Justin writes:

CNN: CDC was pressured ‘from the top down’ to change coronavirus testing guidance, official says.


This blows my f**ing mind.

Maybe we shouldn’t have political appointments in important science based agencies.



Ruth writes:

Hello Twivvers, and a special hello to Kathy Spindler in Ann Arbor where I spent 2 years getting my master’s degree in Psychiatric/mental Health Nursing at the expense of the Federal Government in 1978,

I just listened to TWIV #657 and have, once again, had my mind blown by all that is known and all that is not yet known in the world of viruses, immunology and vaccines. A couple of months ago, my 52 year-old son suggested I listen to TWIV. I am 77 and he must know me better than I know myself because I am now listening to TWIV, Immune, Virology 101 and once I finish posting another 1000 photos on my website from 18 years RV and world travel, I will be checking out more of these podcasts. 

I have lots of questions for you. But at this time, I just want to make sure you have seen the New York Times article on Dr. Anthony Fauci’s speaking gigs. TWIV gets more than just a mention in this article. I ponder why I and so many others love TWIV. I think one reason for me is that I become involved in what is similar to reading a detective novel and the non-staged commentary by you dear scientists leaves room for me to join you in the mystery.

You have made my being alive during this pandemic an exciting adventure, even though I suffered through a moderate case of COVID19 and am getting really tired of staying put in my retirement community. Thank you all for showing the public what real scientists and real science is like. I am SO grateful. 


James writes:

As a retired physicist, I appreciate TWIV’s scrutiny of opinion, expert or not.  Keep up the good work.  I’ll keep listening.

Recently this article was posted on Yahoo News.


It summarizes the experiences of an ER physician who was exposed to the virus and developed symptoms.  Her husband (an ER physician) was first in the family to exhibit symptoms. Per hospital protocol, both were tested.  His results were positive, hers were negative.

Over time, as she isolated with her 11 year old son, she received negative tests 4 additional times (PCR and rapid antibody), even after developing symptoms.  Eventually, her son became infected and tested positive.  

Several weeks after recovery, serum antibody tests were positive for all members of the family.

The author attributes the negative results to timing:  when samples were taken relative to the course of infection.  But, timing isn’t the only possible contributor to the discrepant results.  

My question for you is related to an issue I dealt with throughout my career: representative sampling.

Publicly recommended personal protection measures seem to assume that the eyes and upper respiratory tract are by far the most likely locations of primary virus infection.  The CDC guidelines for collection of test samples (https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html) also reflect this assumption.  “For initial diagnostic testing for SARS-CoV-2, CDC recommends collecting and testing an upper respiratory specimen.”

But, isn’t it possible for an infection to develop in another location, say the lower respiratory tract, without migrating to the upper respiratory tract?  

Do you know if such localization of respiratory infections have been evaluated?

It seems that too much attention is given to sensitivity (“signal/molecule”).  Equal attention should be given to where the molecules come from.

Joyce writes:

Hi Vincent,

 I just wanted to make sure you saw this. which I just found out from this Hopkins update

Not quite $1 but $5 is not bad.

Abbott Wins U.S. Authorization for $5 Rapid COVID-19 Antigen Test (Reuters) Abbott Laboratories (ABT.N) said on Wednesday it won U.S. marketing authorization for a COVID-19 portable antigen test that can deliver results within 15 minutes and will sell for $5. The portable test is about the size of a credit card, requires no additional equipment to operate, and can be conducted using a less invasive nasal swab than traditional lab tests, Abbott executives said on a call with reporters


Joyce, A microbe TV fan

Stacy writes:


I’ve listened to every episode since around episode 600 and am a huge fan! Several people have written in asking how they can combat the misinformation that’s out there. I joined up with this campaign (linked above) that seeks to do just that. I feel that at the very least, it may be something you can share with your listeners, if not partner with to provide more avenues to counter the miasma of anti-think!

