Thread by @GongGasGirl, Now @peripatetical : epidemiology and the global response to the covid19 response. [...]

Now @peripatetical : epidemiology and the global response to the covid19 response. He's live on stage in Melbourne.

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Pros and cons for Australia’s response.
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Public health governance in Australia is quite fragmented. No CDC for starters. #ASM21MEL

Notes PH measures initially successful (travel bans for eg). Then Victorian outbreak. Hotspots in 6 areas in Melb; led to mobile clinics, door knocking, pop up clinics etc.

Stamford Hotel, Rydges, Cedar Meats.

20,000 cases in Vic, 800 deaths by end of Sept.

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Early lessons: importance of community engagement ( @peripatetical is 1st gen Chinese - not the same as new student from China - everyone needs different engagement). Important to avoid stigma. Localised response.

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Lesson 2. Rapid response required for vulnerable settings. Residential aged care not set up for it. Who is taking out the waste? Who has ordered PPE? All very difficult to organise with no time.
Meat processing, cold storage - cleaning fluids freeze in freezer.
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lesson 3. Social determinants of health.
Not isolating - can't, won't, don't know (essential industries poorly protected, aged care workers)
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Lesson 4. PH interventions need to be fast
control is possible but every day matters
balance of speed, and not over-reacting difficult

(reminds me of Mike Ryan - speed trumps perfection)

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Lesson 5. Scaling responses and workforce is difficult.

Surge workforce - ID physicians, IPC nurses, contact tracers

Hard to think in exponential frame of reference - anchoring bias, how do you double capacity?

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COVID-19 Vaccine strategy covered whole process.
Two main groups ATAGI and Science and Industry Technical Advisory Group.

Early on, plan was to invest in vacc's which fell into diff categories - inactivated/attenuated, protein subunit, viral vector (AZ), MRA(Pfizer)

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Thrombosis with thrombocytopenia syndrome

Rare but serious 25% die

Uncertain and changing risk estimate: UK 209 in 22 mill first doses, 1 from 4.4 mill second doses

Au: 6 in a million doses

Respect patient autonomy. But hard to counsel on risk.

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Thrombosis in usual sites (central venous sinuses, splanchnic circulation)
Onset 4 - 20 days following AZ vaccine.
PF4 antibodies detectable by ELISA

Message: CALL THE HAEMATOLOGIST.

Don't give heparin or platelets.

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Data hot off the press.
Weighing risks vs benefits of covid19 vaccination.
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Benefits quickly outweighs risks during second wave. #ASM21MEL

Where we are going with the Australian response.

May well move in future to managed transmission. Many elements uncertain eg efficacy of vaccine.
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Thank you @peripatetical .

This time last year, I was petrified that we would be swamped with covid like our colleagues overseas. I cried with relief when our experts shut the border. Our public health leaders have had to make v hard decisions. Kudos to their bravery.

Thank you @peripatetical

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Talk will cover:

Pandemic NY Style
Impact on @BJAJournals
Impact on scientific publishing (balance of quality and immediacy, rise of the pre-print).

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NY became epicentre. In retrospect should have moved faster. Travel restricted March 8. WHO pandemic declared March 11.

Issues: PPE availability. Limited testing. OR safety. Donning/doffing. Redeployment of staff. New teams formed. Intubation and line teams.

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This was the Cover of the @BJAJournals. Remembering those healthcare workers who died caring for covid19 patients. https://twitter.com/BJAJournals/status/1313343607194243072?s=20

https://twitter.com/BJAJournals/status/1313343607194243072?s=20

Anaesthetists in NY worked 14 hour days 7 days a week for 3 months.

Daily zoom meetings.

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Covid surge:
90% of operations cancelled.
ICU staff arrived from across the country.
Philanthropic support: food, childcare, housing for healthcare workers
7 pm clap from public @HughHemmings walked home to the clap each day, says doesn't miss it

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Plunge in elective surgical cases - 70% reduction across March /April 2019

Secondary pandemic: burnout, stress, anxiety, PTSD, pandemic fatigue, financial crisis, civil unrest. Reliving nightmare as pandemic spreads to the heartland, fear of second wave.

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Now onto impact on @BJAJournals .
Large increase in submissions, esp correspondence.

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Will the pandemic permanently alter scientific publishing.

Are pre-prints here to stay?

They have:

Minimal to no fees.
Anyone can see.
Rapid

(Hmmmmm .... sounds like Twitter to me .... my tweeties are great at peer review ... )

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'Social media discussions such as Twitter provide a valuable service for critical appraisal of peer-review literature and preprints alike, also help with faster dissemination during times of crisis such as the pandemic.'

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Pre-print embraced by @BJAJournals. @HughHemmings believes pre-publication is here to stay.
Has risk - some covid19 papers retracted.
However, open review found flaws, so system working.

(45; 30% as preprints Cortegiana - Retracted papers on sarscov2 and covid1)

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