Robert Roos and Lisa Schnirring * Staff Writers
May 3, 2007
(CIDRAP News) – Though there is little scientific evidence to go on, wearing a surgical face mask may make sense for people who have to go into crowded public places during an influenza pandemic, federal health officials said today. Furthermore, people who care for a pandemic flu patient at home or have other close contact with sick people in a pandemic should consider wearing an N-95 respirator, a more elaborate type of mask designed to stop virus-sized particles, the Centers for Disease Control and Prevention (CDC) advised.
CDC officials said avoiding crowded conditions and infected people are the most important precautions in a pandemic, but masks and respirators may provide additional protection. Standard precautions such as hand hygiene and social distancing should also be used, officials said.
"If people are not able to avoid crowded places, [or] large gatherings or are caring for people who are ill, using a facemask or a respirator correctly and consistently could help protect people and reduce the spread of pandemic influenza," CDC Director Dr. Julie Gerberding said in a news release.
For example, says an 11-page guidance document the CDC released, people might choose to wear a face mask when going to a grocery store or a religious service, and they might want to use a respirator when visiting a sick neighbor to deliver food or medicine.
Surgical face masks are simple masks designed to fit across the nose and mouth and catch large respiratory droplets produced by the wearer, but they also offer some protection from others' secretions. They are inexpensive and typically fit fairly loosely.
"Think of it as a way to catch and contain respiratory secretions," Gerberding said at a news briefing today. "These masks are very good catchers of those droplets, they keep your secretions contained within you."
N-95 respirators are thicker masks that are designed to fit tightly to the face and block at least 95% of small airborne particles. They must be specially fitted for the wearer. Surgical masks and N-95 respirators used for infection control in the United States are intended to be discarded after one use, though washable fabric masks are used in a number of countries.
In presenting the CDC guidance today, Gerberding said the agency is doing research to learn more about the role of masks and respirators in blocking flu viruses, but the results won't be available for months or years.
"So we decided to gather our best experts to give some practical advice," she said.
Flu spreads mainly when people come in close contact, meaning about 6 feet, with those who are sick, according to the CDC guidance. Long-distance transmission of flu viruses through the air, such as through ventilation systems, has not been proven. Sick people are most likely to spread the virus early in the illness, especially when they first start to cough and sneeze, the document says.
The CDC said people should consider wearing a face mask during a flu pandemic if:
* They have the flu and think they might come in close contact with others.
* They live with someone who has flu symptoms (resulting in possible exposure) and they need to be in a crowded public place.
* They are well and don't expect to have close contact with a sick person, but they need to be in a crowded place.
People should consider wearing an N-95 respirator if they are well and expect to be in close contact with someone who is known or believed to have the flu, and particularly when caring for a sick person at home, the agency said.
The guidance also suggests that, for necessary group meetings, everyone be encouraged to wear a face mask. Another option, it says, is to screen people arriving at a meeting and exclude anyone who has a cough or fever or has been exposed to a sick household member.
Although child-sized face masks are available, children may find it hard to wear them correctly, and the Food and Drug Administration (FDA) has not cleared them, the guidance says. Therefore, other prevention strategies, such as handwashing and social distancing, should be considered for children.
Gerberding said the CDC is not recommending that people stockpile masks or respirators now. However, she said, "This might be a good time to get one and check it out, find out what's comfortable for you. Can you even wear an N-95 respirator?"
Because respirators fit tightly, they make it harder to breathe, which can be a serious problem for people who have heart or lung disease, she said. Also, "For people who have a beard, it's just about impossible to make it fit tight enough to the face to work as an effective filter."
The CDC is stockpiling masks and respirators for use by healthcare workers in a pandemic, mainly because the supply depends heavily on imports. "We have almost 52 million regular surgical masks,
and of N-95 respirators w e have almost 100
million in the stockpile, with several million more
on order," Gerberding said.
If N-95 respirators run short during a
pandemic, face masks can be used instead—and should be used when close contact with sick people
is expected, the CDC guidance says.
Gerberding acknowledged today that it would be hard for people
to properly test the fit of an N-95 respirator on
their own, since fit-testing requires training.
