Interesting. Yes, a lawyer's input would be good @syrpis ?

had also just retweeted this- thought it excellent, and, for what it's worth, on my understanding of the 2010 UK Equalities Act, some consideration of these questions is actually legally mandated (would love to hear lawyer's input here)

Very good points. The "who" is such an important question that is rarely asked. Many of the freedom loving "risk takers" do not take much risk themselves--they want others to take the risk for them. @SciBeh @ProfColinDavis @rpancost @chrisdc77Quote TweetDr Ellie Murray, ScD@EpiEllie · 24 JanFour questions to ask about every COVID response decision: “will it reduce transmission, infections, hospitalization, chronic disease, &/or death?” “who will it reduce these for?” “who will be left out &/or bear the burden or cost?” “what can we add or do to help them too?’

.....those were the daysQuote TweetAlitis@Alitis__ · 26 JanReplying to @truthshamesthe6 and @Unusual_TimesYou guys mean there's still a pandemic going on?

Link to the meeting:journalismcourses.orgWEBINAR: How to improve COVID-19 coverage - Journalism Courses Knight Center      View a recording of this webinar on YouTube in English,

This is the first step in making this a reality. After this proof of concept in mice, this strategy needs to be tested for safety and efficacy in larger animals and in clinical trials. Similar strategies can be used to combat other mucosal viral pathogens in the future. (End)

This work was led by two brilliant colleagues, @tianyangmao and @BenIsraelow, along with @wmsaltzman and his lab members, and @marioph13 @rjhomer57 (17/)

The intranasal spike protein booster will also be much easier to administer (via nasal spray), quite stable (just protein) and is much more likely to be accepted by people who are hesitant of mRNA or those with needle phobia. (16/)

Because Prime and Spike also establishes tissue-resident memory T and B cells, this strategy is likely to confer long-lasting and cross-reactive memory that can be quickly restimulated to prevent viral spread. (15/)

This study shows that unadjuvanted recombinant spike or PACE-mRNA-spike can be used to safely boost mucosal immunity in hosts primed with conventional mRNA vaccine to reduce infection and prevent disease. A heterologous spike boost can induce variant-specific T and Ab. (14/)

Remarkably, when SARS-CoV-1 spike was used as booster IN (red), mice developed lots of TRM (reactive to both CoV-1 and CoV-2) as well as boosted mucosal and systemic IgA and IgG against both CoV-1 and CoV-2 without suffering original antigenic sin. (13/)

@tianyangmao @BenIsraelow took it one step further. Can Prime and SpikeX (a heterologous Spike) generate cross-reactive immunity against SpikeX? They set up Prime (mRNA IM) boost (mRNA IM) vs. Prime (mRNA IM) and Spike (protein IN) groups and compared. (12/)

Similarly, Prime (mRNA IM) and PACE-Spike (mRNA in PACE IN) (green) also protected mice from death and disease, when challenged 42 days post boost. (11/)

Prime (mRNA IM) and Spike (protein IN)(blue) protected all mice from disease and death. Moreover, Prime and Spike reduced both nasal and lung viral load. Prime alone (gray) was not able to protect mice from infection, disease or death. (10/)

So how well does Prime and Spike work compared to Prime alone? To mimic waning immunity, we gave very low dose of mRNA IM to prime the mice, then boosted nasally with Spike. 42 days later, they challenged mice with a lethal dose of SARS-CoV-2. (9/)

This strategy is versatile, and instead of using a recombinant protein, we show that spike mRNA encapsulated in immune-silent nanoparticle called Poly(amine-co-ester)s (PACE) developed by @wmsaltzman lab (PACE-Spike) IN was also capable of inducing TRM, BRM and mucosal Abs. (8/)

Further, in every respiratory compartment, lung parenchyma, lung lumen, nasal cavity, Prime and Spike led to increased CD4 tissue-resident memory (TRM) and spike-specific CD8 TRM (blue). Note that IN Spike without Prime (gray) does not induce Ab or T cells (7/)

To do this, @tianyangmao @BenIsraelow tested variety of boosting agents and found that simple purified spike protein (in stabilized prefusion confirmation) was able to boost nasal, lung and serum IgA/IgG & resident memory B & ASC following an IM Pfizer mRNA prime (blue). (6/)

How do we overcome these problems? Intranasal inert antigens are not immunogenic, but adding adjuvant is unsafe. The answer lies in taking advantage of the existing adaptive immunity and use it as natural adjuvant to boost immunity. Hack the immune system. (5/)

Adjuvanted inactivated vaccines have had safety concerns, as shown for the the intranasal flu vaccine significantly increasing the risk for Bell's palsy. (4/)nejm.orgUse of the Inactivated Intranasal Influenza Vaccine and the Risk of Bell's Palsy in Switzerland |...Original Article from The New England Journal of Medicine — Use of the Inactivated Intranasal

To elicit mucosal immunity from scratch, live attenuated vaccines are often necessary, due to the need to introduce sufficient antigen and innate immune signals needed for priming via mucosal surfaces. Live vaccines are not safe for immunocompromised. (3/) https://nature.com/articles/s41577-021-00583-2

Current COVID vaccines are given intramuscularly. This induces robust circulating antibodies and systemic T & B cell responses that block viral spread and disease. However, to better block infection, immunity has to be established at mucosal surfaces. (2/) https://annualreviews.org/doi/10.1146/annurev-immunol-032414-112315?url_ver=Z39.88-2003…

Update

Kelly

They haven’t even deleted their old tweets from before they changed username

This account is fake

What’s been happening This Week in Covid? The schism between reality and policy grew even wider this week... Omicron B.2 sent cases soaring and stock markets sinking! #TheWeekInCovid

Two years of Covid news for behavioural science #MyTwitterAnniversary

Two years of Covid news for behavioural science #MyTwitterAnniversary

Widespread vaccination is necessary to minimize or halt the effects of many infectious diseases, including COVID-19. Stagnating vaccine uptake can prolong pandemics, raising the question of how we might predict, prevent, and correct vaccine hesitancy and unwillingness. In a multinational sample (N=4,452) recruited from 13 countries that varied in pandemic severity and vaccine uptake (July 2021), we examined whether short-sighted decision-making as exemplified by steep delay discounting—choosing smaller immediate rewards over larger delayed rewards—predicts COVID-19 vaccination status. Delay discounting was steeper in unvaccinated individuals and predicted vaccination status over and above demographics or mental health. The results suggest that delay discounting, a personal characteristic known to be modifiable through cognitive interventions, is a contributing cause of differences in vaccine compliance.

