☕️ SARS2 Journal Club

h/t @trishgreenhalgh

'Hidden hazards of SARS-CoV-2 transmission in
hospitals: A systematic review'

Very timely, given #Omicron

@mjb302 @andymoz78 @microlabdoc @LawtonTri
I think you'll like this

'SARS-CoV-2 can be frequently detected in hospital air since 1:6 air samples were contaminated with SARS2. Airborne SARS2 RNA was detected throughout the hospital, regularly beyond the social distance of 2m from patients even extending up to 7.6m away from the nearest patients.'
'The nature of air contamination revealed the existence of patient-generated, size-fractionated, & infectious aerosols & that...only fine [<5microns] aerosols contained viable SARS-CoV-2.' @drkristenkc @Don_Milton
'The prevalence of virus-laden, fine aerosols [<5microns] in hospitals was also significantly higher than that of coarse aerosols or droplets, with a peak in size ranges <1 μm.' @kprather88 @jljcolorado
'In line with...published studies, these findings suggest that aerosols can both dominate particle exposure during close patient or staff contacts & remain suspended in the air over longer distances, underpinning the short & long-range aerosol transmission potential of SARS2.'
Irony alert:

'The most frequent & intense contamination of surfaces was found on air outlets...located either at the ceiling or far above head height. Such high deposition rates on surfaces that are hard to reach are unlikely to be the result of frequent touching...'
'...or contamination through large droplets.'

Lol; obvs. @YouAreLobbyLud @NjbBari3

And regarding mitigation of transmission risk...
'In addition, when HEPA filters were utilized, regardless of the type of ventilation, number of ACH or hospital area, minimal surface-borne & no airborne SARS-CoV-2 RNA was detected.'

Worth repeating...
@mjb302 @andymoz78 @huwwaters @LawtonTri @CathNoakes
'In addition, when HEPA filters were utilized, regardless of the type of ventilation, number of ACH or hospital area, minimal surface-borne & no airborne SARS-CoV-2 RNA was detected.'

Important because...
'In our review, patient rooms with 12 to 15 ACH or 12 air supplies & 16 air discharges per hour were similarly associated with surprisingly high detection rates of air- & surface-borne contamination.'

Very few NHS clinical areas have >15 AC/h; ICU has 10, general wards 0-6.
Great work by Noach Leon Ribaric, Charles Vincent, Günther Jonitz, Achim Hellinger & Goran Ribaric.

Anyone know them?

Hoping you can pass on my thanks please.

#COVIDisAirborne: another win for #HEPA
PS Universally applicable physical laws mean that these data will hold true everywhere on planet Earth.

Even in schools.
@AlisonGeorge10 @karamballes @HoppySaul @Sandyboots2020 @HelenRSalisbury @KamranAbbasi @ProfEmer @petermbenglish @SafeDavid3 @gallagher_rose @ShellyAsquith

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More from @DRTomlinsonEP

17 Dec
Covid-19: Runny nose, headache, and fatigue are commonest symptoms of omicron, early data show

But there follows a truth [👏 @timspector] & a lie [@DHSCgovuk]


'@timspector said the UK was now an international exception in not listing cold-like symptoms as likely indicators of covid infection, noting that the @CDCgov, @WHO & European countries...had all updated their advice.'

“They [UK Gov] should amend it if the majority are presenting that way.”
@ShelaghFogarty @fascinatorfun @ScienceShared @ProfCalumSemple
Read 9 tweets
16 Dec
The Case for Ultraviolet Germicidal Irradiation (UVGI)

Report for 🇬🇧 & 🏴󠁧󠁢󠁳󠁣󠁴󠁿 Gov, Oct 2020

'As a means of preventing airborne transmission of SARS2 we advocate the immediate installation of...upper room 254nm UVGI in indoor public spaces with low AC/hour &/or recirculated air.'
Link to report: www-star.st-and.ac.uk/~kw25/research…

'For the current pandemic...very low doses of UVGI are required to inactivate SARS2 & can be delivered in around twenty-five minutes at current safety limits.'
'As the safety of far-UV-C devices is demonstrated, raising the current regulatory limits would allow lamps to deployed at increased intensity levels & reduce the virus inactivation times to seconds.'
Read 4 tweets
15 Dec
Dear NHS,

A lifeline for anyone facing another day at work w/o access to airborne PPE - & I know that’s the vast majority of you 💙.

Send this article to your CEO. 👇

The IPC team will prob object but it’s the CEO’s risk.

You MUST be given FFP3 during known/poss COVID19 care.
‘Most of the serious shortcomings in protection of workers…from contracting covid at work arise from the authorities & many employers ignoring legislation & precautionary principles as well as inadequate enforcement, rather than from the existing law being unfit for purpose.’
Read 4 tweets
9 Dec
‘Let us hope that certain problems with the influenza vaccine — such as the failure of vaccination, in some years, to produce the desired increase in protection in previously vaccinated people — do not occur with the SARS-CoV-2 vaccines.’

‘Let us hope…’ nejm.org/doi/full/10.10…
@jmcrookston Monto may be a coronavirus expert, but I think he lacks imagination:

‘We need to learn to live with these illnesses, just as we have learned to live with influenza.’

Knowing the health system as I do, I think we’d be better off learning to live without SARS2.
Plus I dislike the premise of hope-based science:

• That mRNA vaccines maintain high efficacy

• That antigenic variant emergence can be outpaced by vaccine manufacturers

• That multiple rounds of exposure to a neurotrophic virus leave humans free from neurological injury
Read 5 tweets
4 Dec
‘UK Legal Position

Biological Agents (such as SARS-CoV-2) are covered under the Control of Substances Hazardous to Health (COSHH) Regulations 2002.

COSHH provides a framework of actions designed to control risk. from exposure to hazardous substances.’


‘The Approved Code of Practice (ACOP) to COSHH Regulation 7 states that if employers cannot prevent exposure to a biological agent, they should take steps to ensure that it is controlled adequately & consider all the requirements set out in regulation 7(3), (4), (6) and (7).’

‘They [employers] should apply the principles of good practice and use each requirement where, and to the extent that:
• it is applicable;
• the assessment carried out under regulation 6 shows that it will lead to a reduction in risk.’

Read 13 tweets
3 Dec
Paediatric critical care & ECMO: interim
update Nov 2017

'Paediatric critical care is a highly valued service that saves the lives of children in England every day.'

#OmicronVarient #RWCS?

'@NHSEngland analysis supports an initial hypothesis that – if the model of paediatric critical care does not change – the services will not be sustainable or affordable in the medium to long term.'

#OmicronVarient #RWCS?

'There is variation in the number of patients from each hub who receive ECMO' [extracorporeal membrane oxygenation]

👇 4 yrs' data (2011-15): per annum ECMO Rx

E Mids: 70
London: 66
NE: 31
NW: 14
SW: 6
Wessex: 9
W Mids: 17
Yorks & Humber: 6

#OmicronVarient #RWCS?

Read 5 tweets

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