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COVID-19 in the UK: the state of play and the road ahead. THREAD. 1/
It's perfectly possible/probable that I'm shouting into the void by tweeting about this. Twitter is after all a series of algorithm driven echo chambers. But if ONE person takes the pandemic more seriously, or if ONE person who can effect policy makes a change it's worth it. 2/
We'll start with the bad news, then move on to the good news, and then move on to policy options that could do with more attention 3/
The bad news in a nutshell: things are bad, and likely to get worse before they get better. In many areas and respects they are already worse than the spring and the 1st wave and likely to continue getting worse for some time. 4/ https://twitter.com/chrischirp/status/1342943424585064448
Many of you may have seen this. This is *NOT* normal practice in the health service. This is a sign that all the warning lights are flashing red and have been for some time. This picture risks being replicated across large swathes of the country and the NHS. 5/
Even in areas that were previously managing to gradually bring the caseload down, cases have surged in the past week. The 7-day rolling average in Scotland is already approaching levels not seen since mid October. 2.5 months of progress wiped out. (H/T @TravellingTabby) 6/
All three devolved nations are now in a form of lockdown similar to the spring and the 1st lockdown. This is likely to have an effect and help break the chain of transmission, but it'll take weeks to appear in the data. England continues to persist with the tier system. 7/
The tier system in England is almost certainly not tenable. The differences between Tier 3 & Tier 4 restrict are marginal, and cases remain vastly too high. Extending Tier 4 across England would bring the whole of the UK (with the exception of various islands) into alignment. 8/
The next 1-2 months is likely to be the hardest for the health service since the pandemic began. Elective & non-urgent work is retreating across the board as the system moves to a footing of maintaining mission critical functions at all costs. There is no way around this now. 9/
The news from the NHS front line speaks for itself. @charlot_summers has been erudite and articulate throughout this long crisis and her writing continues to be worth reading. https://twitter.com/charlot_summers/status/1343176819428749314
The media is currently not paying anywhere near as much attention to this as might be expected. Partly due to other political events and likely due "pandemic fatigue". It remains important that people take notice. Some journalists continue to do so 10/ https://twitter.com/ShaunLintern/status/1343169934789136385
It remains a fair question to ask "what is the point of lockdown". This is where the story IS different than the spring.
Lockdowns help break chains of transmission and help suppress the exponential growth of the virus. That is their most immediate and important function. 11/
Lockdowns help break chains of transmission and help suppress the exponential growth of the virus. That is their most immediate and important function. 11/
However, unlike the spring, safe & effective vaccines now exist and are being rolled out. Every infection that lockdown prevents is now a person who can potentially receive the vaccine & be protected BEFORE the virus can reach them. The UK has already vaccinated 600k+ people 12/
So far the UK has used the Pfizer/BioNtech vaccine as it was the first out of the gate and thanks to the work of the MHRA received timely approval. This vaccine has huge logistical challenges due to its deep freeze cold chain requirements. Supplies are limited. 13/
The long awaited Oxford/Astrazeneca vaccine, may be about to deliver a game changer to pandemic suppression efforts. It is becoming increasingly clear that the MHRA is likely to grant it approval, backed up by favourable data, within days. 14/ https://twitter.com/hendopolis/status/1342959069792002050
The Oxford vaccine is based off a modified animal Adenovirus vector (that cannot replicate or cause disease in humans), so differs from the mRNA technology of the Pfizer vaccine. Crucially, a normal fridge and normal cold chain is sufficient, and it's much cheaper. 15/
Earlier in the pandemic, when the Oxford candidate started proceeding towards large scale clinical trials, the UK made a large investment in "at risk manufacturing". I.E. manufacturing doses before the full efficacy was known to minimise the time to roll out if approval came. 16/
The aim, back then, was for the UK to have 30 million doses (enough for 15 million people to receive a full course) ready and to hand by the end of September. 17/
More recent data has suggested that a half dose followed by full dose of the Oxford vaccine (0.5+1) may be more effective than a full dose (1+1). The scientific reasons for this are for another time but are plausible. This may expand the number of people the UK can vaccinate 18/