Confidence of others trumps confidence of self in social information use

Meta-shmeta analysis. They claim they find that lockdowns reduced mortality in Europe and U.S. only by 0.2%. After browsing through their methodology and results though, it's obvious they aren't doing what they claim they're doing and their analyis is deceptive.

2/2 it's like comparing how wet you got in a down pour with and without umbrella... the biggest surprise to me in this pandemic hasn't been the 'overreaction' it's been the constant failure with respect to basic counter-factual reasoning

it makes little sense to numerically compare this pandemic *with all of the intervention that occurred* directly with past ones where medicine and epidemiology where of a completely different standard to conclude that *this one* "wasn't bad".

We're not an airline but we do fly planes

"carping about anti-vaxxers"? you mean constant attempts to try and save lives and end pandemic by generating, curating and promoting research data on the benefits of vaccination and/or generating, curating and promoting data that undercuts the wilful disinformation on vaxx?

Whilst an ACH of 6 can eliminate 99.7% of particles in a room within 1 hr, here is a good visual of the relationship between ACH and steady state particle concentration when someone in the room is constantly emitting particles. Demonstrates why a high ACH is a necessary goal.

Great video of @dgurdasani1 discussing the Covid stats and the effect on children #LongCovidKids

Hospitalizations in England per age group: Decreasing 0-5 6-17 Increasing 18-64 65-84 85+ 2/2

After weeks in decline, hospitalizations are growing up again in England . 1/2

BA.2 projections in the US: Coming off of the massive omicron wave (Rt=0.64) will provide a lot of immunity to restrict BA.2 spread rate. A good chance we may see a BA.2 wave in April-May. A lot of factors to consider:

huge thanks to @PepperMarion @deeptabhattacha @TheBcellArtist @KatieMG @David_RMartinez Rafi Ahmed, John Moore for speaking with me on this topic. and, back to vacation for me.

this is in some ways a companion piece to the vaccine durability piece I wrote a few weeks ago, which discusses some of the factors that can convince the immune system to properly remember a vaccine, and keep its guards against a pathogen high

I wrote (last week!) about the future of boosting - how many more shots will we need? will they all contain the same ingredients? ultimately, it depends on our immune systems, how the virus looks, and how much of the virus is around.

Daily COVID-19 hospitalization in the US: observed and forecasted https://covid19forecasthub.org

Damn, nice findQuote Tweetsloppy_steaks@NToola9 · 27 FebGranzyme B and PASC (Long COVID). AICD in a clever way: bypasses CD95 to induce apoptosis through caspase cleavage. Significant expression of Granzyme B is found in NK and CD8+ long after recovery from COVID. T cells: Friend *AND* Foe. #LeonardiWasRight

A lesson in how misinformation becomes fact in too many minds. Thread: Meet @SaraCarterDC. Her bio says she's an award winning correspondent who works with @FoxNews. Three hours ago, Sara tweeted that someone in the occupier demo died after police on horses pushed through. 1/

With these data, we find that reinfection with #Omicron BA.2 can occur in patients previously infected with BA.1, as early as 20 days after initial infection. 85% had symptoms during the Omicron BA.2 reinfection, though mainly mild disease and similar duration of 4 days 5/n

This work was only achievable through a very dedicated effort by many people @SSI_DK including @mobdjek, @tyragovekrause @rskskov @andersfomgaard, @sieber_r, @henrik_ullum, @Alexandersens, @JannikFonager, @TLillebaek, @SteenEtTo, @marcbennedbaek, @anna_c_ingham, @kimleeng 10/n

In conclusion, we provide evidence that #SARSCoV2 #Omicron BA.2 reinfections are rare but can occur relatively shortly after a BA.1 infection, causing mostly mild disease in unvaccinated young individuals 9/n

Viral load and subgenomic RNAs among reinfection cases showed significantly reduced viral load in secondary BA.2 infections compared to initial BA.1 infection together, a lower ratio of subgenomic to genomic RNA indicate a more superficial and transient secondary infection 8/n

Also investigated if #Omicron BA.2 reinfections are caused by a specific subset of BA.2s. No sign of clustering, indicating that the capability of BA.2 to cause reinfections in recently infected Omicron BA.1 cases with low or no vaccination may be an intrinsic BA.2 property 7/n

The median age of the BA.1->BA.2 cases was 15 years, and no cases were older than 38. Majority were under the age of 20 (70%). 89% were not vaccinated, no cases had received the booster. Compared to Denmark in total, 81% are vaccinated twice and 62% have received the booster 6/n

We used a genomic approach to gain insight into the state of infection of the BA.2 reinfected cases within 20 to 60 days.Includes information on vaccination, demographics, and self-reported clinical information on the individuals found to have been infected with both variants 4/n

The #SARSCoV2 variant of concern #Omicron has rapidly spread worldwide. With the surge of the distinct subvariants BA.1 and BA.2, we investigated whether BA.2 specifically can escape the natural immunity acquired shortly after a BA.1 infection 3/n

Key messages 1) Reinfections occurred mainly among younger, unvaccinated individuals 2) Disease severity associated with BA.2 infections was similar to previous BA.1 infections – and only cases with mild disease. 3) Reinfections were not caused by distinct genetic variants 2/n

New preprint on #COVID19 is out: “Occurrence and significance of Omicron BA.1 infection followed by BA.2 reinfection”. Using the national surveillance system in Denmark, we show that reinfections with #SARSCoV2 VOC #Omicron BA.2 can occur after recent BA.1 infection #SSI_dk

When you realize you've gone too far

Hi, @socarxiv. I would like to kindly request a lifetime ban for @ppmerino, @EduardoClark, and the other coauthors of this deeply problematic and unethical pre-print.

