Devan Sinha
@DevanSinha
Followers
6K
Following
38K
Media
2K
Statuses
9K
Radiology Resident | Molecular Medicine | into science and data | via Oxford Med | https://t.co/V1TDFk8fVq
Joined September 2013
This CT scan is definitely the most traumatic during lockdown I've been shown. Archery accident. Arrow through the heart. Miraculously and thankfully the patient survived. Let's look at all the ways they were lucky:
103
554
2K
The Pfizer booster trial is pretty spectacular. 10k previously 2x dosed (median 11 months from dose 2). Randomised 1:1 placebo and 30ug. 95.6% relative risk reduction in symptomatic infection in intervention arm vs control (2dose only). 5 v 109 events 7+ days from boost.
116
553
2K
15 cases of B1617.2 (🇮🇳 variant) in care home in London a week after 2nd dose of Oxford/AZ- likely too soon for full effectiveness. 0 deaths. Chance of this outcome without vaccine was ~ 1 in 800.(0.12%).
28
304
1K
Quite interesting. Figure 6D 👀. Omicron appears to have switched cell entry preference to endosomal fusion (rather than ACE2+TMPRSS2 mediated cell surface fusion like previous variants, incl. the well adapted Delta). Pre-print from Glasgow Uni:.
64
382
1K
Wonder if any other G7+P5 developed European nation would be embarrassed if they couldn't afford to staff a Major Trauma Centre that covers a 1/4 of their nation's capital city and some of their wealthiest counties?. ~4.5 million population covered by 2 trauma surgeons now.
King's Majora Trauma Centre serves south London, Kent and Medway. 3 locum trauma surgeons have been cut to save cash leaving just 2 trauma surgeons on a 24/7 rota and staff tell me they fear it is unsafe.
16
357
874
"Doctors in radiology started refusing to talk to me about scans". Maybe bc UK physician associates are not legally entitled to request ionising radiation studies.Moreover increasing volume of poor quality referrals is breaking NHS rad depts. @NickTriggle .
18
145
907
99% booster vax effectiveness vs hospitalisation. UKHSA test negative case control study for Delta.
39
186
786
Doctors pay dispute is only one, though totemic & overwhelming, of many serious issues affecting working conditions & unattractiveness of the NHS to doctors. Once started listing issues to express problems doctors face:. XVI Theses on UK Postgraduate Doctors’ Discontent😬
Why is the NHS workforce so angry? Why is med twitter so toxic and lashing out? Why is goodwill and discretionary effort in freefall? Because of crap like this.
39
333
743
It's Diwali tomorrow 🕯️. Bloody hell the pressure on asian kids in this country is going to go up a gear. 'See Beta, why couldn't you be Prime Minister?'
22
120
719
There's concern over out break of South African variant in South London old age care home. 10 residents infected (6 after 1 dose of AZ vax). Mainly asymptomatic and 0 deaths. Chance of this outcome without vax is ~1 in 100. Given 36% infxn fatality in care homes (ICL report 41)
22
87
586
Unexpected Christmas Eve update to ONS infection survey and model!. 1 in 10 Londoners would have tested positive for COVID .on 19th Dec
28
157
510
🇬🇧.First happened in 1918 Manchester, UK using natural radioactivity in Rutherford's lab. Then 1932 Cambridge, UK in first linear particle accelerator by Cockroft & Walton. Popculture/zeitgeist views early 20thC UK as quaint vs US at edge of science & tech revolution. V wrong.
Who told Trump the US split the atom first?.
10
52
542
Who in NHS England signed off that example medically? . Sinusitis is not a diagnosis needed to be made by a CT scan let alone imaging. Why has NHSE decided to unilaterally override NICE guidelines & medical best practice. Waste of time & resources=longer waits & higher costs.
So this is the new great idea🤔.I’m pretty sure if Sarah had seen a GP she wouldn’t have needed to have a CT scan, no need to speak to the ENT registrar & yes it could be managed in the community .Why does NHS England always underestimate the skills of GPs.
16
143
526
@x3notrope They don't have a single monolithic national healthcare provider. More people are employed in healthcare sector in Germany & France than UK. But they are employed by thousands of separate institutions & organisations. Eg look at top employers Berlin: 3 of 10 are health providers
4
0
425
My favourite graph in months (since 3 dose vax data)🤞. Syncytia formation (viral induced cell fusion) is one hallmark for tissue damage and inflammation and why we find 'ground glass' consolidation in lungs. Thank you @GuptaR_lab and all involved for sharing so rapidly!.
