David Elfstrom Profile picture
May 1, 2021 14 tweets 6 min read Read on X
1/ I wear an N95 at locations outside of my home. I wear it to the grocery store, pharmacy and my doctor's office.

It's comfortable, doesn't hurt my ears, doesn't fog up my glasses, and easy to breathe through. I can wear it all day, anywhere. EXCEPT at the hospital! Photo of @DavidElfstrom wearing an N95 respirator and presen
2/ Many health care facilities require visitors to REMOVE their superior respiratory PPE and don a basic surgical ASTM Level 1 mask.

This practice must stop. Understanding the difference between surgical masks and N95
3/ Here's my friend Annamaria's experience this past Thursday when she went to @NGHSimcoe for her second vaccination, shared with her permission👇 When I got there, I stood in full view of the door and took
4/ @NGHSimcoe's current policy for visitors (and presumably all staff) is "must wear appropriate PPE including the hospital-issued mask".

NEWSFLASH: The hospital-issued mask is NOT appropriate respiratory protection. It's designed to protect against sprays of bodily fluids.
5/ The greatest potential route of COVID-19 infection is inhalation of small floating droplet nuclei (bioaerosol) containing SARS-CoV-2, produced when a person coughs, talks, or merely breathes.
6/ Universal masking helps reduce output, but aerosols still escape from a surgical mask.

(image source: Rothamer et al, 2020 medrxiv.org/content/10.110…)
7/ Many people at greater risk from the impacts of a COVID-19 infection have been advised by their physician to wear improved respiratory protection. Downgrading to a surgical mask goes against this advice, and the precautionary principle. It's asinine.
8/ Hospital IPAC:
🤔If I wear safety boots, will you require me to remove them and don hospital-provided clown shoes? No.

If you're actually worried about contamination you'd follow Ontario's COVID-19 workplace guidance and provide boot sanitizing trays or shoe covers. Ontario workplace poster: Protect against COVID-19: Use boot
9/ So, at the VERY MINIMUM please alter your policy to allow people to keep their own PPE and apply the surgical mask over top.
10/ Look to others:
1️⃣Trillium Health Partners changed their policy in 24 hours👇 Screen shot of tweets
11/ 2️⃣University Health Network also changed their policy in 24 hours👇 Screen capture of tweets
12/ 3️⃣@NGHSimcoe will you be next? I have my vaccination appointment on Tuesday 🎉🥳🎉 and on the advice of my physician I will be wearing a fit-tested N95 and will NOT remove it for inferior protection indoors. Please alter your masking policy like THP & UHN did. Photo of @DavidElfstrom wearing an N95 respirator and presen
13/ ⚠Attention ALL EMPLOYERS:
Please allow your employees up their mask game. Ideally, provide it for them. Essential workers deserve it. Your continued business operation without ill workers justifies it. Masks4Canada Infographic: Filter, Fit, Function
14/ UP YOUR MASK GAME with Masks4Canada's Advanced Mask Purchase List and Tip Sheet. There is ample local supply of respirators. Use them.
Let's push through until we're all vaccinated. It's not much longer. docs.google.com/document/d/1ma…

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More from @DavidElfstrom

May 31
Vancouver Coastal Health has released an updated Ventilation and Indoor Air Quality resource for Schools and Childcare Facilities () but their CO2 page needs some edits. vch.ca/en/document-li…
States high levels of CO2 and other contaminants ... can contribute to [list of five health effects, such as headaches, fatigue, difficultly concentrating], says CO2 should be below 1000 ppm, then says (incorrectly) that health effects from CO2 occur at levels above 5000 ppm. No, those effects can occur below 5000 ppm.  It also states the CO2 concentrations do not indicate a risk of infectious disease transmission in a space. No, ASHRAE's position statement on CO2 states that elevated CO2 concentrations CAN reflect higher risk. Obviously, because it indicates poor ventilation, which IS an i...
Vancouver Coastal Health "CO2 concentrations do not indicate a risk of infectious disease transmission in a space". No.
ASHRAE's position document on indoor CO2 says "higher CO2 conc correspond to lower ventilation and potentially increased risk of airborne transmission"
Vancouver Coastal Health "Note that health effects from CO2 occur at levels above 5000 ppm". Did WorkSafeBC interfere? Because that's contradicted by your Health Canada reference in the sentence immediately before it.
Read 10 tweets
Mar 28
Three years ago on this day ASHRAE stated that Airborne transmission of SARS-CoV-2 is significant.

