🧵 On Seasonality:
SARS-CoV-2 has "seasonality" as a contributor to transmission dynamics

People often refute it - So I made graphs and this thread

NOTE: Seasonality does NOT = "just a cold"
Many of worst viruses have seasonality

Transmission Dynamics ≠ Pathogenicity

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The first figure is Wastewater SARS-CoV-2 RNA levels averaged across the whole United States

See the REMARKABLE stability in the winter peak

The peak happens in the exact same week each year

Additionally, the start up the upswing to the peak (triangles) is also consistent

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Huge News for access to STI tests in the U.S. to help curb the growing syphilis epidemic

The @US_FDA just authorized the first fully at home OTC test for syphilis

A finger prick blood test for antibodies against the bug that causes it (T. Pallidum)

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nbcnews.com/health/sexual-… For a number of decades, syphilis has been trending up in the U.S.

The cause isn’t singularly but likely is associated with relaxations of prevention of STIs in the context of more effective prophylaxis for HIV (PrEP). Plus general lack of awareness



2/publichealth.jhu.edu/2024/why-is-sy…

Such a bad interpretation that stands to harm patient care

Let's not throw the baby out w the bathwater for COVID-19 (and flu etc)!

Suggesting to only run PCR & not rapid means most (50%-80%) of patients get WORSE care & at higher costs

Here's why:

A 🧵

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https://twitter.com/CIDRAP/status/1786081979521224936

When I see publications & docs say “don’t use a rapid test, only use a PCR”

it assumes this is an OR only situation

Ridiculous!

A rapid test is… RAPID… and highly affordable

You lose ~nothing by it and give your patient the opportunity to GAIN tremendously

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Here we go again with this asinine cautious approach to testing for H5N1

CDC is NOT recommending that people with no symptoms - but who have had contact w infected animals - be tested at all… and certainly are not recommending a swab w any frequency.

Though we should have learned it in 2020, Here’s why this doesnt make sense:

1/ Firstly, tests are our eyes for viruses. It’s literally how we see where viruses are

If we wait until people are getting sick, we may have missed a major opportunity to find viruses jumping into humans before they learn to become so efficient in us that they cause disease

2/

A lot of questions still on:

How long should I isolate?

Do I need to isolate?

When can I go back to work?

Is 5 days enough?

What if I’m still positive?

Why am I not positive when I first get symptoms?

This thread below (and the embedded thread) goes through many of these questions Now that symptoms start earlier w COVID (bc immunity activates symptoms fast after exposure)

A frequent ? that comes up is what this means for Paxlovid

Often ppl think it means you have to start Paxlovid earlier

Nope - Opposite! You have more time

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A heartbreaking consequence of lapses in vaccination!

A measles outbreak is spreadinf in Philadelphia.

MEASLES! It sends kids to the hospital, erases existing immune memory (creating long term risks) and kills 1 in 1000

It was eliminated in the US, but we seem hell bent on reversing that

inquirer.com/health/measles… A particularly deadly consequence of measles is its erasure of previously acquired immune memory - setting kids and adults up for infections that they shouldn’t be at risk from!

https://x.com/michaelmina_lab/status/1435037668027641861?s=20

This paper from Kaiser on new XBB1.5 vax formulation is misleading

NO, it does NOT say that prior vaccination w non updated XBB1.5 vaccines offer no protection

No, it doesn’t even say the XBB1.5 updates to the vaccine formulation are important

🧵
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medrxiv.org/content/10.110… Here are the key conclusions.
They are WAY misleading

The major issue is w the timing

The comparison is

A) a VERY recent XBB1.5 vaccine given in last 30 days,

Vs…

B) A vaccine received ~1 year or more ago!

Any effect is first and foremost owing to recency of vax

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Tip on pooling home tests

I’m gathering w family. Had one @Pfizer Lucira multiplex COVID-Flu home molecular test

Had 6 people and 6 swabs

Everyone used one swab. Dunked all 6 into one Pfizer Lucira test

Neg.

Tested everyone for price of one!

Pooling at home works! Pooling can work w home tests including rapid antigen and rapid molecular tests

However for antigen id be a bit more cautious and not put more than 3 swabs in the buffer

With molecular, particularly Pfizer Lucira bc it has a large volume buffer, 6 is no problem.

Please note - If you use expired rapid antigen tests - here's how I think about interpreting them

1) If Negative - do not trust it - especially if control line is faint / absent

BUT

2) If Positive - trust it - *very likely* true positive.

(short thread)
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https://twitter.com/ManifestingMom7/status/1735650894039892268

An expired test will Not aberrantly turn positive just because it's old

Expiry makes lines not show up. Does make them become dark.

So, if using an expired test:

Do Trust a Positive.
Do Not Trust a Negative.

*And note that many tests have had extended expiry dates...

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Does halving a vax booster dose make a difference to protection?

It shouldn’t

But could lower adverse effects

New @TheLancet paper is a great reminder that the immune system works on exponential scales

Halving the dose has min impact

Compare blue vs orange (half) per group The paper is a great demonstration of the studies to perform in order to enhance vaccine distribution & access globally

If in emergencies we halve doses could we drive costs down and massively increase access??

