Pandemic Flu Masks

I was discouraged reading this after having just purchased some masks, but I've bolded a paragraph toward the bottom that gives me hope. If we realize the limitations going in, then we can take greater precautions.

Don't count on masks if bird flu strikes

Devices offer little protection, could lead to false sense of security

Updated: 5:52 p.m. ET April 27, 2006
WASHINGTON - If a worldwide flu epidemic strikes, don’t reuse a face mask — and don’t assume, either, that it will offer a lot of protection, the Institute of Medicine said Thursday.

That’s the bottom line from an anxiously awaited probe requested by the government as it stockpiles supplies in case a flu pandemic begins.

If it does, millions undoubtedly will turn to masks, raising a dilemma for the prestigious scientific organization: There’s little evidence about whether masks truly block the influenza virus — and if they can, just how much protection they offer.

Without that information, wearing masks might spur a false sense of security, perhaps encouraging people to go into crowds or near infected patients when instead they should have stayed away.

“We don’t want to say, 'Don’t use it,' but don’t expect to be fully protected if you do use it. That’s a tough public health message to get out,” said Dr. Donald Burke, a professor of international health at Johns Hopkins University who co-chaired the IOM panel.

'Last resort'
Hence, “respiratory protection is the last resort to control infectious spread,” the report notes.

Health workers use masks — simple surgical masks or better-filtering ones called N95 respirators — to keep from breathing their own germs onto vulnerable patients, and to protect themselves from specific respiratory diseases, such as tuberculosis.

The masks are supposed to be used once and discarded. Anticipating a staggering demand if the bird flu or some other super-strain of influenza sparks a pandemic, the Department of Health and Human Services asked if such masks could be reused, to conserve supplies.

No, the IOM report concludes.

“We’re not surprised,” said William Raub, who oversees emergency preparedness at HHS, which has placed an initial order of 150 million masks for a national stockpile.

“While masks have a role to play, we must discourage people from an undue reliance on them,” he added.

The report shows the government should buy more, said Jeff Levi of the advocacy group Trust for America’s Health. Much smaller France, he said, has ordered 200 million N95 masks.

Raub said officials would reconsider federal stockpile levels once the initial order was in, but that hospitals and state officials should be stockpiling their own masks, too.

The bigger question is one the government didn’t ask: If different masks really block influenza, the IOM panel noted, calling for urgent study of that issue.

Flu can spread three ways:

By hand. Someone sneezes into his hand and then grabs a doorknob that you touch, or shakes your hand.

By large droplets of virus, if someone is in the direct path of a sneeze or cough. Those heavy droplets fall quickly to the ground.

By tiny particles, which can stay suspended in the air for far longer periods.
No one knows which of those methods is most important.

But, the IOM said, surgical masks aren’t designed to block tiny airborne particles, just larger ones. Thus, they probably would be of most use when worn by infected patients, to help cover coughs and sneezes.

One size doesn't fit all
While the N95 respirators haven’t been tested to see how effectively they block flu virus specifically, they are designed to block small particles and would be a logical choice for health workers. But N95s must be individually fitted to users’ faces so that air doesn’t seep into the sides, a problem for men with facial hair. Also, they come only in certain sizes, with none for children, and they’re uncomfortable to breathe in for long periods.

Regardless, if someone with flu sneezes on any mask wearer, the outside is contaminated, so users must remove them carefully to avoid infecting themselves, the IOM panel stressed.

More expensive reusable masks do exist, but there is no good way to decontaminate and reuse surgical masks and standard disposable N95s, the panel concluded.

It listed one exception: Someone could reuse his or her own N95 if the outside were protected from surface exposure, such as by placing a disposable surgical mask over it, stored it carefully to avoid creases or damage, and the user thoroughly washed hands before and after removal and rechecked the fit with each wearing.

What about using a handkerchief or some other improvised mask? They’re not likely as protective as even a surgical mask might be, but the panel hesitated to discourage use — assuming that some protection would be better than none. Generally, the tighter the fabric weave, the better.

Independent Team Declares Pandemic Level 4

H5N1 Pandemic Level 4 Declared by Research Team Citing 23 Clusters and Case Histories


"Using the World Health Organizations own guidelines for determining pandemic level status, an independent research team has gathered enough factual H5N1 data to substantiate the need to declare a "Pandemic Level 4" response to Avian Flu. The Information that supports this claim is derived from scientific and medical papers, laboratory reports, government, geneticist, virologist and other experts around the world. The combined effort focused on a three year period from 2003 to the 2006, listing 23 documented clusters of H2H. The report is based on millions of Internet searches and thousands of hours verifying data."

