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DiseaseEcology's profile
A Marm Kilpatrick
A Marm Kilpatrick
A Marm Kilpatrick
@DiseaseEcology

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A Marm Kilpatrick

@DiseaseEcology

Disease Ecology, Population Biology

Univ California Santa Cruz
kilpatrick.eeb.ucsc.edu
Joined August 2013

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    A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

    Are we already near the herd immunity threshold for #COVID19 ? New paper by highly respected Oxford authors is shockingly bad. Why is #COVID19 making great scientists lose their mind? Very short thread. https://www.medrxiv.org/content/10.1101/2020.07.15.20154294v1.full.pdf …

    1:57 PM - 16 Jul 2020
    • 191 Retweets
    • 430 Likes
    • blah Martina Jed Adrian Gary Thompson Paul Ennis Dr Kevin Purcell 🇬🇧🇮🇪🇺🇸 😷💉 Ethanhunt Oliver Maclaren
    28 replies 191 retweets 430 likes
      1. New conversation
      2. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        A Marm Kilpatrick Retweeted A Marm Kilpatrick

        There have been a bunch of recent papers showing that simplistic calculations of the herd immunity threshold (HIT) assuming a "well-mixed" homogenous population produce values that are too high. I wrote a detailed thread about it here:https://twitter.com/DiseaseEcology/status/1275595167936868352 …

        A Marm Kilpatrick added,

        A Marm Kilpatrick @DiseaseEcology
        What is #herdimmunity threshold for #COVID19? A topic of much discussion due to large uncertainty & huge consequences for long term impact. New paper illustrates 1 key aspect that can reduce it substantially (spoiler: we still don't know value). Thread. https://science.sciencemag.org/content/sci/early/2020/06/22/science.abc6810.full.pdf …
        Show this thread
        2 replies 5 retweets 57 likes
        Show this thread
      3. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        This new paper is downright silly biologically. It assumes some fraction of the human population is fully resistant (i.e. cannot transmit, Rt=0) and shows graphs where this fraction is 50% of population. Then, big surprise, HIT is lower than if everyone is equally susceptible.pic.twitter.com/HtyTIAX3SI

        5 replies 11 retweets 77 likes
        Show this thread
      4. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        This paper might have been a fun math exercise on a rainy day when we were planning a picnic pre-COVID, but during a pandemic when we have hard data that shows the assumptions of the model to be false is worse than counterproductive. It's Ioannidis' territory bad.

        1 reply 28 retweets 202 likes
        Show this thread
      5. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        There are plenty of studies showing that the virus has swept through entire households (https://twitter.com/DiseaseEcology/status/1275870064181276672 …), and moderate fractions of larger groups of people -NYC- became infected despite societal lockdowns (https://twitter.com/DiseaseEcology/status/1253416781923794950 …).pic.twitter.com/FbNpdC79h6

        5 replies 6 retweets 62 likes
        Show this thread
      6. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        How then is it plausible to suggest that up to 50% of people might be resistant to infection? It's simply nutty. Authors amazingly conclude that the HIT might be 10% or less. Simply ridiculous. Seroprevalence is >10% in several small-med pops now.pic.twitter.com/klrJJH9zwh

        11 replies 13 retweets 103 likes
        Show this thread
      7. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        Note that this is the same 1st and last authors who proposed back in March that half of UK might already have been infected. Nicer people than me suggested they were just illustrating uncertainties that needed to be addressed with seroprevalence studies.https://www.medrxiv.org/content/10.1101/2020.03.24.20042291v1 …

        4 replies 14 retweets 81 likes
        Show this thread
      8. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        This follow up paper suggests they must have some very weird perspective on the world and aren't aware of the voluminous data that makes the assumptions they propose as reasonable clearly false.

