“Our experience is that 10 infections quickly grow to 100’s...[If you are testing to control spread] you have to be close to perfect”
It seems that way - but it’s not true at all.
1/x
2/x
To limit spread and stop outbreaks you fo not need perfection. This is the great thing about outbreaks...
They either grow exponentially... or they fall exponentially. That’s why we see sharp spikes all the time, like this in the US.
2/x
To stop outbreaks from arising or to cause out of control outbreaks to fall, we only need to ensure:
for every 10 new cases that occur, they cause 9 new cases (or fewer)
We don’t need 10 to infect 0, we just need 10 to infect 9. If we do that...
3/
If 10 cases cause 9 new infections (sounds like a failure of a public health program, right??), then after 4 weeks there will be a 90% reduction in cases compared to when 10 cases cause just 13 new infections.
Massive difference. Outbreaks rise or fall on a razors edge.
4/4
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To maximize vaccines to halt #COVID19 - look to immunity 🧵
When someone gets their first dose - they should be offered to take a fingerprick blood sample at same time
That should be tested for SARS-CoV-2 antibodies
If positive, then don’t come back for a second dose.
1/
There is now abundant evidence that shows that people who have been infected have as good a response to their first dose vaccine as those in infected and w 2 doses.
A nice paper here discusses an approach based on knowledge of being infected in past
This was a great paper in @ScienceMagazine that demonstrated strong B and T cell responses following single dose vaccine that rivaled or was even better than a two dose vaccine schedule (when absent the prior infection)
I posted this and have seen that many question it.
From my vantage the changes remain below radar yet are massive.
Virtual medicine, at-home testing/treatment. The virtualization of healthcare towards consumers is happening fast. This pandemic is accelerating this 5-10 years.
Whether it will be for best, or not... well, only time will tell how it shakes out. I'm not going to say one way or the other since it's impossible to know.
But I get to see glimpses of what is happening and the many companies getting involved. Remarkable pace.
To be clear though - this is about medicine, not public health.
If I'm being honest, I don't think "we" will learn much from this pandemic about how to do good public health. I think the energy around it will fade and we will see billions wasted trying to set up crappy systems.
Now that we are seeing vax'd ppl turn up PCR pos, only now will public health leaders FINALLY understand why #rapidtests have always been the appropriate **public health** test.
When the question is "Am I infectious", PCR is overly sensitive to reliably answer this.
For too long this critical piece has been avoided
Comparing rapid Ag tests to lab PCR made it *look* like rapid tests have low sensitivity...
Real issue is PCR stays pos for wks after ppl are no longer infectious
PCR is badly NOT specific for identifying ppl needing to isolate
Rapid antigen tests are highly sensitive AND specific to be able to answer the question "Am I Infectious"
PCR is highly sensitive but NOT specific for this question. Pretending like it was led to millions of ppl being put in isolation and the wrong ppl quarantined
A large majority of the public (72%) believes the activities of public health agencies are extremely or very important to the health of the nation.
3/x
The American public has higher trust in health care professionals than in public health institutions and agencies.
A particularly concerning though not surprising finding is a Particularly low level of trust in the @CDCgov (51%), the @NIH (37%) and the @US_FDA (37%)
Surprised at lack of trust the government has in the Irish ppl
Instead of supporting access to simple at-home tests to tell if u r infectious, position appears to be to limit access bc they don't trust ppl to handle a negative test
We do not defeat a pandemic without properly engaging & trusting in the public
To actively advocate against an asymptomatic person to be able to access a rapid test that has a very high sensitivity to tell you if you are spreading the virus doesn't make sense.
2/
Similarly to actively want to force symptomatic ppl to NOT have access to at-home tests bc u want ensure they get a much less accessible PCR test isn't good policy. Do we want symptomatic ppl leaving home to get PCR tests?? A rapid test is accessible and fast.
3/
FAQ: Why is a lab test w a 12-48hr delay not as useful for screening?
Simple
Even super high sensitivity lab tests have 0% sensitivity while awaiting results
So you can be @ peak viral load & superspreading virus and not be detected by a lab test while spreading for 2 days
1/
For evaluating a tests “Effective sensitivity” to help stop transmission, this 0% sensitivity while awaiting results must be taken into account since ppl live their lives while waiting on results
If a test takes 2 days to return it’s effectiveness is already reduced by 33%
2/
So w a 2 day delay, a theoretical 100% sensitivity PCR test may already be maxing out at 67% effective sensitivity to slow spread... which is what we are trying to do w screening test programs.
3/