Mark Toshner Profile picture
University of Cambridge/ Director Heart Lung Research Institute Clinical Research Facility/ actively seeking snappier job title/ views are… etc
Aviva Gabriel Profile picture Steve Profile picture 3 added to My Authors
Apr 2 23 tweets 4 min read
🧵on why our current approach to covid is storing up problems, and one that isn’t being talked about. Quick summary. Vaccines work, things are much better.
Dec 5, 2021 22 tweets 4 min read
Anybody want to discuss what we might do about the inevitable problems created by 2 years of pressure overload on hospital systems? A 🧵 I’m going to restrict myself to secondary care as I know it well (primary care others are better informed to talk about but goes without saying it is inter-related and needs viewed as a whole). I have many ideas but will talk about 2 of them.
Dec 3, 2021 5 tweets 2 min read
As cases rise again above Oct (53,945), happy to rediscuss why I think people being too black/white in the pandemic is one of the major problems @andrew_lilico Image Given your confidence seems misplaced on your only 6 weeks later and way before any Omicron wave if it happens, can you perhaps consider why people being definitive like this colours public debate? Image
Nov 7, 2021 19 tweets 3 min read
Do vaccines prevent transmission? A 🧵for donut lovers. Should be accessible to donut skeptics too. First thing to outline is how the majority of the vaccine trials were set up. This was to measure direct infection. Some measured asymptomatic but most just measured symptomatic.
Nov 5, 2021 18 tweets 3 min read
What does a collapsing healthcare system look like in practice? 🧵 The first thing is- it will still function and see patients. It will have to prioritise, so anything non-urgent or life threatening goes first. Out-patients for chronic conditions, operations for anything that can be delayed etc.
Sep 16, 2021 12 tweets 3 min read
Wuhan long term data- This has been given a positive spin by the authors "Most COVID-19 survivors had a good physical and functional recovery during 1-year follow-up" 🧵 on why I think this is optimistic at best thelancet.com/journals/lance… In this post-hospital cohort which always hits the journals first (for obvious reasons) and often patterns how we think of disease, far from being a reassuring demonstration of everybody getting better...
Sep 15, 2021 12 tweets 2 min read
🧵on why ICU docs shouldn't be like a daily brick to the head-
I used to know a martial arts champion. He toured China giving demonstrations for a year. He was in a remote monastery teaching students where all the rooms had a wooden bed and a brick. It turned out the students were given the brick to toughen them up. Last thing at night they would try to break the brick (with their heads). If you broke the brick.... you got a bigger brick.
Point is- this was daily and normalised, like hearing ICU staff tell you how difficult
Jul 20, 2021 25 tweets 6 min read
With JCVI advice out- some thoughts on vaccines and children. If you want black/white certainty, don't bother reading on
🧵
gov.uk/government/pub… First. If you followed me for vaccine commentary I have been a bit muted recently because
-I haven't had much interesting to say not being said by others
- I sit on some vaccine safety boards and felt public commentary on some hot topics not appropriate
Jul 20, 2021 5 tweets 1 min read
Composing my out of office for HOLIDAY on Friday. Vowed this will be the first one ever when I don't spend half the time pissing my family off by continuing to do some "urgent" work... so needs to be nailed on. Comments/suggestions welcome First Draft

Dr Toshner is out of office until the 8th Aug. He has dropped his phone down a toilet and retreated to the wilderness. If your enquiry is urgent please phone his secretary, who will then send a telegram to a remote station where a note will be left under a bench...
Apr 10, 2021 18 tweets 3 min read
Now the thrombocytopaenia/ thrombus evidence with ChAdOx is clearer- some thoughts on what this means for populations and individuals 🧵 There are 3 questions
1) what should we do at population level?
2) what should we do at individual level?
3) what is best for vaccine confidence?
Mar 16, 2021 13 tweets 2 min read
Never make predictions. Especially about the future...

