The NHS has an abusive relationship with its workforce. Under the guise of "professionalism" & "vocation", many staff are expected to work long hours, often antisocial ones (nights/weekends/bank hols), & work over & above their contracted hours. Staff feel guilty if they don't... ...do the hours. You're shirking/slacking, letting down your patients/colleagues, it's unprofessional, etc.
We select them young (on the basis of them being caring, having a vocation), & indoctrinate them at medical/nursing school, perpetuating this abusive relationship...

The NHS is under tremendous strain at the moment, & this is occurring across many sectors - primary care, ambulance services, acute hospital care, mental health & community care. The huge demand for care outstrips what the system can currently supply.
1/
hsj.co.uk/quality-and-pe… This has consequences.
Longer waiting lists, reduced patient access, delayed investigations & treatments, all of which will impact on the experience of care as well as health outcomes.
2/

Operational public health considerations for the prevention and control of infectious diseases in the context of Russia’s aggression towards Ukraine.
Informative @ECDC_EU guidance particularly relevant to refugee health issues
1/
ecdc.europa.eu/en/publication… Ukrainian refugees may be at risk of certain infectious diseases.
Key ones to watch out for for kids are measles & polio, due to insufficient vaccine coverage (82% & 80% respectively).
Crowded bomb shelters & reception centres can facilitate spread.
businessinsider.com/video-ukraine-…
2/

Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine ... cdc.gov/mmwr/volumes/7… via @CDCgov PROTECT is a prospective cohort study monitoring SARS-CoV-2 infections in participants aged 6 months–17 years in Arizona, Florida, Texas, & Utah. The kids were tested for SARS-CoV-2 weekly from July 2021–February 2022 & had various data collected monthly.
2/

Self-isolation period for people infected with COVID in England will be reduced to 5 days from Monday 17 Jan. But it's conditional: 2 NEGATIVE tests on days 5 & 6, & no symptoms, & not in certain high risk situations e.g. working with vulnerable people
1/
gov.uk/government/new… I understand the desire to reduce the isolation period to minimize the impact on the workforce, the economy, strained businesses/NHS & people's lives.
But, this is not a risk-free approach and I'm concerned...
2/

🇨🇭 preprint study comparing RNA & infectious viral load between pre-VOC strains & Delta VOC in unvaccinated patients as well as in vaccination breakthru' infections due to Delta and Omicron.
Useful study as virus culture may be a better proxy for infectiousness.
1/

https://twitter.com/medrxivpreprint/status/1481003870067298311

Findings:
🔹Low correlation between RNA genome copies & infectious viral titres.
🔹No correlation between infectious viral load & age & sex of patients
🔹Unvaccinated patients infected with Delta have higher infectious viral load

2/

Thoughts for today
Thus far we've focused a lot on the public/patients as COVID casualties. But I think there are 2 distinct groups of casualties we need to consider too that may be neglected or hidden:
1) Our frontline responders, and
2) Unpaid carers

1/ Many of our frontline responders (health, social care & public health) have been working flat out & then some more over the past 2 years. They're not machines & if not cared for will burnout or worse.
We will need them not just for now but for the pandemic recovery & beyond.

2/

Person catches bird flu in "very rare" case of animal to human transmission
1/
newsweek.com/bird-flu-avian… Essentially flu viruses are bird viruses. Some have evolved to be able to spread in other hosts e.g. pigs, bats, camels, dogs, cats, horses, mink, seals & humans. Humans may be infected either directly from birds, or via an intermediate animal host.
ncbi.nlm.nih.gov/pmc/articles/P…
2/

There's some clamour to ⬇️further self isolation duration (esp after CDC suggested 5 days). The timing of transmission is thought to be centered around the onset of symptoms, with 1 study estimating 3/4 of events occur 2-3 days before to 2-3 days after.
papers.ssrn.com/sol3/papers.cf…
1/ But,⬇️isolation period will ⬆️residual risk of infectiousness.
At 14 days isolation, without other mitigations, the risk is ~1% (or more).
bmcmedicine.biomedcentral.com/articles/10.11…
At 10 days, unmitigated risk ~5%, and so on.
2/

Of all the teaching I do for my medical students, I feel most passionately about the one on learning disabilities for our first years. If there was a single topic that encompasses the broad spectrum of public health, it is this. Vulnerability, inequality, health needs, ethics.
1/ Disability is more than just the physical/mental limitations they have. It is the result of negative interactions that take place between a person with an impairment and her or his social environment.
What we do as a society creates & exacerbates the disability.
2/

Penultimate session today on our @ScHARRSheffield MPH module on Disaster & Emergency Management where we covered Business Continuity Management - all about how organisations can plan in advance how to maintain critical services in the event of an emergency or any disruption.
1/ This involves identifying
a) Key functions: what is the minimum that needs to be done in an emergency to keep things working?
b) Key personnel needed: what is the minimum number needed & what are the key skills required?
c) Key resources: What resources/equipment are needed?
2/

