Thread on our new state of the science review on #LongCovid. Commissioned by @TheLancet, peer-reviewed, coauthored with @sivanmanoj, @calirunnerdoc and Janko Nikolich. Link for free access is here (after 50 days that won’t work, then you’ll have to register and use this one:
1/kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F%2…
thelancet.com/journals/lance… In writing this article, we wanted to get the basic science of Long COVID into dialogue with the clinical management of this condition and the patient lived experience. @calirunnerdoc brought lived experience to our author team. 2/

It’s out! Our new state-of-the-science review of MASKS/RESPIRATORS in reducing transmission of respiratory infections. 13 authors (for our disciplines, see posts 3-4). 38000 words. 413 references. One conclusion: these devices work. For detail, read on. 1/
journals.asm.org/doi/10.1128/cm… The commissioned review, which was independently peer-reviewed, had 3 objectives: 1. Summarize the evidence on masks/masking. 2. Examine why this evidence is so widely misunderstood, misinterpreted, or dismissed. 3. Outline an agenda for future research. 2/

BREAKING
The senior officers of the Royal College of Physicians commissioned a survey of MRCPs’ views on physician associates (PAs). They have today released the actual findings, but the back story is shocking. I’ll link to the raw data at the end of this 🧵.
1/ We now know that senior officers presented a flawed and distorted version of the findings at the Extraordinary General Meeting on 13th March 2024. Here’s my thread on that presentation (from before I’d seen the actual results).
2/

https://x.com/trishgreenhalgh/status/1768307567908790584?s=20

At yesterday’s #RCPEGM, a senior officer presented the results of a survey of MRCPs on their views about Physician Associates (PAs). They unwittingly supplied some good teaching material about how NOT to go about doing a questionnaire survey and how NOT to report the results. Here’s the first slide after the title slide. What do you notice? They jump straight into “methodology”. Students, don’t do this! Start with a RESEARCH QUESTION!! You must be clear what EXACTLY you want to find out, and from whom. Ideally, state some HYPOTHESES.

Our new paper:
‘Training needs for staff providing remote services in general practice: a mixed-methods study’, out today in @BJGPjournal
🧵 1/

bjgp.org/content/74/738… Around one in 4 consultations in general practice occurs remotely (usually by telephone but sometimes as video or asynchronous e-consultation). Appointment booking and triage usually occur remotely too.
2/

Our paper on safety in remote GP consultations is getting a lot of coverage. Shout out to @oohGPwales who was lead author and analysed the 95 tragic safety incidents.
1/ 🧵

https://x.com/Oohgpwales/status/1729757152263152123?s=20

But NOTE: this paper is MAINLY about how remote care in GP land is remarkably SAFE. We followed 12 GP practices for 2y, looking for (among other things) evidence of patient harm from remote consultations. We found NONE.
2/

At @IndependentSage we've made a series of short MYTHBUSTER videos to address misconceptions about covid-19.

I'll thread them here. Some are still to come - will add as they come out.

Please disseminate, especially to people who might be confused about these issues.

0/ Myth-buster 1: Is there a point to vaccines if we can still get infected?


1/

Anti-vax movements cause a lot of harm. By ‘anti-vax’ I don’t mean anyone who raises concerns about harms or possible harms from vaccines. I mean people who *ignore scientific evidence* and perpetuate a distorted and entirely negative message about the benefit-harm balance. 🧵
1/ Vaccines against covid-19 greatly improve survival and reduce (though they do not eliminate) the risk of long-term complications like long covid and the risk of transmitting the disease to others. [there is much evidence here – example paper linked]

2/nature.com/articles/s4159…

🧵The UK General Medical Council has adopted an antiquated position on doctors who spread false & misleading information on social media. This position is putting the public at risk. It must be challenged, or doctors with ‘fringe’ views will continue to have harmful influence.
1/ In USA, a doctor is not allowed to spread misinformation (inaccurate or misleading information) or disinformation (deliberate lies) about vaccines. US regulators recognise that doctors’ right to ‘free speech’ is not absolute and that they must not abuse public trust.
2/

THREAD ON GMC CASE
I‘ve made contact with the group of doctors who are pursuing a case against the GMC for failing to address vaccine misinformation by doctors.

Crowdfunder is here (was BROKEN over weekend but now fixed, they think-please try again!)
actions.goodlawproject.org/gmc
1/ The doctors are real, they range from F1/F2s to consultants and GPs. They each complained to GMC about a doctor who (they felt) was propagating misinformation about covid vaccines. They found out about each other, and joined forces to appeal the GMC’s decision.
2/

Our paper on orthostatic tachycardia (fast heart rate when you stand up) after covid-19 is now #OpenAccess in @bmj_latest. Summary 🧵 1/
#longcovid @AnaBelenEspino2 @HarshaMaster3 @RogersNat70
bmj.com/content/380/bm… We found that fast heart rate on standing was common and sometimes very disabling in people whose recovery from covid-19 was prolonged. 2/

