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Michael Mina Profile picture
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1 Dec, 5 tweets, 2 min read
🧵

This issue Re: Trump and positive UNdisclosed test just got crazier, and I need to update / fix my thread below

First, I was incorrect on timeline

Trump likely did NOT use a Test before Rose Garden Event

Fitting early reports that he was not compliant

1/
Trump tested AFTER the Rose Garden event

He was notified of positive molecular test AFTER he was already on his helicopter out of DC

He was then notified by WH of a “negative” repeat test performed on BinaxNOW while he was STILL on helicopter

This begs the question…

2:
How did WH perform BinaxNOW test to confirm initial positive if he was already on helicopter and didnt return for follow up test??

Most likely scenario is they used an adulterated swab that was already in a molecular reaction and then placed that same swab into the BinaxNOW

3/
or they used a swab collected earlier and was sitting out

But this unlikely given his dislike of swabs-hard to believe that from March-September, the WH was always collecting a 2nd swab just in case

So most likely the “neg” rapid Ag was not performed/not performed correctly

4/
Either way, its very likely Trump was the superspreader

While original thread (see OT) is essential to understand in general.. Understanding what happened w Trump isn't even that nuanced

-He skipped testing before hand & the neg rapid Ag after was not done/not done correctly
5/

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More from @michaelmina_lab

Michael Mina Profile picture
1 Dec
Anti-viral treatments are here

BUT, the life saving treatments must be started FAST <3 days of symptoms

Most ppl take 2+ days deciding to get tested then days to result

I joined eMed @eMedCertified to help solve this problem!

*Test to Treat* at home
1/
 nytimes.com/2021/11/29/hea…
The therapies work best when started early

Immediate access to tests is a problem in much of the US, esp high risk individuals

Between determining you have symptoms, making an appointment, getting tested, waiting for results… starting in <3 days from symptoms is unlikely

2/
Medicare/others should place rapid tests in high-risk people homes with rec to use the test moment symptoms are felt. Use with a telehealth proctor.

If test is positive and person fits criteria, an Rx can be ordered and medicine delivered to them at home

Test to Treat

3/
Read 4 tweets
Michael Mina Profile picture
1 Dec
Was Trump the superspreader?

For a year, I’ve suggested Trump was the likely superspreader at White House Rose Garden on 9/28/20

All were supposedly tested, so how would a superspreader enter?

Now we know Trump tested COVID positive 2 days earlier.

1/
theguardian.com/us-news/2021/d…
He was testing daily and on Sept 26th, 2 days before the Rose Garden Superspreader event, he tested positive on a fast molecular test.

Bc he was testing so frequently, he was likelu detected using a molecular test at the earliest time, before becoming infectious.

2/
So when he immediately tested again with a rapid Ag test, it did not yet register positive because he was not YET infectious

Had he used a rapid test later that day or next day though, once he was becoming slightly infectious, he almost certainly would have been positive

3/
Read 13 tweets
Michael Mina Profile picture
30 Nov
Many countries are asking for proof of vax, or testing to travel

I don’t understand this. Vax work Well to stop disease…

But it’s time to clarify they do not stop transmission. They slow it down

But it simply is not appropriate to assume that vax = not infectious

1/
If we don’t appreciate this soon immediately, then we will see irresponsible policy that allows the virus to keep on spreading.

This is almost certainly even more true for Omicron which, if anything, will spread more efficiently, not less, than other variants among vax’d

2/
We can be fully transparent about what vaccines do very well (protect you!) and what they are not doing very well (stopping transmission) while still advocating for everyone to be vaccinated

Most ppl see this and any lack of transparency harms vaccine uptake even more.

3/
Read 11 tweets
Michael Mina Profile picture
30 Nov
🧵

This from ⁦@CDCgov⁩ is exactly why Rapid tests are important!

A PCR 2 days before an event, flight or (fill in blank) does NOT reflect you today

2 days ago can be neg but you can be a superspreader now

A rapid test used just before the event is always best.

1/
Its remarkable & contradictory that while CDC makes this figure 👆showing that neg tests 3 days before do not mean you’re negative on thanksgiving… while still recommending testing 2-3 days before travel.

The safest approach is to recommend a rapid test hours before travel

2/
In the midst of Omicron, instead of border lockdowns, we can use rapid tests just before a flight. Could even consider a PCR 24-48 hrs before amd a rapid test just a couple hours prior to flight.

3/
Read 4 tweets
Michael Mina Profile picture
29 Nov
Monitoring wastewater for viral load estimates outbreak size

In just a few weeks, in Pretoria S. Africa (north of Johannesburg) viral load detected in wastewater has reached similar levels as the peak of Delta

This at least indicates that transmission may be remarkably swift
More information on this metric can be found here.

IMO this offers a fairly unbiased view into viral load at a population level which, barring major changes in the viral loads within individuals, can be extrapolated to an extent to cases or prevalence across a population.
Here is the website:

nicd.ac.za/diseases-a-z-i…
Read 5 tweets
Michael Mina Profile picture
27 Nov
🧵 Why some vaccines stop transmission & others don’t:

Vaccines that stop transmission are often against viruses that replicate internally first and only then transmit (like measles). So if the vaccine stops internal replication, it stops transmission.

For COVID vaccines…

1/
For vax against upper respiratory viruses like SARS2, these viruses often don’t require “internal” replication. They just land in the nose, replicate locally & transmit on. So the vax can block “internal” replication and thus stop disease separate from stopping transmission

2/
The immune response in the upper respiratory tract is somewhat distinct from response in lungs, blood, lymph, etc.

Most vaccines create a multitude of layers of protection that can block a pathogen in lungs, blood, lymph, without offering the same in the nose/mouth/throat

3/
Read 5 tweets

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