Abraar Karan
@AbraarKaran
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infectious disease doctor, researcher @stanford
Stanford, CA
Joined February 2012
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Upgrade your masks
The single best way at an individual level- even once vaccinated- to prevent infection is to upgrade the mask you have and make sure it is on when you are near others in public, esp indoors
Tight fit, high filtration. We can’t wait for the government on this
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We knew from day 1 that fit tested N95 respirators could protect people— as a doctor I wore these for two years treating patients and stayed safe. Two years later, our public health response not once even bothered to create a true program to get people fitted masks. Insane.
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Dropping public mask mandates on travel— where people are literally packed together; when they are traveling to different places where they may seed more transmission; while we are greatly under-detecting cases as evidenced by wastewater— is a costly mistake at this time.
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Future generations will look back and say “why didn’t they clean the damn air?”
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When we said to mask, they said masks don’t work
When we said to test, they said cases don’t matter
When people died, they said it wasn’t from, only “with”, covid
Skeptics provided no solutions but to downplay this
A million are dead & we are still arguing about it
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One thing I guarantee you will notice if you pay attention
Doctors who have cared for
#covid19
patients will never underestimate what this virus is capable of
The antivax, antimask pundits who have been tweeting from the safety of their home for the past two years often will
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The idea of ‘learning to live with Covid’ is wildly premature
I say this very unapologetically
Let’s first get through one friggin wave that doesn’t completely disrupt society & kill thousands of Americans before we start using that phrase?
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Weird how quickly the strategy shifted to
-disregard cases
-disregard morbidity
-disregard equity
-disregard prevention
-disregard superspreading
-disregard missed days of work
-disregard vaccination gaps
-disregard immunocompromised
All to reassure the public - “all good”
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I’m concerned abt the nearly weekly new data revealing harmful effects on organs such as the brain & heart from
#covid19
Over time, the unforeseen consequences of infection become more clear. But many are being infected in the process, reassured by pundits that they’ll be fine
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Covid is not the flu— & yet, even for those making these comparisons— since when has it been ‘normal’ to get the flu every few months?
The reason some are normalizing recurrent surges is bc they are *hoping* repeat infections don’t end up being a big problem. We don’t know this
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1/ Been saying this for a while, but I’m going to say it again. Do not indoor dine right now. Order takeout. Tip restaurants. Support businesses. But I would not be dining indoors. Last night, there were no ICU beds left at a hospital where I work in Boston.
#COVID19
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You know that moment when all the water pulls back from the beach until it’s completely & eerily empty right before a huge tsunami hits?
That was how it felt leaving the hospital today. Nearly every patient I took care of was
#covid19
positive, up until the end of my shift.
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I know there are many who are concerned about mask mandates being dropped on crowded public transit— it’s a bad public health move but it’s here for now
Two N95 models that are comfortable & can/should be used (+ can be reused) for these situations include the 3M Aura & Vflex
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The graphics in this article are excellent— this is a huge part of communications that has been missing. If you want to understand how layered interventions reduce
#covid19
spread— why masks are indispensable but not always “enough” — read this.
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Maybe I’m wrong here but I feel like the ignore it and it will go away strategy doesn’t work well for pandemics
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1/ It’s a strange feeling reflecting on the current covid19 situation. Truly feels like public officials have given up on mitigation completely. A few individuals & community organizations are trying to fight back because it need not end like this. There is more that can be done.
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Regardless of what happens with mask mandates, I would hold onto your N95 masks
Omicron is not the last variant
The gov may have short memory w/ pandemics but you don’t have to. Better respiratory protection will remain relevant — no more getting caught unprepared
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A traveler who tested neg 48 hrs prior to flight was infectious by day of flight, pre-symptomatic; using genomic analysis, traced to 4 cases of in-flight transmission
This doesn’t mean don’t get tested; it means *don’t travel unless an emergency*
#covid19
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1/ One of the truly terrifying parts of the epidemic was how quickly people made it clear they no longer cared about others
Everyone from pharma leaders to politicians to certain groups who were just “over it” also made this clear by actions
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1/ Over time, the effects of
#covid19
on heart, brain, lungs, vascular system, sensory system, kidneys & more will become better understood
Until then, any reassurance that massive levels of infection are ‘ok’ for society is a gamble—a gamble with unknown long-term costs.
