1/ I work in a hospital with a steady flow of Covid. Just a few weeks ago, we were overcapacity- more ICU patients than beds, more Covid patients than isolation rooms, more telemetry patients than telemetry beds
This was in August when we usually have a lull in overall caseload
2/ In pre-Covid winters, we typically fill to capacity & periodically have to 'surge' not even because of flu but other respiratory viruses & environmental triggers for chronic lung disease
If that happened a few weeks ago, there'd literally be no way to manage the patient load
3/ Without more aggressive reductions in circulating virus, we are on pace for not a 'twindemic,' but a 'multidemic'
This will come at a time when many hospital systems are actually cutting back staffing due to revenue losses from elective procedures
4/ Months from now, we'll think back to this exact moment & remember how we either did what we needed to do or didn't & fell further into the spiral we're in
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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…
(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
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?
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
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
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..
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