At every step of the way, WHO has gotten major chunks of social science of pandemics wrong. Not everything for sure, but some of the most important things, like clinging to baseless claims of false sense of security to block progress on masks and maybe even aerosols.

What the person just chosen to lead the "Technical Advisory Group on Behavioural Insights and Sciences for Health" for WHO wrote on February 28 ("if you're worried about COVID, it's irrational panic") and what I wrote one day before ("We have to get ready so we can lessen risk").

COVID Update June 28: August will be another twist in the road. That comes tomorrow. But I need to do something first. I’m reminded many people follow me for COVID info so I want to call out & atone for my mistakes. 1/

What the he’ll is going on in the Stock Market. GDP dropped by 32.9%(a disastrous number)and over the last 3 trading days the NASDAQ is up over 300 Points! Never mind the Pandemic and Rampant Unemployment.

A quick visual aid of major studies & levels of evidence against #hydroxychloroquine for the use in COVID-19 patients. No robust studies have found any type of benefit for HCQ.

What concerned me was the talk about transmitting to others, which suggests using antibody tests to test people who are actively infected. Of course someone could be recently infected, not know it, and get a negative antibody test, but this would be rare in the scheme of things.

It is unclear to me why false negative antibody tests would present an important risk. If you think you are still susceptible to infection (even though you really had been infected before), you would behave more cautiously.

An advantage of antibody tests is that they can (mostly) detect prior infections in people who didn’t even have symptoms, so were missed by PCR testing. A disadvantage of these tests is they can return false positives. Someone thinks they are immune and adopts riskier behavior.

Antibody tests look for presence of different antibodies in your blood. It takes time for your body to mount an immune response (1-3 weeks). Thus, they are not used to detect acute infections. Instead, they are used to detect evidence of prior infection.

To explain, we use PCR (swab) tests to detect acute infections (it tests for viral particles). A concern with PCR tests is that you can get false negatives, where you are actually infected but the test comes back negative. This is bad because you may act as if you are uninfected.

Thanks, @MelissaKariWard, for capturing the since deleted tweets. This is why I expressed concern.

RT @ChathamHouse: ‘We may have a vaccine in the next 12 months...And already we are seeing the rise of an anti-vaccination movement...'

Of all things I forgot rapid genome sequencing of the virus that allows us spatiotemporally track it, ice transmission dynamics, follow evolution of the virus (which is thankfully very slow)

It's 100+ years later and we're a lot smarter, more capable. Why aren't we beating the crap out of #SARSCoV2? We will. Just a matter of time.

Promising findings and very wide confidence intervals: the truth is usually not somewhere in the middle

Update: New Mexico crushed its resurgence. Closed indoor dining and enforced mask mandate about two weeks ago.

It's sort of interesting which COVID-19 studies get widespread media attention. Not very well correlated (in fact, perhaps negatively correlated) with the ones the subject-matter experts I follow seem to find compelling.

Researchers have estimated the infection fatality rate – the proportion of infected people who die – at between 0.6 and 1 per cent. So far though, there are no estimates of how this is changing over time. (4/4)

Does that mean the virus is getting less deadly? It’s unclear, reports @mjflepage. It could be the result of better treatments, earlier detection, or younger people getting infected. (3/4)

However, the number of deaths in the US reported as being due to covid-19 has fallen from more than 3000 a day in mid-April to well under 1000. (2/4)

Thread on #covid19 trends in the US: Coronavirus infections have surged since the start of June from around 20,000 new cases a day to over 60,000. (1/4)

This is a kind reminder that most issues with data (e.g. measurement error, incomplete data, confounding, selection) do *not* disappear just because you have N = ginormous

31. Another way to think about it is that the bad things that COVID does occur after transmission and only to a small fraction of people, so natural selection can't really "see" those things or operate effectively on them.

30. That means that evolutionary changes in virulence will not necessarily not change transmission much, unless they change other things by coincidence as well. And *that* means that selection on COVID-19 virulence is likely very weak.

29. The really bad things that COVID-19 does to people happen (1) only in a small subset of people and (2) after most or all of the transmission has already taken place.

28. Second, when death occurs, it typically occurs long after the usual window of disease transmission, a couple of weeks or more after the onset of symptoms. Why do these thing matter?

27. There are really a couple of key observations to make about the virulence of SARS-CoV-2 in this respect. First, note that disease severity varies widely among patients. Most infected people do not suffer severe disease. Approximately 5% are hospitalized. 0.5-1.0% die.