Today, WHO finally released a model () of #CovidIsAirborne risk by experts in the field. /1 iris.who.int/handle/10665/3…

Landing page for the WHO document titled: Indoor airborne risk assessment in the context of SARS-CoV-2: description of airborne transmission mechanism and method to develop a new standardized model for risk assessment
Four years ago on this day WHO said : "FACT: #COVID is NOT airborne."

Today, WHO finally released a model () of #CovidIsAirborne risk by experts in the field that warned of airborne even earlier, but were shut out. /2
iris.who.int/handle/10665/3…
WHO Tweet March 28, 2020 FACT: #COVID19 is NOT airborne.   The #coronavirus is mainly transmitted through droplets generated when an infected person coughs, sneezes or speaks.  To protect yourself: -keep 1m distance from others -disinfect surfaces frequently -wash/rub your hands -avoid touching your eyes / nose / mouth  Cover page of Indoor airborne risk assessment in the context of SARS-CoV-2
This document has been a long time coming. As described by @jljcolorado, Lidia Morawska, co-chair of the group that published the new WHO airborne model, was previously cut off by John Conly when making the case that #COVIDisAirborne to WHO. /3
Acknowledgements: WHO ARIA Technical Advisory Group:  First name: Lidia Morawska (Co-Chair) (Queensland University of Technology, Australia) (many other names) John Conly (University of Calgary, Canada)
Read 4 tweets
Feb 23
Air purifier manufacturers say HEPA should always be the filter of choice, and their product's proprietary filter delivers. Which HEPA? ISO 35H at 99.95% or ISO 40H at 99.99%? Why not ISO 50U? That's 10x better at 99.999%. Why stop there? Go for ISO 70U at 99.99999%! /1
The answer is, single-pass filtration efficiency DOESN'T MATTER except in specific cases like Powered Air Purifying Respirators (PAPR), clean rooms, operating theaters, or nuclear laboratory exhaust—HEPA's original purpose. /2
For portable/in-room air cleaners, all that matters is the Clean Air Delivery Rate (CADR) for a target particle size and type, within acceptable for sound power and frequency characteristics for the people in the room. /3
Read 13 tweets
Jan 3
Four years into this and we can't keep duct-taping in-room filter solutions for clean air. It's just filter(s) and a fan. We need open-source, optimized design, certifiable product, efficient, repairable using commodity filters and commodity components. /1
We need air cleaners assembled and distributed by not-for-profit community-based social enterprise. No more lock-in to proprietary filters. Verified replacement commodity filtration performance for safety. /2
Low income with donated CR boxes will pay over time in electrical costs for the duct-taped solution for clean air.
Power utilization for Smoke CADR, same filters:
Conventional CR Box: 4 CADR/W. (77 W)
PC fan array air cleaner: 24 CADR/W. (8 W)
/3
Read 4 tweets
Aug 28, 2023
1/ Levoit Core 400S versus Austin Air HM400 in a challenge to see which portable air cleaner removes submicron salt particle aerosols the fastest! Which do you think will win, and by how much? Poll in next tweet below... A large indoor tent with taped seams on a concrete floor is shown. On the left is a bench with instruments. A webcam is mounted on the top of a chair facing the instruments. In the middle are two air purifiers: The cylindrical Levoit Core 400S and the larger boxy Austin Air HM400. In the back right corner is a circular floor fan pointed diagonally upward into the middle. At the front right is a chair holding what looks like a tiny pitcher with a spout. A long thin clear plastic tube is connected to the side of this device, and exits the frame. Power cords are on the floor.
2/ Which has a higher CADR (Clean Air Delivery Rate):
Levoit Core 400S, or Austin Air HM400?
See if you can find the manufacturer's claims for both, and then come back and vote:
[sarcasm] Not only is the Austin Air bigger and far heavier, it also draws way more power, is much louder, and more expensive. It couldn't possibly be *worse* than the Levoit, right? Right?
Read 13 tweets
Jun 12, 2023
When to change the filter on DIY #CorsiRosenthalBox? Holder et al (onlinelibrary.wiley.com/doi/10.1111/in…) showed that performance degradation depends on contaminant: Dust reduces airflow. Smoke kills electrostatic properties. @JimRosenthal4 @joeyfox85 @CorsIAQ Table for MERV 13 single-fi...
@JimRosenthal4 @joeyfox85 @CorsIAQ Note the test substance for the CADR PM2.5 performance measurement was simulated wildfire smoke.
The same would likely apply to a commercial HEPA air cleaner. Monitor for clearing time for a fixed release of contaminant with a simple PM meter.
Read 6 tweets

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