📍VIRAL LOAD SAME regardless of symptoms. Korean study found that viral load of #SARSCoV2 were similar in asymptomatic patients versus viral load in symptomatic patients.

➡️ Thus, isolation of infected #covid19 patients needed regardless of symptoms. 🧵 jamanetwork.com/journals/jamai…

2) “303 patients with SARS-CoV-2 infection isolated in a community treatment center in the Republic of Korea, 110 (36.3%) were asymptomatic at the time of isolation and 21 of these (19.1%) developed symptoms during isolation.”

➡️ 81% of asymptomatic remained so thru isolation.

3) Also worrisome—“The median (IQR) interval time from diagnosis to symptom onset in presymptomatic patients was 15 (13-20) days” !

➡️ Pre-symptomatic patients are those who start asymptomatic but then show symptoms later... and 15 days (13-20) is much longer than 2 weeks.

📍HIGHWAY ROBBERY:

Remdesivir, made by @GileadSciences, has now set the price ➡️ $2,300 to $3,100 per patient.

So how much does it cost to produce each vial?

➡️ Just $1.

US taxpayers also had paid for the drug’s NIH trial.

Borderline criminal drug pricing.

#COVID19

2) As result, @PATreasurer @JoeTorsella is demanding @GileadSciences change the pricing and recognize the contribution of American taxpayers and demand the end of pharma price gouging. patreasury.gov/newsroom/archi…

3) “It is immoral for any company to reap excessive profits from a treatment against a global pandemic. American taxpayers deserve a fair price for a drug they already paid to develop. In these turbulent economic conditions, each new breakthrough in treatment or prevention...”

Jurassic Park 🦖 COVID is BACK—“you’ll be pleased to know that Jurassic Park has the highest velociraptor attack survival rate in the 🌎. Sure, maybe it’s because our EMTs have spent last 6 months reattaching dismembered appendages is mere muscle memory” 🧵mcsweeneys.net/articles/juras…

2) “let’s focus on the bright side. Like the fact that most velociraptor attack victims survive with just a few missing fingers or toes. And even amongst those that are severely mauled, the vast majority still pull through”

3) “Given these great stats, I think it should be pretty clear to everyone that reopening the Jurassic Park Academy for Young Paleontologists this fall is the right move. Sure, a few kids have been mauled this summer at our popular sleep-away camp, Camp Triceratops.”

Welp—because of Israel heat wave, "the govt exempted everyone from wearing masks for 4 days, & schools shut the windows (for AC). That decision proved disastrous." Led to school outbreaks.

➡️ Points to aerosol transmission & lack of ventilation. #COVID19
nytimes.com/2020/08/04/wor…

2) “Confident it had beaten the coronavirus and desperate to reboot a devastated economy, the Israeli government invited the entire student body back in late May.

Within days, infections were reported at a Jerusalem high school...”

3) “which quickly mushroomed into the largest outbreak in a single school in Israel, possibly the world.

The virus rippled out to the students’ homes and then to other schools and neighborhoods, ultimately infecting hundreds of students, teachers and relatives.”

A note—I’ve deleted a confusing post that some completely misinterpreted about vaccine—we absolutely need Phase 3 trial—I was advocating for compassionate expansion of P3 vaccine enrollment to people in hotspots. I was clear further down a thread but the beginning was murky.

2) I reiterate my previous recap: Expand vaccine via Phase 3 trial expansion to eligible people volunteering for early access in hotspot epidemic areas as part of Phase 3. We are NOT SKIPPING PHASE 3 trial. There’s still randomization in expanded trial access. Don’t misinterpret

3) some argue compassionate use is only for end of life cancer care. But we don’t just have 1 case w/ imminent death—we have thousands. 1200-1400 per day dying in US alone. Expanding P3 trial enrollment in hotspot areas could have a huge impact now even if 50/50 randomization.

260 employees have tested positive for the coronavirus or are in quarantine because of possible exposure.

Gwinnett County Public School teachers began in-person pre-planning Wednesday at 141 facilities throughout the county. Then boom, outbreak. #COVID19 ajc.com/news/atlanta-n…

2) Many could be community spread. But this in-person gathering of teachers just doesn’t make any sense.

FOLKS—I’m going to keep hammering and sharing info about airborne transmission of #COVID19 until I’m blue in the face & WHO + CDC comes out strongly with aggressive guidelines for this. The aerosol evidence so far is overwhelming that indoor stuff so risky nature.com/articles/d4158…

2) Repeat after me. The Coronavirus is Airborne. Say it again. Then read this article why. (HT @mykfish of @FAScientists). #COVID19 slate.com/technology/202…

3) Another renowned scientists (double National Academies inductee) who believes the coronavirus aerosol is inherently airborne for simple everyday understanding.

https://twitter.com/kprather88/status/1289750718585303041?s=21

https://twitter.com/kprather88/status/1289750718585303041

Wow. CDC reports of a huge superspreading event in 260 kids+adults from YMCA camp. ~1/2 children aged 6-10 positive. 44% aged 11-17 positive.

