Thread by @HZiauddeen

🧵 'What's the alternative?!'/'What's your alternative?!'

This question came up several times in the replies to this 🧵 so I'll take it in good faith and answer it. I'll be very clear and explicit so that you won't have to presume what I really mean or want, I'll tell you.
1/24

https://twitter.com/HZiauddeen/status/1475828212265594886

Here goes:
First up, there is NO zero-inconvenience option for controlling the pandemic.
We have an airborne virus that is highly transmissible and can cause severe illness and death.
There is no option that will mitigate the impact of the pandemic without inconvenience.
2/24

I say zero-inconvenience very deliberately because all through this pandemic, measures like masks have been deemed an unacceptable inconvenience.

So what is the alternative that many of us (I am not even a bit player) have been fighting for?
3/24

It's this:
1. Clear & honest public messaging.
2. Control transmission (using multi-layered measures- masks, ventilation and air cleaning are 3 major interventions here, also physical distancing)
3. Protect the people (vaccinate, support with isolation, support financially)
4/24

4. Protect children specifically (make schools safer with ventilation, air purifiers, masks; vaccinate)
5. Monitor and limit the spread of infections (test, trace & isolate, quarantine).
5/24

6. Work towards a global end of the pandemic (incl vaccine equity) because the pandemic doesn't end until it ends everywhere. Even countries who have controlled their local pandemic will have surges when they open up travel.
7. Do all the above to prevent new surges/waves.
6/24

If you don't, you end up in a surge and then you have to take more stringent measures. The less you were doing to control transmission before you got into a surge, the more you have to do in the surge e.g. lockdowns.

That's it. That's the alternative I'm proposing.
7/24

So let's be clear about what this is & isn't.

What it is, is a strategy of progressive global suppression.
If you manage to do it well, you can achieve elimination (v.v. low case numbers).
If you just aim for it, you'll greatly reduce death, illness & disruption to life.
8/24

You'll still have significant cases but you can greatly reduce numbers, deaths and LongCOVID. Schools & businesses can be open, you'll get small surges but you can control them. Health services will not be overwhelmed. Vulnerable folk will be able to have their lives back.
9/24

Even if you don't do all 6 steps, each step will provide more protection.
One major risk to bear in mind with this strategy is that the more transmission there is, the greater risk of new and more serious variants.
10/24

What it isn't:
1. It's not zero COVID, that is a harder goal to reach.
2. It's not repeated lockdowns, its a way to minimise the risk of lockdowns, which happen when we fail to control transmission. Nobody wants lockdowns but we've ended up needing them.
11/24

Big question: how long do we do this for?
Answer: for as long as it takes to bring the pandemic under control globally because we want to protect people across the globe and we want to restore travel between countries.
12/24

You can do it for spells, stop and then resume again. Each time it'll be starting over it terms of controlling the local and global pandemics and it'll get harder with more serious variants. Nevertheless, each spell saves lives, health and human and other capital.
13/24

I emphasise this because people ask, 'what was the point of everything we did/went through over the last 21 months?' I have a lot of sympathy for this position. Given how much we were asked to do, it is tragic that our govt did not do more to make those efforts pay off.
14/24

Instead it took us through half-hearted measures that provided temporary and partial fixes and then back into disaster. It is little consolation to think about the worse fate we avoided by taking the actions we took but things could have been much worse.
15/24

There is are other major advantages to keeping the pandemic under control:
1. We preserve our human capital
2. We buy more time for improved vaccines and better treatments.

Now, on to the more directed question of what my 'agenda' is.
16/24

Here is my agenda: I want us to control the pandemic, if possible eliminate it. My most selfish reason is so that my daughter can go to school safely and have more of a childhood.
More generally though, I want life to be safer for everyone, in the present and the future.
17/24

And if we control the pandemic sufficiently to make life safer for children and the vulnerable, it will be safer for everyone.

Now that is my reply in good faith.
However I don't think a lot of people asked that question in good faith, so let's address that as well.
18/24

When you ask 'what's the alternative?' to a strategy of letting everyone get infected and reinfected, you're to some extent saying that the second is a reasonable option.
One can criticise an approach on its own merits (or lack thereof), without offering an alternative.
19/24

This is especially so when the approach is an obviously inhumane one. So 'well if you don't have an alternative, then people will just have to die right?' is not a great response.
20/24

It is not too difficult to understand that people may not want other people to die or fall ill, just because they are other people, and not because they have some agenda of their own.
But, if you are going to imagine some nefarious agenda, at least think it through.
21/24

I mean if you think I want to have the country in repeated lockdowns, at least come up with some plausible story for why I might want this and what I am looking to gain from it.
22/24

Like I said up front, there is no zero-inconvenience plan. If what you want to do is nothing, then something, however small, will be unacceptable.
23/24

PS: I hope you appreciate what I am doing by revealing my alternative and my agenda here. Thus far I have kept it carefully hidden in tweet threads, newspaper articles and articles on PubMed but clearly the time for secrecy is over.
24/24