"As a whistle-blower report would later reveal, in January [2020], Department of Health and Human Services officials effectively dismissed an offer from one of America’s few remaining N95 manufacturers, Prestige Ameritech, to expand its production lines"

nytimes.com/2020/11/17/mag…
2/ "Steve Francis, a special agent in an investigatory division of the D.H.S., told me that the illicit P.P.E. market was so profitable that some transnational criminal organizations turned from smuggling humans and narcotics to moving masks."

Wow. #Covid19 #BetterMasks
3/ "The mayor of Los Angeles described cutting a check for a shipment of masks, only to have FEMA swoop in at the last moment. The governor of Montana complained on a conference call to President Trump that his state lost 4 or 5 orders in the previous week to federal agencies"
4/ "After Massachusetts officials came to suspect that the federal government had snatched supplies already in transit, the state’s Republican governor arranged for over a million N95s to be flown in from Shenzhen on the New England Patriots’ private jet. "

I remember this.
5/ "The Trump administration, however, appeared to do the opposite. On March 19, President Trump declared at a press briefing: “The federal government is not supposed to be out there buying vast amounts of items and then shipping. You know, we’re not a shipping clerk.”
6/ So Jared Kushner was supposed to solve the #PPE crisis in this epidemic response?

It now all makes sense.

#BetterMasks
7/ Interesting-- the DPA was, to an extent, invoked early in the epidemic, to increase respirators for medical workers.

But the federal government left it at that; no plan for any level of public distribution. No public health strategy. No epidemic response. #BetterMasks
8/ "domestic production would more than double over the summer, hitting around 160 million respirators monthly in November. In total, the administration would invoke the D.P.A. at least 30 times to expand the domestic medical manufacturing base..."

Far short of projected needs
9/ "In August, a nationwide survey of nurses reported that 68 percent of them were reusing N95s for days or weeks at a time, often in violation of C.D.C. guidelines. Supply and demand for respirators were locked in a life-or-death race."

Unacceptable
10/ "The administration had used the D.P.A. to compel experienced ventilator producers to share their production techniques with neophytes, leading to one of its signature supply-chain successes in rapidly expanding ventilator production. But it declined to do the same w/ N95s"
11/ This is a key point right here. This is another legacy of the Trump administration. This is why we are still faced with a lack of #BetterMasks
12/ "Admiral Polowczyk felt that the Trump administration had done what it had set out to do"

Here we are pushing for #BetterMasks - need to make sure that those who are in charge believe it's their responsibility to get those to the public.

That wasn't the case before.
Cc @zeynep @linseymarr @jljcolorado @DrEricDing @AliNouriPhD @nataliexdean @gregggonsalves @jabarocas @rvenkayya @thehowie read this piece (or thread) on N95 mask supply chain failure

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More from @AbraarKaran

28 Jan
If any single intervention worked *perfectly*, it could feasibly stop the epidemic- whether test/trace/isolate; fully supported lockdowns until transmission is dead; 100% usage of high-filtration masks at all transmission points; 100% vaccination

Real world doesn't work that way
2/ Instead, we are trying to do a bit of everything. That can work, but it won't if everything is done below standard, which at times it has

This is why trying to improve every intervention we have is critical

More testing
Faster tracing
Safer isolating
Better masking
Vaccines
3/ Sometimes, it feels like new ideas to get us *better* are shot down bc not *perfect*- like #BetterMasks recently; response from @CDCDirector was that they are hard to breathe through- sure, but that doesn't mean they aren't needed, or that they won't help.
Read 5 tweets
28 Jan
Short thread
1/ As much as we have been tweeting lately about #BetterMasks, & as much as wearing masks that offer higher source control & personal protection could quickly paralyze #covid19 transmission- even these are but one more tool in our playbook; they are not the only one.
2/ With that being said, the responses to our push for #BetterMasks from Drs. Fauci & Walensky last night on #CNNTownHall were frustrating- essentially "a mask is better than no mask" & "N95s are hard to tolerate for long periods of time"

??
cnn.com/videos/health/… Image
3/ To bring more nuance here, I have said many times this would not be as simple as "mass produce N95s"- you still need to make sure the fit is correct & that people are using them consistently during high transmission risk situations both outside AND sometimes inside the house
Read 5 tweets
28 Jan
1/ One point of resistance from some is that we don't "need" #BetterMasks for the general public

Yet we still have people saying they took "all precautions" & got infected (while wearing a cloth or surgical mask)- many have reached out to me w/ this story
washingtonpost.com/outlook/2020/0…
2/ @RanuDhillon & I wrote this WaPo piece earlier in the epidemic to highlight that we still do not have a solid grasp on relative contributions of various modes of transmission (think droplets v aerosols as one over-simplified version of this)
3/ Part of the issue is that we have been falling behind on contact tracing since the very beginning of the epidemic & still are.

Moreover, if tracing is only looking for transmission within 6 feet/ 15 minutes, that is what it will find #covid19

Read 7 tweets
28 Jan
THREAD
1/ On #CNNTownHall today- @drsanjaygupta and @AC360 asked Dr. Fauci & @RWalensky @CDCDirector about #BetterMasks

They pressed them on key points- should people get access to #BetterMasks?

Will the federal government help get these masks to people (N95s as an example)? Image
2/ Fauci responded saying "the most important thing is that you wear a mask"

Yes- we agree

A mask > no mask

But a high filtration mask > "a mask"

That last point is not really a "debate"- N95 masks are #bettermasks than cloth & surgical masks bc of fit & regulation on quality
3/ He then says we must "get everybody to wear a mask"

Unfortunately, that's not going to happen

Thankfully it doesn't need to!

Need enough people wearing masks in high risk transmission scenarios to stop cluster based spread

In these scenarios, high filtration masks key
Read 10 tweets
28 Jan
"France has issued a decree banning certain homemade masks from being worn in public, saying they do not offer sufficient protection from the newer, more contagious #Covid19 variants."

theguardian.com/world/2021/jan…
2/ "Last Friday, two associations – one of doctors & a second of victims of Covid-19 – lodged an official demand to the state council demanding the wearing of FFP2 masks be made obligatory in public transport, shops & universities. The council will consider the demand this week"
3/ Have spoken w/ colleagues about this point that is being pushed saying that cloth masks don't protect as well "against the new variants"

Even these variants travel the same way- droplets & aerosols- so the equation is still the same as before- need to block both.
Read 4 tweets
26 Jan
1/ So #LACounty is resuming outdoor dining after #COVID19 stay-at-home order is canceled-- this article quotes California health experts who are concerned that people need to remain vigilant.

It's strange that **outdoor dining** was a target though...

latimes.com/california/sto…
2/ As many of us have said, a key to controlling transmission is for people to avoid high risk situations.

Most if not all of these are *indoors*

If safer outdoor options are shut down, people are likely to migrate indoors where socialization isn't regulated
3/ California has the benefit of tolerable outdoor weather year round

The game plan here should have been to convince people to modify activities in a way that mitigates risk but gives them safer options to continue life.

Outdoors w/ physical distancing is a good way

#covid19
Read 4 tweets

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