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Ranu Dhillon Profile picture
@RanuDhillon
May 14, 2020 • 7 tweets • 7 min read • Read on X
1/From work @sri_srikrishna @diegochowell @g_chowell @AbraarKaran @beier_dbeier & I did several wks ago, we realized that COVID may be stopped w/⬆️but imperfect #TestTraceIsolate IF, combined w/⬆️masks+hygiene+distancing, the COMBINED effect could get R<1

hbr.org/2020/05/a-plan…
2/ It's great to see a #COVIDconsensus coalescing around this COMBINED approach of #TestTraceIsolate + 'protections'

@Atul_Gawande talks about this same combination of masks+hygiene+distancing+screening as a "drug cocktail" @NewYorker yesterday

newyorker.com/science/medica…
3/ @MartyMakary makes similar points with added emphasis on benefits of outdoors & need to focus on high-risk groups in @nytimes today

nytimes.com/2020/05/14/opi…
4/ @mattyglesias provides a similar consolidation of strategies @voxdotcom (while also mentioning outdoors, vaccines)

vox.com/2020/5/13/2124…
5/ So...

vlp.to/yVOFMR9f
6/ As @ashishkjha @JeremyKonyndyk @paulmromer @rajshah @DrTomFrieden @JoiaMukherjee @PIH & many others are already doing, let's continue to push the accelerated scaling of #TestTraceIsolate
7/ In addition, let's optimize 'protections' aka masks+hygiene+distancing (aka whatever you want to call it)

Lots of low-hanging opportunities with - at minimum - important & - at maximum - game-changing impact esp when it comes to masks/face protection

vanityfair.com/news/2020/05/m…

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More from @RanuDhillon

Ranu Dhillon Profile picture
Jun 13
If indoor spaces had adequate air cleaning, most airborne transmission could be negated, making it unlikely for any pathogen to cause a pandemic

Re great Morawska et al article @ScienceMagazine, @sri_srikrishna & I rethink current approach in 2 ways
(1/6)
science.org/doi/10.1126/sc…
Image
(1) Air cleaning must stop long-range spread by calibrating filtration to remove the amount of pathogen emitted in superspreading (not based on # of people in the room)

For many pathogens, most infectious particles are accounted for by relatively few hi-emitting infectors (2/6)
(2) Air cleaning must also prevent short-range transmission by quickly disbursing transient accumulations of infectious particles near the mouth & nose of high-emitting infectors

(3/6)
Read 6 tweets
Ranu Dhillon Profile picture
Dec 15, 2022
The most systemic & sustainable 'solution' to the pandemic is to implement clean indoor air -- eliminate virus from the air enough that risk is always low

A big barrier to this in real life is that there was no guidance on just how clean is clean enough?

jamanetwork.com/journals/jama/…
For years, CDC and ASHRAE, the bodies responsible for putting forward standards, were unwilling to do so

As a result, schools, businesses & other didn't know what to do. Some put one HEPA filter in a room & hoped it was enough (it wasn't)
In this letter, we (@sri_srikrishna @AbraarKaran) push for clear clean air targets &, based on available evidence & guidance, propose 6 air changes per hour (ACH) as a minimum & 12 ACH (which is what hospital isolation rooms have) as the ideal

jamanetwork.com/journals/jama/…
Read 5 tweets
Ranu Dhillon Profile picture
May 9, 2022
Thanks @Bob_Wachter for sharing such a personal situation that allows us all to learn

What strikes me is that so many factors in how you’re navigating this situation are beyond the means & agency of our most vulnerable yet are being thrust on them to manage on their own

(1/6)
The judgements you expertly made are ones that are currently being put on all individuals irrespective of their knowledge & comfort with Covid

Just like we wouldn’t leave it up to individuals to determine what traffic rules to follow, guidance should be clearer

(2/6)
In addition, you & your friends are appropriately doing serial testing to offset onward spread & access Paxloid promptly, something that many families can't afford

I’m @harvardmed & mainly work abroad but, due to family reasons, work clinically in low income areas in CA..

(3/6)
Read 6 tweets
Ranu Dhillon Profile picture
Aug 20, 2021
I've been working in a hospital in a low-income area for the past several nights

From talking with our many unvaccinated Covid patients, there are 2 general responses I've heard as to why they weren't vaccinated...

(1/4)
1) Several people said they knew vaccination was *important* but never perceived it as their *most immediate* need until they got sick

Had we been going door-to-door, eliminating the burden on them to search out & get vaccinated, most felt like they would have gotten it

(2/4)
2) Distrust -- not of vaccines -- but of the formal authority structures from whom they see them pushed

This rational distrust is from decades of injustices & continued negative interactions with these structures that is hard to undo or overcome quickly & amid a crisis

(3/4)
Read 4 tweets
Ranu Dhillon Profile picture
Mar 11, 2021
We've never meaningfully addressed spread in high-risk workplaces despite this likely being a major driver of the pandemic

In communities like mine, workplace spread seeded transmission in crowded multi-gen homes with at-risk elderly & others working in similar settings

(1/6)
Most of our 'standard' strategies -- cloth masks, "stay-at-home", distance -- do nothing to address this cycle of transmission

(2/6)
In my community, anecdotally, hospitalizations from this cycle of spread has only declined with rising vaccinations

It should never take waiting for a vaccine - & allowing thousands to suffer & die in the interim - to stop one of the main drivers of this pandemic

(3/6)
Read 6 tweets
Ranu Dhillon Profile picture
Jan 28, 2021
1/ Just heard @CDCDirector on @CNN @drsanjaygupta push back on the proposal @AbraarKaran @sri_srikrishna & I put forward on the gov't sending N95-caliber masks to every home (cnn.com/videos/health/…)

A quick rebuttal

THREAD
2/ Dr. Walensky's counterpoints to this idea seem to be:

- N95-caliber masks aren't necessary; multi-layer cloth + 6 feet is good enough

- access to masks is not a bottleneck

- N95-caliber masks are hard to wear for long periods
3/ For the 1st point, we know that Covid can spread via aerosols indoors & in crowds

Cloth masks only variably block (~50-70%) & surgical masks up to 80%

People -especially essential workers, those at high-risk- need better protection particularly in poorly ventilated scenarios
Read 9 tweets

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