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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
Oct 3
🧵 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
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
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
Michael Mina Profile picture
Apr 20
Here we go again with this asinine cautious approach to testing for H5N1

CDC is NOT recommending that people with no symptoms - but who have had contact w infected animals - be tested at all… and certainly are not recommending a swab w any frequency.

Though we should have learned it in 2020, Here’s why this doesnt make sense:

1/Image
Firstly, tests are our eyes for viruses. It’s literally how we see where viruses are

If we wait until people are getting sick, we may have missed a major opportunity to find viruses jumping into humans before they learn to become so efficient in us that they cause disease

2/
So waiting until we actually have highly pathogenic strains harming humans - when we have a pretty discreet population at the moment to survey - is short sighted

3/
Read 11 tweets
Michael Mina Profile picture
Jan 16
A lot of questions still on:

How long should I isolate?

Do I need to isolate?

When can I go back to work?

Is 5 days enough?

What if I’m still positive?

Why am I not positive when I first get symptoms?

This thread below (and the embedded thread) goes through many of these questions
Now that symptoms start earlier w COVID (bc immunity activates symptoms fast after exposure)

A frequent ? that comes up is what this means for Paxlovid

Often ppl think it means you have to start Paxlovid earlier

Nope - Opposite! You have more time

2/
Bc symptoms start faster but the growth of the virus still takes about the same time as it used to…

Symptom onset today is ~2d post exposure where before it was ~5d

So, as far as virus growth is concerned, day 5 post symptoms (when the trials took place) is day ~8 today

3/
Read 6 tweets
Michael Mina Profile picture
Jan 8
A heartbreaking consequence of lapses in vaccination!

A measles outbreak is spreadinf in Philadelphia.

MEASLES! It sends kids to the hospital, erases existing immune memory (creating long term risks) and kills 1 in 1000

It was eliminated in the US, but we seem hell bent on reversing that

inquirer.com/health/measles…
A particularly deadly consequence of measles is its erasure of previously acquired immune memory - setting kids and adults up for infections that they shouldn’t be at risk from!

We found for example that measles can eliminate as much as 80% of someone’s previously acquired immunity to other pathogens!
science.org/doi/full/10.11…
Image
Read 6 tweets

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