1. They compare same-day PCR against self-administered/interpreted rapid tests.
For most ppl, that's not reality. It's RAT today or PCR result in 1-3 days (or do both).
A fairer comparison would be a RAT today versus a PCR yesterday (since you'd have to wait for results).
2. They excluded 13% of the sample who were "confirmatory testers" (weird term) -- basically, people who had just tested RAT+ and were coming in for a PCR.
Basically, they excluded the people for whom the test easily worked. Drug trialists pull this stuff all the time.
3. The study excluded ppl with symptoms. Some people use RATs before socializing to reduce risk (hopefully with other Swiss Cheese slices). BUT many use RATs when symptomatic. I don't think the study fairly represents how RATs are being used.
4. As RATs became more common, many novices started using them without following instructions well. It would have been helpful if the researchers also administered and interpreted a RAT. I suspect the diminished utility is more "user error" than a property of the test. Fixable.
5. RATs detect most closely the infectious window. A PCR will flip positive a litter earlier & stay positive longer. If a goal is to prevent forward transmission, rather than merely diagnosis, then studies like this are not testing hypotheses with real-world significance.
Mina:
Overall, I see RATs as an important piece of mitigation. Even in this anti-RAT study, positive & negative predictive values were 85%-98% across tests (Table S2).
That's about as efficacious an N95 among a novice wearer. All of our shields have holes, so we combine them.
RAT efficacy estimates are much higher than many "too good to be true" interventions you see pushed heavily: SSRIs, enovid, nasal sprays. 🤣🤣🤣
The evidence that those protect against COVID is so poor as to harm by distraction. Go buy some bittrex.
During this 12th COVlD wave, the CDC reports 1-in-3 states have "High" or "Very High" levels.
PMC estimates the proportion of residents actively infectious (prevalence):
◾️USA: 1 in 67
◾️IA: 1 in 27
◾️MI: 1 in 25
◾️IN & CT: 1 in 23
◾️ME: 1 in 21
◾️OK & SD: 1 in 17
🧵1/
On average, Americans have have 5.0 cumulative SARS-CoV-2 infections.
This week's infections are expected to result in 1/4 to 1 million new #LongCOVID conditions and ≈2,000 excess deaths.
🧵2/
The wave peak is now estimated >10% higher than last week at 1.2 million new daily infections, nearly double the Delta wave.
We expect sustained high transmission (≈600,000 to 750,000 new daily infections) the next few weeks as COVlD circulates through schools/families.
🧵3/
Based on today's CDC & Biobot data, we estimate the following for the week of Jan 19:
🔸1 in 52 people in the U.S. actively infectious
🔸25% chance of exposure in a room of 15 ppl
🔸Nearly 1 million new daily infections
🔸5 cumulative infections per person all-time (avg)
🧵1/5
Transmission estimates have been marginally corrected upward.
11 states have Very High COVlD levels:
🔸PA: 1 in 25 estimated actively infectious
🔸MI: 1 in 23
🔸OH & KY: 1 in 22
🔸SD: 1 in 20
🔸NE & IA: 1 in 18
🔸IL & ME: 1 in 17
🔸IN: 1 in 16
🔸WV: 1 in 11
🧵2/5
We're in the middle of a 12th COVlD wave.
The peak has likely passed, but with students headed back to school, transmission is expected to remain high for at least the next several weeks.
The size of the winter COVlD wave has been revised upward as post-holiday data come in.
We estimated 1 in 55 people in the U.S. are actively infectious.
🔥WV: 1 in 14
🔥IN: 1 in 15
🔥MI & OH: 1 in 21
🔥MO: 1 in 22
🔥CT: 1 in 24
🔥KS: 1 in 25
🔥MA & IL: 1 in 27
Quick 🧵 1/4
Nationally, we are seeing an estimated 892,000 new daily SARS-CoV-2 infections, meaning a 1 in 4 chance of exposure in a room of 15 people. Risk varies considerably by state.
We are approaching an average of 5 infections per person since pandemic onset.
🧵 2/4
We are in the 12th COVlD wave of the U.S.
Current transmission is higher than 68% of all days since the pandemic onset in 2020.
🧵 3/4
You might not have heard, but the northeastern U.S. is in a COVlD surge.
We use wastewater levels to derive estimates of the proportion of people actively infectious in each state (prevalence), e.g., 1 in 24 people in Connecticut.
We told you that 109,000-175,000 Americans would died of COVID (excess deaths) in 2025.
Today, the CDC estimates 101,000 deaths/year (flat from Oct 2022 to Sep 2024), and likely higher when considering more nebulous non-acute excess deaths (heart attack 6 months later). 1/5
The CDC estimates are actually higher than I would have guessed, given their methodology, which models estimates based on easily countable factors in healthcare and expert input on multiplier values. It lends credence to the PMC upper bound of excess deaths of 175,000/yr.
2/5
What's troubling is the CDC has annual mortality flat. My expectation based on mortality displacement and Swiss Re data is that it should be declining. If is stays flat, we're running on something like breast+prostate cancer or lung cancer deaths per year in perpetuity.
3/5