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Ranu Dhillon Profile picture
@RanuDhillon
Sep 7, 2020 • 4 tweets • 2 min read • Read on X
There is real-world data showing that what we are doing right now isn't working

Widespread serial rapid screening hasn't been done before bc regulatory agencies have blocked it. At minimum, many more cases will be caught early

And remember, nothing has to work 100% to get R<1
And here is some modeling data that suggests that rapid testing in this manner could have reduced the number of infections in the West African Ebola epidemic by *a third*

nature.com/articles/natur… Image
And, if used aggressively as a concerted strategy, may be even more abruptly:

thelancet.com/journals/lanin… Image
@KatherineJWu

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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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