This leaves the UK in the position of potentially being on the verge of being able to move the vaccination program to a truly massive scale. Hundreds of thousands, if not millions of doses a week should be the target. 19/
Coming back to lockdown, this is why lockdowns and breaking the chain of transmission is more crucial than ever. By flattening and then crunching the curve lockdowns give the vaccine program a chance to try to "outrun" the virus. Outrunning the virus is the endgame. 20/
Now onto policy options to make the most use of the difficult period effect. 21/
Public health messaging is crucial during this. Increasingly complex rules, tiered systems, varying restrictions all leave people unsure what they can do, and encourage some to look for loopholes rather than follow the spirit of the message. 22/
Japan cracked this early in the pandemic. The UK (and other countries in a similar position) should copy the three C's campaign wholesale. Hammer home the message that this bug is in the air, and people need to act accordingly. 23/ https://twitter.com/nataliexdean/status/1264379008348762113
Accepting aerosolised and airborne transmission rather than droplets alone means asking some difficult questions. As Victoria discovered during the Melbourne outbreak, equipping those in health settings (even those outside ITU) with FFP3 PPE will help reduce HCW infections /24
Worth noting some areas of the NHS are moving towards this, but this needs to become more widespread. A fluid resistant surgical mask simply is not enough if you are treating COVID positive patients. /25 https://twitter.com/BDChadwick/status/1342412784231997443
The last policy area to talk about for this thread is the border. The UK currently has one of the latest COVID border regimes in the world. This is a fact. Beyond a passenger locator form, and a legal requirement to self isolate if arriving from some places, there's not much /26
The Isle of Man is a powerful example of the utility of border controls during a pandemic. The IOM is the one place in the British isles close to zero covid thanks to strict border controls and isolation requirements. They have suffered no major second or third wave 27/
It's worth noting the majority of UK nationals are likely to be banned from entering the EU at the end of the brexit transition period on the 1st January, once they are classed as non-exempt third country nationals. Reciprocal tightening of covid border testing makes sense 28/
At the bare minimum, the UK should introduce a requirement that all inbound air travellers provide proof of a negative COVID19 PCR screen taken at most 72 hours before take off. This would at least prevent the most egregious examples of people boarding flights whilst positive 29/
Ideally, this should be followed up by the gradual introduction of managed isolation/hotel quarantine for all inbound travellers (hauliers crossing the channel with essential goods will need different rules). This will help reduce the reimportation of chains of infection 30/
Serious consideration should also be made, in the immediate hear and now, as to whether covid testing prior to departure on domestic flights ought to be introduced. Currently, dozens of flights potentially act as vectors for transmission between the furthest corners of the UK 31/
The UK is not likely, for political, logistical and economic reasons, to introduce strict controls on internal travel. The Western Australia "g2g pass" system is still worth reading about and policy makers should consider what could be learned here. 32/
https://www.wa.gov.au/government/publications/g2g-pass-travel-wa-frequently-asked-questions
https://www.wa.gov.au/government/publications/g2g-pass-travel-wa-frequently-asked-questions
At the least, clear public health messaging discouraging long distance and non-essentisl internal travel for the duration of the next 8-12 weeks ought to be a priority. Keeping chains of infection tied down locally helps prevent the virus finding new hosts 33/
Overall the TL:DR/summary is
1) infections are soating and the NHS is under major pressure
2) stay home, avoid crowds, limit exposure to others, wear a mask
3) vaccines are coming. Get vaccinated when offered
4) UK borders are currently nearly unguarded re covid, needs fixing /34
1) infections are soating and the NHS is under major pressure
2) stay home, avoid crowds, limit exposure to others, wear a mask
3) vaccines are coming. Get vaccinated when offered
4) UK borders are currently nearly unguarded re covid, needs fixing /34
People worth following during all this include
@devisridhar
@charlot_summers
@DrNeilStone
@rosieICM
@drphiliplee1
And many others I don't have space to list here!
Stay safe and best wishes for New Year folks! 35/END
@devisridhar
@charlot_summers
@DrNeilStone
@rosieICM
@drphiliplee1
And many others I don't have space to list here!
Stay safe and best wishes for New Year folks! 35/END
