Experment: Surface Best COVID19 threads from @ThreadReaderApp

30 Sep
We desperately need these rapid tests for infectious covid (not PCR for infected). The rationale and the obstacle (FDA) laid out so well by @michaelmina_lab, @DanLarremore, Roy Parker @CUBoulder in today's @NEJM nejm.org/doi/full/10.10… ImageImageImageImage
In today's superspreader/overdispersion piece by @zeynep (the best, comprehensive one on this topic to date), she also reviews how important these cheap, frequent, rapid turnaround tests can prevent such spread
theatlantic.com/health/archive… @TheAtlantic ImageImage
When you combine this w/ @ScienceMagazine yesterday on PCR tests (CT, cycle threshold) you realize that the testing we have today, mostly detecting infections but not infectious, are way off the mark.
We should all have had the home rapid tests months ago!
Read 5 tweets
30 Sep

1. If your headline isn’t “Hey, I’m in charge of the racists,” then I’m not reading your summary.
2. Biden told Trump he was the worst president ever.
3. I wouldn’t let that guy in my house. I’d call the cops if he was in my neighborhood. And if he started insulting someone’s family in a bar in any local class bar, they’d have to intervene.
Read 8 tweets
30 Sep
Going to try to fact-check what Trump says on COVID.

Wish me luck.
"It is what it is because you are who you are."

Fact-check: Yup, as I told Vox back in March.

Trump says if the country had listened to Biden, the country "would have been left wide open."

False. Biden didn't speak against the China ban, and when Trump banned EU travel, Biden rightly pointed out that the ban was not a substitute for a plan:
Read 13 tweets
29 Sep
We're now passing very sad milestone of 1 Million deaths from COVID in the world. Its worth thinking about what is working effectively internationally, and what isn’t, esp in terms of global cooperation and systems. Here are some thoughts on that: 1/x
.@WHO and most countries in world have joined together to jointly plan and buy vaccine via the COVID-19 Vaccines Global Access [COVAX] Facility. There has never been an effort like this before. This has potential to do enormous good. pulitzercenter.org/reporting/who-… 2/x
If it succeeds as planned, it'll accelerate vaccine development + allow access to vaccine to high income + low income countries. But it'll require substantial fundraising. Unfortunately neither China nor US are partners in it, which is leadership failure on both their parts. 3/x
Read 14 tweets
29 Sep
The first Lancet COVID-19 Commission Statement is 👉bit.ly/345MP7T Here are our 10 priority actions:
1. Track down the origins of the virus in an open, scientific, and unbiased way not influenced by geopolitical rivalries.
2. Continue to suppress the epidemic through a proven package of non-pharmaceutical interventions—and learn from countries in Asia-Pacific.
Read 11 tweets
29 Sep
Instead of working like hell to establish conditions for safe resumption of in-person schooling, the White House put all energy into denying any risk existed.

Resulting national failure to prioritize reopening schools is as big a scandal as anything in our political lifetimes.
As @AlecMacGillis writes, the failure to open schools is doing real damage.

Even in my own privileged household, we see the harm it does to our kids.

Then we go down the street and see MD bars and restaurants open. It's infuriating and indefensible. propublica.org/article/the-st…
What the bars vs schools contrast - which is mirrored across much of the country - reveals is a failure to sanely prioritize reopening.

Which in turn flows from a failure at the federal level to establish clear guidance and communicate relative risks.
Read 14 tweets
29 Sep
White House press conference today on 150M Abbott rapid antigen tests. whitehouse.gov/briefings-stat… Some reactions to what was said at the event: 1/x
As background: coming arrival of the Abbott rapid antigen testing was previously announced by White House on Aug 27th. washingtonpost.com/health/white-h… 2/x
150M is substantial number of Ag tests. Their arrival will be very welcome. Important to plan for how these and other Ag tests coming on line should best be used. It’s a very big supply of testing, but not enough to meet range of potential public and institutional needs. 3/x
Read 15 tweets
29 Sep
1/ Covid (@UCSF) Chronicles, Day 195

As a politics junkie, I spend much of each day refreshing the election projections @538politics (tinyurl.com/y4vqs85a; it currently has Biden at a 78% chance of victory).
2/ While @NateSilver538’s model has many variables, I’m guessing it’s missing one of the most important: Covid status in swing states. That’s today’s topic.

I’ll focus on the 8 states that 538 deems the most likely to be tipping points: PA, FL, WI, MI, AZ, NC, OH, and NV.
3/ My thesis: in a close race, whether Covid is front of mind may determine whether persuadable voters base their votes on Trump’s handling of Covid, or on other things.

