Prof. Christina Pagel Profile picture
Jul 23 14 tweets 8 min read Read on X
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
Baroness Hallett spelt it out explicitly. Under the existing flu plan, up to 835,000 deaths were considered *possible* - more than 3x the number the who have died from Covid so far (!).

More to the point - this number was considered *acceptable*. 4/14 Image
It could not be clearer: 800,000+ deaths was considered acceptable and planning was about how best to cope with that number.

During the Inquiry, Hancock called this a “flawed doctrine” and others testified that not enough consideration had been given to prevention, 5/14 Image
And prevention - or at least reducing the number of deaths - *was* possible.

WHO had warned of the need to consider non-flu diseases in 2017/8. Lessons from SARS-CoV-1 and MERS in the 2000s would have left us better prepared. 6/14

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Instead, when Covid hit, there were NO plans which had *thought through* quarantine/isolation, border controls, contract tracing.

Hallett called this an "obvious gap". Just read some of these screenshots of the report! 7/14


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Of course when reality hit, this plan crumbled. 100,000s of deaths were NOT acceptable after all.

But our lack of planning meant that these crucial policies on isolation, education, key workers, furlough etc were made on the hoof. And vulnerable populations were harmed. 8/14
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Hallett said that the strategy's flaws were obvious. So why did no one do something?

Yes - issues of too narrow remits and lack of oversight were clear (report paragraphs 2.46; 2.90; 6.18) but I think this misses a key point. 9/14 Image
Who decided that 800,000 deaths were acceptable in 2011 strategy?

Later, When Covid hit, the policies enacted were informed by some (opaque) underlying values (no policy is value-free).

Whose values were they? The govt? Hancock? Parliament? The Public? 10/14
I belive that public deliberation is needed IN ADVANCE during pandemic (or any emergency) planning - what ARE our national values that will inform the difficult trade offs in any response?

This process will also help with public buy-in & the success of difficult policies 11/14
There are methods for this - citizens' assemblies, juries or panels.

Incorporated into Hallett’s proposed new independent statutory body should be concrete plans to elicit, codify, and communicate our nation’s values and priorities in future emergencies. 12/14


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Essentially Hallett's Module 1 report confirms that we gave up long before it even started.

More people died and more ended up with Long Covid than needed to.

Countries that had a plan based on controlling the pandemic saw just that. 13/14 Image
Read her report here:


My @bmj_latest article is here:


I have more thoughts on the report which I may write about later! 14/14 covid19.public-inquiry.uk/reports/module…
bmj.com/content/386/bm…
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More from @chrischirp

Jul 19
Quick thread on current Covid situation in England and Long Covid.

I have Thoughts about the Inquiry Report published yesterday but am still trying to organise them.

TLDR: high Covid levels remain, Long Covid remains 1/11
This wave is not over. While the number of admissions with Covid remains lower than the autumn/winter waves, it has now remained highsh for several weeks.

This means there are a lot of people out there getting sick - and having their work, plans and holidays disrupted. 2/11 Image
Scottish wastewater data to 9 July shows a sharp decrease, suggesting that prevalence might be on its way down.

Obviously Scotland and England can have different dynamics, but it’s the best we’ve got as long as England refuses to analyse its own wastwater. 3/11 Image
Read 12 tweets
Jul 3
THREAD: Given tomorrow's election, I've been thinking about our nation's (poor) health, the wider determinants of health and how these have worsened and what it means for policy....

TLDR: worrying only about NHS & social care is missing the point

let's dive in... 1/25
The UK has a health problem. After steady gains in life expectancy for decades, it flatlined during the austerity years and fell for the first time this century with the Covid pandemic.

The number of people out of work for long term sickness is near record levels. 2/25
There are huge inequalities between rich & poor. Boys born in the most deprived areas can expect to die almost 10 years earlier than their peers in the least deprived areas.

Even worse, they can expect to spend 18 fewer years of their life in good health (52 vs 70 years) 3/25 Image
Read 38 tweets
Jun 4
As ever, I am getting lots of pushback.
Here is a compilation of the European countries I've found with recent wastewater data. Some are going up a bit, some down a bit, some are flat, none are anywhere near previous peaks.
I can't see anything here to be panic anyone. 1/3
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I can't find the dashboard for Spain, but others saying it is in a wave. Perhaps it is. England has just had one - the last data we had (a couple of weeks ago from Bob Hawkins) looked as if our wave had peaked.
So, I'm not seeing reason to think things are terrible here! 2/3 Image
Yes there are new variants growing right now. They are not growing faster than JN.1 grew in December and that wave did not end up as bad as feared.
Clearly it remains true that Covid is NOT a seasonal disease (unlike Flu and RSV)
3/3
Read 5 tweets
May 8
Quick thread on the Astra Zeneca (AZ) covid vaccine since it's been in the news today.

TLDR there isn't a new "smoking gun", the AZ vax was one of first and cheapest, it saved millions of lives globally, there are better vax out there now, adapted to new variants 1/9
the AZ vaccine was one of the first approved at the end of 2020, cheaper than Pfizer, and - importantly - easier to administer in lower resource settings as it didn't require super low temperatures for storage 2/9
In most countries it was first rolled out in older adults. As it was rolled out in younger adults, a *very rare*, serious, side effect was noticed - it could cause deadly blood clots

This was spotted quickly and studied. Vax monitoring did its job. 3/9 Image
Read 11 tweets
Apr 2
A short thread on why this is not a scary chart and why all the evidence suggests that there is not much Covid around right now. 1/6 Image
the above chart is recorded covid hospital admissions / reported covid cases. It is close to 100% now *because basically only hospitals can report cases since Feb 2024*

It is to do with changes in case reporting and NOT hospital testing
2/6
In fact hospital testing has been steady since the change in testing a year ago (only symptomatic patients get tested now).

The % of people PCR tested who have Covid is 4% - there is no evidence that there are loads of symptomatic people in hospital being missed. 3/6
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Read 6 tweets
Dec 21, 2023
Beyond a shadow of a doubt that England is in its biggest Covid wave for well over a year now, with latest ONS infection survey results published.

I've written about it here
1/7 tinyurl.com/ru7h3m28
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The UKHSA have now published their modelled estimates of what percentage of English population has Covid. And as of a week ago it's high (4.3%) and rising.

Read all about it here!
2/7
It's highest in London, South East and East & in young and middle aged adults.
The main thing is it's going up and fast, so prevalence will already by significantly higher now than it was last week. 3/7
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Read 8 tweets

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