BC GOVERNMENT
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I'm honestly at a loss as to understanding what our government is thinking & what evidence they're considering in enacting gravely negligent policies that will almost certainly lead to tens of thousands of deaths in the coming weeks. Thread.

 To recap - NHS capacity is critical in many places. Hospitals have reported oxygen shortages, and doctors are talking about having to choose who to put on ventilatory support. We have rapidly rising case numbers, >50,000 daily reported cases & 981 deaths reported yesterday.
Let's remember that the impact of socialising over christmas hasn't even begun to show in our numbers yet. And that hospitalisations are indicative of infections that happened ~2-3 wks ago (since then we have been seeing exponential rises in cases).
This means even if we act today, and bring R to below 1 right now, hospitalisations will continue to rise for another 2 wks or so - in line with exponential rises in cases over the past 2 weeks. And deaths will continue to rise for 2-4 wks after we act.
Given current doubling periods, this means very conservatively, 20-30,000 deaths over the next 4 weeks or so, which we sadly can't do anything about now, because most of those who will die during this period have already been infected.
It also means that we will almost certainly breach NHS capacity (if we haven't already), because the situation will worsen at least for the next couple of weeks. And that is if we take decisive action TODAY.

What is decisive action?
Data from the last lockdown, and what we know about the new variant strain makes clear that current restrictions are not sufficient. They were not sufficient to contain increases in cases in SE England then, and we haven't seen any plateauing of cases despite tier 4 restrictions.
While tier 4 restrictions have only been in place for a limited period of time, previous experience from lockdown suggests this won't be enough, and given the current situation, we don't have time to squander time to see if these have the desired effect or not.
Even flattening the curve isn't sufficient- given current rates of transmission. We need to go hard and fast. The speed at which we reduce transmission will determine the number of lives saved. The evidence that schools have contributed to transmission is incontrovertible.
Highest rates of infection in primary & secondary school children. Rises in infection in these age groups during lockdown. Yet, we've done nothing to address this. Shutting down schools now could save thousands of lives. I know shutting schools isn't what anyone wants to do.
I understand the hugely damaging impact on children, and families. But scientists, parents, teachers have all been asking for schools to be made safer for months, and the government did nothing. Now we're at a point, where if we don't do this, thousands more will die.
This isn't an exaggeration. This is sadly where we are. With this more transmissible strain, we need all measures possible to control spread. Half-way measures won't be enough. We've already squandered away valuable time.
Let's also remember that this variant is rapidly increasing in frequency in other parts of the UK now, including Wales. We know that increases in R directly correlate with variant frequency. We can expect the exponential rate of growth to increase even further, given this.
This means the doubling time isn't likely to remain constant- it's likely to increase over time if we don't act. Every day of inaction costs hundreds of lives in the future. If the government doesn't act now, its policy is equivalent to accepting mass infection & mass death.
Can't possibly overemphasise the urgency here.
When will government act on this? Both SAGE & @IndependentSage have urged urgent action.

Are we prepared to do nothing, and watch helplessly while thousands die of negligence?
Sorry, just want to mention that in the earlier tweet, I meant doubling time is likely to decrease *not* increase over time (in line with increase in R) - thanks to @RodneyP72773409 and @GeorgeChiesa for pointing this out.

More from Deepti Gurdasani

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I've been seeing a lot of discussion around the dosage gaps recommended by government for the Astra/Oxford & Pfizer/BioNTech vaccines. My thoughts on the potential benefits & risks of such an approach, and the need for much greater transparency around these decisions. Thread.


The UK govt announced recently that both the Oxford & BioNTech vaccines would be now administered with a gap of between 4-12 weeks (so prioritise administration of first dose, given limited resources).

What is the basis of this?

The basis that's been discussed seems to be that
1) the first dose is likely to confer some degree of protection against disease, so better to roll this out as fast as possible, and
2) that for Oxford/Astra efficacy may be higher when the gap between doses is greater.

I discuss some of the technical details around the Oxford trial below for those interested in these. If you'd just like a summary of this, please skip to the summary tweet titled 'SUMMARY'.

What does published evidence show? The Astra/Oxford data are a bit messy because of protocol changes during the trial. This is because the trial was originally planned as a single dose trial, but a booster dose was added when developers realised that this would likely help.
GOVERNMENT
Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
My thoughts on the govt announcement yesterday regarding a new viral strain potentially driving an increase in cases in London. The claim, at least from listening to the daily briefing seems to be based on the strain increasing in frequency more recently. 1/N

Cases have been rising exponentially in England- much of the increase being attributed to the South, although declines have slowed even in the North following easing of lockdown. Much of this is anticipated, and expected, given the behaviour of the virus. 2/N

SARS-CoV-2, like any other viruses mutates as it multiplies (albeit slower than influenza). Mutations occur randomly and most are 'neutral' - i.e. have little to no effect on transmission, ability to evade the natural or vaccine-related immune response

Having said that, few mutations have been shown to be less likely to be neutralised by plasma from patients infected by the usual (wild-type) virus. Whether this translates to a lower response to vaccines or higher risk of re-infection is unclear at the moment.

