For the avoidance of doubt:
SARS-CoV2 transmission is mainly aerosol, some droplet - proportion varies with activity. Hence, indoors = super-spreader events, outdoors = dissipates quickly.
Well ventilated/filtered indoor spaces or outdoors, keep distance to avoid droplets, reduce
time spent in proximity to others, wear well-fitted filter masks (FFP2/3) if distancing is problematic, for long durations, and/or if prevalence is high.
Poorly ventilated/filtered indoors - masks as above are ESSENTIAL. Limit time, distance if possible to avoid direct exposure.
Now apply some logic...
Face shields do next to nothing, unless you're expecting a sneeze in the face, and even then will only prevent "direct inoculation"...
Similarly, whoever has spent the last 2.5 years making pretend force fields and castles out of Perspex with handy holes in them to pass things through, again, nice idea but primarily will prevent you experiencing direct exposure...does NOTHING to stop aerosols!
It pains me that I need to say this, but in a poorly ventilated space for any significant time (depending on the size of the room), "social", or indeed antisocial distancing will do NOTHING without a proper mask!
OK, so droplets CAN cause fomites, but sanitising our hands only prevents a minor route of SARS-CoV2 transmission.
However, much more effective for e.g. RSV, Influenza etc...but not Norovirus, soap and water required!!!
Please remember that your mask must actually be on your face, covering BOTH your nose and mouth, with a good fit and seal. FFP2/N95 or FFP3/N99 recommended. They are not chin, elbow, or neck warmers. They should be clean, dry and undamaged. This will protect you AND others.
Finally, none of these things are magic bullets. They will each partly reduce risk and work together. NPIs are variant agnostic - the virus spreads the same regardless. However, they should be used to SUPPORT vaccines. Get boosted, protect your kids. Stay safe. #VaccinesPlus
Oh, perhaps consider these ideas in places where, say, clinically vulnerable, unwell, very young, or elderly people might spend a lot of time...for example, SMEGGING HOSPITALS, SCHOOLS AND CARE HOMES!!! Or, ideally everywhere...winter is not going to be fun at all... #COVIDpledge
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@RajeevJayadevan @CoronaHeadsUp @gwladwr @red_loeb @PJeffcock Rajeev. SARS2 waves are still driven almost entirely by virus evolution with very little influence from extraneous factors. Hence, it remains unpredictable, not cyclical.
The dynamics between viral variation and immunity dictate the scale of epidemic waves as well as severity.
@RajeevJayadevan @CoronaHeadsUp @gwladwr @red_loeb @PJeffcock Yes, the individual risk of severe acute COVID has been dramatically reduced by vaccines, but this scales by prevalence at population level. E.g. ~12-13K certificated deaths in the UK during 2024, ~60% as underlying.
The other issue is morbidity. #LongCovid & latent sequelae.
@RajeevJayadevan @CoronaHeadsUp @gwladwr @red_loeb @PJeffcock Govt guidance focuses very much on the individual risk, and it's understandable that individual clinicians may not appreciate the population impact.
However, as we r seeing yet again in SE Asia, when balance favours the virus, there is no doubting the additional health burden.
1. Lockdown is an extreme response. There should only have been one. 2. The fact that there was >1 is due to policy failure and meddling from eejit GBD types, PRE-VACCINE🤬💔 3. Kids are NOT invulnerable.
4. Failures to act quickly, unlocking too soon, and lack of mitigations set in place just continued the roller coaster ride. 5. Restrictions highlighted and exacerbated preexisting inequalities. As @covidinquiryuk shows, #Austerity, #Brexshit 6. "Key workers" faced higher risks.
7. Re kids, misguided narratives that kids somehow magically were not infected/affected/able to transmit SARS2 are, put simply, bollocks.
The harm done by this was, and continues to be, criminal, IMHO. Yet, it is still perpetuated by some who, frankly, ought to know better.
OK, I have a busy day, but I've been asked about why I've criticised the GBD, antivax rhetoric etc...
First, re vaccines, see my 📌. TLDR, they're not perfect, no medicine is, but lies about modifying our DNA, mass cardiovascular problems, graphene, pharma/WEF/Gates plots are 💩
On to GBD itself...and I must be brief, you could write an essay.
Amongst its many flaws, the GBD would never work because: 1. When you segregate society, bad things happen. 2. Vulnerable people have just as much right to a life as anyone else & already put up with too much.
3. Identifying "vulnerable people" isn't easy...just look at the exclusions from vax programmes nowadays. 4. We're all one Doctor's appointment away from "vulnerable" 5. The invulnerable...aren't. 6. Individual risk scales by prevalence. Don't quote %s at me, you utter plonkers🤦♀️
I'm not going to go into details, mainly cos it makes me so angry to sit reading it for any length of time.
Also, the bespoke model leaves me dumbfounded. What follows are generalisations, mainly because this is basically an iteration of the 23 model, where this attrition began.
First, yet again, the focus, or rather the most favourable cost-effectiveness, is avoiding deaths and acute hospitalisation.
Of course, this is critical, especially as we still do nothing to mitigate uncontrolled prevalence, and I include effective vaccination in this regard.
We have a very safe, efficacious paediatric SARS2 mRNA vax, used 6m+.
Reduced dose and age minimises small risk of myocarditis seen in adolescents.
This sobering study by @katebrown220, @chrischirp et al shows 6m+ kids are always at risk from acute COVID.
Maternal antibodies should help protect newborns during the first 6m of life, but this is optimal when mums are vaxd during pregnancy. Sadly, this only happens if your term coincides with a booster campaign 🙄, which is just plain daft. Highlighted many times by @VikiLovesFACS
The first exposure to a pathogen is always the highest risk, no matter what age it occurs.
Whilst kids tend to develop severe symptoms less frequently than adults, this is the wrong comparison and does NOT mean they are invulnerable.
Both short term and long term problems arise.
Sorry, looooong thread, but hopefully done soon!
Where was I?
So, let's say the small elite team of virus particles has survived the journey and landed where they want to be...
First, they will encounter innate barriers, eg mucus, which they must cross to physically reach a cell.
There will also be complement, mucosal antibodies (if host is immune), and these can both inactivate and clump viruses together such that phagocytic cells literally eat them up!
So, many of the hurdles from the way out also hit on the way in, and this time, numbers are limiting.
So, viruses need to infect their target cell as quickly as possible before they succumb to defenses.
This mainly depends on the affinity of the viral attachment protein for the cellular receptor used to gain entry. But you have to both unlock the door AND walk through it...