The explosive growth seen in early outbreaks within community may be a result of highly exposed individuals rapidly spreading to their many connections. As we re-open we may see slower spread because many of the highly connected people are now immune 1/
But it’s important note that this phenomenon only applies after the virus has been spreading in the community for a while. As the people of Albany Georgia learned, it only takes one individual in the wrong setting to trigger a large outbreak 2/
Also we talk to much about testing as binary “+” or “-“, but positive at Ct 16 on an RTPCR is a millions times more virus than positive at Ct 36. Bad things happened when a highly contagious person shedding lots of virus gets into a setting where many people can be exposed 3/
Conversely, many of the RTPCR tests positive at high Ct are just fragments of viral RNA not live virus, and these fragments may persist for weeks. If we insist on repeated “-“ RTPCR tests before discharge, we are unnecessarily tying up people and resources 4/
Viral shedding often peaks early after exposure, often when the individual is presymptomatic. A test that is only performed after symptoms develop and then takes multiple days to report back is useless for controlling disease spread 5/
As Bill Gates says, “If you don’t test until you have symptoms and it takes 3 or 4 days to get a result back, what are you going to do, send all your contacts an apology care, ‘Sorry if I infected you.’” 6/
To control viral spread we need fast, field deplorable, direct to consumer/employer/venue tests. It’s OK if they’re not as sensitive as RTPCR, the need is to detect highly contagious people so that they can self-isolate before they expose many others 7/
I’m mystified by FDA’s decision to halt a Gates Foundation program evaluating exactly this kind of testing program. Are we still trying to keep the “numbers” low instead of trying to figure out what’s going on? Let’s get the data & stop the virus
8/fin
nytimes.com/2020/05/15/us/…
8/fin
nytimes.com/2020/05/15/us/…
