There is another article out there somewhere about hospitals not being overwhelmed.
That is untrue.
We have blown through our KPI’s. These are numbers and limits that are meant to keep you safe. This is the very definition of overwhelmed.
Aug 8 • 8 tweets • 2 min read
So, I see people are taking pot shots because @denise_dewald said pox contaminated sewage may cause pox reservoirs in rodents (a well known risk) potentially setting up the US for endemic monkeypox…
LOL. I’ll take it one further.
We’ve got COVID-19 and pox in the sewage…
Now we do a lot of experiments in mice, but they are humanised mice. Perhaps we can’t extrapolate data directly.
Also, one is an RNA virus and the other a DNA virus, so the can’t combine into a super virus just like that…
Aug 8 • 9 tweets • 2 min read
I know someone that has “gone back to normal” but is very frustrated with “other people” for not getting vaccinated.
“Why won’t they just get vaccinated so that we can all get on with our lives and not worry about the numbers dying?”
Where does one start with this?
Eligibility and access issues. (Little ones not even eligible yet. Many younger adults/older children thought to be low risk and have no access.)
Anti-vax messaging from some very prominent “experts”.
Aug 8 • 5 tweets • 2 min read
It’s actually very hard to discuss this sensibly at this point because of the data that has been presented in the past has generally been generated by symptomatic individuals presenting for assistance.
Contact tracing may pick up a larger number of milder cases, but ->
the rash has always been typically described as painful before.
There may also be a skewed effect of assessing cases early, when pain may not be present or severe, and not reassessing data later in the presentation, when lesions may be more numerous and more painful.
Aug 7 • 14 tweets • 2 min read
Observing the narrative around monkeypox with increasing alarm.
The narrative may turn out to be lethal in itself.
Very worried. Something that should have been so simple has come to life like a dragon breathing fire.
Everyone that is part of a community that is affected by disease should have vaccines, testing tracing and isolation with support available to them.
This is not homophobia. This is a common sense and care.
Aug 6 • 4 tweets • 1 min read
I’m thinking of buying enough ice cream to last two years.
I won’t, because that’s naughty hoarding… but it did cross my mind.
I’ll just get one tub and try to make that last two years?
Aug 6 • 4 tweets • 1 min read
La La land is nice.
In La La land you can say a virus isn’t airborne, kids don’t get sick, schools are safe (without airborne disease mitigations) and anything else you wish were true.
Shame you can’t go to La La land and wish your dead friends and family back.
Not so long ago, there was an article written by a prominent infectious diseases person saying respirators were not good to use in healthcare because most people can’t use them properly.
Yes, because we are all idiots and can’t be trained.
Aug 6 • 7 tweets • 2 min read
We do have decades of data on monkeypox, which are all being ignored.
It wasn’t a disease of men who have sex with men, although it tended towards males having symptoms, and it was classified as an airborne HCID.
I accept that it is affecting MSM community greatly though.
It started off as mainly a zoonosis with very limited human to human transmission, and has slowly become more prevalent with more sustained transmission in humans.
Aug 5 • 4 tweets • 1 min read
It’s about time that we revisit #TargetingZero.
COVID-19 is a serious disease with a high mortality despite all pharmaceutical interventions thus far.
It also has serious long term health outcomes.
It warrants control just like TB.
Aug 4 • 11 tweets • 2 min read
Bookmark this one. It's a systematic review of outbreaks of monkeypox prior to 2019. It has lots of references and links to explore from the main article.
It may have some clues for us.
This is a table of identified cases and the sex ratio of these cases. Many outbreaks are rural and also there are older outbreaks which were mainly diagnosed clinically.
Aug 4 • 7 tweets • 1 min read
This needs to be talked about more.
Infectious diseases more broadly, and how we can reduce risk but still connect.
Multiple hospitals in England have tried running services without masks. They had to bring back masks.
I expect this is because not only are the staff getting sick, but they are getting sick in *work cohorts*. That can very quickly disable services.
Aug 3 • 5 tweets • 1 min read
As previously found, patients can have monkeypox either asymptomatically or with such minimal symptoms that they aren’t aware they have had an infection.
No evidence found in this small sample of inward transmission from such cases BUT->
Major limitations are small sample, onward contact tracing was only done by asking about symptoms (no clinical examination for scars or serology) and only male cases screened from the start (inclusion criteria).
Aug 3 • 4 tweets • 1 min read
OH MY GOODNESS!
I have just seen the cutest thing.
A parent picked up a mask and put it on. As he was doing this, his toddler was watching with a critical eye. Once the mask was in place, and the nose wore pinched, the little egg gave his Dad the BIGGEST smile and thumbs up!
This is someone that I know doesn’t routinely wear a mask, but even their tiny kid knows what to do and how to do it!
We absolutely should not assume anything about what kids are thinking.
They are smart!
Aug 2 • 4 tweets • 1 min read
Why aren’t people that talk about diseases spreading by touch through *visibly intact* skin and fomites accused of fear mongering?
It’s not like it’s easy to wipe and wash everything all the time!
Airborne disease is far more straightforward!
Wear a well fitted mask/respirator and either open windows or flick a switch in a HEPA/UVC device.
No, we didn’t have to “payback” deaths. Controlling disease early is not working against us now.
People are working against people. Spreading disease unnecessarily.
SARS-CoV-2 is a particle, until we breathe life into it.
It’s human activity, done without protections, that is killing us. We have to use our intelligence to reduce the harm.
Ideally, learned experts should advise government and people of the same.
Aug 2 • 6 tweets • 2 min read
4th of September 2020.
After a long battle, my Aunty, a Professor in Obstetrics and Gynaecology in Dhaka🇧🇩 , died of COVID-19. It’s coming up to the second anniversary of her death, and here we are again, sending healthcare workers into danger, without adequate protection.
Two critical errors are occurring again.
1 Downgraded pathogen from airborne transmission so adequate PPE won’t be available, especially in LMIC.
2 Vaccine supply and equity issues.
Aug 1 • 7 tweets • 1 min read
If you are in a monkeypox outbreak zone, I recommend disposing disposable masks responsibly after use, rather than the COVID-19 recycle in a bag thing.
That won’t work so well for pox. :-(
If using elastomeric, read manufacturers instructions for decontamination. ->
and check to see if CDC approved solutions are OK.
They will probably degrade some masks over time so check carefully for damage before wearing again.
I’m not going to tell anyone who or what to vote for. I too believe in democracy, not a technocracy.
However, I believe in a free and fair democracy.
I believe in a democracy informed by the most accurate information.
I believe in free (not hate) speech.
Aug 1 • 5 tweets • 1 min read
I get asked often “which respirator”…
Unfortunately there is no good answer to this. If you read the reviews, some are more likely to fit more people than others, but in reality, you have to try them out yourself.
I can tell you the kind of things I look for.
Fit. Got to be flawless.
Filtration. Minimum N95 for shopping. N99/100 equivalent for high risk close contact.
Will glasses fit? (Best to wear your mask when buying new glasses to line up pupils properly.)