Vaccine policy was in the news lots this week regarding #JCVI's decisions on COVID vaccinations in teenagers. It's been highly contentious. Some I agree with. Some I don't. But I respect that they'll have deliberated carefully on this complex decision.
1/
sciencemediacentre.org/expert-reactio… Here's my short summary of vaccine policy considerations:

The objectives of vaccination usually boil down to either:
- protecting individuals from specific diseases,
- and/or protecting populations.
2/

The AMS report last year wasn't far off its winter predictions. They've now produced another report for 21/22 which is worth a read:

👉COVID-19: Preparing for the future - Looking ahead to winter 2021/22 and beyond 15 July 2021
acmedsci.ac.uk/file-download/… They predict a resurgence of respiratory infections (not just COVID19 but also flu & RSV); wider health & wellbeing impacts e.g. long COVID, mental & physical deconditioning, & impact of delays in diagnosis and
disease management during the pandemic.

JCVI statement on use of the AstraZeneca COVID-19 vaccine: 7 April 2021
Balance of benefit:risk still in favour of vaccination. Under-30s to be offered alternative vaccines instead if available, as a precaution.
gov.uk/government/pub… Cerebral venous sinus thrombosis (CVST) is rare.

Background rate 2-5 cases per million per year. Linked with cancers, autoimmune disease & blood clotting disorders, pregnancy, contraceptives, infections etc

Possibly 2-3 CVST per million vaccinations.
1/
onlinelibrary.wiley.com/doi/full/10.11…

OpenSAFELY: Risks of COVID-19 hospital admission and death for people with learning disabilities - a cohort study

HT: @apsmunro @DFTBubbles

Some concerning trends...
1/

medrxiv.org/content/10.110… Cohort study of data from primary care linked to secondary care & mortality records in England.
89% of adults with Down Syndrome & 38% with cerebral palsy on the learning disability register.
For under-16s: only 34% with Down Syndrome & 11% with cerebral palsy on LD register.
2/

An intriguing preprint (modelling study by LSHTM) just out: "Within and between classroom transmission patterns of seasonal influenza and implications for pandemic management strategies at schools"
1/
assets.researchsquare.com/files/rs-32236… Simulations suggest⬇️class sizes may not be effective in⬇️risk of major school outbreaks, possibly due to contact behaviour between students i.e. students may have certain no. of ‘close friends’ with whom they have more interactions that could facilitate transmission.
2/

On a lighter note this weekend, let me tell you the story of a (not so secret) service dedicated to protecting the human population from aliens.
1/

(They don't usually dress like that btw with exception of maybe @antmikeg & @Smithkjj ) And by aliens I mean the bug kind...

(Sometimes real biology looks worse than our imagined extra-terrestrial invaders)

If you've not guessed yet I'm referring to Health Protection teams across the UK who deal with communicable diseases & environmental health threats.

2/

Normally I enjoy the high standards of journalism in @guardian . Not today as disappointed with misleading headline that suggest infections are spreading fastest in children. It'll worry parents/teachers & I doubt most readers will unpick the headline.
1/
theguardian.com/world/2021/feb… The latest REACT1 report shows prevalence of infection in ALL age groups has fallen, including children aged 5-12 from 1.59% in Round 8 to 0.86% in Round 9a. The authors of REACT1 report also (wisely) didn't try to interpret the prevalence figures.
2/
spiral.imperial.ac.uk/bitstream/1004…

In the past 15+ yrs I've worked as a GP in some of the poorest parts of Sheffield with all the social ills of poverty: debts, joblessness/job insecurity, crime, abuse, domestic violence, mental ill health, disrupted lives, chronic diseases, alcoholism, early deaths, etc... 1/ For many of my patients, poverty isn't an abstract concept you read about. It's their lived experience. It's real. It's pervasive. It wears you down. It kills your hopes & dreams. And they're trapped in a repeating cycle across generations. 2/

Our @ScHARRSheffield MPH disaster management class recently looked at the topic of post-disaster recovery. Several key points that will be relevant as we look ahead to the coming months. (I know we are in the thick of pandemic response, but never too early to look ahead!) 1/ It needs to be a managed process that starts the moment an incident has occurred. Not just about rebuilding and recovery, but also has to incorporate prevention/risk reduction measures & preparedness for potential further crisis. 2/

I tweeted last week the link to @ECDC_EU evidence review of EU & international evidence on: COVID-19 in children and the role of school settings in transmission. Just finished reading it in full & it's balanced & comprehensive. (1) ecdc.europa.eu/en/publication… Reiterates finding that children are very unlikely to have severe illness with COVID19 infection. (2)