Normally I enjoy the high standards of journalism in @guardian . Not today as disappointed with misleading headline that suggest infections are spreading fastest in children. It'll worry parents/teachers & I doubt most readers will unpick the

The latest REACT1 report shows prevalence of infection in ALL age groups has fallen, including children aged 5-12 from 1.59% in Round 8 to 0.86% in Round 9a. The authors of REACT1 report also (wisely) didn't try to interpret the prevalence figures.
2/
https://t.co/SR9PioFNHd
If this were a research trial you wouldn't place much weight on the age differences in % prevalence because of the wide confidence intervals, i.e. differences weren't statistically significant.
3/
I've previously tweeted on the challenges (& dangers) of interpreting surveillance data. One would need lots more contextual info to make sense of it & arrive at sound conclusions.
4/
https://t.co/CRW6uFXUdf
Undoubtedly some will extrapolate from the prevalence of infection figures in children to other settings i.e. schools based on the headline. I'd advise caution as there is a real risk of over-interpretation through extrapolation of limited data. Association is not causation.
5/
What REACT1 can’t tell us is how infectious children are or how much child infections drive the pandemic. Finding viral RNA on PCR from a child tells you nothing about how much virus they are shedding. Neither can it tell you the direction of transmisison (who infected who).
6/
Those of us in public health are well familiar with Bradford Hill criteria for causation that outlines key factors to consider. It would make sense to apply this approach to this issue.
7/
Is there CONSISTENCY? What’s been reported has been mixed, but @ECDC_EU , @CDCgov , @RCPCHtweets & other expert review groups have concluded the balance of evidence suggests kids aren't key transmitters of infection.
https://t.co/llVkHkwrRS
https://t.co/c8oOgua9FE
8/
Is the SPECIFICITY of the association or are there other confounders? Indeed the REACT1 report clearly show there are multiple other drivers such as deprivation & household size, etc...

9/
What about TEMPORAL SEQUENCE, i.e. does a rise in school outbreaks then follow a rise in community outbreaks? We aren’t seeing that.
https://t.co/VPbAmsbApG
10/
For me what also matters is PLAUSIBILITY & COHERENCE with what is known about the natural history and biology of the disease. Studies have shown that kids, being smaller, produce far fewer aerosols than adults. They also shed less virus than others.
https://t.co/Rv1e2VfJi6
11/
And also

https://t.co/GHa0FoJ34m
https://t.co/vW1b7j9p9j

And we know symptomatic persons shed more virus. So it follows that an adult is more likely to infect a child than the other way.
https://t.co/NpVoTakbzs

12/
This isn't to say that infections from children to adults don’t happen. Of course they do, but at much lower levels than the other way around. We mustn't lose sight of the fact that adults still account for the bulk of infections.

13/
We know that of all settings, household transmission is the highest risk. If infection is introduced into the household the majority of household members are likely to get infected. Community transmission matters.
https://t.co/OvWN28MZ0Y
https://t.co/fEOOvn6eE0

14/
This in no way refutes need for public health measures in schools to reduce risks of infection. Yes precautionary principle is important but need to balance both benefits & harms. Measures must be proportionate to actual (rather than perceived) risk.
https://t.co/VkugKMnS9R

15/
See also @apsmunro's excellent thread that outlines the evidence base.

https://t.co/VkugKMnS9R

More from Education

** Schools have been getting ready for this: a thread **

In many ways, I don't blame folks who tweet things like this. The media coverage of the schools situation in Covid-19 rarely talks about the quiet, day-in-day-out work that schools have been doing these past 9 months. 1/


Instead, the coverage focused on the dramatic, last minute policy announcements by the government, or of dramatic stories of school closures, often accompanied by photos of socially distanced classrooms that those of us in schools this past term know are from a fantasy land. 2/


If that's all you see & hear, it's no wonder that you may not know what has actually been happening in schools to meet the challenges. So, if you'd like a glimpse behind the curtain, then read on. For this is something of what teachers & schools leaders have been up to. 3/

It started last March with trying to meet the challenges of lockdown, being thrown into the deep end, with only a few days' notice, to try to learn to teach remotely during the first lockdown. 4/

https://t.co/S39EWuap3b


I wrote a policy document for our staff the weekend before our training as we anticipated what was to come, a document I shared freely & widely as the education community across the land started to reach out to one another for ideas and support. 5/
https://t.co/m1QsxlPaV4
You asked. So here are my thoughts on how osteopathic medical students should respond to the NBOME.

(thread)


Look, even before the Step 2 CS cancellation, my DMs and email were flooded with messages from osteopathic medical students who are fed up with the NBOME.

There is *real* anger toward this organization. Honestly, more than I even heard about from MD students and the NBME.

The question is, will that sentiment translate into action?

Amorphous anger on social media is easy to ignore. But if that anger gets channeled into organized efforts to facilitate change, then improvements are possible.

This much should be clear: begging the NBOME to reconsider their Level 2-PE exam is a waste of your time.

Best case scenario, you’ll get another “town hall” meeting, a handful of platitudes, and some thoughtful beard stroking before being told that they’re keeping the exam.

Instead of complaining to the NBOME, here are a few things that are more likely to bring about real change.

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The entire discussion around Facebook’s disclosures of what happened in 2016 is very frustrating. No exec stopped any investigations, but there were a lot of heated discussions about what to publish and when.


In the spring and summer of 2016, as reported by the Times, activity we traced to GRU was reported to the FBI. This was the standard model of interaction companies used for nation-state attacks against likely US targeted.

In the Spring of 2017, after a deep dive into the Fake News phenomena, the security team wanted to publish an update that covered what we had learned. At this point, we didn’t have any advertising content or the big IRA cluster, but we did know about the GRU model.

This report when through dozens of edits as different equities were represented. I did not have any meetings with Sheryl on the paper, but I can’t speak to whether she was in the loop with my higher-ups.

In the end, the difficult question of attribution was settled by us pointing to the DNI report instead of saying Russia or GRU directly. In my pre-briefs with members of Congress, I made it clear that we believed this action was GRU.