Calling all GBD fans, your continued reinfection loyalty card. Nice one, @PeteUK7

The risks of cognitive symptoms lasting at least 12 MONTHS were much higher in the infected group. 4.8x higher for fatigue, 3.2x for brain fog, 5.3x for poor memory, and an incredible 51x for altered taste and smell. We need data on children, but it could easily be similar. (17)

BA.2 & BA.1.1 (Omicron variants) are growing in many countries . Quite what this means in terms of cases, hospitalisation, deaths & long covid is unknown but - once again - Omicron from Dec (BA.1) is not the last variant. Also @Unusual_Times highlighted BA.1.1 in UK weeks ago.

NYC update Cases down 40%; positive rate 4.0% Hospital census back to levels of December 27 and declining. New hospitalizations back to levels of 12/19 and declining. BA.2 may well be of concern, but not meaningful impact... yet.

Speaking of which, latest COG UK data shows that BA.2 is dominant already in NI & likely dominant within Scotland & Eng within 2 weeks. It doesn't seem more severe, but some (v early) sign that kids get reinfected with BA.2 faster than adults https://twitter.com/kallmemeg/status/1494100192873885698?s=20&t=RgXoqBNEVDl_Tf-rv78QOQ… 5/7

Addendum: please see Dr McCafferty's wonderful tweetorial on milestone surveillance & screening for more info.

You could also just read the paper that clearly outlines this thinking rather relying on bad journalism and misinformation from contrarian doctors. End/

A higher 75% threshold or identifying the 25% of kids not reaching that milestone (30 words by age 2) will mean more referrals for these at risk kids & less "wait & see." All of this is clear to anyone with knowledge of child development. But isn't clear to an adult oncologist.3/

The prior developmental milestone screening tools hinged on 50% of children not reaching that goal (e.g. 50 words by age 2) to identify delays. The unintended result is that many times parents, providers, etc adopted a "wait & see" approach rather than referring to therapy. 2/

No, the CDC did not quietly revise language development guidelines to hide mask induced delays. This is misinformation. The change is based on a 15 year update on the 2004 recs & a lit review performed in *2019* with the explicit goal of identifying higher risk kids. 1/

About 33K children were hospitalized in 6 weeks during the Omicron wave, so far https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions

Here is the reality…

Did anyone hear any mention of long COVID, an illness affecting 1.3 million people, of whom 500,000 have had this for more than a year during the briefing? Are we just going to pretend it doesn't exist?

Effectiveness of mRNA-1273 against-Omicron and Delta variants The 3dose VE was 71.6% and 47.4% against Omicron infection (14-60 days) The 3dose VE was 29.4% against Omicron infection in immunocompromised individuals H/T ⁦⁦@michaelgcollett

Fantastic work by @UKHSA comparing serial intervals of BA.1, BA.2 and Delta as published in the most recent technical briefing. BA.2 seems to have even shorter serial interval than BA.1 This could help explain different relative growth rates of BA.2 vs BA.1 in different countries

BA.2 risk assessment New this week is upgrading Immune Evasion - Amber from low to moderate that BA.2 is antigentically different to BA.1 Unsurprising given the mutation profile, with BA.2 *slightly* more immune evasive than BA.1 on neuts studies

Updated graph with numbers the “flu=covid for kids” folks are too afraid to share.

There's some urgency to understand what's going on here... #COVID19

“Wear face masks indoors,” says Boris Johnson, who has repeatedly refused to wear face masks indoors.

Long COVID isn't the first "long" post-viral illness. https://nature.com/articles/d41586-022-00414-x… Also: influenza, measles, polio, Ebola, EBV... to name just a few.

If you have a little one who’s getting a vaccine soon but feeling a bit scared, this new book from @JanZauzmer is quite cute & might help them preview the experience. #VaccinesSaveLives

5) Even if #Omicron is slightly milder in adults (but 20% more severe in kids), total hospitalization drop is not that much compared to Delta (which is already well known to be 2-3x more severe than Wuhan). We are somehow letting “it’s mild” mentality keep endangering folks.

) Booster campaign in UK likely are bringing cases and hospitalizations down slowly. But bending it takes time. And remember - even when cases peak— we are only ad 50% of the wave. The other 50% is experienced on the way down. And hospitalizations will keep going for a while.

3) And we need to be honest also that vaccine boosters wane too. This figure in French from UK data shows that even boosters wane against highly evasive #Omicron 10 weeks after a booster shot -VE down to 45% for symptomatic. We need new multivalent vaccines & masks & ventilation.

2) Boosters are critical, yes, but we need a higher sea wall of protection that can handle virus evolution & adaption. That’s why premium masks & ventilation & air disinfection key. Special thanks to @theosanderson for the animation. Data via @ONS. https://ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveyantibodyandvaccinationdatafortheuk/13january2022

WATCH—Despite 97.5% of all adults in England with antibodies to #COVID19 (via vax/infection)–hospitalizations still surging. Why? Because variants like #Omicron are adapting. Need multivalent vax, plus N95 & ventilation are agnostic to variants—key!

