1/A mask mandate map of America. #covid19

But- this needs to be about more than mandates; needs to be about getting people to understand & implement masking when/where it is most important (often, not outdoors which is where mandates seem to be focused)

nytimes.com/interactive/20…
2/This is not to say outdoor transmission doesn't happen.

But it is presumably much lower than indoors.

Indoors includes public spaces. But it also includes unregulated private spaces.

If people believe in masks as protection, they will use them.
3/ Understanding drivers of ongoing transmission- the where/when/why/how (@RanuDhillon) continues to be key.

Beyond frontline workers who are getting infected in the workplace (which should be a main focus of our interventions/support), where else and how else?
4/ Is some of it happening in smaller private gatherings? Presumably. How much? Unclear.

Indoor dining? Presumably. How much? Unclear.

Getting people to conceptualize notions of "shared air" I think will help- & divert limited attention from hygiene theater
5/Need to tighten our personal protection in high risk situations.

One of the reasons why we have pushed #BetterMasks.

But along with this- is getting people to consistently use masks in highest risk situations (indoor crowding). #covid19
6/Put another way- outdoor mask mandates that are not addressing getting people to understand why and when masks are key, will fail to stop higher risk transmission settings where we can't regulate mask use. Let not outdoor masking --> less indoor masking (hopefully it isn't)
7/ Don't get me wrong- I am in favor of mask mandates for a # of reasons; one is that it normalizes maskin + reminds people that masks are our means of protection; also gives anti-maskers an excuse when telling their friends why they have now masked (maybe some actually want to?)
8/ Also makes it easier to seal all the public gaps where transmission could happen rather than putting the onus on people to just figure it out; BUT need to also make sure people understand the point of masks & how transmission happens so that masks stay on when they need to
9/ Because we can't regulate/mandate our way out of this. Beating this relies on changing community norms; it depends on people trusting & understanding and deciding they are on board w/ this. Public buy-in is huge; it's possible; it will take time & the right messaging.

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More from @AbraarKaran

13 Feb
Some of the framing around impoverished countries not getting adequate vaccine doses center on this being bad for wealthy countries because there will be ongoing reservoirs of disease/ more mutations etc

Why is the framing always relative to the effect on wealthy lives?
2/ Why is the focus not on equity?

Why are all lives not treated equally?

Why are impoverished countries seen as vectors of disease rather than places with human beings deserving of vaccines like everyone else? #covid19
3/ I ask these questions of course rhetorically.

This is always how it has been.

This is not surprising.

This has been every part of the pandemic, from testing, to treatment, to vaccines. #covid19
Read 6 tweets
10 Feb
1/ Here is official @CDCgov @CDCMMWR report out today

They assessed various modifications incl:

•wearing a cloth mask over a medical procedure mask (double masking)

•knotting the ear loops of a medical procedure mask & tucking in the sides

#covid19
cdc.gov/mmwr/volumes/7…
2/ Simulation set in a 10x10 foot chamber; aerosols generated simulating someone doing “light work” load and the receiving dummy doing “moderate work”

Pic below of some key mods as described:
3/ “Ten mask combinations, using various configurations of no mask, double masks, and unknotted or knotted and tucked medical procedure masks, were assessed”
Read 12 tweets
10 Feb
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
Read 9 tweets
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.
acpjournals.org/doi/full/10.73…
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

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