26. Taking stock, the theory is telling us that (1) the first successful mutations may not move us toward reduced virulence and (2) even if they do, it'll take years to get there. Now let's look at how natural selection operates on virulence in a pathogen like SARS-CoV-2.

25. A new mutation is *very rare* because there are millions of active cases worldwide, and it is just one of them. If it transmits say 10% more effectively (a very big advantage by evolutionary standards) it would take hundreds of generations—multiple years—to become common.

24. (Technical aside: if R0 isn't much bigger than 1, the new mutation probably goes extinct. We can approximate transmission as a Poisson branching process, and calculate exactly what that probability is. But let's ignore that, by supposing the mutation arises and persists.)

23. It matters because of the nature of competition and the nature of exponential growth. Suppose that tomorrow a new mutation arises that decreases virulence but increases transmissibility—just the kind that Ridley is hoping for in his argument. What happens to it?

22. As we think about timescales, the next thing to keep in mind is that we are currently in expansion phase of a pandemic to which comparably few people on earth are already immune. Why does this matter?

21. Given the limited genetic variation we are seeing in SARS-CoV-2 and some other factors I'm about to discuss, "early on" will be on the order of years or even decades. So any predictions of the sort Ridley is making pertain to the 2030s or later better than to 2021.

20. So early on, basically any old thing could happen to virulence, depending on what mutations arise first. In this short piece below, I briefly describe a lovely modeling paper by Jim Bull and Dieter Ebert, that explains how this works.

19. If the virus is originally more virulent than optimal, the first successful mutations could make it more virulent still, so long as they help it spread. Only once the virus gets "really good" at spreading in humans could we expect it to approach any sort of virulence optimum.

18. That's SARSCoV2 as of last November. What happens next? Well, that depends on what mutations happen to arise and what those mutations do. In general, those that increase how well the virus transmits will also increase in frequency. (But we'll revisit this; it's also subtle.)

17. When a virus emerges into the human population from another species, we don't expect it to be perfectly adapted for transmission. It may be inefficient at replicating, or may colonize the wrong parts of the body. It may be too virulent, or not virulence enough.

16. If we could expect it to happen over the course of a year or so, that could help should a vaccine fail to materialize. If it would take 100 years that's little consolation to me—and while Viscount Ridley may not agree, I think we're going have other, bigger problems by then.

15. I can't cover all that here but I do want to raise a few key points. Let's start with time scale and mutation supply. *Even if* evolutionary theory unambiguously predicted a major decrease in COVID virulence, we still ought to be asking how long it would take.

14. These include the vertical vs. horizontal transmission, competition between co-infecting strains, effects of an immune system, heterogeneity in host condition or genetics, and the role of vector spread. I sometimes spend 2 weeks on this in my course. It's not nearly enough.

13. So if we just look this far, we might expect to see the evolution of intermediate levels of virulence. But of course this only scratches the surface. There are a whole host other considerations and there have been literally hundreds of papers written about these.

12. If a strain is to transmit, it needs to reproduce within the host and facilitate its own spread. This is hard to do without harming the host somewhat. But if it is too virulent, it may kill the host too quickly and miss out on opportunities for transmission.

11. The most basic idea behind the theory of virulence evolution is that viruses face tradeoffs between virulence (the harm they cause to the host) and transmissibility (how well they spread to other hosts.

10. Ridley is telling us an evolutionary story based in the theory of virulence evolution. So what does that theory actually say about what we should expect SARS-CoV-2 to do over the next few years? Let's take a look.

9. Virulence evolution is not a simple, predictable, one-way trajectory.

8. Indeed, myxoma virus did evolve reduced lethality, from nearly 100% to less below 50%. At the same time, the rabbits also evolved increased immune resistance. But here is the scary part: that trend turned around. Myxoma became more lethal again.

7. Other endemic virus remain highly virulent. Influenza remains far worse than a common cold. Measles, even more so. Smallpox, worse yet. When spinning these evolutionary tales, people often invoke myxoma virus, introduced into Australia in the 1950s to control wild rabbits.

6. We simply do not have the evidence to draw that conclusion with any kind of certainty. I can't think of a human viral pathogen that has evolved this level of reduced virulence in recent enough history that we were able to monitor it. In any case, it's clear that not all do.

5. Even if OC43 was the Asiatic flu—a pretty huge leap—I wouldn't want to gamble that SARS-CoV-2 would follow its trajectory. The final sentence is striking. No speculation, no "maybe"—just the assertion that unchecked COVID-19 will become indistinguishable from every other cold.

4. Ridley goes on to speculate that perhaps if the Asiatic flu was OC43, it then rapidly evolved lower virulence. Maybe, he suggests, SARS-CoV-2 would do the same thing—if we just ended the lockdowns and let it spread through the population.

