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I told @Brabbott42 in the @WSJ that the US is facing a "perfect storm" of #COVID19 test demand. But what does that mean? @RickABright @PPI_Insights @RockefellerFdn @uche_blackstock @HelenBranswell https://www.wsj.com/articles/covid-19-tests-get-harder-to-find-as-omicron-variant-spreads-11639922403 … 
1/15pic.twitter.com/nv6xvfEmoR
When it comes to testing, there are 6 kinds of people we need to consider:
1.) The worried well
2.) The worried ill
3.) Those with #SARSCoV2.
4.) Those exposed to SARS-CoV-2.
5.) Those who need a test for work/school/travel.
6.) Those who need a test for the holidays. 2/15
1. The "worried well" have no symptoms, no known exposure, etc., but are freaked out because of the news around #Omicron. There's not much data on this group, but--based on our experience with H1N1 in 2009--we should assume demand is going up. 3/15http://sciencedirect.com/science/article/abs/pii/S1386653212002065 …
2. The "worried ill" have #COVID19 symptoms, but are infected with something else. This is a new problem for our healthcare system this pandemic because we didn't have a flu wave last year. Flu positivity (along with non-flu/non-covid respiratory illness is WAY up). 4/15
Data from @BioFireDX shows that 85% of people being tested for respiratory symptoms in the US are infected with something that isn't SARS-CoV-2! 5/15 https://syndromictrends.com/ pic.twitter.com/aK9mdO3Uaw
The CDC's key indicator, ILI or the percent of healthcare visits for influenza-like-illness, is now at 3.5%. This is our first time above the baseline for flu season (we crossed a couple weeks ago) in two years. 6/15https://www.cdc.gov/flu/weekly/index.htm …
Part of what's driving the increase is a mismatch in the vaccine strain for flu this year. But, the mismatch isn't only because we still struggle with vaccine strain selection... 7/15https://www.medrxiv.org/content/10.1101/2021.12.15.21267857v1 …
When we passage the virus through eggs (one of the manufacturing processes) it picks up mutations that are adaptive for eggs! The result is that the antigens are different and our antibodies trained against them aren't as effective. Evolution 
8/15pic.twitter.com/GTCpyv8UCP
You can get a flu vaccine grown in cell culture, which typically performs better. No data from this season, but you can read about past performance. I do *not* have a COI with the makers of Flucelvax. I'm just a fan of the evidence for its efficacy. 9/15https://www.sciencedirect.com/science/article/pii/S0264410X20309361 …
Back to our 6 kinds of test seekers. Number 3, those with a SARS-CoV-2 infection. We know this number is already dangerously high in the US and will double every two days in places with #Omicron. Which is basically the whole US now. 10/15https://twitter.com/PPI_Insights/status/1471927775049261059?s=20 …
4. Exposed individuals. For every case there are often many exposures. All of these individuals will need tests. So an exponential growth in cases leads to an even *faster* growth in test demand (could be super exp. as I said here or a higher rate). 11/15https://twitter.com/svscarpino/status/1471625558765314053?s=20 …
5. We know there's persistently high demand for work/school/travel etc. In some places, e.g., universities, tests are handled on site, but for most of us, we have to stand in line at public sites. 12/15https://twitter.com/uche_blackstock/status/1472277174396796931?s=20 …
Last but not least, it's the holiday season and public health officials are rightly stressing the need to test before gathering. This is SO important, especially with higher breakthrough rates from the #OmicronVariant. But, all of this demand is being put on the same sites! 13/15
So, what can we do? 1.) Mail rapid tests to everyone in the US. Let's start with a month's supply and go from there. 2.) Have ubiquitous, *free* rapid and PCR tests at public places like libraries, fire stations, houses of worship, community centers, etc.. 14/15 -cont-pic.twitter.com/hcsDLL9tbH
3.) Sign up for the exposure notification apps! 4.) Free high-grade masks, pop up vaccine clinics, etc. 5.) Paid sick leave & child care. If we take these steps NOW we might avoid lockdowns. Good public health saves lives AND livelihoods! There's no dichotomy. 15/15
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