Will Nurses Work During a Pandemic?

[Rescuer]

Re: Will Nurses Work During a Pandemic?

Thanks for the welcome.

The scary thing is that our community has supplied and I have been told by our sheriff that he has not prepared and if he needs our supplies he will come get them.

I strongly recommend that you keep you preparing information to yourself.

Many new scary things going on in disaster management at all levels.

[Laidback Al]

Re: Will Nurses Work During a Pandemic?

Thanks for the welcome.

The scary thing is that our community has supplied and I have been told by our sheriff that he has not prepared and if he needs our supplies he will come get them.

I strongly recommend that you keep you preparing information to yourself.

Many new scary things going on in disaster management at all levels.

Surviving a pandemic, as well as rebuilding after a pandemic, is a community affair. It requires more than a few families that stockpiled food and water. While you may want to keep your family preps secret, there is a need to urge your community as a whole to prepare. No matter how much food and water you have stocked up, you will eventually run out. Once a pandemic is over, rebuilding will be necessary. But that will only happen if you trust your neighbors in your local community.

The time to build that trust is now, before the we have the start of a pandemic. With enough trusted friends and neighbors you should be able to withstand any demands to give up your preps to others during a pandemic. You and the other members of your trusted group will also be in a better position to start to rebuild once it is over.

[sharon sanders]

Re: Will Nurses Work During a Pandemic?

Welcome Rescuer.

[Sally Furniss]

Re: Will Nurses Work During a Pandemic?

CBN Report: Surgical Masks May Provide Significant Aerosol Protection


By Eric Toner, M.D., February 15, 2007


http://www.upmc-cbn.org/report_archi..._02152007.html


The relative protection afforded by surgical and N-95 masks is an important issue that is prompting much debate in the process of planning for outbreaks of infectious respiratory diseases such as SARS or an influenza pandemic. In an article published recently in the American Journal of Industrial Medicine, Y. Li and colleagues from The Hong Kong Polytechnic University report the results of their study comparing the in vivo protective performance of surgical masks and N95 respirators [1]. The authors found that N95 respirators filtered out 97% of a test aerosol while surgical masks did almost as well, filtering out 95% of the aerosol.

Methods
The authors used a KCl-flourescein solution aerosol as a viral simulant. KCl is the test challenge aerosol recommended by the National Institute for Occupational Safety and Health (NIOSH), and flourescein was added as a visual marker to gauge the degree of KCl penetration. Each of 10 subjects (half men and half women) was tested wearing each kind of mask. The masks were fitted properly, and the subjects were tested at rest and while walking on a treadmill up to 6.4 km/hr (4 miles/hour). The KCl solution was sprayed on the mask twice every 10 minutes, for a total of 14 times, from a distance of 1 meter away using an atomizer.
The degree of filtration of the challenge aerosol was measured in two ways. First, the concentration of KCl in the 4 layers of the exposed N95 and the 3 layers of the exposed surgical mask was determined. Second, the degree of flourescein staining on the portion of a subject’s face covered by the mask was quantified.

Results
The estimated size of the most penetrating aerosol particles reaching the mask was 0.1-0.3µm. By each method, the N95 performed significantly better than the surgical mask, but the difference was small (2%).

Droplet vs. Aerosol
Surgical masks have long been the recommended respiratory protection for diseases transmitted by large droplets (>5&#181 such as plague or meningococcal meningitis. For diseases such as TB that are transmitted by small droplet aerosols, an N95 (or better) respirator or powered air purifying respirators (PAPRs) with high efficiency particulate absorbing (HEPA) filter is recommended. It has been generally assumed that a surgical mask provided little protection from aerosols. With SARS and influenza, both droplet and aerosol transmission may occur, although the relative importance of each is debated.

During the SARS epidemic, in most circumstances, surgical masks were effective in protecting healthcare workers (HCW) from infection. In a case-control study of five hospitals in Hong Kong affected by SARS, W. H. Seto and colleagues found that consistent use of surgical masks was associated with a significant reduction in risk of infection. In fact, of 51 HCW with documented SARS exposure while wearing a surgical mask, none became infected. In contrast, 13 of 198 exposed HCWs (6.5%) who did not wear a surgical mask or N95 were infected. [2]
Similar results were found in Toronto during the SARS outbreak, where consistent use of surgical masks reduced the risk of infection by 50% among 32 critical care nurses who entered the room of a SARS patient. Consistent use of an N95 resulted in an 80% risk reduction. [3]
The experience with the SARS epidemic clearly demonstrated a relationship between the risk of infection to HCWs and certain aerosol-generating medical procedures. The highest risk was associated with endotracheal intubation, airway suctioning, and non-invasive positive pressure ventilation [4]. In these settings, the highest degree of respiratory protection possible is warranted.

