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Some people just shed huge amounts of virus, millions of times more than others. If you look at it as the amount of virus shed into the environment, 99% of the environmental virus exposure is produced by the top 20% of the highest shedders
virologie-ccm.charite.de/fileadmin/user…
12/
We need testing on such a massive scale that we catch people shedding huge amounts of virus before they have a chance to become super spreaders. That means the ability to test all the workers every day, millions of test per day throughput
13/
We can do this, but we need fast read out, really inexpensive, field deployable tests

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David States
@statesdj
Let’s get real on test/trace/isolate. We have ~30k new testing confirmed cases per day. That mean we actually have ~300k new cases per day. Contact tracking is a lot of work, and BLS says we only have about 56 community health workers
1/
 bls.gov/oes/2018/may/o…
First let’s define the problem. Figure shows the amount of virus being shed from the day of onset of symptoms. For both mild and severe cases, it’s already decreasing when symptoms start
2/
 nature.com/articles/s4159…
Presymptomatic viral shedding means you need to catch infected people quickly before they infect others. And SARSCOV2 is a highly contagious virus, you need to trace and isolate most of the infected contacts or it keeps spreading
3/
Read 13 tweets
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David States
@statesdj
“It’s mutating!” No, really, all viruses mutate, but the D614G variants in the spike protein is worth watching. Strains carrying the D614G variant have come to dominate in multiple regions and are associated with a higher viral load in the nasopharynx
biorxiv.org/content/10.110…
All viruses mutate. The coronaviruses mutate relatively slowly, but they do accumulate variants. The D614G variant of the spike protein appears to increase transmissibility, and the higher viral burden in the nose is a reasonable explanation for its increased transmissibility
This adds to the case that people shedding high levels of virus are central to community spread. We need massive scale rapid turnaround testing to identify them quickly, even during their presymptomatic phase. Full disclosure, my company is working to create tests to do this
Read 3 tweets
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David States
@statesdj
Let’s talk testing, specifically the coronavirus test we really need and essentially no one is talking about. What we need is a fast, low cost field test for highly contagious people, and tests like this exist, in fact they’ve been around quite a while
1/
Full disclosure. I am an exec in a biotech company, and my company is developing tests for SARS-CoV-2. I try to keep my posts objective, but obviously I believe that this is an important issue and that the solutions we are pursuing have merit
2/
People are contagious for COVID-19 before they develop symptoms, and the number of virus shed varies dramatically from person to person and for any given person from day to day. This makes testing a challenge
3/
 nature.com/articles/s4159…
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