2. Omicron Spike protein induces relatively poor cell-cell fusion compared to WT and Delta. We expressed spike in cells stably expressing split GFP, so that Green signal could be measured over time upon cell-cell fusion and syncitia formation. The difference is significant.
8
97
412
Fantasy commentary letter in Lancet (not a peer reviewed study)!. It's an unreasonable proposition for most countries like the UK to achieve elimination + constraints of reality negates claimed economic and liberty benefits if attempted. 1/ .
19
109
376
Grateful for the hard work of dedicated public health scientists at @PHE_uk like @kallmemeg and unsung others who work overtime to produce excellent reports on the variant of concern B1.617.2 🇮🇳. 🧵analysis of vax effectiveness, and why interpretation of reduced VE limited. 1/.
13
82
356
tl;dr. GMC: does your 2yr unaccredited non-standardised course makes you as feel as competent & safe as specialist doctors w/ 10-15 yrs selective med degrees + structured postgrad training + royal college exams?. PAs: yeh. GMC: cool, keep doing what you want . Everyone else: 😬.
Today, we’ve published a report on the outcome of our public consultation on the proposed rules, standards and guidance that we’ll use to implement the regulation of physician associates (PAs) and anaesthesia associates (AAs). The report:. - details the key changes we have made.
6
107
383
A good worked through example of why 60% of hospitalised patients double vaxxed is consistent w/ 95% effectiveness against hospitalisation. In fact it's expected as UK has done remarkably well at vaccinating most at risk (cf US). Actually a mark of success.
@NateSilver538 I used to teach Bayes theorem and its results still surprise me!. Here’s the type of diagram that usually helps it all make sense for me:
20
117
360
We have the first live virus neutralisation assay for Omicron from @sigallab:. 41x fold decline. But preserved neutralisation in sera from previously infected+vaccinated.
27
129
324
Even better than that. Portion of population currently double dosed represents 96% of total pop covid hospitalisation risk pre-vaccines (Great JCVI strategy for risk targeting). Only accounting 3% of Delta is in keeping with vax effectiveness 97% against hospitalisation.
Missed opportunity for government comms here. You could say '45% of people have had two vaccine doses. But they only make up 3% of people hospitalised by Delta variant'.
9
72
321
To repeat: 95.6% RR reduction in symptomatic infection was for 3 vs 2 DOSES. UK data has 2dose Pfizer at ~80% VE vs symptomatic infection in Delta era. But follow up time <11 months in Pfizer trial. If boost anywhere near 90% RR⬇️ we're looking at ~98% VE vs immunonaive.
4
53
297
No money to fund traditional partner run GP practices that appear to be clinically well run. But suddenly PCN can afford a 22% per patient funding uplift to hand over contract to company whose board identify "poor quality patient care and clinical negligence" as a key risk. 🤡
What a kick in the teeth to these local GPs who tried their best to keep the practice going, had to throw in the towel only to see their local commissioners hand the contract over with a huge uplift of funding. Wonder if @wesstreeting is aware…
11
201
290
Most outlandish outcome:. - Sunak+Johnson pass 100 MP threshold. - Sunak wins 'indicative' MP vote. - Membership still vote Johnson PM. - Privileges Committee recommends 10+ day suspension for lying to House. - Con rebellion and Commons agrees. - Johnson loses seat in recall elx.
5
35
260
@BallouxFrancois No anglophone country w/ common law concept of liberty believes right to speech/expression/assembly extends to someone else's home or garden. Exclusionary use is definitional of property rights. Public spaces & institutions. The pavement or street outside their home would be fair.
2
3
268
89% [78,95] effectiveness against symptomatic disease. Oxford/AstraZeneca vax, post 14 days from 2nd dose.(will be vs predominantly B117). Well that's certainly good news, much higher than trial data. Avg dose interval longer here.
3
68
252
NHS England's replacement of doctors (GPs) with PAs storm goes mainstream on day that was going so well for Sunak until now. .
