Experiment: Surface Best COVID19 threads from @ThreadReaderApp

Aug 9
When COVID emerged in 2020, one of the serious obstacles to control was that—unlike with the original SARS virus—people tended to be infectious before they showed symptoms. As a result, we couldn't rely on symptomatic screening to slow the spread of disease.
My sense is that presymptomatic transmission is probably less likely today than it was in back then. Due to some combination of the new strains and immune exposure by vaccine or infection, today many people seem to be exhibiting symptoms before testing positive on antigen tests.
This means that (1) symptomatic screening can be a useful control measure and (2) a negative antigen test upon initial onset of symptoms does not rule out COVID.

I suspect that one of the most useful things we could all be doing at this point is to be taking symptoms seriously.
Read 5 tweets
Aug 8
Important #monkeypox paper was just published in @TheLancet, so a quick thread…

Full paper is here: thelancet.com/action/showPdf… Image
@TheLancet The study, run by @oriolmitja and others, enrolled 181 consecutive patients at three hospitals in Madrid and Barcelona.
As usual, over 90% were men who have sex with men. You can see a breakdown of the participants here: Image
@TheLancet @oriolmitja More than a third of patients required medical treatment:

"Complications that required medical treatment were described in 70 (39%) participants, most frequently pain relief for proctitis, tonsillitis, and in participants with anal lesions."
Read 12 tweets
Aug 8
Canadians are being played for rubes on private sector takeover of healthcare. It may work.

I think any of us who have worked in medicine on both sides of the border can tell you: be careful what you wish for.
I worked for a couple of years in Philadelphia at a hospital run by a for-profit, publicly traded healthcare company (Tenet). Unfortunately that hospital, which was a tertiary care center which also provided a lot of care to an underserved community, no longer exists.
You can read about that here: newyorker.com/magazine/2021/…
Read 9 tweets
Aug 8
There is a major victory that hasn’t gotten enough attention.

In the last 2 months, we have passed national legislation that:

-The Gun Lobby
-The Pharma Lobby
-The Fossil Fuel Lobby

have been fighting against successfully for decades.
These wins are long overdue by decades. It is a shame it had to get this bad— raging wildfires; consumers not able to afford basic medicine; frequent senseless & outrageous shootings— for there to be action.

Until now corporate money prevailed.
While none of the new legislation is perfect, and these industries have watered down these bills (see private equity provision stripped, fossil fuel investments, limited guns & rx drug provisions), make no mistake— the dam on corporate ownership over DC has been broken.
Read 5 tweets
Aug 7
This is in the US. One of the real strengths of the Canadian response was not just that it saved lots of lives, but it massively saved lives in younger and middle aged adults, and kids, relative to the US response.

wfyi.org/news/articles/…
As noted previously there are around 100,000 Canadian deaths that DIDN’T happen due to the gap between Canada and US pandemic responses, and those non-deaths are disproportionately under age 70.
Read 5 tweets
Aug 7
Had the chance the discuss the current status of #LongCovid with @holmescnn last evening
We reviewed the new @TheLancet study, best one so far to establish true incidence (pre-Omicron, with caveats below)
And touched on long term sequelae such as cardiovascular (below), neurologic, metabolic (diabetes), mental health concerns
Read 6 tweets
Aug 6
A systematic study of a complete sample of 20 shipwrecks (that involved >19 people stranded for >2 months) out of >9,000 wrecks between 1500AD and 1900AD reveals crucial factors in social order relevant to survival. amazon.com/Blueprint-Evol… #BLUEPRINTbook ImageImage
Crucial factors in surviving shipwrecks in the period 1500-1900AD?

No alcohol in the salvage.
Ability to make a bellows.

But, most important:
Ability to cooperate.
Ability to teach each other things.
And mild hierarchy.

