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14 Oct, 4 tweets, 1 min read
1. Employees should stay home for 14 days after contact (within 6 feet for 15 minutes) with a person who has #COVID19. Period. Even if someone tests negative or feels well, they must quarantine for the full 2 weeks because symptoms can appear 2 to 14 days after exposure.
2. Mike Pence's VP debate appearance 11 days after the ceremony led many to believe that quarantine can terminate early with a negative test. This fallacy was reinforced by the CDC Director, who cited "serial negative test results" to end quarantine early. That is not a thing.
3. It's possible, although unlikely, to develop symptoms more than 14 days after exposure. The Labor Secretary's wife, Trish Scalia, attended the Rose Garden ceremony and tested positive outside of this window. It is unclear when her infection occurred.
The ripple effect of the Rose Garden ceremony is hard to overstate & extends to all sorts of industries. Many feel compelled to bring in experts to explain why such carefully-worded CDC recommendations have been so flagrantly disregarded. Can they disregard the guidance, too?

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More from @DrMattMcCarthy

Matt McCarthy Profile picture
16 Oct
NEW: There's an emerging argument that masks don't actually work. It's based on a recent study published by the CDC, which reportedly showed that 85% of mask-wearers contract #COVID19. This is a dangerous mischaracterization of the study. Here's what the work really showed:
CDC looked at 154 adults with symptomatic #COVID19 and compared them to an uninfected control group. Of the patients with #coronavirus, 70.6% reported ALWAYS wearing a mask and 14.4% OFTEN did. From a distance, it looks like 85% of mask-wearers got COVID.
cdc.gov/mmwr/volumes/6…
But you've got to read the actual study. Here's the key detail: COVID patients were twice as likely to have dined at a restaurant. Why does this matter? Because people take off masks to eat. You might report that you ALWAYS wear a mask but we know it comes off when you're eating.
Read 4 tweets
Matt McCarthy Profile picture
13 Oct
UPDATE: I expect a recommendation for the general public to continue wearing masks EVEN AFTER a #coronavirus vaccine is rolled out. This is rarely mentioned in discussions of Operation Warp Speed, but the first #COVID19 vaccines may offer only moderate protection. Some thoughts:
1. Approval of a #COVID19 vaccine does not mean a quick return to normal. Volunteers who receive a "successful" vaccine may still get sick. (In June, the FDA set target efficacy at 50%). There will be protection, but it could be leaky. We haven't prepared the public for that.
2. Johnson & Johnson and AstraZeneca have paused trials to explore illnesses in volunteers. We should be reassured by this transparency, not alarmed. Adverse events are an expected part of any large study. Potentially noteworthy that both use adenovirus vectors to deliver genes.
Read 4 tweets
Matt McCarthy Profile picture
10 Oct
UPDATE: The President is set to resume in-person events today. Here's how I think about the potential danger he poses to others:
I want to know if he still has "replication-competent virus" in his system. (I don't actually care if he tests positive today on some rapid test). We're confident that for mild & moderate COVID19, patients no longer have replication-competent virus 10 days after onset of symptoms
But if he had severe #COVID19 (hypoxia, >50% lung involvement on imaging), he could be contagious for longer than 10 days. Based on what we know, he appears to have had moderate COVID19. (I seem to be in the minority in this assessment).
Read 4 tweets
Matt McCarthy Profile picture
8 Oct
Often asked for my opinion of the latest #COVD19 therapeutic. Yesterday it was the antibody cocktail. Here's how I think about this stuff:
For any new treatment, I want to know if it's 1) safe and 2) effective. I also look at distribution mechanisms. Do we have a way to get this thing to the people who need it? In many cases, the answer is no.
I'm not bullish on antibody cocktails because there's a mismatch between supply & demand. Urgent care clinics don't want to administer cocktails because the infusion is time-consuming and reimbursements are low. Primary care clinics will feel a similar crunch. So what happens?
Read 4 tweets
Matt McCarthy Profile picture
22 May
NEW: The long-awaited remdesivir data has arrived: nejm.org/doi/full/10.10…
"These preliminary findings support the use of remdesivir for patients who are hospitalized with Covid-19 and require supplemental oxygen therapy. However, given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not..."
"...likely to be sufficient. Future strategies should evaluate antiviral agents in combination with other therapeutic approaches or combinations of antiviral agents to continue to improve patient outcomes in Covid-19."
Read 4 tweets
Matt McCarthy Profile picture
14 May
NEW: Case definition for Kawasaki-like syndrome created based on 102 children in New York. First standardized criteria for a condition that is being called pediatric multi-system inflammatory syndrome:
Clinical definition: 1) Fever, 2) Hospitalization, and 3) One or more of: Shock/Cardiac illness/Severe organ damage (excluding lung disease) OR 4) Two more more: rash, conjunctivitis, GI symptoms, mucocutaneous inflammation.
Lab criteria: 2 or more: Neutrophilia, lymphopenia, thrombocytopenia, hypoalbuminemia,☝️CRP/ESR, fibrinogen, D-Dimer, ferritin, lactic acid, LDH, IL-6, OR elevated procalcitonin. And: Detection of: 1) #Coronavirus RNA at hospitalization (or within prior 4 weeks) or 2) antibody.
Read 4 tweets

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