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Michael Mina Profile picture
@michaelmina_lab
Dec 27, 2021 • 12 tweets • 4 min read • Read on X
CDC’s new guidance to drop isolation of positives to 5 days without a negative test is reckless

Some ppl stay infectious 3 days,Some 12

I absolutely don’t want to sit next to someone who turned Pos 5 days ago and hasnt tested Neg

Test Neg to leave isolation early is just smart
I am 100% for getting people to drop isolation early.

Heck, I formally recommended it to CDC in May 2020 and Published the recommendation in J of Clin Infectious Diseases in April 2020.

But it was always with a negative test.

What the heck are we doing here?

2/
This is the part that hurts the most. The reason they are doing this:

"The change is motivated by science demonstrating... SARS-CoV-2 transmission occurs... generally in the 1-2 days prior to onset of symptoms and the 2-3 days after"

That was BEFORE OMICRON.

3/
Today, it is OBVIOUS the situation has changed.

Ppl are testing earlier b/c symptom onset is early - no longer two days after people are infectious.

So now people are staying positive even longer after testing positive, because they find out earlier they are positive.

4/
And by positive I don't mean PCR positive. I mean rapid antigen test positive for days longer. Often more than 10 days.

So to say, leave isolation regardless of if you have a positive antigen test is remarkable.

5/
Someone KNOWN to be Pos for 5 days is, in my view, still one of the highest risk individuals in society for onward spread. We do SO much just to find ppl who are positive in first place. When we do identify them, we should do everything possible to keep them from spreading

6/
At least, If leaving isolation at 5 days w/out Neg test - WEAR N95 or similar performing mask

Govn't should provide them to everyone who enters isolation (along with a rapid test!)

If entering isolation - click a button & get N95 & rapid test SIMPLE

@linseymarr @kprather88
7/
This is but one of a nearly limitless set of examples of how reckless this decision is.


8/
The thing that really hurts me the most - is that not requiring a positive rapid test to leave isolation is probably linked to a perception of not having enough rapid tests in the US...

Which is obviously a massive problem in its own right but one that is EASILY changed.

9/
We CAN get the tests

We CAN. Many countries are getting these and more.

This doesn't have to be a hard decision:

In Isolation? Yes --> Click a button --> Get 2 rapid tests delivered to you for free for use on day 5 and if still neg on day 6, exit.

A good example - among so so many of why rote removal from isolate without a negative test is just not a smart public health move.

We put all this effort into discovering infectious people... why not at LEAST ensure those we do discover don't spread on.

/12

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More from @michaelmina_lab

Michael Mina Profile picture
Feb 26
This is horrible & exactly what we are afraid of - measles kills ppl

In ~100 infections in TX, someone has already died

For those w/out vacc- it is not the benign virus you’ve been told

1:5 hospitalized
1:100-1000 die

This will spread further.

1/
apnews.com/article/measle…
The measles vaccine is exceedingly safe

It stops infections & spread extremely well!!

Measles on the other hand

1) kills 1:100-1000
2) hospitalizes 1:5
3) Kills immune cells & deletes protection against other infections
4) causes early immune suppression / coinfections

2/
I am extremely concerned that the communities of vaccine hesitancy have grown enough that they are now “bleeding into each other”

Which means infection in one may well ignite outbreaks of many thousands

That will come w more disease and death

Vaccination will prevent this

3/
Read 4 tweets
Michael Mina Profile picture
Feb 19
Measles cases may likely grow into the 1000’s

The TX measles outbreak continues

With “bubbles” of undervaccination getting bigger, we can expect outbreaks in one to catch on to the next

Igniting transmission that may catch and spread across the U.S.

cnn.com/2025/02/18/hea…
One of the most common tropes is that measles is fine & doesn’t cause damage…

This is highly inaccurate

Measles literally grows by infecting and killing memory immune cells. It causes loss to existing immunity creating vulnerabilities & acute damage that is often severe

2/
To discover the massive-stealth-impact measles has on immune protection against infections not associated w measles, we looked at what happened in populations after measles outbreaks swept through, decade after decade across nations…

What we found was astonishing…

3/
Read 19 tweets
Michael Mina Profile picture
Dec 27, 2024
Important wake up call:

#H5N1 BirdFlu just sequenced by @CDCgov from severe Louisiana patient

Most important, the H5 virus mutated inside the single patient to gain an ability to bind human receptors in the upper respiratory tract

It takes just one…

cdc.gov/bird-flu/spotl…Image
This is exactly the type of thing we worry about.

The mutations developed anew in this patient have been linked to severe cases elsewhere

Thank goodness the patient didnt (as far as we know) spread to any people or wildlife but this is the real concern…

We must do better

2/
And what should we do… there are many things we (USGov) should be doing yet barely have:
Read 6 tweets
Michael Mina Profile picture
Oct 3, 2024
🧵 On Seasonality:
SARS-CoV-2 has "seasonality" as a contributor to transmission dynamics

People often refute it - So I made graphs and this thread

NOTE: Seasonality does NOT = "just a cold"
Many of worst viruses have seasonality

Transmission Dynamics ≠ Pathogenicity

1/Image
Image
Image
The first figure is Wastewater SARS-CoV-2 RNA levels averaged across the whole United States

See the REMARKABLE stability in the winter peak

The peak happens in the exact same week each year

Additionally, the start up the upswing to the peak (triangles) is also consistent

2/Image
A common misconception is that "Seasonality" means "no transmission out of season"

That is NOT TRUE

Seasonal forces are those that drive predictable behavior - like a winter peak in the first week of each year

3/
Read 14 tweets
Michael Mina Profile picture
Aug 18, 2024
Huge News for access to STI tests in the U.S. to help curb the growing syphilis epidemic

The @US_FDA just authorized the first fully at home OTC test for syphilis

A finger prick blood test for antibodies against the bug that causes it (T. Pallidum)

1/
nbcnews.com/health/sexual-…
For a number of decades, syphilis has been trending up in the U.S.

The cause isn’t singularly but likely is associated with relaxations of prevention of STIs in the context of more effective prophylaxis for HIV (PrEP). Plus general lack of awareness



2/publichealth.jhu.edu/2024/why-is-sy…
When left untreated, Syphilis can have devastating consequences on human health

Luckily there is very simple treatment for it (a form of Penicillin) but it only works if you take it - and you only take it if you know you have syphilis

Hence the importance of an OTC test!

3/
Read 7 tweets
Michael Mina Profile picture
May 3, 2024
Such a bad interpretation that stands to harm patient care

Let's not throw the baby out w the bathwater for COVID-19 (and flu etc)!

Suggesting to only run PCR & not rapid means most (50%-80%) of patients get WORSE care & at higher costs

Here's why:

A 🧵

1/
When I see publications & docs say “don’t use a rapid test, only use a PCR”

it assumes this is an OR only situation

Ridiculous!

A rapid test is… RAPID… and highly affordable

You lose ~nothing by it and give your patient the opportunity to GAIN tremendously

2/
If the test is positive, then for that 80%+ of culture positive ppl … your job is done immediately

You’ve spent $5 and 5 minutes and they can get on treatment right away

If you didn’t do it, it will be be 1-2 days and ~$150 before they can get started on treatment

3/
Read 10 tweets

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