#BLUEPRINTbook
In 1864, two ships wrecked on opposite ends of Auckland Island, near Antarctica -- in a riveting natural experiment. The Grafton crew survived, even thrived, and the Invercauld crew fell upon itself (nearly all died). Learn why in #BLUEPRINTbook
Read 13 tweets
Aug 6
This thread sparked quite a bit of discussion (as below tweet suggested – and good faith debate is a good thing). Some think all these things will have massive effect, others think small but useful effect, others think certain things not so useful… 1/
Unfortunately seems increasingly tricky to have discussions about what effect specific COVID measures would have without getting pulled into ‘it obviously works’ or ‘it obviously doesn’t work’ or ‘if you’re not strongly advocating for X you must be advocating against it’… 2/
I’ve previously posted about wider benefits of ventilation: 3/
Read 7 tweets
Aug 5
Fascinating paper on #SARSCoV2 aerosol shedding by @Jianyu16 @drkristenkc @Don_Milton et al

Interesting to see shedding increase for new variants as @drkristenkc describes in her 🧵 below.

But I'm more amazed by person-to-person variation in shedding regardless of viral variant
For instance, look at this plot which shows total aerosol shedding (y-axis) with points being different infected people.

For all viral variants, some people shed many orders of magnitude more virus in aerosols than others.
I was struck by same thing in @bencowling88's important paper on how masks reduce aerosol shedding: nature.com/articles/s4159…

Yes, masks reduce droplet & aerosol shedding. But equally striking is how shedding varies by orders of magnitude from person-to-person even w/o masks.
Read 5 tweets
Aug 5
“I trust my immune system. I don’t need a vaccine.”

Ok, I trust mine to protect me too. Which is why I trained it extensively on what the virus looks like so it can handle it.

Boxers don’t enter the ring without a plan. It’s the punch you don’t see coming that knocks you out.
The Body’s Natural Response (WITH a Caveat)
So how do vaccines help? Vaccines can contain weakened or inactive parts of a particular organism (antigen) that triggers an immune response within the body. Newer vaccines contain the blueprint for producing antigens rather than the antigen itself.
Read 14 tweets
Aug 5
Monkeypox:
- We've had warnings about it for years
- We have a vaccine
- We have antivirals
- We have experience w poxviruses

Pandemic Preparedness is a buzzword right now, but if we don't seem to be prepared to effectively combat #monkeypox... Is that what we want?

1/
I am not implying that combatting #monkeypox is easy - & the current outbreak has plenty new to figure out (cryptic transmission, new presentation & lesion locations, MSM spread, ABOBEC mutations).

But we've had so much opportunity to be better prepared than we seem to be.

2/
Very few viruses arrive with the headlines they do in movies.
But #monkeypox really did send heralds for years before the current outbreaks. 📣 The waning of smallpox vaccines. The signs of ongoing transmission.

So what should we be doing better?

3/
Read 6 tweets
Aug 5
Some things on this list (from bmj.com/content/378/bm…) are hopefully ones most would already agree on (e.g. 2 and 7), while other things will reduce infection by some amount, but I suspect many people would debate by how much and whether it's worth it... 1/
Unfortunately the headline ('plan to suppress covid infections') implies a strong underlying assumption that these combined measures would get R below 1 on their own (i.e. suppress future variants) - given control efforts globally, it's not clear to me this would be the case. 2/
That being said, we should be growing the evidence base around impact of things like sick leave (e.g. bmjopen.bmj.com/content/9/4/e0…), ventilation (e.g. gov.uk/government/pub…), rapid tests (not just for COVID) and masks (particularly in places like healthcare settings). 3/
Read 6 tweets
Aug 5
BIRD QUIZ

Most of us have two words in our name: "Carl Bergstrom".

Some celebrities go by a single name—Beyoncé or Cher, for example.

Most birds are like me; their names have two or more words: Common Raven, American Crow, Black-billed Magpie.

What birds are like Beyoncé?
I love the answers coming in. I was trying to respond to each and every one, but I simply can't keep up.

