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So, you've all seen the rising cases and hospitalisations, you've seen the local lockdowns, you've seen that social gatherings are reduced to 6, and we are now spiralling towards another national lockdown in the winter.
What can we do?
Find, test, trace, isolate, support.
What can we do?
Find, test, trace, isolate, support.
We are seeing the start of the COVID second wave. But important to remember this isn’t weather forecasting – it’s not a storm that will hit regardless. It’s an infection that we can largely suppress with an effective and robust FTTIS, coupled with *some* social distancing.
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In this thread I’m going to summarise the premise of FTTIS, and why it is absolutely crucial to have a robust FTTIS system in place ahead of unis, & wider society reopening, and to save lives and avoid a second national lockdown.
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Find – Finding cases is the bedrock of FTTIS. If you don’t find the cases, you can't isolate them, you can’t trace their contacts, and so you don’t break the chains of transmission.
The more cases, and the earlier you find them, the more chains of transmission can be broken.
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The more cases, and the earlier you find them, the more chains of transmission can be broken.
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Symptomatics get tested by making testing easy to access (localised) & through trusted sources (GPs).
Even when the test system was functioning we weren't finding nearly all symptomatic cases.
Now, symptomatics cant get a test. This is a shambles.
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Even when the test system was functioning we weren't finding nearly all symptomatic cases.
Now, symptomatics cant get a test. This is a shambles.
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But apart from encouraging symptomatics to get tested, how do we actually find more cases?
Testing –
Ideally, testing should be done with <24h turnaround & performed locally, utilising local and mobile labs, & setting up in community spaces too.
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Testing –
Ideally, testing should be done with <24h turnaround & performed locally, utilising local and mobile labs, & setting up in community spaces too.
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Testing can be made 10 times more efficient (overnight) by using pooled qPCR.
Saliva samples, & other innovative testing strategies like lamPORE & rapid at-home kits are contentious but have huge potential.
7/ https://thelancet.com/journals/laninf/article/PIIS1473-3099(20)30362-5/fulltext
Saliva samples, & other innovative testing strategies like lamPORE & rapid at-home kits are contentious but have huge potential.
7/ https://thelancet.com/journals/laninf/article/PIIS1473-3099(20)30362-5/fulltext
As well as assisting with the diagnosis of symptomatic cases, testing can also help find cases. By increasing our efforts to do mass screening in outbreak areas, we can go a long way to suppressing outbreaks & avoiding the need for lockdowns.
But, it's a bloody big job.
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But, it's a bloody big job.
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SAGE produced a pretty excellent document on mass testing. Mass testing is complex and needs to be led by experts.
The government today set out its operation 'moonshot,' plan for mass testing, which is going to be run by an accounting firm & hasn't had input from scientists...
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The government today set out its operation 'moonshot,' plan for mass testing, which is going to be run by an accounting firm & hasn't had input from scientists...
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This mass testing debate isn't going to go away.
Hancock, Harding, Whitty, Vallance + more, and independent experts, should have to come before the Health Select committee BEFORE mass testing is rolled out.
We need some level of accountability in our democracy again.
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Hancock, Harding, Whitty, Vallance + more, and independent experts, should have to come before the Health Select committee BEFORE mass testing is rolled out.
We need some level of accountability in our democracy again.
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Tracing – Contact tracing is critical to breaking the chains of transmission. This should be done by local public health teams, who are well trained and know the area and the people. Atm, the average number of contacts given to tracers is 2, and many aren’t reached.
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In SK, NZ, Germany, 10s, or sometimes 100s of contacts are traced. We should also be trying to do 'cluster busting’, where we trace back up the chain. This has been used very successfully in SK & Japan, & is esp important for COVID given the potential for superspreaders.
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Isolation – The only one that actually matters. We can test and trace as much as we like, but if infected people don’t self-isolate, the chains of transmission aren't broken & our efforts are in vain.
Atm it is estimated that < 30% are isolating fully when told to do so...
