tw-rl

We’re all sick of/with Covid and want it to go away, so the question on everyone’s lips is how best to live with it. As an amateur Covid-watcher, here’s my tuppence worth. First, we need to be clear about the impacts of Covid if we do nothing to reduce its spread: Long 🧵

1: Deaths/hospitalizations. In many countries, Omicron has a relatively low Infection Fatality Rate (IFR) thanks to vaccination and prior infection, as well as Omicron being inherently a bit milder than Delta (but more severe than the original Covid in March 2020). 2/

Nevertheless, sheer numbers of cases are putting healthcare services under extreme pressure and causing a large number of deaths. With better treatments, we should be able to bring down the IFR even further. On the other hand, future variants may be more severe. 3/

Even if the IFR is the same as flu, the risk will be much higher: We catch flu roughly once every 7 years. If we catch Covid twice a year, our annual risk is 14 times higher. Unrealistic? Maybe, but in parts of Iran the *average* person has already had Covid over 4 times. 4/

Richer countries haven't seen that happen due to various mitigations/restrictions. If we remove those, infection rates will rise. We’re seeing that with Omicron: in spite of prior infection/vaccines, it is spreading faster than any previous variant. 5/

2. Long Covid. No discussion of Covid should ignore LC. In unvaccinated adults, LC seems to be a serious problem (see RT). In children and vaccinated adults, it's probably less bad, but if enough people are infected, LC could still affect many. 6/

Benedict Barclay @BarclayBenedictA very interesting Norwegian Long Covid study has just been published. It used the participants in an ongoing "Mother, Father and Child Cohort Study", and included over 70,000 people. Infected and non-infected participants registered 22 different symptoms in March 2021. 🧵 twitter.com

3. Sickness absence. Again we're seeing this with Omicron. You can change isolation rules, but sick people will still need time off work/school. If far more people are infected each year with Covid than are normally infected with flu, more people will be off work/school. 7/

This can mean shortage of teachers, truck drivers, rubbish collectors, supermarket staff, etc. And of doctors and nurses to look after all of the other sick people. It is also very disruptive to teaching: missing lessons, teachers having to repeat material, etc. 8/

4. Vulnerable people. These include the most elderly, people with transplants, people being treated for cancer and many other groups. So far, they have been encouraged to separate themselves from society as much as possible to protect themselves. 9/

That's hard enough for a couple of years, but indefinitely it's completely unrealistic. We must urgently find treatments and/or vaccines that work for people with compromised immune systems and with other underlying risk factors. Otherwise we're throwing them to the wolves. 10/

I'm sure I've forgotten or left out many other issues arising from living with a high levels of Covid, but those are the main ones I can think of just now. To me, they are a very high price to pay, and we should look at ways to reduce them. Which brings me to mitigations. 11/

Ideally, all mitigations/protections against Covid should be voluntary and place as few limits on our day-to-day lives as possible. Nevertheless, while it's true we constantly live with risk, we also live with rules/recommendations to reduce them. 12/

The first mitigation should be information: Clear messaging from govts to people and businesses about how best to reduce the spread of all respiratory diseases, including Covid. This will help to reduce the burden not just from Covid, but also from flu and other illnesses. 13/

This communication needs to be regular and consistent, and range from simple, basic and easy-to-remember advice to complex and detailed advice to help people like facilities managers reduce risks at the properties they run. 14/

Improving indoor air quality (IAQ) through ventilation and filtration should be an important part of this. Poor IAQ is associated with concentration problems, as well as cardiavascular and respiratory diseases, so this is a win-win. 15/

It's something we should have been doing before Covid, but which the pandemic has made more urgent. In general I think a voluntary approach should be taken for existing buildings, but building regs for new-builds should be much stricter on IAQ. 16/

For high-risk locations like hospitals and GP surgeries, improvements to meet new minimum standards should be mandatory. This would help to protect vulnerable people who are more dependent on healthcare services than others, and more at risk from Covid. 17/

The focus should also be on locations associated with superspreading - meatpacking plants were a classic example early in the pandemic. This could be voluntary, but govts should emphasise that improvements reduce sickness absence and thus benefit the companies themselves. 18/

Masks are another area for better public messaging: Explain which masks are best, how long you can use them for, whether they protect you or other people, and where they are most effective. Give free high-quality masks to low-income families and the most vulnerable. 19/

With good messaging, mask-wearing could probably be voluntary, because given the right reasons, most people are responsible. Unfortunately, deliberate obfuscation has turned masks into a culture wars issue. I do think public transport is somewhere masks should be mandatory. 20/

I also think shops should be allowed to require mask-wearing if they think it will protect their staff and customers. Personally I've been wearing a mask in shops for 2 years, and honestly it's a miniscule sacrifice compared with everything else the pandemic has caused. 21/

WFH: Lots of people have found WFH improves their work-life balance, and the nature of our digital society means that various kinds of remote working will become increasingly normal. Govts should help people to WFH if it makes sense for them and their employers. 22/

This could include upgrades to infrastructure, information about IT security and networking and advice on keeping your free time separate from your work when WFH. WFH is one of the most effective measures at slowing transmission, and for many it is a win-win. 23/

Discouraging presenteeism. Too many people think going to work when you're sick shows commitment to your job. Really it shows commitment to infecting your co-workers. This kind of presenteeism should be discouraged at all costs. In many cases, people could WFH. 24/

Even in the many jobs that cannot be done remotely, going to work when ill ends up causing more people to take time off work in the long run. Fixing sick pay is clearly vital if you want to fix this problem. People have been clamouring for this for ages, but without success 25/

I'm sure there are many other things that could be done to slow transmission without significantly restricting people's lives, but the ones I've outlined above are a start. Obviously the more expensive ones could be supported by grants/incentives. 26/

In addition, none of the above implies that we shouldn't continue focusing on developing better vaccines and treatments, and at rolling them out as quickly as possible. 27/

Lots of people say we're all going to get Covid in the end anyway, so why bother. Factually, that isn't the case, and in fact most elderly and vulnerable people have avoided Covid so far. Thankfully. The consequences if they had not would have been horrendous. 28/

Even if we were to all get Covid eventually, as discussed above it matters how often we get it - each time we catch it is a risk of time off work, time off school, hospitalization, death and Long Covid. With less transmission, we get ill less often. That's a good thing. 29/

I'm sure I've left out lots of things, but 30 tweets is probably enough, so I'll call it a day here. Thoughts and comments welcome, as ever. END

Ps 1: Investing in public health infrastructure including public health nursing is another area that would be good for Covid and have wider benefits. This article on public health nursing in Japan was an eye-opener to me when I read it last year. https://spfusa.org/research/public-health-nursing-in-japan-lessons-from-past-and-present/

Ps 2: Contact tracing. We know superspreader events play a disproportionate role in Covid transmission, and backward contact tracing ("cluster busting") can help to nip them in the bud. This is most effective if cases are relatively low, of course. https://sciencemediahub.eu/2021/01/13/mix-of-covid-19-cluster-busting-with-vaccine-push-may-bring-a-new-normal-faster/amp/