        1 reply 7 retweets 80 likes
        Show this thread
      9. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        A Marm Kilpatrick Retweeted A Marm Kilpatrick

        Just for clarity (in case you didn't read my detailed thread on HIT: https://twitter.com/DiseaseEcology/status/1275595167936868352 …), I am NOT suggesting that HIT based on homogenous well-mixed models is correct. It is almost certainly an overestimate. But it's unknown whether it is 30% or 40% instead of 60% if R0=2.5

        A Marm Kilpatrick added,

        A Marm Kilpatrick @DiseaseEcology
        What is #herdimmunity threshold for #COVID19? A topic of much discussion due to large uncertainty & huge consequences for long term impact. New paper illustrates 1 key aspect that can reduce it substantially (spoiler: we still don't know value). Thread. https://science.sciencemag.org/content/sci/early/2020/06/22/science.abc6810.full.pdf …
        Show this thread
        2 replies 7 retweets 57 likes
        Show this thread
      10. A Marm Kilpatrick‏ @DiseaseEcology 16 Jul 2020

        But hard data show it is NOT <10%, and there is no mythical 50% of the pop that is resistant to infection.

        8 replies 7 retweets 101 likes
        Show this thread
      11. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        Addition: This thread takes a pretty harsh tone & I should be more careful to not make personal attacks. So I'd like to explain with less snarky but still very direct words why this paper is problematic, and why it's even worse that it comes from highly respected people at Oxford

        2 replies 1 retweet 23 likes
        Show this thread
      12. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        From early on in this epidemic, the biggest challenge has been a reluctance to take swift & substantial actions to limit the epidemic. The pandemic would be hard enough to control if we recognized it for what it was immediately. But we (US, UK, Italy, Spain, Iran, Brazil) didn't.

        1 reply 4 retweets 32 likes
        Show this thread
      13. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        The reason we didn't act immediately is because many of the larger actions (closing businesses, travel) had huge economic consequences, & if the threat wasn't real, it would be a bad idea to close unnecessarily. So we needed to be sure it would be bad.

        1 reply 1 retweet 25 likes
        Show this thread
      14. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        A Marm Kilpatrick Retweeted A Marm Kilpatrick

        (Business closures aren't only way to control #COVID19, as many countries have shown; we can & should be pursuing these alternate approaches. I wrote about this here: https://twitter.com/DiseaseEcology/status/1272271134696673281 … It is the most important thread I've ever written about COVID19. Please share widely.)

        A Marm Kilpatrick added,

        A Marm Kilpatrick @DiseaseEcology
        Is re-instituting lockdowns necessary to stop rapidly rising #COVID19 cases globally? Answer: No. But we're failing at 2 other approaches, due to poor messaging, human behavior & limited public health capacity. Deaths & lockdowns are unnecessary but we'll have both again. Thread
        Show this thread
        1 reply 5 retweets 19 likes
        Show this thread
      15. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        Early questions about COVID threat were less about transmissibility of virus & more about deadliness. Early work showed that reproductive rate, Rt, of virus was at least 2 & in some places might be 3-5, w/ a generation time of 3-7d. Infections could clearly grow very fast.

        1 reply 1 retweet 15 likes
        Show this thread
      16. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        A Marm Kilpatrick Retweeted A Marm Kilpatrick

        There was huge early debate about the fatality of #COVID19, primarily because of uncertainty about the fraction of infections that were asymptomatic, and confusion about the case vs infection fatality rate (CFR & IFR). I wrote about this here:https://twitter.com/DiseaseEcology/status/1252844190070829056 …

        A Marm Kilpatrick added,

        A Marm Kilpatrick @DiseaseEcology
        What is "fatality" of COVID19? Still lots of confusion out there about case fatality rate (CFR) and infection fatality rate (IFR). One is what you want to know but almost never gets reported (IFR) & the other one (CFR) is reported all the time but is nearly meaningless. A thread.
        Show this thread
        2 replies 1 retweet 14 likes
        Show this thread
      17. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        A Marm Kilpatrick Retweeted A Marm Kilpatrick

        There are now multiple rigorous estimates of age-specific IFR that correct for delays, test inaccuracies, etc. based on serological data or closed pops that make it very clear that COVID is deadly (>10x higher than seasonal flu (https://twitter.com/DiseaseEcology/status/1252844190070829056 …). Pop. IFR ~0.5-1.5%

