Can masks help stop flu spread?

By Nick Triggle
Health reporter, BBC News


One of the abiding images of the swine flu outbreak is the pictures from Mexico of people wandering the streets wearing masks.

And as the disease has spread from country to country, reports have emerged of people purchasing all sorts of products on the internet.

But while the scramble is understandable, experts are sceptical about just how useful they are.

Professor John Oxford, a virologist at leading London hospital, The Barts and the London, said: "Really, there is very little evidence that masks actually offer much protection against flu.

"I think handing them out to the public as has happened in Mexico just destroys confidence."

Health staff

It is these sorts of issues that has prompted officials from groups such as the World Health Organization and England's Health Protection Agency to steer clear of calling for them for general public use.

While Mexico has handed them out to members of the public, most other countries, including the UK, are just reserving them for health staff.

Others, such as Belgium, have bought some for flu patients, while several, including Spain, have handed them out to passengers on planes returning from affected areas.

It is believed there are enough masks for half the NHS workforce, but officials are already in discussion with suppliers about ordering another 30m to help cope if a pandemic develops.

Health workers have been told to wear them, along with special gloves, if they are in contact with potential victims.


“ The problem is that when someone sneezes they tend to take a mask off. I think masks give people a false sense of security ”
Dr Ronald Cutler, of the University of London
Professor Oxford believes this approach is right.

"They are the people who will be most likely to be coming into contact with the virus and the ones who could be passing it on."

The Department of Health has focused on getting what are known as respirator masks. These have filters, which stop a person breathing in some particles in the air.

They are much more effective than the standard surgical masks or dust masks that are sometimes used by builders.

However, none of the masks can stop 100% of the particles getting through and become less effective once they become moist.

Instead, they are better at stopping the virus getting out.

Spread

Dr Ronald Cutler, deputy director of biomedical science at the University of London, said: "If you sneeze with a mask the virus will be contained so from that point of view if everyone wore them it might stop the spread.

"Or you could get the people with flu wearing them, but by the time they are diagnosed it could be too late.

"And the problem is that when someone sneezes they tend to take a mask off. I think masks give people a false sense of security.

"They are not bio-chemical suits. Masks are obviously just covering one part of the body so your hands and clothes could all have the virus on and when you take them off you will infect yourself.

"However, because people are wearing a mask they will think they are protected and may go into crowded areas.

"The best advice is to wash your hands and cover your mouth when sneezing."

Glamorgan University expert Gail Lusardi agreed.

"Masks alone will not prevent spread of the influenza virus and basic hygiene measures like hand washing, safe use and disposal of tissues and cleaning of environmental surfaces are key to preventing infection transmission."

She also said it was important they were correctly fitted - some of the more expensive respirator masks are molded to fit the face unlike standard masks that can be bought on the high street.

And she added: "A mask can be worn continuously for up to eight to 10 hours, but must be replaced if it is taken off at any stage."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/...lth/8024605.stm

Placebo for the public, essential if used properly for medical staff.

__________________ 
She's a mite whimsical in the brainpan.

Masks – people love to rag masks. Normally I’d just keep my thoughts to myself, but I guess I’ll toss in my two cents.

“Can masks help stop flu spread?”… in a word – YES.

Very simply a virus is a very small package of genetic material surrounded by a protein coat. They have no means of locomotion. Their like little biological landmines, they just sit there waiting for something to come in contract with them.

Two main ways of transmission are through touching, and aerosolizing (sneezing or coughing).

If we can reduce the number of times we touch thing and then stick our fingers in our eyes, ears, nose and mouth, then we reduce the odds of it getting in.

Sounds pretty simple? Set up a video camera and watch how many times you unconsciously stick you fingers in your face - it’s unbelievable, rubbing your eyes, scratching your nose, and many unmentionables. Suffice it to say, we’re fascinating the invasion.

So when you see people walking around with masks, in my opinion, as ridiculous as a mask is for preventing airborne viruses from getting into our lungs, a mask is an excellent reminder that we can’t stick our fingers in our face. Oh, but you’ll keep trying – put one on for a couple of hours and see. Trust me; you’ll continue to try to scratch your nose.

If you were in an environment where someone was aerosolizing the virus (excessive sneezing and coughing), gaps in the mask would allow the virus to enter quite easily - the simple physics of a volume of air taking the path of least resistance around the material verses going thru the material.

A properly fitted mask is difficult to achieve (even for professionals), and it’s impossible to maintain over time. But absent of being stuck in a room/subway/bus with a hacking infected person, a mask can help us from injecting the virus into ourselves after coming in contact with the virus with our hands.

So quite simply, yes, masks CAN help. When used in conjunction with some simple common sense, frequent hand washing, reducing exposure to crowds, to name a few, masks can help.

I wish reporters would quit ragging on masks and educate instead.

The problem is...common sense.. Im afraid most people just dont have it.

__________________ 
She's a mite whimsical in the brainpan.

From a public health standpoint with careful evaluation of where to spend the money available - handing out masks is indeed a measure that can be discussed at length with no clear result. Overall not too useful.

For the individual - the equation is much easier. If you know how to put on and wear a mask (not talking about surgical masks) and get rid of it properly it reduces your likelyhood of infection greatly.

Just - most people truly know not how to and will not ever learn how to use a mask properly. No matter the instructions or training given. So for them it still is a little better than no mask but the small benefit begs the question wether it is worth the money and discomfort.

