BC SOCIETY
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Thread on the recent report on the possible risk of increased death associated with the new UK variant (B117)- with a discussion of the evidence around this, and what this means.

 First, there is strong evidence to support increased transmissibility of B117 - current estimates of increased transmissibility range between 30-70% - from epidemiological evidence examining the differential rate of growth of B117 with respect to other variants & increase in R
There is also evidence from PHE contact studies that the risk of transmission from those carrying the B117 variant is ~50% greater than with other non-B117 variants.
Increased transmissibility, even if a variant has the same fatality rate can increase deaths substantially, because the rate of growth of cases is higher- & more cases means more deaths.

Increased fatality rates also increase deaths- but do so linearly.

https://t.co/nqV3udZByu
So how was risk of death with the variant studied?
We don't routinely sequence all samples for the virus. We've found that the variant has a particular deletion which means that some PCR tests on samples with the variant give a different read-out when the variant is present.
They show something called 'spike dropout'. This is because a gene in the virus that's targeted by the PCR is changed by the mutation, so the PCR can't pick up this particular part of the virus. But the PCR test targets multiple parts of the virus, so we still get a +ve test.
Not all commercial PCR tests are able to detect this, as only some PCRs target this part of the virus showing 'spike dropout' when this key mutation is present. PHE data show that spike dropout is a good proxy for the B117 variant, when the frequency of the variant is high.
Given this limitation, we can only study deaths among those who have been tested with a specific PCR test that is able to identify spike dropout. Only 8% of deaths had these data available (Only 1/3rd of tests carried out through pillar 2 have these data), so these were studied.
The analysis carried out in a number of different ways mainly compare 28 day deaths among people whose samples showed spike dropout to those whose samples didn't (tested with tests that could identify dropout).
Given the different transmissiblity of B117, it is possible that differences in deaths may be down to people infected by B117 being different in some way - e.g age, socio-economic status, living in an area where critical care capacity was under pressure.
To try and reduce the impact of these factors, comparisons were matched for age, gender, deprivation scores, time of testing & location.

Different analyses carried out with the data in slightly different ways suggested a ~1.3x increase in risk of death.
Could this increase be attributed to pressure on the NHS during the past month?
Unlikely. The people with the B117 variant were matched to controls by age, specimen data, and location - so they would've been compared with people infected at the same time, in the same area.
They also did additional analyses to adjust further for NHS pressure - by including ventilation capacity, occupancy, and staff sickness factors. These did not change the result, suggesting that the increase is not down to differences in NHS pressure.
Could there be other reasons we see this?
Possibly. A theoretical reason is that people who are infected with the new more transmissible variant are different in some other way- that makes them more likely to die anyway were they infected with any variant.
E.g. if the variant was more likely to result in clusters of infection in care homes rather than the community, just adjusting for age may not account for the relatively greater frailty of a person in a care home vs someone in the community of the same age.
This is unlikely to explain the findings, given we see a uniform increase in risk of fatality across all age groups. So if there is an alternative explanation, it would need to apply to all age groups.
This is possible but would mean transmission dynamics of the strain consistently lead to more infection in people in groups who are *already* at greater risk. In this case the variant wouldn't *cause* the increase in deaths, but would be infected those already at higher risk.
E.g. if the variant was more likely to infect deprived population. But the models have adjusted for many factors that could explain this - including deprivation. So we can't rule out this possibility completely, but the modelling has tried to account for this.
What does this mean?
To me, this highlights the gambles we take when we follow an approach which allows high levels of transmission to continue in the community for long periods of time. The UK govt has consistently minimised the risk posed by COVID-19, which is why we're here.
What's worse is that we now also have the variant from South Africa circulating - a variant that has raised legitimate concerns about vaccine effectiveness - based on early studies showing poorer neutralisation of the strain with antibodies in the laboratory.
While this doesn't necessarily translate to lower vaccine effectiveness, can we really afford to take this risk? No.
Hoping for the best, and dealing with variants after they get out of hand doesn't work. We need to proactively contain these.
Whitty in the briefing yesterday seemed to suggest that the variant from SA coming into the UK was inevitable. It wasn't. Our travel restrictions were put in place several days after the SA variant was reported. Our border restrictions are still extremely lax.
People can exit quarantine on day 5 after a -ve rapid test. This is not grounded in any evidence & is exactly the sort of policy that would lead us to where we are now.

Australia imported the UK variant, but they acted aggressively to prevent it establishing in the community
We now have not one- but at least 2 (if not more) variants of concern circulating in the community. There are >70 cases of the variant linked to SA. What have we done to contain spread? This should have been treated as an emergency.
We don't understand the properties of many of these new variants until much later. We can't risk more virus adaptation & spread. Our health, and even our vaccine resources depend on eliminating the virus. It's the idea that we can 'live with the virus' that's led us here.
There is no way to live with the virus. It's clear virus adaptations can and will continue to occur if we allow this. And the idea that this will make the virus somehow less fit or less likely to cause death isn't grounded in evidence or reality.
We must urgently move to elimination. The case for this has been clear for months, but recent events emphasise this even more. Hoping for the best isn't a strategy- it's a recipe for disaster.