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Those who are immunocompromised also wish they could be “over it”
Those suffering from long Covid also wish they could be “over it”
Those who lost loved ones already also wish they could be “over it”
Those around world waiting for vaccines also wish they could be “over it”
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If there’s no way to slow down the spread of airborne pathogens, why do we have airborne isolation rooms in hospitals, with 12 air changes per hour?
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The coverage at the hospital is slim on the weekend meaning we have to double up shifts.
I spent the entire day caring for patients—just got home at 10 pm.
Watching Trump claim he can better determine the cause of death of patients that we actually watch die— vote him out.
Wow -- Trump pushes a baseless conspiracy theory that US coronavirus deaths are overcounted because "doctors get more money and hospitals get more money" if they say people died of Covid instead of other co-morbidities they might have
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1/ If masks truly “don’t work”, why do we use N95 respirators when caring for patients with airborne diseases?
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I *have seen* a lot of messaging saying cautious or vulnerable people can easily find free N95s & rapid tests now so they should protect themselves & let everyone else return to ‘normal’
What I *have not seen* are the free N95s & rapid tests that are supposedly everywhere
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If CDC is going to put the onus back on vulnerable folks to protect themselves, N95 masks should first have been made free, ubiquitously available with multiple different options.
This would be the bare minimum. And it should have been done before public masking was dropped.
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By the time officials tell you to start masking again, they will probably be weeks behind. Not based on any expert knowledge, just based on our recent history
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1/ If you have to intubate a patient & can't reach family for them to speak one more time-- please offer the option to record a video message for their loved ones
Sounds simple--it may be the most important thing we do. If you have to add this to a checklist to remember, add it
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Fundamentally, I don’t think I’ll ever quite understand why the CDC did not prioritize improving masks for the general public. It’s an airborne epidemic. Most transmission was happening in the community. How was this not a priority? Make it make sense.
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So there was a respirator FOR THE PUBLIC for emergencies such as a PANDEMIC by 3M from 2008
How in the hell did CDC recommend cloth masks for this long instead of pushing the federal government to scale up production for every single American immediately 2 years ago?????
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Many think they’ll eventually get covid anyway so what’s the point of prevention
1. Continuous reinfections every few months with new variants is not a good thing
2. Continuous unmitigated spread contributes to development of new variants
Prevention is our only way out of this
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Writing up a case report that makes clear that immunologic consequences of
#covid19
even weeks after recovering can be devastating; it’s unbelievably frustrating how many people outside of medicine confidently assert that “you’ll be fine” when doctors cannot even assert this.
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Reality now is repeat reinfections soon after our last big wave
Do repeat infections increase risk for Long Covid, clotting, cardiovascular disease, cognitive issues, lung scarring etc?
Until we know the answers to these questions, allowing mass infections is ridiculous
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1/ Just got off a flight where we ran into heavy turbulence. The pilot quickly told us to buckle up. Seatbelts clicked immediately.
It got me thinking about trust & how it was so automatic to listen to the pilot in that moment.
For covid, who is flying the plane?
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Commentary on re-using N95 respirators, by Dr. Tsai, inventor of the filtration material used in these masks.
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Many sighs of relief that the president has finally worn a mask in public.
I am one of those.
For a second though, think about how unbelievable it is that it has taken this long—5 months, 137k+ deaths— for this to happen.
Our expectations of leaders have sunk that low.
