Once people finish with how they ask what's next?

When will social distancing end?
When will there be a vaccine?
When will things be normal?

There ARE simple answers.
But we're in this mess because political people gave too many simple answers

And dodged the hard ones. Detail

1/39
Intro
1. Me: Virology background
2. Not much science on this virus
3. Added fewer sources than usual - it's future looking
4. All (dates) highly speculative.

By the end, you'll be able to explain this defaced chart. I hope you'll agree we must make better decisions

2/39
Before reading this, you might want to scan http://bit.ly/covidfiasco . It's 70 tweets so I'll forgive you if you don't, but it's the background on the #Herdimmunity fiasco which is relevant here.

Immunity and Vaccines are often related. That's why we made a fuss.

3/39

OK to explain all this I'll cover

Some history
Some basic definitions (what is a BAD virus)
What can and cannot be vaccinated against
What that means for #covid19
And what that means for getting back to "normal".

Sound good?

4/39

History

If you're under 30 in the west, you've never seen uncontrolled viruses.

Under 5/60 only a few HIV (before 3combo), Hepatitis B/C, Mumps, Measles

You have to be in your 80s to know Polio

No one alive remembers diphtheria, tetanus, pertussis, smallpox etc.

5/39

Some say Modern Dentistry has relieved more human suffering than anything else.

Modern virology has to be at least competing for a medal.

But the truth is I cheated above. You have seen uncontrolled viruses, just not bad ones.

Common cold
Influenza

6/39

"Bad" = contagion and/or outcome.
e.g.

The common cold (not 1 but 000s of viruses) is very contagious but for very few are the outcomes serious

Hepatitis C had a severe outcome, but outside some endemic communities or less common behaviours, is hard to get.

7/39

Maybe you're still not thinking a cold is bad. And fair enough, but if I replaced it with Measles or Ebola you might ready differently

Those are two ends of a spectrum. Measles is the most contagious virus we know. Ebola is one of the least. Either uncontrolled is bad

8/39
And yes, dear reader, you did guess where I was going. #Covid19 is not "good" on either scale

On contagion we don't quite know where it is yet, but we think about mid-table

On outcome, how inclined would you be to drive if 1/50 trips you died?

https://en.m.wikipedia.org/wiki/Basic_reproduction_number

9/39

There's another factor though. People roughly in their mid 40s and older in the UK never got a measles vaccine, they got measles and now are all immune.

So has it occurred to you why that's true yet you've had a cold or the flu many times and you aren't immune?

10/39

Viruses are no more similar than prostate cancer and pancreatic cancer. It's a mistake to think they're the same.

Sometimes your body doesn't react to the virus (HIV), or it changes a lot (flu) or has many versions (cold). You may not be able to become immune

11/39…
Covid19 isn't the hardest virus for the body to beat (98% do win) and you see detection - big body reaction (temperature, etc.).

The problem is it's a virus that quickly changes, becoming slightly different versions or maybe two or more versions at the same time.

12/39
And the body can't cope with that, it's just not easy for it to fight changing viruses. We know that because while some people know that the common cold is often a rhinovirus it can also be...a coronavirus. You've almost certainly beaten one before. Just not this one.

13/39
Simplified if your body sees a coronavirus, even if it's the "same" one, it's started to shift. That often means immunity is very short. That's likely for @covid19 tho ofc still uncertain.

You now see why we raised our hands in horror at the UKGOV #herdimmunity plan

14/39
Speeding a virus up to infect everyone is already sociopathic, give the death rate worsens if you break the NHS.

But it's genocidal if in so doing the population you think is gaining immunity gains little or no immunity at all.

Schoolboy error. The cancer mistake.

15/39
That error WAS on course to kill 500K people (imperial) IF the NHS lasted (it would break ~ 1.2-1.7m dead). Thank goodness they've now switched to a traditional way to fight a virus you can't treat.*

An approach called suppression

*we think. "Waves" still unsettles

16/39
So am I causing trouble for a Government I consider to be so negligent as to stumble into a genocide? Therefore, should resign, so it never makes another #covid19 decision?

The suppression point is essential to understand regardless. Their trouble is all of ours.

17/39

Supression is a strategy of last resort, it's also the only way the Government begins to recover 2 months of no prep or active sabotage of containment.

It's what you do to an outbreak you think you can't control (mitigate) or let "run slowly"

Economic damage is bad.

18/39

IMHO there was no way to avoid this. But they made it worse and sooner.

The economic consequence was never worth millions dead.

They will eventually need a save economy defence. Remember this.

You know one more thing.
They don't think there's a vaccine coming soon.

19/39

For me, that isn't a conspiracy it's a sigh of relief that human life is at last prioritised, albeit by muppets who almost killed millions by accident/arrogance

But you want to know why no vaccination?

The too-simple answer is we use immunity to make vaccines.

20/39

Even for me that's a simplification too far.

