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Aaron Richterman, MD Profile picture
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19 Dec, 6 tweets, 4 min read
Thankful to Singapore for surveillance systems that allow for the detailed studies required to truly assess the relative transmission risk of asymptomatic vs symptomatic cov-2 👇, which they find to be much higher in those who develop symptoms /1

thelancet.com/journals/lance…
couple points:

1. Use of serology to stratify recency infection was a nice addition

2. A better description of asymptomatic definition would be helpful. We go through this thorny issue here👇 @mugecevik @EricMeyerowitz @BogochIsaac @nicolamlow

/2
thelancet.com/journals/lanin…
This is consistent with limited data summarized in several nice recent systematic reviews:

1. Transmission potential appears lower in asymptomatic infection from @nicolamlow and team ncbi.nlm.nih.gov/pmc/articles/P…
/3
2. Suggestion of faster viral load clearance in asymptomatic infection from @mugecevik et al 👇
thelancet.com/journals/lanmi…
/4
Why does this matter?

There is a prevailing narrative right now that the 90%+ protection from symptomatic cov-2 by the mrna vaccines might not sizably reduce infection or transmission

/5
These studies strongly suggest that even if vaccines do not reduce risk of infection, they will substantially reduce risk of transmission

/end

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More from @AaronRichterman

Aaron Richterman, MD Profile picture
23 Sep
Yesterday @EricMeyerowitz and I presented insights from new COVID19 papers published over the last month at the HOPE conference. Posting slides and video if interested

Video: hopeconference.net/conferences/fi…
Slide deck at end of thread


@HarvardCFAR @RMKGandhi
Agenda
What are the lessons (and unresolved questions) about hospital acquired infection
Read 44 tweets
Aaron Richterman, MD Profile picture
12 Sep
Political appointees move to silence @CDCMMWR reports, the weekly lifeline from a barely functioning institution and the cornerstone of public health reporting in the US

Selection of reports that have been essential to understanding the US epidemic 👇🏻

politico.com/news/2020/09/1…
March 20 — cruise ship investigation with early hint about crucial importance of indoor dining for transmission

cdc.gov/mmwr/volumes/6…
March 20 — investigation in Singapore demonstrates that aggressive test, trace, isolate can be effective if community prevalence is low

cdc.gov/mmwr/volumes/6…
Read 28 tweets
Aaron Richterman, MD Profile picture
9 Sep
This is the key observation that somehow has not really made it outside of hospital circles. Still waiting for the first detailed report from a large health system of in-hospital transmissions in the universal masking era. Per hospital epis I’ve spoken with close to 0
This Lancet report gets highly referenced suggesting healthcare workers higher risk but 1) much of it pre-universal masking 2) don’t report whether community acquired (much of it is per other publications from healthcare) 3) no contact tracing

thelancet.com/journals/lanpu…
This paper of 226 patient contacts of healthcare workers w CoV2 (both pre and post universal masking) is probably the best 1 on the subject — they found one possible transmission, during a 30 minute encounter w both patient and healthcare worker unmasked

academic.oup.com/cid/advance-ar…
Read 6 tweets
Aaron Richterman, MD Profile picture
2 Sep
Really nice to see this WHO analysis in JAMA (along w 3 RCTs) put to bed the importance of corticosteroids in ventilated patients w COVID-19. A lot of good stuff here.

So what to do w steroids in those requiring supp O2 only? /1

jamanetwork.com/journals/jama/…
RECOVERY results suggest a mortality benefit in this population (supp O2 only), and I have seen basically every patient in this category receive dex, appropriately... but there are enough odd features of this single open-label trial that make me wonder. /2
Much of this nuance is explained well in this thread by @FranciscoMarty_



The main thing that nags me personally is how ridiculously high the mortality was in RECOVERY - 26.2% among those requiring O2 and receiving usual care /3 Image
Read 5 tweets
Aaron Richterman, MD Profile picture
1 Sep
To add to this - today we have a very nice study of patient contacts of infected healthcare workers, with universal masking implemented during the study period /1

academic.oup.com/cid/advance-ar…
Out of 226 patient exposures there was only one likely transmission, in a case where both clinician and patient were unmasked. /2
“Our data suggest that the risk of transmission is low even in the absence of eye protection so long as the infected person is masked”
Read 5 tweets
Aaron Richterman, MD Profile picture
22 Aug
Antiretroviral therapy is not enough —
background and findings from our new paper in OFID:

with @LeandreFernet @drdrtsai @drlouiseivers
academic.oup.com/ofid/article/7…
2/ Annual deaths from HIV have decreased by 50% since peaking in 2006, mostly because of expansion in access to antiretroviral therapy

But huge disparities remain – HIV is the leading cause of death in Sub-Saharan Africa, & the 9th leading cause of death in low-income countries Image
3/ In 2014 UNAIDS released a Fast Track plan w the goal of ending HIV as a public health threat & reducing HIV deaths by 90% by 2030

The primary focus of this plan is clinical services expansion & universal ART. In our study we ask – is this enough?

unaids.org/en/resources/d…
Read 10 tweets

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