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Céline Gounder, MD, ScM, FIDSA Profile picture
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18 Mar, 16 tweets, 8 min read
1/ On February 15th, Drs. @RickABright @brosseau_lisa @drlynngoldman @jljcolorado Yoshihiro Kawaoka @linseymarr @drdavidmichaels @Don_Milton @mtosterholm @kprather88 Chip Schooley and Peg Seminario sent this letter to the WH/CDC/NIH:
cidrap.umn.edu/sites/default/…
2/ The CDC has yet to follow the science and fully recognize that SARS-CoV-2 is an airborne virus.
The CDC has yet to recommend appropriate protections to limit the spread of SARS-CoV-2 in high-risk workplaces.
Note that airborne DOES NOT EQUAL freak out.
3/ Airborne means we focus on preventing spread through the air. This means that masks and ventilation are crucial in preventing the spread of COVID.
4/ In high-risk workplaces (e.g. healthcare settings, meatpacking, food-processing, and corrections) WHERE there are high levels of community transmission, this means wearing an N95.
5/ Opening a window may be enough to assure adequate ventilation in many places, but in others, you may need air filtration systems.
6/ We already had much evidence on the airborne transmission of COVID, but here's more on airborne transmission among staff in healthcare settings.
7/ Researchers at @harvardmed, @MGHMedicine (my & @CDCDirector's old stomping grounds), and @BrighamWomens used whole-genome sequencing to show aerosol transmission among staff despite their wearing surgical masks and eye protection.
academic.oup.com/cid/advance-ar…
8/ We've been advising that people maintain a distance of 6 ft from others on the assumption that droplets were the main mechanism of transmission.

Droplets fall more quickly and don't travel far.
Aerosols float in the air and travel far.
9/ But now we've learned that ≥3 feet v ≥6 feet of physical distancing between students made no impact on in-school transmission rates. academic.oup.com/cid/advance-ar… This is consistent with airborne (rather than droplet) transmission.
10/ Note that while it may be safe to have students 3 feet apart in the classroom, you still don't want crowds packed indoors together. The more people in a room, the more likely that one person in that room is infectious.
11/ It is urgent that @CDCgov change its recommendations on preventing airborne transmission of COVID. @OSHA will soon be releasing emergency guidance for workplaces on COVID transmission but can't deviate from CDC.
12/ In the meantime, @NYCHealthSystem and many other health facilities are following the science, and are now REQUIRING that all staff wear N95 masks and eye protection for ALL patient encounters. This makes sense: the risk of COVID in NYC is currently VERY HIGH.
13/ Too many health facilities are fixated on "aerosol-generating procedures." A cough can be more aerosol-generating than intubation/extubation.
14/ We have adequate N95 supply to meet the need. FEMA even OK'ed the export of N95 masks because we have plenty: cnn.com/2021/02/19/hea…
Crisis standards are no longer appropriate a year into this pandemic.
15/ But ultimately, who I'm most worried about isn't healthcare workers like myself. It's people working in meatpacking, food processing, & jails/prisons, where there isn't good ventilation and masks are the be-all-end-all.
16/ Learn more by listening to @linseymarr and
@drdavidmichaels testify before Congress a week ago:

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More from @celinegounder

Céline Gounder, MD, ScM, FIDSA Profile picture
16 Mar
Read 9 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
24 Feb
1/ “The Great Recession of 2008 hit all sectors of local government hard, but whereas other sectors were able to bounce back, funding for public health did not recover."
-- Jennifer Kertanis, Director of Health at the Farmington Valley Health District, testifying before Congress
2/ "...average local health department expenditures per capita decreased 30%, from $80 in 2008, to $56 in 2019.”
"Local public health budget cuts show themselves most clearly in workforce reductions that have made the current pandemic response even more challenging…"
3/ "local health departments have actually lost 21% of their workforce capacity since 2008, with the number of full-time equivalent employees dropping from 5.2 per 10,000 people in 2008 to 4.1 per 10,000 people in 2019.”
Read 4 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
24 Feb
1/ When will the pandemic be over? I talked to @alexismadrigal about it.
2/ The emergency won't be over until most of the elderly and those with chronic medical conditions--who are at the highest risk for severe disease, hospitalization, and death--have been vaccinated.
3/ The elderly population skews whiter. It's essential that we also get people with chronic medical conditions vaccinated, too, as this will capture most of the high-risk persons of color, who've been hit so hard by this pandemic.
Read 36 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
17 Feb
1/ Former Biden-Harris Transition COVID-19 Advisory Board members @ZekeEmanuel @RickABright @llborio @Atul_Gawande @mtosterholm @drdavidmichaels & Jill Jim in the @nytimes today.
nytimes.com/2021/02/17/opi… We're in for a tough spring if we don't act now.
2/ We all want a break from the pandemic, but now is not the time to let up. By late March, the more transmissible B.1.1.7 UK variant will be the dominant strain in the U.S. This variant spreads more easily from person-to-person and is more virulent. justhumanproductions.org/podcasts/s1e61…
3/ What can we do?
- Every American needs to wear a high-quality mask, and wear it correctly. Snugly, over your nose & mouth. No air leak on the sides.
- Stay in your household bubble.
- Get vaccinated. usatoday.com/story/opinion/…
Read 6 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
17 Feb
1/ SARS-CoV-2 is spread through the air.
nytimes.com/2021/02/17/hea…
2/ A combination of administrative (e.g. screening & testing), environmental (e.g. ventilation), and personal protective equipment (e.g. masks) can control the spread of airborne infections. cdc.gov/tb/publication…
3/ Some workplaces (e.g. schools) have very low levels of risk. Some workplaces (e.g. hospitals) have especially good ventilation to reduce risk. Other workplaces (e.g. meat-packing, prisons/jails) have minimal protections in place. nytimes.com/2021/02/17/hea…
Read 7 tweets
Céline Gounder, MD, ScM, FIDSA Profile picture
7 Feb
1/ Should we give as many people one dose of the Pfizer and Moderna vaccines as possible? Or half as many people two doses of vaccine? It’s a data-free zone.
2/ Here’s the Pfizer COVID vaccine clinical trial data. Study participants got their 2nd dose at 21 days. We only have data on how well one dose of the Pfizer vaccine was at protecting against COVID during that 21 day / 3 week period after the first dose. nejm.org/doi/full/10.10…
3/ We don’t know how good or how long that protection would last if someone did NOT get that 2nd dose at 21 days.
Read 17 tweets

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