Finite Supply of N95s

It has been argued that since influenza transmission occurs through both aerosols and large droplets [5], all personnel with direct patient contact should wear N95s or PAPRs. However, there are several problems with this approach: N95s cost approximately 10 times as much as surgical masks; they are much less comfortable to wear, especially for prolonged periods of time, which could result in under-utilization; and there is a finite national (and global) supply of N95s. The Strategic National Stockpile (SNS) has 105 million N95s on hand or on order [6]. Added to the stocks maintained by hospitals and distributors, this supply may be enough to provide an N95 for all HCWs in direct contact with flu patients during a relatively mild pandemic. This supply is probably not enough for all in a severe pandemic, in which case use of N95s would have to be restricted to those at greatest risk.

The HHS guidelines

On October 17, 2006, the U.S. Department of Health and Human Services (HHS) released new interim guidelines for the use of surgical masks and respirators in an influenza pandemic. [7] These new interim guidelines are meant to augment and supersede previous recommendations located in Part 2 of the HHS Pandemic Influenza Plan (www.hhs.gov/pandemicflu/plan/). This plan was released in November 2005 and may be updated or amended as new epidemiologic information becomes available.
Specifically, HHS now recommends that a properly fit-tested, NIOSH-certified N-95(or higher) respirator should be worn in lieu of surgical masks when:

1. Participating in procedures that have a high likelihood of generating aerosolized particles (e.g., endotracheal intubation, nebulizer treatments, cardiopulmonary resuscitation, and bronchoscopy) performed on a patient with confirmed or suspected pandemic influenza.
2. Providing direct care to patients with confirmed or suspected pneumonia due to pandemic influenza.

Furthermore, HHS says that the use of an N95 is prudent in the direct care of all other patients with confirmed or suspected pandemic influenza if there is a sufficient supply.

With an insufficient supply of N95s, the guidelines recommend prioritization for use in high risk, aerosol generating situations. In addition, in the event of a shortage, other NIOSH-certified N, R, or P- class respirators or powered air purifying respirators (PAPRs) may be considered; however, re-usable respirators, such as PAPRs, must be decontaminated after each use. The guidelines reinforce that proper training in the use, removal, and disposal of respirators as well as the medical contraindications to respirator use is critical.

In the event that no respirators are available, the guidance points out that surgical masks will provide benefits against droplet exposure and should be worn by all HCW having direct contact with confirmed or suspected pandemic influenza patients.

Summary

The current study, supported by the clinical observations from the SARS epidemic, provides evidence that a surgical mask may provide significant protection from aerosols as well as droplets. In high risk settings, N95 respirators or PAPRs should be used if available. However, if N95s are not available, as might be expected in a severe pandemic, use of a surgical mask along with other routine barriers (gown, gloves, and goggles) may afford significant protection from infection, especially in low risk settings. Since surgical masks vary considerably in design, further study is needed to evaluate the aerosol filtering efficiency of various masks. The Institute of Medicine is hosting a meeting entitled “Workshop on Personal Protective Equipment for Healthcare Workers in the Event of Pandemic influenza: Next Steps and Research Agenda” on Feb. 22, 2007 in Washington, D.C. to explore these issues [http://www.iom.edu/CMS/3740/39644/39679.aspx].

References

[1] Li Y, Wong T, Chung J , et al. In vivo protective performance of N95 respirator and surgical facemask, Am J Industrial Med 2006:49:1056 –1065.
[2] Seto W, Tsang D, Yung R, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003;361:1519-1520.
[3] Loeb M, Mcgeer A, Henry B, et al. Emerg Infect Dis. 2004;10:251-255. Available online at http://www.cdc.gov/ncidod/eid/vol10no2/03-0838.htm. Accessed February 8, 2007.
[4] Fowler R, Guest C, Lapinsky S, et al. Transmission of Severe Acute Respiratory Syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med 2004;169:1198-1202. Available online at http://171.66.122.149/cgi/content/abstract/169/11/1198. Accessed February 8, 2007.
[5] Tellier R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis. 2006;12: Nov. Available from http://www.cdc.gov/ncidod/EID/vol12no11/06-0426.htm. Accessed February 15, 2007.
[6]DHHS. Pandemic Planning Update III, A Report from Secretary Michael O. Leavitt November 13, 2006. Available online at http://[URL="http://www.pandemicflu.gov/plan/pdf/panflureport3.pdf"]www.pandemicflu.gov/plan/pdf/panflureport3.pdf[/url] . Accessed February 8, 2007.
[7] Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic. Available at http://www.pandemicflu.gov/plan/heal...uidancehc.html. Accessed on October 19, 2006.

[AlaskaDenise]

Re: Will Nurses Work During a Pandemic?

......health care workers were the first to suffer losses. He said that he felt that it would not do the community any good if all the Doctors die first.