Also worth noting that just because a variant becomes more frequent in a region doesn't necessarily mean it offers a fitness advantage to the virus. Many mutations rise to different frequencies in different regions due to random processes. The frequency of strains varies globally
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Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
We've been falsely told 'schools are safe', 'don't drive community transmission', & teachers don't have a higher risk of infection repeatedly by govt & their advisors- to justify some of the most negligent policies in history. 🧵


data shows *both* primary & secondary school teachers are at double the risk of confirmed infection relative to comparable positivity in the general population. ONS household infection data also clearly show that children are important sources of transmission.

Yet, in the parliamentary select meeting today, witnesses like Jenny Harries repeated the same claims- that have been debunked by the ONS data, and the data released by the @educationgovuk today. How many lives have been lost to these lies? How many more people have long COVID?

has repeatedly pointed out errors & gaps in the ONS reporting of evidence around risk of infection among teachers- and it's taken *months* to get clarity on this. The released data are a result of months of campaigning by her, the @NEU and others.

Rather than being transparent about the risk of transmission in school settings & mitigating this, the govt (& many of its advisors) has engaged in dismissing & denying evidence that's been clear for a while. Evidence from the govt's own surveys. And global evidence.

Why?
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Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
Brief thread to debunk the repeated claims we hear about transmission not happening 'within school walls', infection in school children being 'a reflection of infection from the community', and 'primary school children less likely to get infected and contribute to transmission'.

I've heard a lot of scientists claim these three - including most recently the chief advisor to the CDC, where the claim that most transmission doesn't happen within the walls of schools. There is strong evidence to rebut this claim. Let's look at


Let's look at the trends of infection in different age groups in England first- as reported by the ONS. Being a random survey of infection in the community, this doesn't suffer from the biases of symptom-based testing, particularly important in children who are often asymptomatic

A few things to note:
1. The infection rates among primary & secondary school children closely follow school openings, closures & levels of attendance. E.g. We see a dip in infections following Oct half-term, followed by a rise after school reopening.


We see steep drops in both primary & secondary school groups after end of term (18th December), but these drops plateau out in primary school children, where attendance has been >20% after re-opening in January (by contrast with 2ndary schools where this is ~5%).
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Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
This is the exact problem with our government's thinking & response- despite this strategy of 'tolerating deaths' and half-way measures having spectacularly failed, it's quite amazing that our govt still hasn't learned anything, & continues to promote a policy of death. Thread


Had we adopted an elimination strategy early on, rather than one of tolerating a certain level of infection, we wouldn't be here now. The reason we're here is because the govt never committed to elimination.

We eased lockdown in May when infection levels were much higher than when other countries in Europe did this. The govt was warned about this, but did this to 'help the economy'. Not only did this lead us into the 2nd wave, the need for further lockdowns harmed the economy further

It's very clear from global evidence that we cannot 'tolerate a level of community transmission' and maintain 'R at or just below 1', which has been our governments policy for a long time. This isn't sustainable & very rapidly gets out of control, leading to exponential rises

Coupled with late action to contain these surges, not only does this lead to many more deaths, and much more morbidity with Long COVID, it also creates a fertile ground for viral mutations to accumulate with a greater risk of adaptation, which is exactly what happened in the UK
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Keir Starmer who worked with Theresa May as DPP said '“Whether you agree with her or you don’t, this was a woman broken who had tried to genuinely deliver on what she thought she had to do … I can’t pretend I didn’t feel something.”: #StarmerOut https://t.co/0NzX7Ouv2a


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May was someone who was always straight with him, who always phoned him to ask whether she could use something he had said. “A lot of politicians didn’t do that. She never double dealt. She said what she would do and she did what she said.” #StarmerOut #LabourLeaks

At the end of his term as DPP in 2013, she invited Sir Starmer to dinner at an Italian restaurant in Westminster to say thank you.
“It was a difficult 90 minutes. Both of us were pleased to see the hour and a half was up.” #StarmerOut #LabourLeaks

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@ProjectLincoln @tedcruz Texas failed to winterize its generation sources the last time this happened in 2011.

Now ask yourself, why?

Simple. Texas's extended power outage is a result of negligent GOP infrastructure policy.

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@tedcruz The Texas GOP has continuously rebuffed plans to invest in better infrastructure to upgrade TX power grids.

Texas was warned to weatherize power plants.

Why didn’t they?

@tedcruz TX power companies said electricity prices are too low to provide incentives (profit) to build new plants or improve older ones. (a result of privatization of basic services.)

@tedcruz The electrical grid in Texas was deregulated, privatized, and removed from interconnected networks to avoid federal regulation and increase profits for a small number of wealthy individuals.

Go figure.

@tedcruz If TX ERCOT grid was on the national grid, or simply reinvested in their privatized infrastructure, they'd be fine by now.

They did neither, b/c it wasn't profitable.

It's a failure of TX leadership –– total, inexcusable, and utterly catastrophic.

Not fucking windmills.
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What are the features of a normal urine?

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