Michael Mina Profile picture
Nov 18, 2020 15 tweets 9 min read Read on X
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

May 3
Such a bad interpretation that stands to harm patient care

Let's not throw the baby out w the bathwater for COVID-19 (and flu etc)!

Suggesting to only run PCR & not rapid means most (50%-80%) of patients get WORSE care & at higher costs

Here's why:

A 🧵

1/
When I see publications & docs say “don’t use a rapid test, only use a PCR”

it assumes this is an OR only situation

Ridiculous!

A rapid test is… RAPID… and highly affordable

You lose ~nothing by it and give your patient the opportunity to GAIN tremendously

2/
If the test is positive, then for that 80%+ of culture positive ppl … your job is done immediately

You’ve spent $5 and 5 minutes and they can get on treatment right away

If you didn’t do it, it will be be 1-2 days and ~$150 before they can get started on treatment

3/
Read 10 tweets
Apr 20
Here we go again with this asinine cautious approach to testing for H5N1

CDC is NOT recommending that people with no symptoms - but who have had contact w infected animals - be tested at all… and certainly are not recommending a swab w any frequency.

Though we should have learned it in 2020, Here’s why this doesnt make sense:

1/Image
Firstly, tests are our eyes for viruses. It’s literally how we see where viruses are

If we wait until people are getting sick, we may have missed a major opportunity to find viruses jumping into humans before they learn to become so efficient in us that they cause disease

2/
So waiting until we actually have highly pathogenic strains harming humans - when we have a pretty discreet population at the moment to survey - is short sighted

3/
Read 11 tweets
Jan 16
A lot of questions still on:

How long should I isolate?

Do I need to isolate?

When can I go back to work?

Is 5 days enough?

What if I’m still positive?

Why am I not positive when I first get symptoms?

This thread below (and the embedded thread) goes through many of these questions
Now that symptoms start earlier w COVID (bc immunity activates symptoms fast after exposure)

A frequent ? that comes up is what this means for Paxlovid

Often ppl think it means you have to start Paxlovid earlier

Nope - Opposite! You have more time

2/
Bc symptoms start faster but the growth of the virus still takes about the same time as it used to…

Symptom onset today is ~2d post exposure where before it was ~5d

So, as far as virus growth is concerned, day 5 post symptoms (when the trials took place) is day ~8 today

3/
Read 6 tweets
Jan 8
A heartbreaking consequence of lapses in vaccination!

A measles outbreak is spreadinf in Philadelphia.

MEASLES! It sends kids to the hospital, erases existing immune memory (creating long term risks) and kills 1 in 1000

It was eliminated in the US, but we seem hell bent on reversing that

inquirer.com/health/measles…
A particularly deadly consequence of measles is its erasure of previously acquired immune memory - setting kids and adults up for infections that they shouldn’t be at risk from!

We found for example that measles can eliminate as much as 80% of someone’s previously acquired immunity to other pathogens!
science.org/doi/full/10.11…
Image
Read 6 tweets
Jan 3
This paper from Kaiser on new XBB1.5 vax formulation is misleading

NO, it does NOT say that prior vaccination w non updated XBB1.5 vaccines offer no protection

No, it doesn’t even say the XBB1.5 updates to the vaccine formulation are important

🧵
1/
medrxiv.org/content/10.110…
Here are the key conclusions.
They are WAY misleading

The major issue is w the timing

The comparison is

A) a VERY recent XBB1.5 vaccine given in last 30 days,

Vs…

B) A vaccine received ~1 year or more ago!

Any effect is first and foremost owing to recency of vax

2/ Image
Given everything we know about major short term (weeks - few months) immune responses after vax or infections

The comparison is NOT able to say anything about the importance of updating the vaccine formulation for variants

It simply says what any Immunology 101
Text says..

3/
Read 15 tweets
Dec 24, 2023
Tip on pooling home tests

I’m gathering w family. Had one @Pfizer Lucira multiplex COVID-Flu home molecular test

Had 6 people and 6 swabs

Everyone used one swab. Dunked all 6 into one Pfizer Lucira test

Neg.

Tested everyone for price of one!

Pooling at home works!
Pooling can work w home tests including rapid antigen and rapid molecular tests

However for antigen id be a bit more cautious and not put more than 3 swabs in the buffer

With molecular, particularly Pfizer Lucira bc it has a large volume buffer, 6 is no problem.
Here’s a nasal swab that would work. Don’t use it as a nasopharyngeal swab at home - just use it like any home self swab and swab the anterior nares

a.co/d/iCO1nsI
Read 4 tweets

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