3. The basis is a single paragraph in a 2005 paper about the OC43 genome, quoted below. The main evidence seems to be chronology and symptoms. But phylogenetic dating is notoriously imprecise, and some serological evidence suggests that the 1889-90 pandemic was a flu.

2. First, let's get the blog post out of the way. Ridley is speculating that the Asiatic flu of 1889-90 was not an influenza pandemic at all, but rather the emergence of the now-mild OC43 coronavirus into humans. According to his story, it subsequently evolved lower virulence.

1. In short, no. This is going to take a detailed thread to unpack.

NEW: #COVID19 cases continue to spread at alarming rates. CA is now closing indoor operations STATEWIDE for: -Restaurants -Wineries -Movie theaters, family entertainment -Zoos, museums -Cardrooms Bars must close ALL operations.

Measures at each of these scales will come with a different degree of short- and long-term disruption and effectiveness. But countries will need to find a successful, sustainable combination over the coming year (at least) if they want to avoid large outbreaks. 2/2

Controlling COVID-19 means reducing interactions between infectious and susceptible people. This can include measures at individual scale (test/trace/isolate), community scale ('local lockdowns'), or national scale (closed borders/traveller quarantines). 1/

What actions could we take to mitigate this? @SciBeh and here, please:

will lack of clarity about the guidelines directly impact adherence, and influence peer pressure?Yes100%No0%4 votes · Final results

How should the new advice best be communicated? Should we be aiming forconcrete detail0%general principles33.3%info on levels of risk66.7%3 votes · Final results

Should advice be simplified so that it can be better communicated, even if the result is "inferior" from an economic and/or public health point of view?Yes100%No0%Dumb question0%3 votes · Final results

This means it is getting substantially more complex. + Can this advice be successfully communicated the general public?Yes66.7%No33.3%3 votes · Final results

last week's issue radar had little response. So will try out polls. The issue: As countries come out of hard lockdown their advice is becoming more nuanced (potentially applying differently across age groups, health conditions, professions, and parts of the country).... 1/6

RT @MaartenvSmeden: This is a kind reminder that most issues with data (e.g. measurement error, incomplete data, confounding, selection) do

I had an initial stab at this data yday and compared apples to pears. Was saved some blushes by a contingent of dedicated Twitter data warriors inc @fascinatorfun @0liver_03 @jneill and many, many others who've also dug through the data and shared ideas. Thank you.

Here's a statement from @DHSCgovuk. Impression I get is they're sincerely doing their best to clean up a horrendously messy dataset thrown together in fraught circumstances early on in #COVID19. Tho is releasing this crucial data surreptitiously the right way to go about it...?

And lo and behold this new data series reveals that while @DHSCgovuk was reporting that around 2m people had been tested as of around 21 May, the real total was around 1.8m. It was overstating the reach of its testing effort quite considerably.

Then, yesterday, after @skynews's investigation, @DHSCgovuk quietly posted this data series, which finally ends the mystery. Bit rum. Still: put it alongside data for the rest of the UK and we can finally get a firmer grasp of how many have been tested

A mystery with real consequences, since data on people tested (as opposed to tests carried out) is v v important. Many people end up taking more than one test - so there's double counting there. Comparing cases to people is a crucial metric for judging the spread of the disease.

But on May 23 it abruptly stopped publishing the data. From then until this week we haven't been given any update on how many people in total have been tested in England (Scotland, NI & Wales continued publishing). It's been one of the longest-running mysteries of #COVID19

You may recall that up until late May @DHSCgovuk published daily figures for how many people had been tested alongside its deaths numbers. This is one of the key datapoints in confronting the disease and building a track & trace system. Here's the fig for May 21: over 2m

This revelation stems from data released by @DHSCgovuk yesterday in the wake of our investigation into the handling of #COVID19 data. Full thing here:

Breaking: UK government was routinely overstating the total number of people who’d been tested for #COVID19 by as many as 200,000 at the height of the coronavirus pandemic, according to new Sky News analysis.

i mean, we had nurses wearing yankees rain ponchos, we were sending Covid patients back to nursing homes, and the Surgeon General was telling everyone not to wear masks -- and you're here in July saying, ah, but Florida isn't as bad as NY was? Better fucking not be!

in short, most states had the good fortune to get spared while New Yorkers endured a once-in-a-lifetime tragedy. you got to go second! personally, i'd set the bar for success a little higher than "but look we don't have tent hospitals in the parks!"

also: I am aware that places like AZ and TX are currently at about 20 percent the estimated true infection rate of NY when it became the global epicenter of the disease. This is not, actually, a point in favor of their strategy.