US data via @OurWorldInData Let not anyone tell you that vaccines do not work

Well well well. Source: https://gov.uk/government/publications/sars-cov-2-variants-of-public-health-interest/sars-cov-2-variants-of-public-health-interest-11-february-2022…

At regional level, BA.2 cases are highest in South West England (although a relatively small sample), followed by London, SE and East of England. But it is now increasing in all regions Numbers are spread fairly evenly across age groups.

Samples likely to be BA.2 (SGT positive in TaqPath data) now make up 34% of COVID cases in England. The proportion has roughly doubled in a week. That represents a growth in absolute numbers of BA.2, even if overall infections are falling at the same rate as reported cases

We (UK) don't have to be here: it's a political (and harmful) choice.

We need those who are adept at #SciComm to explain that "Omicron" is sufficiently different from the original strain that was used to make the vaccine. Therefore, the definition of "fully vaccinated" will have to be updated, but that does not mean that the vaccines have failed.

But surely, we should be investing in ventilation so that children do not have to be in classrooms where their cognitive function is impaired by poor ventilation?

The Government have distributed CO2 monitors but say that schools should take action to improve ventilation where CO2 readings are consistently higher than 1500 ppm - and aren't funding actions that could be taken.

It says Cognitive function scores were: - 15% lower for a moderate CO2 day (~ 945 ppm) and - 50% lower on a day with CO2 concentrations of ~1,400 ppm - than on days where CO2 levels were between 500 & 700 ppm.

Ventilation isn't just for Covid.... ...it's for Education This study looks at the impact of CO2 not just as a marker of pollution but as a pollutant in itself. It shows that as CO2 rises above 700/800 ppm cognitive function begins to be impaired https://dash.harvard.edu/bitstream/handle/1/27662232/4892924.pdf?sequence=1&fbclid=IwAR2kWIHIJfssa_sw72MD6W1hnkDvSm4bikK5FOLxwQxhjYLEYjfPCfzXz3E

It seems the people who write the vaccines w/ a booster aren't working against Omicron are completely out of touch with the data I'd consider ~90% effectiveness vs hospitalization pretty, pretty damn good https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1046853/technical-briefing-34-14-january-2022.pdf… Especially compared with 44% without a booster

2) it doesn’t help that US has the lowest vaccination rate among major counties except Russia.

Pandemic leadership matters. #COVID19 mortality per capita by state. Public health is policy, policy is politics. Human behavior is often driven by misinformation. Misinformation is often driven by politics. Politics can be changed by voting — unless voters can’t.

Although some use modelling of future scenarios as a synonym for 'modelling', important to remember a lot of the modelling work during COVID has focused on very different questions: https://twitter.com/AdamJKucharski/status/1244549516352720897?s=20… 8/8

Others would later apply similar methods to estimate cases elsewhere (e.g. https://ncbi.nlm.nih.gov/labs/pmc/articles/PMC7081176/…). And we'd use exported cases and evaluation flights to help estimate changing transmission in Wuhan as measures came in: https://thelancet.com/article/S1473-3099(20)30144-4/fulltext… 7/

I think above is a useful example of real-time analysis because 1) it's pretty intuitive why you'd need a model, and 2) shows these approaches can provide crucial early insights that wouldn't have been possible by just looking directly at the (noisy, biased, incomplete) data. 6/

Now, of course, it's well known there were loads of infections not appearing the data early on (https://thelancet.com/journals/lancet/article/PIIS0140-6736(21)00434-7/fulltext… & https://thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30089-X/fulltext…). Everything is obvious in hindsight etc. But at the time this modelling went against raw data, so valuable situational awareness. 5/

This is what Imperial did, estimating that those 3 exported infections were consistent with 1723 cases (95% CI: 427 – 4471) in Wuhan https://imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-1-case-estimates-of-covid-19/… 4/

To answer this, we need to outline a model: if there are X cases in Wuhan, and travellers leave to different destinations at given rates, how likely is it we'd observe those three exported cases? With this model outlined, we can then use it to infer X given the observed data. 3/

At the time, only 41 cases of 2019-nCoV (aka COVID-19) had been reported in Wuhan. But two exported cases had just been detected in Thailand and one in Japan. How plausible was it that there were really just 41 cases in Wuhan? 2/

Below analysis was two years ago (https://bbc.co.uk/news/health-51148303…). As well as providing an early warning about the COVID threat, it’s a good illustration of what is often an under-appreciated point: if we want to make sense of epidemic data and dynamics in real-time, we need models… 1/

Highlights the *huge* benefits of investing in ventilation, and changes in the way we work (greater flexibility to work from home)- which is better for the environment as well. We need to think long-term & consider how we can change things to do better.

Hearing a lot of people using excess deaths being low to suggest COVID-19 deaths aren't a serious issue, or didn't surge post-omicron. This isn't true unfortunately. We're still seeing ~1,800 deaths/wk with COVID-19 reported, but other deaths have come down.

Mitigations had a considerable impact on on all respiratory diseases, and COVID-19 deaths have actually increased, but deaths from other causes decreased potentially due to behaviour change - reducing contact, and increased mask use/ventilation.

Exactly this We never talk about the huge benefits mitigations have had in reducing other respiratory illnesses... which means deaths from other causes have reduced. Excess deaths are not a good indicator of COVID-19 deaths - which we should be doing a lot more to prevent!

If you, like me, are "skipping ahead" during the ACIP meeting re: Moderna vaccine - this slide really drives home the benefit / risk paradigm among the group at highest risk of myocarditis (men 18-35). 2 million shots = 1903 avoided hospitalizations, and 68 myocarditis cases.