        A Marm Kilpatrick added,

        A Marm Kilpatrick @DiseaseEcology
        What is "fatality" of COVID19? Still lots of confusion out there about case fatality rate (CFR) and infection fatality rate (IFR). One is what you want to know but almost never gets reported (IFR) & the other one (CFR) is reported all the time but is nearly meaningless. A thread.
        Show this thread
        1 reply 4 retweets 26 likes
        Show this thread
      18. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        For those wanting to dig into flu vs COVID deadliness here's a nice detailed article by @GidMKhttps://link.medium.com/tmJQWautc8 

        1 reply 7 retweets 30 likes
        Show this thread
      19. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        A Marm Kilpatrick Retweeted A Marm Kilpatrick

        Debate has now shifted about what fraction of people are likely to get infected if we don't shut down businesses. This discussion involves both the herd immunity threshold (HIT) and "overshoot". I wrote a detailed thread about HIT & overshoot before:https://twitter.com/DiseaseEcology/status/1275595167936868352 …

        A Marm Kilpatrick added,

        A Marm Kilpatrick @DiseaseEcology
        What is #herdimmunity threshold for #COVID19? A topic of much discussion due to large uncertainty & huge consequences for long term impact. New paper illustrates 1 key aspect that can reduce it substantially (spoiler: we still don't know value). Thread. https://science.sciencemag.org/content/sci/early/2020/06/22/science.abc6810.full.pdf …
        Show this thread
        1 reply 1 retweet 11 likes
        Show this thread
      20. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        This is essentially a return to the discussion of "should we (continue) to close businesses?". If we are at or near HIT, then transmission will be lower & we don't need to close businesses. But if we aren't then cases will rise again, and more rapidly if Rt>>1.

        1 reply 2 retweets 12 likes
        Show this thread
      21. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        Cases are rising rapidly in many US states and countries around the world despite some mask use & social distancing recommendations, so it's clear we're nowhere near HIT in these places. NYT separates states by increasing vs decreasing. Almost all are inc.pic.twitter.com/fSGllzOjQx

        1 reply 2 retweets 17 likes
        Show this thread
      22. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        Despite this, many US states (and countries) still do not take rapid action to slow transmission. Businesses in which transmission risk is high & cannot be made safe (e.g. bars) are still open. People think its safe to gather. Masks are still recommended but not required.

        1 reply 1 retweet 20 likes
        Show this thread
      23. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        A Marm Kilpatrick Retweeted A Marm Kilpatrick

        When papers like the Oxford study are published they offer a smokescreen for politicians to stand behind while their citizens become sick & die when they could have taken action to protect them (& their jobs: https://twitter.com/DiseaseEcology/status/1272271134696673281 …).

        A Marm Kilpatrick added,

        A Marm Kilpatrick @DiseaseEcology
        Is re-instituting lockdowns necessary to stop rapidly rising #COVID19 cases globally? Answer: No. But we're failing at 2 other approaches, due to poor messaging, human behavior & limited public health capacity. Deaths & lockdowns are unnecessary but we'll have both again. Thread
        Show this thread
        2 replies 6 retweets 30 likes
        Show this thread
      24. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        The fact that authors are very well-respected & from Oxford makes it much easier for politicians to claim the pandemic is almost over and we should just "try to get through it".

        1 reply 2 retweets 23 likes
        Show this thread
      25. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        Mathematical models have played a unique role in this pandemic in showing us how bad things can get (& how quickly) if we don't take swift action. Models like the Oxford study do the reverse. They suggest - against all evidence - that we can do nothing and infections won't rise.

        2 replies 1 retweet 19 likes
        Show this thread
      26. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        The opposite is clearly true. The skyrocketing cases and associated rising deaths (that come a month later) are clear proof that we are nowhere near herd immunity and to suggest otherwise is both patently false and dangerous.

        1 reply 5 retweets 20 likes
        Show this thread
      27. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        The flawed science in this preprint will be used to justify actions that cost peoples' lives & continued transmission that hurts the economy & society. The authors are very intelligent people employed by a highly respected institution, and they should know better.

        1 reply 3 retweets 31 likes
        Show this thread
      28. A Marm Kilpatrick‏ @DiseaseEcology 17 Jul 2020

        So while I sincerely apologize for tone in tweets above that came across as a snarky personal attack, I strongly stand behind my criticisms of both the flawed science and the lack of responsibility on the authors' part.

        6 replies 0 retweets 33 likes
        Show this thread
      29. End of conversation

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