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/
As fall and winter set in we will be kidding ourselves if we aren’t anticipating that cases will rear their heads again. It won’t be as bad as 2020 - not at all - but it’ll happen.
And those cases don’t need to cause massive disruptions - if we know who is not positive.
4/
So we should have tests at the ready just in case.
As flu RSV and all the other viruses that were tucked away for a year+ set in and take off, we will need to know why our kids are sick.
Rather than guess and send kids home, schools can have some tests at the ready.
5/
Covid has changed things.
We no long have to fly blind w each RSV/FLU/Cold season. We can be empowered to know.
It’s shown us that a parent or a school nurse is in a position to run an infectious disease test on a child and make appropriate actions.
6/
To think we just throw it all away bc we have vaccines is not wise and certainly won’t be wise when cases spill into nursing homes in the winter or schools worry about an outbreak and close down.
We can do so much better than take blunt hammers to these issues.
7/
So while @CDCgov is now recommending not to test if vaccinated, I don’t think it’s that simple.
We don’t throw the tests away, we use them for specific purposes. We haven’t eradicated this virus & we won’t. For a long time, we are going to want to see it. Tests enable that
8/8
And this is just scratching the surface for vaccinated populations.
Much of the world isnt vaccinated. But we can suppress outbreaks b4 vaccines. I wrote about it last fall also in @TIME. We didn’t act on it in US but other nations still can.
Just to be clear: 10% of the *detected* cases. Of course there were many more cases that no test picked up.
“If they had waited until they developed symptoms to get a PCR test, and then waited another 24 hours until they got the PCR results, that’s at least two days where they might have been unknowingly spreading the virus.”
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.
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