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To best utilize #COVID19 PCR test results, we should provide the Ct values for clinical interpretation to help guide clinical decisions and infection control. 1/

academic.oup.com/cid/advance-ar…
Currently results are provided as a positive or negative. Viral titers change over as many as 10 orders of magnitude. Interpreting the ct value could give clinicians more insight into their patient’s course of infection and offer new ways to conserve PPE.
This recommendation comes with all of the caveats of test validation - if the Ct is reported back, then pathology labs would have to validate that the Ct value is itself an accurate measure of biological viral load. Interpretation would have to be taken in clinical context.
Should have written in first tweet... This CID paper is from Michael Tom (current Harvard medical student) and myself.
Also, see this tweet from @CarlosdelRio7 on a related paper discussing a role for interpreting the Ct value in light of infectiousness.

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Michael Mina
@michaelmina_lab
Updates on #COVID19 Serology

Antibody survey data is increasing [All have limitations: hotspots are not representative, some tests may have false positives]

However, LA, Boston, NYC, Santa Clara, Netherlands, ..., now evidence potential transmissibility of the virus...

1/6
Seroprevalence in LA, Santa Clara, Netherlands have ~3+%. and suggest wide transmission

(Recognizing that these may not all be accurate)

These %s are early April & antibodies form ~10+ days post virus exposure. So most exposures measured happened before March ~25.

2/6
Since March ~25, >3x more cases have occurred in these places. Today these populations may have >10% cumulative incidence.

More recently, area of MA had ~30% positivity and one area of NYC, 15% of a pop were positive for virus - antibody results would be higher...

3/6
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Michael Mina
@michaelmina_lab
In US

Perhaps 30+ MILLION have had #COVID19 virus

In NYC, 15% of pregnancies had antibodies
A German town had 14%
Most asymptomatic

Some nursing homes have ~50%+

Clearly this virus transmits fast

If this is the case, it begins to paint a new path forward for society:

1/n
If shown to be consistent in additional studies, such high numbers infected would suggest

1) SARS-CoV-2 has a much lower fatality rate than we think (by an order of magnitude or more)

2) Population immunity is already building up

Elderly would still remain vulnerable... 2/n
US as of today

among least vulnerable (<55y)

877 deaths; 231M people.

For different assumed % infected (mostly b4 social dist), infection fatality would be:

a) 0.1% infected = 0.37% IFR
b) 1% = 0.037%
c) 10% = 0.0037%
d) 30% = 0.0012%

Truth most likely near c (or d).

3/n
Read 6 tweets
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Michael Mina
@michaelmina_lab
Could the US have >2 million #COVID19 cases by now?

I'll be astounded if not! We simply don't test.

The ratio of who gets a test vs who should, likely worse than 1 in 10.

So given 220K cases reported ->

>2.2 million COVID cases in US already?

>4 million? Perhaps...
I've not heard too many suggesting such huge numbers. I worry it's because we're stuck. Is infection fatality 1% or is it 0.1%.

We ground our models in data - but when key data is just not accurate (i.e. case counts are not), the models can be off. Sometimes by a lot
To be clear - I hope that there have been 5 million or more cases in the US by now.

This would suggest a lower infection mortality, higher population immunity, and would start to paint a clearer path how to get society back functioning.
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