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About the Flu Pandemic Stage
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The World Health Organization (WHO) has developed a global influenza preparedness plan , which defines the stages of a pandemic, outlines the role of WHO, and makes recommendations for national measures before and during a pandemic. Currently, according to WHO, we are at state 3.
This stage is defined as: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.

There has been considerable criticism of WHO's reluctance to raise this to alert level 4 which is defined as: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

(PRWEB) April 23, 2006 -- "Clusters of H5N1 infections," says one research member "They may indicate human to human transmission of H5N1 influenza or alternatively indicate common exposure to the virus from an environmental source, presumably avian. A cluster here is defined as two or more individuals: 1. Who are in close physical contact, 2. Who become very sick with a respiratory disease, and 3. at least one of whom is a confirmed H5N1 influenza case.

China - 2003 February
A family of 5 from Hong Kong visited Fujian province in Mainland China early in 2003. A mother went with two daughters and one son on January 25, 2003. The 7 year old girl developed respiratory symptoms and a high fever on January 27/28. She developed pneumonia on January 28 2003. The father joined his family in Fujian province on January 31. His 7 year old daughter died on February 4, 2003. She was not tested for H5N1 and was buried in Mainland China. Her 33 year old father became ill on February 7 with fever, cough and blood in sputum. The family returned to Hong Kong on February 9 2003. The father was admitted to a hospital in Hong Kong on February 11. He died on February 17. He was tested and was found to have been infected with H5N1. The 8 year old boy in the family became ill with a cough and fever on February 9, 2003. He was tested and was also found to be positive for H5N1, but recovered. Peiris et al 2004

Viet Nam - 2003 December
A 12 year old girl from Ha Nam became ill on December 25 2003 and was admitted to a Hanoi hospital on December 27 2004. She died on December 30 2003. This is first confirmed death from H5N1 in Viet Nam. Her 30 year old mother became ill on January 1 2004 and died of H5N1 influenza on Jan 9 2004. Corresponds to Olsen et al. cluster 1

A 7 year old girl Nam Dinh died on December 29 2003 of acute respiratory distress. No samples were tested from this girl. Her 5 year old brother was admitted to the hospital on December 29 2003. He died 17 days after becoming ill. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 2

Viet Nam - 2004 January
A family cluster of H5N1 infections was observed in Thai Binh province in January 2004 (see also WHO update 15). A 31 year old man was hospitalized on January 7 2004 with severe respiratory illness. He died on January 12. No samples from this patient were tested for H5N1. His 28 year old wife became ill with a severe respiratory illness on January 10, but recovered. H5N1 infection was confirmed. The man’s two sisters, 23 and 30 years old, became ill on January 11 and January 10, respectively. Both died on January 23. H5N1 infection was confirmed in both sisters. Corresponds to Olsen et al. cluster 3

Viet Nam - 2004 January-February
A 9 year old girl in Dong Thap province became ill with diarrhea, but no respiratory symptoms on January 28 2004. She died of acute encephalitis on February 2 2004. She was not tested for H5N1 influenza. Her 4 year old brother became ill with diarrhea on February 10 2004, also with no respiratory symptoms. He developed encephalitis and died of respiratory failure on February 17 2004. This 4 year old boy was tested for H5N1 influenza and found to be positive.

Viet Nam - 2004 July
A 19 year old man in Hai Giang province became ill on July 23, 2004 with symptoms of fever, breathing difficulties and hemorrhage. His 22 year old female cousin exhibited the same symptoms. They both died on July 30. They were not tested for H5N1 infection. The man’s 25 year old sister became ill with the same symptoms on July 31 2004. She died on August 2 2004. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 5

Thailand - 2004 September
A family cluster of H5N1 and severe respiratory illness was observed in September 2004 in Kamphaeng Phet province. A 11 year old girl from Kamphaeng Phet province became ill on September 2 2004 and died of pneumonia on September 8 2004. She was not tested for H5N1 infection, but was considered to be a probable H5N1 fatality. Her 26 year old mother lived in Bangkok but visited her daughter to take of her while she was ill. The mother became ill on September 11 2004 and died on September 20. H5N1 infection was confirmed. The girl lived with her 32 year old Aunt. The Aunt became ill on September 16 2004 but recovered. H5N1 infection was confirmed. The Aunt’s son became ill with a respiratory infection. This cluster is considered one of the most convincing cases of human-to-human transmission of H5N1 because the mother lived in an area which had no infected birds, Bangkok, and was exposed to H5N1 by her daughter (who did have exposure to sick chickens). Corresponds to Olsen et al. cluster 6

