1/ A hang-up on rapid tests that I've heard is that it'll be difficult for health depts to track results

Decentralized screening makes that difficult but stopping spread should be the overwhelming priority; monitoring indirectly helps stop spread but is a secondary consideration
2/ We shouldn't hold up something that can stop transmission because it will be harder to monitor or collect data on

The current counterfactual is that we're missing most infections anyway & neither stopping onward transmission from them or getting any data on them
3/ What's generally been missing from the rapid testing discussion are counterfactuals

Anyone can point out issues that arise if using them but that is meaningless without considering what is happening w/o them & thoughtfully strategizing on how to address potential downsides
4/ Right now, thousands of people who are infected go undetected & are functionally 'false-negative' anyway

The restrictions we continue to live with also treat all of us as if we were infectious & therefore akin to being 'false-positive'

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More from @RanuDhillon

27 Aug
1/ Still learning about new Abbott rapid test but a few immediate impressions from what's circulating
- high sensitivity & specificity
- can be used - like device-based rapid tests already with FDA authorization (BD, Quidel) - at workplaces, schools etc.

2/ BD & Quidel rapid tests can't do frequent home screening as needed to really paralyze transmission because (1) they require devices that are difficult to scale to every home & (2) require nasal swabs & processing steps that may be difficult for many people to do on their own
3/ The Abbott test is similarly not authorized for home use but its big advance is that it doesn't require a device like BD & Quidel do

However, it still seems less than ideal for home use because it still requires nasal swabs & further processing steps

Read 6 tweets
19 Aug
1/ Based on our work on Ebola & Zika, when Covid hit in January, we called for mass screening with rapid tests as a way to stop Covid in US & globally

>21m cases & 750K deaths later, this approach hasn't been used but still could help stop the pandemic

2/ In @washingtonpost, @sri_srikrishna @AbraarKaran & I discuss how tests that provide fast results, can be decentralized widely to people's homes & used frequently to detect more infections quickly can close the window of transmission & paralyze spread

washingtonpost.com/outlook/2020/0… Image
3/ This approach can be key to stopping Covid in the US & globally

The tests exist - they just need regulatory approvals, scaled up production & strategic buy-in to be deployed

We need @US_FDA & @WHO to clear hurdles and push this strategy forward
Read 5 tweets
9 Aug
1/ Frankly the pushback hasn't only been regulatory; many 'experts' haven't agreed or understood this approach

For 6 yrs, @sri_srikrishna & I have written extensively about it as a go-to strategy for uncontrolled epidemics & for Covid in Jan, Feb & March

2/ There is a big problem effectively translating scientific ideas into policy

We published conceptually the same idea @TheLancet @TheLancetInfDis @bmj_latest @BulletinAtomic @nytimes as well as almost verbatim for Covid @HarvardBiz

That wasn't enough

3/ We spoke w/CDC & HHS's top epidemic leadership, NIH's top epidemic leadership, WHO's top epidemic leadership

We shared & discussed with 'who's who' of pubic health "thought leaders" many who said we were crazy including some who are now very vocally supportive about this idea
Read 6 tweets
4 Aug
1/ 13 REASONS WHY...

...we can't wait for a vaccine or tolerate slow declines & need to shift to a more aggressive 'zero Covid' approach that aims to get cases down as low as possible as quickly as possible
2/ Reason #1: Preventable deaths

~160K Americans dead - the most in the world

We're on pace for too many more families to be on the receiving end of FaceTime calls like the ones my patients about to be put on ventilators make to see loved ones in case they don't make it thru
3/ Reason #2: Death isn't the only outcome that matters

Growing research suggests that even the young+healthy w/mild infections may suffer organ damage w/possibly permanent effects on their hearts, brains etc

Why let 100s of 1000s more be put at risk each day?
Read 14 tweets
27 Jul
There's a way we can stall the epidemic within a few months

If we locked down everywhere with active transmission - stringently except people who *absolutely* need to work - for 2 weeks, everyone could be tested daily using rapid paper-strip tests

At the end of the 2 weeks, even with lower sensitivity of the tests, we should find nearly every infected person

We could then isolate (ideally in separate housing) those infected & follow & test people in contact with them & so on until each transmission chain is burned out
The 2 weeks would be enormously painful but, given the stakes & the cost of our crushed economy, it would enable us to find & break off most transmission (some may linger due to imperfect execution, missed cases, unreported positives, etc.)
Read 12 tweets
1 Jul
1/ Something that those of us in global health can attest to:

Figuring out & talking about what to do is one thing & often the easier part

Current political & institutional barriers notwithstanding, actually getting things done is very difficult
2/ When I worked on health systems in Rajasthan, an old woman (who looked like my grandmother) in a village asked me why I hadn't made things better

I told her about ideas we were pushing but weren't happening bc of political & bureaucratic challenges in the gov't health system
3/ She yelled at me - "So my family & neighbors have to continue to suffer because it's too hard or too messy for you to get into that. I don't care about any ideas unless I see them happening here"

I'll never forget that
Read 5 tweets

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