With restrictions having ended across all home nations, it’s time to have a look at the results of the 'natural experiment' that we've had in the UK since July 19 when policies diverged with England having fewer restrictions than Wales, Scotland & Northern Ireland since then.
1/6 While some described England’s approach as a "dangerous & unethical experiment", @CMO_England, I & others thought that ongoing restrictions in a highly immune population would simply postpone infections - not prevent them.
So what has happened with infection & death rates?
2/6

Studies like these (based on models) ignore what is now well-established i.e. key role of voluntary behaviour change in controlling Covid - with behaviour changing more in response to the level/fear of Covid ('voluntary lockdown') than govt. mandates
1/7
telegraph.co.uk/news/2022/04/1… e.g. household visiting & mobility fell more in the week before lockdown than after lockdown came in. There is limited evidence that the govt. mandate produced a bigger fall than that which occurred anyway & we know that compliance with mandates is associated with level of risk

With hospital admissions in England approaching the 1st Omicron peak (& hospitals being busier overall due to more non-Covid patients) & ONS likely to show a record no. infections this week, some are again calling for a return of mandatory measures assuming this will help but
1/6 evidence for this is lacking.
In the absence of better evidence, we look at the real world data from the natural experiment we've had since July 19 when the home nations diverged & we don't see any indications from the case, death or ONS survey data that England has fared worse

V. important paper published in the Lancet - the first peer-reviewed global estimates of excess deaths (the most reliable way to compare Covid deaths) over first 2 years of pandemic with findings that will surprise many & correct five widespread misconceptions / assumptions:
1/9 1. Far from the UK having the worst death rate in Europe (or even Western Europe) as many still think, it is actually 29th in Europe & 9th in Western Europe - below the Western European average & at the same level as France & Germany (no statistically significant difference)

A note on excess deaths last wk:
1. They are 8.6% lower when comparing to the 5 yr avg which includes 2021 - unsurprising as it was peak of 2nd wave & no-one fully vaccinated - but
2. More significantly, they are also 3.3% lower than the 5 yr avg. for 2015-19 (pre-pandemic)
1/4

https://twitter.com/ONS/status/1488448434419941377

This is a huge contrast to the same week last year when there were 18,676 deaths (about 1.5 times higher than now) and deaths were 41.3% above the five-year average again illustrating the massive impact of vaccines and Omicron's decreased severity (& very low deaths from flu)
2/4

There is understandable concern about increasing numbers of children being admitted into hospital with a positive Covid test recently. This needs urgent investigation but from what we know so far the data suggests the headline figures may be hiding a more complicated reality: Firstly, the situation with children is in many ways similar to that with adults in that we need to distinguish between those who are admitted for a Covid-like syndrome versus those who are admitted with another condition (eg. abdominal pain) but have an incidental positive test

I really don't understand why some people - despite having zero clinical experience of looking after Covid patients - insist that Omicron is not causing more mild disease in the vaccinated than previous variants.
You can't judge severity just by looking at numbers/graphs -
1/5 you have to look at the clinical presentation of patients as well. And based on my own and others frontline experience of all 4 waves, it is clear that so far Covid patients are less likely to have pneumonia and more likely to have an incidental +ve test or milder symptoms.
2/5

The critical question in the coming days/weeks will be how much pressure the NHS will come under - both from patient demand and staff absences.
For demand, the current Covid stats available are insufficient - here are 7 other stats we need to make that assessment, ideally daily: 1.Total number of acute admissions per day into hospital (Covid plus non-Covid)
2.Total number of admissions per day into ICU (Covid plus non-Covid)

Important point in SAGE minutes re. severity:

'10. Anecdotal evidence from clinicians suggests reduced severity of illness for those with Omicron infection attending hospital, albeit these are mostly younger patients (low confidence).
The most dependable data on severity The most dependable data on severity in hospital will be the number of patients requiring oxygen. Currently the number of people requiring oxygen is fairly stable.'

I don't know if this is published anywhere but we clearly need to monitor it.

gov.uk/government/pub…

Unexpected data release from NHS last night with new figures for London:
No. of Covid +ve patients in hospital/admissions is better than expected & actually shows fall from
390 to 278 from 23/12 to 24/12 - driven mainly by fall in admissions from community from 279 to 210.
1/7 This is not just a Christmas effect (all hospital admissions usually fall just before Christmas as patients are understandably keen to avoid admission if at all possible) - as it wasn't seen last year when admissions continued to rise.
england.nhs.uk/statistics/sta…
2/7

Just catching up with last week's data releases from ICNARC (ICU data) & EDSSS (A&E data) & there are some more encouraging signs there on severity and also the types of patients presenting with Covid to A&E (which is consistent with what I'm seeing on the ground too):
1/6 First, on severity - ICU admissions are not increasing as they did at equivalent point in previous waves (even taking into account the lag: cases in under 60s have been rising for 6 weeks and the majority of ICU admissions are in under 60s, (75% of admissions are aged 43-66).

