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learning from our mistakes, and taking lessons from those who have handled this pandemic best
a Trainspotting inspired
1/n https://twitter.com/BBCScotNine/status/1347627955665711110
a Trainspotting inspired
1/n https://twitter.com/BBCScotNine/status/1347627955665711110
at the start of this pandemic, the WHO and others advised that restricting international travel was not an effective way to stop the spread of SARS-CoV-2
https://www.who.int/news-room/articles-detail/updated-who-recommendations-for-international-traffic-in-relation-to-covid-19-outbreak 2/n
https://www.who.int/news-room/articles-detail/updated-who-recommendations-for-international-traffic-in-relation-to-covid-19-outbreak 2/n
we now know that this was wrong 3/n
the deadliest infectious disease event of the last century, the 1918-19 Spanish Influenza pandemic, was propagated by the main form of mass transportation at the time: sea travel during the closing stages of World War I 4/n
this century’s deadliest pandemic (*so far*) has in turn been spread by international air travel
numerous research studies in the countries hardest hit by Covid-19 (United Kingdom, United States, Brazil) have arrived at the same findings regarding importation 5/n
numerous research studies in the countries hardest hit by Covid-19 (United Kingdom, United States, Brazil) have arrived at the same findings regarding importation 5/n
the virus arrives in hundreds or thousands of separate events, and from these is seeded to spread throughout the entire population
https://science.sciencemag.org/content/early/2021/01/07/science.abf2946 @ScienceMagazine @laduplessis @arambaut @erikmvolz 6/n
https://science.sciencemag.org/content/early/2021/01/07/science.abf2946 @ScienceMagazine @laduplessis @arambaut @erikmvolz 6/n
for Scotland, research has found that the virus had been introduced at least 283 separate times, mainly from continental Europe, and most commonly from Italy
https://www.nature.com/articles/s41564-020-00838-z 7/n
https://www.nature.com/articles/s41564-020-00838-z 7/n
I believe that we could have avoided this first wave in Scotland
the novel coronavirus was first reported to the WHO on the 3rd of January 2020
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline/#event-3 8/n
the novel coronavirus was first reported to the WHO on the 3rd of January 2020
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline/#event-3 8/n
by the 14th of January we knew that there was human to human transmission
https://twitter.com/UNGeneva/status/1217146107957932032 9/n
https://twitter.com/UNGeneva/status/1217146107957932032 9/n
by the 9th of February there were reports of it being spread by attendees at international conferences, in this case a business meeting in Singapore
https://www.bloomberg.com/news/articles/2020-02-09/virus-fallout-from-singapore-conference-spreads-across-europe
despite this large conferences were still being held in Scotland at the end of February 10/n
https://www.bloomberg.com/news/articles/2020-02-09/virus-fallout-from-singapore-conference-spreads-across-europe
despite this large conferences were still being held in Scotland at the end of February 10/n
by the 21st of February we knew that SARS-CoV-2 was spreading within Italy.
https://www.reuters.com/article/us-china-health-italy/coronavirus-outbreak-grows-in-northern-italy-16-cases-reported-in-one-day-idUSKBN20F0UI 11/n
https://www.reuters.com/article/us-china-health-italy/coronavirus-outbreak-grows-in-northern-italy-16-cases-reported-in-one-day-idUSKBN20F0UI 11/n
but in Scotland we were too slow to act: advice was issued to self-isolate after returning from travel to selected parts of Northern Italy only, and not from Italy as a whole, 4 days later
https://www.gov.scot/news/coronavirus-travel-advice-updated/ 12/n
https://www.gov.scot/news/coronavirus-travel-advice-updated/ 12/n
only on the 10th of March did the Scottish government advise all international travellers to self-isolate on return from travel abroad
and only in early June did the UK government start to enforce these quarantine rules 13/n
and only in early June did the UK government start to enforce these quarantine rules 13/n
the first lockdown, although painful in a number of ways, and extended for longer in Scotland than in England, was highly effective
by some days in July we were down to just 2 confirmed Covid-19 cases in the *entire country* @TravellingTabby @P_H_S_Official 14/n
by some days in July we were down to just 2 confirmed Covid-19 cases in the *entire country* @TravellingTabby @P_H_S_Official 14/n
further research, conducted by my academic and NHS colleagues, suggests that there were only a handful of viral lineages left at this point in Scotland, each causing a small number of cases 15/n
https://www.cogconsortium.uk/wp-content/uploads/2020/12/9th-December-2020-COG-UK-Report-Scotland-SARS-CoV-2-a-genomics-perspective-SAGE.pdf
https://www.cogconsortium.uk/wp-content/uploads/2020/12/9th-December-2020-COG-UK-Report-Scotland-SARS-CoV-2-a-genomics-perspective-SAGE.pdf
but by September we were back to rising case counts. The source of these new cases?