He did not tell me his plan but I think he will stay away.

Welcome rescuer. Your input is appreciated.

I think a lot depends on the eventual infectivity & CFR of any pandemic influenza.

Unfortunately, given what we know now, it could be very bad.

One has to ask......if EMTs, etc. will risk their lives and especially if there is a high probability that they will contract & die from H5N1 in the process of performing their duties, and if folks seeking the help of a hospital are already to sick to be saved (which may well be true), is it the best use of resources to follow the prepandemic customary procedures?

I believe that the rule of thumb in times of insufficient resources, is to put the resources with those who stand the best chance of living. Following that same logic, I would assume it would follow that it's imperative to save resources from certain death, so they will be available when their efforts will be needed to safely give others a chance of living.

Hopefully various health organizations have prepared instructional videos (for TV broadcast), etc. to show folks how to care for their sick family members at home. A good use of resources might be for doctors, nurses, and EMTs to supply this information by telephone.

.

[tropical]

Re: Will Nurses Work During a Pandemic?

Masks matter, read on a (aproved for public release) pdf research report from Edgewood 2004:
DRAGER_biological_masks_Test_Report_DefendAIR.pdf- attachment
_____
and
From an FluWiki writer, gs Tue Dec 05, 2006 :

<TABLE width="100%"><TBODY><TR><TD>masks </TD></TR><TR><TD>by: gs
Tue Dec 05, 2006 at 10:40:23 AM EST

</TD></TR><TR><TD>it's annoying, that we still have no results on the efficiacy of mask-filters.
N95 is recommended, better -maybe- N99 or N100
but this is apparantly not tested.
Some sources say, that good surgical masks are as effective as N95s.
Flu-viruses are 0.1microns large, but only
0.3 microns are tested even for Hepa-filters.
Still masks are probably somehow efficient
as was demonstrated with SARS.
Lots of different masks and filters are being offered and I was searching for microscope pictures of the material instead of tests
as done by NIOSH with sodium-chloride particles or such.
This was invain, I couldn't find microscope pictures. I'd like to see how a N95 differs from a surgical mask or a paper mask or a Hepa mask.
So, can you please put your masks under the microscope and post your pictures here ?
Here is what I found about the classes:
(EN 779):
G1 Am <65

G2 65<AM<80< p>
G3 80<AM<90< p>
G4 90<AM< p>
F5 40<EM<60< p>
F6 60<EM<80< p>
F7 80<EM<90< p>
F8 90<EM<95< p>
F9 95<EM< p> (EN 1822)
H10 E(0.3micron)>95 , E(MPPS)>85
H11 98,95
H12 99.99 , 99.5
H13 99.997 , 99.95
H14 99.999 , 99.995
U15 E(0.12 micron) >99.9995 , E(MPPS) >99.9995
U16 >99.99995 , 99.99995
U17 99.999995 , 99.999995
N95 : >95%
N99 : >99%
N100 , P100 ("Hepa"?): >99.97%
(EN 149)
FFP1 : >80%
FFP2 : >94%
FFP3 : > 99%
Am%=average degree of separation
Em%=average efficacy level
E%=average fractional degree of separation
MPPS=most penetrating particle size I assume the FFPx and Nx - classes are also for MPPS ? (translated from a German webpage, US-sources
and norms appreciated)
_____

and
Masks May Not Help Against Super-Flu
<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD bgColor=#cbcbcd><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD height=2></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>Email this Story
Copyright 2007
May 4, 6:46 PM (ET)

