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Abraar Karan Profile picture
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20 Sep, 8 tweets, 6 min read
From @linseymarr excellent piece in @IDSAInfo CID journal, re transmission of respiratory viruses

"This dichotomy overlooks the reality that respiratory droplets of all sizes, incl aerosols, are most concentrated close to the source (i.e., the infected individual) and that..."
"exposure at all but uncomfortably close distances is dominated by inhalation rather than the impaction of large droplets that are sprayed onto mucous membranes"

Why does this all matter? Because functionally it changes the type of protection that is most needed
And it is critical to acknowledge that there has a been a paradigm shift on this topic.

At my old stomping grounds @BrighamWomens our excellent infection prevention team shifted their views over time, as more evidence emerged that short-range aerosols contributed the most
Eventually, the argument for N95s for all healthcare workers during epidemic surges became the clear answer

For much of last year, I wore N95s on service for all patient encounters-- some cases we had were occult infections that were detected later

academic.oup.com/cid/advance-ar…
Some of these cases led to further spread among patients & healthcare staff-- and this was at a hospital with excellent infection prevention and very regular testing

I can only imagine what was happening at other places that were not being quite as vigilant
#covid19
Our own study in @IDSAInfo added further evidence here-- roommate infections posed an extremely high transmission risk despite those patients being roomed 7 feet apart with a curtain in between. cc @jljcolorado @kprather88 @j_g_allen

academic.oup.com/cid/advance-ar…
This is all to say-- yes, there has been a big shift within the ID world re dominant mode of transmission of #SARSCoV2

That still needs to translate into our gov providing more resources to this effect-- ventilation & high filtration masks being 2
academic.oup.com/cid/advance-ar…
Cc @DFisman @PaulSaxMD @michaelzlin @MonicaGandhi9 @CarlosdelRio7 @jlsalinas7 @ArunaSubraman12 @Marisa_Holubar

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More from @AbraarKaran

Abraar Karan Profile picture
18 Sep
1/ At the FDA meeting— the topic of global vaccine equity was pushed away as an irrelevant consideration to their decision making

This is reflective of a deeper problem— wealthy countries truly believe they can win if they just continue to protect themselves
2/ while the US is going to be purchasing “hundreds of millions” more doses to donate— winning a pandemic that hinges on the generosity or altruism of wealthy countries w/ histories of exploitation is problematic & likely short lived.

washingtonpost.com/health/2021/09…
3/ The global vaccine supply issue & need for more decentralized production + technology transfers for scale up is likely the most urgent global dilemma facing the world.

Is it being regarded with the same level of urgency?

It doesn’t seem or feel like it but hard to say
Read 6 tweets
Abraar Karan Profile picture
15 Sep
People who test positive for #SARSCoV2 with a high viral load who are sent back home to isolate should be given a box of surgical masks for their family members to reduce home-based cluster spreading.

I wish we had done this last year. We can still do this now.
2/ Ideally this would be N95 masks— if we can get there, that would be ideal.

But at minimum, surgical masks which I think can be done immediately; & equipped with mask fitters, if possible.

This is most important in crowded homes with high risk folks, & poor ventilation
Cc @zeynep @linseymarr @ashishkjha @DrTomFrieden @Bob_Wachter @EricTopol @j_g_allen @apoorva_nyc
Read 4 tweets
Abraar Karan Profile picture
13 Sep
1/ As much as people push the “personal responsibility” narrative, so too should they remember when we were telling people to “stay home” when their very livelihoods depended on not staying home— the same low wage workers who ended up being the majority of patients we treated
2/ Personal responsibility to avoid getting infected with #covid19 - for many of my patients last year- ended when it meant they couldn’t get a living wage. For them, the decision was really health v health- w/ no good options.
3/ We are quick to view the lives & challenges of others through our own lens of responsibility- one that is often biased towards the privileges we have in our own lives. This is precisely how “stay home” became a social media movement early on by those who could stay home
Read 4 tweets
Abraar Karan Profile picture
12 Sep
CDC has added a new line about use of N95 masks for the general public now that “availability…has increased”

We should have used the Defense Production Act last year to overcome the supply issue

But more importantly- we must ensure we aren’t caught w our pants down next time
2/ In May 2020 we wrote our first piece about how we can get out of this epidemic— a key part of it was ensuring the general public had access to #bettermasks

This was well before vaccines. This was when the debate was focused on ‘virus vs economy’

hbr.org/2020/05/a-plan…
3/ As the epidemic pushed on, @RanuDhillon & I both continued seeing patients and we almost exclusively utilized N95 masks for most of last year

But hospitals are often much safer than community settings

Better ventilation & everyone was being tested on admission
Read 9 tweets
Abraar Karan Profile picture
11 Sep
1/ This week I have treated multiple cases of #covid19 that were fully vaccinated several months ago; all were elderly & mostly immunocompromised. A few became quite sick.

A short thread
2/ This is a reminder: if you have high risk folks at home who were vaccinated near the start of 2021, it is worth being extra careful around them.

Avoid high risk areas of transmission; & if you must, then please wear a surgical mask or higher grade if you have it. #covid19
3/ While spread from fully vaccinated folks to others is unlikely, it’s not impossible.

It happens. And risk higher if community transmission is high; also highest indoors, crowds, poor ventilation
Read 6 tweets
Abraar Karan Profile picture
10 Sep
On Biden #covid19 update- yes to vaccine mandates + paid time off for workers; yes to increasing rapid tests— but we need more on masks than increasing fines. Cloth masks are better than nothing; but that’s too low of a bar now

Need: Surgical masks + fitters; or high filtration
2/ Risk is dependent on where you are & who is around you

That’s a given but that’s also hard to control

Esp important for those with children or unvaccinated / elderly / immune compromised in their homes
3/ Important not just for now but for future variants, future respiratory threats

Has to be about more than fines

Must be about access and the right communication about why #BetterMasks are key for a virus primarily spread via aerosols #covid19
Read 4 tweets

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