NEW: FDA approves Pfizer and Moderna vaccine booster shots for all adults in the U.S.

unsere ersten Daten zur Neutralisation von Omicron versus Delta sind fertig: 2x Biontech, 2x Moderna, 1xAZ/1x Biontech nach 6 Monaten 0% Neutralisation bei Omicron, auch 3x Biontech 3 Monate nach Booster nur 25% NT versus 95% bei Delta. Bis zu 37fache Reduktion Delta vs. Omicron

All that herd immunity …. Covid 3 times. Balloux

Preliminary look into the visitor locations to http://usps.gov mapped with new COVID-19 cases shows some overlaps, but many areas with high case counts are currently not showing high levels of web traffic. This analysis does not take social vulnerability into account.

The latest "Nowcast" from @CDCgov suggests Omicron has pretty much swept the table. https://covid.cdc.gov/covid-data-tracker/#variant-proportions

surprising how the logic of argument around C19 has not updated to the fact that reinfection is a big thing, as are new variants. Delay = a round of infection you never got...Quote TweetRyan Radecki, MD MS@emlitofnote · 12 Jan“Wearing an n95 is pointless … exposure is inevitable.” … many people don’t want to meet omicron until hospitals are out of crisis standards, or until testing and treatment is readily available.

ok, you've lost me a bit there, but I think the reduction in disease burden is what matters going forwards as per my original thread.

I'm sorry but I genuinely do not see how this is a response to what I said about the presuppositions in the "delay framing"? This reply is about your views on disease burden, not -as mine is- how choice of terminology implicitly shapes the argument space

Apologies. Covid is now highly transmissible and our immunity to it rapidly wanes, so whilst delaying infections will reduce overall burden a bit, it will not reduce it very much at all relative to addressing the outcomes of the inevitable infections with vaccines & drugs.

not the point- I am merely unpacking the presupposition in your delay framing. A helpful response would be to agree or disagree with that, rather than ask me to debate elimination of flu (which is not the aim of this account as I have stated)

Have we ever tried to eliminate flu before? and if not, why not?

I think that's a bad comparison FWIW. Not only are the diseases very different but it conflates an individual level of protection with a societal level of protection.

I can't, for example, imagine someone saying "handwashing is of limited use it only "delays" getting norovirus". So, I think it seems worth unpacking the many presuppositions involved in your "just delay" framing 1/n

As I said before, it's not the function of this account to argue/advocate covid policies, but I will comment on the shape of the argument. The use of the frame "just delay" here seems hugely prejudicial. We don't talk that way about flu or other diseases we might get repeatedly

The key question is what’s actually reducing most of the disease burden? Seems like it’s vaccines, and soon drugs. NPIs in contrast only delay cases given waning immunity. I think we can get to ~95% reduced burden just through the PIs:Quote TweetProf Tim Colbourn@timcolbourn · 21 Dec 2021* COVID THREAD ON BEST WE CAN DO LONG TERM * Yes we’re in an acute crisis with Omicron and that needs dealing with, but it has actually made me want to think a lot about how this horrible pandemic ends, maybe you too? Let’s go through it… 1/35 (sorry, but this is troubling me)Show this thread

how many countries in the world presently have *no* NPIs during an omicron wave?

Fair enough - then I disagree it's an empirical fact

I never said it was a logical truth that NPIs needed- I said it is presently an empirical fact, and likely remains true for foreseeable future

And this is where we differ. So to go back to the original point...it's not a logical truth that lowering disease burden requires NPIs. We've already lowered the burden. The question is HOW low does it need to be. Only then can we conclude whether mitigations are needed.

and vice versa- lowering disease burden presently still requires use of NPIs and likely will for foreseeable future given new variants

likewise, what is required for reducing disease burden- in particular vaccination- also overlaps with elimination

not convinced of logic here as the kinds of mechanisms needed for elimination (air control, waste water surveillance, masks, devising flexible response schedules etc) also extend naturally to other pathogens

And I think this is important. Not only is there a possible trade off in the goals, but there are tradeoffs in assessing the goals. The more effort spent assessing zero COVID is possibly therefore a reduction in effort in assessing or implementing mitigation of impact of COVID.

Of importance to Covid goals I think is an acceptance that there might still be lots of cases but that outcomes can be dramatically improved with vaccines & drugs so that 95% of burden can be reduced. Strategy therefore needs to be very different to go after all cases too.

Thanks, but seems too different to the actual impossibility of zero Covid. A relevant stretch goal for Covid might actually be 95% reduction in all countries of the world. That’s extremely unlikely but actually possible? Going further still likely to do harm as needs restrictions

I think you are an economist? This literature might be of interesthbr.orgThe Stretch Goal ParadoxAudacious targets are widely misunderstood—and widely misused.

Maybe, though it seems intuitive to me that continued single minded focus on achieving a truly impossible goal will have net harms (even just in terms of opportunity costs - not focusing on other things) after some point?

obviously you won't be able to count the goal itself as a benefit (as impossible) but that doesn't preclude the costs and benefits of the actions taken in pursuit of that goal outweighing those of some alternative

Thanks. Does that hold for truly impossible goals though? at some point doesn’t continued pursuit of such clearly impossible goals do more harm than good? In any case I think continued pursuit of Covid elimination will do more harm than good, as explained here:Quote TweetProf Tim Colbourn@timcolbourn · 21 Dec 2021* COVID THREAD ON BEST WE CAN DO LONG TERM * Yes we’re in an acute crisis with Omicron and that needs dealing with, but it has actually made me want to think a lot about how this horrible pandemic ends, maybe you too? Let’s go through it… 1/35 (sorry, but this is troubling me)Show this thread

that also doesn't follow logically. As human beings we *pursue* many goals we fail to attain without that meaning that the costs of the pursuit necessarily outweighed the benefits.