At least New York's hometown newspaper, the one that has more subscribers than the WSJ, WaPo, and the 250 Gannett papers combined, nailed this, right?

As one well-compensated columnist put it, "America shouldn't have to play by New York's rules." Well, it didn't. Congrats?

That's what gave Texas and Florida the space to say, "Couldn't happen here!" Even though there was plenty of evidence, even in the early days, that it could and would — that NYC's outbreak was NOT, say, tied to certain subway lines....

I hope the pundits who said that New Yorkers got Covid because of density, the subway, or apartment buildings (NY's own self-serving governor among them!) take a moment to reflect on how much damage that opinion did

Breaking: Los Angeles and San Diego school districts will be remote-only in the fall. California’s 2 largest public school districts said instruction will be remote-only in the fall, citing concerns that surging coronavirus infections pose too dire a risk for students & teachers.

He believes bearing this virus is possible. He hasn’t seen anything thrown at us by this virus, as nasty as it is, that we can’t defeat. He got evidence today. Thank you to our heroes in New York & in memory of all who we lost. /end

Our country’s leading pandemic epidemiologist and I spoke for a while today. He gave a Ted talk in 2006 on this pandemic. He has advised presidents of both parties. I have been talking to him fairly continuously for the last 4 months. 26/

I spoke to Bernie Sanders about this today. He was worked with Mark Warner & Doug Jones (the full expanse of the Democratic caucus) on a Bill to protect Americans’ paychecks. Your move Mitch McConnell. Now that this is in red states apparently he’s taking another look. 25/

The Senate must also honor what they’ve seen. Bar & restaurant owners should be protected. Unemployment ins. Prevent evictions. Help Americans get through this. Hire the contact tracers, get us the testing. Understand without a president, you need to work with the governors. 24/

I have talked to governors & mayors across the country. Follow Abbott. Don’t learn the lesson a third time. We CAN do it. “Yes we can” someone I know said. 23/

And for other states, the movement to begin closing bars today, to consider starting school online, to close churches, to roll things back is the beginning of the political courage they need to show. 22/

The way they can make it up is with a rapid steep decline. 5ey should follow Greg Abbott in TX. He also got it late & didn’t learn the lesson of NY. But once he saw it, he acted w seriousness. All these states can achieve the same sharp drop as NY if they get serious.21/

Sadly, some are deciding they must learn for themselves. AZ has now passed NY in peak cases/mm with 528, eclipsing NY’s 508. FL is now at 436. Both governors openly flaunted their lack of preparation & lack of seriousness. They disrespected the sacrifice of their countrymen.20/

Them way to honor them? Let them be our teachers. Sit there in Phoenix & Houston & Charlotte & Miami and don’t doubt them when they tell you not to mess around with this very scary virus. 19/

New York now takes the virus as seriously as the rest of the world & they know how to contain this. Their vigilance is just beginning. And sustaining it will be hard. But the backside of that curve brings tears to my eyes. The nurses. The doctors. The paramedics. 18/

It’s no longer just foreign countries who have shown this can be done. New Yorkers, who many rallied for, flew to NY, and jumped in to help, showed us THIS IS POSSIBLE. WE CAN DO THIS. 17/

People died for 120 straight days in NY. It is 64 days after peak. 508 cases/million at peak. Overall 20,600 cases/million. 32,075 people gone, 22,795 in NYC alone. Yesterday, in every ICU, nursing home, ER & hospital bed, it was quiet. Not a single reported death. 16/

We have seen the death by infection & by suicide of so many many New York health care workers, one of whom saw 40 ICU visitors in a row die. For all of them, yesterday was for them....

The only thing as steep as NY’s rising curve was NY’s falling curve. It was spectacular & historic. And that is a credit to New Yorkers. To discipline. To community. To respect for the medical workers. 14/

But this isn’t a defense of Cuomo. The fact is NY became the world’s epicenter of COVID-19 for reasons we are still understanding: a new strain, dense conditions, late reaction, nursing home controls. But what happened next was remarkable. 13/

It turns out that the nursing home deaths were caused by the same reason as in every other state. Staff bringing it in, untested, from the community. 1 in 4 staff got infected. And they lacked sufficient PPE. Same thing is now happening in the Sun Belt. 12/

Trump Admin, out of state operators, state inspectors. Yes to all. And sadly while this meme was great as a way to shift the state to blue states, today 40% of Texas cases are coming from nursing homes. Turns out it’s difficult to keep spread out. 11/

