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Bio: Infectious Diseases / Virology Clinician & Researcher @univofstandrews • #HIV #TB #GlobalHealth • #vegan🌱• #FaceTheClimateEmergency • RT ≠endorsement
Location: Scotland
True asymptomatic cases may account for about 20% of SARS-CoV-2 #infections. This estimate is based on a new review #study in @PLOSMedicine by researchers of the @ISPMBern. #unibern #COVID19 #Corona @dianacarbg @nicolamlow
Really useful thread. (Via @Harkaway.) To use a road safety metaphor: you'd be wise to respect the government's tiresome speed limits and traffic signs. But it's knowledge like this that will actually make you a safe driver on the dangerous roads ahead. twitter.com/mugecevik/stat…
Thank you Ian and Amy 🙏really great to have you on this platform. hope to meet in person once this is over! :)
Our article is now published online.
We argue that SARS-CoV-2 transmission dynamics should inform policy decisions about mitigation strategies for targeted interventions.
academic.oup.com/cid/advance-ar… pic.twitter.com/aEZZVA2AAS
academic.oup.com/cid/advance-ar…
Our article is now published online.
We argue that SARS-CoV-2 transmission dynamics should inform policy decisions about mitigation strategies for targeted interventions.
academic.oup.com/cid/advance-ar… pic.twitter.com/aEZZVA2AAS
academic.oup.com/cid/advance-ar…
Truly groundbreaking research. Affirming what many public health people already knew about inequities being ready-made disease vectors.
Solutions are very clear. Improve income & job protection, increase funds for social welfare to livable levels, address poor insecure housing. twitter.com/mugecevik/stat…
is very tough on people making hard decisions and holding up day after day
no matter personal politics, @NicolaSturgeon articulates all the right values here
thankyou twitter.com/BBCScotlandNew…
true - i would say this is a good visualisation of the available evidence. to put the scientific evidence into context there is often a need for expert opinion imo. but the challenge is to explain complex interactions in a simple way - see my poor venn diagram!
Yes - I agree. I thought it is a nice graphic to demonstrate the spectrum of risk, but probably I should have crossed off the mask and avoiding touching surfaces in outdoor activity section - it is a bit extreme.
best comment on this thread so far! :)
As restrictions (hopefully) ease in the coming weeks in Victoria, we need to be getting these type of public health messages about the spectrum of risk - from Governments & the media.
No more pictures of people at parks or beaches! twitter.com/mugecevik/stat…
This is the best COVID related thread I have ever read, a must-read for all those (like me) who are getting lost in government and expert contradictions on low/high risk exposure... twitter.com/mugecevik/stat…
Cuanto más leo más difĂcil no llegar a una conclusiĂłn. Si el contagio familiar es frecuente, es muy alto en viviendas pequeñas y crece con el tiempo de exposiciĂłn en interior, nada parece más contraproducente q impedir a la gente q tiene hogares pequeños pasar tiempo en parques
SARS-CoV-2 transmission risk is not equally distributed and policies should be designed accordingly. Thread on our new paper. 👇 twitter.com/mugecevik/stat…
Another superb 🧵by @mugecevik on COVID-19 transmission.
Key points for me:
1. redefining "vulnerable" beyond medical co-morbidities
2. advice on how to avoid transmission within a household (too many people think it's inevitable...it's really not!) twitter.com/mugecevik/stat…
This thread is based on our new paper with @JuliaLMarcus Caroline Buckee and @aetiology
Accepted in CID - preprint version can be accessed here: (papers.ssrn.com/sol3/papers.cf…) pic.twitter.com/FQzkrwfyHW
papers.ssrn.com/sol3/papers.cf…
Public health strategies will be needed to mitigate transmission in nursing homes, prisons and jails, shelters, meat-packing plants such as personal protective equipment and routine testing to identify infected individuals early in the disease course. (28/n)
Avoid crowded indoor poorly ventilated environments. Spend more time outdoors. Maintain your distance (more is better but 2 metre is not a panacea). Improve ventilation: open windows/doors. Wear a mask indoors. Wash hands. (27/n) (vox.com/science-and-he…) pic.twitter.com/KbEpUlNWyC
Policymakers and health experts can help the public differentiate between lower-risk and higher-risk activities and environments and public health messages could convey a spectrum of risk to the public to support engagement in alternatives for safer interaction (26/n)
There are many things that could be done within families to decrease transmission. We need to provide clear instructions, and means of support to enable those with symptoms/positive test and their contacts to isolate. (25/n) abc.net.au/news/2020-09-1… pic.twitter.com/UwrrVzLTqm
Early viral load peak in the disease course indicates that preventing onward transmission requires immediate self-isolation with symptom onset (for a min of 5 days). Messages should prioritise isolation practices, and policies should include supported isolation. (24/n)
