In response to @TalkJennie and this document advising how NHS Trusts should respond to pressure from workers to allow widespread FFP3 use in hospitals. https://twitter.com/IPS_Infection/status/1366709890660642817

Aerosols that are produced mechanically, once released will still behave like aerosols produced by breathing, of the same size, when it comes to assessing viability of SARS-CoV-2... because all other parameters remain the same.

Seems unwise to dismiss this evidence.

It is well established, that R is not a good way to define the route of transmission. R is a measure of the quantity, not the route of transmission. TB is well established as airborne with a low R=0.8

If you wait for SARS-CoV-2 to have the same R as measles, before you recognise it as airborne, it is possible that no other disease will ever be classified as airborne and you would have to declassify TB as airborne.

The danger of this poor strategy is that there will be ongoing transmission of SARS-CoV-2 which will continue to allow adaptation, and R may rise, causing further danger to all of society.

Yes, there is evidence of greater risk to healthcare staff compared to the community. Australian data indicated at one point more than 20% of infections were occurring in HCW. Contact tracing indicates at least 85% of those occurred at work. https://twitter.com/njbbari3/status/1328669298194149383?s=21

You make the staff sound greedy, or cowardly in this. Yes, the staff have a preference to remain healthy, as is their right. They also want to protect their family, as is their duty.

Quite a low statement.

The @NHSuk has had over a year to sort the problem of fit testing staff out. There is no excuse for the fact that a single person remains untested.

It’s the persistent dissemination of very poor science& absence of OHS safety culture that has allowed this to remain unattended.

The level of evidence is HIGH ENOUGH to commence an effort to save workers from preventable disability and death. Any country that commenced airborne protections in hospital is well ahead of those that haven’t in terms of reducing worker deaths. The NHS record on this is shameful

Quoting statistics from a time that we didn’t even test asymptomatic persons routinely, will give a very flawed chain of transmission. In Australia, it is quite clearly demonstrated that covid doesn’t just appear in homes. A school child or worker brings it in. Both need fixing.

The data also shows that no PPE (in homes) is worse than poor PPE (in ED and on wards) which is in turn worse than good PPE with great engineering and source control (in ICU).

Speculative? No. This is evidence right under your nose that you are choosing to ignore. You are also choosing to exclude all evidence from around the world that respirator use works. Singapore, Vietnam, Australia and others have all used respirators and find they add safety.

Here is a hospital that spent the vast majority of 2020 in a community that had active #COVID19 outbreaks. It has not contributed or sustained those outbreaks itself due to good engineering and airborne level PPE. https://twitter.com/NjbBari3/status/1355052492954890245

This evidence has been superseded and should no longer be cited. Multiple samples of air have cultured live virus, including the paper cited by WHO itself. Attached is just one paper of many.

https://www.cidrap.umn.edu/news-perspective/2020/04/study-finds-evidence-covid-19-air-hospital-surfaces

Incidentally this level of evidence has never been achieved for another airborne pathogen before. Requiring it, while simultaneously observing thousands of workers get sick and hundreds die, was a crime.

Actually there is evidence of respirators giving much greater protection. I have already cited one hospital, there are many others. At this time this statement is just untrue.

WHO meta-analysis July 2020 found respirators may give at least 20% additional protection over FRSM.

To have this information for all this time, watch thousands of HCW getting sick and some dying was just the most hard-hearted unethical policy and position to take.

There is no role to do RCT’s on humans when the non-inferiority test cannot be passed, as is the case for respirators vs FRSM. Respirators are clearly superior using observational data. An RCT in this intervention is now unethical.

Stop asking for this data, it’s cruel.

This is just a bizarre paragraph to gaslight workers. Of course masks don’t protect the eyes, and we are not talking about fomite transfers (which play a dubious role at best).

There is no difference to the worker regarding hand washing when removing or adjusting a mask.

Another paragraph blaming workers and implying they are unable to do the most basic tasks and therefore unworthy of protection.

Let me make this abundantly clear. Social distancing amongst staff is NEVER going to happen.

The nature of our clinical work means that we must be in each others space and close to patients. That’s what makes PPE even more important.

Stop using this excuse to blame workers.

See this... open your eyes and recognise healthcare cannot be delivered in a socially distanced way between staff.

It’s a mad proposal, again designed to gaslight.

If it is tea rooms then the NHS is responsible for providing safe break areas either outdoors or by filtering the air in tea rooms.

If it is at computers and desks, then the NHS is also responsible for spacing these out and ventilating these areas.

No excuses.

Another paragraph designed to gaslight. Yes, of course you will need all the other levels of airborne mitigation, but then why the failure at the last level? Respirators?

Only reason would be the false economy of thinking you can save some money, or hubris.

Do not try to confuse workers by saying respirators are not needed, and that we should uproot the furniture that is screwed into the floors instead or open non existent windows.

NHS has failed to provide engineering solutions. The least it could do is provide respirators.

No, we don’t have to prove ourselves worthy of protection by passing a hand washing champion contest.

Yes, hand washing is important, but compliance is likely no different between hospitals using airborne precautions and not. So this is entirely invalid.

Yes!

Of course patients should be protected from one another! If they can wear FFP3 then they should! More importantly, patients that are covid negative should all be protected from each other by using engineering controls; spacing walls, doors, ventilation, filtration.

It has been a horrific thing to watch the apathy towards airborne transmission of covid allow patients to go in to hospital with one thing, and come out with covid... or die!

The only reason there is not sufficient supply of FFP3 in the UK is because of the denial of airborne transmission of COVID19.

No excuses.

You’ve had 1 year to buy supplies already.

Pivot to reusables.

Fine, buy some goggles too. Then you will finally give NHS workers the same protection as Vietnam does.

Another poor excuse.

Respirators are not comfortable, but unless you have respiratory issues, there is no evidence that they cause CO2 retention to a clinically significant level, or hypoxia.

We wear ours in Australia for four hours at a time, no issues.

These are not valid reasons.

Also, FRSMs tend to slip much more often than respirators. So touching will be at least as common with FRSM as with respirators.

Try making an effort to achieve zero community covid, because that is the only time to work with humans without respiratory protections.

Otherwise, invest in reusables, we are in for a long war, not a skirmish.

The conclusion of your guidance is chilling.

Suppress the workers now, or they will speak up forever?

We will never forget what you did to us. You and all your group at the top...

and we will never be silenced.

@threadreaderapp please unroll