The Trump Administration began in 2017 announcing they would not enforce the sweeping nursing home rules the Obama Admin put in place. Too many regulations. And it got worse from there. Many people have their hands on this mess.10/

The nursing home meme was generally spread by people whose principal skill is retweeting unread click bait. I ran the agency the Agency that oversaw nursing home safety & have been talking about this on TV, in writing & with governors. You can watch. 9/

This isn’t about Cuomo as much as it is about New Yorkers. But I have to make one more comment. There’s a right wing meme about how Cuomo killed people in nursing homes. 8/

For all his flaws, when Trump was hiding under his desk, pointing fingers, searching for credit, ignoring scientists, Cuomo was fully present. 7/

I have had my issues with Cuomo & don’t like the way he runs NY’s Medicaid program. But I respected what he was doing. I have never mentioned this but I saw the data Cuomo was first presented with that he later shared. And I saw the model Trump was presented with. 6/

Something else. He didn’t lie. He didn’t sell. He didn’t pat himself on the back. Or avoid responsibility. We had that already. He told the hard truths. He showed data. He asked for help. He demonstrated some empathy & some effort. And the country needed that. 5/

At the time, he was doing what Angela Merkel, Jacinda Ardern, Katrin Jakobsdottir & others around the world were: -This situation is going to be difficult -I know it will be hard for you -Here’s what we need to do and why -We will pull through this 4/

So some thought it was unfair that Cuomo drew such high praise for his handling of the crisis. He earned it for one reason. He talked to people. 3/

New York did not get off to a good start. In fact, it was the example of what not to do. California acted 6 days earlier than NY did when they had cases hit. The mayor clearly didn’t take it seriously & Cuomo was slower to act. Mostly @CoreyinNYC was ringing loud alarms. 2/

COVID UPDATE July 13: There are successful examples of taking on COVID-19. And there is one story like no others. New York. 1/

There’s no randomised trial evidence for social distancing, hand washing or even testing & contact tracing on #COVID19 so why is it being demanded for masks? I’m for it in all enclosed public spaces (if you can). We need to smile a tiny bit wider though so it shows from our eyes.

RT @ObsoleteDogma: The U.S. is averaging more new covid cases than any continent is right now

RT @ProjectLincoln: Of course teachers and families are afraid.

And why don't they know or care that THESE DATA CANNOT BE REAL!

And patting ourselves on the back because the study was covered in TIME magazine.

And instead of pausing for a second to consider the possible limitations of the "study", hell no we are making info sheets for patients...

But he's the ******* editor!

And if you point this stuff out, the response is to write the journal editor.

And then you see all these sycophantic tweets from other docs that just remind you how little some research active people actually understand.

What I find most shocking is that there is zero discussion of these figures in the paper. They LEAP off the page. I just can't for the life of me come up with anything even approaching a plausible explanation for these splits.

If you find @MicrobiomDigest's spot the duplication challenges a bit tooooo challenging, I'll give you an easy one. See if you can spot the batshit crazy in this table 1, which is supposedly describing a nationally representative sample.

I'm not sure how with that data sampling, you can pick out PPIs as the culprit, regardless of what regression you do. We're going to need far better evidence than this before we throw PPIs under the bus yet again based on an observational study.

But here's where I raise an eyebrow. 69.6% of the COVID-19 patients had a high school education or less (28.7% in control), but 63.5% of the COVID-19 made 200k+ per year (7.4% in the control group). Ultra-wealthy non-college 30-39yos, who mostly smoke. Huh? 3/

74.5% of the COVID-19 patients were 30-39 yo (27.1% in the control group). 69.7% were Latinx (15.3% in control). 73.1% smoke every day (22.5% in control). 2/

While I commend them for this work, a few things jump out at me right away looking at the data tables. The sample of the patients was heavily skewed towards a few demographics. 1/

Curious if the 70% threshold we see in the data are nearly identical repeats. Authors would have to release the data to know for sure. In short, my faith in this study is zero, zip, zilch. f/real

In conclusion, the underlying data of this study appear to be horribly flawed. I'd send this to the editor, but the lead author is EIC of the journal. The journal should seriously consider retraction of this paper, which does not make sense. h/t: @supermarioelia f/

The authors opted to pursue a kitchen sink model of multivariable logistic regression. Glad to know the Crohn's disease is on the causal path as well as marriage status.

