Lazarus Long Profile picture
Jul 26, 2022 44 tweets 23 min read Read on X
Speaking of the CDC - a thread on them NOT recommending masks - although an outbreak on a plane in 2021 was stopped by masks.

Per the actual monkeypox lead for the CDC.

And more - enjoy:

#MonkeypoxIsAirborne.

According to the CDC Travel department. Thank you, @jmcrookston .

"... Person to person spread is principally respiratory..."

Someone is going to try and squawk about respiratory droplets. Let's head that off at the pass.

wwwnc.cdc.gov/travel/yellowb… Image
The word is respiratory. Not respiratory droplets.

The word comes from respire.

Which comes from the Latin word "respirare."

To breathe in, and to breathe out.

I don't breathe in and out spittle. Neither do you.

We both breathe in and out aerosols. Airborne aerosols. Image
Expect that page to change now that I am notifying @CDCgov that their travel department has given the game away.

And relax. Breathe in clean air through your N95. Don't breathe in monkeypox.

(H/t @fitterhappierAJ ) Image
If there is asymptomatic transmission with a disease already suspected of airborne transmission? Odds go way up that it's airborne.

Because it moves airborne ahead of droplets. No symptoms means no coughing (no droplets).

Further tying asymptomatic transmission to monkeypox. It would be foolhardy to think this does not happen.

You might wonder why I am hammering down on this? #CoVidIsAirborne was SIGNIFICANTLY delayed due to authorities proclaiming not airborne since not asymptomatic.

Not this
time.

At the very least, even the most stubborn Benjamin Button type of science writer would concede that we should assume asymptomatic transmission is occurring.

Especially because they report what the authorities are reporting.

And the CDC as seen in an MMWR, used the
precautionary principle to euthanize those animals who might have asymptomatically transmitted monkeypox.

This was the 2003 outbreak:
cdc.gov/mmwr/preview/m… Image
This next one is an exercise in logic and an understanding of aerosols.

H/T @NjbBari3 !

Ok, noninvasive means ... See 👇

And here's the thing.

Those who were close to an animal? 80% experienced upper respiratory symptoms.

Using Occam's Razor, is it more likely the person touched the animal, then their mouth having just touched a prairie dog? Image
Or they were close enough for the concentrated cloud of near field aerosols surrounding the clustered cages, to be inhaled?

Keeping in mind, fomites, once thought to be one of the two main ways of infection of CoVid, are now relegated to the 1in 10,000 kitchen junk drawer.
Now, this is a HOT #MonkeypoxIsAirborne update.

You see, evidently they have been collaborating with Congo for a long time.

And it turns out it's airborne.

Per them.

H/t to @lavika and @sri_srikrishna .

Image
Of course, some will try to twist the above sneezing and coughing to mean droplet.

The key is "through the air" . And this is why you are glad that a #CoVidIsAirborne team member is now giving you the guided tour.

Because the phrase "through the air" has only one
meaning in CDC-landia.

For example, with TB. For sure known to be airborne by the CDC.

"Through the air."👇

cdc.gov/tb/publication… Image
Here is the Congo travel warning. Lots of backups to web archive.

wwwnc.cdc.gov/travel/notices…
Another #MonkeyPoxIsAirborne Update!

H/T @DrEricDing and the US DHS.

"Humans can be contagious
before a visible rash appears and can continue shedding the virus weeks after symptoms
have dissipated. "

No symptoms means no lesions. No coughing.
dhs.gov/sites/default/…
What does that leave?

Just like CoVid, breathing, talking, laughing, etc - because it is airborne via aerosols.

And look at that, @celinegounder @benryanwriter, DHS confirming airborne aerosols

"Sources of laboratory-acquired infections include exposure to aerosols..." Image
The CDC should just write this thread on #MonkeypoxIsAirborne .

"... Wear a well-fitting mask..."

You don't need a mask for lesions or fomites.

You don't need a well-fitting mask for droplets.

You only need a well-fitting mask for airborne.

Image
This is getting embarrassing.

How is a smaller Anon account just beating the daylights out of the @CDCgov with their own words, over and over?

BTW, @CDCgov, in the linked doc, why not just recommend N95s?

There is no shortage.

Hmm.. let me put it in terms you can
understand.

@3M, a multinational corporation, will make more money if you actually say "N95."

