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5 Oct, 4 tweets, 4 min read
A rather important letter @ScienceMagazine just published that stresses #SARSCoV2 aerosol transmission (size < 100 μm) and what should be done about it.
By @kprather88 @linseymarr @mmcdiarm @Don_Milton and colleagues science.sciencemag.org/content/early/…
For background, this is the previous, now classic essay on the topic by @kprather88 and colleagues @ScienceMagazine science.sciencemag.org/content/368/64…
One of the most downloaded papers of the pandemic (millions)
That was quick!
Thread on this @CDCgov change by @linseymarr

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More from @EricTopol

Eric Topol Profile picture
4 Oct
Did monoclonal antibodies save the President's life?
We'll never know, but it's possible and the implications are profound.
Let me explain 1/
Trump's risk profile by demographics was high (age, male, obesity) but it markedly increased when he had blood oxygen desaturation, had an abnormal lung CT scan of pneumonia, and was hospitalized
Mortality risk > 32% isaric4c.net/risk/ 2/
Sometime on Friday (<-presumably) he received a monoclonal antibody cocktail (2 different antibodies to override the potential of a virus escape variant)
Diagram from @VirusesImmunity 3/
Read 17 tweets
Eric Topol Profile picture
4 Oct
The lies are coming out now
1. There was a rapid decline in oxygen saturation Friday
2. He received supplemental oxygen
3. He had a high spike in fever
4 .Lung CT abnormal
5. Transferred expediently d/t change in condition
time.com/5895970/trump-…
Now dexamethasone has been added to the kitchen sink of drug interventions. For his "brief" need for oxygen? (compared with no oxygen). Patients in the pivotal trial showed no benefit, and potential harm, if oxygen was not received.
Examples of the extreme deception
—How low did the oxygen saturation go? In the low 90's?
—It did not go into the low 80's

—What did the lung scan show?
—The expected findings
Read 5 tweets
Eric Topol Profile picture
3 Oct
A day after infusion of an experimental drug, helicopter transfer, hospitalization, Remdesivir, 2 brief notes from his doctor on the medications....we're going to hear directly from Dr Conley shortly. That'll be interesting.
No supplemental oxygen now, oxygen sat 96%, walking around, "doing extremely well," no fever since Friday morning. On therapy: "For the President, I didn't want to hold anything back." Not going into anything specific on lung findings (CT?). Why transfer: "He's POTUS" End. Image
Mostly a delayed, evasive, lack of transparency (on oxygen, lung scan, vital signs, real reason for use of treatments, differences from other reports) but, ironically, one inadvertent and potentially serious disclosure on timeline
nytimes.com/2020/10/03/us/… Image
Read 4 tweets
Eric Topol Profile picture
2 Oct
Some comments on treating w/ the @Regeneron monoclonal antibody infusion.
1. @statnews piece by @matthewherper statnews.com/2020/09/29/reg…
and company press release with more extensive data
The viral load clearing effects were related to being antibody negative
2. The dose given (8 g) was the highest tested. There were also non-human primate studies.
Here is the main paper @ScienceMagazine rationale for the "cocktail" as compared to a single monoclonal for the other antibody programs.
science.sciencemag.org/content/369/65…
3. Here are the prophylaxis and treatment data preprint in macaques and hamsters
biorxiv.org/content/10.110…
Read 8 tweets
Eric Topol Profile picture
2 Oct
We have no proven early therapy for covid-19 to prevent its progression, especially in people in a higher risk category (eg age >70, male, obesity).
Fast forward.
Time will likely make a difference in our approach to how @POTUS would be treated.
By Dec/Jan monoclonal antibodies will probably be proven safe and effective. 2 Phase 2 trials have had encouraging results in outpatients. More randomized trials are ongoing.

Inhaled β-interferon also has had promising data and larger RCTs are pending.
More color on this, mAb access, by @katie_thomas
nytimes.com/2020/10/02/hea…
Read 4 tweets
Eric Topol Profile picture
30 Sep
We desperately need these rapid tests for infectious covid (not PCR for infected). The rationale and the obstacle (FDA) laid out so well by @michaelmina_lab, @DanLarremore, Roy Parker @CUBoulder in today's @NEJM nejm.org/doi/full/10.10…
In today's superspreader/overdispersion piece by @zeynep (the best, comprehensive one on this topic to date), she also reviews how important these cheap, frequent, rapid turnaround tests can prevent such spread
theatlantic.com/health/archive… @TheAtlantic
When you combine this w/ @ScienceMagazine yesterday on PCR tests (CT, cycle threshold) you realize that the testing we have today, mostly detecting infections but not infectious, are way off the mark.
We should all have had the home rapid tests months ago!
Read 5 tweets

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