@CDCgov needs to harmonize/update all websites on spread of COVID-19
1 updated page has clear &(nearly) accurate information:
cdc.gov/coronavirus/20…
(here's detailed thread on update:
)
Many other CDC pages still focus on wrong mechanisms of spread
Thread
Updated page is clear about #1 mechanism of spread:
close (<6') contact
It also makes it clear that further >6' spread is possible
("airborne transmission") & when this occurs (indoors, poor ventilation)
Perhaps most importantly it accurately tells people how to be safe. Image
Relative ranking isn't completely right, but pretty good (still too much focus on surfaces, hand washing). For far more details on update see:
Unfortunately if you google "cdc how is corona spread" you get these pages:
cdc.gov/coronavirus/20…
cdc.gov/coronavirus/20…
Neither of these link to the updated webpage (cdc.gov/coronavirus/20…). The 1st of these pages (Spread faq) is ok... (cont)
It gets the #1 mechanism right, but overemphasizes surface transmission that is still very rare (including NZ trash lid). It mentions aerosols & >6' which is great but it'd be better to just link to updated page w/ fuller explanation. Image
Unfortunately on this same faq page the link for "How can I protect myself" goes to this page:
cdc.gov/coronavirus/20…
This page is very old & lists #1 thing to do is Wash hands. Ugh. Definitely not top priority. Bad guidance. Image
Why does this matter? Because many people are still confused about what is most important to keep people safe. So much early focus was on hand washing & surface transmission that public still thinks that is biggest risk, leading to excessive focusing on surface cleaning.
Instead people should be focusing on masks, distance & ventilation (best version is outdoors). Surfaces & hand washing are very distant 4th priority (but still good general practice, of course).
@MackayIM has nice visual of how layers of protection help:
Outside=good. Outside+6'=great. Outside+6'+mask=even better.
1 shortcoming of cheese slices is that they all look equally important. They aren't.
@MackayIM can you revise to clarify this?
Main point: CDC should have all websites on how SARS-COV-2 is spread point to their updated page which gives proper focus to each mode of spread & how to be safe. This would help people focus on key issues which is extremely important since it's hard to do everything.
Some restaurants have people standing in lines waiting to be seated for >15 minutes while removing the shared salt and pepper shakers from tables or pulling the dispensable ketchup packets. Same for some stores. This improper focus will lead to infections. Please fix @CDCgov

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More from @DiseaseEcology

10 Oct
How do we survive next 6-12 months?
Tweets by @TinaG_SD epitomize what many feel - even w/ relatively good measures in place, as in CA (mask mandate, bars/restaurants closed or nearly so, sick pay, etc.), transmission continues & cases ebb & flow & restrictions crush jobs.
Thread
COVID cases are surging in many parts of the US now where there are few measures in place (no mask mandates, open bars, etc.).

These measures certainly help but don't seem to be enough (see previous tweet). Why?
Transmission of COVID-19 is inherently a 2 step process. Step 1: Transmission w/in households is rapid with whole households sometimes getting infected.
Step 2: Transmission between households.
Read 17 tweets
5 Oct
CDC's updated webpage on how COVID-19 is spread & prevention tips is now (almost) in line with science!
(WHO please do the same!)

(Hooray! only 10 months into epidemic & when Trump in hospital so maybe isn't paying attention?)
Thread
cdc.gov/coronavirus/20…
Webpage 1st summarizes dominant mode of transmission which is consistent with epidemiology data: mostly from people w/in 6' of each other & clearly states that people w/out symptoms (pre-symptomatic or asymptomatic) can transmit also!
2. Website give ranking of how easily SARS-CoV-2/COVID-19 spreads relative to flu and measles.
(I'm not sure this is supported by data. R0 is higher than flu, but might be due to length of infectious period, not higher infectiousness. Anyone know of data to support/refute?)
Read 10 tweets
3 Oct
PSA: We (STILL) have no data to know the pattern of viral loads over time from infection to recovery. So we don't know how test sensitivity & infectiousness correlate.

Tons of stories w/ quotes from top people are not making this clear & it matters.
Clarifying thread
You may have seen this figures showing viral load over time, with thresholds for testing +.
(This one from @michaelmina_lab @DanLarremore paper). Simple & straightforward, right?
Conceptually yes, but what is this figure based on? Is it SARS-CoV-2/COVID-19 data in people? Nope!
This figure is (loosely) based on data from other viruses in people & SARS-CoV-2 in animals. Here's data from macaques (10.1126/science.abc4776) & cats (pnas.org/cgi/doi/10.107…). Looks similar to schematic but not quite identical. Where is the virus-negative period pre-peak?
Read 39 tweets
29 Sep
I posted this thread earlier because there's a serious challenge ahead: now that antigen tests are being used on a huge scale (WHO bought 120M; Abbott is producing ~50M/month), key Q is: what to do w/ result?
CDC says: + antigen test = "presumptive case".
wwwn.cdc.gov/nndss/conditio…
Understandably, this makes some health care professionals uncertain what to do next, especially if confirmatory PCR test takes days to get results back. Do they treat it like a confirmed case, try to get case to isolate & trace their contacts?
If few false +, no problem!
But if false +s are relatively common (even 1-2% would count as relatively common) & antigen tests are used for frequent screening of asymptomatic people, this would lead to large number of isolated/quarantined people, awaiting PCR tests. Here's an example...
Read 8 tweets
29 Sep
Specificity of antigen vs PCR-tests: data needed!
Many are understandably excited about the new rapid antigen tests. But there are a couple issues I haven't seen robust data on. Maybe you can help?
What is specificity of antigen tests vs PCR?
Thread
@michaelmina_lab
EUA (fda.gov/media/141570/d…) for BinaxNOW specificity (1-false +)=98.5% but:
- sample size is tiny (25 people submitting a total of 102 swabs from SYMPTOMATIC patients)
-95% CI (which should incorporate repeat testing & be analyzed as f(days since symptom onset) is: 92%-99.96%.
This means up to 8% (or more, if analysis done properly; totally unknown for asymptomatic people) of + antigen tests could be false +. If that's the case, these tests would be a disaster for screening people without reason to suspect they are infected (e.g. school kids).
Read 5 tweets
24 Sep
Hawaii is lifting quarantine requirement if travelers take 1 test & United is now offering rapid test for flights to Hawaii.
This will miss some infected people traveling to Hawaii as I detailed earlier:

usatoday.com/story/travel/a…
Hawaii is clearly trading off tourism $$ vs risk of infected people coming to Hawaii. However, they could greatly reduce risk further w/ 2nd test (). Testing capacity has been constraint before, but less so w/ new rapid tests United is using.
Having a few more infected people reach Oahu w/out quarantine isn't a huge deal w/ current case # in 100s, but imported cases could make big difference to other islands & if Oahu could reduce cases it would matter there too.
nytimes.com/interactive/20…
Read 4 tweets

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