By LAURAN NEERGAARD
<TABLE cellSpacing=0 cellPadding=1 width=210 align=right border=0><TBODY><TR><TD align=middle><TABLE borderColor=#cbcbcd cellSpacing=0 cellPadding=1 width=150 border=1><TBODY><TR><TD><TABLE cellSpacing=0 cellPadding=0 border=0><TBODY><TR align=middle><TD></TD></TR><TR><TD>(AP) University of Michigan freshman Alicja Sobilo wears a surgical mask at work as part of a study as...
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WASHINGTON (AP) - If a super-flu strikes, face masks may not protect you. Even so, the government says people should consider wearing them in certain situations, just in case.
The consumer advice issued Thursday reflects the fact that the science behind it is unclear. Whether widespread use of masks will help, or harm, during the next worldwide flu outbreak is a question that researchers are studying furiously.
But it's a question the public keeps asking as the government makes preparations for the next flu pandemic. So the Centers for Disease Control and Prevention came up with preliminary guidelines.
"We don't want people wearing them willy-nilly," said Dr. Michael Bell, a CDC infection-control expert. "The overall recommendation really is to avoid exposure."
<TABLE cellSpacing=2 cellPadding=0 align=left border=0><TBODY><TR vAlign=top><TD align=middle><SCRIPT language=javascript>if ((typeof tag300_2) == 'function') {tag300_2();} </SCRIPT></TD></TR></TBODY></TABLE>When that's not possible, the guidelines say to consider wearing a simple surgical mask if:
_You're healthy and can't avoid going to a crowded place.
_You're sick and think you may have close contact with the healthy, such as a family member checking on you.
_You live with someone who's sick and thus might be in the early stages of infection, but still need to go out.
Consider wearing a more expensive, better-filtering mask called an N95 respirator if you're well but must take care of a sick person, they conclude.
But remember the mask doesn't take the place of basic precautions, including hand washing and avoiding contact with people who have respiratory infections, said Dr. Julie Gerberding, CDC director.
"We are concerned people will think the mask is the magic bullet. It can have a role in personal protection but they are not the only thing," Gerberding told a news conference in Atlanta.
Influenza pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people never have experienced. Scientists cannot predict when the next pandemic will arrive, although concern is rising that the Asian bird flu might trigger one if it starts spreading easily from person to person.
It would take months to brew a vaccine, so the hunt is on for simple infection-control measures that communities could use in the meantime.
Topping that list: Avoid crowds, and avoid close contact with the sick unless you must care for someone, the CDC has long stressed. Flu spreads most easily to those within 6 feet of an infected person. And flu tends to be most contagious before people realize they're truly sick, when the very first coughing and sneezing begins and they're still likely to be out and about.
Why aren't masks a no-brainer to add to the list? They can help trap virus-laden droplets flying through the air with a cough or sneeze. But it's unclear whether large droplets or far tinier, so-called aerosolized particles are the bigger risk from flu.
Simple surgical masks only filter the larger droplets. But better-filtering respirators aren't for everyone. They must be fitted to the user's face, don't fit over beards, and many people find them hard to breathe in. Most people don't know how to use them properly, Gerberding said.
Plus, the CDC has wrestled with whether masks would create a false sense of security. Perhaps someone who should have stayed home would don an ill-fitting mask and hop on the subway instead.
Nor does flu only spread through the air. Say someone covers a sneeze with his or her hand, then touches a doorknob or subway pole. If you touch that spot next and then put germy hands on your nose or mouth, you've been exposed. (Hint: Public health experts now recommend sneezing into your elbow instead.)
It's harder to absent-mindedly rub your nose while wearing a mask. Conversely, faces get pretty sweaty under masks. Reach under to wipe that sweat, and users may transfer germs caught on the outside of the mask straight to the nose, Bell cautioned.
The CDC has long recommended that health workers who care for the sick during a pandemic be given masks, and the government is stockpiling for that purpose - amid dire warnings that supplies would quickly disappear once a pandemic struck.
Thursday's guidelines are the first for the general public, and likely will change later in the year as long-awaited results from mask research emerges. Meanwhile, there's no need for personal stockpiles, Bell said, although "if an individual feels more comfortable having a few at home, that's not unreasonable."
"When the CDC says 'consider,' the average citizen is going to respond by saying, 'I really ought to do this,'" said Jeff Levi of the advocacy group Trust for America's Health.
That will mean shortages, he said, calling for the government to increase stockpiles.
---
Associated Press Writer Dorie Turner in Atlanta contributed to this report.
--- On the Net: Pandemic flu information: http://www.pandemicflu.gov
______