🚨 “The country is not stupid.”. Rishi Sunak is confronted by someone who appears to be a GP at a campaign event in Wiltshire on the state of general practice:
4
103
231
UK medical degrees are regulated by law to include 6,000 hours of medical training. They are accredited, have external quality assurance of standards & GMC approval. UK PA schools: 1,600 hours training; unaccredited; unregulated & have no external quality assurance of standards.
Leaders of @FPARCP again comparing PA studies to a medical degree…. Presentation given to hospital managers to encourage them to employ PAs. Is this appropriate for an arm of @RCPhysicians?. Doctors are being replaced. Source:
4
137
247
Fig 5B: repeat w/ live Omicron previous pseudotype study findings that Om does not induce cell syncytia (cell-cell fusion, which is highly pathogenic/inflammatory). Fig 5D: confirm much reduced lung epithelial replication (an order of magnitude). All-in-all Om looks distinct.
7
66
228
This is false vaccine misinformation. Reported as such. Cohort matched retrospective studies by PHE (Alpha) shows in break through after 1 dose 40-50% lower hospitalisation and mortality. That's just how mathematically higher VE against hospitalisation and death works.
If you are one of the vaccinated people who get a covid breakthrough case, data indicate you have the same chance as an unvaccinated person that your covid infection results in hospitalization, severe disease or death. 1/.
13
30
211
In fact from this CT slice it appears the arrow may have stayed supra diaphragmatic avoidng communication between the abdominal cavity and thorax. Now the big one! The arrow missed the descending thoracic aorta by 1.5 mm. No bleeding to death in mins.
2
6
212
Update:. UK is now the most boosted country. (population >1m, Iceland is damn fast)
We are about to overtake Israel and become the most boosted population on the planet
16
56
215
How many total COVID-19 deaths in the UK?:. ▪️ 173,248.mentions on death certificates to 24th Dec'21. ▪️ 150,154.within 28 days of positive test reported by 9th Jan'22. ▪️ 119,600.age standardised excess deaths from Continuous Mortality Investigation (CMI) to 24th Dec'21. 1/.
9
71
205
I wanted to force the country's young people to do a year of national service whilst demonstrating I'm incapable of doing even a single afternoon of service myself.
1
60
184
@iDrSunny If the GMC position now fully clarified is that PAs don't "study medicine" then how can they simultaneously claim PAs are "medical professionals" given they have not studied medicine?.
4
50
197
@Xeon4f145d96s1 Min of 15 yrs of medical training: 5/6 medschool + 2 Foundation + 8 Neurosurg + likely more yrs as junior fellow + MSc/PhD bc neurosurg competitive. to level of skill & expertise considered safe for independent work as consultant. £33.8k starting salary full time in London. wtaf.
3
17
207
Astonishing that UK govt negotiating position is:. 1) ok to pay less to more qualified staff for a decade bc eventually docs pay > non-docs (+ignore debt & rotational training cost). 2) comparator for international pay is global bttm half ie developing and least developed nations
7
49
210
There we have it:. "Omicron emergency booster national mission”. Boosting all 18+ who are 3 months from 2nd dose by New Years. 18 million in 19 days ≈ . ONE MILLION a day. 👏Let's get going 👏.
If the message isn't ONE MILLIION boosters a day until Christmas, it's just tinkering at the edges with broadly annoying and disruptive restrictions that won't do very much. A door to door service would be good, getting to the vulnerable home bound and ensuring uptake up 95%+.
32
40
198
Hell yeah! First study specifically for vax transmission effect. 38-49% relative reduction in transmission in break through cases after 1 dose on top of infection effectiveness. = 75-82% total single dose transmission reduction. Eagerly awaiting paper!.
It's fairly likely the effectiveness of vax programme reducing transmission will be greater than reducing individual ifxn risk. We have a decently strong prior here. *more tailored studies/data obviously needed*. Anyways enjoy your Sunday
5
72
194
Note mechanically ventilated bed occupancy tracking/marginally outpacing relative daily admissions. As average patients now younger (unvaccinated or 1 dose) ITU triaging means higher proportion eligible in this wave. But ITU is also the main limiting factor in NHS capacity.
12
70
193
Charges for GP consultantations in other countries with universal state subsidized health systems:. Germany €15 (insured).France €25.Australia A$50.Ireland €55. If England charged £30 per visit we could double the NHS GP/primary care budget.
