BC HEALTH
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1/23 We haven't had a lot to celebrate during this pandemic. But achieving the milestone of offering vaccine to the over 70s, health and care workers and the most clinically vulnerable just before target date is a huge cause for celebration, given the scale of the achievement.

 2/23 When Margaret Keenan got her first jab in Coventry on December 8th last year, who’d have thought that, by Valentine’s Day, we’d have vaccinated over fourteen million people across the UK in just ten short weeks? Amazing, extraordinary and truly, really, world class!
3/23 I’ve been struck by how much joy and relief has been brought to those doing the vaccinations and those receiving them. A GP told me yesterday that nothing had given him greater pleasure in his long career. And that the patient's relief was sometimes overwhelming.
4/23 It's vital to recognise the extraordinary contribution of the staff and volunteers who have made this happen. One of my close family had their jab yesterday and was in awe of the volunteer standing outside in the freezing cold for a four hour shift meeting and greeting.
5/23 What I wanted to share in this thread was the slightly untold story of some of the extraordinary challenges the NHS has had to overcome to deliver this target. Requiring superhuman effort from NHS leaders and staff, way beyond the call of duty. Five challenges set out below.
6/23 Challenge 1. The complexity of the end to end delivery process required. Here’s just a few of the steps needed from an NHS delivery perspective. Receiving the vaccines in a central warehouse and then ensuring distribution to the frontline on the same day…
7/23 ...Setting up & ensuring safety and staffing of more than 1,500 vaccination sites across country. Contacting right patients from JCVI’s priority groups & inviting them for vaccination. Storing, at right temperatures, and then making up, vaccines ready for administration...
8/23 …Meeting and greeting often frail patients or going out to their home/care home. Getting their informed consent (a major challenge for some who are unable to easily give that consent). Administering the vaccine safely and then checking no adverse reaction…
9/23 …Ensuring meticulous record keeping so there is a clear record of who has had the vaccination. Frequent reporting of detailed data to assess and publicly report progress and identify problems in particular communities. All done at whole nation reach and huge pace.
10/23 Challenge 2. The lumpiness of vaccine supply. When you set up a logistical delivery chain as complex, and at such a large scale, as this you want the supply going through it to be as even and predictable as possible. Especially delivery of vital jabs to vulnerable people…
11/23 …Although it's getting a lot better now, it's important for everyone to understand how, in these early days, vaccine supply into the NHS, and therefore out to the NHS frontline, has been incredibly lumpy. This has lead to major problems to be overcome on the ground…
12/23…Different to expected/planned volumes delivered, days of delivery, gaps in supply, often at less than 24 hours notice, have caused major frontline headaches. Good example of problem and heroic (word used advisedly) frontline reaction here:https://t.co/BsxBQbj0Fk
13/23 …This lumpiness is nobody’s fault. Manufacturers, batch approvers, @beisgovuk, @DHSCgovuk and NHS national team under @Emily_JR_Lawson have all done everything they can to try to reduce the lumpiness. But there have been a range of problem to overcome on the ground….
14/23 …This has meant huge amounts of rapid turnaround work at the frontline e.g. extended hours working, working at very odd hours at short notice, delayed leave etc. Willingly done given importance of campaign but source of some understandable frontline frustration as well!
15/23 Challenge 3. The lack of forward visibility of supply. Highly complex “just in time” logistical delivery operations like this depend on forward visibility of supply. They can then deliver the right goods to the right place at the right time (think supermarkets)...
17/23 …But visibility on forward vaccine supply has been severely constrained by supply lumpiness & globally competitive race for vaccines. Governments internationally have been (and had to be) very coy about what supply they have, when (ref EU vaccine row a fortnight ago).
18/23 Challenge 4. Doing an unprecedently large, at pace, vaccination campaign at the same time as a 2nd/3rd wave of pandemic and winter, always the NHS’s busiest time. Two community NHS trust CEOs I spoke to yesterday said their trusts have been under unbelievable pressure…
19/23 …And one of a group of GPs I spoke to yesterday said that last week had been their busiest ever in terms of “ordinary GP demand”. Juggling “ordinary winter workload”, a covid peak and the vaccination campaign has been an unbelievable stretch for an already exhausted NHS.
20/23 Challenge 5. Tacking vaccine reluctance. NHS nationally and locally has worked very hard to combat any misinformation, monitor take up and adjust strategy / approach to maximse take up wherever needed. Excellent work, for example, with BAME community and faith leaders.
21/23 There are many more challenges to overcome. Expanding campaign to vaccinate the rest of the population at real speed. But note how target for remaining 5 JCVI initial priority groups has already come forward from initial end of May to end of April thanks to NHS hard work…
22/23 …And there's a huge challenge to build new, long term, sustainable infrastructure needed to administer an annual covid-19 vaccination booster campaign. For example a workforce model that allows us to sustainably administer jabs and do core NHS work at same time.
23/23 But the way NHS has overcome challenges to deliver vaccination campaign so far should give confidence we can meet these new ones too. There’s a huge, quiet, pride and satisfaction across the service that, once again, when the nation needed us most, the NHS delivered.

