2/ There was a lag between determining a need & getting it established so the best we could do was use modeling to start deployment &, if transmission shifted & changed, we revised our models & adjusted our projections & plans
3/ In many instances, we were part of the way towards establishing a testing or treatment site when transmission shifted differently & they were no longer needed at the place we planned but required elsewhere
4/ This was the nature of responding to a constantly & unpredictably evolving epidemic.
It is also why - for Covid & future epidemics - we need more agile response capabilities that can be set up & redirected more easily (eg, more nimble decentralized testing)
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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