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Lazarus Long Profile picture
@LazarusLong13
Sep 20, 2021 • 12 tweets • 6 min read • Read on X
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Here's a true CoVid story from the Chicoutimi Hospital in Quebec, Canada. From catastrophe to redemption.

Huge outbreak of 400 employees over 2.5 months, directly linked to nosocomial infections. 70 HAI patients.
To be frank, at first the employees were blamed.

Because of overtime due to CoVid - but the employees were blamed.

lequotidien.com/actualites/dur…

Was that the end of the story?
No. The workers did not want to catch CoVid. They were careful.

See the quote below from Anne who caught CoVid below.

And the outbreak continued, until someone decided to test the ventilation.
Right now, you just raised an eyebrow.

"Why test the ventilation? It's not airborne!"

But, as you can see above, Anne was wearing her droplet protection.

So, here were the ventilation results as measured in CO2 (a decent aerosol stand-in).

Up to 1611 ppm. In a hospital!
So, what did they do?

Spent $200,000 to improve the ventilation (bring in exterior air) and bring in negative pressure rooms.
The ventilation improved, as expected. But it wasn't quite enough.

Why? Ventilation/ filtration solve far-field aerosols, but cannot act quick enough to remediate aerosols that are up close (near-field aerosols).

Those can only be remediated by airborne PPE.
In February, N95's were mandated.

ici.radio-canada.ca/premiere/emiss…
N95's are great - but they can be expensive if replacing them all the time, right?

N100 Elastomeric respirators, though - a little more expensive up front - but within a few days much, much cheaper.

Have these been deployed anywhere? Yes- at the Alleghany Health Network.
13 hospitals, 250 locations, 21,000+ employees.

Here is Dr. Chalikondra, CMO of AHN (ahn.org/about/leadersh…), talking about that roll-out:


Or here is a study that was done on that roll-out:
journalacs.org/article/S1072-…
Here's a cost-save calculator from MSA for elastomeric respirators over N95's:
webapps.msasafety.com/apr-calculator/

But besides the cost-save that will make you the hero of your administration?

You will be the hero to the HCW's under your charge. Why?
After the AHN roll-out, guess how many wanted to go back to N95's? 0.

facs.org/media/press-re…

N100's medical grade silicone is much more comfortable than scratchy N95 material.

And safer since they protect against 99.97% of particles vs. 95%.

cdc.gov/niosh/npptl/to…
What about the patients? Like anything new - it's just a matter of education.



My DM's are open for any questions that you might have - not just HCW's! Regular people wear N100 elastomeric respirators, too:

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More from @LazarusLong13

Lazarus Long Profile picture
Nov 18
Fascinating educational article about vaccines and the immune system.

And this was an interesting bit -
Bacterial and viral infections predispose to other infections.

Get the flu? You are at greater risk for pneumococcal pneumonia.
/1 Bacterial and viral infections, on the other hand, often predispose children and adults to severe, invasive infections with other pathogens. For example, patients with pneumococcal pneumonia are more likely to have had a recent influenza infection than matched controls.62 Similarly, varicella infection increases susceptibility to group A-hemolytic streptococcal infections such as necrotizing fasciitis, toxic shock syndrome, and bacteremia.63
Those 👇 post influenza infection effects look familiar.

Where have I seen those types of symptoms before?

COV_D. Which we are getting every year, unlike the flu which is every 5-6 years.

Anywho.....

wellesu.com/10.1086/313772The theoretical bases for susceptibility to bacterial pneumonia following influenza infection are plentiful and include decreases in the function of polymorphonuclear leukocytes, macrophages, lymphocytes, and monocytes; increases in the adherence of bacteria to the respiratory epithelium; and decreased mucociliary clearance [14–19]. In studies of pneumococcal pneumonia in mice and squirrel monkeys, greater severity of disease and mortality resulted from infections due to pneumococcus and influenza virus together than from infections of either organism alone [20–21]. These animal studies sup...
Varicella (chickenpox)? Leads to Group A-hemolytic Streptococcal infection. Known affectionately as GAS, and exhibiting as
necrotizing fascitis.

researchgate.net/publication/12…VZV infection itself may cause a predisposing immune aberration or may allow invasion via another less apparent portal, such as lesions on the oral mucosa or the respiratory tract. In favor of an immune aberration is the fact that NF, the most severe manifestation of soft tissue infection, tended to occur more commonly in association with chickenpox than in nonchickenpox cases. Furthermore, Fujimara et al33 have presented evidence of a switch of the CD41 T cell profile in patients with varicella and underlying atopic dermatitis from a TH2 toaTH1 dominant type with a relative immunosuppressi...
Read 14 tweets
Lazarus Long Profile picture
Nov 16
I have my head so far up the governmental cow's butt on this one, I think I am uniquely qualified to answer on the difference between Biden and Trump on H5N1.

Ready for a🧵?
Biden's USDA is still denying airborne, and is still not telling the Spanish-speaking dairy workers that it is airborne. Or to wear an N95.

