THREAD

1/ Our new piece in @statnews — along with vaccine rollout, the US needs a high filtration mask initiative

Every American should have access to high filtration masks for use any time they have to be outside their home in indoor spaces #covid19
___
statnews.com/2021/01/07/nat…
2/ As the pandemic surges, most of the cases I am now seeing in the hospital do not know where or how they were infected

A number of them report wearing cloth masks regularly, & this is much better than no mask

But we know that not all masks are created equal

Cc @EricTopol
3/ N95 masks that healthcare workers like myself use in the hospital offer the best protection

We use these masks for *any* #covid19 patient we are treating, whether or not they are undergoing an “aerosol generating procedure”

Cc @DrTomFrieden
4/ Why? Because we know that even normal speaking emits aerosols. We know that both droplets & aerosols contribute to spread of #covid19

Earlier in the year, when masks were in short supply, we were told to either not even wear a mask or wear cloth masks

nature.com/articles/s4159…
4.5/ Now, 10 months in when we have consensus that better masks are a win-win- we are stuck in a place where people can’t get them

People have been trying to navigate this market on their own with basically no support & running into issues incl fake masks

cc @meganranney
5/ We are now in situations around the country where literally 1 in 5 residents are testing pos

And we know people transmit before they show symptoms

More than ever, we have invisible transmitters around us during anything we are doing outside our homes @skarlamangla #covid19
6/ And the vast majority of us cannot afford to “stay home” no matter how much this phrase is repeated. We have to get groceries/other basic supplies; many work on the frontlines in diff jobs, healthcare or otherwise; others use public transport. #covid19
coronavirus.medium.com/messaging-abou…
7/ So there are two major components to better masks

🔹 Source control- reducing the amount of droplets & aerosols emitted into the environment from an infected person (many whom won’t know they are sick!)

🔸Personal protection- protecting healthy people from breathing these in
8/ Masks that can do both of these things well will have a sig effect on reducing growth

They essentially function as a temp vaccine in terms of stopping spread (possibly better, given we don’t know how well our current vaccines stop onward transmission) #covid19 @AdamJKucharski
8.5/ We outline in other pieces we have written what qualities those masks need to have

Filtration, fit, scalability, reusability, comfort, style #covid19

@RanuDhillon @sri_srikrishna

Cc @ASlavitt @ashishkjha @Bob_Wachter @Atul_Gawande @JeremyKonyndyk
hbr.org/2020/06/we-nee…
9/ From the beginning of this epidemic, if we all had high filtration masks at our disposal, we could have started reopening more safely

Many of us brought this up numerous times this entire year

We are now looking to @Transition46
@mtosterholm
#covid19 hbr.org/2020/05/a-plan…
10/ Better masks balance competing interests- stopping #covid19 & protecting those of us that literally have to work

We have been pushing temporizing measures like elastomeric N95s, which are already available; but these have issues
cc @ScottGottliebMD

hbr.org/2020/10/essent…
11/ I was shocked to hear this week that *healthcare workers* in parts of this country still don’t have adequate supplies of N95 masks

Some said they were not even allowed to bring their own N95 masks in to work (!) & were only allowed work N95 masks for aerosol gen procedures
12/ While there is now continuous news about the new #B117 variant, & whether vaccines will hold equivalent efficacy against this strain (& others), here too we can rely on better masks

Because masks are focused on stopping *how* the virus transmits rather than the virus itself
13/ Many experts have called for the best way to slow the spread of new variants is to keep doubling down on transmission-halting interventions

Better masks should be a serious priority here

The Defense Production Act should be leveraged for this just as for vaccines #covid19
13.5/ Other private efforts have also been underway like @xprize awarded to @LuminosityLab @ASU which is a group of college/grad students that designed the “Floemask” which builds on existing surgical mask designs

@getusppe
#covid19
14/ As vaccines roll out over this year, we cannot afford continued spread as it is happening

