There is a lot that went wrong with face masks from day 1– we went from don’t wear them, to wear them, to double mask, to no mask, & now possibly CDC coming around to high filtration masks.

I lay out 4 lessons we can learn from this in @bmj_latest

bmj.com/content/376/bm…
2/ Acknowledge uncertainty— definitive statements about masks not working in the beginning were costly & based on lack of knowledge/evidence but were presented as if CDC was certain masks weren’t needed. They were wrong & then had to backpedal on it
3/ Precautionary principle — we should have assumed Covid19 was airborne and started with high filtration masks

3M had an FDA approved respirator for public health crises. We should have scaled this up (or something like it) for the public since day 1
4/ Setting expectations— this goes for vaccines too; needed to be clear on what an intervention could do & to what extent— otherwise people jump to conclusions that something ‘doesn’t work’ when it actually does work, just within its limitations
5/ the invisibility of prevention— people are quick to call preventative measures overblown because we have a hard time measuring something that didn’t happen. Masks are one of those— we don’t measure all the infections that were prevented, but this still matters

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More from @AbraarKaran

8 Jan
1/ All healthcare workers that are treating patients right now should be wearing N95 masks. Spread is like wildfire. We all risk bringing infections from the community into hospitals — from staff, visitors, & patients in whom initial screening is missing early incubation
2/ Hospitals are completely overwhelmed in terms of testing—it would be great to be testing staff and patients multiple times per week but this isn’t feasible when spread is happening this fast. Just testing those who need a test is taxing enough let alone regular screening
3/ Ventilation — some hospitals can increase ACH in certain rooms that have airborne capability (12 ACH) but for most these are limited ; cannot revamp entire system in the middle of a surge

cdc.gov/infectioncontr…
Read 5 tweets
6 Jan
New JAMA piece by @drdavidmichaels @ZekeEmanuel @RickABright calls for many things incl respirators for all

First, thank you

Second, can you *please push the administration* to move on this?

This is no longer feels like it’s public health— it’s starting to feel like politics
2/ there’s no way the administration hasn’t heard about the request for public respirators. Many of us brought this up since spring 2020. @drsanjaygupta directly asked Dr. Fauci & Walensky about this on @cnn townhall early in 2021

Something here isn’t adding up at all
3/ Preparation around public respirators goes back at least to 2008 with the 3M 8612F and 8670F models.

There were products ready to be scaled up and mass distributed. There’s no way this was a cost issue for the federal government.
Read 5 tweets
6 Jan
I know there are a lot of amazing journalists covering #covid19. Can someone please look into this— this is from the 3M technical briefing Aug 2021 on their public respirator models where they mention 2 models from 2008 made for a pandemic crisis that were discontinued
2/ what happened to these— why was there no effort to scale up respirators for the public, ESPECIALLY if they already existed and had been approved for this purpose in the past?
3/ I can understand if these weren’t ready to go in March 2020– we were caught off guard. But between then & vaccines in December 2020, there were months without any action. Also, all of 2021– knowing vaccines didn’t provide sterilizing immunity— what happened?
Read 4 tweets
6 Jan
*MUST READ*
This August 2021 technical bulletin by 3M is a must read— it covers all the questions you would have about respirators for the public; the limits of surgical & cloth masks; fit, filtration & more

multimedia.3m.com/mws/media/1791…
They even mention that FDA had approved 3M respirators 8612F and 8670F for an airborne infectious disease outbreak; they were discontinued “following a long period of inactivity”

We need some answers folks
Read 5 tweets
5 Jan
1/ Transmission & infection are very complex dynamic processes

To cause clinical infection, need adequate dose of inoculum

Adequate dose depends on many factors, including
-proximity
-duration
-infectiousness of host
-symptomatology
-use of mask & which type
-ventilation
2/ Some of those factors are modifiable, but that depends on what you are capable of doing

You cannot control the infectiousness of random people around you, what viral strain they have, or what type of masks they have on (if any)
3/ You cannot (always) control the ventilation of space you are in (esp for necessities like travel or grocery shopping etc)

You can sometimes modify duration of time in a place or proximity to others, but often you cannot (public transit)
Read 5 tweets
5 Jan
1/ Important Aug 2020 commentary from @CDCDirector in @JAMA_current on N95 masks

Even with suboptimal fit, N95 significantly better than unfitted surgical masks (let alone cloth)

This was pre-Delta, pre-Omicron

jamanetwork.com/journals/jamai…
2/ later in the commentary, authors refer to pragmatism around mask use and cite that N95 masks are suffocating and uncomfortable

Here, I disagree bc as mentioned there are many models; users should be allowed to decide

And user seal check is a very teachable process
3/ additionally they cite cost issues for consumers

I agree— which is why these masks should be made free during times of crisis or surges.

You should not have to go out and find the right masks

Please @CDCDirector - incorporate better masks into this surge & the next
Read 4 tweets

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