Have a #COVID19 test results that took more than a few days after the swab was taken??

Throw it out and refuse to pay!

A lab result delayed more than a couple days isn’t just not useful, it’s misleading and dangerous!

A test with a 4+ day turnaround should have EUA revoked.
The only way it’s useful is if it’s positive. Remember, start the isolation clock from the time of the swab. Not the result.
Also, I’m not blaming the labs here. Im highlighting a massive systemic problem.

Though I will say that all clinical labs have a responsibility to accept only specimens that they can process within a clinically relevant time. A 7-day turnaround does more harm than good.
In case not obvious - I'm not referring to manufacturer EUAs - but LDTs. Also though referring to labs using manufacturer EUAd tests.

Point is that TIME is as important for these tests as accuracy. If the delay is excessive, it's potentially as bad as inaccurate testing
And if symptomatic, start at time of symptoms...

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More from @michaelmina_lab

1 Dec
Getting tested during a pandemic is mostly to keep others around us safe. If +ve, the test wont change that

• Tests for #COVID19 should NOT require MD order
• No person should have to pay for a test intended to help them not infect others

This is Public Health, not medicine
Testing is also performed for medicine, of course.

And if you end up in the doctors office b/c you're sick-all bets are off w regard to pay (I'm not wading into chargemaster wars!)

But if getting a test simply b/c you don't want to infect others... you should NOT have to pay.
Also- lets be honest - the questionnaire to get a test to get an automatic doctors prescription from some doctor you don't know and will never talk to... it's complete BS.

It hikes up prices, plays into a medical versus a concerted public health response and offers little else
Read 4 tweets
30 Nov
Interesting to listen to how we were thinking in April vs today

This interview w @bbcworldservice on April 21 asks question "How likely are children to spread #COVID19"

We didn't have data- but models showed (correctly) kids are important in spread

bbc.co.uk/sounds/play/p0…
I think going back and seeing what we got right and what we got wrong, in hindsight, will be an important exercise to help us understand, with some objectivity, what tools/models will be most useful in future pandemics and what are total rubbish.
Read 4 tweets
28 Nov
New efforts w mass testing in Liverpool have dropped incidence by 2/3rds in weeks

Not a “clean” pilot study of rapid tests bc other interventions also started at same time.

There are a few items that I’m not so aligned with that they are doing...

1/ washingtonpost.com/world/europe/l…
First I think it’s great that they are using rapid tests for asymptomatic screening! This absolutely needs to happen - particularly as evidence builds that transmission peaks before symptom onset.

So that is great!

2/
Also, for those in the US - know that UK is purchasing their rapid tests from a California based company!! Shipping 1 million tests to the UK for mass rapid test screening.

Wouldn’t it be nice if Americans could also reap the benefits of this American innovation... :/

3/
Read 9 tweets
23 Nov
Rapid Antigen tests are very sensitive at Ct < 30

Above which-too little live virus to detect

Ppl worry transmission could occur at Ct > 30 and thus missed by Ag test

Transmissibility is NOT BINARY
Possible at 34? Yes
Likely? No.

This graph helps place Cts in context!

1/
(If do not see the full graph above - please click on it)

Easy to forget Ct values are LOG scale

They place as much emphasis on an increase of 1000 viral particles as they do an increase of 1,000,000,000!!

2/
But when we change from a Ct scale to a scale that shows the number of viruses withouth "zooming in" on the low end, we see just how stark a different 20-25 is versus 30-35.

3/
Read 8 tweets
22 Nov
@DrEricDing @VirusesImmunity @PeterHotez This is a great question

The vaccine is not necessarily a more trusted source of immunity. Both an infection AND a vaccine are likely to induce good immune responses. All of the information we have suggests that immunity to infection for this virus is... well... as expected

1/
@DrEricDing @VirusesImmunity @PeterHotez However, to the questioners point, we are hoping the vaccines will induce potent and long lasting immunity. The vaccines are designed specifically to direct our immune response to look in the right spot - vs searching all over the virus...

2/
@DrEricDing @VirusesImmunity @PeterHotez The leading vaccines are all designed to induce, primarily, an antibody response that specifically blocks virus entry. To do this, they display a piece of the spike protein - the key to unlock entry into the cell.

3/
Read 15 tweets
21 Nov
(SHORT) Thread
NEW paper on RAPID TESTS

Another terrific study showing rapid tests WORK & can be key tools to combat this virus

Of 897 people w high virus (Ct<25): 888 were detected w Rapid Test

Sens: 99.1%
Spec: 99.5%

medrxiv.org/content/10.110…

*repeat tweet b/c typo in last
THINK

If these ppl were screening, this would be 888 INFECTIOUS ppl who'd KNOW they’re contagious–and be empowered to act IMMEDIATELY Instead

In USA today, these 888 INFECTIOUS ppl would simply NOT be tested OR find out ~3-7 days later -> often AFTER contagiousness clears!

2/
In this study there was a specificity of 99.5%!

In other words, out of 1000 tests, 5 people would be called falsely positive

This is OK–simply test again- w another rapid confirmatory test that should come with the first test. Those 5 would NOT be likely to be pos on both

3/
Read 8 tweets

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