Took 3 days of trying (& a lot of stress) before I gave up hope of an appointment with an NHS GP. I paid £59.00 for a private 10 min appointment to see a doc on video. She was great. V experienced. It’s a lot of money. The Govt (& Labour) must zero-in on fixing Primary 1/.
31
12
190
@ianmulheirn what is your policy proposal here:. ban/tax people for using spare room as a home office?. punitively tax families who's children have left home or partners/parents have died to incentivise downsizing?. tax couples who have not yet had children until they relent and procreate?.
4
4
186
Phase2 neutralisation data that complements this RCT👇. We should just call Pfizer a 3 dose primary vaccine regimen (others similarly).
Nice to see some neutralisation data on 3rd Pfizer (booster) dose. Neutralisation to WT, Beta and Delta all similar, no huge drops against Delta. Hopefully, this is sustained! .
12
26
180
The arrow missed the sternum and so didn't cause multiple shards of bone to rupture the right ventricle and communicate with a large external wound. It passed through the right ventricle (the low pressure side of the heart).
1
2
176
Really wanted this CDC masking study to be the one. Promising start: test negative design with case controls looking reasonably matched in Table1 characteristics. Then cont. find vast majority +ve tested bc had symtoms and -ve controls tested for asymptomatic screenings 😭
10
35
182
It passes into the left pleural space at the bottom most edge of the costophrenic recess. No lung penetration/laceration or collapse. Lodges into the 12th rib. No outside communication posteriorly. No tension pneumothorax.
4
2
172
Lower pressure allows clot formation and sealing of the exit and exit sites. Arrow then passes through the muscular interventricular septum at an angle into the left ventricle muscle wall missing LV cavity. So no hole between left and right hearts, phew.
1
3
165
Unabashedly good news. Hope Paxlovid can be deployed in days rather than weeks or months, otherwise it's going to miss the Omicron boat.
🆕 A #COVID19 antiviral made by @Pfizer has been approved for use across the UK by @MHRAgovuk. More than 2.75 million courses of Paxlovid have been secured for NHS patients and plans for deployment will be set out soon. More:
13
26
167
This is good news. The longer it takes to statistically tell difference between vax effectiveness against variants the smaller the actual dip (if any) in protection will be. 1/.
After two doses, the range of protection we’ve been living with is 85-90%. The new data showing 87% for B.1.1.7 implies ~zero drop-off. 81% for B.1.617.2 is a very small dip and the confidence intervals overlap with the 85-90% range, so it’s possible there is no drop-off at all.
3
30
160
Arrow exits muscular LV wall with with no communication with the LV cavity so avoids high pressure leak of blood into the pericardium, no tamponade, no significant bleeding into thorax. Misses left atrium. Arrow then misses the oesophagus. Another viscus perforation avoided.
1
2
154
If the message isn't ONE MILLIION boosters a day until Christmas, it's just tinkering at the edges with broadly annoying and disruptive restrictions that won't do very much. A door to door service would be good, getting to the vulnerable home bound and ensuring uptake up 95%+.
As pressure from virus rises, PM will give national address at 8pm tonight, updating the booster programme - sounds like this will NOT include new restrictions.
15
22
159
Temperature and SARS-COV-2 transmission:. Some seasonality expected for resp viruses, hard to say how much. England had unique circumstance Feb 7-13th. - week long cold snap across country of similar magnitude.- no change in restrictions.- no increase in daily mobility. 1/
7
49
159
Staggering from NHSE leadership & comms teams.🫣.Didn't even vet the front guy for their misinfo piece hadn't illegally intimated he was a paediatric surgeon or bragged about his prior lack of health experience b4 PA course & 2 days surgical training on professional & SoMe sites.
Since @thetimes decided to go there…. Is this level of deception acceptable?. Should parents who google this individual be lied to that he’s a paediatric surgeon?
4
50
164
*one modelling scenario input assumption by one of the three SPI-M teams is not the same thing as an actual study comparing AZ an Pfizer symptomatic effectiveness against Delta*.
3
12
155
@paulbristow79 @LBC The BMA committee just received a 98.4% mandate in favour of continuing industrial action from its membership. On 71% turnout. "do not represent rank and file in the medical profession" 🧐. I think Sunak is onto something about compulsory maths education.