70% from south vs 40% 3.2% with GERD!!!!! vs 12.5% overall Yet, 72% use daily PPI vs. 28% (THIS DOESN'T MAKE ANY SENSE) 5/

The CoViD+ group is 6% and is bonkers. 3/4 were 30-39, but 18-29 is 1/2. Way more female 70% Latinx compared to 15% overall 70% high school vs 29% overall 82% unmarried vs 46% 63% >$200k vs 7% of overall 75% normal wt vs 39% 73% smokers vs 22% 79% 1-3 drinks vs 36% 4/

Let's take a look at Table 1. Wowsers, this is one of the weirdest table 1's I've ever seen. - Overall cohort looks reasonable, but with really high PPI use for a supposed nationally representative sample. (28%, which nationally probably <10%). 3/

Looking to see if PPI's are associated with CoViD dx (reasonable ?). They asked via survey with methods that are really sparse. Where the respondents paid (I bet they were given the responses)? 2/

This paper has got some MAJOR problems. I don't know why this paper was accepted for publication (nor submitted for publication to be frank). Let's dive in. 1/

This was just to say: finding risk factors is a risky business if we are not specific our aims and methods end rant.

And there is a place for each, IMHO: It is helpful to identify strong predictive factors that help with diagnosis and prognosis It is helpful to identify the true causes of bad outcomes after infection It is helpful to describe which patients ended up in ICU 13/n

Many will already be familiar with the often helpful distinction between prediction, explanation (or counter-factual prediction) and description Those who are not, this is a great place to start: https://stat.berkeley.edu/~aldous/157/Papers/shmueli.pdf… 12/n

This thread is not just to complain (okay, maybe a little) We can do and should do better. To start, by defining what it is we are after when we study these dangerously ambiguous "risk factors" 11/n

With COVID-19, finding risk factors and high risk groups clearly isn't just an academic exercise If we aren't careful, COVID-19 patients will suffer from arbitrary risk grouping, statistical malpractices and/or hidden health(care) inequalities 10/n

Take the example above, the researchers decided to take 60 years as the cut-off for a "young" versus "old" people analysis. Why? Who knows! And why were people with a BMI of 35 and over compared only to people with a BMI in the 30-34 range? There. Are. No. Rules 9/n

That brings us to the second, related issue: there are no rules in the find-a-risk-factor game 8/n

Should people with overweight start losing weight quickly to avoid COVID-19 related morbidity? Or are we looking at a complex relationship between access to care, history of diseases, social economic status and a bad outcome? And why below 60 you ask, and not, say, 53? 7/n

Sounds simple enough? Well, take this example: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa415/5818333… Conclusion: "Unfortunately, obesity in people <60 years is a newly identified epidemiologic risk factor which may contribute to increased morbidity rates ..." 6/n

It depends on what the risk factor represents Is it a factor that when changed immediately changes the risk of a bad outcome? Is it a factor that we should keep in mind when making prognosis? Or is it a factor that simply covaries with other "known risk factors"? 5/n

That brings us to the first problem: an important "risk factor" for, say, a bad outcome (death, for instance) after COVID-19 diagnosis can make good TV AND be completely meaningless for doctors and patients 4/n

The term "risk factor" is popular in medical research. It has been used in literature since at least the 1950s BUT definitions for what a risk factor really is or should be varies. As this article argues quite convincingly

We talk about risk factors all the time. Not just in the medical scientific literature: you will find risk factors being discussed in the popular media and on social media too

Let's talk about the "risk factors" for COVID-19 for a moment 1/n

Share this with whoever needs to hear it: "risk factors", even strong ones that are robustly identified, are almost never useful for making actionable predictions, especially when considered in isolation. TLDR: [Big OR] does not equal [Good, Useful, or Easy Decision]

@MLevitt_NP2013 @ProfKarolSikora @FatEmperor @freddiesayers @AlistairHaimes @RuminatorDan @InProportion2 @LockdownNo @JohnDStats @daniellevitt22 @SunetraGupta @profshanecrotty @unherd @hendrikstreeck @carlheneghan @kerpen @andreascaie @Cescoxonta @profshanecrotty

Having studied outbreaks in poor countries, I look at US & UK and see what a privileged position these countries are in giving their wealth & resources.They can truly protect their residents unlike poor countries which have all the odds stacked against them.Why don’t they do it?

Tough decisions ahead & can’t have it all without a vaccine. Opening schools, or keeping pubs & bars open. Keeping borders largely closed or having free movement & constant outbreaks. Saying popular things like ‘eat out & party’ or prioritising those shielding & vulnerable.

Gov’ts need to look ahead 6-8 months and make a plan, make a strategy for how to protect their residents lives & jobs & how they will weather the storm. Encouraging people to pretend the virus is gone & to celebrate the end of the pandemic is negligent.

