Bill Hanage Profile picture
Assoc Prof at Harvard T. H. Chan School of Public Health and Gooner. Currently cosplaying Dr Rieux in some weird re-enactment of La Peste. Tweets are personal
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10 Jun
The pandemic has been especially dangerous in nursing homes, and many handled it badly (yes @andrewcuomo that includes you). This from the U.K. includes some retrofitting of what we did and didn’t know, and what experts would have advised 1/n theguardian.com/society/2021/j…
Starting point is that we have known a long time that outbreaks of respiratory infections are deadly in nursing homes. I and many others have written about that in the past. The danger was expected but not prepared for 2/n
This from @DHSCgovuk is shameful. I was watching the evidence at the time. I and most of my colleagues thought some asymptomatic/presymptomatic transmission was likely. This misrepresents the state of the science at that time, and what about the precautionary principle? 3/n
Read 6 tweets
9 Jun
The US has (overall) pretty good levels of vaccination by now and this is excellent and *everyone* involved deserves credit - but the virus is not gone and it is wrong to pretend that it is (teeny slightly ranty thread)
First we have a new variant on the scene (Delta) which is pretty unambiguously worse than its predecessors. Already about 6% of cases and climbing
Then there are a bunch of states in the south that experienced a surged over the summer last year. Some of them are mooting shifting to once a week reporting, which is not a good idea coronavirus.jhu.edu/pandemic-data-…
Read 9 tweets
4 Jun
So growth rate and R number in the UK now over 1. Unsurprisingly given that Delta variant now dominant. A short thread on the next few weeks there, which will be (sorry) big on uncertainty gov.uk/guidance/the-r… 1/n
That's quite a large increase. The caveat of course is that it is from a *very* low base indeed. And cases will not necessarily translate into severe illness, especially in vaccinated people 2/n
Unfortunately these too are up, from a low baseline. This should be treated with caution because when numbers are this low they can be impacted by unusual events like clusters of infection in vulnerable populations - although you'd hope such folks were vaccinated 3/n
Read 9 tweets
3 Jun
Have digested the latest excellent technical briefing from @PHE_uk on variants and Delta (the variant formerly known as B.1.617.2) in particular. as ever, all findings are context dependent and should be interpreted with care, but this is serious and deserves a wide audience 1/?
First, read all about it yourself (don't take my word for it!). Briefing here assets.publishing.service.gov.uk/government/upl… and Risk Assessment assets.publishing.service.gov.uk/government/upl… 2/?
This is from the risk assessment. Yes there is a lot of red. There is now very good evidence of increased transmissibility (will come back to that) compared with Alpha/B.1.1.7 (already quite transmissible). This is important. There is also... 3/?
Read 18 tweets
2 Jun
I read this article this morning and it made me uneasy, I've just figured out why. Not linking deliberately although easy enough to find if you really want to 1/n
The article admits that a definitive answer on the origins of the pandemic is probably never going to be available (I agree), and then proceeds as if it were. This is silly 2/n
If there will never be a definitive answer to the question, why act like there will be? In its absence people will pick sides based on pre-existing positions rather than accepting uncertainty. And the thing is we'll be better off in the future accepting that uncertainty 3/n
Read 6 tweets
27 May
I was wondering earlier today if change was afoot in the UK due to B.1.617.2, but @jburnmurdoch's thread is better than anything I could put together. It deserves your time. I do think it misses something out however. Hospitalizations are climbing much earlier than I'd expect 1/n
First it certainly looks like B.1.617.2 has become readily established, and is sweeping in multiple different places suggesting that it is more transmissible even than B.1.1.7, itself no slouch. IMO we can't put this down to founder effects/networks 2/n
(I still don't understand why given what *looks* like high transmissibility it has an MRCA so far back, but it's clearly capable of causing outbreaks like these. That's enough to take it seriously) 3/n
Read 14 tweets
26 May
A few points about "Chicken Pox parties", and why they should never have been part of any serious discussion of pandemic management thejournal.ie/dominic-cummin… 1/n
Like Covid, chicken pox is more likely to lead to severe illness and complications the older you are when you are first exposed. In the UK in the 1990s about 25 people died every year of the infection, 80% being adults ncbi.nlm.nih.gov/pmc/articles/P… 2/n
It is generally thought that on recovery from chicken pox immunity is lifelong. As a result in the 70s and 80s some people would arrange for their kids to be infected at an age they would be at lower risk of complications. This is not a good idea 3/n infectioncontrol.tips/2015/12/18/its…
Read 8 tweets
25 May
How to start on the problems with this? Herd immunity to SARS-CoV-2 through unmitigated outbreaks comes at an abysmal cost in deaths, and chronic outcomes of infection. Ok we know that now but... 1/?
