Many are torn between frustration and sympathy for @CDCgov. Given all the things CDC are failing to get done (eg rapid data dissemination and analysis), I am shocked by what they DO they spend time on. 🧵sharing observations from my interactions with CDC staff. 1/14
I was happy when CDC contacted me in Dec 2020 after this NYT story nytimes.com/2020/12/07/tec…, to urge rapid publication of the data supporting our claim of exposure notifications for up to 12% of transmission. The fact of CDC outreach got data release unblocked at @uarizona 2/14
We put a very informal preprint on github nearly immediately, and a more formal one on medrxiv soon after doi.org/10.1101/2021.0… . A CDC coauthor was added to shepherd it through @CDCMMWR 3/14
Our @CDCMMWR preproposal was rejected. Informal feedback was that they liked it but were so backlogged that a peer reviewed journal was likely faster. This initiated 6 months of clearance procedures needed for CDC coauthor to stay on paper 4/14
What CDC staff spend a LOT of time on: rewriting manuscripts with meticulous attention to style guides. Eg, Methods must follow exactly the order they are used in Results, all interpretation must be in Discussion not in Results, etc. to a point truly unimaginable in my field 5/14
Many CDC editors didn't grasp main premise of manuscript (that tracing doesn't matter for all contacts, only the ones that are infected), and made edits that inappropriately changed meaning, requiring more back and forth 6/14
6 months and endless CDC work hours later, after new CDC edits overclaimed efficacy in ways we deny, at CDC's urging we removed the CDC coauthor in order to terminate clearance to instead make the deadline for a relevant CDC-run special issue journals.sagepub.com/pb-assets/cmsc… 7/14
On top of minor revisions from reviewers, more style guide edits required by CDC journal editors. Eg because style bans reference to an individual as a primary or secondary case, we now refer to individuals who test positive v. infected individuals v. those infected by each. 8/14
After resubmission in <30 days, rejected months later despite green light from peer reviewers. Bottom line from CDC editor: because our data is now too old, we longer conform with journal guidelines. But editor still rewrote our manuscript for us anyway, again...9/13
So after the manuscript spend the vast majority of the previous 12 months on CDC desks not ours, we were rejected by the CDC because the data had become >12 months old. 10/14
Second CDC story: would be nice to know test sensitivity as a function of test date. NCAA schools gave CDC the necessary data to estimate it. CDC published without this analysis and without releasing de-identified data cdc.gov/mmwr/volumes/7…. We wrote to ask for data 10/14
CDC said they couldn't share data because they collected it from schools under narrow data use agreement permitting just the one study. Why on earth, in a pandemic, is the CDC using such a narrow agreement? Why rule out subsequent re-analysis? 11/14
CDC agreed to send a bcc email to their school contacts, inviting them to independently send us their data. Discussions to get to that point took a couple of months. 12/14
Many still defend the CDC as basically good, but suffering from political interference etc. I agree that individual CDC employees are trying hard. But engrained CDC culture incapacitates the agency as a whole. My vignettes show how rank and file are spending time. 13/14
Sorry about premature tweet-all just when I was fixing the numbering...
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Key insight is that if some control process keeps the geometric mean of R(t) near 1 one way or another, better it should happen via targeted measures than indiscriminately. Value is calculated without needing to trade off lives for livelihoods
Thread on why the launch of @CovidWatch in Arizona yesterday is different from other launches. This GAEN app is superior re risk scoring, re rollout strategy, and re customizability (the last two related) blog.covidwatch.org/en/covid-watch… 1/10
Other apps try to reproduce 6 feet (or 1 meter or 2 meters) for 15 minutes. But how infectious someone is also varies ~10-fold as function of timing relative to the day their symptoms begin 2/10
@CovidWatch integrates timing, duration, and Bluetooth signal (a noisy correlate of distance) to estimate infection risk. 7 feet for 8 hours at most dangerous time is much riskier than 5 feet for 15 minutes at edge of infectious period
Longer viral shedding in asymptomatics, if true, would matter. With limited testing, it would mean very long quarantines. So I pulled the easily available data from this @NatureMedicine paper and tried to do a meta-analysis including other data 1/4
@mugecevik kindly pointed me to 3 other papers with similar comparisons for covid-19 (plus one for flu). None deposited their data. Two corresponding authors did not reply, the third refused, citing ethics. All I want is shedding durations
@JAMANetworkOpen's data sharing policy is risible. For clinical trials only, authors are required to state whether or not data will be available. How can such a journal have "Open" in its name!? jamanetwork.com/journals/jaman… 3/4