Immune kinetics suggests so.

thelancet.com/journals/lanwp…

You can extract more information from rapid antigen tests than you may realize

How quickly or slowly the test takes to turn positive, and how dark the line gets can help to understand how much virus you have in your sample.

Here’s a diagram I made to describe it.

https://twitter.com/michaelmina_lab/status/1706545922857992354

Importantly, the amount of virus on your sample is only one aspect of an infection and infectiousness

Some ppl may be infected but have no virus in their nose, for example, and not detectable on any nasal swab test including PCR - Probably not particularly infectous if so.

Wondering if you should get your baby the new RSV shot?

I’ve studied respiratory viruses like RSV, and their vaccines and treatments for years

Here’s a 🧵 of key info

We just had a baby last week

We chose to protect our newborn with it

And we’re lucky we could get a dose

1/ 1) First and most critical is that the new RSV shot is very protective against RSV

In large placebo controlled “gold standard” trials it was ~75% effective to prevent RSV requiring medical attention in babies

2/

nejm.org/doi/full/10.10…

Soon, any lab will be able to synthesize their own DNA molecules

So too will ppl at home, much like how 3D printers are much more accessible

Great for innovation
Terrifying for biosecurity

Will be very tough to keep checks to prevent “homemade” viruses

science.org/content/articl… To place in context, today synthetic DNA is made MANY reasons

Labs usually order it from companies that are required to check to make sure nefarious sequences are not being ordered

I’ve experienced this myself when getting *pieces* of smallpox DNA synthesized

2/

Very important & massively sad how long it took

@CDCgov publishes guidance on indoor air quality to help keep spaces healthy

While the guidance is directed at COVID-19 (oddly the day after the PHE ends…) it will help health overall far beyond COVID

cdc.gov/coronavirus/20… These are some of the highlights of the new recommendations
/ guidance

2/

This is a decent article

But time to just be blunt - the data from the repeat infection papers from the VA are hugely misleading

A single, major bias makes the conclusions wildly off

The denominator of total repeat infections is massively off!

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nature.com/articles/d4158… The authors look only at 2nd, 3rd, 4th infections that cause disease enough to cause someone to drive to the VA hospital and get a test

The population funnel down from 1 to 3 infections spans multiple order of magnitude - and this drives massive bias!

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Interesting!

New research in @Nature highlights meningitis & how bacteria invade the brain

Bacteria hijack a critical (often overlooked) key interaction between

Nervous System (i.e. brain and nerve cells)
+
Immune System

"neuroimmune hijacking"

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nature.com/articles/s4158… To invade the brain, bacteria must get through immunity

Bacteria like Strep pneumo have figured out how to take advantage of certain "pain stimulating" nerves to help shut down immunity and ease passage of the bacteria into the brain tissue

2/

“Textbook” & “immunity” does NOT mean to subscribe to or allow exposures in early life!

It does not mean I think this virus is mild

If you think SARS-CoV-2 is unique in causing debilitating disease, your ignore millions of people w debilitating disease from “textbook” viruses

https://twitter.com/michaelmina_lab/status/1640594588158025728

I study “textbook viruses” and immunity to them specifically because they are debilitating for many

Not all & not nearly a majority - that’s where immunity comes in - but for MANY

For those who only started thinking about viruses during COVID, it’s easy to overlook

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🧵 Ive written SARS-CoV-2 is a “textbook virus”

• Textbook does NOT mean mild
• Textbook viruses kill people
• Textbook viruses harm long-term immunity
• Textbook viruses cause dizzying amounts of poorly understood debilitating problems

I explain w examples here!

1/40

https://twitter.com/zeynep/status/1640386857182560261

Through history, the medical community just lumps long term problems associated with viruses as “idiopathic”

Which literally just means “We don’t know what caused it”

For years Ive discussed that “Idiopathic” problems are very often driven by unknown effects of viruses

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This should be great news! @LuciraHealth gets first EUA for home COVID+Flu tests

Unfortunately this decision comes late :/

Lucira just filed for bankruptcy

Per the release, in part bc @US_FDA dragged their feet for many months-through the tripledemic
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fda.gov/news-events/pr… Once again, when people living in the US needed to know their status the most (ie during the tripledemic) problems w slow and opaque decision making kept critical public health tools out of reach

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🧵 On Annual COVID Vaccines:

I think it’s WAY too early to recommend all ppl get COVID shots every year

I) Protection against severe disease lasts decently well

II) Unrecognized frequent exposures undoubtedly provide considerable “natural boosting”

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nature.com/articles/d4158… A decision to recommend a blanket schedule of annual boosters is premature, IMO

If anything, older adults will be largest group of people who benefit the most

For younger people, I think the relative gains may be very low - particularly in context of exposures

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NEWS!

@NIH is launching the

*Home Test to Treat Program*

To give free more equitable access to Treatment by linking home rapid tests to telehealth

Implemented by @eMedCertified using eMed Test-to-Treat Telehealth Kits & Community Research Platform
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nih.gov/news-events/ne… The program - a hybrid public health initiative & community research program - has been a long time in the making

It was spearheaded by NIH to respond to inequities in distribution of in-person care + the public health risks of seeking in-person care when infectious

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