We knew that *then* theguardian.com/commentisfree/… 2/?
We knew it in the autumn too theguardian.com/commentisfree/… 3/?
Read 8 tweets
16 May
Thinking about the uncertain situation w B.1.617.2 in the UK as the country opens up, this is very good (no surprise, it's @adamhfinn answering the questions). I have a few additional points and a mild point of disagreement 1/n theguardian.com/world/2021/may…
The additional point - it's really not clear what is going on with 617.2. It has certainly been growing, but that doesn't necessarily mean it is (much) more transmissible. It may have merely had more opportunities 2/n
As more contacts and opportunities for transmission arise in the UK, we can expect them to result in more cases. Having said that of course, we need to ask why one lineage rather than another is lucky enough to take those opportunities - maybe it's more than luck 3/n
Read 11 tweets
16 May
Upon seeing this I had to go look for what prompted it. Although that might not have been the intent of the original post, I’m glad I did 1/n
Here’s the preprint. It’s not clear why MIT should feel ‘shame’ (isn’t academic freedom a good thing?) or what it has to do with the prolific aforementioned scientist. arxiv.org/pdf/2101.07993… 2/n
If nothing else, we need to accept that preprints happen, that sometimes they are less good than regularly published work and sometimes they are better. They have a special role in a rapidly changing situation like this 3/n
Read 4 tweets
10 May
There will be a lot of people answering this the obvious way, but what strikes me is that *even now* there’s not enough immunity from prior infection in Sweden to stop this happening.
Whatever else that means, it suggests that population protection through infection induced immunity is not going to happen without bad consequences. The idea might have been defensible at the start when we were more uncertain about severity, it hasn’t been for some time
If people compare per capita mortality in Sweden with elsewhere note that an appropriate comparison is the other Nordic countries, all of which took a very different route, rather than other European countries with their own stories
Read 4 tweets
8 May
It’s great that public health has been getting some recognition. Many 🙏🏼. If you’d like to donate to help this work, which is mostly done by really underpaid and devoted people, here are some ideas. @MSF_USA @CEPIvaccines @PIH @NFIDvaccines for a start 1/n
If you want to help public health donating to established non profits is better than say, someone from twitter on patreon, for a bunch of reasons. For a start there’s oversight of where your $ go and an existing system of governance, hopefully with accountability! 2/n
I don’t want to deter donations to new initiatives like @crisisreadiness, but just to point out that if you really want to help, think about the best way to help 3/3
Read 5 tweets
7 May
This article, on the arrival of B.1.617 (et al) in the U.K. is important, but is missing some really important context. Notably, we expect clusters, even in vaccinated people. It’s how *many* there are when compared with unvaccinated that matters 1/n theguardian.com/world/2021/may…
Look at this. No deaths. That’s not the usual story when it comes to this virus and care homes. I don’t want to draw strong positive conclusions from small numbers, but nor should we draw strong negative ones 2/n
It’s actually rather like this. Again an outbreak, but nowhere near as bad as we’d have expected in the absence of vaccination cdc.gov/mmwr/volumes/7… 3/n
Read 6 tweets
1 May
The only thing more mind boggling than the fact this is happening, is the idea that it is a “test” that will provide useful data. It isn’t, period.
It is happening at a time of low prevalence, in this age group due to few contacts offer the last few months, which makes any findings of questionable relevance to circumstances with higher prevalence
Negative test before entry is good, but ‘urging’ people to get tests after (or before for that matter) is not follow up. It’s not even an adequate study.
