Peter English #FBPE
@petermbenglish
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Public health Dr, recently retired. Interests in vaccination and health intelligence. Tweets may not even express my own views!
Epsom, UK
Joined April 2009
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Last Seen Profiles
When I graduated in 1984, and became a junior doctor, I had to pay my GMC membership, professional indemnity insurance, and for ongoing professional exams and Royal College membership. Just as junior doctors do now. BUT…
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1/ I have been married for 35 years, and my wife, Doro (
@Fifino9
) died this morning.
Long, raw thread…
In 2010, Doro found a lump in her breast. Lumpectomy, chemo, radiotherapy, hormone treatments (and consequent spotting and endometrial cancer scare) followed.
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Some viruses are cancer-causing ("oncogenic"). HPV and anogenital and head and neck cancers, Hepatitis B and C viruses and liver cancer; Epstein Barr virus and lymphomas etc…
I'd be surprised if SARS-CoV-2 doesn't join the list.
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"Mandatory wearing of masks [on public transport]… during peak hours reduced infection rates by 93.5%…"
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…But, as a junior doctor in the 1980s, I had no "student debt". Like nearly all my colleagues, I'd had a government grant to pay my fees and living expenses.
And I had free hospital accommodation for the first three years…
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Junior doctors work nowadays is more unpleasant.
Constantly short-staffed and under-resourced, they cannot plan leave, and they cannot do their jobs properly.
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…and then, when I bought a house, house prices were much more affordable.
Today's junior doctors have to pay for hospital accommodation, and much more than I did for their own house or flat.
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…Many junior doctors now gave to pay to park at work (and work hours that prevent many from using public transport). They have to pay all the professional and exam fees I had to pay.
They graduate with enormous student debts after their long university courses.
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And, on top of all that, junior doctors have had their pay eroded over a decade or more, so they earn a lot less than I did (per hour - and, on paper, they work many fewer hours than I did - no 1 in 2 rotas now - although most routinely work many additional, unpaid hours).
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On
@TimesRadio
I just compared the PM's approach to Covid-19 to Lord Farquaad in Shrek: "Some of you may die, but that's a sacrifice I'm prepared to make".
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The 1 in 2 rotas I worked sound dreadful - it means that I ADDITION TO routine "9-5" (plus the obligatory unpaid extra hours for start- or end-of-day ward rounds etc) have an appalling deal, you are on duty every second night and weekend.
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1/ The presenter on
@BBCRadio4
's 5pm news programme,
@bbcpm
, asked a scientist about a libertarian argument. "A libertarian would say, 'If I don't get vaccinated, I'm the one whose going to suffer; why isn't it OK for you to let me make that decision for myself?'"
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But the less often you were on call, the busier you would be. On a 1-in-2 rotas, you'd often only be covering one other doctor's patients, so there wasn't so much to do out of hours. On a 1-in-5 rota, you'd be run off your feet all the time.
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60/ I keep getting messages or things happen, and I find myself thinking "I must tell Doro about that". I even found myself thinking "I must tell Doro how I keep wanting to tell her about things and then realising… oh, wait…".
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1/ There's been a lot of talk about Covid-19 becoming "endemic".
Which means it circulates normally.
It doesn't mean "trivial" or unimportant.
(Long thread.)
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My nine year old nephew has had his first dose of Covid-19 vaccine.
He lives in USA.
What a shame people his age in the UK are denied this protection.
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The BBC has objected to being described as state media.
I just heard the news report on the doctors' strike.
Entirely one-sided, repeating government lies about preconditions preventing negotiations, reporting demands for pay rises without explaining it's only pay restoration…
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We know SARS-CoV-2 can infect the brain.
So can measles, which occasionally causes SSPE - a progressive and invariably fatal brain disease, which typically becomes apparent years after measles infection.
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1/ I've just tweeted two twitter threads - from
@dgurdasani1
and
@DrEricDing
- about "highly pathogenic avian influenza" (HPAI) virus spreading in cattle and on to humans.
This is a step along the path to epidemiologists' nightmare scenario.
There are many strains of influenza.
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1/ Regarding infections in schools, a colleague has pointed out that it is Department for Education directives that require schools to stay open, not PHE advice.
I am aware of this.
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This would mostly have been avoided if 12-15 year-olds had been vaccinated in July/August (as they could and should have been), and if ventilation, masks, and air filtration put in place over summer.
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If I'm right (and I hope I'm not) it will likely take at least a decade for any such cancers to become diagnosable.
My point is that we shouldn't be complacent about minimising infections now, as we don't know the consequences (& we already have evidence of long-term sequelae)
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Johnson. "This pandemic is not over."
But the government's half hearted attempts to manage it are over.
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Priti Patel has "authorised" border force to "turn back" small boats.
Apparently this is because "British people expect results.
It means many people drown.
It is barbaric.
