Thread by @AbraarKaran

PROTECT FRONTLINE WORKERS
THREAD
1/ There is a lot of talk about protecting the vulnerable. Yet, unsurprisingly, that has yet to be a priority.

And for those in crowded indoor conditions where aerosol spread can happen, cloth masks aren’t always enough.

hbr.org/2020/10/essent…

2/ For months, @RanuDhillon @sri_srikrishna and I have been arguing for better masks. We did this because we knew that aerosol spread was likely, even if not the dominant mode of transmission, & that many situations would require this level of protection. hbr.org/2020/06/we-nee…

3/ As doctors, Ranu and I both know that we would not walk into a room w/ someone that has COVID19 without the proper PPE, which would be an N95 mask in the healthcare setting.

But what level of protection is needed outside the hospital in other crowded conditions is less clear.

4/ We are not arguing that everyone needs N95 level protection. They don’t- especially if COVID19 is primarily transmitted by droplets that are sufficiently blocked by surgical or cloth masks

But, for many who work in crowded, indoor workplaces w/o good ventilation, we need more

5/ One of the current problems is that we don’t know enough about what is sufficient— because we have yet to find significant counterfactuals to cloth masks being enough— most spread in reported outbreak studies (see thread) is between people who are not wearing masks at all.

https://twitter.com/AbraarKaran/status/1318230350250807298

6/ But— we have enough data now to suggest that in crowded, indoor work environments, spread via aerosols is indeed possible & has happened.

The CDC has acknowledged this formally, even if it did so several months after we knew it was possible. npr.org/sections/healt…

7/ This bus outbreak investigation from China shows clear spread more than 6 feet from the index case (no mask use of any kind as this was quite early in the pandemic).

jamanetwork.com/journals/jamai…

8/ So back to frontline workers—>

We know that food processing plant workers were hit hard, all around the world.

Theories included crowded working conditions; & the need to yell over loud machinery (remember yelling is thought to aerosolize further)

bbc.com/news/53137613

9/ And the inequity/exploitation here is crystal clear:

“Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance.”

cdc.gov/mmwr/volumes/6…

10/ In meat and poultry processing facilities, across 23 states where race/ethnicity data was reported, 87% of cases occurred among racial and ethnic minorities.

cdc.gov/mmwr/volumes/6…

11/ We need to get frontline workers protection, & we need to do it fast.

N95s are in significant shortage, & even if they are made, they are unlikely to be prioritized for the poor & vulnerable. I wish that weren’t the case, but this is where we live.

npr.org/2020/09/17/913…

12/ In this @HarvardBiz piece, @sri_srikrishna @RanuDhillon @beier_dbeier and I lay out the case for elastomeric N95s— which are not in short supply, & which could be mobilized right now to protect the most vulnerable among us. hbr.org/2020/10/essent…

13/ If these eN95s can stop large clusters among frontline workers in food processing plants, factories, jails & more, we could help to stop spread amongst some of our most critical and vulnerable workers.

And we could arguably do it right now.

14/ These masks are reusable, cost effective, comfortable, have less variability in their fit, and are already NIOSH approved.

We cite the one major problem, which is that they have an exhale valve- but this calls for innovation & testing by @3M @honeywell & others.

15/ Some have proposed taping over the valve or putting a surgical mask over it, but we admittedly don’t know w/ certainty if that works or not.

But, if all workers were wearing these masks in a workplace, the exhalation issue is less relevant as they are all protected.

16/ @nytimes @ChrisDHamby wrote about these masks being used in hospitals back in May.

But the N95 shortage currently seems to be more concentrated amongst other frontline workers at this time.

We need to do more for equity & protecting the vulnerable.

nytimes.com/2020/05/27/us/…

17/ Elastomeric N95s may be one way to do this, ASAP, for those who are suffering or will be suffering in crowded close working conditions, esp as businesses reopen and cold weather pushes all of us back indoors.

This pandemic needs a focus on equity.

18/ One final thought— while these E95 masks may do the trick, the fact that we are pushing for vulnerable people to work without hazard pay, without PPE, & for the benefit of large corporations that benefit off their labor, all while they get sick & possibly die is horrible.

19/ We wrote this piece with the idea that if vulnerable workers are exploited to work out of desperation at the guilty hands of capitalist greed, while that system needs dismantling in itself, we also need to protect these workers as soon as possible.

This is one way forward.

Cc @jljcolorado @linseymarr @apoorva_nyc @kprather88 @AliNouriPhD @zeynep @Armstrws @gregggonsalves @drdavidwalton @ReganHMarsh @uche_blackstock @thehowie @JeremyKonyndyk

Cc @ASlavitt @DrTomFrieden @T_Inglesby @ashishkjha @nataliexdean @j_g_allen @cmyeaton @paimadhu @CarolineYLChen @edyong209