Thread by @michael_hoerger

In JAMA Oncology today, the "debate" continues.

Should hospitals do MORE or less to help people with #cancer avoid severe outcomes from COV1D?

I'll take you through each article! 🔁

1/ twitter.com/i/web/status/1…

Dr. @drlennardlee and colleagues found that people with #cancer had diminished vaccine antibody response, leading to breakthrough infections and hospitalizations.

2/

jamanetwork.com/journals/jamao…

Dr. Lee's study was one of the best I've read in a long time, so we wrote an Editorial building on it.

We offered 10 tips for hospitals to provide people with #cancer with more comprehensive supports.

3/

https://twitter.com/michael_hoerger/status/1638601749710745601

People with #cancer are particularly vulnerable, not solely in terms of diminished vax response, hospitalization, and mortality either.

Also, increased chances of #LongCOVID.

https://twitter.com/michael_hoerger/status/1591701380267384834

4/

Additionally, even a "mild" infection can knock people with #cancer out of treatment for 1-3 months. Other studies document how such delays increase cancer mortality.

https://twitter.com/michael_hoerger/status/1616311313231134720

5/

Drs. Prasad/Haslam critiqued the 10 suggestions. There are no late-stage community-based randomized comparative effectiveness trials of N95s & HEPA filters. They also critiqued patient education.

The authors did acknowledge 9 conflicts of interest.

jamanetwork.com/journals/jamao…
6/

The authors went on to note that such patient protections could have a financial "downside."

They did not weigh in on the financial downside of hospitalizations, infection-induced treatment delays, LC, or death.

7/

In response, we delineated the efficacy for patient education, N95s, and air cleaning.

We explained how late-stage community studies do not test efficacy, commented on the importance of avoiding reinfections, especially during #cancer treatment.

jamanetwork.com/journals/jamao…

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Patient education has been the bedrock of #oncology since the 1970s. Before that, people were rarely even told they had cancer (shocking article linked below).

Today, there are journals focused on patient education and many supportive meta-analyses.
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jamanetwork.com/journals/jama/…

NIOSH establishes the efficacy of N95s in an extremely rigorous process. "Efficacy" means that something works under ideal conditions.

Scientists obviously don't use community-based effectiveness & comparative effectiveness trials to test efficacy.
10/
jamanetwork.com/journals/jamao…

Thanks to @PPEtoheros for meeting with me, sending info, and fact-checking my questions so that we provided clear, accurate, up-to-date information on how #N95 efficacy is established and monitored.

11/

We also provided a basic overview of #HEPA for people who are entirely unfamiliar with how air filtration can reduce the risk of airborne infections illnesses and more.

HEPA can keep people with #cancer safer.

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jamanetwork.com/journals/jamao…

In closing, I believe we're at the onset of a #CleanAirRevolution. Using ventilation and filtration, we can keep a lot of people in better health.

Acknowledging this fact, ASHRAE is about to substantially update building standards for air cleaning.

https://twitter.com/joeyfox85/status/1657020668406378498

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If you want to see hospitals doing more to help patients avoid severe outcomes of COV1D, please share. 🔁
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https://twitter.com/michael_hoerger/status/1664381565730783232