These include social and income protection and support to ensure low paid, non-salaried and zero-hours contract workers can afford to follow isolation and quarantine recommendations, provision of protective equipment for workplaces and community settings. (23/n)
In summary:
The disproportionate impact of COVID-19 on households living in poverty, and the racial and ethnic disparities observed in many countries, emphasize the need to urgently update our definition of "vulnerable" populations for COVID-19 & address these inequities. (22/n)
A real overlap in the causes of mortality and deprivation can be seen here. The age-standardised rate of deaths involving COVID-19 in the most deprived quintile was more than double (2.3 times higher) than in the least deprived quintile in Scotland. (21/n) nrscotland.gov.uk/files/statisti… pic.twitter.com/BIXfi6uEOj
nrscotland.gov.uk/files/statisti…
Covid-19 could now be endemic in some parts of England that combine severe deprivation, poor housing and large BAME communities, national lockdown in these parts of the north of England had little effect in reducing the level of infections (20/n) (theguardian.com/world/2020/sep…)
theguardian.com/world/2020/sep…
Previous research suggests that although social distancing during the 2009 H1N1 pandemic was effective in reducing infections, this was most pronounced in households w greater socioeconomic advantage. Similar findings are emerging for COVID-19. (19/n) (pnas.org/content/117/33…)
In Madrid, 37 neighbourhoods are seeing the highest incidence, 4 x the Spanish average. Common factors: these areas are poorer, denser and have a high proportion of immigrant population. (18/n)
(elpais.com/sociedad/2020-…)
PHE surveillance report shows that while the number of infections is increasing mainly in 20-29, 30-39 ages in England, SARS-CoV-2 is spreading most in highly deprived areas - where people are in poorly paid work and can't afford to isolate. (17/n) assets.publishing.service.gov.uk/government/upl… pic.twitter.com/CdyzD8GG5s
assets.publishing.service.gov.uk/government/upl…
Households in socioeconomically deprived areas are more likely to be overcrowded, increasing the risk of transmission within the household. These disparities also shape the strong geographic heterogeneities observed in the burden of cases and deaths. (16/n)
People in lower-paid occupations are often classified as essential workers who must work outside the home and may travel to work on public transport. These occupations often involve greater social mixing, exposure risk due to prolonged working hours and job insecurity. (15/n)
Socioeconomic factors and racial/ethnic disparities:
Global figures suggest that COVID-19 pandemic is strongly shaped by structural inequities, adverse living and working conditions and structural racism that drive household and occupational risks. (14/n)
The largest clusters of cases observed in the USA have all been associated with prisons or jails. In the largest meat packing plant in Germany, while the common point of potential contact was workplace, risk was higher for a single shared apartment, bedroom and carpool. (13/n)
Much worryingly the largest outbreaks from across the world are reported in long term care facilities such as nursing homes, homeless shelters, prisons, and meat-packing plants where many people spend several hours working, living together, and share communal spaces. (12/n)
Prolonged indoor contact in a crowded and poorly ventilated environment increases the risk of transmission substantially. But decreasing occupancy and improving ventilation through opening windows/doors can lower the risk. (11/n) pic.twitter.com/SwBI0cLc5P
Environment:
Contact pattern also depends on the setting of the encounter. Contact tracing studies suggest an almost 20x higher risk of transmission indoors compared with outdoor environments. (10/n) (ft.com/content/2418ff…) pic.twitter.com/OIfRHSQu8n
Transmission is also affected by other host factors, including host defence mechanisms and age. For instance, given the same exposure, susceptibility to infection increases with age, higher in > 60yo compared to younger or middle-aged adults. (9/n)
(medrxiv.org/content/10.110…)
While asymptomatic patients can transmit the virus to others, emerging evidence suggests that asymptomatic index cases transmit to fewer secondary cases. Attack rates are highly correlated with symptom severity (8/n)
(medrxiv.org/content/10.110…) and (medrxiv.org/content/10.110…)
When we look at the viral load dynamics & contact tracing studies, those who are infected are very infectious for a short window, likely 1-2 days before and 5 days following symptom onset. No transmission documented so far after the first week of symptom onset. (7/n) pic.twitter.com/DmTVh4ur4O
Individual factors:
Many ppl either do not infect anyone or infect a single person, and a large number of secondary cases are caused by a small # of infected ppl. Although this also is related to other factors, individual variation in infectiousness plays a major role.(6/n) pic.twitter.com/L4vN1BgyZW
For non-household contacts, engaging in group activities such as dining together or board games have been found to be high risk for transmission. So, the risk increases with longer & frequent exposure, close proximity, # of contacts, and group activities especially dining (5/n)