1
13
152
The most positive thing I've seen in a while. In London observed growth of Omicron/Delta looks to have slowed a little in the last two days of specimen data 10th and 11th Dec w/ 44.5% avg. (SGTF as marker for Omicron). Had growth continue as before wld have been 51% v 43% on 10th
15
19
153
The closer you inspect JVCI dosing decision (upto 12 week interval) the more it looks like they played an absolute blinder. ✅Maximising population protection in short term, in a difficult wave. ✅Maximising individual protection long term. ✅Maximising protection from variants.
Increased dosing interval of @AstraZeneca @OxfordVacGroup vaccine likely to result in increased efficacy against Symptomatic COVID caused by B.1.351🇿🇦. Reduction in Neutralisation for P.1🇧🇷variant comparable to B.1.1.7🇬🇧, suggesting high efficacy maintained against this variant.
9
30
149
If @MattHancock offers to legally change his name to Jabby McJabface when 95% of adults get vaxxed at least a handful of extra people in country would take up vax offer for the troll factor. Every additional protected person counts.
5
16
152
The reasons countries have serious covid outbreaks (infections or higher deaths rates) are multifactorial. Not all of them are under the control of public/health policy makers. #coronacentrist manifesto👇. 13/
6
36
152
Imperial Omicron model rather ground breaking. Not only singularly relying on correlation of neutralisation Ab titre for severe disease and death VE, but also for extrapolating to NAT levels for which there's no actual data. (Cf @DiseaseEcology systemic approach for vax data)
19
17
145
@TomStocks1982 Middle grade residents are typically ST3 & above. By then they've completed:.✅4-6yr selective rigourous multi-pt assessed med degree.✅2yr structured foundation program.✅3yr competitive & assessed core medical/surgical training.✅specialty royal college exams. Insane comparison.
3
29
153
Pandemic record of 5% of all over 70s in England (highest risk) would now test positive for SARS-CoV-2. That's 450% of Jan '21 peak. Hospital admissions (incl incidental) are 45% of Jan'21 peak. Deaths are 8% Jan'21 peak. #vaccines
8
34
144
Good indication towards Oxford/AZ vax maintaining some efficacy against death/serious illness even in this most vulnerable group.
2
7
136
They found no statistical difference for age, sex, race, ethnicity, or co-morbidities within the limitation of study size. The primary course in the trial would have been with a 3-4 week dose interval between dose1 and dose2. (cf 10 week typical in UK).
3
12
133
@ThatRyanChap @PaulMainwood Only 82% of NYC over 65s fully vaxxed at least 2 doses. Cf in England >98% double vaxxed and >92% boosted (denominator issues tho!). Very few countries have as efficiently targeted vax uptake distribution to minimise total population hospitalisation or death risk as the UK.
6
19
138
Why can't a GP in my local practice say I'm alright to pick up a few GP sessions?. RCGP hv a national scope for doctors preventing me. Despite having a med degree, completed FY training incl 4 months GP, obtained MRCP & FRCR postgrad med exams. But it's ok for PA w/ 2yr course 🫠.
4
36
132
Vaccine effectiveness against Delta variant hospitalisation >14 days from 2nd dose:. Pfizer 96% [86,99]. Oxford/AZ 92% [75,97]. No statistically significant difference within the limits of this retrospective study using adjusted Cox model.
8
41
138
MHRA updated Ox/AZ vax surveillance:. after 20.6 million first doses. 22 thrombosis+thrombocytopenia (VITT) fatalities sadly. 1 per 936,000. Benefit : Harm in terms of C19 lives saved still in favour for AZ in all ages over epidemic, by many orders of magnitude for older ages. 1/
11
36
138
@declamare @arvsinghal Yep! I used that very paper. 96% of Delta seeding events occurred after Pak/B'desh red listed April 9th. We'd have cut 505 events to <40 total (mostly pre April 9). Delayed current wave 4-7 weeks more than current opening delay plans. (stochasticisty w/ exp growth from small no).
3
48
132
NHS now spends > 2X annually on settling obstetric related litigation than on providing the maternity and neonatal services itself. £8.2B vs £3B. But yes. "The NHS embraced the philosophy of excluding doctors because it would save money".
Letter in the Times from a retired obstetrician explaining how the anti-medical ideology of natural childbirth was embraced and how it affects services.
