Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and how to manage it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from qualified healthcare experts over some person on Facebook.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
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Rapid tests screen at 97%. "Rapid tests work very well to answer 🧵 AM I INFECTIOUS and a RISK TO OTHERS
This is THE public health ? we care about I made a BIG chart of rapid tests - Overall sensitivity vs any PCR pos - what FDA judges - Sensitivity if infectious (97%!) - what we actually care about 1/
This data above comes from the UK COVID-19 Lateral Flow Oversight Team. What the data above shows is that rapid tests are excellent public health tools to quickly identify almost anyone who is currently infectious and needs to isolate What it also shows is... 2/
This shows why there is so much damn confusion about if rapid tests are sensitive Answer: YES they are... if the question is "Am I Infectious Now and do I need to isolate" However, if we compare them to PCR, then we are asking a different question: Do I have any RNA in me 3/
For Public Health, we want to identify & isolate (+ trace) ONLY ppl who are currently infectious. And, if someone is currently infectious, then we must know FAST - not tomorrow (duh) and definitely not in 3 days! We don't care much about if someone was infectious last month. 4/
So, rapid tests are perfect public health tools! Rapid Tests continue to get a bad wrap bc Docs (& regulators) fail to distinguish: A Med Device: Do I have any RNA in me, even if from an infxn 3 weeks ago... & I don't care how long the result takes vs A Public Health Tool! 5/
We must define the tools we are using during this pandemic We cannot keep putting public health tools in the same bin as medical devices It is THE reason we lack these critical public health tools in the US - bc FDA is asking them to do something they aren't designed to do 6/
There is a solution for US to accelerate access to tests We just define these PUBLIC HEALTH tools - during a PUBLIC HEALTH emergency - as... PUBLIC HEALTH tools & not medical devices Simple? Then, CDC can evaluate them based on *public health* metrics 7/
The chart in the First tweet of this thread is adapted from this terrific paper by the UK COVID-19 Later Flow Oversight Team - which has (arguably) had the most experience using and evaluating rapid antigen tests in the world now. 8/
Also, the chart not only shows Sensitivity, but also Specificity For Public Health especially, It's extremely important to have high specificity so we don't get a lot of false psitives. These top tests have great specificity with only 0 or 1 in 1000 turning falsely positive. 9/
This graph shows relationship between time, viral load and transmissibility - and why Sensitivity against PCR looks horrible, even if the test is 100% sensitive to catch infectious people. The infectious period is days. PCR is not specific for this & stays pos for weeks 10/
Why is Defining a rapid test as a public health tool so important? it's because there is a massive supply of rapid tests across the globe yet very few are available to American's bc we regulate them as medical devices... making it nearly impossible to gain an FDA EUA. 11/
This is because when defined as a medical device, the comparison is to the gold-standard medical device: PCR. As the data in the first tweet in the thread shows, a 100% sensitive & specific test for being contagious will only have a 50% or lower sensitivity against PCR... 12/
The reason is simple The gold-standard PCR FDA requires rapid Ag tests to compare to is NOT SPECIFIC for the public health ? being asked: Am I infectious? It's not that rapid tests have low sensitivity - it's actually that the PCR has low specificity for a public health ? 13/ "
Source:
Commentary: I wholly agree that we're not using rapid testing properly or enough. At any gathering, every single person should be screened that day, and each day. If we catch 97-99% of infected people and prohibit them from entering the airspace, we will substantially cut back on superspreading events. Rapid antigen tests take 15 minutes to process; it's not like you'd have to wait in a holding room for hours for a result. Show up at the office, at work, at a conference or event, at a sports game, get tested on the spot, and then go about your business for the day.
The tests cost around $5 in bulk; $5 added to the price of a movie ticket or a sports game would be trivial.
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Boosters not needed? "Food and Drug Administration scientists have expressed skepticism about the need for additional doses of Pfizer’s Covid-19 vaccine for all people who have received it.
The assessment by the agency’s staff, included in documents released Wednesday, sets up a high-stakes debate over who will need an additional booster dose — and when they will need it — at the meeting of experts being convened by the Food and Drug Administration on Friday.
