Lazarus Long Profile picture
Nov 12, 2021 16 tweets 9 min read Read on X
A thread on ambulance ventilation.

And why you are going to see more staffing EMS staffing shortages - resulting in you laying forever next to your wrecked car.

Waiting to be picked up by CoVid+ EMT's in surgical masks.
Study is here - click the PDF button....or just ride along in this clown car.
researchgate.net/publication/33…

Looks like in the USA, there are no standards for ventilation in ambulances.

Used to be 30 ACH..which would be amazing.
In the UK, they recommend not using the recirculating air during AGP's, during pandemics.

assets.publishing.service.gov.uk/government/upl…

Currently, surgical masks as long as within 6 feet of the CoVid+. No recirculating.
gov.uk/government/pub…

All based on WHO guidance. (Foreshadow.)
The default ventilation of the ambulance is 5 ACH, IF the exhaust blower was on.

They replaced the default ventilation tho with the below HEPA filter, so they could get accurate measurements, avoiding external aerosols, and reset quickly.

Quite clever.
americanlaboratorytrading.com/lab-equipment-…
Here's the rest:

"For each test, four optical particle counters
(OPCs) were placed in locations representing possible positions for a seated EMS worker treating the
patient. OPCs were placed in the positions labeled OPC 1-4 when the cot was at 0° or 30°, and positions ..."
Before going on, let's touch on the 5 ACH that all of you will be hit with in surgical masks.

Even with surgical masks on, we have certainly seen a huge number of outbreaks in hospitals with 6 ACH (better) ventilation
and continuous surgical masking.

For example, Alberta Health Services, @AHS_media, which is the embodiment of the @WHO's IPC guidance.

Stands to reason as Dr. Conly rules over AHS AND the WHO with a very clean fist.

Back to our clown car, Lindsley (yep, the famous one) found that a single cough resulted at least some worker exposure.

Given that Delta is everywhere, and we now know it takes under 3 virii to successfully infect?

Not good.

Might not be a bad idea to buy a @FixTheMask brace
in case you have to go to the hospital or even ride in an ambulance.

Or make the 3 rubber band version and keep it in your wallet or purse:


Why would there still be exposure?

"Air circulation pattern in the ambulance patient compartment generated by...
the ventilation
system. The jet of air created by the air inlet causes a clockwise recirculation pattern to form which
circulates aerosol particles throughout the compartment. Even if the cough is directed toward the rear
of the ambulance, aerosol particles are carried
toward the front by the recirculation. Thus, a worker
anywhere in the ambulance is exposed to the cough aerosol particles."

Thus, you will be exposed to the same.

But does it have to be this way?

No. Or I should say, N100.

The same solution as in this thread that was
slightly viral about 25 years of no infection in the Texas TB hospital:


And the same solution being used today by NYC's EMS:
nydailynews.com/new-york/ny-fd…
But the story does not end there.
Did you know that someone tried putting a HEPA filter into an ambulance?

cdc.gov/niosh/hhe/repo…

"The effective
air change rates ranged from about 43 to 46 ACH in
the HEPA ambulance, and from 26 to 32 ACH in the
non–HEPA ambulance."

This provides further proof that
portable air cleaners such as the Corsi/Rosenthal Box are additive to any current air cleaning infrastructure.

And...they help remove aerosols much faster.

The message is the same because this is NOT rocket science.

Vax.
N100.
HEPA if you can afford it.
CR Box if you can't
A very cool simulation model study confirming what Dr. Noakes shared below. Thank you!

1 - An ambulance transport with a patient actively emitting a virus.
2 - A subsequent transport with an uninfected patient <- very interesting setup here.

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More from @LazarusLong13

May 10
Great article by @EmilyJoshu here.

Emily, there's another article in this that's even more shocking.

The aerosols from milking have long been discussed by many of us on X.

People like myself, @sri_srikrishna, @AbraarKaran have long advocated for comfortable aerosol
protective gear like PAPRs. But, have been ignored by the USDA who, of course, thought it was only contaminated milking gear like the claw.

But there is one more source of aerosols besides cow breath.

The wastewater. When you spray anything you generate huge amounts of Image
aerosols. And that farm wastewater, filled with milk dumped from being full of H5N1, gets reclaimed and reused.

Those milk and wastewater lagoons are on most dairy farms (my grandfather owned a dairy farm).

And there's something you should know.

Image
Read 15 tweets
May 7
Humanity's hubris vs the precautionary principle.

The virus, ANDV, will do what it will do. Pandemic? History tells us "NO." But history is in the past.

