Thread by @amorvincitomnia

1/18 Oh no lol oh god lmao- Hanging up my jesters privilege for a bit of earnest posting. Here's what I submitted earlier this evening to HICPAC for their November meeting about the importance of layered mitigation strategies in healthcare settings.

2/ I am {whatevs} with 18 years of experience in public health research, direct service work, and advocacy, specializing in infectious disease mitigation including HIV and HCV.

3/ I write today as a concerned member of the public regarding HICPAC's proposed guidance on respiratory protection in healthcare settings.

4/ The urgency of strengthening respiratory protection standards cannot be overstated. The WHO reports 8.2 million new tuberculosis cases in 2023—the highest since monitoring began in 1995, with one-third being treatment-resistant.

5/ TB remains a leading cause of death among people living with HIV. This global trend threatens to reverse 120 years of progress in U.S. TB control The threat extends beyond TB. We're seeing alarming increases in RSV, mycoplasma pneumonia,

6/ and a five-fold rise in whooping cough cases, while facing potential H5N1 risks. Combined with over 1.2 million U.S. COVID-19 deaths and millions affected by Long COVID, we face compelling evidence that current protection standards are insufficient.

7/ The proposed distinction between "routine" and "special" air precautions is fundamentally flawed. This two-tier approach fails to protect healthcare workers and patients from the reality that respiratory viruses and bacteria require consistent, high-level protection. The

8/ success of universal precautions for bloodborne pathogens during the HIV crisis proves that standardized, comprehensive protection measures improved quality of life while saving patient lives. We need similar universal standards for airborne protection. cdc.gov/mmwr/preview/m…

9/ The United States has a proven track record of successful airborne disease control when comprehensive measures are implemented. Since 1904, when Dr. Edward Livingston Trudeau founded what would become the American Lung Association, lung.org/blog/how-we-co…

10/ innovated medical and public health approaches to effectively control TB transmission. This legacy of comprehensive protection should inform today's standards.

11/ Evidence continues to support this approach. The Texas Center for Infectious Disease (TCID) tuberculosis clinic demonstrates both effectiveness and cost-efficiency of comprehensive respiratory protection. By providing elastomeric respirators archive.ph/EOy4z

12/ with replaceable filters to all 170 employees, they reduced annual costs from $44,000 to $2,000 while maintaining zero TB cases among staff since 1996. This example directly refutes concerns about cost or practicality of universal N95-level protection.

13/ I urge HICPAC to: 1. Eliminate the proposed two-tier system of air precautions 2. Require fit-tested N95 respirators or elastomeric respirators as the universal minimum standard for healthcare workers 3. Include specific guidance for reusable respiratory protection programs

14/ to address both cost and sustainability concerns 4. Recognize that ALL airborne pathogens pose risks requiring consistent, high-level protection The tools exist. The evidence supports their use.

15/ The cost-effective solutions are proven. HICPAC must now show the leadership to implement these protective measures before we face another preventable crisis.

Regards, C̶͚̃a̵̯͠s̸͌͜s̷̜̎ả̵̻n̵̥͑d̸̓ͅr̶̦̽a̵̛̠

16/ On the cutting room floor: Mentioning this book. Does the hard stuff for 'em National Academies of Sciences, Engineering, and Medicine book published 2019: Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use. nap.nationalacademies.org/catalog/25275/…

17/ Mentioning Far-UV tech that's been deployed successfully since 1903... and adopted significantly more in the post World War 2 era: uvtglobal.com/what-is-uv-c/t…

18/ The 2009 the US Department of Labor produced 5-and-a-half-minute video that covers the differences. Titled simply: “The Difference Between Respirators and Surgical Masks.”

A special 19th tweet has entered the timeline.

https://x.com/amorvincitomnia/status/1857294320166109372