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

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

https://twitter.com/chrischirp/status/1797931963996889533

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

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

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 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

https://x.com/kallmemeg/status/1774362389627953570?s=20

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
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

https://x.com/kallmemeg/status/1737768682695041041?s=20

Short thread on what I said on Channel 4 news tonight.

1. Did I find Hancock a sympathetic witness?

A: I find it hard to have sympathy for someone who repeatedly claimed to have thrown protective ring around care homes, while discharging covid+ patients into them.

1/5 There were *28,000* excess deaths in care homes Apr-May 2020.

Harries thought it was "clinically reasonable" not to treat covid +ve residents in hospital. Even it was, it was NOT reasonable to return them somewhere they could infect so many other very vulnerable people. 2/5

Hancock: "there was no way we could allow the NHS to become overwhelmed"

Except, the NHS WAS overwhelmed

Here is what NHS staff said about that time - Pls read whole 🧵
"Heartbreaking"
"Horrific"
"It broke my soul"
"We cried, we came home exhausted. We were overwhelmed"

1/16 "Overnight we were told that all “safe working rules” were gone. There was no choice, we were forced to do it"

"It felt like a death sentence. It felt out of control"

"We were put on wards with no senior support, sometimes makeshift ... with little of the right equipment"

2/16

THREAD: England Covid update

TLDR: modest August wave with flatlining hospital admissions, but expect a bigger wave later this autumn 1/12 Hospital admissions with Covid in England are still quite flat for 3rd week in a row and at a level below previous troughs.

Number of people with covid in critical care & primaril yin hospital because of Covid also flat & low.

Deaths ⬆️, from case rises few weeks ago 2/12

THREAD: Various new or expanded cancer screening programmes have been announced recently and coverage has been overwhelmingly on the pros. But there are cons too.

So let's explore some of the pros and cons...

expansion of my @guardian article


1/24 theguardian.com/commentisfree/…






First a screening recap : a relatively simple test that flags potential cause for concern. If flagged, you are offered more, gold standard, testing, often in a hospital (e.g. MRI scans, blood tests, other diagnostic procs). If those +Ve too, you are offered cancer treatment. 2/24

SHORT THREAD on current state of the NHS in England:

TLDR: Ambulance response times improving, A&E improving but still bad, diagnosis and treatment waits are not good.

First - ambulance response times higher than pre-pandemic but way down on their peak - thankfully! 1/5 % of people waiting >4 hours from arrival in A&E to either admission *or* discharge is falling but higher than pre-2020.

A *bit* better than 2022.

% waiting >12 hrs *after admit decision* falling.

BUT % who need admission waiting more than 12 hrs from *arrival* is v high 2/5

Covid update: bigger jump in England hospital admissions with Covid this week (40%⬆️). Also now seeing increase (28%⬆️) in number of patients in hospital primarily because of Covid.

Definitely in a wave but starting from much lower base than previous ones 1/6 Not sure how much it will take it off in Aug with holiday season (and biggest increases are in England holiday areas like the South West). There is a new Omicron variant around called EG.5.1 alongside XBB.1.16, and UKHSA estimate it's got about a 20% weekly growth advantage. 2/6

THREAD: what I think is happening with Covid in England right now.

TLDR: while data is sparse & comes with lots caveats, it's all pointing to pretty low Covid prevalence right now. 1/13 Firstly let's look at hospital data. Recorded Covid admissions are lower than they've been in a LONG time.

People often doubt this data because testing has changed (there is less testing in hospitals now). And that's true - but we can dig further into the data too. 2/13

THREAD: update on how the NHS is doing across ambulances, A&E, diagnostics & treatments.

TLDR: better than last winter (worst ever) but still much worse than pre pandemic. 1/10 Ambulance response times are much faster than they were this winter which is good, but still significantly slower than there were before "freedom" day in July 2021. 2/10

🧵our new definitive @bmj_latest peer-reviewed paper on kids hospitalisations in England!


More accessible & shorter version in this @ConversationUK article from me & @katebrown220
https://t.co/nNQnxiFhrR

read on for the highlights! 1/15bmj.com/content/382/bm…
theconversation.com/covid-in-kids-… The paper was led by @katebrown220 & specialist docs, with number crunching by @HarrisonDWilde using @BHFDataScience data on all admissions, tests etc.

We looked at all recorded first infections in kids 0-17 rys & any associated hospitalisations from Jul 2020 - March 2022. 2/15

THREAD: why the NHS is not the key to saving the NHS

Health care to each according to their need and free for all is the NHS.

To protect that, the absolute number one thing we have to do is reduce need for health care.

My new article for @WiredUK
1/10wired.co.uk/article/christ… E.g. take diabetes - a 2018 govt report listed as one of biggest issues for NHS accounting for 9% of NHS spend. 1 in 6 people in hosp were diabetic.

2/3 UK adults are overweight - a key risk factor. We now have record number of diabetics.

globally accelerating crisis 2/10

THREAD: latest numbers on Covid in England.

TLDR: Disappointing uptake of Spring Booster but good news is that hospitalisations and deaths are going down and are at lowest we've seen in a while... 1/8 almost 60% of over 75s have had the Spring booster but only about a quarter of immuno-compromised. This is disappointing uptake - at equivalent time last autumn, about 80% of 75+ had been booster. 2/8

THREAD: OUR NEW PAPER on vax for 5-11 yr kids.

Most kids unvaxxed but have had at least 1 infection

Do they need vax & what are poss benefits inc vs Long Covid?

Our peer-reviewed paper in @Vaccines_MDPI is here:
mdpi.com/2076-393X/11/5…

READ ON FOR SUMMARY 👇👇 1/26 Benefits depend on time since infection, strength of protection from inf & vax, future waves

Vax can be v beneficial if future attack rates high & long time since last inf. More benefit for Long Covid than hosp, cos LC is more common & prev infection offers less protection. 2/26

QUICK THREAD on workforce sickness absence in 2022...

TLDR: highest sickness absence since 2004, increases across all age groups, Covid def contributing to that, high exposure to (all) infections in health, education, hospitality and sick pay here remains far too low! 1/6 First, much higher overall sickness rate in 2022 compared to 2021 and all years since 2010. 2/6

THREAD: state of the NHS

The collapse of emergency services that we saw in December/January may be over (for now), but the broader NHS is still very much struggling as the latest performance indicators show... 1/8 Firstly, % of people waiting more than 4 hours in A&E from arrival to admission remains stubbornly high at 29%. Emergency care is still very stretched (often due to bottlenecks discharging patients from hospital) 2/8

THREAD: update on Covid in (mostly) England covering vaccines, hospitals, deaths, wastewater (sort of!) & variants...

First off, the spring vaccination campaign has started for 75 yrs+ & immunocompromised with 7-18% coverage so far but still a way to go 1/11 Before discussing hospital admissions (inc people who caught it in hospital) here is a summary of how testing has changed over the last year - with impacts on in-hospital transmission & reported admissions.

This is what I've pieced together from legacy websites! 2/11

THREAD on CEV & COVID:
A reminder of how Covid has disproportionately impacted the clinically extremely vulnerable (CEV) community and that they remain less well protected now. 1/6 First deaths - ONS data is from 2022 but clearly shows that after adjusting for age, men and women with disability had much higher rates of death from Covid compared to those with no disability. 2/6