4/ In terms of administrative controls, policies & procedures that are consequential: mandatory vaccinations & during surges, addition of mandatory masking
Easier to do this in a workplace; for society at large, many other factors at play incl & especially politics
5/ Last but especially critical because we have failed at creating a sustained response with the first 3 is PPE— fundamentally, one of the biggest reasons why #BetterMasks are so important is because our other levers haven’t been adequately utilized to obviate their need
6/ People are then left to figure it out for themselves
That hasn’t worked well, esp for masks
Improving mask quality is probably the easiest of the above measures to quickly fix
Which will buy time to fix the others too but it won’t stop #Covid19 on its own
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If your hospital only requires N95 for aerosol generating procedures, they are wrong
“the term aerosol-generating is a misnomer. It is not the procedure that increases risk but sustained proximity to the respiratory tract of a highly symptomatic patient.” jamanetwork.com/journals/jamas…
“These factors explain the intubation paradox, the fact that controlled intubations generate negligible amounts of aerosols (far less than volitional coughing), but intubation has repeatedly been associated with increased risk for health care worker infections.”
“The answer is that intubating a patient with viral respiratory failure forces the operator to be very close to the respiratory tract of a highly symptomatic patient, often while also forcing gas over the respiratory mucosa…”
1/ Most hospitals will not be able to catch all healthcare worker infections, esp not before there is some nosocomial transmission to patients. These will largely start from the community & come into hospitals. Many levers to address here— universal N95 use during surges is one.
2/ Why does this matter?
Bc hospitals have many patients who, despite vaccinations, are still at high risk of severe disease if they become infected
Patients should be able to feel safe & be safe in hospitals
The bare minimum we can do during surges is to wear N95 masks
3/ We have likely under-counted in-hospital transmission of #covid19 — most hospitals are not tracking this to the level of detail that would confirm exactly where/ how transmission happened, & from whom and when for all cases
2/ But I shouldn’t have to be explaining this to the CDC. They already know all of this. And they know that blanket responses about mask comfort are not what any of this is actually about.
It’s about how it will look politically to backtrack on what masks are best
3/ and then what a commitment to providing high filtration masks consistently & nationally will actually entail, from admin & cost perspective
And the challenges associated with increasing mask uptake
3/ But our government and institutions and the way society is fundamentally structured has proven that at this point, in yet another surge, the most tangible ask is to get people something immediately that they can put on their face and be as protected as possible.