Thanks and yes except if elimination is actually impossible (and there is a very strong case for that being so) then continuing to try to achieve it will always be too costly as you'll have very high costs for no marginal benefits at some point.

it's not actually a logical truth that such a point exists- it is logically entirely possible that the costs of trying to live with the virus outweighs those of elimination. Which is more costly is thus an empirical question

There can, and should, be a discussion about where the point of diminishing returns is. But to simply believe it doesn't exist is hardly a starting point for a reasonable discussion.219

There HAS to be a level where there are diminishing returns-eg eliminating last (say) X cases per week/year would harm more than it prevents. My fundamental issue with zero COVID isn't the aim but "single issue" approach. You can't look at zero COVID ignoring its non CV impact.

Agreed. I've noticed an increasing amount of entrenchment the last few weeks. This should be a discussion. Not an emotive and angry debate but a genuine discussion (which people may not all meet in the middle on) about the "least bad" route. For society as a whole.

The lack of critical discussion and reflection on Covid twitter is starting to get really upsetting (I might take a break). Seems like people are doubling down rather than opening up to engaging with different points of view. Short Thread: 1/7

This FLCCC COVID protocol gets nuttier with each version. Now hydroxychloroquine is “preferred for omicron”? What?! Stuff that actually works (monoclonals & fluvoxamine) are 2nd line And steroids, which increased mortality in people NOT on O2 in RECOVERY, are recommended?

.@YaleMed immunobiologist @VirusesImmunity leading research into long #COVID19. @FOX61Newsfox61.comYale researchers study long-term impacts even mild COVID can haveThe goal is to try to find out what's causing long COVID, which can affect multiple organ systems.

Wow. This is concerning. h/t @ForesightWisdom it is learning to become more chronic.Quote TweetFriedemann Weber@Friedemann1 · 22 JanTogether, our results indicate that Omicron has an increased capability to - suppress IFN production - evade the IFN antiviral state As IFNs belong to the innate immune system, this is a kind of immune evasion

"Eight countries achieved the 90–90–90 targets for testing, treatment access, and viral suppression of #HIV by the end of 2020; and a further 20 countries are close"-@DrTedros #EB150

"China and El Salvador were certified by WHO as #malaria-free last year, and the Islamic Republic of Iran recorded three consecutive years of zero indigenous cases"-@DrTedros #EB150 #EndMalaria

"On communicable diseases, 2021 was a historic year, with the WHO recommendation for widespread use of the world’s first #malaria vaccine, which could save tens of thousands of young lives each year"-@DrTedros #EB150Quote Tweet

"But despite the ravages of the #COVID19 pandemic, we are demonstrating that with the right strategies and the right tools, we can bring some of the world’s oldest infectious killers under control"-@DrTedros #EB150

"...and the proportion of people facing financial hardship due to out-of-pocket health spending has increased"-@DrTedros #EB150 #HealthForAllQuote TweetWorld Health Organization (WHO)@WHO · 24 Jan"The most recent WHO Global Monitoring Report on #HealthForAll shows that while service coverage has improved over the last 20 years, about half the ’s population still lacks access to essential health services..."-@DrTedros #EB150Show this thread

"The most recent WHO Global Monitoring Report on #HealthForAll shows that while service coverage has improved over the last 20 years, about half the ’s population still lacks access to essential health services..."-@DrTedros #EB150

"As a result of the #COVID19 pandemic, we could now be facing a shortfall of up to 840 million people, mostly in lower-income countries. More than 90% of countries continue to report disruptions to one or more essential health services"-@DrTedros #EB150 #HealthForAll

"Even before the pandemic, the world was off track for the “triple billion” targets. Now, we’re even further behind. That is particularly the case for our target to see 1 billion more people benefiting from universal health coverage [#HealthForAll]"-@DrTedros #EB150

"For that reason, the Secretariat is proposing a two-year extension of the GPW to 2025, to give us all a chance to get back on track, apply the lessons of the pandemic, intensify investments and accelerate progress"-@DrTedros #EB150

"The #COVID19 pandemic has been a severe disruption to health systems, economies and societies the world over, and to much of our shared work to advance towards the “triple billion” targets of the 13th General Programme of Work"-@DrTedros #EB150

"The challenges of supply we have faced in the past year are now being replaced by the challenge of rolling out vaccines as fast and far as possible. WHO and our partners are working with countries around the clock to overcome these challenges"-@DrTedros #EB150 #VaccinEquity

"But we 𝗰𝗮𝗻 bridge it, and we are making progress. Just a week ago, #COVAX delivered its 1 billionth dose. In the past 10 weeks, COVAX shipped more vaccines than in the previous 10 months combined"-@DrTedros #EB150 #VaccinEquityQuote TweetWorld Health Organization (WHO)@WHO · 15 Jan#COVAX just delivered its 1 billionth #COVID19 vaccine dose. We’re grateful to all our partners and donors for their support and contributions. However, the work is not done. We must ramp up #VaccinEquity efforts and vaccinate 70% of people in ALL countries by mid-2022.Show this thread

"85% of the population of Africa is yet to receive a single dose of vaccine. 𝗛𝗼𝘄 𝗰𝗮𝗻 𝘁𝗵𝗶𝘀 𝗯𝗲 𝗮𝗰𝗰𝗲𝗽𝘁𝗮𝗯𝗹𝗲 𝘁𝗼 𝗮𝗻𝘆 𝗼𝗳 𝘂𝘀? We simply can't end the emergency phase of the pandemic unless we bridge this gap"-@DrTedros #EB150 #VaccinEquity

"86 Member States across all regions have not been able to reach last year’s target of vaccinating 40% of their populations 34 Member States, most of them in @WHOAFRO and @WHOEMRO, have not been able to vaccinate 10% of their populations"-@DrTedros #EB150 #VaccinEquity

"Vaccines alone are not the golden ticket out of the #COVID19 pandemic. But there is no path out unless we achieve our shared target of vaccinating 70% of the population of every country by the middle of this year"-@DrTedros #EB150 #VaccinEquity