Surgical mask? Sure, put it on the patient. And why not wearing it in low risk situations just to keep your hands off the face and the people at a distance.

I think handing out masks to the public provides a false sense of security - it's to keep people maintaining their routines, going to work, shopping, etc, keep the economy going.

__________________ 
Originally Posted by Judith Anne -
If that doesn't make sense, you just aren't on the right meds.

Well naturally there are more studies now than when I looked at this before and I had to read them ... ALL,

So it looks like there are a few more studies documenting influenza aerosols. Figures, just when I need confidence I'm writing policies that actually are supported by the data. And of course, there is no Cochrane review on respirator use. Health care worker safety always takes a back seat to disease research.


PRO: FLU IS AIRBORNE, NOT JUST DROPLET SPREAD:

Measurement of Airborne Influenza Virus in a Hospital Emergency Department.

Inactivation of influenza A viruses in the environment and modes of transmission: a critical review.


THIS ONE USES CONFUSING TERMINOLOGY BUT THEY INCLUDE A DEFINITION. They use the terms 'droplet transmission' and 'contact transmission' interchangeably.

Quantifying the routes of transmission for pandemic influenza. Notice that while they claim aerosols are likely, they stick to the conclusion droplet spread should be assumed until further studies are done. From the standpoint of facing a risk, I'd think it should be the other way around.


N95s SPECIFICALLY ADDRESSED USING A TEST VIRUS, RESULT, N95 NOT SUFFICIENT:

Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are surgical masks?


CON: DROPLET SPREAD IT IS, NOT AIRBORNE (Apparently now in the minority of the study results, Psst, don't anyone tell CDC, it is not a PC point of view since there is no practical solution.) :

Transmission of influenza A in human beings.


AND ANOTHER INTERESTING RELATED MEASURE OF AIRBORNE TRANSMISSIBILITY:

Human HA and polymerase subunit PB2 proteins confer transmission of an avian influenza virus through the air.


REVIEWING MOST OF THESE SAME STUDIES, CIDRAP CHOSE TO EMPHASIZE DROPLET SPREAD OVER AEROSOL. I think even for careful scientists it's hard not to look for data that confirms what you already believe.

CIDRAP says the following:


What we need is a good study testing the two kinds of masks and no mask in an actual situation. Since we have Tamiflu as a safety back up, and the best conditions to test this I sure hope someone in a big hospital thinks to undertake a study.


On another note, my feeling is if the mask keeps your hands out of your eye/nose/mouth, it has done its job.

Thank you - my point exactly.

As the story goes.... In the 1960's, the US and Russia were trying do develop an instrument that they could use to write notes in space. The US spent tens of millions of dollars developing the "Space Pen". Design reviews, performed extensive research, let out contracts, produced 80 pens. The Russians picked up a pack of pencils and went to space.

Sometimes you've just got to do what makes sense.

Nice story!

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

I have N95 "respirators" (I'm uncomfortable refering to cloth masks of any type as "respirators"), rubber half face respirators w/canister filters, and full face respirators w/canister.

Despite the fact that two of the three would stop the inhilation of the virus, there are other factors that are often overlooked. Protective clothing and the removal of protective clothing and respirators after egressing from a contaminated area. Unless you have a spray down area that you can use to kill any active virus before removing the PC's and respirator, you're still going to potentially expose yourself to any virus droplets that may have gotten on to your clothing. If you disturb the droplets when removing the gear, you may end up inhaling the virus anyway...despite your precautions. And just how much will it take to infect you?

I've worked in respirators in contaminated areas of nuke plants, and it requires a deliberate effort to to disrobe cleanly. And that is dealing with a more forgiving contaminant.

Make me wonder if there is any way short of complete isolation to prevent exposure to the virus. My plan is more of a layered protection beginning with bolstering my immune system with supplememnts and vitamins. Next is maintaining personal distance from others (six foot rule), and personal hygiene. Then will come the various respirators depending on the perceived severity of exposure. After having worked in the nuke industry I've learned how to keep my hands away from my face. There's nothing like having your face scrubbed with potassium permanganate a time or two to teach you...

My plan is more of a layered protection beginning with bolstering my immune system with supplememnts and vitamins. Next is maintaining personal distance from others (six foot rule), and personal hygiene. Then will come the various respirators depending on the perceived severity of exposure.

Same here. I bought a half face respirator with P100 Hepa filters. I know it won't filter 100% of the virus but it offers some protection so I'll use it.

I think the media reports of masks being ineffective so people shouldn't worry about them is a simple supply and demand. There aren't enough so the PTB want to maintain as many as possible for healthcare workers and they don't want citizens to panic when they all sell out in 30 mins and they can't find them.

I placed an order for N95 masks and P100 filters on Saturday and a second on Sunday from one place and they still haven't shipped. They have a "we are extremely busy and are shipping in the order orders were received" note on their website so I'm going to just wait them out. Luckily I decided to pickup some more filters from another source or I would have zero and be more nervous.

__________________ 
"He said to me I understand now why the 1st and 2nd Amendment are the way they are. The 1st Amendment is the most important and if they take that one away then you should start loading your weapons." Ron Suskind 8/5/2008


(\__/) This is Bunny. He says "Those who would
(='.'=) give up essential liberty to purchase a little
(")_(") temporary safety deserve neither liberty nor safety."

