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…”
“…for the purposes of preoxygenation or preintubation respiratory support.”

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More from @AbraarKaran

4 Jan
1/ This was a public email sent to all of Stanford healthcare from our CMO last week

With the #Omicron surge, we have had more healthcare worker infections than at *any week* in the entire pandemic

And this is at an awesome hospital w/ excellent testing capacity!
2/ Just imagine what the numbers are like at other hospitals, esp ones in big crowded cities

I doubt most hospitals are doing as much staff testing as we are, which means many HCW infections are going undiagnosed

We saw this all of last year too

This is a real issue
#covid19
3/ Mandating N95 masks for all healthcare workers right now makes sense— it can stop occult transmission between patients & staff

This is literally a no-brainer policy with insane community incidence of #Omicron!

Every single hospital should be doing this, now.
Read 4 tweets
3 Jan
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
Read 8 tweets
3 Jan
One of the key measures for mask “breathability” is pressure drop

For instance, 3M N95 masks which many have reported feel comfortable have lower pressure drop than others

When CDC says N95s are “too uncomfortable”— assume all masks are the same (false!)
multimedia.3m.com/mws/media/9006…
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

Yes- public health is really tough
Read 4 tweets
3 Jan
1/ In the hierarchy of infection prevention, you have “more” & “less” effective ways to stop spread (used in hospitals)

But we can apply this concept to specific efforts aimed at reducing community transmission as well
2/ ‘Elimination’ or prevention of entry of a pathogen; I see rapid testing as a key part of this

If we could stop infectious people from entering public spaces, we could fundamentally stop super spreading

Cc @RanuDhillon @sri_srikrishna @michaelmina_lab @ADPaltiel
3/ In terms of engineering controls, restructuring spaces to improve ventilation = essential

People have tried to emulate this by moving activities outdoors when possible, opening windows, buying home filtration devices etc

@kprather88 @j_g_allen
Read 6 tweets
1 Jan
1/ A short & friendly thread on masks for NYE

To start, the mask that we were all supposed to have from 2008 that isn't in production anymore for unclear reasons.

It was replaced by bandannas when no one was paying attention.

I present:

The 3M 8670F

2/ Next we have the 3M 1870+

If you're a healthcare worker and you can get fit tested for this, do it.

You can work out in this.

You can scream at the CDC in this.

You can do basically anything in this. @CDCDirector you gotta try this one.

3/ Then we have the cousin of the 1870+

the 3M 9205+

This is the mask that shockingly has been hiding at your local Home Depot but that could have been your go-to for the past 2 yrs

Seems like the 8670F in disguise

We can blame Home Depot (or the CDC)
Read 7 tweets
1 Jan
1/ People that are arguing about what kind of masks are “good enough”

What we are asking for— “better masks”— is literally the *bare minimum*

We are in a respiratory pandemic that has killed over 820,000 Americans.

Asking for better PPE for the public is *a TINY ask*
2/ Will better masks alone stop #covid19 epidemic?

Obviously not. This epidemic has been driven by insane societal inequities & profit-driven structures

We wrote about this in NPR.

We aren’t naive to think masks are the be all end all!

npr.org/sections/healt…
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.

Bare minimum.
Read 6 tweets

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