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1/ Everyone is on-board w/ ‘protecting the vulnerable’ as long as they no longer have to do anything about it
As time passes, immunity wanes, booster gaps remain, & BA2 spreads, ‘the vulnerable’ will again become you, your family, your neighbors…no longer a nebulous ‘other’
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1/ The idea that individuals can indefinitely protect themselves breaks down quickly. Both times I was infected, my likely exposure was from a loved one who became sick first & was visiting my 1 bedroom apartment. How they got infected was less clear. It doesn't matter.
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Many individual scientists trying to sound the alarm
I don’t see any political leaders doing so
Public sentiment around masking & mitigation in general - unclear right now
What is clear:
-
#BA2
is here
-immunity wanes
-Big booster gaps
-
#LongCovid
is a problem
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There is no way to get around the reality that surges of
#Covid19
are problematic-- they result in people being sick enough to be out of work; others sick enough to be in the hospital; others sick enough to have longer term issues; normalizing surges is bad public health, period
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The rapid spread of new variants is a *symptom* of a deeper issue. We can continue to try & protect ourselves against variants--talking third doses in rich countries--OR, we can address one of the biggest underlying drivers: most of the world having little access to vaccines.
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1/ Undeniable that cases are quickly on the rise; ventilation upgrades haven't been made; & we are back to high filtration masks being your best bet in crowded high risk settings
What has changed is a few experts don't think cases matter anymore-- I disagree
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1/ It is a mistake to discount new cases just because death rate remains relatively low
Big surges of cases tells us something important: we are not good at slowing spread, which means we are betting on many things
first, that future variants will be ‘mild’ (no guarantee)
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1/ The arguments in favor of one-way masking are efforts to shift responsibility away from communities onto individuals so that some can go ‘back to normal’. Except those ‘normal’ others then get infected & eventually infect everyone else w/in homes & smaller intimate gatherings
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The more I read about the literal violence that is erupting around the use of masks, the more I am realizing that this is the symptom of a failure of leadership to unite us against a common enemy. Instead, people are re-framing this as a battle for their personal rights.
#covid19
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We could have saved many lives if:
- we treated the virus as airborne until proven otherwise
-we focused on getting *everyone* better masks from the very start
-we utilized rapid antigen tests as a public health tool rather than a medical diagnostic
/1
#covid19
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While we don’t know all the details here, I’ll say this— if you’re having dropping oxygen levels and being started on
#dexamethasone
, your discharge day shouldn’t be tomorrow.
#covid19
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Do we know the health costs of cumulative reinfections with different variants every few months?
If we don’t (we don’t) then why are our leaders so nonchalant about it?
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US Covid public health response right now is somewhere between “you do you” & “thoughts & prayers”
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If everyone is wearing high quality well fitting N95/KN95 in a crowded bus or train, you will slow transmission—esp compared to if no one is. Issue now is matter of goals: some ppl frankly no longer care about cases nor early surges. Consequences are high for all if they’re wrong
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A short thread
1/ Throughout my time working on
#covid19
response here in Massachusetts, I have come back time & time again to this single video by the head of the WHO epidemics response,
@DrMikeRyan
If there's only one thing you watch, let it be this:
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There’s a difference between being afraid of covid & demanding accountability from government & public health leaders.
Most people who are being framed as “afraid” & not “living life” are actually people that want to hold leaders accountable *before they get sick again*
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Nothing is promised to us
Immunity wanes
New variants can be more transmissible and/or virulent
Long term effects of disease or recurrent infections are unclear but concerning
We started losing ground as soon as we moved away from stopping transmission— may cost us big time
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THREAD
1/ To all my friends in their 20s/30s
Even if you don’t care about spreading to others (grandma etc), the threat
#covid19
directly poses to you is serious too.
A few reasons you should rethink going to indoor clubs/bars/gyms/rallies— all high risk for spread— right now:
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Fit tested N95s + HEPA filters work
"We found that the combination of a N95 mask that passed a quantitative fit-test and portable HEPA filter provided near complete protection against high viral aerosol loads at close range for prolonged periods of time"
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"Together, our findings indicate that BQ and XBB subvariants present serious threats to current COVID-19 vaccines, render inactive all authorized antibodies, and may have gained dominance in the population because of their advantage in evading antibodies."