I know the economy is suffering & jobs are being lost. I recognise the toll that lockdown has taken and I’m not ‘pro-lockdown’ at all. In fact my worry is about a second lockdown & how to avoid this happening. Lockdown/release cycles will destroy society & the economy.

Why would the UK be any different? This is what I asked myself also on Feb & March when the UK stayed fully open while others moved in opposite direction. Eliminate the virus over the summer then open up safely. Otherwise enter winter & flu season in a dangerous halfway house.

I look at what’s happening in several U.S. states including my home state Florida; I look at Israel and Spain and Iran and...and I know that everyone wants the economy to go full steam ahead in the UK. But I fear we will be in another lockdown within months, if not weeks.

#Texas is a disaster! RECORD day for deaths, hospitalizations, and cases. Positive rate is stable, but remains high. Prayer and magical thinking is not enough. The lack of federal leadership combined with a lethargic and political response from @GregAbbott_TX has cost lives.

Hospitalized pts w/Covid in #Texas growing by almost 6% per day. In some regions, already near capacity. In < 2 weeks, entire state will be challenged (as NY, CT, MA, & NJ were) to maintain normal hospital operations (already suspended elective surgeries in many regions).

Health officials praise Laos after coronavirus-free declaration (some new concerns here, so far nothing major) Cambodia has zero reported deaths, broadly consistent with anecdotal evidence too. Vietnam reports 14 new cases, all imported.  Broader record of zero deaths. No new Covid cases in Thailand Tuesday. Have you noticed that those four countries are right next to each other?  (Within southeast Asia, most cases are in the relatively distant Indonesia and Philippines.) I genuinely do not understand why this heterogeneity is not discussed much, much more. Those countries also have very different institutions and systems of government and state capacity.  Do you really think this is all because they are such policy geniuses? Those countries have instituted some good policies, to be sure.  But so has Australia, where there is a major coronavirus resurgence. Inquiring minds wish to know.  One hypothesis is that they have a less contagious strain, another is that they have accumulated T-cell immunities from previous coronaviruses.  Or perhaps both?  Or perhaps other factors are playing a role? I do not understand why the world is not obsessed with this question.  And should you be happy if you have, in the past, traveled to these countries as a tourist?

RT @EU_Social: In May, #unemployment in the EU was 6.7%, up from 6.4% in March when it was the lowest:

Playing a starring role in this thread is Board of Trade adviser and @trussliz fan Andrew Mills (who has just changed his twitter handle). Nothing at all to see here.

Thank you everyone. So, in addition to the chocolatier and the pest controller contracts, shall we go after the:tiny employment agency14.2%Mauritian family office85.8%20,110 votes · Final results

We have litigation in train in respect of the chocolatier and the pest control company. We can probably take on one more - if you'd like to support it.

Anyway, as Ayanda Capital's contract is by far the biggest I've seen; and its business lines don't include supplying PPE; and it is owned through an especially grim tax haven; and has links to the Tories, this might be one for journalists to take a look at.

A fair bit of White Lives Matter type stuff with the characteristic sprinkling of support for transphobes. But mostly it is RTing support for @trussliz.

And he has a twitter profile which is rather on-brand for the modern Conservative Party.

But his LinkedIn entry describes him as a Senior Board Adviser. Oh, and an Adviser to Liz Truss' Board of Trade (which does contain an Andrew Mills).

This rather interesting man doesn't appear anywhere on Ayanda's website...

Its website says that it is a "family office" focusing on currency trading, etc. Not an obvious place to buy PPE. (A family office is a rather ugly creature of late capitalism. If you have SOO much money you need a business specially to look after it then...)

Its net assets (in its unaudited accounts) look healthy but are swamped by its intangible assets, which could be anything.

So what do we know about Ayanda Capital Limited? Well, it is owned by the Horlick family through an entity based in Mauritius, one of the worst tax havens in the world.

Government does give you the chance to click through and read the contract but (as with every single on I have tried) the link is broken (

But wait, that is nothing. The Government spent a cool quarter of a billion quid buying facemasks from a rather interesting outfit called Ayanda Capital Limited (again it was apparently the only tenderer).

You may think it is not the most obvious place from which to purchase £18.5m worth of facemasks (for which contract it was apparently the only bidder). This Government disagrees.

It's an employment agency with net assets of £322.

We are already pursuing a Government over the £108m PPE contracts it said it entered into with a chocolatier and a supplier of pigeon netting. I know there's only so much of this weirdness you can take but here are two more. First Aventis Solutions Limited.