Sometimes a story is just that, a story.

Snopes on the Russian space pencil story.

Darn, you were doing so well until this point. While significantly poor nutrition hurts the immune system, there is no convincing evidence 'extra' nutrition boosts it.

And if you were severely malnourished, you'd be sick even without the infection.

Just don't waste too much energy and money on those vitamins and supplements.


The taste of those waterless hand cleaners is a good reminder you've put your hand in your mouth as well. It makes for a nicer training tool that pp scrub I would think.

Ahhh...you so underestimate the power of the placebo, Skeptigal...

With the lack of verifiable evidence regarding so many of the "remedies" we employ, I suppose it comes down to doing that which has worked for us in the past. Or, as what we believe has worked in the past. A matter of perspective, perhaps. A doctor friend of mine once pointed out that a conclusion I had reached (on an another, unrelated issue) was based on anecdotal evidence. I replied that it was in a purely clinical sense, but the only "clinical" study I was interested in involved only one subject...me.

I've always had a very robust immune system. Generally, while others around me are dropping out with the seasonal flu and various cold viruses each year, I just seem to walk right through it as though invisible to the viruses. Despite having been exposed to both the '57 and '68 pandemics as a kid, I've only had one case of the flu in my life, and that was in 1986. Must have been a seasonal virus, but it was a doozy. While all this is somewhat comforting, I still take nothing for granted, though...especially as I get older.

As to the PP lesson: I've always been very good at learning lessons through observing others who don't. I've never had to endure the embarrasment of "the purple stain" myself.

Notice: This thread has been moved from forum Flu Discussion to forum Flu Prep.

Note: This is an automatically-generated CE thread move message. If you have a problem with this thread move, please try to find something that's actually important to worry about. If you can't, and really want to take up our time over this, please post your complaint at the Help Desk. Be sure to include the thread number. Thank you.

__________________ 
.
.

Roscoe and Miss Priss

In the US, I think one of the more beneficial aspects of wearing a face mask is that they are so uncommonly seen in public, if someone sees anyone wearing them here, they think 'illness', are unnerved, and will stear clear of the wearer. Good way to help keep everyone from invading one's personal air space if nothing else.

And as people have said in the past, even if wearing one doesnt prevent inhaling things, it really cuts down on face touching.

__________________ 
.
.

Roscoe and Miss Priss

Staff in flu frontline ‘given wrong masks’
Aug 2 2009 by Tim Lewis, Wales On Sunday
http://www.walesonline.co.uk/news/w...91466-24294276/


NHS workers battling swine flu have been put at extra risk after being given the wrong protective face masks, nurses have claimed.

A mix-up with orders of specialised fluid-repellent masks has left frontline workers having to wear ordinary surgical masks which are virtually useless at protecting those wearing them against swine flu.

One NHS worker from Swansea, who asked not to be named, said: “We were all given masks but then they sent out a letter to everyone to say they were the wrong ones and would have to be replaced.

“Some of the nurses queried straight away whether they were the correct ones and it turns out they weren’t.

“Staff are still wearing the masks but they know they do not offer a lot of protection.”

The nurse said many of the workers felt let down by the failure and said it had increased the risk of doctors and nurses catching the disease.

She added: “The people working on the front line have a right to be protected properly but that’s not happening because of someone’s mistake.

“It is one of the problems with having a devolved health service, nurses in England have the correct ones but we don’t because the people who run the systems are different.

“Staff are always willing to get stuck in and it’s been a very busy time with the swine flu problems.

“Is it too much to ask that they have the right equipment?”

Martin Semple, of the Royal College of Nursing in Wales, said he had been made aware of the problem by a number of members.

He said the problems were disappointing as a strategy to deal with a flu pandemic had been in place for some months.

“As far as I know there was an issue with delivery and this prevented the right masks being given to the workers,” he said.

“They have a supply of the masks needed to deal with the patients with the most serious forms of swine flu but they don’t have the droplet-repellent masks.

“At the moment the pressure is on the GPs and the community workers but if there is going to be a surge of cases in hospitals, we need to make sure they have the right equipment in place to deal with it.”

A Welsh Assembly Government spokeswoman responded to the claims by saying a stock of the correct masks was now available for distribution.

“As a precaution, Local Health Boards (LHBs) were issued with face masks which are in general use in the NHS in a surgical/theatre setting,” she said.

“We have fluid-repellent masks available and these are being sent to LHBs this week for onward distribution.”

Conservative spokesman for health Andrew Davies AM praised the work of frontline staff in the NHS and said it was vital protection was being given to those dealing with patients with the virus.

He said: “It is a concern if the safeguards that are supposed to be there are not in place.

“Dealing with the effects of swine flu is obviously going to be expensive for the Government so they need to ensure no money is being wasted unnecessarily.

“Plans to deal with a major outbreak have been in place for some time so it is critical that we get it right for the people of Wales.

“Overall, the sharing of information about the outbreak between the parties has been good and it is very welcome.

“My only criticism would be that we don’t have a dedicated ‘flu line’ and website like they do in England, as this would help to relieve some of the pressure on the NHS workers who are working tremendously hard at this time.”

