Share this page!

Enter URL or ID to Unroll

You can paste full URL like: https://x.com/threadreaderapp/status/1644127596119195649
or just the ID like: 1644127596119195649

How to get URL link on X (Twitter) App

  1. On the Twitter thread, click on or icon on the bottom
  2. Click again on or Share Via icon
  3. Click on Copy Link to Tweet
  4. Paste it above and click "Unroll Thread"!
  5. More info at Twitter Help
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
@ToshiAkima
Jun 29, 2022 • 16 tweets • 7 min read • Read on X
1. I am hearing more and more stories of people catching COVID on a plane while wearing an N95 mask. There are numerous reasons for this and we'll go through them to help you avoid getting COVID
2. During boarding, the air filtration system is usually not running. You know how stuffy it can get on board a plane on a hot day, when departure is delayed. Before take-off, the CO2 levels climb to eye-watering levels (it should be less than 700ppm)
3. Due to worker absenteeism, there are delays in take-off, which means longer periods with stratospheric CO2 levels. This leads to more crew getting COVID and an increase in take-off delays. It's a vicious cycle cbsnews.com/news/airlines-…
4. By getting rid of the mask mandate, airlines are failing to provide a safe environment for their employees and customers. Apparently, turning planes into COVID Petri dishes is “good for business”. The industry solution is to deny it is happening. This enjoys union support🤡
5. There is evidence that in such high-risk scenarios, N95 masks alone may be insufficient unless an air filtration system is operational. This means that when one-way masking on a plane, a P100 elastomeric is preferred academic.oup.com/jid/advance-ar…
6. Another part of the problem identified in that paper is that most crew and passengers have not been fit-tested for their N95 masks. Elastomerics have a much higher pass rate on fit testing. …ccess.s3-ap-southeast-2.amazonaws.com/AustralianAnae… Image
7. You can also do a home qualitative fittest if you really want to make sure you have a proper seal on your elastomeric mask. This thread shows you how to set up a testing system at home
8. The minimum is a negative pressure test. Cover the filter with both hands and sharp inhale to see if there are leaks. Repeat with head up-down, left-right. See how far you can open your mouth before a leak develops (all masks have their limit) Image
9. Also do a positive pressure test by covering the filters with both hands and exhale. This is demonstrated in this video of the Dräger X-plore 2100. Repeat with head up-down, left-right, plus with mouth a little open as when speaking
10. My first recommendation for P100 elastomerics is the @DentecSafety Comfort-Air NxMD (review coming). The GVS Ellipse P100 is popular. The Dräger X-plore 2100 is cost-effective. The 3M 6000 is widely available. The Sundström SR100 has a high pass-rate cleanaircrew.org/masks/
11. The non plus ultra solution is a @cleanspacehc Halo PAPR, here modelled with and without an exhalation filter. But it is rather expensive despite its recent price drop. If you want the first-class option, this is it. ImageImage
12. All this could be avoided if there were mandates for filtration during boarding, taxi and takeoff, coupled with universal mask-wearing by staff and passengers. Two-way masking plus air filtration may mean P100 filters are no longer necessary. Until then, P100 filters stay on Image
Postscript on long flights: a Halo PAPR needs recharging every 8hrs, and the bulky motor sits around the neck. Ensure your elastomeric doesn't rub during prolonged wear, causing ulceration of the nose/face
Postscript on eye protection: there is modest evidence for this. It's preferable that you get a reasonable seal from goggles, rather than wearing open frames or face shields with gaps. Aerosol, like smoke, gets in your eyes uvex-safety.com.au/en/products/sa…
Another comment. The argument that the airport chaos is due to the demand for services outstripping supply, is simply not tenable. If that is the case, then that would be an admission of outright fraud
Another postscript. Airlines vary in the quality of their engineering-based management of onboard air quality. Do your research before flying and, as a consumer, demand that they upgrade their aerosol mitigation systems

• • •

Missing some Tweet in this thread? You can try to force a refresh
　

Keep Current with Dr Satoshi Akima FRACP 『秋間聰』

Dr Satoshi Akima FRACP 『秋間聰』 Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @ToshiAkima

Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Oct 19, 2024
I was always suspicious of the thousands of freshly minted clichéd Canadian trucker convoy and MAGA accounts pushing anti-vaxx propaganda. You'd block a thousand only to have a thousand more appear. They'd all repeat the same set of messages over and over.
We clinicians are naive. All we could do in reply to the misinformation campaign was quote some RCT as though it were a scientific debate, when really it was an act of war. Yes, a proxy war waged by atypical means, but a war nonetheless.
As they got the UK to shoot itself in the foot with Brexit, the troll farms politicised the bipartisan issue of vaccination. The result was a civil war waged with biological agents, causing an enormous mortality disparity between left and right.
Read 6 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 29, 2024
The paper is now out in @Nature after I tweeted on this oral presentation @ISTH 2023 by @AkassoglouLab. Fibrin/fibrinogen may be a therapeutic target in СОVΙD neuropathology. Link in next tweet.
“...results reveal a role for fibrinogen as a SARS-CoV-2 spike-binding protein accelerating the formation of abnormal clots with increased inflammatory activity”…“fibrin-targeting immunotherapy suppresses SARS-CoV-2 pathogenesis”.

Image
Image
From an #immunothrombosis perspective, this paper now shows fibrinogen to be a far more critical player in this field than previously thought. We used to focus more on contact, TF, and thrombin but now must look further downstream in the fibrinogenesis/fibrinolysis pathways too.
Read 7 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 8, 2024
It's not so bad a comparison if you accept that to get a similar “depletion of the susceptibles” by a Darwinian evolutionary mechanism, you'd have to deplete 2-400M vulnerable pheno-/genotypes from the pool.
It's always assumed that “evolve to become milder” means that the virus evolves, when it is just as likely that humans are “evolving” via a survival mechanism involving “depletion of the susceptibles”, leaving only those less prone to a lethal outcome. This, too, is evolution.
GBD types would likely argue that intervention to halt the depletion of the susceptibles is a perversion of the natural selection process and a crime. By opposing it, we are simply prolonging the pandemic.
Read 11 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 5, 2024
And this week's Grand Rounds “just a cold” is another young patient with enterovirus-induced fulminant myocarditis needing intubation, ECMO, and an Impella LVAD. I've never seen so many severe post-infectious complications presented in my life.
Last week's Grand Round? Another “just a cold” with Mycoplasma in a paediatric patient who developed encephalopathy, needing IV pulse methylprednisolone and IVIg. It's like every week we see a new case of previously rare infectious complications in young patients.
Another Grand Rounds case. A pregnant woman with severe cardiomyopathy caused by a combined adenovirus and enterovirus infections. Required ECMO.
Read 4 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Aug 3, 2024
Subjecting trial subjects to wearing surgical mаsks against an airborne virus is like running a bike helmet RCT with subjects in Tupperware helmets that weren't designed for that purpose. “But we don't know it doesn't work until we run an RCT” isn't good enough.
Image
“But there was a 30% reduction in head injuries in the Tupperware group vs. placebo.” Not good enough! In a high-risk scenario for major head injury, a Tupperware helmet won't do. The magnitude of risk test subjects were exposed to needs investigation and quantification. Image
Non-pharmaceutical physical protective devices are subject to engineering standards of proof of efficacy. In the case of helmets, that means crash testing in a lab to see how they fare in high-risk situations that live subjects can't be exposed to. helmet.beam.vt.edu/lab.html
Image
Read 7 tweets
Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Jul 31, 2024
A reminder that there was once a titanic struggle between contagionists vs miasmatists over the mechanism of transmission of cholera before the need to cleanse the water of waterborne pathogens was accepted. We are going through a similar struggle today, fighting for clean air. abc.net.au/news/2024-07-3…
If you want to read about how divisive the debates between the contagionists and miasmatists was, you should read “Death in Hamburg” by @RichardEvans36. They didn't need Twitter back then to be almost reduced to pistols at dawn.
Quoted in the article by @Hayley_Gleeson is our latter-day Professor Pettenkofer from Down Under: “I want to believe…”
Image
Read 4 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

Send Email!

:(