Here’s my new mask thread from late Feb 2023:

https://twitter.com/trishgreenhalgh/status/1629827584568565760?s=20

Other key threads (which I’ve written in the past) are linked in this short pinned thread: Long covid

https://twitter.com/trishgreenhalgh/status/1533803118705664003?s=20

New mask thread. Addresses
- Why so much controversy?
- Airborne transmission
- RCTs of masks - strengths/weaknesses, community, healthcare settings
- Meta-analyses - gold standard or lazy lumping?
- Non-RCT evidence - why is it needed, what does it show?
- AOB
1. 2.Before I start, here’s the OLD mask thread from July 21, which ran to >100 tweets. Some of that is now rather dated but a lot still holds. I’ll paste the best old tweets into this new thread.

https://twitter.com/trishgreenhalgh/status/1414294003479089154?s=20

A thread on primary health care 101 (#PHC101). Do you even know what primary [health] care is? Do you care about it? Most people, if they were honest, would probably answer ‘not really’ to both. Read on if interested. Mute this thread if not.
1/ Primary health care (PHC) has 4 defining features:
-First-contact (i.e. you don’t need a referral)
-Accessible (you can get an appointment, whoever you are*)
-Relationship-based (“my GP”)
-Undifferentiated (any illness, any problem—‘generalist’ rather than ‘specialist’)
2/

An adequately funded system of universally-accessible primary health care is associated with
- better overall health
- lower overall healthcare costs
- fewer inequalities between rich and poor
- lower mortality

Which of these benefits do you have a problem with, @wesstreeting? Good primary health care is characterised by
- accessibility
- therapeutic relationships
- continuity of care
- multidisciplinary teamwork
- coordination

A vote-winning policy for LABOUR would be to STRENGTHEN PRIMARY CARE.

Happy to help you write this one, @wesstreeting.

MASKS are back (=> they’re trending on social media and I’m getting hate mail). A short thread. See my pinned tweet for a longer thread with lots of peer-reviewed articles.🧵
1/ Masking is a deeply symbolic practice. In some social groups, a mask is a muzzle, a ‘face diaper’ or a sign that you’ve given in to state control. Criminals, pirates, political protesters and others with something to hide wear masks. Masked people are suspicious.
2/

We’re on the nth wave of covid-19 and all the old anti-mask arguments are doing the rounds. “No robust evidence”. YES THERE IS – see my pinned tweet – and btw the I-only-accept-RCTs trolls don’t have a monopoly on the word ‘robust’. 1/ Do we have to wear masks everywhere, forever, for all time? NO!!! We need to get used to ASSESSING THE RISK and adapting our behaviour accordingly. If the incidence of covid is low, risk is low (but not zero). But if it’s high, risks are high. 2/

Thread on my PhD students. I currently have 15 (yeah, I know…). They are all awesome. You might like to follow some of them – they’re all from different backgrounds and researching very different topics. Acknowledging also their amazing co-supervisors!
1/ (in no particular order)
First comes @HeleneMarivdW who has recently *handed in* her thesis on infection control practices (masks and more) in rural South Africa. Started with TB, stayed for Covid-19. Here’s her BMJ paper on social aspects of masking.
bmj.com/content/370/bm…
2/

My big threads (mostly on Covid-19) linked in this new pinned short thread.

Masks

https://twitter.com/trishgreenhalgh/status/1414294003479089154?s=20&t=_Gj92tVyztw7cQb6S1pJiA

Long covid

https://twitter.com/trishgreenhalgh/status/1533803118705664003?s=20&t=_Gj92tVyztw7cQb6S1pJiA

More of my big threads:

Aerosol generating procedures

https://twitter.com/trishgreenhalgh/status/1370723908802990080?s=20&t=_Gj92tVyztw7cQb6S1pJiA

Air quality

https://twitter.com/trishgreenhalgh/status/1485352276235538432?s=20&t=_Gj92tVyztw7cQb6S1pJiA

THREAD on LONG COVID for non-specialists (GPs, patients). Covers what it is, who gets it, what causes it, what to do, what the outlook is. Drawing on in-preparation paper with @bcdelaney @ruairidhm @REvans_Breathe @sivanmanoj @LOCOMOTIONstudy
1/
[mute thread if not interested] DEFINITION
A ‘patient-made’ term referring to symptoms persisting > 4 weeks after an acute covid-19 illness, and not explained by any other diagnosis. Includes ‘ongoing symptomatic covid-19’ (4-12w) and ‘post covid-19 syndrome’ (beyond 12w) [NICE].
nice.org.uk/guidance/ng188…
2/

Short rant on definitions:
I keep getting invitations from researchers who seek to "develop a standardised definition" of X. Such pursuits are usually futile and counterproductive. We need a standardised kilogram but not a standardised way of talking about how the world is.
1/ The American Pragmatist Charles Sanders Peirce (thanks for the intro, @MisakCheryl) said “Nothing new can ever be learned by analysing definitions”. Rather, we need to understand how a concept is used and what it contributes to our understanding.
2/