Here’s what will happen with vaccine clots reporting in next few weeks 1/n 1-2 weeks of loud noises about need for high safety bar. I’ve spent some time assessing causality of events for drugs- at least half of the reported cases will be complicated and best the European regulators will be able to say is 2/n
Mar 15, 2021 10 tweets 2 min read
So Germany followed suit today in what appears a bit like vaccine hysteria, but not based on PE. Instead based on 7 cases of sinus venous thrombosis in 1.6 million people. I’m going to put this in context below of 1/n Normal annual rate is apparently anywhere 2-15 per million. link.springer.com/article/10.100…
In UK 3 have been reported (I am told) in 11 million 2/n
Mar 11, 2021 11 tweets 3 min read
I have tweeted about likely over-reporting of side effects of vaccines extensively in the past but will have another go again for pulmonary embolism as it is my area of expertise 1/n
theguardian.com/society/2021/m… Firstly this was always going to keep happening. Take any intervention rolled out to whole populations and there are going to be a lot of spurious associations made and links touted that eventually quietly get shelved 2/n
Jan 30, 2021 18 tweets 3 min read
Quick tweetorial on why the design of the different vaccine studies is important. I'm also going to talk about how reporting has coloured the debate.

My disclosures- Minor investigator on ChAdOx trial. No funding to declare. 1/n First thing is funding/ sponsorship (who is responsible for trial). Most western vaccines are commercially sponsored and funded though with variable govt involvement. Exception was ChAdOx which was sponsored by Oxford Uni (with some trials yet to report further from AZ) 2/n
Jan 30, 2021 4 tweets 1 min read
@BijuCherianDr really important point in thread (and thanks for nod). We saw early in ChadOx that BAME underrepresented. This is panning out also in vaccine rollout. We need to urgently address complex, difficult community concerns. 1/n Valid and deeply held concerns about govt, institutions and medical scientists that have not always had their back. These are added to the normal mix of mostly addressable safety concerns. I’m white and pretty privileged. Hard for me to walk a mile in their shoes. 2/n
Jan 24, 2021 13 tweets 3 min read
Thought a longer thread on the Pfizer delayed dose in UK might be useful. 1/n Firstly important to keep local UK context clear. Pfizer will end up a minority vaccine in UK so this will not have much of a long-term effect on population coverage. However because of the way we are prioritising, it will disproportionately land in 2 groups. 2/n
Jan 24, 2021 5 tweets 1 min read
Vaccine news coming out of Israel remains positive. google.co.uk/amp/s/amp.ft.c…

Few comments. 1/n The statements on antibodies are reassuring and in line with the infection profile 2/n
Jan 23, 2021 10 tweets 2 min read
Timing seems odd, but we need to start the conversation about the second UK NHS restart. Why do this when we are still up to our necks in the current wave? 1/n Firstly, at some point this will either improve for the NHS or become a cyclical new normal for most of the year. In either scenario we still need to figure out the reopening of services 2/n
Dec 30, 2020 10 tweets 2 min read
I've been tweeting about vaccines for a while now. Next 6 months are crucial in misinformation war so here are a few things I have learned 1/n 1) Vaccine hesitancy is widespread, and a lot of it is soft. Many folk just need simple concerns addressed 2/n
Nov 20, 2020 8 tweets 2 min read
Next vaccine thingy to address. Getting asked mostly about long term vaccine effects. Important to be straight/honest. Nobody knows yet. Best way to understand the future is to look at past so... 1/n ... if you look at every vaccine ever developed, you see a clear pattern. Side effects are overwhelmingly short term. It is built into how vaccines work. 1-2 doses promote short term immune response that primes us for later. 2/n
Nov 17, 2020 7 tweets 2 min read
More on vaccines. I'm going to get boring and geeky on this (no apologies) on the 10 year thing. Vaccines "normally take 10 years". This is being use as a reason to be fearful (ie rushed job). I'm a clinical trials doc. I can tell you most of that time is spent doing...1/n .... nothing. It's spent submitting funding requests, then resubmitting them, then waiting, then submitting them somewhere else, then getting the money but the company changes it's mind or focus, then renegotiating then submitting ethics, then waiting for regulators...2/n