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There a lot of scientists in reflective mood as we face up the prospect of an autumn second wave of SARS CoV2 and what it may or may not mean, and in particular whether we can or even should contemplate further lockdowns. So I’ll add my twopenneth’ 1/n
At the beginning we didn’t heed the warnings from China and Italy until it was too late and we ended up playing catch up with a rapidly spreading virus that we didn’t understand. 2/n
The ability to test samples and act on that knowledge was rapidly outstripped by resources and the govt were woefully slow to alleviate bottlenecks in testing, diagnostics and PPE, all of which had been highlighted when wargaming a pandemic 2 years earlier. 3/n
ICUs filled up, not just with the old and infirm, but with middle aged (and younger) with chronic, but not terminal, conditions, many of whom died horrible deaths. 4/n
Academic scientists up and down the country volunteered, cajoled, begged the DoH and PHE to be allowed to help. And while understandably there were concerns about quality and regulation, a very large talent pool went unused for a long time. 5/n
And then we locked down in late March – too late in retrospect. I was personally very wary of lockdown for exactly the reasons we all know. I was particularly worried that the of strategy about how we were going to get out of it wasn’t clear. 6/n
But at the point I think we had no choice. The Health Service would simply have fallen over and had to be protected. 7/n
But, and this is absolutely key, by then we knew that most people who get SARS CoV2 only have a self-limiting respiratory illness, and some (proportion still debated) have no discernible symptoms at all. 8/n
If, as we had to assume, everyone was susceptible to infection, the small percentage of people who get very sick was still going to be a very big number, and certainly bigger than can be coped with by an overstretched health service in the autumn and winter months. 9/n
Eventually Matt Hancock set out his tests for lifting lockdown. And they essentially boiled down to being able to test, trace and isolate infected people. Great fanfare was being made about the number of tests, but what really mattered was deploying them right. 10/n
The govt set up the Lighthouse labs, staffed by volunteers and run by people who really know what they’re doing. But the problem is the highly centralized nature of them and their reliance on private logistics firms, making them very big ships. 11/n
That’s ok if you have more agile little ships to manoeuvre, as Paul Nurse put it. We didn’t really for a very long time. 12/n
And of course the IT and tracing has been an absolute disaster, compounded by putting someone so unqualified in charge (Dido Harding) as to be beyond satire. 13/n
So by the time that the economic and social cost of lockdown began to bite, and growing clamour to exit, with Cummings being the final nail, bounced us out. 14/n
Summer was always going to be a phony war. Many respiratory viral infections don’t transmit that well. And SAGE told the Govt and Harding repeatedly that preparation for autumn and winter needed to be sorted by Sept. 15/n
Going back to work, schools and college were obviously going to lead to a re-emergence of the virus. It was also going to be (at least to start with) in a younger demographic so the pathogenesis will be lower. 16/n
So where are we: IMO we have to be able to manage the transmission of infection in the population without further blanket lockdowns, I just can’t see how one could do it again both economically and socially. Kids need to be at school, people need to be able to work. 17/n
But we need to understand where the virus is so that we can protect the vulnerable, and need to retain some necessary (if uncomfortable) restrictions on our day-to-day lives that together will take the edge off transmission. And this is where we are failing. 18/n
We didn’t use the time well enough to put in the TTI systems properly over the late Spring/Summer, or deploy more targeted community monitoring in a way that would steal a march on the virus. 19/n
Another thing we really need to understand much better, and build into the strategy, is the relative risk of transmission by asymptomatic individuals. And even more importantly, the level of positive signal in a test that correlates with infectious virus. 20/n
This latter point is crucial. It isn’t ‘false positives’ that are the issue really, it is people who have been infected and cleared the virus remaining RNA positive for some weeks afterwards. 21/n
We have known this for a while, and it is much harder to do. But if we don’t, we will be closing schools a lot based on positive PCRs. And the public will put up with a lot but messing around with their kids’ education will be the killer. 22/n
So, we are coming into autumn. Covid is coming back, it’s probably here to stay as a new seasonal coronavirus (I’m not convinced Covid Zero is realistic, sorry). We don’t know how it will behave when other respiratory viruses start coming out. 23/n
Testing, testing, testing is still key, but it is how we test, who we test and what we do with the information that is really important. Despite the hard work of so many on this, we have been so brutally let down by the government that it almost feels like square 1. 24/n
So we can’t lockdown again, but we don’t yet have the strategy and the tools to protect the vulnerable and keep life going on as normal(ish). That’s what scares me about winter. 25/n
Long thread, but one last plea to everyone: Wear your bloody masks, maintain the social distancing, support the NHS and the people trying to sort this out, and get a Flu vaccine 26/n
(oh, and if you care about this country, irrespective of your party allegiance, never vote for someone like Boris again)
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