Thanks for all that you do,


Charles writes:

Hello TWiVers;

It is a nice day in Chapel Hill, 92 F (33 C) and a low chance of rain.

So we now have $5 point of care rapid testing for SARS-CoV-2 virus.  I am an IT worker at a medical practice.  All the workers here are essential for providing medical care.  Now that rapid testing is available and at a cost that would not break the bank, that brings up the question: who should be tested, how often and who should pay.

Personally, I think every essential worker (health care workers, teachers, grocery store workers, meat packers and many others) should be tested every day.  That is an expense that a lot of places can not afford, even at $5 per worker.  Nor is it really fair.  So I think the government should be paying for the tests.

What do you think?



Wayne writes:

Masks work


This is from a South Korean news source…you might find it interesting.

Your latest Immunology podcast is very interesting.you contribute so much to we lay folk who love science! I’m getting close to 80 and all your podcasts keep my brain as well as world view flexible.

Best and stay safe and ‘grumpy’😤

Wayne G

Wakayama JP

Rachel writes:

Hi again! I have another question that will perhaps be close to some of your hearts, as fellow New Jerseyans.

I just saw news that NJ is considering re-opening gyms (albeit with restrictions) on Sept. 1. I personally feel this is a very bad decision, even with the guidelines they have in place. I have been tweeting policymakers trying to get their attention—we in NJ have done such an amazing job flattening the curve over the last few months, but if we want schools to open, we really need to be making tough choices, and gyms seem to be a bad choice.

Much like choirs, which you’ve spoken about, gyms will be a prime location for heavy breathing. I also think group classes will be the beginning of complacency, where people push and push their boundaries until it’s as if there is no distancing at all.

Am I overreacting? How do you TWiVers feel about gyms reopening?

Article with new guidelines attached.



John writes:

Hi All,

I am a junior at Marietta college and my school is about to finish up its second week of in person classes. I have enjoyed listening to this podcast all summer and as well as watching the virology lectures. Today my school has announced its first positive case along with a quarantine for 13 other people. We are required to wear masks and most people have committed to that, however certain groups have been throwing parties on the weekends, which we all know can easily contribute to only a few cases getting out of hand very quickly. I am a TA for a few intro biology classes this semester and I believe if I put out bounties for the underclassmen to have parties shut down, I believe that this can contribute to controlling the spread before school has to shut down again.

Hope you are all staying healthy.



Robyn writes:

G’day all,

Further to your discussion on Climate Change during TWiV 654, I thought you might enjoy the following little comment:

WORLD: There is no way we can shut everything down in order to lower emissions, slow climate change and protect the environment.

MOTHER NATURE: Here’s a virus, practice!! (Anon)




Covid free, South Australia (hopefully!!)

Robyn writes:

G’day all

Love listening, very informative. I am in Adelaide  South Australia, very cold and very dry (very worrying in supposedly the driest state in the driest inhabited continent, as we were taught in school). 

Two questions:

1. Re Dr Mina et al rapid testing, I have tried and tried to get thru to the Australian Health Departments re using these tests but I keep coming up against negativity (they don’t seem to understand that sensitivity is not random, but depends on the amount of virus being shed) or alternatively I get no answer, but I shall persist. However, one thing about the idea that a person is shedding up to three days prior to and up to three-or four days after onset of symptoms, makes me wonder why so many front line health workers get Covid-19. I would have thought that a person would not present to hospital until several days after onset, if/when they begin to get ill enough to require hospitalisation and by then they wouldn’t be shedding. I say this because in Victoria, where there was a stuff up in quarantine, and the virus escaped, very many nurses and doctors have become Covid19  positive. And another unrelated question:

2. How did the Spanish Flu die out and is it possible that Covid19 will come to a natural end and if so,  hopefully earlier rather than later?