Viet Nam - 2005 January
A 45 year old man from Thai Binh became ill with a respiratory illness on December 26 2004 and died on January 9 2005. H5N1 influenza was confirmed. His 42 year old brother, from Hanoi, was hospitalized on January 10 but recovered. He was also confirmed to be infected with H5 influenza. A third 36 year old brother was reported to be positive for H5N1 infection, but did not exhibit any symptoms Corresponds to Olsen et al. cluster 7

A 17 year old boy from Bac Lieu was hospitalized on January 10 2005. He died of H5N1 influenza on January 14 2005. His 22 year old sister also had respiratory symptoms and was hospitalized. Her fate and H5N1 status were not reported.Corresponds to Olsen et al. cluster 8

A 35 year old woman from Dong Thap became ill on January 14 2005. She died of H5N1 influenza on January 21. Her 13 year old daughter became ill on January 20 2005. She later died. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 9

Cambodia - 2005 January
A 14 year old boy from Kampot province became ill with respiratory symptoms and died on January 20 2005. He was not tested for H5N1 infection. His 25 year old sister became ill on January 21 2005. She traveled to Vietnam to receive care but died on January 30. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 10

Viet Nam - 2005 February
A 21 year old man from Thai Binh province ate meat from a sick chicken on February 8 2005. He developed a high fever and cough on February 14 2005. On February 20, he was admitted to an hospital with severe pneumonia. He received oseltamivir (Tamiflu -75 mg twice a day for 7 days) on February 23. He was discharged from the hospital on May 13. H5N1 infection was confirmed. His 14 year old sister cared for him from February 14 to February 21. She became ill with a mild cough and mild fever on February 23 2005. H5N1 infection was confirmed. She received an initial treatment with oseltamivir (Tamiflu -75 mg once a day) from February 24 to February 27. She was admitted to a hospital for observation on February 24. At this time, she had no fever but did have a mild cough. On February 27, she developed a high fever and severe cough. On February 28, she received oseltamivir (Tamiflu -75 mg twice a day for 7 days). She was discharged from the hospital on March 14 2006. The girl had no contact with poultry prior to becoming ill. A 26 year old male nurse, who cared for 21 year old male patient mentioned above, was admitted to a hospital in early March. H5N1 infection was apparently detected. The 80 year old grandfather of the 21 year old and 14 year old brother and sister was reported to be infected with H5N1. He did not exhibit any symptoms. Corresponds to Olsen et al. cluster 11

Viet Nam - 2005 March
Five members of a family in the city of Haiphong were all reported to be infected with H5N1 influenza and were hospitalized on March 22 2005. The 35 year old father, 33 year old mother, 13 year old daughter, 10 year old daughter and 4 month old daughter were all infected. Corresponds to Olsen et al. cluster 14

Indonesia - 2005 July
An 8 year old girl from Tangerang, a suburb of Jakarta, became ill on June 24 2005 and died on July 13. She was reported to be H5N1 positive, but was later judged by the WHO not to have an acute H5N1 infection. Her 1 year old sister became ill on June 29 2005 and died on July 9. She was not tested for H5N1 infection. The father of the two girls, a 38 year old man, became ill on July 2 2005 and died on July 12 2005. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 15

Indonesia - 2005 September
On September 10 2005 a 37 year old woman from Jakarta died of confirmed H5N1. Her 9 year old nephew became sick with respiratory symptoms. Initially he tested postive with PCR. It was later reported that he was not infected with H5N1.

On September 20 2005 a 21-year-old man from Lampung province developed symptoms. On September 24 2005 he was hospitalized; H5N1 infection was confirmed. On October 4, the 4 year old nephew of this man became ill. H5N1 infection was confirmed.

China - 2005 October
On October 8 2005, a 12 year old girl from Hunan province became ill with respiratory symptoms. She died on October 16. Her 9 year old brother became ill with respiratory symptoms on October 10 2005. He was confirmed to be infected with H5N1. He was released from the hospital on November 12 2005.

Thailand - 2005 October
A 48-year old man from Kanchanaburi province became ill on October 13 2005 and died on October 19. His 7 year old son became ill on October 16, but recovered. H5N1 infection was confirmed in both cases.