Biden's CDC is running Spanish ads on the radio and Facebook. Offering testing. Workers still not trusting the CDC.
Trump will get the CDC to continue to offer free testing clinics - and arrest the workers when they come in.

Nobody will want to milk or take care of the cows. They will continue to get sick, but really die without the intensive care they actually need with H5N1.
Read 15 tweets
Lazarus Long Profile picture
Nov 15
You go to the doctor to get better, not sicker.

There is a group called the HICPAC that tells the CDC what they should do regarding whether or not the guy with bright pink eyes in the bed next to you is wearing an N95 or not.

Whether your doctor comes back from Bermuda with
Covid - and either wears an N95 when he sees you or not.

Whether the hospital gives you attitude about your N95 - or joins you in wearing an N95.

They are going to vote today to say that Surgical Masks are Respiratory Protective Equipment - which is a lie. Per NIOSH/ OSHA.
What can you do?

Read this thread and then call the Inspector General’s office is very receptive. The direct phone number is 202-619-3148. Tell them the HICPAC did what is in that thread, and about them ignoring all airborne evidence.

Read 11 tweets
Lazarus Long Profile picture
Nov 14
The Canada BC teenager is in a hospital that barely uses surgical masks, under Bonnie Henry who screwed up SARS1, then C0V1D.

She thinks aerosols only come in cans.

⚠️ Trigger ⚠️

I am going to lay out the worst case for you. Going to get dark.
First, the subclade, or variant, that this poor kid has is D1.1.

It is not the dairy cow subclade - that is B3.13.

Good breakdown of what a clade is here:
cdc.gov/flu/about/viru…

D1 is lighting up the Pacific flyway.

33 outbreaks in 2.5 weeks.

x.com/0bFuSc8/status… Pacific flyway is basicallywedt of the western tip of Texas, Wyoming etc.
"Genotype D1.1 has:
• Eurasian HA, PB1, MP, NS – all ea3
• North American PB2 (am24), PA (am4), NP (am13), NA [am4(N1)]"

PB2 is not good.

Read 16 tweets
Lazarus Long Profile picture
Nov 13
Numerous people are pointing out that C0V1D brings with it "pink eye" - conjunctivitis.

It also brings with it some interesting comparisons to H5N1.

Some thoughts on both. If you are trying to minimize your exposure to airborne diseases, you will want to read this.

🧵 Mystery thread star. Next tweet for their name.
It was Dr Li Wenliang, an opthalmologist, who first publicly warned us all, may he rest in peace.

He was seeing ophthalmological problems, and that led him to alert us all.

bbc.com/news/world-asi…Picture of Dr Li in a hospital with Covid.
But no one thinks about the eyes getting infected with aerosols.

There is a reason for that - we are far more likely to breathe it in as we inhale 2,900 gallons or 11,000 liters of air.

C0V1D is very airborne (Ashish Jha called it purely airborne).

Read 11 tweets
Lazarus Long Profile picture
Nov 12
So, while I was reading up for the below thread, I came up across an interesting bit about H5N1 and eyes.

How ARE those 👇 eyes getting infected? Rubbing their eyes with dirty, dirty hands?

Thread. Dairy worker with bird flu never developed respiratory symptoms, only pinkeye The authors of a new report detailing the man's case suspect that he was infected by rubbing his eyes with a contaminated hand.
The CDC just did a serologically study that calls into question those dirty, dirty hands - if you even only half-carefully read it.

3 of the 8 showing antibodies had used eye protection. A little difficult to stick your fingers in your eyes with eye protection on. Among 115 persons, eight (7%; 95% CI = 3.6%–13.1%) had serologic evidence of recent infection with A(H5) virus; all reported milking cows or cleaning the milking parlor. Among persons with serologic evidence of infection, four recalled being ill around the time cows were ill; symptoms began before or within a few days of A(H5) virus detections among cows.
Cleaning the milking parlor was the only task significantly associated with a positive test result (p<0.001). None of the workers with serologic evidence of infection used respiratory protection; three used recommended eye protection. Among the eight workers with evidence of infection, only one reported close contact with cows known to be infected,§§§§ compared with 68 (64%) workers with negative test results. However, all worked on farms with herds that were reported to public health officials as being HPAI A(H5)–infected.
Only 1 of the 8 had close contact. So, that means either fomites or more than 6 feet away infection.

It also means no droplets.

But none of the 8 were wearing respiratory protections - so no protection from aerosols. Cleaning the milking parlor was the only task significantly associated with a positive test result (p<0.001). None of the workers with serologic evidence of infection used respiratory protection; three used recommended eye protection. Among the eight workers with evidence of infection, only one reported close contact with cows known to be infected,§§§§ compared with 68 (64%) workers with negative test results. However, all worked on farms with herds that were reported to public health officials as being HPAI A(H5)–infected.
Read 31 tweets

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