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Atm it is estimated that < 30% are isolating fully when told to do so...
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In Senegal (& China & elsewhere), they offer isolated accommodation to anyone who needs it. https://twitter.com/ScienceShared/status/1268578015086358528?s=20
We could do this too (hotels), & it would go a long way to preventing spread within multigenerational households, where transmission often occurs.
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We could do this too (hotels), & it would go a long way to preventing spread within multigenerational households, where transmission often occurs.
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Support –
In order to self-isolate properly, people need to be supported properly.
A recent study showed (if not obvious already) that if we don’t pay people sick pay when they have to isolate, many won't isolate and will continue to go into work. http://oecd.org/coronavirus/policy-responses/paid-sick-leave-to-protect-income-health-and-jobs-through-the-covid-19-crisis-a9e1a154/
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In order to self-isolate properly, people need to be supported properly.
A recent study showed (if not obvious already) that if we don’t pay people sick pay when they have to isolate, many won't isolate and will continue to go into work. http://oecd.org/coronavirus/policy-responses/paid-sick-leave-to-protect-income-health-and-jobs-through-the-covid-19-crisis-a9e1a154/
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We have seen this in action time and time again, with outbreaks happening in workplaces where people felt they couldn't stay off, even with a positive test.
These outbreaks then spread to communities, and have resulted in local lockdowns, crippling for those communities.
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These outbreaks then spread to communities, and have resulted in local lockdowns, crippling for those communities.
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Out of all the countries in Europe, the UK is at the very bottom of paying sick pay for isolation. https://twitter.com/The_TUC/status/1289456328293875714?s=20
If we don’t invest in support systems which enable people to isolate, all the rest will be in vain.
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If we don’t invest in support systems which enable people to isolate, all the rest will be in vain.
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As well as financial support ensuring sick pay and ensuring no discrimination comes from employers, we also need to ensure healthcare professionals can check up on those with symptoms. Currently, you can go through symptoms, test, 'recover', with no contact with a doctor.
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Given the potential for things to turn south quickly, and the damaging effects of long COVID, it is important to monitor people with symptoms, both to help them recover but also to better understand long COVID in general.
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If we had implemented this FTTIS system over the summer, we would have been able to really drive case numbers down, & make the reopening of schools, unis, society & the economy safer. We would also have been much better placed to deal with this second wave.
But we didn't...
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But we didn't...
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'If we don’t take FTTIS seriously our economy will spiral downwards. With better pandemic planning, we could and should have had an effective isolation policy in February. Not to have one 7 months later is nothing short of public health malpractice.' https://independentsage.org/an-independent-sage-discussion-document-on-contact-tracing-and-self-isolation/
It's also important to note that effective public health communication is key here, and is failing spectacularly. https://twitter.com/richardhorton1/status/1302897692222402562?s=20
One more thing.
Focus less on the vaccine. It is unlikely to be a magic silver bullet.
Focus more on a robust FTTIS, which shouldve been sorted months ago.
An effective FTTIS system can have the same effect as a vaccine.
Focus less on the vaccine. It is unlikely to be a magic silver bullet.
Focus more on a robust FTTIS, which shouldve been sorted months ago.
An effective FTTIS system can have the same effect as a vaccine.
Politicians & senior medical officers in the gov have said people have "relaxed too much" over the summer.
This ignores that over the summer the UK has failed to set up a solid Test Trace Isolate that would have monitored & tackled the situation before it got out of hand. Again
This ignores that over the summer the UK has failed to set up a solid Test Trace Isolate that would have monitored & tackled the situation before it got out of hand. Again
Political pressure can give us a more effective FTTIS system, whereas it can't speed up a vaccine trial.
Please forward this thread to your local MP.
Lives, the economy, hugging your friends, going to a rave, the gym, the pub, & most fun things, depends on it.
Please forward this thread to your local MP.
Lives, the economy, hugging your friends, going to a rave, the gym, the pub, & most fun things, depends on it.
