Its finally dawning on me that there is an endless supply of ppl - many in public health & medicine - who will not understand science of testing & how to interpret the sea of (poorly performed) studies (including by CDC)

This is a failure of messaging by Federal government

1/
Confusion around rapid tests is becoming immensely harmful at local levels as every small town and city has their own decision makers trying to wade through a mix of confusing and often conflicting messages, with no guidance and no idea who or what to trust.

2/
The frustrating thing is that this doesn’t need to be hard!

The science and biology of rapid Ag tests is extremely simple/straightforward if we allow their formal evaluation to be towards why we take the tests: answering “Am I infectious” or “Do I need to isolate still?”

3/
We have a @US_FDA that STILL will not recognize that people use tests for public health purposes.

We ONLY have a regulatory path based on medicine and NOT for public health. Why won’t FDA recognize that tests are used for Public Health in this Public Health emergency ?

4/

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More from @michaelmina_lab

4 Jan
Should @CDCgov reconsider guidance on isolation & add a Neg test? Yes!

Why?

Bc relationship between symptom start & peak virus load has changed!

Guidance must keep up accordingly.

To explain: I made a (tough to read) chart based on real experience of Prof. Kato @neurotheory Image
@CDCgov @neurotheory Here is the original tweet by @neurotheory showing this TERRIFIC Time course of tests.

@CDCgov @neurotheory I've written a bit more about this in a similar thread on Omicron, testing and symptoms.

3/

Read 7 tweets
2 Jan
Uncomfortable Fact:

PCR stays Pos far too long

Most who test Pos on PCR are No Longer contagious-Esp if no symptoms

Millions have Isolated entirely AFTER contagious

(Rapid tests don’t cause this)

Why won’t FDA evaluate tests for how ppl use them: to answer “Am I Infectious?
PCR has its place…

For medical diagnostics OR when you know that someone was recently exposed etc

But 2 years in, we continue to use a Binary PCR to tell people they need to isolate, without using the right cutoff or tests to ask the public health question: am I infectious?
2/
Currently, FDA evaluate tests ONLY based on their medical diagnostic utility

2 years in to the worst public health crisis in modern history, there STILL is NO effort at FDA to regulate tests based on their ability to answer relevant PUBLIC HEALTH questions.

Why?

3/
Read 5 tweets
30 Dec 21
LOL

Only at @MassGenBrigham - two of the Top Hospitals in the nation…

@harvardmed@Harvard

Where “breakthroughs” happen daily within the ranks of America’s top doctors

Maybe time for a new marketing approach? :) Image
Here’s the link.

Wonder if/when it’ll change. Not that it needs to or should. Just amusing.

massgeneralbrigham.org
Sorry - if anyone didn’t get the joke - I Was making fun of the use of the word “Breakthrough” as a positive to market just because the word these days is so caught up w Breakthrough Infections.
Read 4 tweets
30 Dec 21
Misleading

This is referring to transmission over time IN THE AVERAGE case, and there, 10% of one’s transmissibility may be after day 5.

But being an average, there may be a full 30%+ of people who are greater than average & remain highly infectious through days 6,7,8

🧵

1/
In addition the AVERAGE case mentioned was based on viral loads where ppl were becoming symptomatic/testing once already at peak virus load & transmission always coming down

But now ppl are becoming symptomatic day 1 & day 4,5 may now be when ppl still at peak infectiousness

2/
I’m 1000% on board with cutting down isolation as much as possible

Heck - most ppl who tested positive in this pandemic on PCR over the past 2 years were already no longer infectious by the time they started isolation. I have argued that those ppl required 0 days isolation

3/
Read 6 tweets
30 Dec 21
@US_FDA’s remarkably vague (likely false) statement w ZERO supporting information that serves only to damage confidence in one of the best tools we have is insane

The data FDA offers is:

“early data suggests… rapid tests MAY have reduced sensitivity”

fda.gov/medical-device…
Because of this line - with no supporting information - effectively every major news outlet today has reported that rapid tests are less sensitive to detect Omicron.

But the actual data suggests otherwise. Omicron is not mutated where the tests detect.

2/
It’s a bit like saying

“I got plastic Surgery on my face”

and FDA says

“Oh, Your shoes may not fit you anymore”

The reality is the tests likely detect Omicron same as they did Delta… but Omicron is more infectious so any test will have a harder time picking up at first

3/
Read 5 tweets
29 Dec 21
NOTE:

This headline (From @US_FDA) is very likely NOT Accurate

Why?

1) Antigen Tests Detect a part of Omicron that isnt mutated

2) What the study identified is not that rapid tests are less sensitive - but simply that Omicron is more infectious

1/

politico.com/news/2021/12/2…
So what’s going on here?

When measured against a certain amount of virus, the tests perform equally well across all variants, including Omicron

2/
But, when asked how well do tests detect Omicron given an amount of “infectivity” in cells, tests were less sensitive for Omicron v Delta

Importantly, the issue isn’t the test!

Instead It shows a difference in Omicron infectiousness - and thus impacts ALL tests (PCR too)

3/
Read 8 tweets

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