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

These disposable respirator masks (Micromask) with antimicrobial protection are being marketed by a firm in the UK. They are made by the same company that produced the nanomask.

http://www.nanomask.co.uk/~NEW_MicroMask_T5000/37.htm

Nanomasks and their fake N-95 rating and giant gaps? First responders being furnished masks with one-way valves to be placed on the patient, when the valve works the other way? Copper impregnated silly masks?

The mask thing is pretty much a mess. Sceptigals' post pretty well covered it, but it's a bit of common sense. too.

There's facial touching, people keeping a distance because you look like a cootie, viruses hitching a ride on a droplet, and airborne. A good mask works for the first 3, and not so well on the 4th.

Still worth it, for the first three reasons.

Masks won't be encouraged by the PTB, for the reasons mentioned by the other poster. Bird flu taught a lesson about mask supply. Backorders for medical users grew to 6-8 months.

The makers of Nanomask were originally tasked by the U.S. Department of Defense to develop filtration technology to be used by the military. Their new product, Micromask, does not suffer from the short shelf-life of the Nanomask, and appears to be a barrier mask that filters microbes in the very small range, including viruses.

http://findarticles.com/p/articles/...4/ai_n13609658/

http://www.nanotechwire.com/news.asp?nid=1939

Today, I also came across a WebWire article about another facemask, the NT-V (Pasture F550G™ and Pasture A520G™ masks ) capable of filtering viruses that is under development in Europe, and soon to be on the market. http://www.webwire.com/ViewPressRel.asp?aId=99614

Emergency Filtration Technologies is expert at writing their own PR Web-type articles, and presenting them as 3rd party, real news. Frankly, I don't believe anything they say.

My viewpoint is that of an ex-wholesale customer, one who was furnished masks from them with fake NIOSH certification, and amateurish, careless fit.

The Internet is rife with fake news, written by those tooting their own horn. It isn't against the law, you can basically say anything you want.

If I want to go this minute and publish some fake clinical trials with made-up figures for mask efficiency, nobody will stop me. I just pay the PR services and they'll distribute for me.

In the future, hopefully there will be more "trusted site" types of certifications.

By Heather Mayer


From Mexico to China, people around the world have worn face masks to protect against swine flu, also known as the H1N1 virus. The problem? Experts could never say for sure whether such masks actually help you stay healthy.


Now, the largest study to date on the subject suggests they do. When sick people and their families wear surgical face masks and wash their hands within the first 36 hours of symptoms, healthy family members are indeed less likely to get seasonal flu, researchers say. They think the results may apply to H1N1 as well.

So far, 94,512 people around the world have been infected with swine flu, and there have been 429 deaths in 122 countries.

"Many people believe that coughs and colds are so infectious that there is really no stopping them, however hard we try," says Benjamin Cowling, Ph.D., the lead author of the study published this week in Annals of Internal Medicine. "Our results suggest that is not the case, and, in fact, transmission can be effectively stopped with just some simple precautions."

Cowling, an assistant professor in the School of Public Health at the University of Hong Kong, and his colleagues looked at 407 locals who came down with regular seasonal flu (not swine flu), which was confirmed by laboratory tests. Health.com: Four things you didn't know about natural medicine

The patients were divided into three groups: One group (the control group) was told about the benefits of a healthy diet and lifestyle in terms of preventing illness; members of a second group were told to wash their hands with soap and water frequently, including when they coughed or sneezed, and to use an alcohol hand rub after touching contaminated surfaces; and a third group's member were told to wash their hands and use surgical face masks as often as possible at home (except when they were eating or sleeping).


The researchers found that when people and their families wore face masks and washed their hands within 36 hours of the first symptoms, their family members were less likely to become infected. However, those who started using masks or washing their hands after the 36-hour time period had passed saw no benefit.

In tandem with hand-washing, face masks seem to work better than hand-washing alone, but the authors could not conclusively prove which intervention was responsible for the drop in infections of family members.

Cowling says these results definitely apply to the H1N1 virus too, because swine flu is transmitted much as seasonal flu. Health.com: Young and short of breath: Could it be COPD?

Currently, the Centers for Disease Control and Prevention, which partly funded the study, does not generally recommend the use of face masks or respirators to prevent the spread of H1N1 because of their uncertain benefit. The CDC says face masks are recommended only if a person is at a very high risk of flu complications (such as someone who is pregnant), and has no other choice but to be the primary caregiver for a family member with H1N1. (The CDC says this scenario should be avoided if at all possible.)

Despite the new study, CDC spokesperson Artealia Gilliard says the current guidelines for face masks will not change. "This is another piece of great information, but this study alone shouldn't have an effect on current CDC guidelines about face masks," says Gilliard.

It's still not clear whether healthy people who wear face masks in public can prevent themselves from getting the flu. The researchers could not determine whether the masks worked because they prevented sick people from transmitting viruses or if they helped prevent healthy people from picking up the virus. Health.com: Eat smarter in your 30s, 40s, and 50s

Cowling explains that the healthy subjects had a hard time wearing the face masks and were less likely than sick people to do so. Only about half of the sick patients used the face masks routinely, and some people in the control group wore them because their use is common in Hong Kong.

"Perhaps with better compliance even more transmission could be prevented," he says.