Flying for 18 hours today (Edinburgh to Seattle) hasn't helped.

Even if I don't respond directly, I appreciate the answers so much. So cool that some birds are mononymous!
I got ratio'd (and I love it)
Read 6 tweets
Aug 4
Reasonable, modest, & budget-neutral. An easy way to fix drug pricing policy legislation (currently being debated in Congress) that would earn support of patients, doctors, investors, & whole innovation community.

Why won't Congress make the fix? pink.pharmaintelligence.informa.com/PS146809/Dont-…

(1/x)
There's no reason to treat small molecules differently than biologics - but current bill's price negotiation sets in at only 9 years for small mols, while biologics get 13 years. That's four fewer years for a small molecule to generate a return. (2/x)
Certainly, Congress is busy, and there's a lot going on in the reconciliation bill that's worthwhile.

But this is one small fix that would avoid a monumental snafu. (3/x)
Read 11 tweets
Aug 3
Based on the experience in winter 2020/2021, seasonal influence on SARS-CoV-2 transmission is quite clear, but much of the Northern Hemisphere is currently experiencing large summer epidemics driven the spread of evolved BA.5 viruses. 1/11
It's necessarily fraught to try to make predictions of seasonal circulation patterns going forwards, but we can gain some intuition from simple epidemiological models. 2/11
In particular, we can use an SIRS system in which individuals go from Susceptible to Infected to Recovered, and then return to the Susceptible class due to immune waning / antigenic drift of the virus. 3/11
Read 12 tweets
Aug 3
Them: Is there any other vaccine in history that required three doses in a year and yet still didn’t prevent transmission of the virus it was meant to protect against?

Me: *taps the sign*

Your childhood vaccinations would like a word with you.
But wait, there’s more. Reminder that your TDap: Tetanus-Diphtheria-Pertussis (every 10 years) are technically a repetitive vaccine series or rather boosters during adulthood. In addition, for HPV, the recommended schedule is two doses given 6-12 months apart.
The term infection refers to the virus entering and being detectable in your system regardless of whether OR NOT it makes you sick, whereas the term illness refers to the virus entering, being detectable in your system AND making you sick. It it important not to conflate the two.
Read 14 tweets
Aug 3
I’m more cautious than @Bob_Wachter when it comes to #WearAMask indoors (basically always w/ ppl from outside my 🏡 except briefly when I have to eat). I share his🧵 because this approach is sound: choose deliberately knowing current trends & weighing risk vs benefits. I differ…
On one point: I don’t agree that “the tools now exist” means everyone has the tools. We know that #COVID19 treatments are being underutilized in low-income & minoritized groups. We know that the high-quality N95 😷 that Dr. Wachter concedes are tough to wear all day every day…
Are what is needed to optimally protect workers in high-risk settings (think public mass transit workers, etc). Each time any one of us chooses not to #WearAMask & risks getting infected, we make it more necessary for others to wear N95 level masks to stay safe from us.
Read 6 tweets
Aug 3
Making decisions about how cautious (or not) to be w/ Covid remains challenging. In this 🧵, I’ll describe my current approach.
For me, with today's #'s, I find there's only 1 tough call, though it’s clear that most folks disagree – they’ve ditched their masks & moved on. (1/25)
I don't criticize anyone’s choice to be less careful. For many people, the value of "normal" & ditching the mask outweighs their perceived risk of, and from, getting infected – particularly now that the risk of a severe case (in vaccinated/boosted people!) is very low. (2/25)
Yes, your decision not to mask DOES ⬆risk to others around you. But we're now are able to keep ourselves protected via our own choices, which makes masking an individual risk-benefit decision. This wasn’t true in the pre-vax, pre-N95 era (thus, the need for mandates then).(3/25)
Read 25 tweets
Aug 3
We know masks/respirators mechanistically filter our particles–effectiveness varying with type, style, fit and use.

•They work in practice, not only in theory.