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I'm honestly at a loss as to understanding what our government is thinking & what evidence they're considering in enacting gravely negligent policies that will almost certainly lead to tens of thousands of deaths in the coming weeks. Thread.

To recap - NHS capacity is critical in many places. Hospitals have reported oxygen shortages, and doctors are talking about having to choose who to put on ventilatory support. We have rapidly rising case numbers, >50,000 daily reported cases & 981 deaths reported yesterday.

Let's remember that the impact of socialising over christmas hasn't even begun to show in our numbers yet. And that hospitalisations are indicative of infections that happened ~2-3 wks ago (since then we have been seeing exponential rises in cases).

This means even if we act today, and bring R to below 1 right now, hospitalisations will continue to rise for another 2 wks or so - in line with exponential rises in cases over the past 2 weeks. And deaths will continue to rise for 2-4 wks after we act.

Given current doubling periods, this means very conservatively, 20-30,000 deaths over the next 4 weeks or so, which we sadly can't do anything about now, because most of those who will die during this period have already been infected.
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Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
We've been falsely told 'schools are safe', 'don't drive community transmission', & teachers don't have a higher risk of infection repeatedly by govt & their advisors- to justify some of the most negligent policies in history. 🧵


data shows *both* primary & secondary school teachers are at double the risk of confirmed infection relative to comparable positivity in the general population. ONS household infection data also clearly show that children are important sources of transmission.

Yet, in the parliamentary select meeting today, witnesses like Jenny Harries repeated the same claims- that have been debunked by the ONS data, and the data released by the @educationgovuk today. How many lives have been lost to these lies? How many more people have long COVID?

has repeatedly pointed out errors & gaps in the ONS reporting of evidence around risk of infection among teachers- and it's taken *months* to get clarity on this. The released data are a result of months of campaigning by her, the @NEU and others.

Rather than being transparent about the risk of transmission in school settings & mitigating this, the govt (& many of its advisors) has engaged in dismissing & denying evidence that's been clear for a while. Evidence from the govt's own surveys. And global evidence.

Why?
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Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
Brief thread to debunk the repeated claims we hear about transmission not happening 'within school walls', infection in school children being 'a reflection of infection from the community', and 'primary school children less likely to get infected and contribute to transmission'.

I've heard a lot of scientists claim these three - including most recently the chief advisor to the CDC, where the claim that most transmission doesn't happen within the walls of schools. There is strong evidence to rebut this claim. Let's look at


Let's look at the trends of infection in different age groups in England first- as reported by the ONS. Being a random survey of infection in the community, this doesn't suffer from the biases of symptom-based testing, particularly important in children who are often asymptomatic

A few things to note:
1. The infection rates among primary & secondary school children closely follow school openings, closures & levels of attendance. E.g. We see a dip in infections following Oct half-term, followed by a rise after school reopening.


We see steep drops in both primary & secondary school groups after end of term (18th December), but these drops plateau out in primary school children, where attendance has been >20% after re-opening in January (by contrast with 2ndary schools where this is ~5%).
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Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
I've been seeing a lot of discussion around the dosage gaps recommended by government for the Astra/Oxford & Pfizer/BioNTech vaccines. My thoughts on the potential benefits & risks of such an approach, and the need for much greater transparency around these decisions. Thread.


The UK govt announced recently that both the Oxford & BioNTech vaccines would be now administered with a gap of between 4-12 weeks (so prioritise administration of first dose, given limited resources).

What is the basis of this?

The basis that's been discussed seems to be that
1) the first dose is likely to confer some degree of protection against disease, so better to roll this out as fast as possible, and
2) that for Oxford/Astra efficacy may be higher when the gap between doses is greater.

I discuss some of the technical details around the Oxford trial below for those interested in these. If you'd just like a summary of this, please skip to the summary tweet titled 'SUMMARY'.

What does published evidence show? The Astra/Oxford data are a bit messy because of protocol changes during the trial. This is because the trial was originally planned as a single dose trial, but a booster dose was added when developers realised that this would likely help.
GOVERNMENT
Deepti Gurdasani
Deepti Gurdasani
@dgurdasani1
This is the exact problem with our government's thinking & response- despite this strategy of 'tolerating deaths' and half-way measures having spectacularly failed, it's quite amazing that our govt still hasn't learned anything, & continues to promote a policy of death. Thread


Had we adopted an elimination strategy early on, rather than one of tolerating a certain level of infection, we wouldn't be here now. The reason we're here is because the govt never committed to elimination.

