THREAD on England & Omicron and what is going on.

My take on it.

TLDR: things are pretty bad and I'm sad & bewildered at lack of govt action and general levels of hopium. 1/18
First off cases... reported levels in England now more than twice as high as previous peak last January and more than three times higher than at start of December.

Latest numbers reflect infections *before* Christmas mixing.

These numbers are an underestimate.

2/18
Positivity rates are also rising v steeply - testing is not keeping up with cases.

All regions rising fast, London highest and earliest. Do not take London small case drop too seriously - drop in pre xmas tests & positivity still rising. Plus xmas likely to boost again. 3/18
As I (+ many others) warned a few weeks ago, we are now at limit of how many tests we can do - and that means case numbers increasingly poor indicator of spread. Positivity is what we need to watch out for.

Lack of tests also increases transmission - esp over New Year. 4/18
Infections still highest in 20-29 year olds, but rising fast in all other age groups apart from under 10s.

Rise in 60+ esp worrying - now approaching level last seen in Jan peak. Obv vax will make a massive difference - but how much higher will cases go - esp with Xmas? 5/18
And yes - cases ARE feeding into rapid rises in hospital admissions. I said we should expect increases after Xmas and that is what we are seeing.

Admissions are rising in *all* age groups.

Again, these admissions are from infections pre-xmas & just after Omicron dominant 6/18
And to 21 Dec, 70-75% Covid admissions *for* Covid. Many of rest caught it in hospital - which is not a good thing.

data available here
england.nhs.uk/statistics/sta…

7/18
It *does* seem as if fewer admissions need intensive care (good) but needing hospital is not a good thing and massively restricts NHS ability to treat other conditions - esp with so many staff sick.

An NHS crisis based on the wards instead of ICU is still an NHS crisis. 8/18
So what next? Firstly, cases have NOT peaked yet. With Xmas and then New Year mixing, likely to peak in early(ish) Jan. Admissions will keep going up steeply.

So far, admissions higher than recent LSHTM projections and have met SAGE prediction of >2K by end of year. 9/18
Warwick (also feeding into SAGE) published their projections today over a range of scenarios. I think we are in their "Omicron 80% less severe than Delta & Plan B only" scenario.

This gives peak hospital admissions *higher* than last January (but with fewer deaths). 10/18
Putting in a short circuit break before Christmas or even on Boxing day could have greatly reduced this peak. Returning slowly to normal from mid Jan would have minimised resurgence.

But govt has missed that boat and ignored the science. 11/18
Note that admissions are already higher than Warwick peak in best case "Plan B" scenario of 90% less severe.

NHS is planning for mini Nightingales and tents in car parks. Staff shortages are causing massive problems for all care. 12/18
We've recorded 1.4m cases in England in last 2 weeks alone.

Even if Omicron less severe we know *nothing* about its long term impact. Even if less likely to cause long covid, *hundreds of thousands* more people likely to suffer long covid - affecting them *and* economy. 13/18
We've also done nothing to protect schools - which will prolong Omicron wave & put kids at risk.

New York is warning of rising admissions in young kids - they can't be vaxxed & rely on LOW community transmission to protect them. 14/18

The usual people are out there saying all will be fine soon - we just have to let people get infected and it will be done. Just as they did at previous waves.

Mass prior infection have *not* stopped the Omicron wave. Nor has mass vax. Omicron is not last variant. 15/18
We have made a tremendous progress in boosting adults - 75% eligible now boosted. Our booster programme will turn an absolute tragedy into a "mere" terrible period.

But when will we realise that (current) vaccines cannot do it all on their own?! 16/18
We *could* have prevented the NHS strain over the next weeks. We *could* have prevented the economic damage of mass sickness in businesses. We *could* have invested in ventilation like Japan. We have not.

Instead of prevention we are planning hospital tents in car parks. 17/18
Many from govt to scientists to the media to the public have decided that 100,000s cases a day are fine. We are dangerously weakening our NHS & its staff.

Too many people will end up with chronic illness & too many will die.

All I can do is keep saying it's not fine. 18/18
PS some have asked why I've not shown death data. Firstly holiday reporting backlogs have made recent data non informative and secondly any increases from Omicron wave won't show up for at least another week, likely longer.

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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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