"We'll be experimenting with others at the FDA
and elsewhere to see if there's a way we can help
people with that," she said.
She added that a
respirator can lead to a "false sense of
security," because if it fits poorly so that
air can leak around it, it provides less protection.
. . . "If you're going to choose a mask right
now, it's probably best to think about a simple face
mask that prevents your respiratory secretions from
infecting someone else" and that also offers
some protection from incoming droplets, she said.
"We're not
really sure what role an N-95 will play in
protection beyond caring for the sick," she
added.
In response to a question, Gerberding played down somewhat the role of masks and
respirators in business settings. She suggested that
employees should follow the same approach the CDC is
recommending for the public in general, but said the
most important thing in pandemic preparations for
businesses is to develop an overall continuity plan.
"Masks may be an extra margin of safety, but
none of the masks are likely to make a very big
difference," she said. They are "something
businesses may consider, but they wouldn't be our
priority in terms of preparedness."
The CDC
recommendations drew a positive response from two
non-CDC public health officials contacted by CIDRAP
News today.
"I think the guidance will be
useful in the context of getting standardized information out to the
public," said Jeffrey Duchin,
MD, chief of communicable disease control for
Seattle King County Public Health in
Washington
. Though public health experts don't have definitive
answers on how helpful masks and respirators will be
in a pandemic setting, the CDC's guidance is a good
source of information for people who are interested
in their use, he added.
Duchin said he senses that the
threat of a pandemic has waned in the public's
consciousness. "But when people are engaged in
discussing pandemic preparation, masks and
respirators are something they ask about," he
said.
Paula A. Steib, communication
director for the Association of State and
Territorial Health Officials, commented, "While
masks alone will not eliminate the risk of infection
during an influenza pandemic, the CDC interim
guidance is a good starting point.
"State and local public
health agencies are continuing to work with their
communities to prepare for a possible pandemic and
to ensure that citizens understand that facemasks
and respirators should be used in combination with
other preventive measures, such as hand hygiene and
social distancing."
Today's interim guidance is
intended to augment and supersede information in the
Department of Health and Human Services (HHS)
Pandemic Influenza Plan, released by the agency in
November, 2005.
The new guidance was preceded
about 3 months ago by CDC recommendations on general
nonpharmaceutical community measures to combat a flu
pandemic. The new document comes about 6 months
after the CDC called for stronger respiratory
protection for healthcare workers in a pandemic. In
guidance issued in October, 2006, the agency said
the use of N-95 respirators is prudent for medical
staff providing any direct care for pandemic flu
patients.
See also:
May 3 CDC news release
http://www.cdc.gov/od/oc/media/pressrel/2007/r070503.htm
CDC's "Interim Public
Health Guidance for the Use of Facemasks and
Respirators in Non-Occupational Community Settings
during an Influenza Pandemic" interim guidance
document
http://www.pandemicflu.gov
/plan/community/maskguidancecommunity.html
Feb 1 CIDRAP News story on
nonpharmaceutical measures recommended by CDC
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news
/feb0107pandemic.html
Oct 18 2006 CIDRAP News story
"HHS backs respirator use in caring for
pandemic flu patients"
http://www.cidrap.umn.edu/cidrap/content/influenza
/panflu/news/oct1806masks.html
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New section of emergency.cdc.gov: "Emergency Preparedness and You"
The possibility of public health emergencies arising in the United States concerns many people in the wake of recent hurricanes, tsunamis, acts of terrorism, and the threat of pandemic influenza. Though some people feel it is impossible to be prepared for unexpected events, the truth is that taking preparedness actions helps people deal with disasters of all sorts much more effectively when they do occur. To help, Centers for Disease Control and Prevention (CDC) and the American Red Cross have teamed up to answer common questions and provide step by step guidance you can take now to protect you and your loved ones.
http://emergency.cdc.gov/preparedness/
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Preparing for a pandemic influenza outbreak involves everybody. The threat of pandemic influenza is real, and America needs leadership from respected community members to prepare our towns and cities, reduce the impact of pandemic flu on individuals and families, and reduce or even prevent serious damage to the economy. ...
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