THREAD: Statement on new FDA guidelines for Screening programs

Today FDA announced new guidelines for screening programs (i.e. testing asymptomatic individuals frequently to detect positive cases before they spread to others).
fda.gov/news-events/pr…

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While this appears to be good news and a positive step forward to increasing regular testing for public health, we still don’t have a full understanding of how to interpret these guidelines.

There are a few details that we are trying to get clarification on from the FDA.
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For Ex:

1) Does this allow schools to implement a screening program without a CLIA waiver or prescription? (both barriers to testing)

2) Will FDA designate previously approved tests for screening purposes or will the test developers need to apply for a screening claim?

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Another example:

3) Will there be a designation for the types of entities allowed to perform “screening”? i.e. schools, workplaces? How does this impact performance requirements of Ag and molecular tests if these are used for screening/serial testing?

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I’ll attend tomorrows FDA Town Hall to gain clarity on what I hope is a big step in right direction.

I thank @US_FDA for listening to science & public health experts and hopefully paving way forward on important regulatory steps to accelerate progress.

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Overall I feel this is a clear signal that public health testing is being prioritized by the @JoeBiden administration for K-8 reopenings and other public health uses. Much will be clarified in the coming days and I'll try to keep people posted w my interpretations.

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A few things that I do not think this is:

This does not look like a new pathway to get rapid at home tests available nor to make it accelerate test companies getting their tests into homes. For Over The Counter use at home, I suspect tests will need to achieve same requirements

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More from @michaelmina_lab

10 Mar
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.

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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.

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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.

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Read 7 tweets
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.

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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.

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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.

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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

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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.

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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

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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.

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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?

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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?

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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!

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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).

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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...

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Read 9 tweets

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