Cowling says his research is different from past studies because it didn't rely on symptoms alone; the researchers swabbed the healthy family members at three-day intervals and confirmed infections in the laboratory. (Nearly one-third of people with influenza may not develop classic flu symptoms, such as a cough, fever, and muscle aches.) Health.com: Diabetes and sick days: Expect a rise in blood sugar

Henry Chambers, M.D., the chief of infectious diseases at San Francisco General Hospital, says the results aren't surprising. The flu virus is spread in droplets in the air, so face masks may help prevent sick people from spreading these infectious droplets, or healthy ones from inhaling them, he says. Hand-washing helps kill germs too.

According to Gilliard, the CDC recommends that people with H1N1 remain home for seven days after symptoms begin, or until they've been symptom free for at least 24 hours. People should avoid touching their eyes, nose, and ears, because infections can get started when the virus is picked up by the hands and transmitted to the face. Health.com: The healing power of tea

Health Library
MayoClinic.com: Swine flu (H1N1 flu)
Cowling believes a surgical face mask is an effective way to reduce flu transmission; even the World Health Organization advises health-care workers to wear face masks when treating H1N1 patients, he says. He adds that N95 respirators, which are tight-fitting masks that filter airborne particles, are also beneficial, but they can be uncomfortable to wear for long periods of time.

A second study in Annals of Internal Medicine found that long-term treatment (more than four weeks) with the antiviral drugs zanamivir (Relenza) and oseltamivir (Tamiflu) could prevent seasonal flu with symptoms, but did not prevent symptom-free influenza infections. In terms of efficacy, there was no difference between the two drugs, according to the research team from Stanford University School of Medicine.
http://www.cnn.com/2009/HEALTH/08/0....flu/index.html

Well, Teal, how you can tell fake from real NIOSH certification is another story, I'm sure. But you're the expert. The rest of us are doing our research to find a reasonably-priced mask that offers some kind of protection against viruses. Is anything for sure on the internet? Heck no. Same as the real world. I think we all know that.

Certified masks are marked with "Particulate Respirator NIOSH" and it's rating (N95, R95 etc.)

A couple of years ago I did some fit testing on the general public (randomly chosen people brought in specifically for the test). The idea was to see how people did when handed instructions and told to follow the instructions to put the mask on properly and then fit test using a quantitative method. The results made me pay attention, that's for sure. Crossed straps, folded edges, strange placement of straps all equalling a very bad fit. Some masks (those certified for public health emergencies) have special instructions, simplified to make proper donning and doffing easier to understand for those who will not be fit tested and instructed.

During this period, I also had the opportunity to try on many manufacturers masks and be fit tested in them with a quantitative process. I can tell you first hand, fit does matter. Comfort level will affect your ability to wear the product for any period of time. Some were stifling just sitting still. Others more tolerable.

The article above is interesting if only that it appears, perhaps, that the masks make people more aware of face touching and hand infections. Still a good tool. Evidently, even the cheeseball masks that we all saw so many pictures of in Mexico had a positive effect.

Cumulatively, all good news. A barrier, is a barrier I suppose. If we were talking about H5N1 on the loose, I don't think I would be nearly as calm about the whole, mask vs. no mask argument though.

I got a letter from NIOSH about the fake certification number on the Nano.

I didn't need the letter to tell they couldn't pass, though. They sucked.

After years of playing with these things, I like the 3M 9211 and the Moldex 2300, for different reasons.

http://www.cdc.gov/niosh/npptl/topi...t/n95list1.html

list of approved masks.

http://www.flu.gov/fluexperts.html#09828
Q:Can I use an N95 mask for more than one day?

A:N95 respirators should be worn only once and then thrown away in the trash.

When using facemasks or N95 respirators, please remember:

* Used facemasks and N95 respirators should be taken off and thrown away in the regular trash so they don't touch anything else.
* Avoid reusing disposable facemasks and N95 respirators if possible.
* After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand rub.

Very little is known about the benefits of wearing facemasks or respirators to help control the spread of influenza in community settings.

In areas with confirmed influenza virus infections, the risk for infection can be reduced through a combination of actions. No single action will provide complete protection, but an approach combining the following steps can help decrease the likelihood of transmission. These actions include frequent handwashing, covering coughs, and having ill persons stay home, except to seek medical care, and minimize contact with others in the household.

People should consider wearing a facemask during a severe influenza (flu) outbreak if:

* They are sick with the flu and think they might have close contact with other people (within about 3 feet);
* They live with someone who has flu symptoms (and therefore might be in the early stages of infection);
* They will be spending time in a crowded public place and thus may be in close contact with infected people; or
* They are well and do not expect to be in close contact with a sick person but need to be in a crowded place.

During a severe flu outbreak, people should limit the amount of time they spend in crowded places. They should also consider wearing a facemask while in crowded areas.

People should consider wearing a respirator during a flu pandemic if:

* They are well, but expect to be in close contact with people who are known (or believed) to be sick with flu; or
* They are taking care of a sick person at home.

In these situations, people should limit the amount of time they are in close contact with those who are ill, and should consider wearing a respirator. If a respirator is unavailable, the use of a mask should be considered.

Respirator use should be in the context of a complete respiratory protection program in accordance with Occupational Safety and Health Administration (OSHA) regulations. Information on respiratory protection programs and fit test procedures can be accessed at http://www.osha.gov/SLTC/etools/respiratory. Staff should be medically cleared, fit-tested, and trained for respirator use, including: proper fit-testing and use of respirators, safe removal and disposal, and medical contraindications to respirator use.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

Another method to note and train away from face touching, dip your fingers in some jalapeño pepper juice and wipe it off with a dry paper towel. You will note your habits very quickly.

