“People have been doing this for almost a year without backup.” Each COVID-19 peak has sapped more energy & morale, & afterward, fatigued HCWs have had to deal with a backlog of postponed surgeries, as well as new pts who have been sitting on their medical problems..”
Dr. @drjessigold -“In a crisis, you can say, ‘It makes sense that I’m anxious, sad, and not sleeping.’ But there’ll be a surge of problems once people finally get a chance to breathe and realize what the toll has been.”
This really resonated -"But many tragedies are still hidden. Some of the most overworked people, including health-care workers and caregivers, have had little time to record their experiences”
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In terms of aerosols, droplet, & “airborne”- the best approach to communication I’ve found is that this requires enhanced respiratory protection in a healthcare setting. It’s not entirely airborne and it’s not entirely droplet, but rather something in the middle. (1/n)
We know this means different things for AGMP. For the public, I think it’s a good lesson in that the “6 ft” rule isn’t a hard rule in that there’s no magic force-field that prevents the virus from going further. Infection prevention involves multiple things simultaneously (2/n).
That Swiss cheese approach comes to mind - ventilation won’t do it all. Just like masks or distancing alone won’t. When we describe transmission it’s important to discuss these principles. Scicomm is critical & I’m hoping the CDC is working to explain these pieces better (3/n)/
It's increasingly worrisome that we're not talking about healthcare-associated infections (HAIs) in COVID-19 patients. Across the country we are seeing spikes and several studies have shown elevated risk for HAIs, especially bloodstream infections. 1/
COVID-19 patients, especially those in ICUs, are more likely to have invasive medical devices (urinary catheters, ventilators, central lines, etc.) - these are wonderful medical tools but also increase the risk for infection. 2/
These pts are medically complex, fragile, & we are still learning about how to improve their quality of care. For example -placing them in the prone position makes line care in pts with vascular issues that much more challenging, especially w/respiratory secretions. 3/
And this is why we read the whole study - "The temporal, spatial, and exposure evidence suggests that SARS-CoV-2 transmission may have occurred during the flight. However, the majority of 16 cases in the outbreak were not attributed to transmission on the flight.”
“Exposure to the virus in Wuhan or by infected members within the same tour group account for most cases in the outbreak."
"Our investigation suggests that it is important to take measures such as wearing a mask, temperature screening, and quarantine of close contacts to reduce the transmission of SARS-CoV-2 before, during, and after flights.” - Again something we know and have been emphasizing.
Folks, it's SO important to differentiate masks in terms of efficacy/wearability/medical contraindications. This is a prime example of why we need to explain that sure, N95s are higher particulate filtration, but they also require fit-testing to *truly* work + health screening.
I'm a trained fit-tester to help expedite mask-fitting in our hospitals during this pandemic. It is dangerous to push N95s on people without explaining that they require a TRUE fit to work effectively and ultimately, many people can't wear them due to medical conditions.
A few thoughts on the “airborne" conversations right now…First, I ultimately think this comes down more to scicomm & our ability to communicate nuanced situations & data. How we approach airborne vs droplet is antiquated & even more so in how we communicate it… (1/x)
So much of this really plays into healthcare infection control where these situations are approached extremely different. In the community, as @apoorva_nyc@BillHanage emphasized, it's really the indoor, close setting that sees the super-sreader events involving aerosols (2/x)
This isn't profoundly new and something @CDCgov@WHO have noted before. To me, this gives us better insight into those super-spreader events and potentially expanding the “exposure" criteria we heavily rely on. (3/x)
A couple of things to unpack from this before hitting the panic button... first, concerns for toilet plumes aren’t new (ahem, norovirus) (1/x) Flushing may release coronavirus-containing ‘toilet plumes’ - @washingtonpost washingtonpost.com/health/2020/06…
Second, this study looked at fluid dynamics, which is an important distinction. A big piece of concern with plumes comes down to two pieces- infectious dose and how much has been excreted and then aerosolized in the plume. (2/x)
Third - many of these studies use PCR, which is highly sensitive but that doesn’t mean the sample is getting an actual virus that can cause infections vs viral fragments. Fourth- no cases have been found as a result of this transmission route, which is a good indicator (3/x)