Thread by @AbraarKaran

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?
jamanetwork.com/journals/jamas…

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
-distance
-duration
#covid19

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