The fact that the US is likely now starting its 3rd surge (whether in your state or not) should be enough…
Read 25 tweets
29 Sep
I feel it is important to call out misunderstandings about what 'herd immunity' means. It is clear from this little thread that @TheEliKlein has no idea. I'm not trying to be mean, just to correct a decidedly... odd take. I hope he'll end up understanding it a little better 1/n
First, I am going to ditch the phrase 'herd immunity' because bluntly it annoys me and it understandably makes folks indignant about being compared to cattle. We will use population immunity instead 2/n
There are lots of very clever (too clever by half imo) takes on how few people you might actually need to have immunity in order to exclude the virus from a community. That's what the term means by the way, not just *slowing* it 3/n
Read 15 tweets
28 Sep
It's pouring on now:
"#Trump's Taxes Show He's a National Security Threat
What trade-offs would a president with this level of indebtedness be willing to make to save face?"
(His financial needs mean he will sell out the nation motif)
"It was the moment when Donald #Trump's 'Art of the Deal' fabulism, billionaire tycoon bluster and populist standard-bearing for forgotten Americans was revealed to be what it always looked like: a sham."
(Emperor has no clothes motif) MORE
"But the eyes that really matter are the federal and state tax authorities charged with reviewing whether or not Trump and the Trump Organization broke tax laws.
And whether the President could possibly go to prison."
(The lock-him-up motif)
Read 12 tweets
28 Sep
VACCINE EFFICACY 101: A biostatistician's primer

Ten tweets to cover:

- How is vaccine efficacy calculated?
- Distinguishing between infection, disease, & severe disease.
- Measuring reduced infectiousness.
- Vaccine efficacy vs. effectiveness!
2) Vaccine efficacy (VE) measures the relative reduction in infection/disease for the vaccinated arm versus the unvaccinated arm. A perfect vaccine would eliminate risk entirely, so VE = 1 or 100%. This can be calculated from the risk ratio, incidence rate ratio, or hazard ratio. Image
3) Vaccine efficacy of 50% roughly means you have a 50% reduced risk of becoming sick compared to an otherwise similar unvaccinated person. Or you have a 50% chance of becoming sick given that you were exposed to enough infectious virus to make an unvaccinated person sick.
Read 10 tweets
28 Sep
“Last week we reached an important milestone in which, @WHO issued the first Emergency Use Listing for a quality antigen based rapid diagnostic test, and we expect other rapid tests to follow. ”, says @DrTedros at #covid19 presser.
@WHO @DrTedros Good news: 120 million of these tests will be made available to low- and middle-income countries, to "enable the expansion of testing, particularly in hard to reach areas that do not have lab facilities or enough trained health workers to carry out PCR tests”, says @DrTedros.
@WHO @DrTedros These tests are cheaper ("priced at a maximum of 5 US dollars per unit”) and faster (15-30 minutes) than PCR, says @DrTedros. "The quicker #COVID19 can be diagnosed, the quicker action can be taken to treat and isolate those with a virus and trace their contacts."
Read 10 tweets
28 Sep
NEW: The loss of credibility in CDC has sent morale to all-time low. “The worst is the silence,” one scientist said. “You can’t explain what’s going on, correct mistakes, clarify things quickly before they spin up and out of control.” Me + @joelachenbach wapo.st/30hUXkC
@JoelAchenbach 1/ Career staff at CDC remain proud of the expertise, talent and professionalism that the agency can bring to bear in a crisis. But they see the agency’s situation clearly.
@JoelAchenbach 2/The CDC has endured false accusations and interference by Trump administration political appointees, leading to loss of institutional credibility at a time when the nation desperately needs to know whom to trust.
Read 6 tweets
28 Sep
1) SARS-CoV-2 Vaccines - I promised a Tweetorial and here we go. This is going to be long and nerdy. But I'll make sure it is easy to understand. If you want more details, please just read this: nature.com/articles/s4158…
2) I'll try to give an overview of the process, the technologies, correlates of protection, the candidates, how they perform in non-human primates and what we know about their performance in humans so far.
3) Let's start with the process. Developing vaccines usually takes a long time. Usually there is a medical need and some idea of how to design the vaccine, often in an academic lab. Versions of the vaccine are tested in iterative processes, the constructs are optimized....
Read 138 tweets
28 Sep
Some thoughts on wastewater (sewage) testing...
Of most benefit when used in an area with no known cases. Lets us look for a signal that virus is somewhere in that region. Pop-up testing may then be deployed to get a better idea of the situation
💩Mature technology?
Methods/usefulness still being evaluated.
What does a positive mean? How often are false negative/positives likely? Which PCR-based tests are best? What processes in place to confirm wastewater positive result & what response will that trigger if confirmed?
💩Do all agree?
Full spectrum of responses to wastewater testing, from exuberance to dismissal. I think time and continued refinement of the methods will tell which was the best position. As with everything in this pandemic, we're learning many new things as we go.
Read 7 tweets
27 Sep
Many important things happened related to COVID in the US this past week. Here are some of the good and some of the not-good developments, and their implications. First, here are some of the good: 1/x
J&J started large (60,000 person) phase 3 trial of its vaccine. Its 1 dose only, which distinguishes it. Safety + efficacy results by early 2021. Storage requirements (-20 C) are compatible w/ standard vaccine distribution approaches. Very good. 2/x fiercebiotech.com/biotech/j-j-st…
This is more forward progress from Op Ward speed collaboration btwn gov & vaccine makers. Potentially invaluable for fight against COVID. Important to let trials and regulatory process proceed safely, so people don’t lose confidence in what could be most helpful tools. 3/x
Read 20 tweets
27 Sep
Its been nearly 3 weeks since Labor Day

We were all worried about surge after holiday

Has it happened?

