Thread by @tulunsokit

A thread on why I think we need to ramp up testing for #COVID19 in Malaysia so we can flatten the curve faster.

Peak Viral Load doesn't correlate with symptom strength.
This is why just temperature screening might not work as well and why asymptomatic contacts should be screened. thehealthcareblog.com/blog/2020/03/1…

From a Virologic standpoint - the peak viral load (>1000 times that of SARS) actually occurs at around day 5 of illness with the virus detected in the oropharynx. medrxiv.org/content/10.110…

And it has been shown that minimally symptomatic carriers can be responsible for clusters possibly via fomites
wwwnc.cdc.gov/eid/article/26…

Thereafter there is a decline in viral loads even in sputum except in those with pneumonia where sputum loads peaked at around 10 days. medrxiv.org/content/10.110…

if we tested all contacts and expanded our testing capability to include those with just minimal symptoms or almost no symptoms and quarantine them, we might be able to slow down the spread. But it depends largely on whether we can emulate countries like Korea

By the time we get fully symptomatic breathless patients we might not even be able to detect the virus as they have largely cleared the virus, probably aren't even spreading much and have entered into a hyperinflammatory phase

els-jbs-prod-cdn.literatumonline.com/pb/assets/raw/…

COI: Nephrologist here. Not ID or epidemiologist.
Be kind when you whack me for rambling - just random thoughts