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

29 Apr
U of T is making all classrooms achieve 6 ACH with #ventilation and #filtration, the same as for health care patient exam rooms. They measured air flow.
THIS should be the target for all Ontario daycare, elementary, and secondary schools too.
utoronto.ca/news/u-t-asses…
Children will be the last to be vaccinated. Schools & daycares will benefit immensely from reduced cold, flu, seasonal allergies by upgrading to 6 ACH. The time to start was a year ago. The next best time is tomorrow.
Big shout out to @ShellyMBoulder and the UC Boulder team that led the way on this last summer.
Read 4 tweets
28 Apr
This is bullshit policy @UHN. You won't permit a person to wear a clean N95 *respirator* (not mask) in your facility. You won't even allow someone to place your gappy surgical mask over top. Other health care facilities have no such problem. It's indefensible & unacceptable. /1 Image
Does a manufacturing facility say to a visitor "oh hey, take your safety shoes off and don our loafers".
Likewise, I've never been asked to remove my own provided hard hat in exchange for a bump cap or unprotected, as long as it meets sanitary requirements. /2
And you double down on it, even on April 22nd 2021. Can your Entrance Screening Working Group see their own logical fallacy?
If UHN wishes to maintain this policy, it should provide from a selection of pre-approved respirators. Charge a nominal fee if you must. /3 Image
Read 10 tweets
10 Apr
LISTEN as highly influential Prof John Conly (upper left) of UCalgary, AHS CV19 sci advisory grp, Public Health Agency Canada, Chair WHO Infection Prevention & Control R&D Expert Grp. opposes N95 wearing citing acne harm vs @DFisman & @kprather88 precautionary principle. /1
"there's been decreased O2 concentrations in pregnant women" yeah, well here's the reference from one of his publications, dissected in fine form by @caruzycki /2
Here's an example of Prof Conly's influence by the dedicated @jmcrookston /3
Read 8 tweets
9 Apr
Naaah, the massive gym outbreak couldn't possibly be lack of #ventilation. That rooftop unit is in excellent condition. 😬😬😬
I don't even know what I'm seeing. Is that charred polyisocyanurate spray insulation?
To be fair it's only one of six units, the others appear to be better.
Read 5 tweets
7 Apr
What's the risk of COVID in apartment buildings? This review covers much of the basics but I believe the prevalence is much higher ... (THREAD) /1
ncceh.ca/documents/evid… Screen shot of PDF document
We've long known air flows throughout a building despite walls and floors because there's strong driving forces and little attention to air sealing, both on the building envelope, and between units. /2
Figure: Ueno, Lstiburek, Bergey 2012 buildingscience.com/documents/bare… Simplified diagram of stack effect in multifamily buildings
The three driving pressure forces are: Wind, Stack (chimney) effect, and Mechanical (both negative and positive). /3
Figure: Air Leakage Control for Multi-Unit Residential Buildings, CMHC 2017 agency.coop/media/747/down… Image from PDF showing the forces acting on buildings
Read 16 tweets
18 Feb
#COVIDCO2 readings in an Ottawa classroom. Never reached a steady state. At 3152 ppm every breath contains 7.2% of other people's breath‼️‼️ 🤮. #DontShareYourAir #Onted
Classroom has below 0.4 air changes per hour.

Target MIN: 3-4, Good: 4-5, Excel 5-6, Ideal 6+
/1
For COVID, air changes from HEPA filtration are equivalent to outdoor air. Typical classroom portable HEPA air cleaner:
400 CFM on max at 65 dB adds 2.7 ACH
200 CFM on med at 55 dB adds 1.3 ACH.
Two on med would be 58 dB.

BUT there's still the cognitive impact of 3000ppm!
/2
Here's the back-calculation assumptions used to reach 0.4 ACH in a classroom. I'm assuming 12 foot ceilings for an older naturally ventilated school. Other values are typical as well. The calculator throws an exception in red at 19 students, but not at 18.
/3
Read 10 tweets

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