"We can only do this with engaged and empowered communities, sustained financing, a focus on equity, and research and innovation"-@DrTedros #EB150 #ACTogether

" It means learning critical lessons and defining new solutions now, not waiting until the pandemic is over"-@DrTedros #EB150

" It means restoring and sustaining essential health services"-@DrTedros #EB150 #ACTogether

" It means the ability to calibrate the use of public health and social measures when needed"-@DrTedros #EB150 #ACTogether

" It means boosting testing and sequencing rates globally to track the virus closely, and monitor the emergence of new variants"-@DrTedros #EB150 #ACTogether

" It means reducing mortality through strong clinical management, beginning with primary health care, and equitable access to diagnostics, oxygen and antivirals at the point of care"-@DrTedros #EB150 #ACTogetherQuote TweetWorld Health Organization (WHO)@WHO · 24 Jan"What does that look like? It means achieving our target to vaccinate 70% of the population of every country, with a focus on the most at-risk groups"-@DrTedros #EB150 #VaccinEquityShow this thread

"What does that look like? It means achieving our target to vaccinate 70% of the population of every country, with a focus on the most at-risk groups"-@DrTedros #EB150 #VaccinEquity

"If countries use all of these strategies and tools in a comprehensive way, we can end the acute phase of the pandemic this year – we can end #COVID19 as a global health emergency, and we can do it this year"-@DrTedros #EB150

"It’s difficult, and there are no easy answers, but WHO continues to work nationally, regionally and globally to provide the evidence, the strategies, the tools and the technical and operational support countries need"-@DrTedros #EB150 #COVID19Quote TweetWorld Health Organization (WHO)@WHO · 24 Jan"Each country is in a unique situation, and must chart its way out of the acute phase of the #COVID19 pandemic with a careful, stepwise approach"-@DrTedros #EB150 https://twitter.com/WHO/status/1485556211323965440?s=20…Show this thread

"Each country is in a unique situation, and must chart its way out of the acute phase of the #COVID19 pandemic with a careful, stepwise approach"-@DrTedros #EB150Quote TweetWorld Health Organization (WHO)@WHO · 24 Jan"We recognize that: -everyone is tired of this pandemic -people are tired of restrictions on their movement, & other freedoms -economies & businesses are hurting -many govts are walking a tightrope, attempting to balance what is effective with what is acceptable"-@DrTedrosShow this thread

"We recognize that: -everyone is tired of this pandemic -people are tired of restrictions on their movement, & other freedoms -economies & businesses are hurting -many govts are walking a tightrope, attempting to balance what is effective with what is acceptable"-@DrTedros

"On the contrary, globally the conditions are ideal for more variants to emerge. To change the course of the #COVID19 pandemic, we must change the conditions that are driving it"-@DrTedros #EB150Quote TweetWorld Health Organization (WHO)@WHO · 24 Jan"There're different scenarios for how the #COVID19 pandemic could play out, & how the acute phase could end – 𝗯𝘂𝘁 𝗶𝘁 𝗶𝘀 𝗱𝗮𝗻𝗴𝗲𝗿𝗼𝘂𝘀 𝘁𝗼 𝗮𝘀𝘀𝘂𝗺𝗲 𝘁𝗵𝗮𝘁 𝗢𝗺𝗶𝗰𝗿𝗼𝗻 𝘄𝗶𝗹𝗹 𝗯𝗲 𝘁𝗵𝗲 𝗹𝗮𝘀𝘁 𝘃𝗮𝗿𝗶𝗮𝗻𝘁, or that we're in the endgame"-@DrTedros #EB150Show this thread

"There're different scenarios for how the #COVID19 pandemic could play out, & how the acute phase could end – 𝗯𝘂𝘁 𝗶𝘁 𝗶𝘀 𝗱𝗮𝗻𝗴𝗲𝗿𝗼𝘂𝘀 𝘁𝗼 𝗮𝘀𝘀𝘂𝗺𝗲 𝘁𝗵𝗮𝘁 𝗢𝗺𝗶𝗰𝗿𝗼𝗻 𝘄𝗶𝗹𝗹 𝗯𝗲 𝘁𝗵𝗲 𝗹𝗮𝘀𝘁 𝘃𝗮𝗿𝗶𝗮𝗻𝘁, or that we're in the endgame"-@DrTedros #EB150

"It can't mean that we: -accept almost 50,000 deaths a week, from a preventable & treatable disease -accept an unacceptable burden on our health systems -ignore the consequences of long #COVID19 -gamble on a virus whose evolution we cannot control, nor predict"-@DrTedros #EB150

"...which will provide a platform for preparedness for future pandemics. But learning to live with #COVID19 cannot mean that we give this virus a free ride"-@DrTedros #EB150Quote TweetWorld Health Organization (WHO)@WHO · 24 Jan"So where do we stand? Where are we headed? And when will it end? It’s true that we will be living with #COVID19 for the foreseeable future & that we will need to learn to manage it through a sustained & integrated system for acute respiratory diseases..."-@DrTedros #EB150Show this thread

"So where do we stand? Where are we headed? And when will it end? It’s true that we will be living with #COVID19 for the foreseeable future & that we will need to learn to manage it through a sustained & integrated system for acute respiratory diseases..."-@DrTedros #EB150

"The explosion in #COVID19 cases has not been matched by a surge in deaths, although deaths are increasing in all regions, especially in Africa, the region with the least access to vaccines"-@DrTedros #EB150Quote TweetWorld Health Organization (WHO)@WHO · 24 Jan"Since Omicron was first identified just 9 weeks ago, more than 80 million #COVID19 cases have been reported to WHO - more than were reported in the whole of 2020"-@DrTedros #EB150 https://twitter.com/WHO/status/1485553292683972609?s=20…Show this thread

