HERE IS THE PLAN TO GET US OUT OF THIS #COVID19 WAR

• NO lockdowns
• NO waiting for vaccines
• Reverses cases in weeks

A true public health approach focused on the ppl

To end the public health *WAR* we are in.

RAPID At-Home COVID Testing for All

ti.me/3kEGOoM
This Plan works WITH the people and meets them where they are.

It works WITH all the other public health approaches we are already taking - it does not replace them

It is bold and and ambitious - and addresses the fact that we are actually in a war with a virus...

2/
It is time the government STOPS the nonsence of treating this like scattered medical problems to be addressed medically

We MUST address the pandemic as a public health problem - with the RIGHT TOOLS - only then will the medical issues resolve

Not the other way around

3/
The tools we need are NOT those needed for sick people

Nor is the @US_FDA evaluatory pathway

We Need new thinking - a new paradigm - a new approach to a crisis causing public suffering, hardship, poverty, disease, and death

We Need to Readjust what we falsely believe works

4/
Our Leaders must rise to find the courage to buck the trends and be true leaders.

They must try new, bold ideas in the face of failure after failure

And the approaches must respond appropriately to where American's are today...

5/
It is not enough to tell people to stay home and don't go see their family for Thanksgiving

That's a failure of a response!!!

That's a poor attempt to do damage control for a failed response in every of the 50 states of these United States.

It's simply not good enough

6/
We MUST STOP FAILING

And we can't stop failing by doing the EXACT SAME THING OVER AND OVER FOR MONTHS

Trump did not help. No.
But states could have taken action earlier.
We can start now. Today.

7/
States can start to use states powers and Say to the FDA - and the Federal Government - enough is ENOUGH!!!

We MUST ACCELERATE new approaches and we simply cannot just wait around to see what is FDA authorized next in hopes that it maybe possibly will be useful.

8/
If Congress won't provide $5B to produce 20M first in class rapid antigen tests every day for America, we need @elonmusk @Facebook @Apple @ATT @Verizon @amazon to start to build the tools we need so we can go home for the holidays!

And we need States to work with them!

9/
Simply put - we must change our approaches

The classical public health approaches haven't worked
The sputtering lockdowns won't work and will hurt

We need to treat this like an all out War. It is the greatest catastrophe in our country in decades

We must act like it!

10/10
This isn’t the first mention of this... have been beating this drum for a while

Here is an OpEd in @nytimes
nytimes.com/2020/07/03/opi…
Discussed this all w @profvrr on This Week in Virology 640 too quite a while ago.

If you got to hear and didn't notice - the first tweet of the thread has a link to an article I wrote in
@TIME
. This tweet thread rant was really not meant to take the place of reading the article.

Here it is again if needed.

time.com/5912705/covid-…
This is the Slovakia data I refer to in the @TIME piece... this graph annotations from my research colleague in crime (we do a lot of the frequent rapid test thinking together) @DanLarremore

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More from @michaelmina_lab

15 Jan
Apparently I cannot say this loudly enough

The recent @bmj_latest articles by @deeksj et al deriding Rapid Ag Innova Tests are simply WRONG

They simply do NOT appropriately interpret Ct values & do NOT consider massive importance of how long PCR remains + post-infectiousness
Inspection of Ct values among the Asymptomatics & correlation to RNA copies / ml shows Ct values in Liverpool are ~8 lower than often seen in literature. The failure to recognize this means the estimates of Ag test sensitivity for "high virus" are totally off.

2/x
The sensitivity for "moderately high" or "high" viral loads in the Liverpool data are ~90% and ~100%.

But to know this you cannot just assume a Ct of 25 elsewhere (often described as entering "high viral load") means same thing as a Ct value in other labs.

3/x
Read 5 tweets
14 Jan
Will delaying #COVID19 vaccine doses cause vaccine immune escape?

This nice article misses an extremely important part - that unvaccinated ppl too have so called “partial immunity” while infected.

Escape from immunity isn’t same as from antibiotics

1/x

sciencemag.org/news/2021/01/c…
Unlike antibiotics where resistance happens w partial doses, to be a risk you also must be taking them in first place.

When considering escape from spike protein derived immunity - must consider everyone w/out sterilizing immunity at risk to induce a mutant upon infection.

2/x
Whether no vaccine or a single dose (or two) people create antibodies against the same part of the protein.

If discussing “partial immunity” or low affinity antibodies, must consider that a fully naive person might pose greater risk for escape than a single dose person

3/x
Read 11 tweets
13 Jan
CLARIFICATION:

Much confusion about rapid antigen tests

ALL evidence - when evaluated appropriately! - shows these are VERY good at detecting infectious virus

• ~100% if used frequently

• >95% for single samples with high, most likely contagious viral loads

The tests work
We've been evaluating rapid Ag tests on campuses. We find these tests - when used as screening w/out symptoms DO miss most PCR positives!

BUT EXPECTED! - ALL misses were previously detected and already finished isolation.

Ag is MUCH more specific than PCR for contagious virus
this is the whole point of rapid antigen tests - they find people who are currently infectious. They are fast, give crucial immediate results and unlike PCR do NOT stay positive for weeks/months after someone is no longer infectious.
Read 4 tweets
12 Jan
Dear ⁦@guardian

This article is incomplete & represents a minority view of the science.

The experts here are gravely misinterpreting the data and sowing confusion among the masses.

The rapid tests are working well!

This coverage isn’t balanced theguardian.com/world/2021/jan…
The details are difficult to describe via Twitter but I’ve tried on many occasions. The described low accuracy is false. These tests are doing very well to catch infectious people. We do NOT want to detect and isolate people who are not infectious and just have old remnant RNA.
I know people want to hate on the government for purchasing tests - but the Innova test is working entirely as expected. Very good for detecting contagious people. Which is the only goal here.

I’d be happy to write an OpEd for @guardian to explain.
Read 4 tweets
10 Jan
UK Rolling out #COVID19 Rapid Tests!

**NOTE: A quote says rapid tests missed 60% of positives in Liverpool

NOT accurate

VAST majority of MISSES were LOW PCR RNA & thus NO LONGER CONTAGIOUS.

(PCR remains Positive for a long time, rapid Ag does not)

theguardian.com/world/2021/jan…
Despite some poor messaging in UK - Rapid Ag tests work WELL to find CURRENTLY INFECTIOUS ppl

Frequent rapid Ag testing sensitivity is >95% to find infectious people.

(ppl get confused & say they're low sensitivity - but that's when compared to RNA on PCR from prior infection)
A major attribute of rapid Ag testing is they can be FREQUENT

It's not the sensitivity of a test to find virus particles that matters

It's the sensitivity of the testing program to find and isolate infectious people that matters.

For that, PCR often fails. Rapid Tests do well.
Read 6 tweets
9 Jan
Honestly @US_FDA @CDCgov

HOW have we FAILED to get frequent rapid testing out?!

•The science & plans are there

•All you've given is pushback

Almost 5 months ago I wrote:

"So we're not looking back 5 months from now wishing we acted"

PLEASE ACT NOW!

@ASMicrobiology @APHL
I know @ASMicrobiology & @APHL you do not support these tests - pity

Confounding sensitivity & specificity for EFFECTIVENESS in midst of a pandemic is a dangerous and now deadly decision

(1) Define the use
(2) Then take a stance on test effectiveness

You never really did (1)
Here is a primer for what I'm referring to.

Read 4 tweets

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