Indonesia - 2005 October
On October 19 2005, a 19 year old woman from Tangerang became ill. She died on October 28. Her 8 year old brother became ill on October 25. H5N1 infection was confirmed in both cases.

Indonesia - 2005 November
On November 3, two brothers, ages 7 and 20, from West Java province developed fever and respiratory symptoms. They died on November 11. On November 6, their 16 year old brother also developed fever and respiratory symptoms. He was hospitalized on November 16. H5N1 infection was confirmed in the 16 year old. The 7 year old and 20 year old were not tested for H5N1.

Turkey - 2006 January
The first reported case of H5N1 influenza in Turkey occurred in a 14 year old boy from Dogubayazit, in the province of Agri. He died on January 1 2006. His 15 year old sister died of H5N1 influenza on January 5 2006. The 12 year old sister of these children died on January 6 2006. The 6 year old brother of these children was hospitalized.

Two brothers, 5 and 2 years old, from Ankara province were reported infected with H5N1 on January 8 2006.

A 9 year old girl and her 3 year old brother, from the Dogubeyazit district in Agri Province, were reported infected on January 9 2006.

A 14 year old girl from the Dogubayazit district of Agri province became ill on January 4 2006. She died of H5N1 influenza on January 15. Her 5 year old brother also became ill on January 4 2006. He was confirmed to be infected with H5N1 influenza.

Indonesia - 2006 January
On January 6 2006, a 13 year old girl became ill. She died of H5N1 influenza on January 14. On January 8 2006, her 4 year old brother became ill. He died of H5N1 influenza on January 17. Their 14 year old sister was hospitalized with respiratory symptoms on January 14 2006. Their 43 year old father was hospitalized on January 17 with respiratory symptoms. On January 19 2006, a 9 year old girl from a neighboring village was hospitalized, but later recovered. H5N1 infection was confirmed.

Iraq - 2006 January
The first person reported to contract H5N1 influenza in Iraq was a 15 year old girl from the town of Raniya. She became ill on January 2 2006 and died on January 17. A US naval Medical Research Unit located in Cairo, Egypt confirmed infection with H5N1. Her 39 year old uncle, who cared for her while she was sick, became ill on January 24 2006. He died of a respiratory illness on January 27. H5N1 infection was confirmed in the uncle.

Indonesia - 2006 February
A 12 year old girl from Boyolali, Central Java became ill on February 19 2006. She died on March 1. H5N1 infection was confirmed. Her 10 year old brother also became ill on February 19 and died February 28. He was not tested for H5N1.

Azerbaijan - 2006 March
A 17 year old girl from Salyan Rayon died on February 23 2006. H5N1 infection was confirmed. Her first cousin, a 20 year old woman from Salyan Rayon died on March 3. H5N1 infection was confirmed. This woman’s 16 year old brother died on March 10. H5N1 infection was confirmed. A 17 year old girl, who was a close friend of this family, died on March 8. H5N1 infection was confirmed. A 10 year old boy from Salyan Rayon became ill. H5N1 infection was confirmed. A 15 year old girl from Salyan Rayon became ill. H5N1 infection was confirmed.

Egypt - 2006 March-April
A 6 year old girl from the Kafr El-Sheikh governorate became ill. H5N1 infection was confirmed. Her 1.5 year old sister became also became ill. H5N1 infection was confirmed.

"We substantiate the claim based on the data above to elevate the current WHO pandemic level from 3 to 4," says Cornelius Robertson team spokesman. "The importance of recognizing level 4 is a key to minimizing public heath impact and the welfare of the general public. By informing the public of pandemic flu alert from level three to four would increase survivability from this natural flu cycle. Pandemics run in historical waves every 30-45 years

Robertson continues, "Evidence points to global organizations and world governments reacting in the same manner as in the 1918 Spanish Flu pandemic which killed Tens of millions. Either for social economic reasons, geographical differences there is much foot dragging and under reporting in areas of like Africa the Middle East and Southeast Asia."

In this information age, using online resources of thousands of data bases, the team compiled its opinion. "We say facts are facts. We are declaring Pandemic level 4 for Avian Influenza."

Sources
http://www.who.int/csr/disease/avian_influenza/updates/en/index.html
http://www.cdc.gov/ncidod/EID/vol11no11/05-0646.htm
http://www.promedmail.org/pls/askus/f?p=2400:10001:1001333047747557695
http://www.recombinomics.com
http://www.fluwikie.com
http://www.avianflutalk.com