1/ This article is important. Skeptics say that this research only shows that infectious #covid19 aerosols exist/that we breathe them in, but that we can’t be sure that they are *enough* to cause clinical infection.

Let me add a doctor’s perspective to this uncertainty...thread https://twitter.com/apoorva_nyc/status/1293227820047634433

2/ During our peak in Boston, I worked both in the #covid19 emergency room & the medicine wards.

More Covid+ patients than I can count coughed inches away from my face.

Even those who were just talking would often start coughing/short of breath as well.

I had an N95 mask on.

3/ If someone asked me to go into one of those rooms w/ just a surgical mask on because there wasn’t an “aerosol generating procedure”, or because they didn’t believe that aerosols played a big role in spread, I would have some choice words, or let them do the honor.

4/ In real life, the academic debate over whether/how much aerosols lead to spread goes out the window when you are going into a COVID19 patient’s room; when your health is on the line; when you’re going home to family members—you’ll assume aerosol spread every time—> N95 mask

4.5/ The community setting is of course not the same as being in the hospital room of a patient w/ COVID19.

But—when spread is asymptomatic, & we know that even without symptoms, viral load can be significant; & we know even just talking/laughing produces aerosols...

5/ If we are indoors in close quarters with others, there are increasingly going to be situations —workplace, schools, salons etc— where just cloth masks should be questioned as “adequate PPE” until we know otherwise definitively.

5.5/ Yes, data is important. But when you aren’t sure, & the data is equivocal, you play conservative; you take aerosols seriously (even if < droplets)

If that means testing HEPA or other air filters, test them.

If that means making better masks, make them.

And do it quickly

6/ This reminds me of the same debate we had over masks initially— when we didn’t have enough masks, we diverted to absence of data. We said don’t mask in the community bc there was no data suggesting it works, rather than saying we really don’t know, & masks could have a benefit

7/ We now have people fighting against installing air filters bc the data for *transmission* isn’t there.

They want proof of transmission before we “waste” money on putting in safe guards that can filter air better as we head indoors for the winter.

8/ We know that these can filter small particles.

And we know that these small particles can have infectious virus.

There is a balance b/w having *all* the data, & acting quickly.

Failing to restructure indoor spaces to exchange air better feels like a mistake.

9/ Some have argued it could be a waste of $. Sure. Possibly. It could also save us *far more* $ if it slows spread.

On top of that, it could protect the health of our children; make our workplaces safer; & can reduce the impending damage of the winter.

|| Benefit > cost ||

10/ Ventilation isn’t everything, but it likely isn’t *nothing* either.

It is additive— w/ masks, hygiene, distancing, avoiding crowds etc, ventilation could seriously help us when we are spending more time indoors with many others.

11/ To those who want to do nothing without data...

This is one of the issues w/ academic medicine trying to run an emergency pandemic response. Time is of the essence. Data will always be limited.

But doing nothing can also do much harm. We need to keep moving.

12/ If multiple aerosol experts believe these filters could work, I think it’s worth trying & *testing* in a community setting ASAP

The benefits here could be huge; the cost, monetarily, could be as well, but the cost of uncontained virus in the winter is going to be much worse.