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)
This is a terrific thread from @EricTopol discussing the strong immune responses from a single dose after prior infection With a paper from @NatureMedicine
The paper shows 500 ppl who went to a concert and were rapid tested before hand.
They also received super high sensitivity molecular lab tests before as well - but the results arrived only after the event.
2/x
What they found was interesting.
First - no one turned up positive on the rapid test at the outset. So a strong evaluation of its ability to screen ppl out didn’t really happen. But that’s ok, we already know the test sensitivity.
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%)