At the population level, of course. But the question that’s coming up is not for source control but as PPE for individuals already wearing masks in environments they don’t control—others they encounter are unmasked, poor ventilation etc. So PPE considerations are in play as well.
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Replying to @zeynep @mugecevik
Aaron Richterman, MD Retweeted Anne Helen Petersen
Aaron Richterman, MD added,
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Replying to @AaronRichterman @mugecevik
That’s why we need guidance. It doesn’t have to be one-size fits all. There are people in poorly ventilated places around people who don’t mask. There are high-risk people: indoors or around crowds. Plus, transmissibility increase is real so need to consider potential mechanisms.
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PPE (unlike source control) is well-studied so we’re not starting from scratch. As with all things in an evolving pandemic, different contexts need guidelines. (Aaron: what if the transmissibility increase is ID50 shift? Wouldn’t masks which filter at different levels matter?)
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Replying to @zeynep @mugecevik
Plausibly, sure. But it would be surprising if we went from a pathogen w little to no (to my knowledge) epi evidence of transmission in context of surgical masks to one in which an upgrade beyond standard surgical mask made more than a small difference.
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Admittedly I am biased by my hospital experience, with 100s of personal exposures using a surgical mask +/- face shield and this being standard practice, with patients +/- on masking and occupational health contact tracing finding single digit patient to hcw transmissions
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In the end im an empiricist. If someone is particularly vulnerable & in high exposure setting of course perfectly reasonable to upgrade if they wish, tho still seems to me simple guideline of 1 surgical mask most justifiable, esp w comfort/fit issues
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766070 …2 replies 0 retweets 0 likes -
Replying to @AaronRichterman @mugecevik
I agree for hospital setting! But there, you have aggressive ventilation standards plus universal masking. The question is often coming from individuals who are forced to interact with people who don’t mask or do badly, and in poorly ventilated areas. PPE, not source control.
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Patient rooms have increased air exchanges, but that’s not always the case with touch-down areas and common spaces, like break rooms. For many, they move to surgical masks when in those spaces.
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Right. I have no opinion on the hospital setting, to be honest. It's working well and there are professionals on the job. The question I keep fielding is from people who work, for example, in a grocery store, are high-risk and their fellow workers are not the most diligent.
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They're asking what can I do to protect myself better? I mean, if we had a magic wand we'd start by paying the highest-risk to stay home, masking everyone around them well, better ventilation... Meantime, though, there are people at risk, looking for upping their own defenses.
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Replying to @zeynep @SaskiaPopescu and
And I'd like the CDC to provide us with guidelines on that, especially for frontline essential workers and/or high-risk people who want to up their own defenses. What are their options? Can make it clear that this isn't what you need for your daily walk etc.
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I think the current recs are helpful (IPC intervention strategies) but agreed that some critical skills for handling situations where folks may not be masking would be helpful. Ultimately, I think the biggest issue is people leaning more on 1-2 of the interventions & not all.
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