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

2/

thelancet.com/journals/ebiom…
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)

science.sciencemag.org/content/early/…
This is a terrific thread from @EricTopol discussing the strong immune responses from a single dose after prior infection With a paper from @NatureMedicine
Also - cost is not prohibitive here!

Vaccines are paid for in many countries

The cost of a blood spot, lancet and to run the Antibody test will pay for itself in the vaccine doses saved!

We perform tens of thousands of Antibody tests/wk in my lab for research for <$1 ea
And here @rozeggo has already done the analysis (not yet peer reviewed).

On a quick skim it looks like exactly the types of analyses we need to be thinking of.

Important item to add - the blood drop can be done concurrent with the first dose of vaccine to increase convenience
And here is another nice thread from @swapneilparikh on this issue discussing the potential massive importance to India right now.

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More from @michaelmina_lab

28 May
We have vaccines. But it doesn’t mean we stop caring to see where the virus is and adapt quickly if and when outbreaks take off.

Rapid accessible tests are not just tests. They represent real time accessible information on the virus in and around us.

time.com/6050846/covid-…
The type of testing we will need in a well vaccinated population isn’t the frequent rapid testing I’ve called on for a year.

I don’t want us to remain in testing purgatory.

The landscape is changing and so too is the type of testing that will be useful...

2/
We will now move into a type of testing that is more targeted.

Less about suppressing massive outbreaks and more about having the tools to respond *effectively* if and when they arise.

Tools that allow us to not have to close anything down - but test to stay open.

3/
Read 9 tweets
27 May
This is one of the most rationally written papers yet on #rapidtests to keep society running, shops open, people dancing and curb transmission

It also demonstrates well the problems of using high sensitivity lab testing for public health screening.

thelancet.com/journals/lanin…
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.

What is much more interesting...

3/x
Read 13 tweets
25 May
1/ Epidemiology Lesson, short 🧵:

In a conversation today, someone said:

“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/
Read 4 tweets
23 May
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.
Read 4 tweets
19 May
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
Read 5 tweets
17 May
THREAD:

New Poll from @RWJF & @HarvardChanSPH

71% of adults want substantial increases in federal spending to improve the nation’s public health programs.

1/
2/x

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%)
Read 4 tweets

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