We are not a nation of barbarians,
@pritipatel
.
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That's one reason why I worry so much about the "children aren't at risk" messaging. It will be years before we will be able to say this with confidence.
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"Learn to live with the virus."
An expression usually used by people who really mean
"Fail to learn anything but, rather, tolerate unacceptable levels of AVOIDABLE Covid-19 mortality and morbidity."
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"Mild" Covid disease means "didn't die or require hospital treatment". Might still have had a week of fever and prostration.
As hospitals fill up, prioritisation will mean you have to be sicker to get admitted.
So the disease will become "milder"…
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I'm delighted that my 6yo granddaughter will be getting the first of two doses of Covid-19 vaccine soon. She brought the information and consent forms home today!
I'm sad that her UK-resident peers won't be getting this too (yet). She lives in Vienna.
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@
Vaccinating children 5+ is NOT a difficult decision. The very cautious US regulator approved this in October, and we now have oodles of real world data. It is safe and effective.
Prevarication undermines, rather than increasing, public confidence.
@BBCWomansHour
@Emmabarnett
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50/ We were able to say our goodbyes; to apologise for our failings to each other; and to assure each other we had always loved each other, and that our lives had been enriched through our marriage.
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BBC news banging on about how "both sides" in the negotiations between EU and UK will "need to compromise".
Why should EU give in to the UK's unreasonable demands?
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59/ …say.
Her death was peaceful and comfortable. We all cried and said our goodbyes.
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@trishgreenhalgh
And communicable disease experts like me were forced to
1 implement this insane policy
2 keep stum about how insane it was.
Do you wonder I'm glad to have retired, having been forced to betray all ethical principles by Jenny Harries?
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@perkleberry
@Richard_GP
I remember when my kids were small feeling a bit threatened by teenagers and nearly-teens. Then my own kids became teenagers. All their friends were lovely. Of course, there'll be the odd one, but on the whole, they're great.
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What an appalling interview from Sajid Javid starting a few minutes ago on
@BBCr4today
.
He is clearly incompetent, way out of his depth. I've seldom heard a minister say so many stupid things in a single interview.
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3/ In other words, you're twice as likely to infect somebody else if you don't get vaccinated, than if you do.
If the person you infect gets sick or dies because you refused to get vaccinated, that's down to your decision. They didn't decide to stop you from being vaccinated.
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17/ The government's recklessness about Covid prevention - ending protections such as mandatory masking, while disease and transmission rates were still high - meant we had to isolate ourselves and be scrupulous about protecting ourselves with FFP2 masks (although as she became…
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Deepti's absolutely right. The Today programme
@BBCr4today
had people queueing up to cite discredited Great Barrington Declaration cant to justify letting the virus rip, with virtually no pushback.
Antiscience; anti-common sense, wishful thinking. Great disservice to the nation.
I honestly cannot believe that we're living in a country where our govt is acting against scientific advice once again, and delaying action on rapid exponential growth, fully aware of the consequences- for the fourth time- a stance normalised by a complicit media.🧵
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@edpetrie
Same here! My wife is German, the children (& wife, expensively) dual nationals & I am FURIOUS.
This has caused us immense distress; & for what? So rich bastards can avoid paying their taxes, & racists can feel validated.
Nothing positive comes out of Brexit, only bad things.
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58/ Doro was frightened of dying - particularly that it might be painful (as far as I'm aware, the worst pain was from the tight mask on Tuesday morning), comforted by the care and by the delightful Father Philip; and she indicated that she had said all she wanted and needed to…
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2/ There wasn't much time for an answer; and the virologist probably wasn't prepared, so let me have a go.
If you get vaccinated, you're roughly 1/3 as likely to infect somebody else. They might be one of the ones who couldn't get vaccinated, or in whom the vaccine won't work.
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6/ "This is my public health advice… I understand that you are not obliged to follow it, and indeed may be required not to do so by DfE policy; but I do nevertheless expect to document that you have received and decided to go against my advice."
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8/ Let me tell you about my friend with cancer.
He was in agony for months, because he couldn't get his operation.
Why couldn't he get his operation? Because all the ICUs were full of patients with Covid-19.
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@PeteDeveson
@Fifino9
Thanks, Pete!
I read "your wife was really cool", and immediately thought, "I must tell Doro…"
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4/ The same applies with masks. Masks are good at preventing the wearer from infecting others. Not 100%, but still good - see this thread: .
LONG THREAD on masks. Mute if not interested.
Do masks work? Why do some people claim they don’t work? Do they cause harm? What kinds of masks should we wear? How does masking need to change now we know that Covid is airborne? When can we stop wearing them?
Get your popcorn.
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18/ Perhaps we should copy Singapore and require people who refuse vaccination to pay for their own Covid-related healthcare.