We cannot rely on incremental policy changes with exponential viral growth

We need to do everything we can do urgently— better masks are central

coronavirus.medium.com/incremental-po…

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More from @AbraarKaran

6 Jan
1/ Important point from @K_G_Andersen — variant #B117 in San Diego; may not change what we need to do— but is an urgent reminder that we are not even doing what we need to do well enough as it is.
2/
▪️testing— unable to scale rtPCR; have not utilized rapid testing correctly

▪️tracing— cannot keep up w current spread; digital tracing attempted but never picked up enough

▪️isolating— safer isolation spaces outside the home were built- many patients did use, many did not
3/
▪️masks— better masks never produced at scale; cloth masks still most common; hospitals w ongoing N95 shortages

▪️ventilation— talked about; unclear that any major at-home breakthroughs introduced (aside from opening windows, which helps)

▪️vaccines— inefficient rollout
Read 4 tweets
6 Jan
✈️THREAD✈️

1/
Outbreak of #covid19 on an 18 hour flight in September flying from Dubai to New Zealand now officially published

7 ultimately infected; 4 likely in flight, sitting within 4 rows of one another, 2 of them while reportedly wearing masks ImageImage
2/ 5 out of the 7 had been tested **before the flight** and tested negative

2 didn’t report getting tested before the flight but are *not* thought to be the index cases (those who started the outbreak)

BUT Index case was tested **5 days** before the flight! Image
3/ I circled the days that index case *should have been tested* — 24-48 hours before flight, when they had likely started incubating the virus; when detection could have happened; when the outbreak could have been prevented Image
Read 12 tweets
5 Jan
THREAD
1/ I initially hesitated sharing this video clip- its hard to watch & fear mongering is not my goal. This is reality.

But it brings up another point.

Many patients I've cared for have wanted to share their stories & warn the public

Hospitals v hesitant on this #covid19
2/ My own hospital among others was fined for TV filming in 2014/15 as a violation of HIPAA and patient privacy.

I get this is a major issue & the privacy of our patients is of utmost importance.

No argument there

modernhealthcare.com/article/201809…
3/ With that being said, in parts of the country (not all), there are many who are not sure about the virus

The vehement #covid19 deniers are a minority (I think)

People on the fence about "is it really bad", or about day to day decisions on social gatherings etc is much larger
Read 7 tweets
5 Jan
Having to text my family to completely hunker down in Los Angeles

Someone dying of #covid19 every 10 minutes in LAC

1 in 5 tests returning positive

Not all patients are brought to hospitals at this point to conserve resources
Read 4 tweets
4 Jan
1/ A quick rundown of some of my recent tweets/thoughts in this @BostonDotCom article

We need to stop spread quickly to buy time & healthcare resources while vaccines roll out

Need to repurpose workforce toward all hands on deck vaccination effort

boston.com/news/coronavir… Image
2/ Term “lockdowns” can instill fear & memories of first surge

New efforts shouldn’t be this- must take advantage of virus’ weaknesses such as outdoors, masks, ventilation #covid19

hbr.org/2020/08/the-u-…
3/ key is protecting frontline workers

PPE, $$$, staggering shifts, better isolation options

Policing & punitive measures are regressive & target the poor

Not going to police our way out; must support people and protect them #covid19
Read 4 tweets
4 Jan
1/ So we know that we need to vaccinate a lot of people, preserve hospital capacity, & buy time

& we know that we have ⬆️ spread all over the country & even more w/ recent holiday travel

We need an emergency 🛑 on spread, w/ more drastic policy measures hbr.org/2020/08/the-u-…
2/ We need to implement absolute, not incremental, restrictions on nonessential venues. Those businesses need additional $$ protections in return. Anything that needs to remain open (grocery, pharmacies) needs to operate at regulated capacity w/ ⬆️protection for frontline staff
3/ Need to repurpose hotels/dorms etc as safer & better isolation & quarantine spaces; & $$ incentivize people to use them (punitive measures don’t work as well here & tend to become regressive)

Mandate masking in any indoor public space that remains open washingtonpost.com/outlook/2020/0…
Read 10 tweets

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