This means that rapid tests aren't catching people during their first few days of infection. But sensitive PCR tests are slowed by day++ turnarounds.
Suggests we're unlikely to test our way out of the current surge, even if we each had a week's supply of rapid tests at home. 2/4
One point which will not escape folks like @CaseyEMiddleton and @SBtotheDub is the "infectious" and "not infectious" annotations on the plot, based on N-gene RNA Ct.
While link between Ct and infectiousness is imperfect, the authors *also* directly document transmissions! ✅ 3/4
And...
More reinforcement of why preprint-sharing and #sciencetwitter are absolutely brilliant. Kudos to the authors for openly sharing their work quickly. Thank you! 4/4
After praising #sciencetwitter, let me tip the hat to @DiseaseEcology who noted that my comments combine issues associated w/ (1) saliva-vs-nasal specimen and (2) Ag tests.
Would saliva+Ag outperform nasal+Ag? Potentially, though unclear how much earlier. Would love data! [n+1]
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By definition: when no one is vaccinated, 0% of infections are breakthroughs. When everyone is vaccinated, 100% of infections are breakthroughs.
So what happens in between?
Our study examines this question using a modeled population with mixed vax & prior infection status. 2/
Two things happen as vaccination rates increase:
1. Total infections decline—even imperfect vaccines reduce transmission.
2. The % of those infections that are breakthroughs increases, hitting 50/50 at 68% vax coverage in this scenario (35% prior inf. rate, VE≈2x mRNA). 3/
This study starts with the observation that students who lived in multiple-occupancy rooms were more likely to test COVID-19+ by RT-PCR screening during the Fall 2020 semester.
This, in spite of higher testing rates among singles students. 2/
In multiple-occupancy rooms:
* only index roommate PCR+ in 398 rooms
* 2+ roommates PCR+ on same day in 44 rooms
* 2+ roommates PCR+ 1-14d apart in 116 rooms
* 2+ roommates PCR+ >14d apart in 6 rooms
This allows comparison between transmission & non-transmission rooms. 3/
But taking the idea from the medrxiv report cited above, and using *one* dose for each seropositive and *two* doses for each seronegative, one can derive a similar formula (pic).
Our recent work on vaccine prioritization for COVID-19 is now published in @ScienceMagazine, but this paper has evolved because of both formal and informal peer review. So while the paper is linked, here's a quick summary of the results. 🧵 1/
First, rather than reading another Twitter summary, there's a great discussion of this work in the broader context of vaccination strategies by two vaccine/modeling experts @MeaganCFitz@Alison_Galvani. Highly recommended for both theory & history. 2/
Updated preprint: Model-informed COVID-19 vaccine prioritization strategies by age and serostatus.
Smart suggestions from formal/informal review mean that the paper still asks how demographics, contacts, vax efficacy, & seroprevalence affect prioritization by age, but now...1/
We asked whether transmission-blocking properties affect prioritization. Intuitively, as the vaccine's transmission blocking properties become worse, direct protection of adults 60+ became/remained the clear best prioritization—across countries, R0 values, & vaccine supplies. 2/
Btw—there's a nice piece by @MollyEFG & team that shows why indirect effects are critical. In the medrxiv version of their NatMed editorial, they have this figure, showing how transmission blocking effects are *extremely* valuable at pop. scale. nature.com/articles/s4159…
Preprint: COVID-19 screening and surveillance are critical, but molecular tests haven't come close to meeting needs, and temperature checks fail. We modeled the epidemiological impacts of using loss of smell as a screening symptom. Here's what we found. 1/ medrxiv.org/content/10.110…
Loss of smell is an interesting screening symptom because it's highly specific to COVID, precedes most other overt symptoms, and typically lasts ~1 week. Critically, its prevalence goes from ~45% when self-reported up to ~80% when a test is used. 2/
Contrast this with fever: ~20% prevalence, not specific to COVID, and lasts 1.5 days on average. So why do we still screen for fever? You can look for it in seconds with a contactless thermometer.
Could rapid, contactless, cheap tests for anosmia, impact transmission? 3/