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This is a limited point about availability of efficacy data for vaccines under development in the context of the approval for CovidShield and Covaxin in India.

There have been many so-called experts on the idiotbox opining about apparent availability of P III data which 1/n

2/n apparently the SEC had access to based on which it "supposedly" approved Covaxin. Another argument that is prevalent is other regulators (US FDA and MHRA) also approved vaccines based on P II data alone. Let me give you a few facts so that you can make your own decision.

3/n The protocols for both mRNA vaccines are publicly available. You can check. Both protocols *define* when the interim analysis will be done. This is not subjective. They clearly define how many infections need to be documented before the Data Safety Monitoring Board meets.

4/n Find the protocols for the bridging study for CovidShield and Covaxin and look for a similar milestone.

Here is one set of efficacy data post the interim analysis of a mRNA vaccine.

Source: https://t.co/BAPnP3PxEb


5/n This data was analyzed post the interim analysis where the blind was broken by the DSMB. Now ask yourself this question:
How does the SEC, or the sponsor of these studies, or the experts who are offering their opinion liberally on the idiotbox know what the efficacy is
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If you have #ADHD & are struggling please know you’re not alone. This week on @Overview, we're talking about living w/ ADHD & Anxiety during the pandemic & many the stigmas & misconceptions that making things worse.

I was diagnosed w/ ADHD when I was 7. And in so many ways it’s been a blessing. I love my energy, the hyper-focus, the calm I feel in chaos, the ability to & feel emotions so intensely. It’s allowed me to to see the world differently be in a constant state of wonder.(2)

But realizing all that has been a long, difficult journey so figured I’d share some of my own struggles as well as the resources from @HowtoADHD because Jessica's channel has been a game-changer for me.(3)

First off, #ADHD Attention Deficit Hyperactivity Disorder is a dumb description. It implies a deficit in attention & always hyper people. ADHD is a spectrum, & what we all have in common isn’t that we can’t pay attention. It’s that we have trouble controlling our attention.(4)

There are amazing analogies out there, like trying to watch 6 TV’s at once when someone else controls the remote. Or like driving a race car on city streets and spinning out whenever you try to turn.
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Fun fact: the standard advice for if a dog, cat, or human bites your hand, is to feed the bite. Push your hand further into their mouth, forcing the jaw open.

Nurses, EMTs, veterinarians, etc are taught to respond this

The advice for a human biting you is to jam your hand or arm deeper into their mouth, and rub the spot under their nose back and forth.

If you attempt to remove your hand, or forearm, the teeth do what they're supposed to and gouge out a chunk.

This vicious wolf attack illustrates proper technique.


So: every EMT and nurse who gets bitten by a human, is trained to jam their hand or forearm deeper into the mouth, feeding the bite so the jaw widens enough to remove the limb

Also, every redneck learns this along with the advice of "never run from an angry dog"
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Tamar Haspel
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Let’s talk about ORGANIC.

Robert Paarlberg’s new book on the food system is out today, and here’s an excerpt.

He’s not a fan of organic, and he makes some good points but misses others.

Here we go.

Organic's biggest shortcoming is that you need more land to grow the same amount of food.

The yield penalty happens in almost every crop, in almost every study.

The gap could narrow with more research/varieties, but it won’t go away.

This has big, bad climate implications.

The second issue I have with organic, which Paarlberg shares, is that its basic criterion is naturalness.

Natural doesn’t mean safe, or even safer. A farming standard based on it forces farmers to sometimes use more dangerous, less effective tools.

On human health, there’s scant evidence that pesticide residues on conventional produce are harmful to consumers (though it’s possible farmworkers could be at risk).

What I don’t want is for folks who can’t afford organic to worry about feeding their kids conventional produce.

On the plus side, Paarlberg acknowledges that the organic standard has some real advantages for animal welfare.

This is why I buy organic animal products.

Many in the organic world would like more regs ensuring animals have decent lives.
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I’m deeply saddened to learn that Dr Joseph Sonnabend, one of the most important figures in the history of AIDS, died yesterday. I spent time with him in 2018 for one of the last interviews he ever gave. Let me tell you about this man and what he did:

Sonnabend was one of the first doctors to raise the alarm. In 1979, while running a sexual health clinic in Greenwich Village, he wrote to the NY Health Dept to warn them of the symptoms he was seeing: low white blood cell counts, enlarged lymph nodes. He didn’t get a reply. 2/

So he kept speaking out. When a patient of his developed a very rare cancer – Kaposi’s Sarcoma – he linked up with a dermatologist at NYU who said that over a dozen gay men had it. Sonnabend knew there was something very wrong. He started working at the lab at NYU — for free. 3/

It was soon after this in 1981 that the New York Times famously reported “Rare Cancer Found In 41 Homosexuals”. The next decade would kill most of Sonnabend’s patients and friends — and all of his lovers. What Sonnabend did was to fight for every single of them. 4/

Want to know who was the first to publish advice to wear a condom? That was Sonnabend. In 1983 he co-authored the first safe sex leaflet to fight AIDS: “How To Have Sex In An Epidemic”. 5/
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