1. LONG THREAD (25+ tweets sorry) of my somewhat depairing musings on Covid.

Where we are, how we got here, why I'm sad about it.

2. So I downloaded latest Sanger data on variants for England today after 2 weeks away.

Delta (B.1.617.2) is now at well over 90% of all sequence cases in Englandand Alpha (B.1.1.7, prev "Kent") is dying out.

photo

3. Dominant in every region - some took longer to get there but all are at or over 90% now.

photo

4. And it made me think about the last few months, and the next variant.

Back in April I wrote a long thread about variants and highlighted B.1.617's (as it was then) rapid rise - from 0.2% to 1% of all cases.


5. I argued that while we didn't have definitive proof that it was more transmissible or more vax resistant than Alpha variant there was reason to be worried from situation and early evidence in India.

photo

6. *and* I said that because we sequence much more than India (and most other countries) the first definitive evidence of either would probably come from the UK - but almost certainly after it was too late to contain it.


7. I said it was doubling every week and that - although very early days - it could be dominant by the end of June. In fact, the doubling rate was saying mid May but even I didn't believe it and so pushed it back to June in my tweet.


8. In fact, cross over to Delta becoming dominant in England *was* in mid May.

photo

9. I then laid out three possible scenarios for Delta compared to Alpha:

1) that it was more transmissible than Alpha
2) that it was more transmissible and more vax resistant
3) that it was more transmissible and a LOT more vax resistant

photo

10. I said that the 3rd scenario was the least likely, but had v serious consequences. All the scenarios were worse than keeping Alpha as our dominant variant - the devil we knew.

We are in scenario 2. Our vax programme has sped up which has helped but not enough to stop a wave

11. I urged the UK to add India to the red list (tweet 17), to cancel the PM trip to Delhi and to stamp down on Delta instead of waiting for proof.

India did go on red list 23rd April, Delhi trip was cancelled but few measures were taken domestically to stop its growth.

photo

12 Public Health England first had high confidence in Delta being "at least as transmissible" as Alpha in 13 May risk assessment.

By 3 June PHE had high confidence that it was lot more transmissible than Alpha *and* had more vax escape.

Tho v quick, solid proof took *6 wks*

13. I basically then did at least a thread a week since April all along the lines of "guys, it's still doubling we should be doing something". e.g. here is one from mid-May where latest data (always 1-2 weeks behind) showed it was 30% of cases in England.


14. People were still coming up with possible reasons why it wasn't that bad. The govt tried to blame vax hesitancy.

Me & others were accused of being alarmist, of not understanding the data complexities, of talking down vaccines.

We argued for precautionary principle.

photo

15. Me and others (esp @dgurdasani1 ) also highlighted the need to make schools safer - cases were highest in school age children (unsurprisingly when you have large unvaxxed populations mixing every day!).


16. We were told we were being anti education, alarmist, misunderstanding the data.

Recent REACT study showed large growth in school-age kids.
You keep kids in school best by stopping covid spreading in their communities and by making schools safer.


17. In mid May, overall cases were flat, hospitalisations declining, deaths very low.

SAGE Spi-M's models published 13 May showing how bad a more transmissible or more vax resistant variant could be were ignored.

"everything is fine" people said. Step 3 of roadmap went ahead.

18. But cases were flat because the decline in Alpha was offsetting the increase in Delta. Once Delta became dominant, cases started going up. Then hospitalisations.

By end of May, Govt still saying "no need to delay roadmap" - I thought this was crazy.


19. They did delay it by 4 weeks in the end (right decision). They've accelerated vax roll out (right decision).

We're now told that the NHS won't be "overwhelmed" this summer - that it won't get to Jan '21 or April '20 peak so all good, no need to worry.

I disagree so much.

20. We have been lucky that vaccines work against Delta sufficiently to be effective against severe disease - avoiding worst case scenarios.

But NHS is already overloaded - we should be avoiding extra burden. Even a third Apr 2020 peak is still bad!


21. Many people who have been hospitalised with Covid struggle for months with ongoing problems - even younger adults.

We should be avoiding covid hospitalisation to protect people as well as the NHS!

https://jamanetwork.com/journals/jama/fullarticle/2777784

https://jamanetwork.com/journals/jama/fullarticle/2768351

https://jamanetwork.com/journals/jama/fullarticle/2774380

22. Plus we know that Covid can cause long term symptoms in many who aren't hospitalised - inc 5-10% of children & 10-20% of young adults.

There is increasing evidence that Covid can cause memory / cognitive issues ("brain fog" and fatigue).


23. And every case is a new opportunity for further mutation - both here & abroad (e.g. recent new Lambda variant in S America).

How many chances do we want to give covid to overcome our vaccines? They *are* the way out - we should be protecting them!

https://www.news18.com/news/lifestyle/heres-everything-you-need-to-know-about-lambda-the-new-covid-19-variant-found-in-29-countries-3862820.html

24. So no, I think it's wrong and irresponsible of the govt and others to be fine with thousands - potentially soon tens of thousands - of new cases a day here just because we likely won't bring the NHS to near collapse again.

25. We should be trying to get cases *down* by supporting & protecting vax program by adding public health measures like supported isolation, support for ventilation, masks in schools, better communication.

AND tightening border measures to prevent importation of new variants.

26. I can't quite believe that govt is not doing any of this. That many people have given up even asking for these measures.

I know it's frustrating & exhausting to keep asking for the same basic proven measures and being ignored.

But they're still the right thing to do.

27. Israel - a highly vaxxed country with hardly any covid - supported its vax roll out with many public health measures.

A recent outbreak of Delta variant in two schools has triggered public health action and consideration of reinstating mask wearing.


28. And what I really really want is that the *next* time we see a variant doubling every week - outcompeting the dominant strain (now Delta) - that we take it seriously.

That we learn from other countries (if it's emerged their first).

29. These 2 months has felt like an exemplary cateloguing of Delta's victory by PHE, COG, Sanger etc.
When early doubling times are only a week, we can't wait for solid proof.
For the *next* variant, we need to *do* something when it's less than 5% of all cases. /END