We've summarized the literature supporting airborne transmission of COVID-19 & several other respiratory pathogens. Guess what? #COVIDisAirborne #FluisAirborne #SARSisAirborne #MERSisAirborne

Live version of table & refs: tinyurl.com/2dhb2xny

@jmcrookston @jljcolorado
1/
If anyone has feedback or peer-reviewed publications to add, please share

3/
H/T to @rdumont99 for organizing and encouraging this collaborative effort to get the table updated and released

Required review readings:
science.org/doi/10.1126/sc…

nature.com/articles/s4157…

Several interesting observations when reviewing these pubs- will add to thread later

4/
Small correction to page 2 of table, I made the evidence for TB look too good:

5/
Here’s the “published” version of the table and refs

docs.google.com/document/d/e/2…

6/
"its droplet spread because most transmission occurs at close contact"

Kenyon 1996 NEJM - TB on a flight:
"Passengers seated w/in 2 rows of the index pt were more likely to have + tb skin tests than those in the rest of the section (4/13, or 30.8%, vs. 2/55, or 3.6 %"

7/
Olsen 2003 NEJM - SARS on a flight:
1 flight carrying symptomatic SARS+ passenger
22/119 passengers caught SARS, increased risk if sitting in the 3 rows in front of the index case

Another flight carrying 4 symptomatic persons resulted in transmission to at most 1 other person
8/
"If it were airborne, we would see huge outbreaks with more patients and staff catching COVID on the wards"

Anderson 1985 Infect Control - Chickenpox at BC Children's Hospital
2 pts with chickenpox lead to 7 nosocomial infections (out of 41 susceptible patients).

9/
Keep in mind, there was no universal masking policy at BC Children's in 1985. 17% attack rate doesn't sound too airborne by today's standards...

When they started using negative pressure isolation rooms for + cases, their nosocomial infection rate was 0/110 over 1 year

10/

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More from @JenniferKShea

28 Jul
TL;DR The Tome of Nuance

IMHO this review muddies the messages and flip flops on key mitigation strategies
When the science and our understanding evolves, it’s important to communicate this clearly and concisely to the public rather than fall back on nuance and shades of gray. Even when this means admitting that previous messaging was incorrect.
Side tweet - Probably could have saved some pages by omitting the giant shades of gray diagram - not a difficult concept
Read 7 tweets
1 May
I wear an N95 respirator to protect myself, my patients, my colleagues and my family. Blocking inhalation and exhalation of potentially infectious particles just makes sense during a respiratory pandemic. #PerfectFit on the PortaCount #SayNoToSafetyStewardship #FreshAirWeCare Image
Because a fit factor of 5 (20% leak) - when quietly breathing through a surgical mask - isn’t respiratory protection.
#BewareOfMaskNostrils
#BYOPPE Image
My mask solution earlier in pandemic was a mask brace to optimize my fit. Have since switched to N95s to optimize filtration (respirator material meets higher testing standards) and function (N95 easier to put on, more comfortable, more breathable).
#MacGyverYourMask Image
Read 4 tweets
15 Apr
“During the great COVID pandemic of 2020, you may be shocked to learn that many international ID experts believed that respiratory viruses spread primarily through fomites and eyes, rather than the more obvious route - inhalation...”
“As the pandemic swept across the globe, and cases grew, so did the evidence supporting aerosol transmission. The increased risk in shared indoor air and poorly ventilated spaces and decreased risk outdoors was plain for all to see.”
“The paradigm shift was accepted swiftly by some. Others held firm. Some even postulated that the decreased risk outdoors was related to a mysterious germicidal substance in outdoor air, rather than the obvious answer- dilution.”
Read 4 tweets
25 Mar
Review of available evidence supporting fomites transmission

TLDR: there is no evidence

f1000research.com/articles/10-233
Current IPAC policies are heavily weighted towards preventing droplet/fomites spread and active nosocomial outbreaks are blamed on HCWs for not tying gowns correctly, other donning/doffing errors, not wearing proper face shield, etc
Number of studies that have successfully cultured Covid from used hospital gowns/gloves/HCW hands/face shields? 0️⃣

Number that have found SARS-CoV-2 RNA on these items? 0️⃣

Only positive RNA sample on “PPE” was 1 sample on the front of 1 shoe...
Read 4 tweets
22 Mar
It's widely accepted that #MeaslesIsAirborne

I summarized the evidence for airborne spread of Measles vs. COVID-19 in a table

The results were quite shocking to me ...

How is it that we are still discussing whether or not #COVIDisAirborne??

1/
The disease on the left is managed with airborne precautions, including respiratory protection (N95/respirator) and ventilation optimization

2/
In Canada, the disease on the right is still managed with droplet and contact precautions (gowns, gaping surgical masks with substandard filtration efficiencies, gloves, face shields and plenty of hygiene theatre)

3/
Read 18 tweets

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