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and
Masks
Category: Infectious disease ? Influenza ? Outbreak ? Public health
Posted on: March 8, 2006 10:55 AM
Not the Batman kind--the influenza kind.
I received a questionnaire yesterday from ABC news. Apparently, they're doing a story on pandemic influenza preparation. Included were questions like, "What would you recommend to those individuals who are trying to obtain antiviral medications for their own personal preparedness? When should they start taking them?" and "What would you recommend to individuals who are trying to obtain face masks for their own personal preparedness? When should they start wearing them?", as well as questions about food and water stockpiling and going to work/school. (More below...)
I made it clear that I think antiviral stockpiling is a bad idea, but the mask question is a bit trickier.
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Of course, images of people in masks are what many of us think about when images of 1918 come to mind. Unfortunately, there's no good evidence that they helped reduce the spread of the virus--for every city with mask laws that seemed to have a milder epidemic, there's another one where disease was as severe as areas that had no such law. Similarly, there have been many published studies supporting the idea that the most popular type of masks used in healthcare outbreak situations--the N95 mask--helps to protect healthcare workers, but would that extend to the general public?
The thing is, influenza virus isn't only contracted via inhalation. The masks--if fitted and used properly--can probably decrease this risk. But influenza can enter the body in other ways, such as rubbing your eyes with contaminated fingers. Do masks provide a false sense of security, causing people to be more lax in other ways (such as face-touching, or handwashing?) This is my worry, and this is why I don't universally recommend masks. (Revere at Effect Measure says much the same, with ample additional information). Of course, as noted,
Suffice it to say nothing said here or by CDC or anywhere else is likely to stop people from wearing N95 face masks or stop vendors form selling them on the basis they will protect you and your family from influenza. Whether they will or won't, whether they can be reused or not, whether they will have other untoward side effects (interference with hearing, vision or breathing) remains to be seen.
And this is what concerns me: people who are scared and think, "hey, it can't hurt," and get lulled into that false complacency. This is addressed in this article (dealing more with a bioterrorist event than a natural pandemic, but the sentiment holds:
Even in a biological attack, the masks have major shortcomings. Like fit.
"Does it have a nose piece like a metal clip you can bend over your nose? That's a better model because the big kicker here is getting a good fit," Utgoff says.
Bad fits are deadly. Contaminated air breathed from around the unfiltered edges instead of through the N95-rated material undermines the purpose of a mask.
And, got a beard? "Shave it," says Breysse, who recommends duct-taping the mask to your face to make a good fit.
"For you to take a respirator and put it on without any training or fitting probably wouldn't give you the protection you are expecting," says Ron Herring, general manager of the Safety Products Division at Pittsburgh-based MSA.
Another huge shortcoming is that you don't know when to wear a mask. There are no reliable early warning signs that a biological agent has been released. No big air-raid warning horn goes off. News reports will be after the fact. "So here I am, I've got a mask, and I don't know when to use it," Utgoff says.
Obviously you may know when pandemic influenza is in your geographic area, so it's not quite as random as a biological warfare attack, but what then? Do you wear it all the time? Only around people you know are infected, or in public? Will that be enough to protect you?
Another problem is that the single-use masks don't last. "They are disposable because they deteriorate with sweat and wear and age," Breysse says.
And this is something Revere addresses as well--we don't really know how many uses a disposable N95 is good for. Best bet would be to throw it away and get a new one each time, but that certainly gets expensive after awhile. Recall that a regular influenza season can last 6 months from beginning to end, and for a pandemic, all bets are off.
Like Revere, I don't own any masks. My husband couldn't wear one now as it is due to facial hair, and I too am not convinced that they'll work in the community. Should H5N1 or another pandemic virus surface here, perhaps I'll get one on the chance that I need to visit someone I know is ill, but I don't see myself wearing them out on a daily basis (especially duct-taped!). I'm already a hermit, and that quality would likely be amplified in the event of a pandemic.
(Image from here.)
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Comments
I liken this situation to what we find in automobiles. Cars are much safer now than they were in the past thanks to strict regulations, airbags, seatbelts, ABS systems, better road maintenance, etc. Granted there are some drivers who overestimate their safety and get lulled into a false sense of security. The end result is people still driving recklessly, distracted, drunk, sleepy, etc., and people still dying in car wrecks. But on the whole, I think the safety precautions are for the better.
The same would hold I believe in the case of a potential epidemic. Certainly there will be those who overestimate the protection masks offer, and some will pay the price. But thanks to education and good habit forming, I think they would be a net positive.
Hopefully we never have to be put in such a position.
Oh, and I read in NewScientist today that a bacterium called Microbispora apparently survived the Columbia disaster at temps exceeding 175degC. I'm not sure I'm convinced. Since that wasn't one of the bacteria sealed it may have contaminated the sample after it touched down. It's easy enough to check...take some Microbispora and cook it to see what happens. I think thermophiles have been found in temps as high as 115degC.
Posted by: Dave S. | March 8, 2006 12:58 PM
I've seen it suggested that masks provide very little protection from airborne, but what they do do is keep people from unconsciously touching their mouth and nose with their fingers -- a much more common route of infection. Made sense to me.
Posted by: tavella | March 8, 2006 01:07 PM
I'm not sure about even protection from that. Have you ever watched people without much training wear a mask like that? They just push it up to itch their nose, etc.
Posted by: Tara | March 8, 2006 01:33 PM
I think encouraging people to wear masks in the event of a flu epidemic or pandemic would just create hysteria, raise stress levels ( a factor known to negatively affect immune systems) cause panic behaviour and generally make matters worse.
Posted by: Dale | March 8, 2006 01:36 PM
One Mask may do the job its call Nanomask