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1/ Individual responsibility is insufficient to stop airborne pathogens, especially with high community transmission. Smarter engineering controls in shared spaces can prevent super-spreading; the goal should be low levels of community infections without surges.
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Salt Lake City's new mask mandate has raised the bar-- must be wearing a respirator. But they are also providing citizens w/ free KN95 and N95 respirators (cloth OK until you can get a respirator); for 1 month until surge passes
They got this right
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Those most vehemently against ‘lockdowns’ should in fact be the biggest supporters of N95s — better masking would have allowed us to keep things open and keep people safe.
Any takers? I’ll wait.
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Waiting to renew my N95 fit testing at the hospital right now.
In 2020, public health departments should have set up fit testing booths for the public + free N95 respirators. This could have avoided shutdowns, kept people safe, & stopped surges regardless of variant.
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There are low-cost means to clean the air quickly. The fact that this hasn’t been part of our national strategy says a lot about our lack of implementation. This would save lives for all airborne pathogens— & for all
#covid19
variants.
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If the covid strategy is unmitigated community spread— then the CDC, White House & others should be clear to the US public about what is and is not yet understood regarding repeat infections and the cost of those on our health over time.
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Wastewater data versus detected cases
This was a terrible time to pull back on public masking in crowded spaces that people cannot avoid
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1/ Pushing for things to return to “normal” speaks to blinding privilege
Our “normal” prior to 2020 is exactly what set us up to fail & killed many in our poorest communities
We normalized vulnerable people getting sick & working anyways — both before & during
#covid19
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One of the strangest parts of the epidemic is how Bernie Sanders, in just a few seconds, was able to easily explain that N95 masks offer better protection so if you can, upgrade your mask. Why the Director of the CDC cannot say this— instead confusing everyone in process—🤷🏻♂️🤷🏻♂️🤷🏻♂️🤷🏻♂️
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The clinical impact of Covid19 is under-appreciated . Even when surges have passed, we *regularly* see patients who, solely because of their initial Covid19 infection, have suffered other complications leading to readmissions or ongoing illness.
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We have to stop for a second & realize how crazy all of this is.
We have multi billion $ corporations (
@NBA
) forming literal bubbles through immense power & wealth to cont their business amidst disaster while the rest of us are stuck complaining about an incompetent government.
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Lack of any community mitigation essentially signs everyone up for infection— one way masking can only take you so far if everyone around you is getting infected, incl those you live with. This is far too much to expect of individuals & far too little to expect of our leaders
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Honestly the craziest point in the epidemic is when it became unpopular seemingly overnight to keep pushing for pandemic preparedness
Do people- esp public health professionals pushing for ‘normalcy’ or whatever catch phrase— realize this is the time to prepare?
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1/ At our hospital we use airborne precautions if someone has active
#Covid19
infection
We did at my previous hospital too
Because the virus is airborne
And we wear N95 masks
Because it’s airborne
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The end of mask mandates while new cases remain this high is as much politics as it is public health. And it is probably more of the former.
Upgrade your masks, at least for a few more weeks while cases come down further. Getting infected right now is not inevitable.
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Another consult — another “post-Covid” serious complication in someone with mild initial infection
Talk to docs who are actually treating patients- you’ll get a different story than you will from politicians or those with agendas to push
There is a lot we still don’t understand
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I find it very strange that some people seem to have so much concern regarding long term harms from the vaccines, yet don’t seem to have that same level of concern about long term harms from
#covid19
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Covid is both a clinical and public health problem
Clinically we have made incredible advances to reduce mortality— vaccines, antivirals, monoclonals, steroids etc
The same cannot be said on the public health front to prevent transmission
These are two different problems.
