Let's break down the new US federal policy requiring a negative #covid19 test before boarding announced today because it covers a few important concepts

It requires that people flying into the US have a negative test within 3 days of flying

2/ First, this reminds me of the recent outbreak from September on the Dubai-NZ flight.

The index case tested negative 4 days before the flight.

In theory, had they tested within 3 days, infection may have been picked up, but possibly not

3/ This highlights the "one test is one test" point: all that test is saying is that you are negative when you got it

That is not a reason to not test-- but it is a reason to want a neg result as close to whatever event it is (flight or otherwise) that you can #covid19
3.5/ Because in those 3 days before the flight, you can definitely incubate virus and infect folks on the flight. The Dubai-NZ situation was 4 days & there were other factors (incomplete masking, vents off for 30 minutes etc); but you get the point

Test to fly interval is key
4/ In the hospital (not all, but where I work), we can get rtPCR tests back by the same day if we can get that swab done in the AM

In Wuhan, back in *FEBRUARY 2020*, their PCR turn around time was 4 hours.

What they managed to do there still to this day astounds me #covid19
5/ Another key point- quarantining

So a negative test before you fly is great- it can potentially reduce transmission in packed flights

But I'm actually more concerned about people landing in new places & going about their business thinking everything is cool

It's not.
6/ Bc that neg test is just that- a snapshot in time- quarantining is key (CDC now says 7 day quarantine w/ a neg test at the end of it is acceptable; I think this is reasonable)

But I fear that many people aren't quarantining the right way (& many frankly can't)
7/ Bc when we say quarantine, we mean quarantine in the house too-- you are basically pretending you are infectious; sleeping separately, staying away from others, masks on in the house, the whole deal

Some people (I suspect) are "quarantining" by staying home, but not more
8/ The irony of all of this-- the US has an even worse epidemic than most other places

Frankly, they should be more worried of us flying there

And we should implement better **domestic flight** policies #covid19
9/ Ultimately, I would not recommend flying at this time either way if you can avoid it bc we should be focusing on reducing mobility/viral spread

-- reduce that test to flight interval as much as you can

-- quarantine means in the house too!


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More from @AbraarKaran

14 Jan
Short thread
1/ One of the weirdest things about our quarantine policies in this country is that they were never actually enforced

We’ve been functioning on scout’s honor for 11 months & it doesn’t seem to be working? #covid19
2/ I personally know a number of people that traveled south for the holidays & did not quarantine upon arrival to Massachusetts- hell some even went to bars when they got back (@marty_walsh - one reason why these should be *temporarily closed*- not limited capacity)
3/ And for those that are staying home to quarantine, unclear what % are actually full on in quarantine in the house (essentially pretending you’re infectious, masking if you leave the room, eating/sleeping separately etc) #covid19
Read 4 tweets
11 Jan
1// Have been saying this for months— and have actually have been doing this for the entire year any time I went back to LA to see family, even with a negative test.

High risk workers should mask at home if they have regular exposure. Every layer matters. #covid19
2// Increasingly colleagues of mine are incidentally testing positive without known exposure- takes 1-2 days to get PCR result back; end up exposing whole family in that time.

Nothing inherently safe about the home unfortunately.
3// In fact, may end up being most dangerous given less likely to mask here; very close prolonged exposure; crowding; ventilation variable

Now I’m going to accept that pragmatically speaking, most people are not going to mask at home BUT here are some personal recommendations...
Read 5 tweets
10 Jan
One concept that doesn’t seem to have fully caught on in dialogue— we don’t need to get any single intervention to work 100% effectively, nor is that an achievable goal.

Even if we got every layer of prevention to work 25% better, could still get R<1 and keep it there
2/ What won’t work is doing a whole bunch of different things half-ass w/ none of them really working.
3/ Why I’m bringing this up: as people criticize idea of getting the administration to ship us better masks (ex “not everyone wears masks”)— we don’t need *everyone* to wear masks to stop the epidemic. We do need more people to have access to better PPE along w/ everything else
Read 4 tweets
7 Jan

1/ Our new piece in @statnews — along with vaccine rollout, the US needs a high filtration mask initiative

Every American should have access to high filtration masks for use any time they have to be outside their home in indoor spaces #covid19
2/ As the pandemic surges, most of the cases I am now seeing in the hospital do not know where or how they were infected

A number of them report wearing cloth masks regularly, & this is much better than no mask

But we know that not all masks are created equal

Cc @EricTopol
3/ N95 masks that healthcare workers like myself use in the hospital offer the best protection

We use these masks for *any* #covid19 patient we are treating, whether or not they are undergoing an “aerosol generating procedure”

Cc @DrTomFrieden
Read 21 tweets
6 Jan
1/ Important point from @K_G_Andersen — variant #B117 in San Diego; may not change what we need to do— but is an urgent reminder that we are not even doing what we need to do well enough as it is.
▪️testing— unable to scale rtPCR; have not utilized rapid testing correctly

▪️tracing— cannot keep up w current spread; digital tracing attempted but never picked up enough

▪️isolating— safer isolation spaces outside the home were built- many patients did use, many did not
▪️masks— better masks never produced at scale; cloth masks still most common; hospitals w ongoing N95 shortages

▪️ventilation— talked about; unclear that any major at-home breakthroughs introduced (aside from opening windows, which helps)

▪️vaccines— inefficient rollout
Read 4 tweets
6 Jan

Outbreak of #covid19 on an 18 hour flight in September flying from Dubai to New Zealand now officially published

7 ultimately infected; 4 likely in flight, sitting within 4 rows of one another, 2 of them while reportedly wearing masks ImageImage
2/ 5 out of the 7 had been tested **before the flight** and tested negative

2 didn’t report getting tested before the flight but are *not* thought to be the index cases (those who started the outbreak)

BUT Index case was tested **5 days** before the flight! Image
3/ I circled the days that index case *should have been tested* — 24-48 hours before flight, when they had likely started incubating the virus; when detection could have happened; when the outbreak could have been prevented Image
Read 12 tweets

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