"Since Omicron was first identified just 9 weeks ago, more than 80 million #COVID19 cases have been reported to WHO - more than were reported in the whole of 2020"-@DrTedros #EB150Quote TweetWorld Health Organization (WHO)@WHO · 24 Jan"On average last week, 𝟭𝟬𝟬 𝗰𝗮𝘀𝗲𝘀 𝘄𝗲𝗿𝗲 𝗿𝗲𝗽𝗼𝗿𝘁𝗲𝗱 𝗲𝘃𝗲𝗿𝘆 𝟯 𝘀𝗲𝗰𝗼𝗻𝗱𝘀, 𝗮𝗻𝗱 𝘀𝗼𝗺𝗲𝗯𝗼𝗱𝘆 𝗹𝗼𝘀𝘁 𝘁𝗵𝗲𝗶𝗿 𝗹𝗶𝗳𝗲 𝘁𝗼 #𝗖𝗢𝗩𝗜𝗗𝟭𝟵 𝗲𝘃𝗲𝗿𝘆 𝟭𝟮 𝘀𝗲𝗰𝗼𝗻𝗱𝘀"-@DrTedros #EB150Show this thread

"On average last week, 𝟭𝟬𝟬 𝗰𝗮𝘀𝗲𝘀 𝘄𝗲𝗿𝗲 𝗿𝗲𝗽𝗼𝗿𝘁𝗲𝗱 𝗲𝘃𝗲𝗿𝘆 𝟯 𝘀𝗲𝗰𝗼𝗻𝗱𝘀, 𝗮𝗻𝗱 𝘀𝗼𝗺𝗲𝗯𝗼𝗱𝘆 𝗹𝗼𝘀𝘁 𝘁𝗵𝗲𝗶𝗿 𝗹𝗶𝗳𝗲 𝘁𝗼 #𝗖𝗢𝗩𝗜𝗗𝟭𝟵 𝗲𝘃𝗲𝗿𝘆 𝟭𝟮 𝘀𝗲𝗰𝗼𝗻𝗱𝘀"-@DrTedros #EB150

"At the time, there were fewer than 100 #COVID19 cases and no deaths reported outside China. Two years later, almost 350 million cases have been reported, and more than 5.5 million deaths – and we know these numbers are an underestimate"-@DrTedros #EB150Quote TweetWorld Health Organization (WHO)@WHO · 24 Jan"This Sunday marks two years since I declared a public health emergency of international concern – the highest level of alarm under international law – over the spread of #COVID19"-@DrTedros #EB150 https://twitter.com/WHO/status/1222968733829865477?s=20…Show this thread

"This Sunday marks two years since I declared a public health emergency of international concern – the highest level of alarm under international law – over the spread of #COVID19"-@DrTedros #EB150Quote TweetWorld Health Organization (WHO)@WHO · 30 Jan 2020BREAKING "For all of these reasons, I am declaring a public health emergency of international concern over the global outbreak of #2019nCoV."-@DrTedrosShow this thread

"Dr Yutaro Setoya, is playing a crucial role in channelling communication between @UN agencies, humanitarian partners & the government, incl. through the use of WHO’s satellite phone, which was one of the few ways to get information in & out of "-@DrTedros #EB150

"A national Emergency Medical Team, trained by WHO, was deployed almost immediately following the eruption, and we are supporting them with medical items, first aid kits, tents, portable toilets, and water filtration equipment"-@DrTedros #EB150 #Tonga https://bit.ly/33lrk6J

"As we speak, WHO is working with our partners to support the response, providing medical expertise and supplies"-@DrTedros #EB150 #Tonga

"As the Chair said, we send our deepest condolences and concern, our warmest greetings and our best wishes to our sisters and brothers in #Tonga, who are facing difficult days as they respond to last week’s volcanic eruption and tsunami"-@DrTedros #EB150

LIVE with @DrTedros: Opening of the 150th session of the WHO Executive Board #EB1502:46:53118.1K viewersWorld Health Organization (WHO)@WHOLIVE with @DrTedros: Opening of the 150th session of the WHO Executive Board #EB150

I do think that if we had systematically kept score the quality of the "advice" dispensed on Twitter would have been much betterQuote TweetDan Kelly@dankellyvo · 24 JanReplying to @dgurdasani1 and @wanderer_jasnahWe need so much more of this revisiting old tweets to see who was arrogantly so sure they were right - only to be 100% wrong. We should then make a rating system and see who gets a zero! (Or lots of low scores)

"SPI-M-O currently estimates that a combination of behavioural change...and mitigations (e.g. testing, self-isolation) are currently reducing transmission by 20–45%"

Very disappointing non-answer from the Health Secretary to my question why the U.K. has the highest #Covid19 infection, hospitalisation & death rates in Western Europe.

11) Careful data analysis, and a deep appreciation of local knowledge and specificities, coupled with global action (as argued with @GYamey and @BillHanage last week: https://time.com/6128506/omicron-covid-19-how-to-fight/…) may yet get us through this.

11) Until we have a better sense of the issues raised here (esp in #9), premature celebration is uncalled for outside of SA; and in SA, perhaps we should spare a thought for the families of 250 000 of our fellow citizens whose loved ones will not be joining them for Christmas.

10) No, I do not have the answers. Yes, I am deeply grateful by what we are seeing here. But, I am appalled by how the South African Experience (TM) is being used to weaponise against unfolding events in other countries ("don't intervene, it's a nothingburger" says my bete noire)

9) SO. WHAT IF ... South Africa's 'light escape' (in the context of a QUARTER OF A MILLION excess natural deaths) is _in no small measure because_ we 'bought' that present at horrendous cost during past waves.

8) But the UK had begun to vaccinate extensively by then. Our programme only got going in July, by which time Delta was on us.

7) I am struck by this comparison from OWID. Their SA data are ours (but all-cause not natural-only). And we can see towards of the beta wave, excess deaths in the two countries were of a kind.