In the documents, the FDA’s own scientists seemed to strike a skeptical position about the need for widespread booster shots. Overall, they said, “data indicate that currently US-licensed or authorized COVID-19 vaccines still afford protection against severe COVID-19 disease and death in the United States.”
Other data released Wednesday, both in briefing documents for the Friday panel and by other researchers, add to the swirling debate over a question that will affect millions of people who have been vaccinated against Covid-19 around the world: If the effectiveness of the vaccine wanes, do people need to top it off with an additional dose? If so, when should that happen given that much of the world has not received a first dose of vaccine yet? And should that decision vary by age and by whether people have other health conditions that could make Covid worse if they do become infected with the SARS-CoV-2 virus?
On one side are drug companies and some researchers, who point to data showing the efficacy of the vaccines to protect all infections is waning and that a third shot will provide additional protection. On the other are those who point out that these vaccines are still keeping people out of the hospital and preventing them from dying, indicating that a booster is not needed yet."
Source: https://www.statnews.com/2021/09/15/fda-scientists-strike-skeptical-tone-on-need-for-covid-19-vaccine-booster-at-this-time-fueling-debate/
Commentary: My take on boosters hasn't changed. We need vaccines in arms. We have a LOT of vaccine laying around. If the choice is between using a dose that's going to expire and throwing it out, use it, even if it's a booster. If there's a choice between a booster and a net new vaccination, always choose the new vaccination.
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A reminder of the simple daily habits we should all be taking.
1. Wear the best mask available to you when you'll be around people you don't live with, even after you've been vaccinated. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Verify your mask's NIOSH certification here: https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
3. Get vaccinated as soon as you're able to, and fulfill the full vaccine regimen. Remember that you are not vaccinated until everyone you live with is vaccinated. If you received an adenovirus vaccine (J&J/AstraZeneca), consider getting an mRNA single shot booster (Pfizer/Moderna) if permitted.
4. Wash/sanitize your hands every time you are in or out of your home.
5. Stay out of indoor spaces that aren't your home and away from people you don't live with as much as practical. Minimize your contact with others and avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
6. Aim to have 3-6 months of living expenses on hand in case the pandemic gives another crazy plot twist to the economy.
7. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
8. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).
9. Masks must fit properly to work. Here's how to properly fit a mask:
10. If you think you may have been exposed to COVID-19, purchase a rapid antigen test. This will detect COVID-19 only when you're contagious, so follow the directions clearly. https://amzn.to/3fLAoor
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Common misinformation debunked!
There is no basis in fact that COVID-19 vaccines can shed or otherwise harm people around you.
Source: https://www.reuters.com/article/factcheck-covid19vaccine-reproductivepro-idUSL1N2MG256
There is no mercury or other heavy metals in the Pfizer mRNA vaccine.
Source: https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no basis in fact that COVID-19 vaccines pose additional risks to pregnant women.
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.
Source: https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/
Source: https://www.nature.com/articles/s41591-020-0820-9
Source: https://www.nationalgeographic.com/science/2020/05/anthony-fauci-no-scientific-evidence-the-coronavirus-was-made-in-a-chinese-lab-cvd/
Source: https://www.smh.com.au/national/are-we-ignoring-the-hard-truths-about-the-most-likely-cause-of-covid-19-20210601-p57x4r.html
There is no evidence a flu shot increases your COVID-19 risk.
Source: https://www.factcheck.org/2020/04/no-evidence-that-flu-shot-increases-risk-of-covid-19/
Source: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa626/5842161
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Disclosures and Disclaimers
I declare no competing interests on anything I share related to COVID-19. I am employed by and am a co-owner in TrustInsights.ai, an analytics and management consulting firm. I have no clients and no business interests in anything related to COVID-19, nor do I financially benefit in any way from sharing information about COVID-19.
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A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.
https://twitter.com/i/lists/1260956929205112834
This list is biased by design. It is limited to authors who predominantly post in the English language. It is heavily biased towards individual researchers and away from institutions. It is biased towards those who publish or share research, data, papers, etc. I have made an attempt to follow researchers from different countries, and also to make the list reasonably gender-balanced, because multiple, diverse perspectives on research data are essential.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.