Actually, yes

Data here pretty clear

First, here’s a graph of the number of new daily cases (y-axis) over past month

7-day moving averages

What does this mean?

Cases slowly declining as we entered September

Labor Day weekend 9/5-7

If holiday set off new infections...you’d expect to see cases rising 5 to 7 days later (around 9/12)

That’s exactly what we see in graph

So 2 weeks ago, we were at 34K/day

Today, at 44K/day

Up 30%

39 states have more cases today than just 2 weeks ago

31 states have higher % of tests returning positive

And 16 states have % test positive > 10%

That’s not great. Those 16 states are missing a lot of infections

But patterns vary across states. So let’s dive in

Read 10 tweets
26 Sep
COVID Update September 26: The highway day of new cases in over a month.

But the president is not talking about that. 1/
With 200,000 lives lost, it would be great to say the worst is behind us. All I can say is the worst is still in charge. 2/
A new study shows 9% of Americans have been infected with COVID. Despite the fact the Rand Paul believes otherwise, we are no where close to herd immunity. 3/
Read 22 tweets
26 Sep
Tomorrow's @thesundaytimes. Data is clear. Political & societal decisions on what to do extraordinary difficult. Very little room for a middle way that keeps things open & also prevents transmission, illness & COVID/NonCOVID deaths. Needs a national debate thetimes.co.uk/article/no-fud…
Not possible keep society & economy open as now & suppress transmission,prevent hospitalisations & deaths COVID & non-COVID & pressure on NHS. Anyone suggesting there are easy political decisions or possible to open society & economy & control epidemic is doing a great disservice
Need urgent national debate & political decisions to be made & fairly binary choice:Open up society & economy but accept higher transmission,hospitalisations & deaths vs further restrictions implemented now, reduce transmission, keep schools open & reduce COVID illnesses & deaths
Read 8 tweets
26 Sep
Why did we write a letter to a vaccine company about the need to complete its Phase 3 trial and provide compelling proof of its safety and efficacy?
Letter aboutblaw.com/TnB
An explanatory thread 1/
Normally this process would be straightforward. But these are anything but normal times.
@Pfizer has its 1st interim analysis next week of 32 events (which include mild infections, such as a sore throat or headache +PCR virus). It has its own Data & Safety Monitoring Board. 2/
That DSMB has only 5 members. It could decide to stop the trial due to a predefined efficacy threshold (≥ 26 events w/placebo). It reports to Pfizer. The Pfizer CEO has said @FaceTheNation that its trial will have enough #COVID19 cases to apply for approval by late October. 3/
Read 15 tweets
26 Sep
Round 3?
Half the states "Uncontrolled Spread"
Notables with very high positive test rates
Florida is fully opening
Read 5 tweets
26 Sep
A #SaturdayThoughts 🧵 on a common #Flu FAQ.

Q: What about people who get a seasonal flu vaccine and still get sick with flu symptoms?

A: There are several reasons why someone might get flu symptoms, even after being vaccinated against flu...👇🏽
(1/?) cdc.gov/flu/prevent/mi…
One reason is that you can become ill from other viruses besides flu- e.g. rhinoviruses, which are associated w/ common cold, cause symptoms similar to flu, & also spread and cause illness during #flu season. The flu vaccine only protects against flu, not other illnesses. (2/?)
A second explanation is that you can be exposed to #flu viruses shortly before getting vaccinated, or in the 2 week period afterwards that it takes to develop immune protection. This exposure may mean you become ill with flu before protection from vaccination takes effect. (3/?)
Read 7 tweets
25 Sep
COVID Update September 24: Today I ask the question what fills you with hope?

I have a bunch I received. Feel free to browse and add yours. Or save this for when you need it. 1/ Image
Life goes on. With gusto. 2/ ImageImageImageImage
There is fight left in all of us. ImageImageImageImage
Read 10 tweets
25 Sep
Covid Epi Weekly: People are tired of fighting the virus, but the virus isn’t tired of infecting people

As parts of Europe and the US show, turn your back on Covid and it will come back to bite you. Cases trending up again in many states, likely to hit 50,000/day in October.
2/9 Trends in positivity are getting harder to track. Per Covid Tracking Project, only 9 states documented to follow best practice of reporting antigen & PCR tests separately. (States should also report unduplicated people positive/tested, crossreferencing the two types of test.)
3/9 What starts in the young doesn’t stay in the young. @MMWR reports young adult infections were followed a week or two later by infections in people over 60. We are all connected. The sooner we recognize that, the sooner we can move forward more safely. bit.ly/369yrOu
Read 9 tweets