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Dr Dan Goyal

@danielgoyal

22 Dec

❗️Massive…Omicron Disease Severity Study just released in pre-print.

Huge thanks to our South African Colleagues who must have worked through the night to complete this so soon.

Some thoughts on it…
[summary last two tweets]

A good study.
✅ Only reported on cases that had an outcome
✅ Controlled for age, co-morbidity, etc…
✅ Used quite solid proxy for Omicron

✅ admitted limitations -
❌low numbers,
❌no raw data on morbidity or mortality

The most important limitation the investigators highlighted, was the likely difference in vaccine/immune status. Around 50% of the target adult population had at least one vaccine by the time Omicron hit. It was less than half of this at the start of October.

Read 12 tweets

Dr Dan Goyal

@danielgoyal

17 Dec

There is a real concern that some decision-makers BELIEVE Covid-19 is only a ‘bit’ worse than Flu. This justifies less effort to treat or prevent Covid.

It is so important to dispel this absolutely wrong comparison.

🧵 1/8
RT pls.
#CareForCovid

Let’s use the UK as an example:
Flu directly causes around 4 deaths per day.
Bacterial pneumonia around 55 deaths per day.
Currently Covid-19 causes around 120 deaths per day.

Source: ONS.

Some agencies and scientists report flu and pneumonia together. This leads to the confusing estimate that “Flu and Pneumonia” causes 20k deaths per year. Covid around 40-60k.
Some interpret this as “well Covid is only twice as bad as flu”.
This is entirely wrong!!!

Read 12 tweets

Dr Dan Goyal

@danielgoyal

15 Dec

Funnelling all “available” NHS staff to vaccinate is a poor strategy.

Appropriate response is to:
1. Mitigate properly
2. Redeploy to frontline to treat the sick.
3. Then boost when able.

To avoid a few weeks of sharp restrictions a lot of people will suffer unnecessarily.

1. Letting #Omicron spread without capacity to treat the sick is not a sound public health strategy. Nor is it sound clinical prioritisation or appropriate critical incident triaging. It may temporarily appease those who have little idea of the consequences.

2. Our first duty is to treat the sick. It is pandemic management 101. Find them, isolate them, treat them. Do it well and the threat lessens.
No doubt vaccines lessen the threat, but mortality still depends heavily on access to treatment, as the UK and US have shown previously.

Read 8 tweets

Dr Dan Goyal

@danielgoyal

12 Dec

Preventing lockdown…
Our gov have had one eye on herd immunity since The start. This shaped policy and provision.
It must now change if we are to suppress Omicron - avoid lockdowns - and protect the public.

Mistakes are forgivable; failing to learn from them is not.

RT pls

Herd immunity leads to an attempt to minimise casualties NOT suppress infection.

Omicron is set to overwhelm healthcare providers. This will lead to higher mortality from Covid and Non-Covid disease.

Two things can stop it:
▪️Suppression of cases
▪️Optimising Care Capacity

1. Find the Sick!
Cough, Fever and loss of taste/smell account for less than 50% of presentations in early disease.

We must add “cold/flu-like symptoms” as reasons to test and isolate. It may be test and release is possible. But to avoid lockdown, we must catch more cases early

Read 12 tweets

Dr Dan Goyal

@danielgoyal

10 Dec

@dgurdasani1

I’m sure @dgurdasani1 will correct me if wrong, but the message isn’t that Covid is inevitable or we must eliminate it.

We will get better at treating it and perhaps tolerating it (immune wise).

But to pursue a vaccine only strategy when herd immunity is not assured is wrong.

https://twitter.com/skynews/status/1469037322645782531

Deepti and others have IMO been right: the least global impact would be (and is) to eliminate SARS-CoV2.

The world has not been united enough, at least not yet, to achieve this. And our leaders have lacked the vision to even consider it.

Perhaps it raises important questions about our processes and systems, if we have the power to prevent an infectious disease with a similar mortality as Endemic Malaria from becoming established and have chosen not to.

Read 4 tweets

Dr Dan Goyal

@danielgoyal

10 Dec

@VickiGSP

Take Two:
"The Omicron Variant!"
Can we do better this time round?
Here are three animations born from the belief that we can!
🙏🏼 @VickiGSP

[Pls Share - if we can improve care for Covid, then we can save lives and reduce the hardship of restrictions]

1. The problem...

A lack of clinical follow-up costs lives and resources...

...but we can stay vigilant to signs of deterioration.

2. The Individual Solution

Early Intervention saves lives and resources, and frees up capacity for non-Covid illnesses...

...the more capacity we have to intervene early the safer society is!

3. The Healthcare Provider Solution...

Read 4 tweets

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