The NanoMask is the first face mask in the world to utilize nanotechnology enhanced
filter media to effectively isolate and destroy viral and bacterial contaminants. Nanoparticles enhance
the intrinsic filtration efficiency of the media by acting as a destructive absorbent to kill virus and
bacteria that come in contact with the filtration system.
http://www.emergencyfiltration.com/Products/NanoMask.htm
Posted by: pom!! | March 8, 2006 08:29 PM
That NanoMask add just has me imagining tiny robots crawling around on a piece of filter paper, tiny lasers zapping incoming germs. My imagination frequently reverts to cartoon-mode, so of course the laser beams are visible and red, and the germs look suitably ugly (nasty brown colours, lots of flagella, etc).
I also like the advertising copy:
One Mask may do the job its call Nanomask
Um, shouldn't there be a few more letters in there? Like an "e" and a "d" at the end of the penultimate word? I suspect a comma may be useful, as well.
Posted by: The Brummell | March 8, 2006 09:30 PM
Tara C. Smith is an Assistant Professor of Epidemiology in the College of Public Health at the University of Iowa. She is also the deputy director of the university's Center for Emerging Infectious Diseases. Her research involves a number of pathogens at the animal-human nexus. Additionally, she is the founder of Iowa Citizens for Science and also writes for The Panda's Thumb. Please note the views expressed on this site are Dr. Smith's alone and may not be representative of the groups mentioned above.

[Jonesie]

Re: Will Nurses Work During a Pandemic?

it's annoying, that we still have no results on the efficiacy of mask-filters.
N95 is recommended, better -maybe- N99 or N100
but this is apparantly not tested.
.[/FONT]

?? Is the production of N99 and N100 masks starting to exceed the production of the N95? To whom are the N99 and N100 masks shipped? And in what amount??

[tropical]

Re: Will Nurses Work During a Pandemic?

Hi Jonesie.

The sentence ("anoy...") are from "gs" (2006.).

Is the production of N99 and N100 masks starting to exceed the production of the N95?
I don't know, but versus the N100, the N95 give you an 5% probability to leakage in the same time period, and is probably only for money costs, and breathing difficulties for asthma/lung/cardiac patients that N95 are used.

To whom are the N99 and N100 masks shipped? And in what amount?
To whom are buying, for now. If an pand. start, will be no masks to buy.
The amount is individual shielding purposes at the individual level, I suppose.

If looking the "gs" question:
"I'd like to see how a N95 differs from a surgical mask or a paper mask or a Hepa mask."

- a ordinary thick surgical masks can't shield viruses, only droplets
- a ordinary paper mask is used for dust particles

N100 have also a problem with it's sealing, because it can't press anaugh on the skin to be sure hermetical if you are working, sweating.

This can be resolved only with a rubber/glass masks with a filter for bio-particles (only chemical is not adequate), or a respirator.

For a micron-particulates question, some answers can be seen from the posted pdf doc: masks_Test_Report_DRAEGER_DefendAIR.pdf
at page 13, Table 3. Draeger DefendAir PF Results.

__________________________________________________ _____________

Positive air-pressure respirator (costly):
__________________________________________________ _____________

<TABLE class=Container_mar4 cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=LY04-ContainerT vAlign=center><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=LY04-ContainerTitleTD vAlign=top>Who needs a high purity respirator? </TD><TD class=LY04-ContainerActionsTD vAlign=top></TD></TR></TBODY></TABLE></TD><TD class=LY04-ContainerTR vAlign=top></TD></TR><TR><TD class=LY04-ContainerML vAlign=top></TD><TD class=LY04-ContainerM vAlign=top><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=LY04-ContainerContent id=dnn_ctr375_ContentPane vAlign=top align=left><!-- Start_Module_375 -->
Essential workers and heads-of-household who must protect themselves from being infected by airborne viruses such as the H5N1 avian influenza in the event of, or the threat of a pandemic.
Employees in jobs associated with unpleasant or dangerous air quality (auto repair, garbage, gasoline, insulation, mold, paint, sheetrock, solvents, or animal/human sewage);
Do-it-yourself (DIY) enthusiasts and hobbyists
Asthmatics and those who suffer from significant airborne allergies and respiratory maladies
The elderly and those who are highly susceptible to the ordinary flu or other airborne diseases.
<!-- End_Module_375 -->

</TD></TR></TBODY></TABLE></TD><TD class=LY04-ContainerMR vAlign=top></TD></TR><TR><TD class=LY04-ContainerBL vAlign=top></TD><TD class=LY04-ContainerB vAlign=top></TD><TD class=LY04-ContainerBR vAlign=top></TD></TR></TBODY></TABLE>
<LINK href="04-Container.css" type=text/css rel=stylesheet><TABLE class=Container_mar4 cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=LY04-ContainerTL vAlign=top></TD><TD class=LY04-ContainerT vAlign=center><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=LY04-ContainerTitleTD vAlign=top>Respirator features: </TD><TD class=LY04-ContainerActionsTD vAlign=top></TD></TR></TBODY></TABLE></TD><TD class=LY04-ContainerTR vAlign=top></TD></TR><TR><TD class=LY04-ContainerML vAlign=top></TD><TD class=LY04-ContainerM vAlign=top><TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR><TD class=LY04-ContainerContent id=dnn_ctr376_ContentPane vAlign=top align=left><!-- Start_Module_376 -->Ultra low particle filtration