travel again, this time from England and continental Europe 16/n
travel again, this time from England and continental Europe 16/n
screening travellers is not enough
we know that airport screening is resource intensive, and often ineffective due to the incubation time of the virus
https://www.cochrane.org/news/cochrane-rapid-review-investigates-effectiveness-screening-covid-19
RT-PCR without enforced quarantine is ineffective too 17/n
we know that airport screening is resource intensive, and often ineffective due to the incubation time of the virus
https://www.cochrane.org/news/cochrane-rapid-review-investigates-effectiveness-screening-covid-19
RT-PCR without enforced quarantine is ineffective too 17/n
the countries that have handled this pandemic best are those that have been able to secure and control the passage of people across their borders 18/n
Taiwan, Australia and New Zealand, to pick from the small number of countries that have managed to keep case counts relatively low, introduced stringent travel restrictions from the start of the pandemic 19/n
most importantly, they adopted measures to ensure that new arrivals complied with quarantine regulations 20/n
their low infection rates and tight handle on cases allows them to act quickly and decisively to investigate and contain outbreaks
in August, when a cluster of 4 cases was detected in Auckland (pop. 1.6 million)went into lockdown for 19 days https://news.sky.com/story/coronavirus-breaks-out-again-in-new-zealand-after-102-days-12047011 21/n
in August, when a cluster of 4 cases was detected in Auckland (pop. 1.6 million)went into lockdown for 19 days https://news.sky.com/story/coronavirus-breaks-out-again-in-new-zealand-after-102-days-12047011 21/n
this strategy has proven highly successful: the last case of community transmission in New Zealand was on the 18th of November
http://health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-current-cases 22/n
http://health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-current-cases 22/n
in contrast in a Scotland with (at last count) 2309 cases a day, this degree of disease surveillance and control remains a distant dream
more vaccines will be arriving soon, but so far only just over 100,000 adults have been vaccinated
leaving 4.3 million unprotected 23/n
more vaccines will be arriving soon, but so far only just over 100,000 adults have been vaccinated
leaving 4.3 million unprotected 23/n
by May we may well have vaccinated those over fifty and the most vulnerable https://www.thenational.scot/news/18985311.covid-expectation-50s-scotland-vaccinated-early-may/
but we are unlikely to have full (adult) population coverage until late summer, the autumn or even beyond 24/n
but we are unlikely to have full (adult) population coverage until late summer, the autumn or even beyond 24/n
even these optimistic schedules are contingent on vaccine availability: manufacturers are already struggling to keep up with demand https://metro.co.uk/2021/01/01/covid-vaccine-supply-issues-could-delay-life-getting-back-to-normal-13833708/
in addition, we have no clinical trials to guide vaccinating the 1 million children and young people in Scotland 25/n
in addition, we have no clinical trials to guide vaccinating the 1 million children and young people in Scotland 25/n
given that we can’t rely on vaccines to get us out of our current dire situation
let’s learn from our previous mistakes, and take lessons from those who have handled the pandemic best
Let's: 26/n
let’s learn from our previous mistakes, and take lessons from those who have handled the pandemic best
Let's: 26/n
Choose to continue to restrict travel, including from England, unless it is absolutely essential
https://www.gov.scot/publications/coronavirus-covid-19-update-first-ministers-statement-monday-4-january-2021/ 27/n
https://www.gov.scot/publications/coronavirus-covid-19-update-first-ministers-statement-monday-4-january-2021/ 27/n
Choose to strictly enforce breaches of travel quarantine 28/n
Choose to think hard about continuing these travel restrictions beyond lockdown, until national case numbers are so low that we can effectively investigate and contain local outbreaks 29/n
Choose to seamlessly transition from a Scotland with very low case numbers, to one where everyone is vaccinated 30/n
Choose to minimise unnecessary death and disruption to healthcare and education 31/n
Choose to make sure that this lockdown is the last one we have to endure 32/n