As lockdowns/restrictions come in across Europe and SAGE present their latest scenarios, calls are inevitably rising for more restrictions/lockdown in England too.
A thread on what we know so far, what is likely to happen and whether further restrictions now are justified:
1/n 1st, my aim in writing this is the same as it has been throughout pandemic: to contribute to the public debate on how to achieve what I believe should be the objective of all policies: to reduce overall health harm from Covid - and the response to it - in the short & long term.

People may be concerned by 1% hospitalisation rate for Omicron seen so far in Denmark but we shouldn't assume same will happen here.
We have a higher proportion of population boosted and a lower proportion who are immunonaive - i.e. no prior natural infection or vaccination
1/4

https://twitter.com/jburnmurdoch/status/1463450337688305666

medrxiv.org/content/10.110…
The Danish data is based on a small no. of admissions (37) & it's not yet clear what proportion are due to Covid or incidental. We will have our own UK hospital data within days which is more relevant for informing policy here.
2/3

Back to the Delta wave & an update on what's happened in W. Europe since Oct. when many said that if we had kept restrictions like them, we would have had much better outcomes - not appreciating that our strategy was to prevent Winter peaks & reduce overall deaths/admissions.
1/4 Part 1 of that strategy is working & based on current trends it's likely UK will have one of the lower total deaths/admissions too.
So I hope those who criticised July 19th decision will now see that the restrictions were postponing deaths/admissions, not preventing them.
2/4

Good to discuss current Covid situation with @jennykleeman @TimesRadio this morning.
Main points:
1. Many people are understandably worried about Oimicron and are feeling like we are back to square one & in same position as we were this time last year but we really aren’t.
1/ This time last year, almost none of us had had vaccines, whereas this year over 95% of adults have some degree of immunity mainly through vaccination and also natural infection - and over 80% in the highest risk groups have also had their booster/3rd doses
2/

Oct 22: A common view
"We need to adopt plan B, on masks and vaccine certification – Europe has shown it works
"Germany is managing to control its Covid epidemic and bring down the numbers of cases & deaths."
theguardian.com/commentisfree/…
Oct 23: I explained why this was flawed &
1/4 why our high rates shouldn't be assumed to be due to our lack of Plan B measures but because:

"other countries are at different stages of their third waves & their immunity will wane later than in the UK because their vaccine programs started later."

telegraph.co.uk/news/2021/10/2…
2/4

This is despite mask mandates & vaccine passports - as was predictable (& predicted) based on timing of delta wave & waning immunity.

But why are rates rising faster in Ireland (& eg. Austria, Germany & Belgium) than e.g. UK, France, Spain & Italy?

1/4
thetimes.co.uk/article/irelan… It's not clearly linked to levels of vaccination (or restrictions) but the pattern is more consistent with the total levels of population immunity (from combined vaccination and natural infection) i.e. rates are going up faster in countries which had less infections before
2/4

Important paper on deaths in children & young people (CYP) in 1st year of pandemic. Reassuring results for Covid:
- of 12 million CYP in England, 3105 died
- of these, 25 (<1%) were due to Covid
- 99.995% of CYP with positive test survived
However..
1/6
nature.com/articles/s4159… ..as Dr Camilla Kingdon, the president of the Royal College of Paediatrics and Child Health, said:

Meanwhile, successive lockdowns and social distancing caused far greater consequences “through lost education, mental health, and other collateral damage”,

2/6

A brief thread summarising our current COVID situation and what we can expect going forward - and why - although Covid is by no means over - we should be cautiously optimistic about the coming months:

1/9 First, although it’s easy to forget this given some of the commentary, the situation is so much better now than this time last year when hospital admissions & deaths were much higher and doubling every 2-3 weeks - and we were in lockdown - with all its harms.

2/9

@dgurdasani1
Do you really think that someone who has spent their career trying to save lives & put their own life at risk by volunteering to work, unpaid, to save the lives of Covid patients is now trying to justify policies that lead to mass infection, disability & death?

1/

https://twitter.com/dgurdasani1/status/1451520156983828483

Although it’s tempting to respond in kind, I prefer to assume those who disagree with me are acting in good faith and also want to reduce death and suffering even if- based on my interpretation of the evidence- I believe their policy recommendations are wrong or even harmful.

2/

Seven persistent myths about Covid and lockdowns in the UK / England.

I thought I would put one thread together on what I think are 7 myths that continue to be propagated - mainly by those who, although well-intentioned, always assume that more restrictions are the answer. 1. The UK has had the highest Covid death rate in Europe during the pandemic - mainly due to being late to lockdown twice. (see myths 2 and 3)
Even compared to EU countries, the UK would be 11th on Covid deaths & 15th on excess deaths (20th in all Europe)
economist.com/graphic-detail…