8
67
130
UK vax supply over next 3 months looks very good (graph left). If we average double the vax rate over the next 10-11 weeks as previous as per Zahawi then 1 dose all adults by 31st May-7th June (edited ft graph) inc 2nd doses due for groups 1-7
Nadhim Zahawi told BBC Breakfast this morning: "March will be a very big month for us. We’ll probably going to be twice the rate over the next 10 weeks as we have done over the past 10 or 11 weeks." So that's c40m first doses (out of 53m adults) and c20m second doses by mid-May.
5
30
129
🤯 thought 🇳🇱 were sensible and scientific :'(. 🇪🇺 nations ballsing up vax rollout in every way imaginable. Hesitantancy will explode. Why not halt Pfizer too, higher thrombotic rate detected in UK?.Both < normal rate!!!. Stupidity could shut down vax programme as 'precaution'😡.
BREAKING: Netherlands suspends the use of AstraZeneca's COVID-19 vaccine, citing "precautionary principle".
6
12
123
In London Delta fell from Rt 1.0 ➡️ Rt 0.6 from w/e Dec 12th to w/e Dec 19th. Wld be good to know what caused 40% drop: behaviour change (mixing or testing), viral competition, test capacity. Chart by @theosanderson
26
25
125
Change in real pay (CPI adjusted) over last 14 yrs:. 🔼4.9% Fin & business.🔼2.8% Professional, science, tech. 🔻3.5% All workers. 🔻8.4% Nurses.🔻24.3% Consultants.🔻26.3% Junior docs. No wonder retention of medical talent in UK & NHS is a challenge vs overseas or UK industry.
1/ NEW & IMPORTANT: OK on the eve of junior/consultant strikes, we need to talk about these charts (NEW data just in!) 👇. We need to look at them to fix waiting lists & its increasingly clear next GE will be won or lost on the NHS. Please read the whole 🧵 & share widely / RT
5
64
115
Summary:. - 1 dose VE vs B1.617.2 is likely reduced but this is less certain than presented. - VE will be higher than headline reported results. - 2 dose minimally affected - may take 10ks matched cases to say if difference at all.
13
22
123
Someone has had an elitist change of heart when it comes to their personal medical care. Demanding a caring GI "expert" undertake their own invasive endoscopy 👀
8
12
125
This is insane. GSK don't even have a covid vax that's completed phase II trial let alone approved by any nation's regulator. Irrational self defeating paranoia.
LATEST: Italy’s customs agency is holding up a shipment of GlaxoSmithKline's meningitis vaccine for testing amid suspicion that drugmakers may try to export coronavirus vaccine batches from the EU
10
26
122
An absolute sin to waste, need better global vax equity. But logistics of collecting distributed vax across country and shipping overseas to organise vaxxing in time a big hurdle. Why not: .1) rapidly open to 5+ kids (1/3 dose).2) allow 4th dose if wanted.
11
27
108
A detailed, data rich and nuanced overview on Omicron by @jburnmurdoch and how it might effect health systems and countries. The amount of time+effort to produce, calibrate and double check just one chart is significant. Then the clear explanation. It's exceptional journalism.
NEW: first thread of 2022 is an Omicron situation update, starting with a detailed look at UK hospitals, before going international. Let’s start with severity, and the most important chart:. Despite steep rises in cases and patients, the number on ventilators has barely risen.
4
13
119
Seroprevalence study across India WHO/AIIMS:. Urban: 79.1% [76.5,81.6].Rural: 62.2% [60.7,63.9]. ✅geographic spread.✅cluster randomised (ex Delhi).✅good ELISA assay.❌possible volunteer bias⬆️.❌pre-empted+overlapped delta wave March 15th+ = miss recent infxn/seroconversion⬇️
12
44
117
London likely 70-80% Omicron now. 2 doublings ahead of the rest of the country, 4-5 days. (SGTF data is 3+ days behind via @AlastairGrant4, and sequencing lag even longer).
10
29
108
@ShaunLintern @liambarker @VictoriaAtkins DHSC can continue negotiations during campaign purdah rules. As Health secretary nothing prevents her meeting with BMA. She chooses not to.
2
6
105
@ianmulheirn The British state already spends more on housing benefit than any peer and provides more direct social housing than any country bar the Netherlands. Yet we have the worst housing affordability, do you have any other possible reasons for this?