Immunity mostly doesn't mean the virus can't enter. It is just immediately defeated.

Vaccination is training your body to fight something safely, so when it fights it for real; it's as good as the immune guy is.

21/39
So now you know that immunity and vaccination often come as a pair, can't do one, other is hard. That's the reason HIV had no vaccine btw. Albeit you don't detect it, so can't be trained to fight it

Coronaviruses. We have never created a human vaccine.

Won't be easy.

22/39

This is our third bad coronavirus in recent years (SARS, MERS) and from work done on those we know none of the 8ish vaccine methods we have work.

There's hope for Nucleic Acid Vaccines (specifically DNA plasmid vaccines) and I spelled that out as its a good read.

23/39
AND it's a completely new way of thinking about vaccines. Think of recognising a submarine not with sonar but by examining the torpedoes.

Unfortunately we don't have a single vaccine yet that has passed human trials with this method.

24/39

What we need is global cooperation, a mass effort - humanity alliance, like we were seeking a new science defence against an alien invader (are we not?)

And while we have a bit of that, we have a lot more competition not sharing and hoping to profit...

25/39

These things are above my pay grade to debate (though Gordon Brown said something wise today that unfortunately needs a different US President and UK Government).

This all adds up to make solutions further away

A miracle can happen, just don't bet the species on one

26/39
Congrats 1/4 of chart complete.

A miracle A long term stable vaccine solution.

Once enough get a shot, life returns to what I call Old normal.

No dates - IMHO too hopeful.
Only if some world leaders succumb or resign.

27/39

That isn't death wishing. I wish them recovery. It's realism. Trump and Johnson should have resigned already on death count. But today's politics has no honour.

We need a global effort, pharma and academia collaborating on a break even cure.

That needs honour.

28/39

The other option is the final viral backstop (I knew it was wrong to demonise that word - we now have to persuade 50% to like it).

You have heard a lot about testing. Right now that's efficiency testing, efficiency of diagnosis.

China Data:

29/39

NHS doctors are more mad about our incompetent Government than I am (opinion, no data, but I'm guessing not hard to prove). And that chart was why

As the Chinese became more experienced fewer died, because they tested more. Early diagnosis for life

Including medics.

30/39
There were plenty of reasons to order tests already. But this forced orders.
To not do so after this data was more incompetence or sociopathy.

BTW willingly not participating in EU viral research sharing they give to all neighbours?

Not Brexit. Evil ideology

31/39

UKGov
refuses help twice,
ventilators, viral data
When offered freely, no strings

What other word but Evil

They refused and medics, nurses, hospital staff and you or your relatives will die because our first test orders were made March 16th! http://bit.ly/evilgov 

32/39

But while tests are the front stop of survival, as I hinted they are also the backstop for our society.

Think not the few million test kits. But 66 million or 660 million.

The only way if nothing else works to move out of this is careful controlled testing.

33/39
2nd solution
TEST WORLD
You get up in the morning.
UKGov thermometer checks your temperature. If it's slightly elevated a pin prick test checks. If you're exposed you are quarantined on pain of - something very nasty.
All reported on an app.

A "New" Normal

34/39
If that sounds like Blade runner nonsense, it's basically South Korea, today.

It won't be perfect, occasionally we may need to be locked down, though more limited, if for example a viral "runner" infects people all around a neighbourhood.

(still worried "waves")

35/39
Find a way to like it. It's most likely that until a vaccine this will be life.

It's better than a regular cull of 1.2million.

And upside - solve one, solve other diseases - quality of life...

Or better at risk monitoring.

Just don't give the data to Cummings.

35a/39
If #Covid19 gets me, don't let some smiley persuasive front man tell you that complete compliance wjth lock down will wipe it out.

Humans are never 100% efficient.
Income inequality.
Comms failure
Variable incubation

They're planning something.
Esp if Raaaab is PM

36/39
PIECE 3 -Testing Midstop

Between either testing backstop or vaccine solution you have to start getting people out of homes

That's this. The dates are about the soonest it could be vs the latest it might be from Imperial data.

Very sketchy dates. Too little data.

37/39

Part 4 Where we are now.

Soon to be testing front stop in NHS.

I can promise you, the tests used on all the cabinet would save more lives used on the NHS.

They'll reduce lives used on those negligent egits.

Btw Longer in social distancing means it is working.

38/39
That's it

Testing FrontStop
Apr-Sep

Testing MidStop
STARTS Jul-oct
(ends? No way to even guess)

Then 2 long term solutions

Old Normal
Vaccine when it comes. Miracles happen if that's 18 mos

New Normal
Mass coordinated testing and temp
Occasional local lockdowns

39/39
Please explain caveats.
Please reflect on a Government that could have killed millions.

I don't care why. Every day another decision. Viral data. Ventilators

Bad decision makers running this?
Brexit politics over lives?

We need DETAIL, not ideologues.
Or a liar.

LOOKING


FORWARD