Many thanks



Andy writes:

Let’s say we are in the world before smoke detectors. And there are two new technologies ready for production. One that senses any amount of smoke particles and goes off when you make toast and if you have a small kitchen fire will keep going for two weeks after you extinguish it until every particle is gone. But it takes the detector 20 minutes to register the smoke and start beeping. That detector costs $50,000. And then lets say there is another detector that isn’t sensitive enough to pick up burning toast, but will pick up an actual fire 98% of the time, and then will stop ringing a few minutes after you get the fire out. It would cost $25. Now imagine you lived in a giant apartment building in NYC next to a lot of other giant apartment buildings. Do you think the second detector should be outlawed because it is less sensitive than the first, or instead do you think every apartment should have to have it, knowing that even if one didn’t work and a family died, it is likely that the rest of the building would be saved? Well this is exactly what is happening with U.S. Covid-19 testing. Fast highly accurate when contagious tests could be made for $1, but they are illegal because they are considered not as good as the incredibly expensive PCR tests that continue to ring 2 weeks after the fire is out and return results after the fire has engulfed the neighboring apartment.


Jim writes:

Hello Twivers,

I’m enrolled in the Moderna stage 3 clinical trials and just got my first shot yesterday. Holy cow, my arm hurts way worse than any previous flu shot. I also have a headache, swelling under my armpit, and just don’t feel quite right. I’m not thinking any saline injection would give me this severe of a response. So just hypothetically, if I wanted to see if I developed antibodies, how long would I need to wait before getting serology tested? 4 weeks? 2 weeks after the booster injection? I’m not saying I would unblind a double-blinded phase 3 vaccine candidate clinical trial by signing up for my own test at LabCorp, but I was just curious. Keep up the good work!

– Jim

Anthony writes:

Might the success of the NY – NJ containment have been due to the weather?  Will that unravel with the summer’s end?


Christian writes:

Hello Twiv

Thank you for being my rock in an ocean of misinformation and outright lies, even though some of the stuff goes over my head (I’m trying and learning).

I´m not any kind of scientist, but have been running a larger company with the use of common sense for many years, with what I consider a fairly good result.

So being a Common Sensioligist, I have a couple of questions.

First of all – in Denmark we do not wear masks other than in public transportation.

The reason behind that is, that according to the authorities we’re not having enough infected people to do so when shopping and similar.

So the logic should be – we’ll wait until we have enough people infected, and then we’ll mask up. Does that sound like something you would recommend?

Second – I’ve  just seen a video with a professor from Yale School of Public Health, Dr. Harvey Risch, who is in favor of Hydroxychloroquine, and say tens of thousands are dying unnecessarily due to politics, as politics are keeping patients from getting the right treatment (Hydroxycloroquine). What’s your opinion on that?

Best Regards

Christian R.

John writes:

Dear TWIV team,

I’m less than an hour from you, so my temperature even in Kelvin or Rankine is pretty much the same as yours.  Heck, it’s even going to be the same in Réaumur, which I don’t think anyone has discussed yet.  OK fine, it’s 24Ré. I was actually a French major in college.  They didn’t teach that there either, come to think of it. 

However, I’ll say one mandatory thing: I’m just a Wall Street analyst/portfolio manager doing mostly health care (and a proud Patreon supporter), and as many of my colleagues and competitors have MDs and PhDs I’ve had to get a halfway decent grounding in the science to be able to keep up.  TWIV is one of my non-secret weapons which I recommend to everyone, and I’ve taken a few online classes on top of what I’m learning here, which is something new twice a week (and yes, the non-Covid episodes too!).  And BTW, Rich, if you think that the saying “all models are wrong but some are useful” is relevant in science, imagine how much more so they are in my business, which can occasionally look like random number generators creating earnings estimates (I’ve been doing this thirty years so I can say that and call it evidence-based). 

Anyway, other people can talk about the science better than I can, though I’ve nearly written you several times before today.  But today I was asked by someone what my thoughts were regarding the EUA for convalescent plasma, to which I responded 

Not wholly comfortable with its being approved yet but totally understand its measured use and that it probably should be approved one day if the data come through.  Heck, like Peter Hotez said, I’d want it for myself if the situation were correct. 

