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Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
@ToshiAkima
May 14, 2023 • 9 tweets • 5 min read • Read on X
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Repeating warnings from @H_S_E and @NIOSH about earloops having a low fit test pass rate is unpopular, but what does the published literature say about earloop KN95s? #KN95
One study found that “KN95 masks failed fit testing in all (82 out of 82, 100%) healthcare workers evaluated”. openres.ersjournals.com/content/6/4/00…
Another study of #KF95 mаsks found that: “A result of ‘failed’ was recorded for 39 of 42 fit test episodes”. ijic.info/article/downlo… ImageImage
Another study showed KN95s had an average fit factor of 2.2 out of the 100 points needed to pass. journals.plos.org/plosone/articl… Image
When headstrap Ν95s were modified to take earloops (ELSS), the Fit Factor scores immediately dropped, causing wearers to fail (but improved with a novel fitting system, NFS). The Aura 1860+ dropped from an FF of 161.6 ± 46.9 to less than half of that. academic.oup.com/annweh/article… Image
The last paper shows that even if you get a lucky freak pass on an earloop respirator, your FF score will be bettered by an equivalent headstrap respirator. It really is true that headstraps respirators are generally better.
And no, I know nothing about the novel faceseal system. I can't find anything on it being for sale. If you added it to the headstraps I imagine it would improve the fit factor there too. isrp.com/the-isrp-journ… Image
This table is really quite depressing. Going from headstraps to earloops more than halved the Fit Factor. That's double the inward leakage. It's just not worth it. Image
Look at this study again. That's a 92.85% failure rate for KN95s, despite subjects being allowed to tweak their mаsks to improve the fit. Even if you belong among the 8% who pass, you shouldn't be recommending them to the 92% who don't, as you'll condemn them to be infected. Image

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More from @ToshiAkima

Dr Satoshi Akima FRACP 『秋間聰』 Profile picture
Oct 19
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
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”.

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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
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
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
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
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

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