1// Have been saying this for months— and have actually have been doing this for the entire year any time I went back to LA to see family, even with a negative test.

High risk workers should mask at home if they have regular exposure. Every layer matters. #covid19
2// Increasingly colleagues of mine are incidentally testing positive without known exposure- takes 1-2 days to get PCR result back; end up exposing whole family in that time.

Nothing inherently safe about the home unfortunately.
3// In fact, may end up being most dangerous given less likely to mask here; very close prolonged exposure; crowding; ventilation variable

Now I’m going to accept that pragmatically speaking, most people are not going to mask at home BUT here are some personal recommendations...

•have essential workers mask when they are hanging around high risk family
• eat at different times or outdoors if have backyard & don’t live in freezing weather
•if poss, have essential worker sleep separately
•this is on top of regular testing etc etc
5// If this sounds crazy, remember this is not forever. But if you’re in a place like #LACounty, where spread is unreal— and you are a worker w/ relevant risks at your job AND you have elderly or vulnerable folks at home— masking at home can actually be really important #covid19

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More from @AbraarKaran

13 Jan
Let's break down the new US federal policy requiring a negative #covid19 test before boarding announced today because it covers a few important concepts

It requires that people flying into the US have a negative test within 3 days of flying…
2/ First, this reminds me of the recent outbreak from September on the Dubai-NZ flight.

The index case tested negative 4 days before the flight.

In theory, had they tested within 3 days, infection may have been picked up, but possibly not

3/ This highlights the "one test is one test" point: all that test is saying is that you are negative when you got it

That is not a reason to not test-- but it is a reason to want a neg result as close to whatever event it is (flight or otherwise) that you can #covid19
Read 10 tweets
10 Jan
One concept that doesn’t seem to have fully caught on in dialogue— we don’t need to get any single intervention to work 100% effectively, nor is that an achievable goal.

Even if we got every layer of prevention to work 25% better, could still get R<1 and keep it there
2/ What won’t work is doing a whole bunch of different things half-ass w/ none of them really working.
3/ Why I’m bringing this up: as people criticize idea of getting the administration to ship us better masks (ex “not everyone wears masks”)— we don’t need *everyone* to wear masks to stop the epidemic. We do need more people to have access to better PPE along w/ everything else
Read 4 tweets
7 Jan

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
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
Read 21 tweets
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.
▪️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
▪️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

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
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…
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

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