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It feels like there are (at least) two views forming around the end of mask mandates
One sees the end of mandates as the end of the pandemic & is celebrating
The other sees the end of mandates as the end of any efforts to prepare for the next wave/variant & is worried
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1/ All healthcare workers that are treating patients right now should be wearing N95 masks. Spread is like wildfire. We all risk bringing infections from the community into hospitals — from staff, visitors, & patients in whom initial screening is missing early incubation
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Working at the hospital today, treating multiple patients suffering from
#Covid19
requiring oxygen support on this shift alone. When I read that Biden & Harris won, I wanted to scream; scream in joy knowing that we will finally have leaders that listen to & support us.
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1/ Reinfections are happening yet again. And we don’t know what the health costs of repeat infections are— I certainly don’t & doubt any doctor definitively does
Any policy that disregards the costs of infections does so at the risk of the health of the population
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Covid ‘experts’ giving good news right now feels great— but, if they’re wrong; if
#Omicron
is not the end &
#LongCovid
ends up being a much bigger problem than we are appreciating now— none of them will be held accountable for the advice they gave
Not one
Remain vigilant
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The reason I got covid twice in 6 months and did not during the two years prior has everything to do with how high community transmission was during Omicron waves. Both times, I had a known exposure to someone in the home. We are only as safe as our community.
Infectious disease doctor
@AbraarKaran
suffered the same fate as many in January. Despite being vaccinated and boosted, he got COVID.
Then, just months later in May, he performed a routine test one day and found himself infected again.
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1/ Unmasked exposures & Long Covid 🧵
There is potentially a relationship between inoculum dose (amount of virus you are exposed to when you get infected) & development of
#LongCovid
Having higher early viral load may increase risk of Long Covid
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Multiple cities are now declaring
#Monkeypox
an emergency. It is one. Mobilize $$ & resources. People are tired from Covid, but this is serious & collective fatigue doesn’t change the reality. Experts have warned about this for years— we are here now.
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1/ Public health & politicians ruined one of the lowest hanging fruit in the epidemic since the start which was masking
What they should have done
1) Quickly upgraded recommendation to high filtration, namely N95, back in Feb 2020 (there were many of us who said to back then)
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So if there’s only one tweet of mine you remember — remember that there’s no point in dining outdoors if you’re going to be indoors while you do it.
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“6 feet apart” or “mask up” are cool slogans but 8 months into this epidemic, we should be communicating better than this.
People don’t need more slogans.
They need to understand the activities & scenarios that led to the spread of
#covid19
so they can calculate risk better.
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One commitment I can guarantee is that I will wear an N95 with every single patient I see during this surge, confirmed
#COVID19
or not. It’s the responsible thing to do to protect our patients & to protect ourselves; it’s a critical way to avoid in-hospital outbreaks.
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With every new study that points to the harms of letting
#covid19
infections spread uncontrolled, I want the policy makers who are saying it’s fine to respond. Where is the accountability?
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1/ Many attempts to rationalize why widespread infections aren’t a big deal, everything from “you can protect yourself” to “clinical tools”
It’s one thing to give up trying to mitigate spread; it’s another to falsely reassure people it’s not a problem & pat self on back
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6/ I’ll be frank— we appreciate your support, but we aren’t here to be admired or to get credit— we signed up for this. This was our choice. We are here literally pleading with you to think and rethink your plans this holiday. Please.
That is all we ask.
Thank you!
#covid19
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You will probably regret getting
#covid19
during this surge if you could avoid it
I truly doubt you will regret wearing a mask for a few more weeks while incidence of cases comes down even more
Risk is proportional to community incidence for any given activity
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I understand why people are attending special events that are deeply important to them despite a risk of infection
I don’t understand why anyone would unmask now in crowded settings w strangers like public transit where there is no benefit and only cost
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Lots of predictions about
#BA2
I would much rather our government prepare for the worst and be wrong
than prepare for the best and be wrong
If the last two years haven’t taught us that yet…
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If you search
#Monkeypox
on Pubmed and review even just the past few years, many tried to warn about its pandemic potential. Also— to urge controlling this in Sub Saharan Africa & helping to coordinate resources there. That Europe/US did not do anything then speaks for itself.
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