• Comfortable for long term wear
• Lightweight and compact
• Easy to wear back pack
• Positive air pressure
• On-demand air
• 4 hour lithium battery life
• Disposable, replaceable filters
  Same protection as the most expensive Hazmat suit:
• Outside air is continuously drawn into a base unit worn on a beltpack
• The air passes through an ultra-low penetration (ULPA) disposable filters
• The filters will remove particles and viruses at <100 nanometers, (well inside the range of avian flu and pollen)
• You breath the cleanest air possible with today?s technology

__________________________________________________ ___________

</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>

[Laidback Al]

Re: Will Nurses Work During a Pandemic?

It is not bird flu, but Ebola is dangerous and fatal enough. The current outbreak of Ebola in Uganda may have infected as many as 84 people with 18 confirmed dead including HCWs.

See this thread: New Ebola Strain in Uganda Spreading - Death toll rising

Below is an article from Uganda where HCWs are going on strike to hold out for hazard pay for working with Ebola patients. Hat-tip to Niman.

Bundibugyo Nurses Strike

The Monitor (Kampala)
NEWS
4 December 2007
Posted to the web 4 December 2007
By Tabu Butagira, Joseph Mugisha, and Emmanuel Gyezaho
Kampala/Bundibugyo
HEALTH workers handling Ebola patients in Bundibugyo temporarily abandoned duty yesterday morning over delayed payment of their risk allowances and only resumed work after local leaders cleared the overdue bills in the afternoon.
Citing eight of their colleagues who have since contracted the disease while on duty, one health worker said their condition of work was precarious and it was "inhumane" for government officials to hold back "our" little pay.
"For us, no payment of our risk allowance, no work from today onwards," one of the disgruntled nurses said.
Bundibudyo MP Jane Alisemera sounded alarm bells yesterday in Parliament urging the government to "urgently find financial resources" because "volunteers are withdrawing due to none payments."
"They cannot continue working because they are operating under dangerous circumstances."
Bundibugyo RDC, Samuel Kazinga who heads the local Ebola taskforce in the district, downplayed the morning hitch that sparked a wave of panic among district officials, saying the complainants only "demanded" their pay.
"It is one thing to demand and another to strike but we have now paid part of the money they were demanding," said Mr Kazinga, who had earlier attributed the pay to bureaucratic delays in processing payment.
Daily Monitor has learnt that officials of the district Ebola Taskforce were paying doctors a daily risk allowance of Sh30, 000 while nursing officers and other support staff were getting Sh20, 000 and Sh10, 000 respectively.
In Kampala, Unicef Country representative Keith McKenzie told a government-organised news conference that the NGO had sent Sh230 million directly to Bundibugyo District to support the Ebola fight, "including payment for health workers. Latest statistics show that Ebola has killed 19 people out of 74 cumulative infections.
The latest victim has been identified as Mighten Muliwaviyo, the chairman of the business community in Bundibugyo town council who died on Monday night, amid reports of new infections in Kasese, Kabarole and Mbarara District.
By last evening, a man identified as Mr Johnson Baluku, who showed symptoms akin to that of Ebola, was reported to have been admitted at Bwera Hospital in Kasese while three alert cases were registered in Kabarole District.
The minister is expected to table the "emergency funds" budget to his colleagues during the Cabinet sitting today.
The junior minister had indicated that the Sh6b would be used for among other things; meeting recurrent operational costs, buying medical supplies and protective gears as well as paying risk allowance for health workers handling Ebola patients.
Unicef has through the central government separately given protective materials, medical equipments and supplies worth Sh861m to tackle the epidemic.

http://allafrica.com/stories/printab...712041123.html

[KBD]

Re: Will Nurses Work During a Pandemic?

It would be easy to think that hospital workers fleeing an outbreak were like soldiers disserting in the face of combat. But it's hard to know how much information and personal protection hospital staff are given in these settings for them to carefully weigh up the risks -- not only to them, but also their families.
I know doctors who are certain they would not want to be at the frontlines of a pandemic -- not just because of the risk of infection to them, but more importantly, what the disease could do to their infant children.
Perhaps some of these hospital workers in Uganda are the main bread-winners for their families, and their support is critical for the survival of others.
These are some of the issues that public health authorities need to think through carefully in planning what level of service will be provided in a pandemic situation.

[Laidback Al]

Re: Will Nurses Work During a Pandemic?