(Uh, don't touch your sensitive bits in the bathroom either. For men, your Johnson won't fall off, but you might wish it would. Women, I don't even want to think about it.)

__________________ 
"We face an unusual short term situation that may continue for a long long time." DantesPeak My stuff is just the ravings of an old man at a computer when the porno server is down. Any advice given by me should not be followed....by ANYBODY. I guarantee you my cynical attitude is NOT beneficial to your happiness.

Towards the end of the summer, I preserve chiles from the garden. It's amazing how fast you realize you shouldnt touch your eyes, etc. And you remember, at least until the task is completed.

It never occurred to me to put such heat on my hands as a training technique however.

__________________ 
.
.

Roscoe and Miss Priss

Nurses Association demands medical masks be mandatory to protect against swine flu
By Richard Sisk and Erica Pearson
DAILY NEWS STAFF WRITERS
Saturday, September 5th 2009, 4:00 AM
http://www.nydailynews.com/ny_local..._flu_fears.html


Nurses across the state {NY} are demanding medical masks that effectively protect them from swine flu.

A day after scientists said health care workers who come in close contact with flu patients should wear an N95 respirator, the New York State Nurses Association rallied its 37,000 members.

In an open letter to State Commissioner of Health Richard Daines, the association called for respirators to be standard in New York, saying airborne germs are a "clear hazard for workers."

"Surgical face masks are not sufficient and particles can get through," said registered nurse Renee Gecsedi, the association's director of education practice and research.

Claire Pospisil, spokesperson for the State Department of Health, said the state's current guidelines are adequate and that nurses will be protected by mandatory vaccinations.

N95 respirators, which have filters and a tight seal, can be up to 12 times more effective than surgical masks against airborne swine flu germs, according to Institute of Medicine scientists, who advise the federal government.

As nurses worried about their own health, federal officials urged day care and Head Start workers, as well as parents of kids under 5, to take special swine flu precautions.

"We know this is a young person's flu," said Kathleen Sebelius, U.S. secretary of Health and Human Services. "Children less than 5 years old are at higher risk for complications. Children spread flu quickly."

She said little kids and people in close contact with them should get the regular flu shot now, and added that feds plan to quickly distribute the H1N1 vaccine to day care and Head Start centers once it is available.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

In between the surgical mask and the N-95 vented mask is the N-95 unvented mask. These feel OK at first, but after any activity, or where it is warm,

The vented masks cost a bit more, but the unvented can be miserable. Shop carefully.

Also, N-95 masks are sold in "childrens" sizes. They are really masks made for the Asian market. They really don't fit kids. You're better off getting the soft and flexible 3M 9211, or that good pleated mask (forgot the name) and using duct or medical tape to make it fit a kid. If it isn't a dire emergency, kids have no business out, anyway. I fully expected during bird flu to see somebody in the grocery store with masks on their kids.

CDC keeps N-95 recommendation in H1N1 health worker guidance
Lisa Schnirring
http://www.cidrap.umn.edu/cidrap/co...protection.html


Oct 14, 2009 (CIDRAP News) – The US Centers for Disease Control and Prevention (CDC) today issued eagerly awaited recommendations on pandemic H1N1 infection control in healthcare settings, which affirms its earlier guidance on N-95 respirators but spells out other options for when the respirators are in short supply.

New features in the 17-page report include criteria for identifying suspected influenza patients, suggested isolation periods, methods for balancing isolation precautions, and a more detailed hierarchy for prevention controls.

On Sep 3 the Institute of Medicine (IOM) affirmed the CDC's original guidance that healthcare workers caring for H1N1 patients wear fit-tested N-95 respirators, not surgical masks, as protection against the virus. The IOM report also called for more research on flu transmission and the efficacy of different respiratory protection methods.

Today's CDC guidance came with a caveat that the recommendations will be updated if new information becomes available.

N-95 use in pandemic H1N1 settings has been somewhat controversial; some professional groups oppose routine use of N-95s in flu settings because research on their efficacy has been inconclusive, and many workers find them uncomfortable to wear for long periods.

Recent research has not exactly settled the score. One unpublished study conducted at a hospital in Beijing found that N-95 respirators greatly outperformed surgical masks in protecting workers from flu viruses.

Another study published earlier this month in the Journal of the American Medical Association showed mask protection as rivaling that of N-95s. Some experts, though, have pointed to shortcomings of that study, such as a lack of a control group to account for health workers becoming infected outside the workplace

Hierarchy of preventive steps

In today's guidance the CDC advised facilities to use a hierarchy of controls to prevent flu transmission, starting with eliminating potential exposures such as postponing elective visits by patients who have influenza-like symptoms.

Engineering controls were next, which might involve installing partitions in triage areas or other public spaces. Administrative controls included employee vaccination and enforcing rules about working when sick and implementing respiratory or cough hygiene strategies.

Personal protective equipment (PPE) was ranked lowest on the hierarchy list, because it is the last line of defense when other measures can't be controlled.

The CDC emphasized that focusing on the three other prevention levels could reduce the reliance on PPE. "This is an especially important consideration during the current year, when shortages of respirators have already been reported by many healthcare facilities," the guidance states.

