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

Jul 27
AVERAGE CO2 in the dead space below an N95? 1-3% - or 10,000 to 30,000 ppm. Scary?

No. You see that's the average.

Humans have focused on average or peak exhalations/waveforms.

We haven't studied the LOW POINT with capnography.

We have done it with simulations. Image
There are no published experimental (human) capnography studies inside N95 dead space that show the CO₂ dropping down as low as ~0.4% within a single exhalation. Human trials typically measure peak or average values rather than full breath waveforms.
As you can see, the amount of CO2 in the N95 goes down.

Why? Because the air around us has so much less CO2. When we inhale, it mixes with that high CO2.

Dilution and diffusion both at play.
journals.plos.org/plosone/articl…Image
As all of us who has ever worn a mask/N95, which is most of the world, knows, we don't suffer the effects of inhaling 30,000 ppm all day.

Lets look at this a different way.

What if we were in a room with huge CO2? That's what antimaskers are implying is going on.
Read 11 tweets
Jul 27
How NOT to Science. A time travel thread and magic.

This is Helmut Traindl - the engineer who devised the procedure behind Walach CO2 study that was retracted after 16 days:
jamanetwork.com/journals/jamap…

Then, republished by Dr. Domingo just 6 months later.
sciencedirect.com/science/articl… Image
@RetractionWatch had an interesting write-up on how it was republished by Dr. Domingo.

It rings of plausible deniability. Except it smells vaguely of bad faith.

retractionwatch.com/2022/08/01/one…Image
Turns out that @TecnATox was founded, and is directed by Dr. Domingo.

You'll be hearing from me, Dr. Domingo - and a rather lot more people, once I get done writing all of this up.

You see, I found the pilot video.

Read 14 tweets
Jul 24
So, in your apartment or hotel, we saw below how its heated facade, or front, could drive your downstairs neighbor cough into your lungs.

Let's step inside your living room now, and step forward in time to winter.

What happens if your sick neighbor is seated in that living /1
room?

Where is the worst place for them to be seated if you have your heat coming from a heat register up on the wall?

Next to your cold window.

The cold air cools your sick neighbor's exhaled infectious air, and drives it to the ground.

Where it sidles along until Image
Image
you and your family's bodies' thermal plumes pick up that air, and lifts it up to your faces to be breathed in.

Or....to put this in another way....if you go to a coffee shop as I like to do, and you see someone coughing next to a cold window? Do not dawdle.

Leave.
Read 7 tweets
Jul 21
I looked at your thread @moog77 . The reason that epidemiological didn't work (cases continued to go up)? Is the same reason the 2023 Cochrane fails, ironically, after you touted it as the "gold standard."

Not because clean air doesn't reduce cases. It empirically does. It
just doesn't do it where it's not being applied.

What do I mean?

2023 Cochrane "the gold standard" - for community masking is based on a few studies.

One is Alfelali (2020) set in the Haji season
pmc.ncbi.nlm.nih.gov/articles/PMC75…
2 to 3 million religious pilgrims crammed into a few locations, sleeping 50 to hundreds in tent, head to toe.

Respiratory disease is typically 50% in total. Perhaps the single largest mass infection in history, year after year.

A few of them given surgical masks, and told
Read 13 tweets
Jul 21
Do you live in an apartment or stay in hotels?

Got a "oops, outside air can get you" study. Coming out of Beijing University of Technology - taking airborne transmission seriously.

They rented 50 rooms of a building. Did some very cool CFD work - then, be still my heart, Image
followed it up with tracer gas experimentation.

See room 303 above? 403 and 503 got whatever came out of 303.

With studies like these, there are so many variables. But, if I lived in an apartment, I would set have at least a PC fan CR Box next to those open windows.
Or an HRV set up in that window. And for sure a PC fan CR box next to the front door for under the door airflow.

x.com/VentiloAngel/s…

Not HRV, but equally valid
x.com/Engineer_Wong/…
Read 17 tweets
Jul 20
Swimming and showering.

Below is the thread of collected "swimming/ showering safer in indoor shared air" solutions, so far.

You might be thinking that the chlorine smell protects you near the pool. Chlorox is great.

But you would be thinking incorrectly.

Thread. Filti media wrapped out an inside brace made out of zip ties.  Laugh all you want, but it works, yo.
Have there been indoor swimming pool transmission events? Yes.

jamanetwork.com/journals/jaman…

pubmed.ncbi.nlm.nih.gov/34606662/

And more.

Were they in the swimming pool or in the more likely shower/ locker rooms or lobby? Nobody has teased that out.
You do not smell chlorine gas in the pool. If you were actually smelling real chlorine gas, you had better start running for the door.

You are smelling trichloramine - from sweat, urine, body oils when there is not enough free chlorine.

frontiersin.org/articles/10.33…“It is a common misconception that a strong chlorine odor is caused by too much chlorine in the water. The odor is actually caused by chloramines (combined chlorines) off-gassing from the pool water surface.  Chloramines are formed in the pool water when there is insufficient free chlorine in the pool to address the nitrogen-containing compounds brought into the pool water by the swimmers. These nitrogen compounds are naturally occurring and contained in sweat, urine, body oils, and other proteins that get released into the pool water. If the introduction of these nitrogen compounds outpace...
Read 29 tweets

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