Paula Carmichael

MD in Geriatrics, Home Care Medicine, Disability Issues. LGBTQ issues. She/her/hers.

[Paula Carmichael @DrPCarmichael]

@OliveSiffleur @NukitToBeSure 100%!!! It is heartbreaking, embarrassing, and was totally avoidable

[Paula Carmichael @DrPCarmichael]

@NukitToBeSure A lot of entitled and magical thinking in my fellow US citizens. Sadly enabled by the gutting of our public education systems over the last 50+ yrs.

[Paula Carmichael @DrPCarmichael]

@NukitToBeSure is right on the money here.

[Nukit @NukitToBeSure]

I'll take this as a good-faith question and try to show which parts are fairly solid science, and where things have gone completely off the rails.

"So what changed?"- something did. We're in a kind of "my favorite planet is Pluto" kind of situation, but this time we can't just change what words mean in order to appease people who want what they learned in grade school to stay "true".

A long-held model of how most respiratory pathogens were transmitted was upended. For over 60 years, the theory was that exhaled, coughed, and sneezed droplets took a ballistic path- like a cannonball. They arced, fell, were picked up by hands, and then faces were touched, and infection resulted. If you had a little distance and washed your hands, it was felt the risk was minimal.

Around 2020 we realized that this whole model was really, really wrong.

This covers it quite well:
https://t.co/mSA5b9ZcSd

Also, this paper if you want a bit of a deep dive:
https://t.co/LGoLVkbTgw

This, on its own, doesn't seem like all that big a deal- ok, they don't just drop; it's an aerosol; it hangs in the air, maybe goes further, but at first glance it seems the kind of thing a minor adjustment in infection control would address.

Unfortunately, not so much- and the powers that be quickly realized this, which is why the CDC did not want to acknowledge airborne transmission, and you still don't hear a lot about aerosol transmission versus droplet.

It's a bigger problem than it looks like because in the same 60-year period architectural conventions have undergone massive, unprecedented changes. As various energy crises hit, the soaring ceilings, huge windows, and displacement ventilation that were implemented after the 1918–1920 flu pandemic gave way to modern, energy-efficient buildings that were nearly hermetically sealed. Every liter of fresh air in or out had to be heated or cooled depending on the season, so ventilation was minimal. High ceilings meant lower total leasable square footage- so spaces where exhalations would rise on a thermal plume, and only settle after enough time that some significant inactivation took place, were replaced with low ceilings- where exhalations were forced to drift on a lateral plane between room occupants with little space to do otherwise.

Yurts, long houses, amphitheaters, castles, almost all human lodging for a very long time was fairly well ventilated- so aerosols could escape, and pathogen loads kept somewhat reasonable. In the past 60 or so years, we made sure they could not escape.

Now, in a given day, an urban human will be tightly packed in a series of metal tubes and boxes, inhaling the exhalations of easily a thousand other individuals, within seconds of that breath leaving their mouth.

Potent infections spread worldwide very, very fast, and are very difficult to stop- because the entire infrastructure of our lives is basically ideal for sustaining infection chains.

[Paula Carmichael @DrPCarmichael]

@BriannaWu Sorry you are being attacked. May this New Year turn into something enduringly joyous.

[Paula Carmichael @DrPCarmichael]

@Sunny_Rae1 Fantastic! Thanks to all for the hard inaugural work

[Paula Carmichael @DrPCarmichael]

@triffic_stuff_ I think the road marks suggest the cyclists were driving in the wrong direction. Look especially when the parked car shifts to the left

[Paula Carmichael @DrPCarmichael]

@LauraMiers I am an MD, experienced in med necessity reviews. Allow me to DM you to send more extensive thoughts

[Paula Carmichael @DrPCarmichael]

@TartanArmyGroup @irnbru @RINewsToday Best place to park?

[Paula Carmichael @DrPCarmichael]

@michael_hoerger Big help! Please publish regularly

[Paula Carmichael @DrPCarmichael]

@broadwaybabyto Visible mold or just moldy smell?

[Paula Carmichael @DrPCarmichael]

@CarnivoraCC @scott_squires You can fail a mask test and still get benefits. Aura is a great mask but tends to get loose around the chin/ neck for many. I “flip” the top and bottom straps which gives it a better and sustained snug fut under the chin.

[Paula Carmichael @DrPCarmichael]

@KurtSupeCPA @threadreaderapp unroll

[Paula Carmichael @DrPCarmichael]

@KurtSupeCPA @threadreaderapp unroll

[Paula Carmichael @DrPCarmichael]

@gorskon These are my biggies- the likely outcomes from major health problems, saved by MD’s and pharmaceuticals:
Death from 30% burns, age 9.
Death from ruptured appendix, age 28.
Bedbound and crippled with rheumatoid arthritis age 50.

[Paula Carmichael @DrPCarmichael]

@JennaLuche @LazarusLong13 @rolalaloves Well done! Is not that hard to wear a properly fitting n95

[Paula Carmichael @DrPCarmichael]

@_keyofdestiny_ Actually, the 2021 protests showed pretty clearly that outdoor demonstrations caused no significant bump in Covid rates. Analysis of subsequent outdoor concerts show the same thing. I still think best practice is to n95 mask when in large crowds.

[Cat in the Hat 🐈‍⬛ 🎩 🇬🇧 @_CatintheHat]

Aaarrrghh! The cover-up begins…

The WHO page about Meningococcal Meningitis & its modes of transmission (including the word ‘AEROSOL’) has just been removed from their website.

Original link:
https://t.co/axt5cQa442

Thankfully there’s an archived page:
https://t.co/7OVtGJzT2K

[Paula Carmichael @DrPCarmichael]

@simonmaechling Hi!

[Paula Carmichael @DrPCarmichael]

@Suzierizzo1 Mierda-lago

[Paula Carmichael @DrPCarmichael]

@LauraMiers There are not enough barf bags on the planet for this.