Read 6 tweets
26 Apr
I am seeing a lot of anxiety around partial immunity through vaccination producing selection for escape variants. Here @colinrussell and I explain why we *don't* think that's likely 1/n science.sciencemag.org/content/372/65…
It depends on the supply of the mutations that enable immune evasion. If we assume this happens during breakthrough cases in vaccinated people, there's not much time for it to make a difference, because transmission tends to happen early on in infection 2/n
And if breakthrough cases are less likely to transmit in general (as seems so in at least some cases) that makes it even more difficult 3/n papers.ssrn.com/sol3/papers.cf…
Read 10 tweets
6 Apr
The UK is going to be making free rapid tests available to everyone. As you might imagine, I approve. However it should be remembered rapid tests are most effective when combined with other things. Short thread 1/n
nytimes.com/2021/04/05/wor…
For a start, for tests to be useful they have to be used! It is not obvious to me that there is any incentive for that in the proposal. If people suspect they are infected, but don't want the risk of having to isolate, they're not likely to take a test 2/n
Then there's the perennial question of what happens in the event of a +ve test? If people actually isolate that's great, but that's not been universally the case in the pandemic so far, putting it mildly. Hopefully their behavior would change enough to make a difference 3/n
Read 9 tweets
26 Mar
Getting immunity from a vaccine is vastly safer than from infection, both as an individual because it avoids the negative consequences of infection AND for the community because unlike the virus, these vaccines don’t transmit
So I am quite pleased that a decent fraction of Fla residents have received at least one shot, the more the merrier
I predicted a few months ago that Fla would be quieter than other places over the winter because of larger number of contacts outside. I don’t know if that *was* the reason but the relative quietness did materialize even as variants have grown to a large proportion of cases
Read 6 tweets
18 Mar
Reading this, which looks like a pretty definitive take on the origins of the pandemic. Important conclusion: most zoonoses of this kind would go extinct of their own accord. science.sciencemag.org/content/early/…
That actually makes a lot of sense if you consider everything we know about the clustered nature of transmission. Like they say, we should do better at detecting zoonoses early on
Nice illustration of how a transmission chain could sputter along a bit before making it big. Note that what this means is that while the pandemic descends from the market in Wuhan, that's not necessarily where the index case occurred
Read 7 tweets
16 Mar
Absolutely right. The various aspects of the failure need more thorough unpacking in a medium that is probably not twitter, but it is actually striking to me how *much* we (meaning epidemiologists) knew a year ago about what this virus is capable of, and how little it has changed
Just as a for instance, the varying severity by age has been known pretty much since Jan 2020. And so has the potential for presymptomatic transmission, which is absolutely essential to the effort needed for control, and the importance of rapid testing
I was very aware of the potential for minimally symptomatic transmission because of my involvement in this (true story - I wrote my draft on an overnight flight at the end of feb. Then we all got slammed and it wasn't submitted for months) ncbi.nlm.nih.gov/pmc/articles/P…
Read 9 tweets
13 Mar
There are a lot of think pieces going around about the pandemic one year on. This is one of the best, from @jameshamblin, because it is upfront about the difficulties we face handling uncertainty. That's relevant to then, and now. A short 🧵commenting on the issues raised
The first thing to remember is that uncertainty about precise numbers is not an excuse to avoid action. This is a common misunderstanding about how mathematical modeling results should be interpreted. Depending on your inputs, you can get all sorts of results...
The goal is not to forecast exact outcomes, because you hope you never experience the world in which nobody intervenes *at all*, but to understand how seriously to take the threat. Qualitatively right is not the same as exactly quantitatively right.
Read 16 tweets
1 Mar
A long sobering look at the pandemic in the UK. The success of the vaccine rollout should not obscure the way that leaders failed to heed the lessons of spring 2020 to an extent that beggars belief nytimes.com/interactive/20…
Look at the cumulative deaths. Around 40k in spring of last year. In other words ~2/3rds of the total are from the last few months (data from worldometers.info/coronavirus/co…)
While some of this is down to the emergence of B.1.1.7, it is mostly down to an attitude that resisted taking appropriate action, and ignored scientific advice. As many will know, I think 'led by the science' isn't the right way round - we should be led by those we elect. But...
Read 5 tweets