➡️#COVID19 SPREADS IN KIDS.

➡️WHY NO MASKS WEARING?

...oh wait @BrianKempGA blocked mask mandate rules.
ajc.com/news/coronavir…

2) Camp required a test <12 days before arriving & attempted "pods"

Masks required for staff but NOT campers

Clearly these measures not enough for control. And using the pods is akin to the cohorting that CDC suggested. This is likely not adequate.

3) Here is the CDC report of the attack rates (incidence rates). Pretty uniform scores the board - if anything young adults lower risk likely because camp counselors wore masks. cdc.gov/mmwr/volumes/6…

📍HEADS UP: I’m going to be amplifying key scientists who work in AEROSOL transmission, because critical right now.

💡First—HOW TO MEASURE ROOM’s AEROSOL INFECTION RISK? You first need to measure a room’s VENTILATION RATE. Dr. @jljcolorado has a calculator + cheap $159 method!

https://twitter.com/jljcolorado/status/1289360404271861760

2) Professor Jimenez has developed an easy to use calculator for aerosol transmission risk for a room. You don’t know how safe a room is to be in unless you do air flow calculations with environmental engineering formulas. Luckily there is a calculator. docs.google.com/spreadsheets/d…

3) EXCERPT: Can the ventilation rate be estimated with a portable CO2 meter?

In research, we measure the ventilation rate using a “tracer release” experiment. We release a puff of an inert, non-sticky gas that we can measure with high time resolution.

📍CLEARING AEROSOLS FROM ROOMS: Now that aerosol transmission of the coronavirus is established, the big question is how to disperse aerosols quickly enough. Well, this video explains it all. Thread 🧵of latest evidence. #COVID19

2) Indoor air ventilation is needed to clear aerosols & reduce airborne transmission risk. Video demonstrates time needed to clear smoke from room:

📌2 opposite doors: 7 min
📌1 door: 45 min
📌1 door w/ fan: 21 min
📌1 door w/ 2 fans circulating: 12 min

➡️ 2 doors/windows best

3) Here is the latest evidence from the Diamond Princess supporting aerosols as a major transmission route.

https://twitter.com/drericding/status/1288837200621318144?s=21

https://twitter.com/drericding/status/1288837200621318144

New—Kids with COVID have at least as much of the coronavirus in their noses and throats as infected adults, says study. Children <age 5 may even have up to 100x as much of the virus in the upper respiratory tract as adults. #COVID19 nytimes.com/2020/07/30/hea…

2) ““But one takeaway from this is that we can’t assume that just because kids aren’t getting sick, or very sick, that they don’t have the virus.”

The study caveats: It was small, and did not specify the participants’ race or sex, or whether they had underlying conditions.

3) “The tests looked for viral RNA, genetic pieces of the coronavirus, rather than the live virus itself.” So we don’t know if it’s all intact viruses or just fragments.

❗️HUGE—an @NPR investigation uncovered info about private firm awarded contract taking over CDC hospital COVID data.

➡️TeleTracking CEO Michael Zamagias had links to NY real estate world—a firm that financed billions $ in projects with—Trump Organization. npr.org/2020/07/29/896…

2) Also weird: “The process by which HHS awarded the contract is normally used for innovative scientific research, not the building of government databases.”

3) More weird: “HHS had directly phoned the company about the contract, according to a company spokesperson.”

⚠️AEROSOL—Computer model of the Diamond Princess cruise 🚢 utbreak found that the virus spread most readily in microscopic droplets light enough to linger in the air—it was aerosol. This is now slam dunk for the coronavirus aerosol transmission. #covid19 nytimes.com/2020/07/30/hea…

2) “Earlier, after pressure from more than 200 scientists, WHO acknowledged that the virus could linger in the air indoors, potentially causing new infections.”

3) Pre-print, but shown to nearly a dozen experts in aerosols and infectious disease. The new findings, if confirmed, would have major implications for making indoor spaces safer and choosing among a panoply of personal protective gear.

⚠️What we need now:

📌TESTING—FAST, CHEAP, & AT HOME

📌CONTACT TRACING

📌MASK MANDATE

📌PREMIUM MASKS MASS PRODUCED

📌INDOOR AIR VENTILATION & AIR DISINFECTION

📌FIGHT HEALTH MISINFORMATION

📌CDC & FDA INDEPENDENCE FROM WH

📌PRECISION TARGET HOTSPOT LOCKDOWNS #COVID19

2) Also what we need:

📌TRUST IN PUBLIC HEALTH & SCIENCE

📌GLOBAL COOPERATION FOR VACCINE AND EXCHANGING DATA

📌BETTER COLLABORATION IN GLOBAL GOVERNANCE ON PANDEMICS

📌PROTECTING JOURNALISM INDEPENDENCE

📌SUPPORT FOR WHISTLEBLOWERS

📌SUPPORT FOR EACH OTHER

3) For local communities, we need:

📌FREEZE ALL EVICTIONS & UTILITY SHUTDOWNS

📌FOOD PROGRAMS FOR THE HUNGRY

📌SCHOOL TECHNOLOGY SUPPORT FOR THE POOR

📌SCHOOL INVESTMENT FOR BUILDING UPGRADES

📌FREE COMMUNITY HEALTHCARE FOR ALL

📌STUDENT LOAN INTEREST FREE FORBEARANCE

HUGE—Now we are certain—VIRUS aerosol in the air, when captured from a room, can be infectious. Scientists just proved it by doing just that from hospital ward room, and using the air sample to infect a cell. Aerosol transmission is very real risk. #COVID19

https://twitter.com/AliNouriPhD/status/1288534942276780032

2) Good reminder about aerosols:

https://twitter.com/DrEricDing/status/1286854902225031171?s=20

https://twitter.com/DrEricDing/status/1286854902225031171

Whoa—FAUCI: “Eye protection may be recommended at some point” #covid19

We’ve known coronavirus infection via the eye 👁 is possible. But this is getting serious.

SOURCE of above quote: streetinsider.com/Trader+Talk/Dr…

3) Research shows it’s possible. But it’s more indirect. “to infect via your eyes, the virus would have to penetrate eyes' mucous membrane, be washed by tears behind cheeks into nasal cavity, then flow from nose into throat. "It's a more circuitous route” npr.org/sections/goats…

OMG. The Trump/right-wing popular doctor with a viral video on HCQ & saying masks aren't needed— also claimed that some diseases are caused by sex with demons and witches, and that alien DNA is used in medical treatment. Wowzers. (By @willsommer) #COVID19 thedailybeast.com/stella-immanue…

2) “She has often claimed that gynecological problems like cysts and endometriosis are in fact caused by people having sex in their dreams with demons and witches.” 🧐 ummm.

3) “She alleges alien DNA is currently used in medical treatments, and that scientists are cooking up a vaccine to prevent people from being religious.” Ugh. @PeterHotez, it just got more batshit crazier.

Oy. Even mild #COVID19 infections can lead to long term CVD health consequences. 78% of this group had cardiovascular complication after recovery. Not all hospitalized. Not all even had symptoms. theweek.com/speedreads/927…

2) Moreover, “ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis”. jamanetwork.com/journals/jamac…

✈️AIRPLANE TRANSMISSION: a first-ever documented likely case of transmission aboard airplane. A 44-year-old man was chatting w/ wife & son on flight when he let guard down, allowing his face mask to slip below his nose—the lapse led to #COVID19 infection🧵
bloomberg.com/news/articles/…

2) Researchers apparently did a full investigation and detailed tracing of the incident. They conclude: “the temporal, spatial, and exposure evidence suggests that #SARSCoV2 transmission may have occurred during the flight”. #covid19

3) Notably, “during flight, Case 16 moved to Seat 30F and sat there for an hour. In the seats around Seat 30F, there were four infected passengers, with Case 11 and Case 12 sitting on the left side of him, and Case 7 & Case 8 sitting behind him on right” sciencedirect.com/science/articl…

⚠️CHILDREN COVID SURGING:

On July 16, Florida 23,170 children age <18 who tested #COVID19 positive since pandemic began.

By July 24, that jumped to 31,150.

➡️ 34% increase in new cases among children in 8 days!

➡️ 23% jump in child hospitalizations!
cnn.com/2020/07/27/hea…

📌REMINDER: Kids are not immune. Families with kids aged 10-19 actually have higher risk of transmission than young adults. Kids under 10 only slightly lower than young adults 20-29.

https://mobile.twitter.com/drericding/status/1284888478841556999?locale=ca

https://twitter.com/DrEricDing/status/1284888478841556999

⚠️DEBUNKING HYDROXYCHLOROQUINE (again)—w/ that viral HCQ video today, it’s time to bump up this thread 🧵 on the mega RECOVERY randomized trial of HCQ with 4700 people showing NO benefit for mortality, & even higher risk of ventilator+mortality. And no subgroups benefit. #COVID19

https://twitter.com/DrEricDing/status/1283465624203788290

2) Trials are many fold stronger evidence than any Henry Ford retrospective analysis or case series report. Henry Ford Health system (thsr showed lower risk with HCQ) was also just one of several retrospective analyses. The other ones all showed NO BENEFIT or even HIGHER risk.

3) Moreover here is another RANDOMIZED trial of hydroxychloroquine done by @boulware_dr’s group in the US published in the NEJM showing no benefit for preventing #COVID19.

https://twitter.com/drericding/status/1268309620944261122?s=21

https://t.co/oZA6XXaK67