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
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.
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
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
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
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.
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.