THREAD:

Today I am announcing a new massive public health research study - with @Citibank - to use and evaluate frequent at-home rapid testing. The study is evaluating how well workplace infections are prevented by frequent home-tests.

1/x

bloombergquint.com/onweb/citi-deb…
The study is evaluating whether rapid home-tests used ever M/W/F can successfully prevent workplace transmission better than current status quo of symptom screens and evaluates how well non-medical ppl can perform the tests on their own.

2/x
The rapid tests - which aren’t yet EUA’d but are used globally and we’ve found to be very effective in pilots - are being introduced in conjunction with @LivePerson’s Bella Health app to provide AI-powered assistance to help people at home learn how to use the tests.

3/x
If simple mobile tools like Bella Health and other apps can reliably help people to use these (and other medical devices) at home - it can pave way for a new generation removing need for $$ medical visits and increase equitable testing and increase the usefulness of tests

4/x
My hope, overall, is that this large clinical / public health study will help build a roadmap for how we can keep economies and schools open even where vaccines don’t yet exist and in event of new resurgence of transmission in fall.

5/x
I’m committed to helping us (society) not find ourselves having to distance from our loved ones for a year ever again. And I’ll keep working to identify creative avenues that prevent another year like the one we are emerging from. This study is part of that commitment.

6/x
These types of tests are (remarkably) not FDA authorized for frequent use at home. (The study participants are aware and sign consent)

This study will hopefully help @HHSGov & @CDCgov see why it is important that these tests be defined as public health tools - not medical tools.

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More from @michaelmina_lab

3 Mar
Short thread:

When things work well, they are unnoticeable to the public.

This is especially true of public health efforts. When public health efforts work, they go unnoticed. As in policy, boring is better in public health.

1/x

theatlantic.com/ideas/archive/…
Unfortunately, this fact, that when public health is working well, it is unnoticed, necessarily sets them up to appear like they are failing.

The only time the public thinks about successful public health efforts is when they falter at all, especially if faltering is rare.

2/x
This happens all the time with the most successful vaccines... b/c the only time highly successful vaccines make the news (outside of a pandemic) is when a rare adverse event occurs. We simply don't report the constant daily successes of the best working programs.

3/x
Read 8 tweets
28 Feb
Interesting fact

I’ve not been PCR tested-Yet I helped start what is now the highest (?) throughput PCR lab in the world

Wouldn’t know where to sign up / don’t have time to stand in line for a test w results days later

I do have access to simple rapid at-home tests, 2x/wk

1/x
I’m not special. If I don’t have time to stand in line, millions and millions of others do not have time to do this.

If I’m not readily aware of how to sign up - millions of others aren’t. Sure, Google will tell me, but not everyone can just figure it out.

2/x
Testing is simply not equitable in the US and access is limited

Nearly 65% of Americans have never been tested. Not bc they don’t want to, but bc it’s not simple. Testing is a public good - we must make it simple!

At-home tests will improve equity and our public health response
Read 4 tweets
26 Feb
THREAD: NEW INFORMATION!

A first of its kind national survey out today from @CCDD_HSPH @TheCOVIDCollab and @HartSurveys on at-home rapid testing

What did we learn?

86% of Americans are willing/eager to use at-home rapid tests – BUT awareness of rapid antigen tests is low

1/x
This week Congress is considering $46B for testing, including for rapid tests. What does America think about that?

85% of Americans want government to fund these tests & distribute them. Strong support for rapid tests across political spectrum: 94% of Dems and 74% of Repubs.
But support for testing doesn’t come at any price. Willingness to test at-home decreases as $ increases. At $25 (price of the only two currently EUA authorized rapid at-home tests), only 33% of Americans would test themselves regularly.
Read 11 tweets
18 Feb
On TTI as a control measure:

Early 2020, we said contact tracing would not control community spread against #COVID19 once cases got high

Yet when cases got high, it was blasphemy to suggest lab PCR+contact tracing not useful to control spread.

Data is now catching up.

1/
The tweet thread above by Denis Nash @epi_dude is terrific and contains lots of wonderful data!

For me, It highlights the need for us to re-evaluate what it is we are doing. When our actions weren't working to slow spread, should we have kept forcing the same actions?

2/x
I worry that we get into group-think mentality and peer pressure is immense to "stick with the consensus"...

but when consensus is to stick to a failing test-trace-isolate as control, against our own warnings to our future selves... maybe we should've bucked the trend?

3/x
Read 8 tweets
13 Feb
NEW RESEARCH

Knowing if #COVID19 cases are going up v down is needed for decision making but changes in testing make it difficult to know

We found Instead of case counts, the distribution of Ct values gives a NEW way to estimate epidemic trajectory!

1/

medrxiv.org/content/10.110…
Essentially, we created a barometer that gives the growth rate (or decay rate) of an epidemic based entirely on whether the distribution of viral loads in ppl at a single time in a population is averaging high (epidemic growing) or low (epidemic declining).

2/x
This property of epidemics (when they are going up, detected virus loads are higher on average) has caused massive confusion.

The virus itself isn’t changing nor are the actual virus loads inside of individual people...

3/x
Read 9 tweets
10 Feb
Terrific write up!

Perhaps the most thorough reporting I’ve seen on the controversies surrounding rapid tests

An extremely important point @GiorgiaWithAnI covered is one at heart of the confusion but previously not covered well..

See short thread

1/x

nature.com/articles/d4158…
I’ve spoken on sensitivity and why rapid Ag tests shouldn’t be compared to PCR

Nevertheless, we’re stuck comparing to PCR. So, to deal w this, “we” have taken to comparing rapid antigen tests to PCR results below specific Ct values that may represent contagious virus loads

2/x
In many studies, Ct of <30 or <25 are considered to be likely contagious or “high virus”, respectively

HOWEVER this is bad. We must stop assuming this

Not all labs are the same

A Ct 25 in many labs may = a Ct of 18 elsewhere

This happened in Liverpool w Innova evaluation

3/x
Read 7 tweets

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