We eased lockdown in May when infection levels were much higher than when other countries in Europe did this. The govt was warned about this, but did this to 'help the economy'. Not only did this lead us into the 2nd wave, the need for further lockdowns harmed the economy further

It's very clear from global evidence that we cannot 'tolerate a level of community transmission' and maintain 'R at or just below 1', which has been our governments policy for a long time. This isn't sustainable & very rapidly gets out of control, leading to exponential rises

Coupled with late action to contain these surges, not only does this lead to many more deaths, and much more morbidity with Long COVID, it also creates a fertile ground for viral mutations to accumulate with a greater risk of adaptation, which is exactly what happened in the UK
GOVERNMENT

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Hong Kong protester equipment list:
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- water bottle
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- saline
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Demonstrators find creative methods to battle police tear gas
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AFP graphic charting Hong Kong's main socio-economic indicators and opinion polls on press freedom and government performance

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AFP graphic showing the main equipment used by hardcore pro-democracy protesters in Hong Kong to battle police tear gas, pepper spray and rubber bullets

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Frontline first aid.

Nurses, doctors, medical students and ordinary citizens with first aid training have clamoured to join a small volunteer corps helping treat people involved in the Hong Kong protests

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Our pretensions to civilization have become very thin. Political violence was legitimized last year and is spreading wildly now. "Might makes right" is clearly the only "principle" behind freedom of speech. That's why Chinese Communists will never be censored by Big Tech.

When every "principle" becomes nothing but a ruthless exercise of power, it's not surprising that a growing number of people conclude they must demonstrate some sort of power in order to be taken seriously. Violence is the crudest exercise of power.

A well-run civilization makes it clear *universally* that violence is absolutely unacceptable. Giving free passes for irresponsible rhetoric and destruction to groups favored by the dominant political ideology of the State undermines that message.

We must also people peaceable means of expressing themselves and controlling their own lives, to relieve the pressures that can lead to violent outbursts and other forms of lawlessness. The less healthy discourse and freedom of action you have, the more pressure builds up.

It's dangerous when large numbers of people begin drawing the conclusion that might makes right, that laws and principles bend easily for those who have the political strength to bend them. Might makes right is the code of anarchy and barbarism, the antithesis of civilization.
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Patriotism is an interesting concept in that it’s excepted to mean something positive to all of us and certainly seen as a morally marketable trait that can fit into any definition you want for it.+


Tolstoy, found it both stupid and immoral. It is stupid because every patriot holds his own country to be the best, which obviously negates all other countries.+

It is immoral because it enjoins us to promote our country’s interests at the expense of all other countries, employing any means, including war. It is thus at odds with the most basic rule of morality, which tells us not to do to others what we would not want them to do to us+

My sincere belief is that patriotism of a personal nature, which does not impede on personal and physical liberties of any other, is not only welcome but perhaps somewhat needed.

But isn’t adherence to a more humane code of life much better than nationalistic patriotism?+

Göring said, “people can always be brought to the bidding of the leaders. That is easy. All you have to do is tell them they are being attacked, and denounce the peacemakers for lack of patriotism and exposing the country to danger. It works the same in any country.”+
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It is simply not correct to point fingers at wind & solar energy as we try to understand the situation in TX. The system (almost) had a plan for weather (almost) like this. 1/x


It relied on very little wind energy - that was the plan. It relied on a lot of natural gas - that was the plan. It relied on all of its nuclear energy - that was the plan. 2/x

There was enough natural gas, coal and nuclear capacity installed to survive this event - it was NOT "forced out" by the wind energy expansion. It was there. 3/x

Wind, natural gas, coal and nuclear plants all failed to deliver on their expectations for long periods of time. The biggest gap was in natural gas! The generators were there, but they were not able to deliver. 4/x

It may be fair to ask why there is so much wind energy in ERCOT if we do NOT expect it to deliver during weather events like this, but that is an entirely different question - and one with a lot of great answers!! 5/x
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Rig Ved 1.36.7

To do a Namaskaar or bow before someone means that you are humble or without pride and ego. This means that we politely bow before you since you are better than me. Pranipaat(प्राणीपात) also means the same that we respect you without any vanity.

1/9


Surrendering False pride is Namaskaar. Even in devotion or bhakti we say the same thing. We want to convey to Ishwar that we have nothing to offer but we leave all our pride and offer you ourselves without any pride in our body. You destroy all our evil karma.

2/9

We bow before you so that you assimilate us and make us that capable. Destruction of our evils and surrender is Namaskaar. Therefore we pray same thing before and after any big rituals.

3/9

तं घे॑मि॒त्था न॑म॒स्विन॒ उप॑ स्व॒राज॑मासते ।
होत्रा॑भिर॒ग्निं मनु॑षः॒ समिं॑धते तिति॒र्वांसो॒ अति॒ स्रिधः॑॥

Translation :

नमस्विनः - To bow.

स्वराजम् - Self illuminating.

तम् - His.

घ ईम् - Yours.

इत्था - This way.

उप - Upaasana.

आसते - To do.

स्त्रिधः - For enemies.

4/9

अति तितिर्वांसः - To defeat fast.

मनुषः - Yajman.

होत्राभिः - In seven numbers.

अग्निम् - Agnidev.

समिन्धते - Illuminated on all sides.

Explanation : Yajmans bow(do Namaskaar) before self illuminating Agnidev by making the offerings of Havi.

5/9
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Where to begin?

So our new Secretary of State Anthony Blinken's stepfather, Samuel Pisar, was "longtime lawyer and confidant of...Robert Maxwell," Ghislaine Maxwell's Dad.


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