2
3
105
Great C19 vax data💉. Novavax PREVENT-19 trial:.30k participants 2:1 randomized, placebo-controlled. VE symptoms+PCR = 90.4% [82.9,94.6].VE moderate/severe disease = 100% [87.0,100]. no statically significant difference w/ VOC or high risk population (>65 or severe comorbidities).
2
17
107
Sigh. MIS-C associated hepatitis well recognised. Onset and clinical features of maj of *5* cases cld be subsumed under MIS-C. Study doesn't add much. If you want a decent case series of unexplained ped hepatitis @UKHSA tech briefing 3, with 197 cases analysed. Far from certain.
A study of the hepatitis cases seen in Israel reveals they were likely a delayed consequence of COVID-19. The average delay was 74 days (range 21-130). This is almost certainly why we’ve mostly seen negative COVID-19 PCR tests in affected kids. No adenovirus found in liver.🧵.
14
17
103
The starting salary for a Private in the Army has been cut by 29% since 2009 after inflation (CPI). Cf. -3% for average workers in the economy or -25% for doctors over this time. The Armed Forces are also minimum wage law exempt. Otherwise they'd be in breach given the hours.
2
13
105
Incase anyone needs good/reassuring news 👇. Extremely high seropositivity in UK adults 16+ as a result of vaccination, boosting and prior infection. Expectation of high protection from severe disease even v Omicron.
Our latest #COVID19 data show antibody rates remain high across the UK countries (week beginning 15 November)
4
29
104
@adb0wen FYI your study pre-triaged younger less complex, less acute, less deprived patients to be seen by the PAs. Fact they found statistically the SAME re-consultation rate in 14 days (not great metric) betwn PAs for 'simpler' patients vs GPs w/ sicker more complex patients is .🚩🚩🚩
2
9
104
"One example of reform is in [cardiology], where we can have people who are not [cardiologists], like therapists or one of the roles, will do more [endovascular structural cardiac surgery].".
Rishi Sunak, "One example of reform is in dentistry, where we can have people who are not dentists, like therapists, will do more dental work."
3
15
95
So far there's nothing in it between how good Pfizer and Oxford/AZ vaccines are in terms of keeping the elderly out of hospital. (Ox/AZ maintains higher point estimate for effectiveness). Meta-analysis of 3 UK studies post 1 dose👇. Pfizer 83% [79-88]. Oxford/AZ 88% [80-96]
4
21
102
91% of England's total population has either been infected or jabbed at least once if MRC's latest cumulative attack rate of 47% is correct. Assuming random vaxxing of previously infected. (ONS denominator).
7
14
98
JCVI extension of vax dosing interval to 12 weeks is a great public health decision. 3.5X higher peak antibody levels w/ Pfizer if delayed boost vs 3 week. Really important for protection against variants and duration esp in vulnerable🧵. 1/.
7
17
92
Even though 4 hospitalised they were all non-severe. Chance of 4 OR FEWER hospitalisations without vax AND including severe cases = ~1 in 7 (14%). Will be even lower for non-severe but I have no data reference for that!
3
16
98
Summary:. Attempting an elimination strategy would have resulted in tens of thousands fewer deaths in UK, but it would have failed in definitional terms and required permanent national lockdown diminishing economic and liberty gains. That would be an honest policy debate. ENDS/.
8
9
96
😑everyone w/ headache after vax is in ED today. And I'm rejecting CT venogram scans left, right and centre 🥲. 🚨CVST only associated w/ AZ vax in cases WITH thrombocytopenia🚨. No evidence for association in absence of rare clotting dysfunction. Please do bloods first 🙏.
5
11
91
ONS Infection Survey estimate to 31st December:. 1 in 15 people in England if tested would be positive for COVID ie the community prevalence rate. A little under 7% of total population or ~3.3 million.
4
34
95
Only ~1% of the adult population in England have not yet received a dose of vaccine or been exposed to SAR-COV-2 infection (ie remain immunonaive). We're in a very different immunity landscape compared to March 2020 as the last pandemic regulations and mass testing end.
7
24
93
Thank the stars for the British public and their common sense. 95% of adults continue to state they want/had jab (74% had 1 dose already, 45% had both). Really doing their part to crush future waves and protect each other, especially from variants as they turn up 👏.
2
8
90