KJ Seung Profile picture
18 Oct, 7 tweets, 2 min read
Multiple NE states now dealing with COVID outbreaks in youth hockey. NH has taken the strongest action, a two week "pause" of all activities associated with youth, amateur and college hockey after 158 cases in the past two months.

bostonglobe.com/2020/10/16/nat…
Also now, a serious outbreak on the Yale men's hockey team. 6 positive players reported on Oct 13; 18 additional players subsequently found to be positive. Contact tracing and testing of additional players and staff associated with the team is ongoing.
cnn.com/2020/10/16/us/…
This week CDC published a report of an older outbreak of an outbreak on a recreational hockey team in Florida in June. 14 of 22 players ended up being infected after what appears to be a single game exposure! 3/ cdc.gov/mmwr/volumes/6…
Osterholm: "Ice rinks have a very unique ventilation challenge because you want to keep that ice cold and you have the boards and the glass around it. What you basically do is create a refrigerator out there." 4/
cidrap.umn.edu/covid-19/podca…
"They're going to be skating a lot and they're going to hold that virus in as if I was in a small room with all those players. And moving around in by itself is not going to dissipate the virus away because the cold hangs down tight around the ice skating rink." 5/
"I can't think of anything else in sports where there's something about ventilation that would cause the virus to sink, stay in there and not move or dissipate. And I think this is going to be a real challenge." 6/
If Osterholm is correct, we are going to see outbreaks all across New England in the next few weeks. Youth hockey is a major part of the community and culture of all of the NE states. This is going to have massive ripple effects.

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More from @kj_seung

11 Oct
Example 3: Retrospective ("backward") vs. prospective ("forward") contact tracing.

Lots of interest in backward contact tracing after @zeynep's article!

#1 tests positive. You interview her and she tells you the exact date her symptoms started. 1/
Following protocol, you interview her about everyone she met starting 2 days before the date her symptoms started. Family members are usually obvious. She lives with her brother and sister, parents and grandmother. Also another brother that lives at a different address. 2/
She's a waitress so you call her boss at the restaurant. He's already closed it and told all of the staff to get tested. He and another employee end up testing positive (no symptoms!).

So you've called 11 close contacts and found 2 cases!

Nice job with the forward tracing. 3/
Read 12 tweets
30 Sep
Example 2. Is PCR testing of asymptomatics a good idea?

This man is COVID positive but has no symptoms at all. He says he has been completely healthy for the past month.

The reason he got tested? All staff were required to be tested before the beginning of the school year. 1/
He has no symptoms, so we don't know when he was infected. People can excrete RNA for weeks. He could have been infected 2 months ago!

But if he was infected more than 2 weeks ago, he is no longer infectious.

You're the contact tracer. Did you just waste 45 minutes? Nope. 2/
The man tells you that two days before he was tested, he attended a very small wedding. And a very nice post-wedding banquet.

(Don't shame him, it was only 20 people. And they were careful...)

3/
Read 7 tweets
1 Sep
Another day, another lazy article about pandemic response in the US.

“In the US, contact tracing is failing,” based on links to articles and random stats.

Um. We reach >90% of cases in MA, can we say that US contact tracing is better than NZ (86%)? 1/
No, we cannot. Because it’s not possible to measure the effectiveness of a complicated program with such simple stats.

Ask other questions: How many cases and contacts need support to isolate and quarantine? And what kind of support do they need? 2/
“Contact tracing is successful in all other countries.” Talk to those countries--turns out, contact tracing is hard everywhere.

Sure, journalists love to write about SK tracing system. But in reality, it’s no cultural cakewalk there either. 3/
Read 8 tweets
31 Aug
It's really hard to understand your claims about asymptomatics / CT / aging / infectiousness without actually looking at the data. You are saying that 55% of the MA samples have CT>35. These are not all from asymptomatics because the vast majority of MA cases are symptomatic. 1/
Or maybe CT is high because of delayed diagnosis? But most MA cases are getting tested soon after developing symptoms. CT is from the lab data, symptom onset is from the tracing data. I think it's premature to assume one is correlated with the other without an analysis. 2/
If the CT is high even though the time between symptom onset and sample collection is short, then we would need to consider other possibilities such as sample collection technique, etc. This would indeed be an interesting analysis! 😁3/
Read 8 tweets
30 Aug
A really horrible way to start a confusing thread. The surprising thing is that there is no scientific evidence in this thread, and yet everyone accepts the assertion that CT>33 or 35 is not infectious. Unable to culture virus? No household transmission? What's the evidence? 1/
55% of MA patients are post-infectious? What's the dataset? A hospital lab? Statewide? What's the percentage of asymptomatic college students? What's the percentage of contacts? What's the median number of days after symptom onset? 2/
The other problem is the public health message: that the vast majority of people with a positive test don't need to isolate because they aren't infectious. That's a really dangerous message to throw out there without any scientific evidence. 3/
Read 5 tweets
27 Aug
Example 1. A is 5 years old and is diagnosed with COVID-19.

A attends a small day care. B, C, D are all asymptomatic (as expected in this age group).

Should we test them?

No: they should be quarantined anyway
Yes: to stop "webs of transmission"
1/
Answer: Yes.

It is true that B, C, D should be quarantined anyway, irrespective of the test result.

But B, C, D have 9 secondary household contacts. If B, C, D are diagnosed with COVID-19, the family members can quarantine themselves immediately. 2/
Counter argument: "B, C, D are likely to be positive, so all their household contacts should be quarantined anyway! No need to waste tests on them."

Ok, but B's mom works as a waitress in a restaurant. Should the restaurant co-workers (tertiary contacts) be quarantined too? 3/
Read 4 tweets

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