Specifics on N-95s, isolation

The CDC based its N-95 recommendation on several factors, including low levels of population immunity to the new virus, the rise of virus activity before the vaccine is available, and the increased risk of complications in some healthcare personnel, such as pregnant women.

Given that the respirators are likely to be in short supply, the CDC recommends reserving them for situations when protection is most important, such as during aerosol-generating procedures.

When shortages exist, the CDC urges facilities to consider prioritizing respirator use, keeping in mind workers' intensity and duration of exposure, personal risk factors for complications, and vaccination status. Workers who don't receive N-95s should receive surgical masks.

Because patients with more severe illnesses are likely to shed the virus longer than those with milder infections, the CDC recommends a longer isolation period for hospitalized patients.

It says isolation precautions for those with flu symptoms should continue for 7 days after illness onset or 24 hours after fever and respiratory symptoms subside, whichever is longer. Longer periods may be needed for certain patients, such as those with severe immune system compromise or those who may be shedding antiviral-resistant viruses.

Some opposing views

Today's release of the CDC guidelines drew a mixed reaction from the Society for Healthcare Epidemiology of America (SHEA).

Though SHEA praised the CDC's call for a multipronged approach for preventing flu transmission in healthcare settings, it knocked the N-95 respirator recommendation. SHEA said in a press release that it had urged the CDC, based on clinical and scientific evidence, to replace its N-95 recommendation with surgical masks for routine care of flu patients.

Mark Rupp, MD, president of SHEA and an infectious disease specialist at the University of Nebraska Medical Center, said in the statement that N-95s aren't necessary or practical for protecting healthcare workers and their patients against the H1N1 virus. "The best science available leaves no doubt that the best way to protect people is by vaccinating them," he said.

When the IOM issued its report last month, the Association of Professionals in Infection Control and Epidemiology (APIC) also criticized the recommendation to wear N-95s, saying that the guidance fails to take into account many practical and logistical problems linked to their use, such as discomfort, costs, shortages, and the difficulty of fit testing.

The World Health Organization recommends only standard and droplet precautions for healthcare workers who have routine contact with flu patients. Canada recently called for N-95 use only during aerosol-generating procedures.

SHEA suspects that the CDC was pressured by labor unions to recommend N-95 respirators, despite evidence that they don't offer any extra protection in droplet transmission diseases such as pandemic H1N1.

Continuing to recommend N-95s for routine care of flu patients might have unintended consequences, Rupp said in the statement. "We could actually put healthcare workers at greater risk by further reducing an already short supply of a device that is needed for high-risk procedures such as bronchoscopy by using it for routine care."

He said the N-95 debate has distracted hospitals and clinics from attention toward investing in other measures for controlling the spread of the virus, such as rigorous application of basic infection control tactics and rapid identification and separation of patients who have the virus.

"We understand the role of the CDC in providing reassurance during a period of evolving evidence, and we urge the CDC to continue to revisit its recommendations as new data becomes available," Rupp said.

__________________ 

"I don't want to make money. I just want to be wonderful." - Marilyn Monroe

Don't anthropomorphize viruses. They hate that.

http://www.cidrap.umn.edu/cidrap/co...respirator.html

Reanalysis changes findings in respiratory protection study
Robert Roos News Editor


Nov 5, 2009 (CIDRAP News) – A reanalysis prompted by reviewers has changed the conclusions of a study comparing N-95 respirators with surgical masks, raising questions about earlier findings that the N-95 devices were clearly more effective in protecting healthcare workers from respiratory illness.

Raina MacIntyre and colleagues first presented their findings at a medical conference in mid-September, reporting that N-95s, compared with no respiratory protection, reduced the risk of confirmed influenza in hospital workers by 75%, whereas surgical masks had no protective effect. The findings were hailed by some experts as a landmark in a field where few clinical studies have been done.

But at the Infectious Diseases Society of America (IDSA) annual meeting last week, MacIntyre's team presented a new analysis of their data, made at the request of peer reviewers. The reanalysis excluded the control group of unprotected workers. The result was that workers who wore N-95s still appeared to be better off than those with surgical masks, but the differences were no longer statistically significant.

Some press reports and critics of the study—which has not yet been published in a journal—characterized the reanalysis as a retraction of the earlier report. Critics also suggest that the study influenced the recent recommendation by the Institute of Medicine (IOM) that healthcare workers should wear N-95s when caring for H1N1 patients. MacIntyre was a member of the committee that wrote the IOM report, issued in September.

But MacIntyre says the reanalysis was not a retraction. She asserts that the study results still indicate a real difference in levels of protection, but the changes requested by the peer reviewers left the study "underpowered" to show significance. Further, she says the IOM panel considered only published studies in making its recommendations.

The new development adds another chapter to the controversy over whether healthcare workers should, as recommended by the Centers for Disease Control and Prevention (CDC), wear N-95s when caring directly for H1N1 influenza patients. The devices are designed to filter out at least 95% of tiny airborne particles.

N-95s are often in short supply and are more expensive than surgical masks. Some professional groups, including the Society for Healthcare Epidemiology of America (SHEA), oppose routine use of N-95s in flu settings because research on their clinical effectiveness has been inconclusive, and many workers find them uncomfortable to wear for long periods.

The CDC, in issuing interim recommendations for protecting health workers from H1N1 flu last month, maintained its earlier guidance that workers in close contact with flu patients should wear an N-95. But the agency listed that step as just part of a comprehensive set of precautions, and said that when N-95s are in short supply, they should be reserved for high-risk situations such as aerosol-generating procedures.