(No offense intended 3M... Love your products, but when you speak to 5 year olds, you have to use words they understand.)
Yet another source for #MonkeyPoxIsAirborne.

Dynamed. A point of care solution by physicians for physicians.
dynamed.com/condition/orth… Image
Another update for #MonkeyPoxIsAirborne.

H/t @citlanx.

@celinegounder along with Benjamin has been pointing to the mostly MSM network of transmission as proof positive that it's not airborne.

As I have pointed out, it's just in that network.
Eventually, it will branch out.
You know the phrase - if you don't know your history, you will be doomed to repeat it?

Back in 2008, everyone was reporting that the drug-resistant MRSA was relegated to the MSM network.

And it was. For example, the @nytimes itself reported that MRSA was isolated to gay men.
archive.ph/ZNjAc

"A separate part of the study found that gay men in San Francisco were about 13 times more likely to be infected than other people in the city."

I am grateful that @apoorva_nyc has been reporting the possibilities of airborne transmission
in the NYTimes - even in the face of pushback from the CDC Director.

This MSRA history might be handy, Ms. Mandavilli.
archive.ph/Ftkc2d

Because there is no more mention of MSM with MRSA.

Sometime in the near future, certain parties will take a
mayoclinic.org/diseases-condi…
a break from Twitter. The CDC's website (am I the only one who views the focus on MSM as homophobic?) will be quietly redacted.
Excellent thread disconnecting sexual activity from Monkeypox.

Keep in mind - when we engage in sexual activity, our respiration rate increases - which means we see an increase in intake of aerosols.

Masters and Johnson had some classic work embedded in this study - the whole thing was fascinating.
sci-hub.hkvisa.net/10.1016/s0002-…
I haven't found any studies actually documenting the production of aerosols during sex - would love to give a H/t and include you in the thread if you know of one.

Given that the Gesundheit 2 might be ergonomically difficult to work with during sexual activity? Image
Another #MonkeyPoxIsAirborne update.

I almost feel sorry for
@benryanwriter @celinegounder as the onslaught of non-MSM cases begins.

You two probably won't watch it all the way through, but yep.... she shared that it's also airborne.

tiktok.com/t/ZTRUfTThX/?k…
I've just deleted a tweet where I stated that Monkeypox is only handled at BSL4 labs - that was incorrect.

The law does state that:
law.cornell.edu/cfr/text/42/73…

But, there was a caveat not viewable on that page, but over here is citation #4.

selectagents.gov/sat/list.htm

My apologies! Image
#MonkeyPoxisAirborne - because we breathe it out through - even when there are NO lesions present.

If lesions are present, then it's even more airborne due to those nasty little skin flakes.

Mask up, folks.
#MonkeyPoxIsAirborne - via a saliva test that correctly predicted the infected.

Huh?

Please bear with me.

Excellent results for saliva test:
medrxiv.org/content/10.110…

This is huge for ring vaccination strategies.

Also, huge for airborne. 5 of 22 had no symptoms at the Image
time of test. 23%.

4 of the 5 did not have symptoms AT THE TIME. Which meant they went on to develop symptoms.

And yet they tested positive.

The authors nailed it as a concern.

Most likely - if you can test for it? You can spread it.

Mask it up! Image
#MonkeypoxIsAirborne because fomites are very rare.

"Only about 0.2% of people have caught the virus through contact with contaminated material, according to a recent report from the WHO."

Which suddenly make the sorts of reports in the next tweet?

statnews.com/2022/08/10/wha…
Make you realize it's airborne.

A Six Flags worker caught it just by walking by his coworker.

Image
#MonkeypoxIsAirborne - because NHS from the UK says its spread by coughing or sneezing. Which as we all know is accompanied by turbulent clouds of aerosols.

Which are airborne. This is for sneezing - coughing has the same basic mechanism.

nhs.uk/conditions/mon… Image
As always - there are many forms of transmission with monkeypox. Though as we saw above, thanks to the WHO, actual fomite-based infection is far below .5% of cases.

"A new airborne Ebola-like viral disease, referred to as ‘Monkeypox’ has hit the Niger Delta University Teaching Hospital."

"They said the symptoms of the disease include...cough.."

H/t @mdc_martinus for:
guardian.ng/news/monkey-po…

H/t @Iamgoingtosleep for the top qt and pic. Image
A mystery infection. How, oh how, could he have been infected?

#MonkeypoxIsAirborne. Second study this progression has been observed.

