and also some vaccinated people at lower efficiency are not among them.
Neither do the laws of math and physics bend to the will of politicians. Fewer people breathing the same air means slower spread of disease. Absorption of viral particles on masks means fewer particles to seed infections.
Why bring this up now? Because it matters to how we approach the winter. We have a higher level of people unvaccinated than UK, while age structure is similar:
The 35% who are not vaccinated are mostly of younger ages. However that's only somewhat comforting to those older than 65. This group is highly vaccinated, but efficacy of the vaccine against hospitalization and death drops with age.

Thus reducing disease rates overall is still useful to protecting the most vulnerable.

It is also useful for preventing cases at schools until young kids can be vaccinated.
Now what is the reason for the increase in cases in both UK and Netherlands in the last 2 weeks? I'm not sure but I couldn't identify any policy changes that would explain it (those who know can correct me), so I wonder if it's more people indoors with colder weather.
The implication for the US is that, if cases start rising again due to cold weather, then we would want to maintain or reintroduce measures such as masks in indoor spaces and vaccines for dining, to get cases flattened or trending downward again.

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Michael Lin, PhD-MD 🧬

Michael Lin, PhD-MD 🧬 Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @michaelzlin

23 Oct
Pfizer's application for the vaccine for 5-11yo is progressing well.

FDA analysis identifies no red flags.

VRBPAC meeting Tuesday to discuss risk/benefit ratio. Much will depend on the value of case suppression which I think should be considered in context of schools and families. Meeting materials at link below

Trial was too small (n ~ 1500 in vaccine group) to see myocarditis. FDA estimated benefits vs risks assuming MC rate similar to 12-17yo getting 30ug (maybe overestimate; 5-11yo get 10ug).
Read 6 tweets
23 Oct
Another study just posted comparing Abs & T cells in #JnJers after J&J, Moderna100, or Pfizer boost

Confirms NIH and Singapore studies: Both Abs and T cells are boosted by Moderna100 > Pfizer > J&J

#JnJers should boost accordingly

h/t @ChildrenNeedUs_

Booster happened at 3mo after J&J vaccination.

Fig 2A: Antibody levels after boost go as Moderna100 > Pfizer > J&J

Moderna50 would be in between Moderna100 and Pfizer, most likely Image
Fig 2B: p values were not done for differences in post-boost antibody levels by booster group, but for diffs in fold change within individuals by booster group. Subtle distinction, but the latter is more variable (boxes and whiskers are taller). Anyway all diffs significant. Image
Read 12 tweets
21 Oct
You mean high yield like this? Heard a few public health people quoted saying it wasn't necessary or that it would be harmful.
Probably an unrepresentative minority, but they seem to get a lot of airtime.
But actually it was masks the OP was complaining about: "there is a time and place for them".

Right, like now?
Read 4 tweets
21 Oct
Okay since everyone is asking about which booster to get, I decided to think about it quantitatively and arrived at some general conclusions.

1. If you're J&J or Pfizer, boost with Pfizer or Moderna (the 50mcg booster dose)
2. If Moderna, boost with any depending on your risk...
This supercedes anything I might have said earlier. Reasoning is as follows.

The NIH mix & match booster study tested all combinations in a neutralizing antibody assay where a level of 100 IU50/mL correlates with 91% protection pre-Delta

Preprint link
If you're going to boost, seems might as well try to get to 90% protection again. We adjust for Delta requiring 4x higher antibodies to neutralize (consistent finding across many vaccines, some may remember). That makes 400 IU50/mL, the blue line below
Read 15 tweets
19 Oct
Turns out there were 2 studies last week comparing J&J + J&J booster to J&J + Pfizer booster! One was NIH, as most know. The other is from Singapore and it looks like a solid study too.

Most interesting: they looked at T cells too, not just antibodies!

We see again that J&J+Pfizer gave higher antibody levels and neutralizing activity than J&J+J&J, and similar to Pfizer+Pfizer. Note wide range of interdose intervals (43-71d for J&J+J&J, 11-180d for J&J+Pfizer) but Ab levels actually quite tight.
While antibodies are the first line of defense and what block you getting infected, it's essential to have T cells for avoiding late complicatinos. It's widely proposed that the Ad vaccine of J&J may elicit more T cells.
Read 13 tweets
19 Oct
🎉🎇🙂 Wonderful news! @US_FDA will allow mix & match boosters!

As the linked article below says, booster freedom helps local health officials. And it's also the right thing scientifically, especially for #JnJers

This is the happiest I've ever felt from a FDA decision!
I had some hope FDA might do this, after Dr. Marks' said in Friday's VRBPAC meeting that they'd like to know what info was needed to approve mixed boosters, and some VRBPAC members replied that the "Mix and Match Booster Trial" results were clear enough

I'd learned from repeated lack of action not to hope too much. Gathering info on the benefits of heterologous boosts for #JnJers and seeing it tossed aside for various nonreasons made me feel like Sisyphus rolling a stone

So this news is like Sisyphus finally cresting the hill
Read 24 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!