Original analysis
As reported previously, MacIntyre and colleagues, of the University of New South Wales in Australia, recruited more than 1,900 workers at 24 hospitals in Beijing. They were divided into four groups: surgical masks, fit-tested N95s, non-fit-tested N95s, or control (no respiratory protection). The volunteers wore their assigned form of protection for 4 weeks and were monitored for illness for 5 weeks.

According to the report presented at the Interscience Conference on Antimicrobials and Chemotherapy (ICAAC) in September, the authors found that surgical masks had no protective effect. In contrast, the N95s, compared with the controls, were linked with a 60% reduction in risk for any respiratory illness, a 75% reduction in flu-like illness, a 56% decrease in lab-confirmed respiratory illness, and a 75% reduction in confirmed flu. The reductions met the test of statistical significance.

However, the researchers found that fit-testing of the N95s—recommended by manufacturers to keep air from leaking around them—made no difference in protection.

Before presenting their findings at the recent IDSA meeting, the research team ran a new analysis to satisfy the concerns of reviewers, MacIntyre told CIDRAP News by e-mail.

One change was to drop the control group of unprotected hospital workers, because of the reviewers' objection that those workers were not randomly assigned to not wear protection. MacIntyre explained that her team had to use a convenience sample of workers from hospitals where mask-wearing was not the norm, because the Chinese workers would not accept being randomly assigned to doing without respiratory protection.

The other change was to make statistical adjustments to allow for the possibility of different risks of infection among the various hospitals in the study, MacIntyre said.

After those changes, the differences between the N-95s and surgical masks lost their statistical significance. "When the P value [test of significance] was adjusted for clustering and multiple testing, [there was] no significant difference between N-95 respirators and medical masks for the four primary outcomes," states the team's slide presentation, supplied by the IDSA.

Though the differences were no longer significant, the attack rates in the N-95 group were consistently lower than in the medical mask group, the team reported. They said their post hoc analysis indicated that the probability that this happened by chance is only 3.4%.

Conclusions undermined?
But Dr. Neil Fishman, president-elect of SHEA, said the team's new report signals a real undermining of the conclusions presented earlier. He is director of healthcare epidemiology and infection prevention and control in the University of Pennsylvania Health System.

"I'm certain that if you talked to the investigators, they'd say it's not a retraction, it's just a reanalysis. But at some point you have to look at what your data is telling you," he told CIDRAP News. "You can't keep changing the analysis if you don't get the answer you want. This is definitely a different answer than the first analysis."

He asserted that a failure to show that N-95s provide better protection than surgical masks is "consistent with what we know about clinical transmission of flu among humans. . . . There's no clinical data in humans that this disease is transmitted by any other means than large droplet particles"—the kind that simple masks could block as effectively as N-95s.

As for the special statistical analysis indicating that the lower attack rates in the N-95 wearers probably represented a real difference, Fishman said, "I'm concerned that it's a statistical aberration."

Fishman also said, "It appears that he IOM recommendations were based largely on this study," as MacIntyre served on the committee that wrote the IOM report.

He said the IOM report heavily influenced the CDC's recent interim recommendations, and added, "So now we have a public health policy that's based on a flawed study, and more significantly, OSHA [the occupational Safety and Health Adminstration] has said they're going to enforce the guidance."

MacIntyre, however, insisted that the reanalysis still suggests a real difference between the two types of respiratory protection.

"The study [as presented at IDSA] was not a retraction at all—it was unfortunate that I was unable to attend the conference and clarify this," she said. The findings were presented at IDSA by a colleague.

"What was presented at IDSA is that the rates of infection were double in the surgical [mask] arm compared to the N95 arm for all outcomes, and statistical testing (bootstrapping) shows this is over 97% likely to be a real difference, but the P value (test for significance) just loses significance," MacIntyre said. "What this means is that the study still shows a likely superiority of N95s . . . but the study was probably underpowered to pick up statistical significance when we removed the control group."

She added that the rates of all illness outcomes in the control group "were higher than in the surgical [mask] or N95 groups, so removing over 500 health workers from the analysis also contributed to the P values losing significance."

MacIntyre further commented, "The changes we made in the analysis were in response to reviewer comments when preparing the paper, but there is no clear 'right' or 'wrong' analysis. My conclusions are still that N95s are superior."

As for the IOM report, she stated, "The IOM recommendations were never based on my study, as it was not published, but on the large body of experimental data on fit and filtration which show overwhelming superiority of N95 respirators. . . . I would certainly wear an N-95 respirator if I were exposed to infectious patients."

MacIntyre said her team is currently working to get the study published in a journal.

See also:

Sep 17 CIDRAP News story "Study on respirators versus masks hailed as landmark"

Oct 14 CIDRAP News story "CDC keeps N-95 recommendation in H1N1 health worker guidance"

Sep 3 CIDRAP News story "IOM affirms CDC guidance on N95 use in H1N1 setting"

Oct 2 CIDRAP News story "Study suggests masks rival respirators for flu protection"

CDC interim recommendations on infection control for H1N1 in healthcare settings
http://www.cdc.gov/h1n1flu/guidelin...ion_control.htm

__________________ 
.
.

Roscoe and Miss Priss