Question today: A man develops a fever and is diagnosed with #COVID19. How long should his wife quarantine?
After her initial exposure, she is careful to stay six feet away from him, but they live in a small(ish) apartment. 1/
Until recently, the recommendation was for her to quarantine for 14 days. But the CDC just changed guidance and now indicates that 7 days (with a negative test) or 10 days (no test) is also sufficient.
But is it?
Roughly 97.5% of patients will develop symptoms 11.5 days after exposure, so the new recommendation is good, but not airtight. And not all exposures are alike; she lives with the guy. Letting her out of quarantine after 10 days with no test seems unwise and potentially dangerous.
What about the other two options?
The CDC doesn't specify what type of test is required (I wouldn't use the rapid test) and we don't have much data (yet) to argue for the 7-day option.
So I told the woman person to quarantine for 14 days.
Was it the right call? I can't be sure.
Doctors are eager for algorithms to simplify the endless stream of daily decisions, but as #COVID19 guidelines continue to change, many of us are forced to rely on something else: judgment.
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UPDATE: I’ve been asked to provide guidance to some doctors who are trying to figure out: 1) whether to take a #COVID19 vaccine issued under emergency authorization and 2) what to recommend to their patients.
Here’s my approach: 1/
On December 10, I'll watch the Vaccines and Related Biological Products Advisory Committee discuss Pfizer's data. I have many questions about subgroup efficacy, safety, & memory T cells. I’m confident those will be addressed. Then, fighting the urge to do something, I’ll wait. 2/
We’ll do it all again on December 17th when the same panel meets to discuss Moderna’s data. After that, I’ll speak with colleagues, compare notes, and hash out a recommendation. I'll explain the rationale and my level of confidence in that recommendation. 3/
The controversial argument to continue placebo-controlled vaccine trials after emergency authorization hinges on this idea: The obligations researchers have to volunteers in a trial are distinct from the obligations that physicians have to their patients. 1/
Researchers must always ensure that placebo-controlled trials remain ethically appropriate, and that takes into account a variety of factors, including local transmission rates and individual risk profiles (volunteer age, medical conditions). 2/
COVID Question: Will vaccination be a yearly thing? Maybe. After the rollout, we'll do surveillance to determine: 1) How long protection lasts and 2) If mass inoculation causes coronavirus to mutate.
It's an RNA virus, and replication is often sloppy, so it could change. 1/
We don't yet know if #coronavirus will behave more like measles or influenza. Both are RNA viruses, but they require vastly different vaccination strategies. Most people are protected from measles by childhood shots; by contrast, influenza requires yearly vaccination. 2/
The difference has to do with how these viruses mutate. Measles has one serotype; influenza has several. 3/
Vaccine Dilemma: When should volunteers who received placebo get the real thing? If vaccines are highly effective, it seems unethical to withhold inoculation from people who bravely volunteered for a study. But that’s what some researchers want. 1/
mRNA vaccines are reportedly 95% effective, but it’s possible that number will degrade over time. Allowing volunteers to cross over from placebo to vaccine unblinds these trial and ends the collection of randomized data.
That prevents us from learning crucial information... 2/
...about the degradation of vaccine efficacy, durability of protection, and long-term safety data. Some argue that volunteers who received placebo should be among the LAST to get vaccinated.
This preserves the integrity of ongoing trials. 3/ nejm.org/doi/full/10.10…
Common question: Do we vaccinate patients with immune impairment? This group, which includes patients on chemo, transplant recipients, HIV, etc. are at high risk, but there's little data on vaccine performance in these groups.
How much can we extrapolate from healthy volunteers?
This becomes an issue when we try to anticipate how #COVID19 vaccines will perform in nursing home residents. Very few (if any?) were included in the tens of thousands who volunteered for studies. Does that matter?
The ACIP vote on vaccine priority was not unanimous because...
...one expert was concerned about the potential effects of COVID vaccine on residents of long-term care facilities. The elderly typically have weaker immune responses to vaccines and there needs to be a robust safety surveillance system for these patients. sciencemag.org/news/2020/12/c…
Giving a lecture at @NYUStern tonight and students were asked to submit questions. A theme has emerged: "How do you get people who are emotionally exhausted by coronavirus to take precautions seriously?"
A few thoughts: 1/
If you really want to engage someone, you have to know their point of view. For me, this means going down some truly gnarly rabbit holes of misinformation. (I know the case against masks inside and out). Occasionally, I hit on something interesting. This happened the other day...
...when a staff writer from the @NewYorker pushed me on the origins of coronavirus. I've trapped bats with some of the scientists featured in "Spillover" by @DavidQuammen and for most of this year, I have been of the opinion that #coronavirus leapt from animal to man.