72 #covid19 cases linked to a spin studio; 2500 have been exposed & are being monitored; the indoor classes did not require masking, despite having limited capacity and 6 feet of distance. This outbreak (to me) suggests contributions of aerosols thespec.com/news/hamilton-…
2/ Remember that all layers are important; not wearing masks during indoor exercise classes is a big red flag.

And, crowds that are indoors doing exercise are certainly at higher risk of aerosol-based transmission.

Concerning as we head into winter & indoor activity increases
3/ A reminder that aerosols don’t follow a 6 feet rule (this class is a great example of where 6 feet is unlikely sufficient- crowded indoors enclosed spaces).

Here is where we think ventilation could be very important in addition to other protections.
4/ Again, it’s hard to know all the details of spread here; could spread have actually happened after the class with close face to face contact implicating droplets? It’s certainly possible.

Likely some contribution of both IMO.
5/ Either way, the reality is that ongoing transmission will likely happen despite our best efforts; but the key is driving it down consistently over time so that we don’t have large surges.

In this case, if masks had been used during this class, or if windows had been open...
6/ ...we might have been able to prevent this large super spreading scenario. If we can stop enough of these, we can have a big impact on slowing down transmission.

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More from @AbraarKaran

17 Oct
It’s easy to propose a hypothetical plan when the consequences of that plan failing miserably don’t actually fall on you directly. If millions get sick over time, & thousands or more need hospital beds, @SWAtlasHoover @VP & crew won’t be the ones at your bedside. We will⬇️
Read 6 tweets
17 Oct
Don’t let @SWAtlasHoover fool you— the reason we have had to “lockdown” is because the administration has *no damn plan*; now they’re trying to push a “plan” where they *do nothing* but want to say it’s ok for you to get sick in the process. This is pure lunacy.
2/ Ask them why when they lost control of this epidemic months ago, they failed to implement working public health systems so that we could get our country up and running safely?
3/ Ask them why when we have 200k+ dead and numerous others *of all ages* suffering from long term effects, when the first surges pushed our hospitals to the limit, they are saying it’s a good idea to allow even more infections with fewer/no protections?
Read 12 tweets
14 Oct
#TheGreatBarringtonDeclaration calls for allowing #covid19 to spread openly while “protecting” the elderly/vulnerable.

While I actually believe the authors mean well, there are multiple reasons why I believe this is a seriously problematic proposition.

-With asymptomatic & presymptomatic spread, the virus will inevitably find its way beyond the first layer of “healthy” people, esp in crowded households & intergenerational households— & especially in our most vulnerable communities who are more likely to run this risk.
-Allowing millions of cases to spread unabashedly will absolutely mean at least several thousands of cases requiring hospitalizations. And those of us who are still working on the frontlines will be the ones — once again— fighting to care for patients w/o adequate supplies.
Read 14 tweets
14 Oct
"One of American culture’s most cherished traditions is for a mix of young & old people from different households to sit close together & share food in a poorly ventilated space without masks on for an extended period of time. It’s called Thanksgiving."

2/ I agree w/ the concern in this piece. The holiday season is approaching. We have all had an exhausting year.

The inclination will be for folks to want to travel & spend time with loved ones in close settings indoors.

But the virus doesn't care about how we feel.
3/ We need to maintain precautions through the rest of this year.

W/ a number of vaccines in phase 3, we could be heading into a new chapter of the epidemic soon.

But until then, we have to double down on what we know works- avoiding close indoor contact is essential.
Read 4 tweets
14 Oct
1/ Interesting piece by @alexismadrigal and @yayitsrob on the current debate re rapid antigen testing for #covid19 epidemic control. As w/ anything, need to ask what the alternative is-- which largely is people not getting tested at all.

2/ They cite one critic who believes the answer is not to increase the supply of tests but to decrease the demand for those tests by improving other prevention measures, such as masking etc

Personally, I think it takes both of those things. Rapid testing is not simple...
3/ To actually implement. The more asymptomatic screening you do, the more false positives you will get (poor positive predictive value when population prevalence is low), & you need a confirmatory follow-up for those, or else risk the system collapsing.
Read 4 tweets
14 Oct
1/ This was an excellent piece on the use of genomic sequencing to better understand #covid19 spread. One of the biggest challenges is understanding how and why spread is happening.


cc @chriscmooney @brady_dennis @sarahkaplan48 @Harry_Stevens
2/ @RanuDhillon and I wrote about this in @washingtonpost earlier this year-- genomic sequencing could provide a lot of this information. This helps to understand if x infected y, or if x and y both were infected separately. washingtonpost.com/outlook/2020/0…
3/ This has big implications.

For instance, if we found that cases in schools were largely happening from adults to children in the home, but not from children to other children in schools, it may change our calculus on school reopening.
Read 4 tweets

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