Enters respiratory. Then to lymph, the off to the races, and finally the lesions on the skin.

H/t @beansprouts_mom

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More from @LazarusLong13

Jun 10
Please explain how a study measuring physical improvement in a Cognitive and Behavioral study can have unmeasured Graded Exercise Therapy - and be considered as well-controlled. Not confounded.

So, I emailed Dr. Ebell and asked how that was nitpicking. Image
Image
I also agreed with the comments at the bottom of the study, linked below.

If you change analysis protocols post hoc? That's not nitpicking in my book. But maybe that is nitpicking?

jamanetwork.com/journals/jaman…
Science is ALL about nitpicking. You ARE SUPPOSED to be very detailed, so you can be replicated, right? Alan is funny.

Anyway, amusing to spot the lobbying group for the Lightning Process on their advisory board.

Tch tch. Or is that nitpicking. ;) ? Image
Read 7 tweets
Jun 1
A thread on airborne Ebola - the rest is accurate.

Let me emphasize that I agree far more than disagree with her, in general.

Declaring a thing debunked without actually debunking it, with facts, is not debunking.

So, let me debunk this. Image
Dr. Kuppila has excellent credentials, and has earned her laurels.

If we accepted the debunking of airborne Ebola on the basis of credentials, we would have given into the fallacy of appeal to authority.

:) not today.

She worked in an Ebola Treatment Unit in Sierra Leone,
coming back in December 2014, and now resides in Dallas per her very interesting StatNews article:



She did not get infected. We could have survivorship bias here - fortunately.

This is a reference to possible surgical mask usage by her.

You see, the web.archive.org/web/2026052103…Image
Read 22 tweets
May 28
Ebola - it's not all about respiratory aerosols.

DYK that you, and me, and everybody are Pig Pen from Charlie Brown?

We shed our entire outer layer of skin every 2-4 weeks, about 500 million cells daily.

Your corneocytes (outermost cells) lift off of your body with the
gentlest of micro-air currents. Like a leaf picked up off the ground for the briefest of moments in fall.

They act like 12 micron aerosols in float time, but 25% of total skin flakes are sub 5 microns...and you know what that means. Deep deposition - or shallow as
sub 5 likes to also deposit in the nose.

It's funny...I embrace push-back in debate. Tightens up my game.

Imagine if those skin flakes now have Ebola on them?

Two studies show that Ebola literally oozes through the skin - both ways. In and out.

Not shown in vivo, but
Read 10 tweets
May 23
The WHO forbids contact tracers from masking or gloving up.

"Do not conduct home visits wearing personal protective equipment like masks, gloves, or
gowns."

It gets worse. Do not conduct home visits wearing personal protective equipment like masks, gloves, or  gowns.
They have a handy how to reduce risk of catching ebola at home.

It even has 5 masks listed on it.

But not for the other family members.

"7. If the patient has vomit, diarrhoea or bleeding, a mask or a dry towel wrapped around the face can be used to protect the nose and mouth Image
7. If the patient has vomit, diarrhoea or bleeding, a mask or a dry towel wrapped around the face can be used to protect the nose and mouth when touching the patient or items soiled with blood or body fluids. A waterproof gown, eye protection, gloves and rubber boots should also be worn in these circumstances.
Here are the 5 face masks. Image
Read 9 tweets
May 22
The "epidemiology" of Ebola tells us that it's not airborne. You've heard this over and over.

What drives it? The questions on the contact tracing form.

Quick 🧵. Image
COVID - the WHO and CDC said it wasn't airborne via aerosols, right?

The CDC said it was spread person to person via close contact - within about 6 feet.



And you remember it took FOREVER to get changed.

The contact tracing form was web.archive.org/web/2020032817…Image
Image
arranged around close contact. These are the questions driving the stats of how many and how are infected.



So, the CDC will only hear back what it's asking. This was the epidemiology of COVID - until it wasn't. web.archive.org/web/2020052514…Image
Read 16 tweets
May 20
Speaking of silly, can we agree that the WHO has Ebola experts?

Let's talk about PPE, and a bias towards "less PPE is better." Image
The WHO EBOLA IPC guidance:


Foreshadow on PPE

"...due to the desirability of an off-
the-face design, and not for protection from aerosols, respirators may be used instead of medical masks"who.int/publications/i…
If you can stay 3 feet away while screening? No medical mask needed. Image
Image
Read 12 tweets

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