Today - I’m excited about not just antigen tests but introduction of at-home PCR-like tests like @HomodeusInc that are in works

These will serve so many purposes!

A major one is as gold-standard to confirm rapid antigen tests in the home/school/work w/out need for lab PCR

1/
These tests will bring the full power of a PCR lab into the home! Or School, or work, or small medical clinic

They won’t scale as high as antigen tests in terms of numbers, but it makes them optimal for them to serve, in part, as confirmatory tests for antigen tests

2/
False positives for example do happen (not frequently) in antigen tests. Confirming w a 2nd antigen test is one way forward

We want to be sure a +ve in a nursing home is true so a person is cohorted correctly (otherwise a potentially deadly mistake).

3/
In very high risk settings where a false positive can be deadly (vs at home where a FP simply means staying home for a day or two) having a new type of very rapid molecular test like the @HomodeusInc or others will be game changing to keep ppl safe

So many other uses too

4/4

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More from @michaelmina_lab

11 Nov
Moving in right direction to reverse outbreaks

Here's how:

At-home frequent rapid tests

10M/day ->

pool 2 ppl/test ->

20M ppl tested/day ->

Ea house tests 1x/wk ->

140M ppl tested/wk!! ->

Herd effects: R << 1 ->

RAPIDLY SLOWS SPREAD in US

1/

medtechdive.com/news/bidens-co…
This plan can work with only 10M paper strip antigen tests per day in whole of US

US Govn't can produce / fund these tests. Ship to participating households. 20 paper strip tests per household...

3 are different (but look same) and are for rapidly confirming positives.

2/
We do NOT need all people to "buy into" the program. These tests are used in private (think... next to toothbrush) and need only half of a community to decide to participate.

So if 50% of people don't want to - they don't need to. Not mandatory... the plan still works!

3/
Read 25 tweets
10 Nov
NEW on Rapid Tests!

Exceptional data that should help path to at-home highly accurate rapid tests

In over 860 samples tested w ⁦@AbbottNews⁩ BinaxNOW, only ONE was falsely positive! The Specificity was > 99.8%!

Why is this so important... and what else happened here

1/
First: here is the pre-print

medrxiv.org/content/10.110…

Which @apoorva_nyc covered briefly recently prior to the study release

nytimes.com/2020/10/15/hea…

2/
Second, we are so frequently talking about sensitivity bc no one wants to miss a case (will come back to this...) but what is equally or even more important when we consider frequent rapid antigen tests to suppress outbreaks with millions of them daily is SPECIFICTY

3/
Read 11 tweets
9 Nov
Wow! Good news! Pfizer press release says vaccine 90% effective at preventing symptomatic #COVID19!

If results hold, this is a very good efficacy for a vaccine, higher than I was expecting, by far.

From this, we can be cautiously optimistic!

1/

nytimes.com/2020/11/09/hea…
We do have to be cautious in interpreting these early results (from a press release) and we don’t know if same level of protection will persist long-term or if this is driven a lot by early effects more than robust immune memory

Nevertheless, this is a positive data point

2/
A couple of other items we will need to look out for

Even it protects from symptomatic disease, does it also protect from onward transmission?

The assumption is it would largely do this (and this would underpin herd immunity). But blocking transmission isn’t a sure bet

3/
Read 9 tweets
8 Nov
Frequent testing is needed to detect people early before infecting others. They must be highly scalable and for buy in, very convenient - i.e. home use

10M Rapid tests/day (i.e. antigen bc scalable / simple) can form the foundation to build back economy

theatlantic.com/health/archive…
Frequent tests alone won’t be the end all be all of this pandemic. Not by a long shot. These can greatly reduce odds of transmission - when used en masse, odds of onward transmission (i.e. Rt) can plummet.

To work, also need huge social/economic safety nets, + masks/distancing.
Although new administration will not officially start till January, we have options now. @JoeBiden and team led by @vivek_murthy can start now to engage manufacturing and begin planning/building these at scale w promise of payment once in office, as one example.
Read 5 tweets
7 Nov
On frequent wide scale rapid testing programs as foundation to slow #COVID19

“Total cost, in tens of billions, would still be far less than the many trillions of dollars of... continued economic loss”

True!

(One comment about the headline...
1/x)
forbes.com/sites/williamh…
Headline says as much as 1M Americans getting COVID daily. This is based on a back of the envelope calculation

We know that only 10% of cases may be diagnosed. So if we have 100k diagnosed daily, then the thinking is that x10 = 1 million

But this misses a crucial piece

2/x
Even though 100k+ new cases DETECTED daily, and we can multiply by 10 for underdiagnosis and get 1M... this is not NEW cases happening daily. This is prevalence of virus positivity daily....

To convert to daily INCIDENCE (Ie new infections daily) takes another step

3/x
Read 6 tweets
7 Nov
Adoption of strategies that aim to allow people to test themselves, privately,simply, at home, 1-2x/week could help suppress outbreaks quickly. Especially in context of other public health measures.

~10M/day to achieve herd effects and drop incidence
healthaffairs.org/do/10.1377/hbl…
We don’t need perfect compliance, at all. We just need decent compliance - we can achieve this. Like herd immunity, we don’t need this to be everyone, just enough people to drop R<1. I estimate 10% of people in a community would test at home per day. So need not have perfection
We still need reporting so public health officials can keep track

No problem... we work w Google, Apple and whoever else to make voluntary reporting easy as a FaceTime call. If I can see my twin brother 2000 miles away w the push of a button, I should be able to report a result
Read 6 tweets

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