Michael Mina Profile picture
Oct 7, 2020 11 tweets 3 min read Read on X
Winter is coming!

If we do not get this virus under control now, we are in for a perfect and terrible storm

We are not taking the expected seasonality of this SEASONAL virus seriously!

Instead, we've assumed our efforts are responsible for decreased cases this summer...

1/x Image
I worry very much that people are confusing the fact that this virus has transmitted in the summer for it not being very seasonal.

This is a grave mistake and misinterpretation...

2/x
The 'force of infection' of this virus is massive! Think of it like the momentum that the virus has to transmit

The huge number of susceptible people is what is allowing the virus to maintain transmission through the summer months - when other coronaviruses go to near zero.

3/x
Mistaking ongoing transmission in the summer for a "less seasonal virus" is not smart. All evidence points in the other direction

Instead, continued transmission reflects force of infection 'going uphill'... which means that as winter sets in, we may see massive increases.

4/x
This virus got out of control because of a handful of imports.

We now have literally 10,000's of cases in the US daily... all potentially ready to explode into massive outbreaks once the weather / other natural or social biology becomes optimal for spread.

5/x
Meanwhile we're not acting now to stop it. We're barely acting to improve any semblance of surveillance. At same time we're saying - we must open back up.

Yes! But, one must come before the other - ideally it would be control first, open fully second, once we're ready.

6/x
We could have been much more ready now. But instead we are just giving the virus a major headstart at the very time when it has its guard down. that we are not taking advantage of it is going to be reflected in many more infections and deaths moving forward I fear.

End
7/7
Here is a review of what’s known about seasonality of coronaviruses.

doi.org/10.1093/infdis…
People say we don’t have evidence of seasonality for this virus - and suggest seasonality may not even be a thing for a pandemic virus. That’s just wrong.

True we don’t have a lot of evidence for THIS virus - but we do it’s closest neighbors. That gets us far...

15/x
But while we don’t have evidence of seasonality in the northern hemisphere - of course... it’s not been a year yet - we can look to the southern...

16/x
In the South Hemisphere - not on equator - most nations with a lot of cases were in the clear until ~June. And then cases started. Some July. The dynamics and timing is quite different than North. Almost no outbreaks requiring shutdowns when North did - were all months later.

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More from @michaelmina_lab

Apr 20
Here we go again with this asinine cautious approach to testing for H5N1

CDC is NOT recommending that people with no symptoms - but who have had contact w infected animals - be tested at all… and certainly are not recommending a swab w any frequency.

Though we should have learned it in 2020, Here’s why this doesnt make sense:

1/Image
Firstly, tests are our eyes for viruses. It’s literally how we see where viruses are

If we wait until people are getting sick, we may have missed a major opportunity to find viruses jumping into humans before they learn to become so efficient in us that they cause disease

2/
So waiting until we actually have highly pathogenic strains harming humans - when we have a pretty discreet population at the moment to survey - is short sighted

3/
Read 11 tweets
Jan 16
A lot of questions still on:

How long should I isolate?

Do I need to isolate?

When can I go back to work?

Is 5 days enough?

What if I’m still positive?

Why am I not positive when I first get symptoms?

This thread below (and the embedded thread) goes through many of these questions
Now that symptoms start earlier w COVID (bc immunity activates symptoms fast after exposure)

A frequent ? that comes up is what this means for Paxlovid

Often ppl think it means you have to start Paxlovid earlier

Nope - Opposite! You have more time

2/
Bc symptoms start faster but the growth of the virus still takes about the same time as it used to…

Symptom onset today is ~2d post exposure where before it was ~5d

So, as far as virus growth is concerned, day 5 post symptoms (when the trials took place) is day ~8 today

3/
Read 6 tweets
Jan 8
A heartbreaking consequence of lapses in vaccination!

A measles outbreak is spreadinf in Philadelphia.

MEASLES! It sends kids to the hospital, erases existing immune memory (creating long term risks) and kills 1 in 1000

It was eliminated in the US, but we seem hell bent on reversing that

inquirer.com/health/measles…
A particularly deadly consequence of measles is its erasure of previously acquired immune memory - setting kids and adults up for infections that they shouldn’t be at risk from!

We found for example that measles can eliminate as much as 80% of someone’s previously acquired immunity to other pathogens!
science.org/doi/full/10.11…
Image
Read 6 tweets
Jan 3
This paper from Kaiser on new XBB1.5 vax formulation is misleading

NO, it does NOT say that prior vaccination w non updated XBB1.5 vaccines offer no protection

No, it doesn’t even say the XBB1.5 updates to the vaccine formulation are important

🧵
1/
medrxiv.org/content/10.110…
Here are the key conclusions.
They are WAY misleading

The major issue is w the timing

The comparison is

A) a VERY recent XBB1.5 vaccine given in last 30 days,

Vs…

B) A vaccine received ~1 year or more ago!

Any effect is first and foremost owing to recency of vax

2/ Image
Given everything we know about major short term (weeks - few months) immune responses after vax or infections

The comparison is NOT able to say anything about the importance of updating the vaccine formulation for variants

It simply says what any Immunology 101
Text says..

3/
Read 15 tweets
Dec 24, 2023
Tip on pooling home tests

I’m gathering w family. Had one @Pfizer Lucira multiplex COVID-Flu home molecular test

Had 6 people and 6 swabs

Everyone used one swab. Dunked all 6 into one Pfizer Lucira test

Neg.

Tested everyone for price of one!

Pooling at home works!
Pooling can work w home tests including rapid antigen and rapid molecular tests

However for antigen id be a bit more cautious and not put more than 3 swabs in the buffer

With molecular, particularly Pfizer Lucira bc it has a large volume buffer, 6 is no problem.
Here’s a nasal swab that would work. Don’t use it as a nasopharyngeal swab at home - just use it like any home self swab and swab the anterior nares

a.co/d/iCO1nsI
Read 4 tweets
Dec 15, 2023
Please note - If you use expired rapid antigen tests - here's how I think about interpreting them

1) If Negative - do not trust it - especially if control line is faint / absent

BUT

2) If Positive - trust it - *very likely* true positive.

(short thread)
1/
An expired test will Not aberrantly turn positive just because it's old

Expiry makes lines not show up. Does make them become dark.

So, if using an expired test:

Do Trust a Positive.
Do Not Trust a Negative.

*And note that many tests have had extended expiry dates...

2/
Here is a thread about the extensions to the expiration dates.

Not all tests are extended but many of them have and that means that the dates on the box may be different from the actual expiration date. I write about it here and how to find out

3/

Read 4 tweets

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