1. The EUA appeared to have been granted without mature data, which often happens for emergency use, but the plasma study was REALLY immature. And the discussion of the patients for whom it worked was an exercise in data mining that a second-semester statistics student would have recognized. (Should be first semester, but they waste half your time on coin flips.)

2. Docs are already dispensing but being very careful–this may make them prescribe it to patients who should not have it because they will have the ethical dilemma of wondering whether they’re withholding life-saving treatment, as discussed in a recent episode of This Week In Virology.  (Well, I’m trying!)

3. FDA themselves said it does not represent a new standard of care. Hardly a ringing endorsement.

The significant issue from my perspective is this—if FDA bowed to political pressure and may need to do so again and again, and I spend a huge amount of my time sifting through scientific literature and statistical studies to understand what’s going on with development-stage companies whose continued existence depends on the ability to bring to market their first product, what happens if FDA loses credibility?  If I can’t trust the agency—and I thought Scott Gottlieb was a superb commissioner, so this isn’t a partisan political issue on my part—then neither can anyone else in my world, or yours.  That, as we say professionally, would be something of a sh*t sandwich. 

BTW, if the perspective of someone with 30 years experience in my own field is ever of any use to you, I’d be only too happy to provide it, either online or off (and yes, I can also rant and yell and be generally grumpy with the pros—it’s an occupational hazard). 

And do please keep up the extraordinary work you do, in the labs, in the classrooms, and in the podcasts!

Keep on TWIVvin’,


PS My wife had all the classic symptoms of Covid-19 in March.  Of course, we all felt like we had it in March, and she tested negative—after a 14 day delay from symptom onset in getting a test (see where I’m heading with this?).   Her rheumatologist told her that she was going to consider it “probable Covid” regardless because the signs and symptoms overrode what was still a test with relatively low sensitivity and the long lag time.  She tested positive for antibodies last week—five months later, though at the lower end of what this test (Liaison) calls positive.  The doctor said it was unusual that the IgG would have that degree of persistence but that it speaks for itself. I have to admit I felt it incumbent on me to suggest “I’m sure she’s right, but you could also have had a terrible bronchitis in March and asymptomatic Covid in June.”  That made me briefly unpopular.  The sacrifices we make. 

PPS I got an antibody test yesterday, it just came back at 9.2AU/ml, which the test calls negative, but which it was suggested might more appropriately be “no longer positive” as negative readings in this test seem to be far lower than this and so I was wondering if there were a spare T-cell assay available.  And I guess my result means I deserved that momentary unpopularity, as one might suggest that I could easily have been the first one in the household to get it.

Shannon writes:

Why settle for a R.A.T. (rapid antigen test) when you can have a H.E.A.R.T. (home everyday antigen rapid test)?

Names are important.  When we are trying to contact our representatives and other government workers to make a change, we need them to be able to connect all the messages back to ONE NAME. Since the rolling out of the rapid antigen tests (RATS) that are still tied to machines and/or specific locations, it has been harder to find the words to promote the desirable home tests. We need to use an easily identifiable name that can instantly be recognized.  My family and I were discussing this over dinner.  On the radio or in news articles, it is hard to understand which test is being discussed right away. We need a name that everyone recognizes without a long list of distinguishing qualities.  I recommend  H.E.A.R.T. (home everyday antigen rapid test).

It has a great poster/post potential:

H.E.A.R.T.S for teachers.

H.E.A.R.T.S for essential workers.  

Everyone needs a H.E.A.R.T.

 H.E.A.R.T.S include everyone. 

Why settle for a R.A.T. when you can have a H.E.A.R.T. ?  

H.E.A.R.T.S for our schools.  

We wanted help

And they still give us a RAT

What do you think about that?

Thank you,