Tweet

Tim Cook

22 Oct, 9 tweets, 3 min read

@Anaes_Journal

Out in all its glory the Bristol Aerosol paper

Ready for tonight's debate
This study showing precious few aerosols generated at intubation
@Anaes_Journal @drjulesbrown @TonyPi314 @_andyshrimp

…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

Lots of respiratory aerosols with a voluntary cough

Almost none during intubation sequence - anaesthesia/BMV/suction/intubation

Note the log scale

Not a lot during extubation sequence -
cuff down/extubate/+/-cough/oxygen

Most aerosols are at cough - and extubation cough 1/4 strength of voluntary

Importantly the particle distribution is similar for voluntary and extubation cough
supports respiratory origin

Particle size at 0.3-10 microns also clinically relevant

Here's the numbers

https://twitter.com/i/status/1318890563303804928

And for a better visual idea of what was done
Here's the cough

https://twitter.com/i/status/1318890563303804928

https://twitter.com/i/status/1319171324401668099

And here's the intubation

https://twitter.com/i/status/1319171324401668099

Tonight's debate: not a battle to see who wins

Important to explore both methodologies, work together to find common ground
More AGP research is needed: would be great to have several groups with same agreed methodology moving forward, to deliver prompt, clear, relevant results

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More from @doctimcook

Tim Cook

@doctimcook

6 Oct

@BJAJournals

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio This is an interesting take.
To be clear, every harm or death of a healthcare worker from COVID is a tragedy

However despite anaesthetists/intensivists proximity to the airway it's far from clear that this raises risk of death compared to other HCWs
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

1/n

@BJAJournals

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio Rather than emphasising increased risk the editorial by @emirakur with @DrSimonLennane highlighted the international evidence showing lower than expected mortality among anaesthetists/intensivists and our co-workers
…-publications.onlinelibrary.wiley.com/doi/full/10.11…

2/n

@BJAJournals

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane Three analyses of HCW deaths were published in the @HSJnews

They're all here
hsj.co.uk/tim-cook/30082…

The notable findings were
- a marked excess of deaths in non-white frontline staff
- the absence of impact on anaesthesia/ICM

3/n

Read 13 tweets

Tim Cook

@doctimcook

4 Oct

Important
At 0.7% this is about 3x the community rate
Depressingly familiar

Surge of Covid cases in London health workers sparks fear of spread on wards | Hospitals | The Guardian

amp.theguardian.com/society/2020/o…

We’ve seen it before

While the balance between allowing access to hospitals & preventing unknown Covid infected patients in is a tough one - it needs to be addressed to protect patients and staff

Read 7 tweets

Tim Cook

@doctimcook

11 Sep

As COVID19 rates start to increase this article might interest those who've not read it. Relevant well beyond anaesthetists and intensivists.

onlinelibrary.wiley.com/doi/10.1111/an…

Important to understand how risk changes as incidence does

@opensafely

Risk is of harm from COVID-19 is now informed by several mayor studies including @opensafely @ISARIC1 @ONS & @ICNARC

Read 17 tweets

Tim Cook

@doctimcook

21 Aug

PHE COVID infection control guidance updated today

You’ll likely love them or loathe them

gov.uk/government/pub…

High medium and low risk pathways created.

Elective surgical patients who have followed last weeks NICE guidance will enter the low risk path.

gov.uk/government/pub…

The NICE guidance means 14d self isolation is no longer routine. Rather isolation is to be from day of PCR test - which is to be up to 3d before admission

So routine isolation is max 3d but may be shorter

nice.org.uk/guidance/ng179…

Read 13 tweets