Michael Mina Profile picture
Physician-Scientist, MD,PhD. Immunology, Epidemiology, Infectious disease, CSO, CMO. Past: Harvard Faculty. BlueSky @michaelmina.bsky.social

Dec 22, 2021, 9 tweets

🧵

Think rapid tests don’t work w Omicron?

In last few days almost everyone I know diagnosed, found out on rapid test & same for MANY MANY others:

PCR test one day - negative.

But then used rapid test day after - BC THEY WERE EASY & ACCESSIBLE & FAST -

Positive

1/

This has never ever been about how good is a single test. Ever.

That ship sailed in Feb 2020 in my view. It’s not about the individual test

I don’t know how to be any clearer

It’s about the testing regimen!

Test once, test again, etc You don’t know when you are infected

2/

A single PCR will not help if it’s a one time thing - Even if weekly. Negative today -positive tomorrow and don’t know it

It is why we published in early 2020 about how we need to focus on serial testing over multiple days

This isn’t a static state

3/

science.org/doi/10.1126/sc…

Somehow I feel like people lost track of the original argument around Testing in a pandemic.

Testing needs to be fast, frequent and accessible.

Anything else falls flat.

4/

nejm.org/doi/full/10.10…

If you miss someone on day one or day two, at least you find them on day 3 and then stop spread on days 3,4,5,6,7

We don’t transmit on one day only. We have to sever transmission chains.

If that happens on day 1, GREAT!

If on day 3, also GREAT just not as great.

5/

Stopping transmission is crucial

Vaccines aren’t doing it all too well

Good masks do it well when worn

Distancing does OK but w huge cost

Tests do it well when frequent

Saying rapid tests don’t work Bc they miss day 1, 2 is ridiculous

Perfect has never been an option

6/

IMO - we are not in a particularly different place from March 2020 in terms of transmission

We have very very few options

Freeze in place
Where masks
Ventilate/filter
KNOW if you are likely infectious and then be able to act

None are perfect except #1 - but impractical

7/

I can’t believe I have to dig back to March 2020 material & talk about this all again Bc people are realizing tests aren’t perfect. They literally never have been.

It’s good Bc it is Bc ppl are at least now wondering - but god, we’ve massively screwed up information flow

8/

I’m massively annoyed right now that ppl are going back to let perfect be enemy of good phase.

One of the most short sighted approaches in public health.

A Long line for a single one off PCR test is not close to better than accessible rapid tests. EVEN FOR OMICRON

9/

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