Tweet

Abraar Karan

27 Nov, 9 tweets, 8 min read

1/ As the virus spreads, more people will "have no idea" where they got infected from. As this happens, we need to gain a better understanding of how & why it continues to spread. For me, one big ? is- what types of masks are needed in diff situations
bostonglobe.com/2020/11/24/nat…

@RanuDhillon

2/ @RanuDhillon & I wrote about the "when, where, why and how" problem of #covid19 spread in @washingtonpost ; this gets worse as case spread outpaces our tracing & outbreak investigation capacity

washingtonpost.com/outlook/2020/0…

@sri_srikrishna

3/ @sri_srikrishna @RanuDhillon and I wrote about masks early on in this context- what is the bare minimum mask you need in different settings in the community? In the hospital, we use N95s w/ #covid19 positive & #covid19 potential rule out cases

hbr.org/2020/06/we-nee…

4/ But hospitals have better ventilation systems than many workplaces; many of the workplaces where essential workers are crowded together wearing only cloth masks is something we were concerned about- we argue here for the potential of elastomeric masks hbr.org/2020/10/essent…

5/ In the community setting, as more people become infected, the % probability that more than one of those people are contagious at any given time (whether in an elevator, a grocery store, a bus etc) increases as well. If every person produces both droplets & aerosols...

@jljcolorado

6/ Then I am increasingly worried about the sufficiency of cloth masks in certain settings that previously were less concerning bc there was less viral spread/ less chance of multiple infected people in the same place/same time cc @jljcolorado @j_g_allen #covid19

@CDCgov

7/ @CDCgov talks about this-- they note cloth masks w/ multiple layers + higher thread counts can provide both source control + personal protection w/ effects on both droplets & aerosols to some degree, although masks w/ triboelectric charges are better.

cdc.gov/coronavirus/20…

8/ The fact that right now- we still don't have a "national mask"; one that has high filtration efficacy, comfortable, reusable etc is really concerning; this should be a task of the fed government to produce this for every American.

We are 10 months into the pandemic!

@vivek_murthy

cc thread- are current folded t-shirt cloth masks still enough in all community situations? @vivek_murthy @RickABright @celinegounder @Atul_Gawande @linseymarr @mtosterholm @zeynep @thehowie @kj_seung @T_Inglesby @MonicaGandhi9 @edyong209 @venkmurthy @ashishkjha @nataliexdean

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More from @AbraarKaran

Abraar Karan

@AbraarKaran

29 Nov

Back again to stigma— have had multiple friends disclose in confidence to me in different states that they contracted #covid19 but didn’t want to tell anyone because of the fear of how they would be perceived. This is a real problem, & it *will not be solved by judgment & shame*

2/ If this makes you angry—this won’t be solved by your anger. In fact, that will make this worse. How someone else got infected is not for you to judge even if you feel like it is. That’s a tough thing to hear when people are making sacrifices.

3/ I get that- I’m a doctor, I too have sacrificed. But when I treat patients, if I sat there judging them/how they got sick— I’d quickly become a pretty bad doctor. So let’s start reframing this as something that no one wants to get- even if they sacrificed “less” than you did

Read 6 tweets

Abraar Karan

@AbraarKaran

28 Nov

If there was ever any doubt that this response was not supposed to be about politics, let that be put to rest now. Claims from Trump & friends were that #covid19 would “disappear” after the election if Democrats won. It’s worse than it’s ever been on most fronts.

2/ As doctors, it has always been difficult navigating messy politics bc we don’t want health to be political, but we also know that it always has been. Health is only partly what we do at the bedside; a much bigger part of it is how people are harmed by systems.

3/ While I’m absolutely hopeful and thrilled with the Biden administration bringing back real scientists & people that can and will bring us back on track for the response, I am also committed to continuously pushing for what is right regardless of how that “looks” politically

Read 4 tweets

Abraar Karan

@AbraarKaran

27 Nov

Trying to reconcile that some of the people in this country who are hardcore "Nationalists" are also the first to exercise "personal freedom" as the reason for why they won't wear a mask that could protect their fellow countryman at little to no personal cost. #covid19

2/ When you dig deeper here, you may find that this isn't about "personal freedom" at all. If political leadership on both sides of the aisle had been consistent about masks from day 1; kept the narrative the same; pushed for cohesiveness & shared values, I wonder...

3/ I wonder if masks could have then avoided politics & stuck within the realm of science only. Many of our country's most ardent nationalists are also people willing to sacrifice a lot for this country/ many already have. But the way that masks have been framed has missed...

Read 5 tweets

Abraar Karan

@AbraarKaran

27 Nov

1/ Flying during the pandemic is a nuanced topic. In theory, planes should have low transmission; mandatory masks+great air filtration. But- tracing transmission specifically back to a flight isn’t exactly easy- as w/ most things, the data is limited

nytimes.com/2020/11/25/tra…

2/ Would need to test folks after the flight to exclude those already pos; would need to serially test others thereafter; in folks who became pos, wld need to make sure transmission wasn’t before the flight (ex on way to airport in taxi, or at airport restaurant before flight)

3/ Also would need to make sure transmission wasn’t during other activities they did after the flight; some studies have used genomic analysis to figure out if similar strain spread to multiple folks on flight which helps to paint the story more clearly.

Read 5 tweets

Abraar Karan

@AbraarKaran

27 Nov

Thankful for all the frontline workers that carry our country on their tireless backs and have been since the day this epidemic started (and before). Many have since died; we must thank them but thanking them isn’t enough; we must stop failing them. #covid19

2/ Thankful for all the people who played whatever role they could; whether that meant canceling a gathering; whether that meant taking extra precautions to reduce risk; whether that meant wearing a mask; thank you. Every action matters. Millions of small actions stop epidemics.

3/ Thankful for my fellow doctors, nurses, PAs, pharmacists, social workers, nutritionists, patient care assistants, physical therapists, care coordinators; Many of you work tirelessly without ever seeking credit or acknowledgement- you do the work for the work. Thank you

Read 4 tweets

Abraar Karan

@AbraarKaran

26 Nov

*short thread*
1/ Really important study here looking at false negative test results for #covid19 in March-May 2020 at a mediocre hospital in Boston (Mass General 😉)– 60% of these ended up being in samples drawn either “too early” or “too late”

academic.oup.com/ofid/advance-a…

2/ And in the few that clinically seemed like they had #COVID19 but had two negative NP swabs, their lower respiratory tract sample was positive in all of them (as we might expect as disease burden migrates from upper to lower resp tract over time)

3/ Peak false negatives occurred during weeks of peak overall positivity — higher pretest probability, higher chance your negative test in a suspected case was actually a false neg

Overall, only 2.2% of tests classified as false negatives (in which subsequent pos w/in 14 days)

Read 5 tweets

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