So, the bugs that put me in hospital recently were multi-resistant E. coli. No oral antibiotics would work, so I was on IV for 8 days; 2nd line was looking challenging had the infection not responded.

#AMR isn't a new problem, but the can is continuously kicked down the road...

https://twitter.com/UKHSA/status/1789951634354667865

It's not the same as a pandemic, so I'm not sure about that comparison.
BUT folks need to be reminded that, pre-penicillin and other abx, any wound or infection could be life threatening.
#AMR is via part over-use, part misuse, part inadequate investment into R&D.

Elsewhere in the multiverse there's a reality where the next pandemic threat is under control.
Here, governments recognised that it was their moral duty to ensure that the suffering and pain of those affected, both directly and indirectly, mattered more than the prior status quo. They rectified #NHS disinvestment and "built back better" to ensure healthcare remained free at the point of care.

They genuinely addressed socio-economic inequality & inequity, channelling sufficient investment to actually "level up" deprived areas, independent of train tracks.

I'm experiencing an acute reminder of pretty much THE major principle of infectious disease pathology...

Namely: disease results from an imbalance between pathogen, host response (immunity and repair), and environment/niche.

Any skewed aspect of this triangle causes pathology. For most instances, the balance is quickly restored; we don't suffer severe disease, even upon 1st exposure to a pathogen, because our immunity is so proficient.

But, otherwise "mild" pathogens can become pretty fearsome, for example, when immunity or underlying health is low...

Spoke to someone from @moderna_tx this week at a conference.
Weirdly, SARS2 vaccines came up!

I was told that 3 separate new large-scale syntheses were prepped last Yr, with only one (XBB) eventually used. These are $bn processes.
Hence, vax sales need to recoup this outlay... This isn't anything sinister on the company's part, far from it - it's an entirely sensible & precautionary approach given the current situation.
As I've mentioned once or twice b4😉, we are still playing catch up when it comes to SARS2 evolution, both the skips and the Jumps!

SARS2 - HG2 or 3?
Some definitions...
ACDP HG2: "can cause disease and may be a hazard to employees. In normal usage they are unlikely to spread to the community and there is usually an effective prophylaxis or treatment available"
e.g. seasonal influenza, measles, herpesviruses ACDP HG3: "can cause severe human disease and may be a hazard to employees. The organism may spread to the community but there is usually an effective prophylaxis or treatment available"
e.g. HCV*, HIV, SARS-CoV1/2, MERS-CoV.
Local BSL3 SOP governs containment & waste disposal.

It's important to remember what's needed as a long-term solution to #COVID and future pandemics.
#VaccinesPlus requires population-scale mitigations, built around a core of broad vax coverage.
Suppression of prevalence is key to reduce exposure, risk to #CEV, and SARS2 evolution. Continued development and access to antivirals, ideally as drug combinations, will blunt the impact whilst we strive for this, increasing pandemic preparedness.
However, prevention always beats cure.
There MUST be Govt recognition and appropriate measures vs aerosol transmission.

OK, joking aside, what does this 💩 mean?
This has vast implications for health, wealth, and wellbeing, IMHO.
Money first, with my vast economic expertise...🤪
So, from a brief web search, there's just shy of 6M people in the UK over 75.
~3.5M CV/CEV, plus others ≈ 10M eligible?

https://twitter.com/SGriffin_Lab/status/1755339391851983063

I'm sure @jneill @chrischirp @Kit_Yates_Maths @Dr_D_Robertson @_CatintheHat etc will correct my numbers!
So, old vax price of ~£10, new price £25 😕...so either £100M or £250M...NOT cheap, plus need to buy/maintain stocks, including mRNA cold chains etc, and task NHS onto it...

...oops, I seem to have hit 25 tweets already! I will get to the point...
1. Well, initially, the paucity of antivirals means combinations aren't possible, fair enough.
2. When a drug 1st gets approved, of course it will be expensive, pharma Co's are BUSINESSES, this is catch 22 3. "We", as in most western govts, rely upon pharma to develop and trial drugs b4. This takes £bns, so don't be surprised that companies want to recoup their investment and then make a profit. Without getting political, welcome to capitalism!
Hence, must stop #NHSprivatisation

It was presumed in 2020 that we'd only be able to repurpose therapeutics.
Great 4 immunomodulators, but mispurposing of HCQ, IVM cost lives, still does.
Now, with 3 protease, two polymerase, M'abs (more needed), ACE blockers...

WHERE R THE COMBO TRIALS?!

nature.com/articles/d4158… Several drugs may yet have their NICE recommendations withdrawn, appeals in progress, but this is based upon MONOTHERAPIES🤦‍♂️
You can only get away with this for so long, esp if you dramatically expand single drug treatments 4 a ridiculously variable virus...as in some countries.

I'm staggered by the complacency here.
Ignores the potential seriousness of SARS2 and a range of so-called "common illnesses".
This is esp true for immunocompromised, otherwise vulnerable, and pregnant women, but could EVEN affect "healthy people" 🙄🤦‍♂️🤢

nhs.uk/live-well/is-m… Schools are community transmission hubs for countless infections. Most households have an indirect link to school children, or staff etc. Allowing this to churn away with uncontrolled transmission is therefore bad for kids and society, all for short-term attendance metrics...

