Short Thread
1/ Another must-read piece from Dr. Mike Klompas @BrighamWomens - lead author of the recent #covid19 outbreak study from our hospital in @AnnalsofIM- I've been lucky to call Mike a mentor this year & have learned a lot from him
What is an AGP?…
2/ "It has become clear that the traditional dichotomy b/w droplet vs aerosol-based transmission is overly simplistic. In practice, people routinely produce a profusion of respiratory particles in a range of sizes that incl both droplets & aerosols as well as particles in b/w"
3/ "Respiratory particles of all sizes can carry virus and all are potentially capable of transmitting infection. The amount of respiratory particles one emits varies by activity. Quiet breathing generates a small but steady flow of aerosols." #covid19
4/ "Loud speaking, heavy breathing, and coughing produce far more."

"This translates into 4 factors that explain transmission risk during medical procedures."

-forced air
-symptoms/dz severity
5/ "These factors explain the intubation paradox, the fact that controlled intubations generate negligible amounts of aerosols (far less than volitional coughing), but intubation has repeatedly been associated with increased risk for health care worker infections." #covid19
6/ "In other words, it is not intubation per se that generates aerosols and facilitates transmission but the circumstances surrounding the procedure"

Read this piece. The concluding remarks are the key for me...(next tweet)
7/ "However, higher-level respiratory protection may be necessary for health care workers practicing in high-prevalence settings who need to be close to patients’ respiratory tracts, present when large amounts of air are being forced across the respiratory mucosa"
8/ "(positive pressure ventilation, high-flow oxygen, coughing, heavy breathing, spirometry), or treating highly symptomatic patients even in the absence of traditionally defined aerosol-generating procedures."

In short, when we have surges of #covid19 in community...
9/ We should be wearing higher-grade PPE (N95 masks IMO) regardless of other risk-mitigating factors. Just as Dr. Klompas' recent @AnnalsofIM article highlighted, despite multiple layers of protection, we still had a serious #covid19 outbreak from a PCR that was initially neg

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More from @AbraarKaran

9 Feb
1/ The major #covid19 outbreak from @BrighamWomens where I work is now published in @AnnalsofIM — definitely worth a read. Phenomenally detailed work here from many smart people.

The index patient tested negative twice, but soon became positive after.…
2/ “The virus was likely introduced into the facility by a symptomatic patient who tested negative twice on admission but in retrospect was contagious from at least hospital day 3 and infected staff and patients for at least a week before detection” #covid19
3/ The infection control team & overall program at our hospital is awesome. They are among the smartest people I know. And despite all of the protective measures in place, transmission & a serious #covid19 cluster still happened.
Read 19 tweets
8 Feb
"And there’s another problem: too much filtration becomes unbreathable. “Are you breathing through the material, or are you breathing through the gaps in the material?” Zangmeister says.
2/ "If you’re breathing through the gaps in between the mask and your face, you’re not getting any filtration production at all."

#covid19 #BetterMasks
3/ "In lab settings, Zangmeister and his team have found these areas where air escapes tend to be behind the cheeks, or right above the bridge of the nose, which can look like a droplet exhalation geyser, he says. "
Read 5 tweets
8 Feb
1/ One of the issues w/ public health policy making is the lack of accountability or even full understanding of the effects of those policies. Yesterday was an example of this when #LACounty @lapublichealth @MayorOfLA restricted outdoor TVs from playing the #SuperBowl.
2/ I personally know of multiple unvaccinated friends who decided to gather indoors as a result.

It was 70 degrees & sunny in Los Angeles yesterday.

The state already opened outdoor dining & made people feel like it was 'safe' to do this.

But then- they ban TVs outside.
3/ What they are essentially telling the public is that they aren't responsible enough to do this.

That the government decides how responsible you are, rather than mitigating risk & giving you ways to socialize more safely.

And then they wonder why...
Read 11 tweets
7 Feb
The messaging from #LACounty is ridiculous. On the one hand, they opened up all of these restaurants for outdoor dining & made people feel like things are getting better- but they aren’t allowing outdoor TVs to play the Super Bowl? People are going to meet indoors instead...
2/ This is bad public health. It’s just like when beaches were closed during July 4th. We need to mitigate risk & create safe options for socialization - bc people have shown time & time again that they will socialize either way (not blaming them)
3/ Alternatively they could have set up outdoor viewing sites at parks etc; created distanced pods— many ways to get creative here as was done in other places. But just assuming that people won’t congregate when they have been told it’s getting much safer now...?? #covid19
Read 7 tweets
3 Feb
1/ This story saying that a local health dept has changed their exposure time to any contact without masks ("1 second") doesn't mean that you will get infected in one second- but it does point out that 6 feet/15 min is not a hard/fast rule & never was.…
2/ There are many possibilities for why new variants are "more transmissible"; but in the real world, figuring out the "why" takes time- and we don't have time. We must utilize the best protections we can right now- mitigation of risk is name of the game

3/ With vaccinations, it seems like our attention to other protection measures have fallen to the side- understandably bc there are only so many resources that public health departments have. Doing one often means not doing another (staff, funding etc)
Read 5 tweets
2 Feb
1/ Contrary to some media headlines, our proposal for #BetterMasks has not been to “just give everyone N95s”

If that was, I would be using #N95Masks

I think of masks the same way I think of any risk mitigation. Better is better. Unregulated cloth masks not the bar to settle on
2/ we even specifically asked CNN to change the headline (they initially chose N95 masks) bc the idea behind this movement was always to provide folks w/ a multitude of options- N95s are one of those. But so are high grade surgical masks w/ mask fitters…
3/ The arguments saying “just get more people to wear any mask”- guess what?

We should do both

& getting “anti-maskers” to wear a mask is actually IMO a harder problem than getting someone who already believes in masks a #BetterMask (which helps them around those who don’t)
Read 11 tweets

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