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"The prime minister said it would be "folly" to think the pandemic was over…"
And also, that it would be folly to do anything more to prevent the massive problems that are predicted.
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About a century ago something - almost certainly virus - caused an epidemic of encephalitis lethargica.
How do we know that SARS-CoV-2 won't do something similar, possibly years after infection?
The answer is that we don't. It might do this.
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51/ She was able to thank our wonderful children, and tell her she loved them, and they could do the same.
Our son and granddaughter in Vienna were not excluded - phone calls and voice messages left by them filled the gap.
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Hey,
@BBCStrictIy
will you please STOP showing people wearing eye-protection visors without masks.
This is useless for Covid-19 protection; yet viewers will conclude otherwise.
This is damaging to our public health messaging.
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57/ The medical and nursing care were exemplary.
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@AdamJSchwarz
WHY DO WE NOT LEARN!
OK, we did a lot worse before - we seeded delta across the UK more and earlier by dithering about India.
But still, this should have been "As of now", not "From a few days' time".
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7/ The people you infect as a result of refusing to wear a mask didn't choose for you to refuse to wear a mask. Other people suffer because you refuse the minor inconvenience.
And it doesn't stop there.
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By insisting that most staff wear only gappy, ill-fitting "FRSM" masks, rather than FFP2 or FFP3 ones,
the NHS is not only failing to give staff adequate protection, but also
modelling inadequate masks as "best practice" for the public.
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9/ After a major operation, many people need a short ICU stay - one and a half days or thereabouts, maybe three or four days after a particularly big operation.
Patients with Covid-19 who are admitted to ICU are typically there for three or more weeks.
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11/ Why don't we just open up more ICU beds?, you ask. But we can't magic up more ICU beds. It's not the physical equipment etc. - it's the highly specialised staff required; they can't be created from nowhere.
So each Covid patient will prevent operations from being done.
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IDS on
@BBCr4today
repeating statements which are simply untrue.
This is antiscience propaganda, and very dangerous.
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1/ People with a Great Barrington Declaration bent ("don't do anything to control Covid-19 and hang the consequences - who cares how many people will die...") are now attacking the rest of us for saying we should continue to do what we can to control the disease.
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It's been hard, since months, to understand the UK decision to leave 5-11yos unprotected.
This paper will make it even harder for decision-makers to justify their current position.
With rising hospitalizations due to Covid in 5-11 year olds, this study is timely
The vaccine is very safe; trials showed a 91% reduction in symptomatic infection
Study conclusion: “Vaccination is the most effective way to prevent COVID-19 infection”
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Is "operation Moonshot" a reference to how far people have to travel for a test?
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2/ At about the time of the original diagnosis, Public Health England blighted our lives, falsely blaming me for errors over the Godstone Farm E coli outbreak, damaging my reputation, and putting my career on hold for five years, for more senior people's mistakes.
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28/ She was desperate to hang on to life for as long as possible, not least as she so enjoyed seeing our delightful, just-turned-one grandson.
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20/ The libertarian "it's my right…" argument has to be balanced against the harm you cause to other people.
And if one particular individual never goes on to infect another person, or to require ICU care - does that invalidate my arguments?
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@SammiMckean
@andrewgregory
@TheBMA
People can choose to avoid the pub.
On the bus you can infect vulnerable people, who may have no choice but to be exposed to you.
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6/ (And don't tell me you'll wear a mask if you think you might have Covid-19. Most people are infected by somebody who didn't know they were infectious.)
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2/ Before I retired in January a complaint was made against me by the education sector for refusing to change my advice that a school or section of a school should close because of an outbreak of Covid-19 that was putting staff, other students, and their families at risk.
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4/ I do hope that PHE staff are not giving up on giving the right public health advice because they know it is unwelcome (and complaints are stressful, no matter how vexatious they are).
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5/ They're not as good at protecting the wearer - certainly not unless the mask is an FFP2 mask or better. So, if you refuse to wear a mask, it makes relatively little difference to you (unless you would have worn an FFP2 or better mask), but you are more likely to infect others.
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48/ Despite having lived as an atheist most of her adult life (brought up Evangelisch - protestant Luteran), she accepted the offer of a Christian priest coming to pray with her. A lovely, South Korean Roman Catholic priest, Father Philip came.
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17/ Why should taxpayers fork out the >£1500 per day, plus drugs and then rehabilitation costs because you exercised what you perceived to be your right to remain unvaccinated?
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22/ We're worrying about the fact that vaccine- and mask-refusers are a significant minority, and on average they harm other people.
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49/ He made her - and all of us - laugh; and she told us all she'd found his visit very comforting.
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I got in a plug for
@cv_cev
and promoted mask-wearing.
Retired consultant Dr Peter English says "we should continue wearing masks" as plan B measures are axed.
"No matter how much we would like to think the pandemic has gone away, there will be another variant. It's not difficult to wear a mask."
