🧵🧵1/ When people ask which mask is “good enough”, I often try to reframe it as better protection is better protection; everything we are doing is to reduce risk.

Is an N95 better than a cloth mask? Yea, it is

Is a cloth mask better than no mask? Yea, it is

#covid19
2/ If there was a good reason to not wear an N95 or equivalent mask during indoor crowded activities, then we wouldn’t be pushing for it.

But frankly, most of the reasons presented have been weak.
3/ The CDC Director on CNN once said it was bc they are hard to breathe through.

I don’t think so

I have worn them for hours at a time in the hospital

We are calling for people to wear them when in higher risk indoor settings. This likely won’t be for hours most of the time
4/ The supply issue doesn’t seem to be clearly true either.

In speaking with manufacturers like @larmbrust that make masks, there are high filtration masks gathering dust in warehouses.

More on that coming out this week but NYT actually wrote about it last week as well.
5/ Others have tried to argue that cloth or surgical masks are “good enough” if everyone is wearing one.

Firstly, not everyone is wearing a mask in many parts of this country.

Secondly, multiple studies have shown that cloth masks provide inferior filtration efficacy ~30-50%
6/ Surgical masks are made from meltblown material but have a generally inferior *fit* compared to N95 masks that have two straps around the back of your head.

This is where mask fitters like @FixTheMask come into play. #covid19
7/ Some have suggested that hospitals with universal surgical masking are a good proxy for the community setting

They’re not

Hospitals have better ventilation; regular testing of patients/staff; & universal masking w/ medical grade surgical masks- & have still had outbreaks
8/ How or why this is a good proxy for the community where people are faced w/ shitty ventilation, cloth masks, not everyone masking, not everyone getting tested, crowding etc is beyond me but alas, people find constant ways to keep the status quo until “proven” otherwise
9/ The problem is that status quo comes at the expense of some of the most vulnerable people in our communities who are working frontline jobs without adequate protection

So if we don’t advocate for #BetterMasks or better ventilation, we sure as hell won’t be getting either
10/ The inertia to new ideas/innovations from “experts” this whole year has been astounding yet also not so, given academia is naturally more likely to do nothing without data than to do something via precautionary principle and assess later or simultaneously. #covid19
11/ This was true all the way from masking in general; to ventilation & the push against HEPA filters in workplaces/schools; to the pushback against #BetterMasks - but, I don’t think that academic medicine/public health functions on same principles as emergency response does

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More from @AbraarKaran

28 Feb
🧵 1/ Presumed #covid19 reinfection (first cases mild, second cases more severe) in five elderly Kentucky nursing home residents w/ multiple co-morbidities, > three months apart.

New in @CDCMMWR

cdc.gov/mmwr/volumes/7…
2/ The patients were elderly with multiple chronic health conditions.

They had confirmed infections in a July outbreak at their nursing home- these were described as very mild, w/ only 2 having symptoms at all.

They had at least 4 negative PCR since their first pos tests.
3/ The second outbreak started at the same SNF on October 30th.

5 tested positive again, 3 with known roommate exposures.

7 who were previously infected did not test positive but further details about them (did they have more severe initial cases?) not included.
Read 5 tweets
26 Feb
🧵 1/ So I read this @BostonGlobe story today about what is going to be reopening in Massachusetts on Monday - restaurants will have *no capacity limit* and can host *musical performances*(??)

Hmm interesting.

So I decided to check again what % we have vaccinated #covid19 ...
2/ So we are at 6.2% in terms of people who have received two doses; 16% for those who have received one dose

So...we aren’t even close to where we need to be for vaccinations, we got lucky to see a rapid decline in cases, but now we are rapid reopening

nytimes.com/interactive/20…
3/ I then took a look at the waste water surveillance data, which tends to precede detected cases— possibly a slight uptick here in the last few days?

All this to say: a decrease in cases should still mean—> scale up vaccinations while temporizing spread

mwra.com/biobot/biobotd…
Read 4 tweets
25 Feb
🧵1/ So CDC published a couple of outbreak investigations from gyms yesterday— heavy breathing, incomplete mask use, aerosols 🗣 —> superspreading #covid19

But we knew this was risky from a May 2020 outbreak in exercise classes in South Korea already...

washingtonpost.com/nation/2021/02…
2/ This was published in May 2020 in the @CDC_EIDjournal - they found that rigorous exercise was associated w/ transmission whereas low intensity (Pilates, yoga) was not.

I think many of you would remember this.
#covid19
3/ What I’m getting at— why is something that isn’t surprising/that we already somewhat knew being presented as novel?

We already could guess from nearly a year ago that gyms- esp w/ heavy exercise- were risky.

Yet ventilation & aerosol risk only recently being highlighted?
Read 4 tweets
25 Feb
🧵1/ Sometimes when you push for an idea for long enough (#BetterMasks) & when the logic makes sense to you- but you are continuously told by other “experts” (CDC leadership) that it’s not needed; you begin to wonder if you yourself are missing something. #covid19
2/ But- the other factors at play- the political ones- make me think otherwise.

If CDC said “yes better masks are better; yes they protect you more”, they are now on the hook for getting these to people.

But- if they don’t have the bandwidth or political backing to do it...
3/ Then they can’t acknowledge it.

But- because we (many of us) pushed for #BetterMasks incessantly, they probably had to do something.

So they did a study with two masks, which worked better than one mask; two masks is easy bc it’s still on the public to figure it out.
Read 7 tweets
24 Feb
Another @CDCgov report today on #covid19 from unmasked exercise classes

The secondary attack rate of infection from instructors to class participants for classes taught within 1 day of symptom onset was 95% (20 of 21)!

And again here, we have CDC 🗣 about aerosol transmission
2/ Transmission despite 6 feet apart w/ instructors yelling during stationary cycling class #covid19
3/ One of the instructors was teaching kickboxing & personal training - two of the infected participants wore masks and were *still infected*
#covid19
#BetterMasks
Read 4 tweets
24 Feb
THREAD

1/ New CDC report on #covid19 outbreak -55 cases in a week- among those attending an exercise facility in Chicago in August 2020...

22 people (40%) attended on or *after* the day their symptoms started

76% reported wearing masks *infrequently*
cdc.gov/mmwr/volumes/7…
2/ Right in the abstract here under "implications for public health practice", CDC says:

"To reduce SARS-CoV-2 transmission in fitness facilities, attendees should wear a mask, including during high-intensity activities when ≥6 ft apart."

So the 6 foot rule has limits...why?
3/ Because of smaller particles- aerosols- that spread farther than six feet, & hang around for more than 15 minutes.

And CDC acknowledges that; but is still hesitant to send people #BetterMasks (announced today they are sending cloth masks)? C'mon man. What is going on?
Read 8 tweets

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