🧵🧵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.
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.
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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🧵 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.
🧵 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
🧵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...
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.
🧵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.
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
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?