@iancollinsuk
|
@petermbenglish
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55/ Shortly before 11 am she took her last breath and, about a minute later, her heart stopped beating.
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56/ We - our three grown-up children and me - spent some time at her bedside, then went into Epsom's Caballo Lounge for food (we had not had time to eat properly the previous day or in the morning); then went back to the hospital to say our final goodbyes on the ward.
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Who was Health Secretary when the London Public Health Laboratory, which provided the backbone of the virology testing in the H1N1 flu pandemic, and so many other PHLs were closed? Despite our concerns for the next pandemic?
You were,
@Jeremy_Hunt
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10/ [Actually, the average length is only about 13 days, according to - although it's highly skewed by patients who die; it's the ones who survive who are there for many weeks).
So each Covid patient will prevent several operations from being done.
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9/ As well as multiple lung mets, she had extensive bony mets in the ribs, skull, scapula, pelvis, sacrum, foot; and more in her liver.
This was distressing.
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16/ But what about all the people denied urgently needed care because of you?
What about the vast cost of your care?
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12/ Operations for people living in agony, needing hip operations.
Operations for people needing life-saving cancer operations.
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14/ But the delay meant a much larger, longer, and more damaging operation, leaving him far more impaired, and requiring far more NHS resources than would have needed to be the case if it could have been done promptly.
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Again,
@BBCr4today
presenter is telling a professor that there is "evidence" that disease caused by the Omicron variant is relatively mild.
What evidence?
It's wishful thinking.
Saying it undermines public health measures.
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14/ The pandemic could not have been worse-timed for us. We would have loved, while she was well enough, to enjoy ourselves. She has always enjoyed travel.
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3/ In 2019 Doro had some abdominal pain. She'd been discharged from the cancer hospital and the "contact us if you need us" service assured us that, this long after the treatment, it was highly unlikely to be related to the cancer diagnosis. A gastroscopy showed no pathology.
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5/ In Jan 2020 my wife went to Heidelberg (she proudly comes from the Black Forest in South West Germany), to visit her ageing and ailing aunts; she was very busy and energetic.
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15/ And he was one of the lucky ones. Many other cancer patients will die for want of alife-saving operation. )
If you refuse to get vaccinated, you get Covid, and you need critical care - well you and your family will suffer, but I guess you've made your choice.
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@HzBrandenburg
@Fifino9
The UK test is a memory test. Meaningless trivia.
It is utterly pointless - except as a political exercise to convince Daily Mail readers (and others of a similar racist persuasion) that there's a "tough" test for would be citizens.
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10/ I was in the middle of working on the first UK cases of Covid-19 I was also Chair of the BMA's Public Health Medicine Committee.
I took leave while we worked things out.
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Interesting but not surprising to see few if any tories wearing facemasks.
It's almost as if they believe wearing a facemask is a sign of cowardice, rather than a way of protecting others from your germs if, without knowing it, you're infectious.
Complete lack of compassion.
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8/ I wondered if she'd had a cardiac event or a PE. We called a taxi and went to the nearest AED.
She had a collapsed lung lobe, due to metastases.
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15/ We have happy memories of holidays in USA, Brazil, Tunisia Greece (a favourite of hers) and the Canary Islands; and if it were not for the pandemic, we would have travelled more, while she was well enough.
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21/ No, it doesn't, because, ON AVERAGE, people who remain unvaccinated are more likely to get sick and fill ICU beds for long periods, and more likely to infect others.
We're not worrying about just one person refusing to get vaccinated or to wear a mask.
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7/ We had lunch first, and Doro, who had been a bit quiet, trailed behind us as we moved on to the museum. We went into the museum, and she peeled off to sit down.
I then got a text from her - she had persistent tachycardia and breathlessness.
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31/ She had her next two doses of chemo - now on a three-week cycle of Vinorelbine tablets; tablets taken (on Wednesday) on weeks one and two, if the bloods showed her white blood cell count to be sufficient (cytotoxic chemotherapy can reduce this), and week three off.
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18/ …more breathless she found these intolerable).
Her function gradually deteriorated. The capecitabine made walking difficult and painful, but we still went for regular, if increasingly slow, walks around the neighbourhood.
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13/ (My friend was lucky. He did, eventually, after a long, anxious wait, in agony, he had his operation to remove his tumour and the parts of him it had attached to, and to get patched up so he can just-about-function, albeit with ongoing neuropathic pain, ulcers, and stomata.
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"…repeated infection is the only route to herd immunity"
I vigorously disagree! A very dangerous and defeatist line from an author of the discredited Great Barrington Declaration.
"Vaccines were never a route to eliminating Covid entirely"
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16/ Knowing that her lungs were compromised, she was terrified of catching Covid-19.
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3/ The complaint went nowhere - I was giving the right public health advice, no matter how awkward it was.
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