Abraar Karan Profile picture
Mar 25 7 tweets 2 min read
1/ Yesterday CDC recommended that hospitals & healthcare facilities allow patients to keep their own N95 masks on

Some would think by now, these facilities should be offering visitors these respirators during a pandemic— but we are celebrating just being allowed to wear our own
2/ The science has not changed. The policy has lagged behind for two years. People are appropriately frustrated. More broadly, policy & comms around N95 masks have lagged for the community too, where ventilation standards are poorer and the average mask 👎🏼 than in the hospital
3/ Very simply— in a pandemic of a respiratory airborne virus, equipping the public with better masks— notably, respirators— should not be a huge point of debate. It’s a low hanging fruit
4/ Yes, some won’t wear them all the time. Some won’t have the perfect fit. But you need to focus on high risk settings, not the strawman “all the time”

And cloth/surgical masks aren’t fitted either. N95 by design will have less leakage than loose earloop masks
5/ Personally have tried many models & the 3M Vflex is the most comfortable IMO

When the USG was pushing out free N95s, they should have approached it pragmatically— which of these models will the public find most useable, comfortable on the face, & breathable?
6/ Instead, they seem to have put out a number of older cup style designs, & not nearly to the scale needed (& notably when the Omicron peak was passing)
7/ Lots of lessons to be learned for the next future wave on this front — even just with regard to masks! Hopeful that we now have @ashishkjha leading the front & who has been a big proponent of #bettermasks & respiratory protection for the public

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More from @AbraarKaran

Mar 13
1/ Over time, the effects of #covid19 on heart, brain, lungs, vascular system, sensory system, kidneys & more will become better understood

Until then, any reassurance that massive levels of infection are ‘ok’ for society is a gamble—a gamble with unknown long-term costs.
2/ Recent work highlighting effects of #SARSCoV2 on brain structure
nature.com/articles/s4158…
3/ Risk of heart disease, heart attacks, strokes sig higher even after mild cases of #covid19

nature.com/articles/d4158…
Read 11 tweets
Mar 10
1/ Over the past two years, we have discovered therapeutics that work for #covid19 such as Remdesivir; later we figured out the optimal time to use them. Months from now, we will have even more data & meds to use.

Delaying infections does have a benefit
2/ Over the past two years, we have discovered that #covid19 has effects on the body that are significant, even if they don’t kill you. The virus affects the heart, brain, vascular system & more. The costs become clearer over time.

Delaying infections makes those costs clearer
3/ When big waves of infection come down, the chance of getting infected during any given activity also goes down. We have certain measures— such as high filtration masks— which, if used right, can protect you through a wave. There are many who haven’t been infected.
Read 6 tweets
Mar 10
Perhaps unsurprising, those most readily downplaying the risks of #covid19 infection, incl #longcovid, have also never treated a covid patient.

You’ll be hard pressed to find many doctors doing this— we have seen enough patients die, or survive & still suffer afterwards.
2/ We have had a lot of spread — & we are at risk of a lot more (unmasking of course not helping). Telling ourselves it is mild doesn’t make that true, esp re more chronic health consequences.

Masking alone won’t solve this either. There’s a lot more needed than that.
3/ While many have been infected with #Omicron, there are likely many who have not been. With increases in BA2 variant, I suspect we will have enough susceptible people to sustain some level of resurgence soon, but unclear what that will look like. I hope I’m wrong. @jlsalinas7
Read 5 tweets
Mar 1
1/ The US #covid19 dialogue is overly focused on how restrictions are being lifted and what experts think about that

The questions I care about right now:
-what are we doing for preparedness?
-what are we doing for health equity?
2/ I want specifics from my government and leaders

How is indoor air/ventilation going to be improved in schools, businesses and public places? What's the timeline? What's the cost? Who is paying? What's the accountability mechanism if this doesn't happen?
3/ When will N95 mask supply be increased and to what extent? How will it be distributed? What were previous bottlenecks & how have they been addressed? When will more comfortable options be added? Will poorer communities have more access & supply? What about the terrible comms?
Read 5 tweets
Feb 20
1/ Unmasked exposures & Long Covid 🧵

There is potentially a relationship between inoculum dose (amount of virus you are exposed to when you get infected) & development of #LongCovid

Having higher early viral load may increase risk of Long Covid

nytimes.com/2022/01/25/hea…
2/ Earlier in the epidemic, @MonicaGandhi9 & Dr Rutherford from UCSF brought up variolation hypothesis as it relates to masking

Could masks have the benefit of reducing the viral load you are exposed to & could this potentially lessen severity of disease + prime immune system
3/ What is concerning now— if you pull back on mask mandates with high community incidence, especially in places with low vaccination / low booster rates

Lots more unmasked viral spread

Higher potential proportion of #LongCovid cases esp in these areas

Important to track this
Read 4 tweets
Feb 20
More hospital-based spread of #covid19 during #Omicron than any prior waves. We knew this was a problem from prior waves— yet there is ongoing resistance to acknowledge it, to test for it, or do more to prevent it.

@politico
politico.com/news/2022/02/1…
2/ We wrote about this issue in @JAMA_current outlining ways to slow hospital-based spread with Omicron.

It remains to be seen whether this will be utilized in hospitals, or if we’ll keep the status quo and pretend this isn’t a problem.

jamanetwork.com/journals/jama/…
3/ & even this is an undercount!

“The total # of people who contract Covid-19 while in the hospital remains unclear bc these figures only count patients who were in the hospital at least 14 consecutive days & don’t account for people who test positive after leaving.”
Read 5 tweets

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