ICYMI: On Thursday, we published a story suggesting that elementary schools, especially, do not seem to be seeding clusters of infection. As all articles on this topic do, it made some people angry, so... a thread for people who did not bother to read it or maybe misread it. 1/x
First, what the article did not say. It did not say kids don’t get infected or that they don’t transmit. They do, on both counts. It did not say that schools are fine to open no matter what is going on in the community. 2/x
Community prevalence is important because if it’s high, it means some number of kids and staff will arrive at school infected, making it more likely that they will spread the virus to others. 3/x
In other words, schools are not magically immune to virus spread, and they do contribute some infections, but elementary schools do not seem to be hotbeds of germs as we worried they might be. 4/x
Again, the risk is not zero, NEVER zero. But in elem. schools, kids do not seem to be driving the infections as much as adults do in their activities—restaurants, bars, gyms—and certainly not *more* than those things. Meaning, young kids do not seem to be super spreaders. 5/x
I say young kids because age matters very much. Elementary age seems to be different from a teen of 15+ so the bar for middle schools and high schools and especially colleges is different. But again, none of this exists in a vacuum. 6/x
If community prevalence is super high, everything, including elementary schools, may need to close. The point the experts were making is that given the info we have, schools should be the last things to close, not the first. 7/x
And to those who love to say that we knew all this 3 months ago—no, we did not. The American south or Midwest is not Europe, and attitudes to mask wearing, the state of schools, risk factors in the population—those are not easily translatable. 8/x
Also, the studies from Europe were extremely mixed. Which brings me to the last point. These data are NOT the final word. They’re still patchy, not great, and not based often enough on random testing. But it’s as much as we can say for now. 9/x
So if you're looking for definitive statements, you're not going to find them here. If more and better data come in that point in another direction, I may well write that, too. Science is iterative, and we are still learning about this virus. 10/x
For eg, if it turns out (and I'm not saying it will) that kids who are infected develop some mysterious syndrome 6 months later, it will change the picture entirely. That's an extreme example, I know, but it's making a point. 11/x
So let's take some comfort in the fact that young kids at least seem to mostly be spared the disease and can maybe go to school without disrupting community prevalence too much.

feat @jenkinshelen @brookenichols and David Rubin


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More from @apoorva_nyc

27 Oct
The headlines, all of a sudden, are everywhere. UK study showed antibodies to the coronavirus decline so we're all doomed. No immunity, no vaccines, no herd immunity.

People, we have enough real things to worry about. Do not worry about this. 1/x

First of all, antibody levels are *supposed* to drop after the infection clears. Imagine if they didn't: Your blood would be a sludge of every type of antibody to every pathogen you've ever encountered. Hence my surprise yesterday at this paper 2/x

In the British study, in 27% of people who were positive at first, they dropped below detection limit. But the test has 84% sensitivity, and we know not everyone makes really high levels of antibodies after coronavirus infection (although nearly everyone makes some) 3/x
Read 9 tweets
27 Oct
A quick thread on what this new article showing worrying signs of autoimmunity in some Covid-19 patients means 1/6

In about 70% of people who were severely or critically ill with Covid-19, Emory researchers saw what are called "autoantibodies" -- auto meaning self. Instead of binding fragments of viral RNA, these antibodies glom onto human DNA. 2/6
Normally DNA is cloistered inside the cell. But under high inflammation (as in acute viral infection), cells can explode, strewing the arena with DNA fragments, and confusing antibodies. Their presence may explain some aspects of severe Covid 3/6
Read 6 tweets
23 Oct
BREAKING: Universal mask use could prevent nearly 130,000 deaths from Covid-19 by next spring, and without mask use, the death toll could top 500,000, acc to new estimates. 1/x

These are extremely rough approximations, susceptible to all the flaws of modeling studies, but plausible nonetheless, experts say. We’re already seeing a fall surge. The trends will continue through to a peak in Jan, and hold at high levels till March, acc to the model. 2/x
If states ease all social distancing mandates, the death toll could hit a million by spring. But more plausibly, if states put some restrictions back in place because of rising rates, the number might be closer to 500K. 3/x
Read 6 tweets
19 Oct
NEW: The Great Barrington Declaration has received a lot of attention, especially from the Trump administration. How did they gain access? And what exactly do they envision? 1/x

Here are some of the main pts: 1) protect the older/vulnerable while letting young people get infected
2) No testing of asymptomatic people
3) No contact tracing. 2/x
BUT how exactly would this work? How do you define, let alone "protect the vulnerable," when a third of the population has underlying risk factors? And how do you physically separate them from the rest of the population? 3/x
Read 7 tweets
19 Oct
In August I wrote a story questioning whether PCR tests are too sensitive. Many clinical microbiologists and others took issue with the piece because they saw it as undermining the PCR. This Medium post raises some of those points: 1/x

The post makes some very important points about PCR, including the huge variability across machines of cycle thresholds (Ct) and even from sampling method. 2/x
The FDA's own analysis confirms this concern. See, for eg, this recent attempt at figuring out the analytical sensitivity of some of the tests with an EUA, the range is very wide: 3/x

Read 12 tweets
16 Oct
There are SO MANY concerns about rapid tests for the coronavirus but a real-world experiment in SF has found that Abbott's BinaxNOW is just as good as PCR at detecting people who are infectious

The study is small, and it has limitations. But the team tested people at a train station in a Latino neighborhood. Looking at a likely range for infectiousness (CT < 33), the test detected 15 of 16 cases picked up by PCR. 2/x
But not rapid tests are equal. and neither, by the way, are all PCR tests. One analysis by the FDA found massive differences in sensitivity, with another Abbott test, ID now, towards the bottom. 3/x
Read 6 tweets

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