It’s hard not to feel complicit.

As high income nations squabble over whether to vaccinate the youngest and least vulnerable, much of the world has yet to vaccinate their absolute most vulnerable.

Global inequities run deep. But this is a particularly egregious one.
Again, these are optimization problems.

We should ask questions like: how many childhood doses are worth a single dose in a 70 year old in India.

Probably you need thousands of childhood doses to offer as much benefit as a single dose to a 70 year old.
Of course, these are not just simple public health decisions that need to be optimized - these are massive geopolitical (mis?)calculations that are above my pay grade.

That or just frank ethnocentric behavior.

Probably a bit of both.
I don’t have the answers. But I do feel complicit in what history may well look back on as cold hearted egregious acts of vaccine nationalism that will over time necessarily translate into a world w even greater nationalism where the rich get richer.

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More from @michaelmina_lab

29 May
Rapid testing found 10% of the cases in Nova Scotia

IMPORTANTLY, that 10% was almost entirely ppl currently infectious and actually needing to isolate.

So the *relative effectiveness* of the rapid testing is much greater than 10%.

nationalpost-com.cdn.ampproject.org/c/s/nationalpo…
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.”
Read 5 tweets
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
26 May
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/…
Read 7 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

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