A comment (to complement some parallel threads from @michaelmina_lab) on the value of rapid testing, even if it is imperfect. So how do you re open say... movie theaters in the midst of a pandemic where anyone could be infected, and many are at risk of fatal outcomes? 1/n
So bad things are that most movies theaters are indoors, probably poorly ventilated. Crowds. Lots of opportunities for close contact. A person at the peak of infectiousness could kick off a Superspreader event 2/n
If you could present reliable evidence you have been -ve in the last 24 hrs, well that would obviously be transformative. But wait - what if that test result is a false negative and there is a resulting false sense of security? That’s where the masks come in 3/n
Even if an infectious person somehow makes their way into the movie theater, a mask is expected to really limit their transmission to other patrons. Result is a serious risk of transmission is cut to minimal. There’s not a single approach. They work together. They synergise 4/n
And such tests do exist. This is one example. What does *not* exist is access. They should be where they are needed
There are ways to control the pandemic better. We need to *want* to control it better. We’ve done the obvious pandemic management really badly. I’d love it if we could do the less obvious, innovative part well 6/end
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The reason for the test was exposure to a suggestive but non-specific symptom in a member of the household who was also tested 2/n
While waiting for the test result, all members of the household quarantined. Child did not go to school. Prevented any risk of transmission outside the household 3/n
There's a lot of talk about 'preserving healthcare' as a primary goal of pandemic management. That's not wrong, but it begs the question of what exactly we mean by 'preserving healthcare'. I recommend this article in the @NEJM & will add a couple comments nejm.org/doi/full/10.10…
So for some 'preserving healthcare' means avoiding all ICU beds being occupied by the pandemic. This is obviously bad. It's also a very low bar. If we get even close to this, where do you put patients recovering from surgery? Or emergency ICU admissions for other things? 2/n
This is not a hypothetical☝️🏽. So let's say we stop short of crashing the ICUs with patients - we would still end up with shortages of skilled nurses elsewhere in the system, compromising healthcare. When they are redirected at the pandemic other care is affected 3/n
Some of the replies to this have made it clear people still think Covid tests are all painful, and would avoid them. That's *not true*. This👇🏽is a swab for a Covid test, and a PCR test at that. And that's as far as it got into my nose 1/n
We've come a long way since the early days of the pandemic. Then, concerns about sensitivity meant that tests were done on nasopharyngeal swabs, because we were not confident that a nasal swab like this would be accurate enough 2/n
The nasopharynx is right at the back of the nasal cavity, a swab like this is the sort of thing you'd remember. And if you don't know much about test sensitivity it is the starting point. As time goes on, we can ask whether you lose sensitivity with other sampling methods 3/n
On the eve of the election, this paper from me and others lays out the impact of the federal government on the pandemic, it's not good link.springer.com/article/10.100… 1/n
1st the failure to prevent introductions. Lots of dramatic posturing against China, while the virus found ample opportunity to enter the country from Europe. Pandemics are, by definition, global 2/n
2nd Have you noticed the appalling numbers of healthcare workers who have lost their lives? We have known all along one of the most important ways to help them is Personal Protective Equipment or PPE khn.org/news/lost-on-t… 3/n
The severity of covid varies greatly by age, with risks of death in young people often said to be equivalent to those of flu. This is one of the most pernicious pieces of misinformation I have noticed in the pandemic. This is why 1/n
first of all, let me be clear that this is *only* based on deaths. There is plenty accumulating evidence that ~10% of people can have long term illness (long covid) lasting for months and this includes young people. I know some. You may too 2/n
It is correct that younger people are much less likely to die from covid, but younger people are much less likely to die period - from covid *or* flu. So how many younger people typically die of seasonal flu? Fortunately @CDCFlu has asked that question for us 3/n
The changing political geography of the pandemic in the US. In the spring the densely populated deep blue NE was hit hard, but since July things have flipped and cases and deaths are now highest in rural GOP voting areas. Featuring work from us washingtonpost.com/health/2020/10…
It also quotes @AliHMokdad who says, rightly "it didn’t show up immediately in rural communities,” he said. “And then people in these communities felt, ‘That’s not us, that’s the big cities.’ They let down their guard.” But there's something else here
the introductions to large urban areas are predictable, simply because of the numbers of opportunities, while for smaller rural communities it is more random. But given time the virus will get there eventually