We argue that the so-called "droplet precautions" do, to a good degree, overlap with "airborne protections" (because aerosols are also nearer) which is fine, but it's important to get the mechanism right, because it's not a complete overlap, and the implications aren't the same.
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Another great paper, making the case for the predominance of airborne transmission and, crucially, focusing on practical recommendations for buildings with a realistic & nuanced discussion of the trade-offs. Three papers in key medical journals in a week! https://twitter.com/j_g_allen/status/1383073549380882438 …pic.twitter.com/cX8TGGrb07
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Our
@TheLancet paper is a work of synthesis in the service of a causal framework that best explains observed phenomenon over a year of intense data collection. I'd be interested to read a case for "it's predominantly and/or largely droplets" fits the data. https://twitter.com/dylanhmorris/status/1382827972239843330 …This Tweet is unavailable.Show this thread -
I don't mean the above as lip service. I don't see how the totality of evidence works well for an explanation that differs fundamentally, but I'd be super interested in reading that framework: not as an assumption in textbooks but as how it fits the full range observational data.
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I want to add two things that I see confused/claimed. First, see this thread and the paper itself where we explicitly discuss whether the predominance of close contact transmission implies gravity-driven droplet transmission is primary or even a lot.https://twitter.com/MackayIM/status/1383370706843410433 …
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This paper looks at totality of observed data and evidence from past year, and argues why aerosol-transmission as primary route can parsimoniously explain it all, while droplets as primary route contradicts key parts of the evidence. I'd love to read the opposite case if written.
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Second: I keep seeing claims that if it's aerosols, that means cloth or surgical masks are useless, and also what's called "droplet precautions" are useless. The aerosol experts have written so many papers on why that's not the case, and, in any case, that's not what we observe.
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The paper, while word-limited, does go into both of these topics, but as with any shift like this, I agree the implications deserves more attention/explanation, and hopefully more soon, partly because part of the problem were some flawed assumptions in multiple directions.
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And, this doesn't bind my co-authors, but I think our evidence-base is stronger for discriminating between droplets vs. aerosols, but not as much for fomites especially through resuspension etc. No, not washing groceries but.. I'd wipe down high-touch surfaces in crowded indoors.
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We briefly address this (word limit!
) but it's not correct to assume that airborne transmission necessitates either a high R0 like measles or even a uniform transmission pattern. Tuberculosis is airborne but has lowish R0—but likely also overdispersion!https://twitter.com/bobby_dread/status/1383787373134184450 …
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Another good addition for people following this topic is Dr.
@linseymarr, a true pioneer in this field (her latest in@bmj_latest, also out this week(!), was titled "Covid-19 has redefined airborne transmission").https://twitter.com/linseymarr/status/1382842521286549508 …Show this thread -
And just putting this thread here so people can get some context of how difficult it has been, for so long, to make progress.https://twitter.com/linseymarr/status/1383066390136041477 …
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Feels like an inflection point. Do read what the article linked by Dr. Karan argues: that short-range (close contact) transmission of respiratory infections is also PRIMARILY aerosols—goes against decades of claims of aerosols only/mostly being long-range. https://twitter.com/AbraarKaran/status/1384240928873844742 …pic.twitter.com/xvf2bQeES8
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