But that doesn't mean they work all the time.
The use of 'masks' (overarching term) 𝗰𝗮𝗻 reduce the risk of transmitting an airborne pathogen.
They are imperfect. They are not a panacea. They cannot be used alone. They are a leaky\"holey layer". This means that outbreaks & epidemics still progress.
If you define "work" as 100% effective, then yes, they absolutely fail. That’s a stupid definition by the way.

•There is entrenched mythology that only healthcare settings need/should use N95/P2s (or better) masks.

Sadly, in the middle of a respiratory virus epidemic..
Read 18 tweets
Aug 2
Lots of small dev-stage biotech companies use ATMs (or will) to raise money. Most have no idea how low fees could really be… answer: way lower than u know (<<2.25%).

Email me (CEO/CFOs have my email) to know which bank offers best rate as of this moment.

Save $’s for trials.
This will no doubt upset a few who currently enjoy the status quo. But times are tough for everyone. Senate bill threatens to kill small molecule drugs for diseases of aging. Cost of capital is high in public markets & higher on private side. Companies searching for savings.
Banks provide useful service & we need them to compete like hell to offer those services more efficiently. ATMs are one service where savings can be found.

No one entitled to any dollars… gotta fight for every one.
Read 6 tweets
Aug 2
#Flu in #Queensland, week to 24JUL2022
😷Total numbers continue to decline for another week
🤧Flu season is not done and dusted quite yet
🔵current data point(s) change in the subsequent week as outstanding results are finalised and reported
😷Percent positive with a moving average.
🤧Steadily in those >20 years
🤧Decline has stopped in those <20
😷Hospital admission numbers because of #flu, broken up by region of Qld, with historical context.
🤒Very small drop in admissions compared to the previous week
Read 6 tweets
Aug 1
I love watching @LizNeeley win, and she won big this week. She & her team convened 10 incredible scientists on Catalina Island for the inaugural @USCWrigley Storymakers fellowship—a transformative week of learning and community-building. 1/
Most (maybe all?) of the fellows who took part described it as life/career-changing. I taught a writing workshop as part of the week and felt the same. It’s the program Liz has always wanted to create and watching it unfold was magical. 2/
Liz has the highest standards, the deepest intellect, & the biggest heart. She chooses the right people to believe in & the force of her belief can lift lives. Watching others experience this is my favorite thing. If Liz ever asks you to do something, trust me: say yes. 3/
Read 6 tweets
Aug 1
The Presidents COVID infection highlights 2 key issues

1) CDC must update their guidance. 5 day isolation is simply not right:

Test to exit is MUCH more science based

2) Paxlovid Rebound is real. We and others are working to understand it better

1/

washingtonpost.com/health/2022/08…
Writing in @washingtonpost (top tweet) @bylenasun documents scientists questioning CDCs “5 day isolation” guidance that, still, does not include a Neg rapid Test before exiting isolation

The President Rapid tests to know he’s no longer infectious

CDC guidance is outdated

2/
I’ve written numerous threads on this issue, based in part on our research

CDC “guidance” that 5 days of isolation is sufficient, is confusing and dangerous. CDC must do better - MANY docs now think infectiousness lasts 5 days max

This is not correct

3/
Read 7 tweets
Jul 30
Masked but got infected?
It's not magic..
😷 Mask removed at a critical time, or
☁️In an unclean airspace so laden with virus aerosol that N95 (95% filtration and 5% not successfully filtered;surgical mask let's through much more) couldn't cope & you received an infectious dose
Room air will still get full of virus if...

☁️The air isn't being filtered, treated or rapidly replaced
😷Most keep wearing baggy surgical masks that aren't designed to filter much of what we exhale, just deflect it

It's time to understand that we should mask up(grade)
This is also about the mask...
😷💨 The mask you wear must be fit for purpose - cloth or surgical masks are better than nothing, but aren't intended to protect you from inhaling an infectious dose of virus-laden airborne particles
Read 9 tweets