Gaslighting over #LongCovid and esp #LongCovidKids...notably from clinicians that, coincidentally (😜), r also against kids vax, pro- infection-induced "immunity", seems now to have been reduced to self-cited, self-obsessed, opinion pieces and/or "reviews" of "the literature"... That minimising LC still carries any weight in policy, press, and practice is an embarrassment.
Nit-picking over "control groups", dismissing physical problems as anxiety, and channelling my old rugby coach telling folks to "run it off" seems more than a little anti-Hippocratic.

Waves of infection are caused by exposure of a susceptible population to an infectious agent.
For endemic/seasonal infections, we see one or two waves per year as this susceptible pool is replenished by young (unvaccinated) kids, and older/other folks losing their immunity... In addition, for viruses that change relatively rapidly to avoid our adaptive immune response, e.g. influenza A virus, this susceptible pool is larger because a proportion of otherwise "immune" people have responses that are unable to stop the virus. We are "used to this"...🙄

So, my BBC thread yesterday has caused some consternation...putting it "mildly"!😉

Folks r bashing the article, me, and what @p_openshaw said re infection induced immunity.

However, this IS, sadly, the reality of the UK/world situation, the question is whether it SHOULD be... You can probably guess my answer is NO!!!

I mean this in terms of whether policy should rely on infection plus targeted vaccination. I believe Peter has said effectively the same thing.

Nevertheless, infection DOES imbue POPULATIONS with a degree of protective immunity.

Important article to read and remember from @JamesTGallagher with @PeterOpenshaw6 & Eleanor Riley.
This really isn't a lesson we should be learning now. It was eminently predictable and worsened by crowbarring a seasonal flu vax strategy onto SARS2, IMHO.
bbc.co.uk/news/health-67… As Peter alludes to, the reason that for many COVID is now far less likely to result in severe acute disease is because of our widespread vax programme in 2021 and following, which blunted impact upon those most vulnerable, and then further reduced problems across the population.

It is abundantly clear hearing testimonies from SAGE members, and the excellent and frank account from @uksciencechief regarding that infamous meeting in Sept 2020, that, unsurprisingly, most sensible scientists recognised the certain harms of allowing SARS2 to spread unchecked. They were concerned for the vulnerable, about long COVID, about discharging +ve patients into care homes, about ignoring airborne transmission, about NHS pressure, about vaccine uptake, about childhood COVID, about the lack of population scale mitigations, about mask politics...

Right.
Seeing as it has somehow become open season on my friends and colleagues from @IndependentSage, it felt like a few points of order were timely...

1. It was NEVER the case that @IndependentSage was set up to oppose or undermine SAGE or any subcommittees. 2. We'll hear about this on Friday, but in general, @Sir_David_King was concerned by the opacity surrounding SAGE, not bc of its members, but bc of the way in which advice appeared to be being used, or not, and the apparent interference by govt advisors, and/or their iPhones 🙄.

I'm incandescent.
Relentless talk in @covidinquiryuk about so-called "segregation", and it seems this found favour with folks in high places...we already know about the current PM.

But, let's NOT beat around the bush here, segregation is sanitised speak for social exclusion... Apartheid is another word.
That it's done under the banner of "focused protection" is as thinly veiled an "I'm alright Jack" attitude as is humanly possible.
The low prevalence during the summer of 2020 clearly bred complacency in the minds of many, and this was hijacked by GBD🤬

Didn't have the energy, still don't, but THAT article...

1. Don't minimise influenza, but💀mainly bacterial pneumonia.
2. SARS2 didn't just circulate last Nov/Dec....>33K💀
3. False binaries and platitudes result from p*ss-poor funding and an acceptance of 2019 "norms". We shld aspire for better, not accept the old "normal". Let's enable Clin Vir and PH to test, vaccinate, and treat infections without robbing Peter to pay Paul.
4. I agree with what was said re UK population immunity NOT being equivalent to e.g. influenza or other endemic viruses.

Fairly mad 24 hrs...I've learned a lot.
I've learned how brave folks are contacting me to discussing NHS staff testing. Most of all, the person who 1st reached out 🙏
I've learned of a massive drive to treat SARS2 as a standard "winter virus", and this is blinding public health. I've learned that there is no acceptance by IPC of aerosol transmission, or that SARS2 can still make you acutely very unwell, or indeed kill (>33K in 2022, 15K so far in 2023💔)
I've learned that the risk of long COVID and ensuing impact on the #NHS just isn't even on the radar.

RE "natural" or "hybrid" immunity vs vaccines... wires crossed, methinks re one being "better" than the other.
Immunologically, you may get a broader, possibly more relevant response from an infection. You may not.

BUT, getting there ALWAYS carries greater risk than a vaccine. On the individual level, it may be difficult to perceive that risk for many, much like crossing the road. But, at population level, the risk is plain to see. Hence, seatbelts, speed bumps etc.

Of course, this is only the case for SARS-COV-2 nowadays...because of vaccines! 😉

So, schools are back (earlier in Scotland), and despite generous deployment of porous concrete, STILL no attention to ventilation 😉

ALSO, STILL NO CHILDREN'S VACCINES 🤬

No, we just bathe them in "natural infection"?🤢

Please @UKHSA/#JCVI, justify this in light of: 1. The notion that kids, esp u5s, aren't harmed by acute SARS2 is nonsense.
Because of insane prevalence, more admissions have occurred during omicron than any other stage of the pandemic...mild?
And no, they weren't all "just vulnerable"


H/T @chrischirp bmj.com/content/382/bm…