Let me show you what the studies tell us - and why I am livid that the WHO is insisting that surgical masks are ok.

🧵
Incubation time, or how long until symptoms show up?

The high risk time frame is 14–32 days. Not to put too fine a point on that, but that can mean a full month later

pmc.ncbi.nlm.nih.gov/articles/PMC32…

There have been some out to 8 weeks, but let's ignore those

gov.uk/guidance/andes… Image
Clinical features The most important complication of ANDV infection is HCPS, which is associated with a high mortality rate. Milder illness without significant cardio-respiratory compromise may also be seen. Illness usually develops 2 to 4 weeks following exposure, but incubation periods as early as 4 days and up to 8 weeks have been described.
But, what receptor does the ANDV attach to?

PCDH1 (protocadherin-1) is primarily expressed in the airway epithelium of the respiratory system, especially in the bronchial and nasal epithelial cells, and in pulmonary endothelial cells.

So, that means in the URT and the LRT.
Read 41 tweets
May 6
@mvankerkhove - a follow-up question on today's press conference.

In this bit, you were thanked for being very clear.

But, you said that the medical personnel taking care of those sick would be wearing PPE.

N95s are not PPE. They are Respiratory Protective Equipment. /1
Surgical masks are PPE.

So, is the WHO advising them to wear surgical masks or N95s/FFP2/KF94/KN95 (respirators)?

Second followup, @mvankerkhove, you referred to "really close contacts"

Close contacts are defined by the WHO as within 3 feet.
Cases 1 & 2 were close contacts.

How did the other cases get it? I realize you cannot possibly have an answer...but you are labeling this as "really close contact" for those cases - as well.

Staterooms are typical 2 person rooms.

It doesn't add up. Image
Image
Read 12 tweets
Mar 26
I've become a bit of a Dental Nerd after just getting savaged by avoiding the dentist due to COVID.

But, now, I have a Dental Nasal PAPR, know all about Stephan's Curve, use a waterpik, Oral-B iO Series 10, chew 8 pieces of xylitol gum - and the dentist just said that.....
He has never seen anyone reverse course so perfectly before.

"Immaculate."

And bonus...I ran into a fellow masker in his lobby!!

She had never heard of Readimask, so I was super happy to share the Good Word with her.

Sharing the Good Word - not COVID!
Read 4 tweets
Mar 16
Now, this is a very interesting PREPRINT.

We've all heard that shingles vaccination reduces risk of Alzheimer's.

And we all know that Covid increases the risk of Alzheimer's by 50-80%.

What happens when you mix them? Will the vaccination offset a different disease?

/1 Opposing effects of SARS-CoV-2/COVID-19 infection and recombinant zoster vaccination on the risk of late-onset Alzheimer disease  View ORCID ProfileCarly M. Rose, Shiying Liu,  View ORCID ProfileWilliam S. Bush, Jonathan L. Haines, Scott M. Williams,  View ORCID ProfileDana C. Crawford N3C Consortium doi: https://doi.org/10.64898/2026.01.21.26344555 This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.
Yes.

But by how much? Conclusions and Relevance SARS-CoV-2/COVID-19 infection and recombinant zoster vaccination are modifiable risk factors for LOAD among older individuals, with a modestly significant interaction between the two. Recombinant zoster vaccination reduced LOAD risk regardless of sex and race, though the protection is greater in those without documented COVID-19 infection. Recombinant zoster vaccination and reduced exposure to COVID-19 infection in the later decades of life reduce the risk of developing Alzheimer disease over at least a five-year period.
Useful for below - "Late-onset Alzheimer disease (LOAD; onset age ≥65)"

"odds of LOAD are 16% higher among those with at least one reported COVID-19 infection" Image
Read 7 tweets
Mar 3
A doctor complaining about wearing N95s? Thread foreshadow in the gif 👇.

Dr. Sax, you should read this.

The arrogance of medical doctors thinking they know better than the CDC NIOSH and OSHA?

This comes as no surprise.
Imagine if an asbestos worker, or a tech working in BioSafety Lab was complaining about this.

But somehow, doctors making over $200,000 get carte blanche and and a piece in the @NEJM Voices.

And he does have a loud voice.
This is Dr. Sax, Clinical Director, Division of Infectious Diseases (ID), at THE Harvard hospital. In 2014, he wrote about how ID docs only make $174,000.

He probably makes northwards of $269,000.

This is very, very relevant.

You see, he is put out by the inconvenience Image
Read 23 tweets

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