In amongst the carnage of the workforce plan there is an obvious thing hiding in plain sight. Let’s solve the PA crisis in one 🧵… (spoiler I won’t) First thing is I think most of the debate on Twitter is terrible quality right now. Like most of the rest of Twitter it has degenerated in the loudest voices in 2 opposed camps insulting each other. Bullying online is rife.

This paper on thromboinflammation is everywhere this week. Unfortunately nobody commenting on it seems to have read it!

I have, and it definitely doesn't say what commentators are suggesting. 🧵nature.com/articles/s4158… Quick summary. Spike interacts with fibrinogen and drives a thromboinflammatory cascade. In the paper, this is tied most closely to lung & brain pathology. I am not going to dissect the figures- take it on face value as true; this is not my problem with the paper/messaging.

Long form 🧵on lung clots, chronic complications and Covid. Data is emerging that call into question how prevalent and important this really is. I think we are in a better place now to be clearer. To begin with-we undoubtedly saw high acute post-Covid thrombosis at the beginning of the pandemic. Here is my starting contribution to this literature (ie I have looked at this a lot)-
national self-case control approach
ICU study pubmed.ncbi.nlm.nih.gov/34607634/
pubmed.ncbi.nlm.nih.gov/34582412/

🧵on PAs in UK NHS. Bit of both-sideism but from a skeptic viewpoint. Strap in. This will not be short! Starting point- can some of clinicians work be done by others? Simple answer is yes. Our jobs can be discretely broken into domains (pick your own schema)
- admin
- clinical assessment + treatment
- procedural
- leadership
- teaching
- holding risk
The list goes on

Are you sitting on Twitter wondering why doctors are on one hand complaining about being understaffed & simultaneously incandescent with rage about mushrooming non-doctor roles? 🧵 for you. We will start off with the simple bit we can all agree on. There are not enough healthcare workers (in any part of the system, not just doctors). UK Workforce plan is clear on this and everybody agrees. …england.nhs.uk/publication/nh…

If you want to understand why doctors strikes will not end any time soon and why this is a disaster, take the temp of doctors from contemporary surveys 🧵 First up GMC. Absolute historic levels of every flashing red light possible, from doctors taking steps to leave, through concern over ability to give safe care to burnout levels.

I’m just having so much fun this am imagining the reviewer 2 comments that led to this being rejected by Science & moved on to Science Advances theguardian.com/science/2022/a… The work lacks novelty. Trees have been doing this for millennia.

🧵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.

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.

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 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?

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.

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.

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...

🧵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

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

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...

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?

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

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

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

@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

https://twitter.com/bijucheriandr/status/1355567112413175809

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