The @HSELive #CovidTracker app is live from today. Download it to help keep us all more safe. #dubw

10. In the absence of more data on the potential effect of cross-reactive T-cells on the severity of COVID-19, it is dangerous to lower our guard and loose certain measures such as wearing masks and social distancing.

9. These findings indicate, that we do not miss many exposed individuals in the current seroprevalence studies. In conclusion, I think we should not fall back into wishful thinking that an underestimated T-cell immunity will resolve this pandemic.

8. In a recent paper from us, http://tinyurl.com/yb9388be we found only 1 out of 44 mild (outpatient) cases after 21 days post onset that did not mount an antibody response. And all asymptomatic patients in another study http://tinyurl.com/y9f39twv mounted neutralizing antibodies.

7. seroprevalence rates are vastly underestimating the true exposure rate and that we are closer to herd immunity that we think. While I do believe that these patients exist, I don't think that they comprise a large proportion that dramatically changes the exposure rate.

6. Yet, as of today we do not know whether this is true or not and we need to investigate it further. Second, it has been descriped that people exposed to SARS-CoV-2 only mount a T-cell response but do not produce any antibodies. From this, some people like to conclude that

5. if the specific T-cell response cannot prevent infection and transmission, the cross-reactive response against SARS-CoV-2 cannot prevent it either. However, the cross-reactive T-cell response might or might not play a role in the protection of patients against severe disease.

4. get regularly infected by them (every couple of years). So it obviously does not prevent infection in the upper respiratory tract and also not transmission of the common cold CoVs, otherwise they should have died out long time ago. Therefore, I think it is save to assume that

3. While I do trust these studies, as the authors pointed out themselves, it is in my opinion quite unclear what this cross-reactive T-cell response means in terms of protection. We know that despite having this specific T-cell response against common cold CoVs, we do

2. There are 2 different points that are discussed at the moment: First, there are some studies, i.e. http://tinyurl.com/y8zzf8tw, that show a cross-reactive T-cell response in sample taken before the pandemic, due to previous infection with common cold coronaviruses.

1. Since there was a huge discussion about T-cell mediated immunity following the Lancet comment on seroprevalence by @EckerleIsabella and me, I'd like to share my thoughts on this in the following thread:

I don't *love* medium, but I'm voting with my money for a service I'd like to be better. If it doesn't improve, I'll leave.

Hmm. For the sake of argument, that *is* the issue. At least for medium I'm incentivising the content I want in a transparent way. If I pay the NYT I've got no idea whether they'll decide to create more of what I like.

Isn't Medium a flat $5 regardless of how much you read? Who the money goes to changes, but that's not really an issue in a news organisation with salaried staff.

but what reason do we have to believe that those would be the financially most viable ones? Doesn't the history of what happened to traditional media in the last two decades suggests this is unlikely?

Sure but if the % of forward looking articles based on reliable track records increases, I'll take that as a win.

interesting idea, but how would that affect content long-term: puff pieces replace "less popular" serious items seems a rather likely consequence

I refuse to subscribe to every newpaper that I read 3 articles from a month. I'm subscribed to @Blendle @Coil and @Medium for content that I pay per use. If news orgs want my money, let me pay only for what I use.

If I was asked to comment on the intricacies of the luxury electric car market or how to secure NASA contracts, I'd defer to him.

When multiple people with infectious disease/epidemiology/virology experience point out that a billionaire celebrity CEO with zero knowledge of any of the above fundamentally doesn't understand how tests work, I'd defer to those with actual expertise.

Therefore he is sand blasted because you believe others over him how do you know who to believe @jan7681

That's not intended to "break his spirit." It is intended to correct the false and dangerous misinformation that he is spreading. Hospitalizations are not decreasing. Deaths are beginning to increase in the most heavily affected states.

you guys are counter productive insulting helps no one do u really believe this is going to break his spirit i hope not rock on Elon @jan7681

If Elon apparently doesn't understand the difference between PCR (false negatives are bad) and serology tests (false positives are bad), he shouldn't make epidemiological pronouncements about why hospitalizations are increasing. Go back to BSing about space travel or whatever

Mask steaming up your glasses? Fix here.

brief video describing the http://scibeh.org initiative here:

How does this relate to test positivity? I imagine testing as starting in the center and then radiating outwards. Originally, only the sickest people were getting tested, then people with mild symptoms. Now some places routinely test healthy employees. 4/11

What we see in states like Florida is a sharp rise in the numbers of new cases. It is the pace of growth that alarms me, and the fact that positivity is rising along with it. As policy hasn't changed over the last few weeks, what stops it from rising more? 11/END