Nurses Want More Training and Social Supports

Josh Pringle
Thursday, February 28, 2008

One out of five Canadian nurses say they are "not at all" ready for an infectious disease outbreak.
A broad-ranging University of Ottawa study of front-line health care workers finds 21 per cent are "not at all prepared" for a natural disaster.
The study asked workers about their ability to cope with large scale health crises.
Almost three-quarters of nurses said they were "a little" or "somewhat" prepared for an infectious disease outbreak.
The report entitled "Caring for Nurses in Public Health Emergencies" finds nurses want more training and social supports to help them be ready to deal with future emergencies. Nurses told researchers they need more in terms of human resource support and social support to help them prepare and train to deal with a pandemic or disaster.

http://www.cfra.com/headlines/index.asp?cat=3&nid=55481

[Snowy Owl]

Re: Will Nurses Work During a Pandemic?

Thanks for your articles Laidback Al

In qu?bec in 2003 I have lobby in the Public Health Institute to recruit elderly nurses and GP's. I dared to post in a prominent paper to recruit 72,000 volonteers.

The Qu?bec Gov now has more than 80,000 volonteers.

Maybe something similar should start in US.

Once retired, children are raised, you have an expertise, and you surely can get your shoulder at the wheel for your fellow beings.

Maybe we should write an article for the MSM, it worked here you know.

Snowy

[Shiloh]

Re: Will Nurses Work During a Pandemic?

More on the Canadian Nurse Study
Source: http://www.canada.com/ottawacitizen/...2b1eb3&k=47417

No one ready for next crisis, nurses warn
Workers and system unprepared for outbreaks, disasters, researchers told
Joanne Laucius, Ottawa Citizen
Published: Thursday, February 28, 2008

Almost five years after SARS, a broad-ranging University of Ottawa study that asked front-line health workers about their ability to cope with large-scale health crises found that many still don't feel prepared to respond.

And many have little confidence in the system's ability to handle a public health emergency.
The study, to be released today, began about two years after the SARS outbreak of 2003 claimed 44 lives in the Toronto area.

It took more than three years to complete and included five focus groups comprised of 100 registered nurses, registered practical nurses and nurse managers.

The sessions were conducted in Ottawa, Toronto, Vancouver and Halifax between November 2005 and February 2006.

The study also included a web-based survey of 1,500 emergency and critical-care nurses.
About half had worked during an outbreak of an infectious disease, such as C. difficile, since the SARS outbreak.

The study's range was from coast to coast, but perceptions were the same across Canada, said lead researcher Carol Amaratunga, a professor with the Institute of Population Health.

The study found that while almost three-quarters of the workers said they were "a little" or "somewhat" prepared for an infectious disease outbreak, 18 per cent were "not at all" ready.

Meanwhile, 21.1 per cent were "not at all" prepared for a natural disaster; 69.4 per cent for a chemical weapons attack and 69.5 per cent for a biological weapons attack.

"Three years post-SARS, they really didn't know what was happening, even in their own institutions," said project co-ordinator Patricia Thille.

The findings are important, because there will be another public health crisis like SARS, she said. "It's just a question of when."

During a crisis, the health of front-line workers must be protected to meet "surge capacity" needs.
If it's not, the health care workforce will shrink due to illness, quarantine and refusal to work, the study found.

But the nurses surveyed said they were already working at maximum capacity.

"The terrible secret is that there is no surge capacity," one participant told the researchers.
Among the issues identified:

. Of three emergency rooms examined by researchers, none had a plan or requirement for regular fit testing of masks and other safety equipment such as gloves, gowns and face shields. One nurse commented that most workers had been fitted for a mask, but the testing certificate had expired six months ago.

. While doctors are provided with "scrubs" in most hospitals, nurses have to provide and launder their own. Wearing uniforms out of the hospital and bringing them home to be laundered poses a risk to the public and workers' families, the study noted.

. Support for quarantined workers was an issue, especially the delivery of food, medications, masks and other protective equipment to workers who have no family member to bring them these items.

"One person was quarantined and had no groceries, no one to walk the dog," said a participant.

. Workers also reported getting conflicting orders.
"I was in quarantine, called Friday afternoon and had a three-way phone conversation. Under no circumstances should I come in," said one nurse.

"Someone would contact me from Public Health. Didn't happen. Said they would send food. Didn't happen. Next day called and asked me to come in."

. More than 27 per cent of the workers reported having multiple jobs. Many nurses work on contract and as casual and part-time workers and have no guarantee that they would be compensated for lost time if they get sick.

"I am part-time. I have no benefits," said one participant. "Should I put myself at risk? What if I get sick for a long time?"

. About 90 per cent of nurses in the field of emergency and critical care are women, and many found their duty as parents and spouses conflicted with their duty as nurses.

About 53 per cent of the workers in the study had dependent children living with them. Many were caught between their duty to care for patients and personal and family safety.

While existing guidelines mention vaccinating children, spouses and dependent children of health care workers, it would not be logistically feasible or ethically justifiable to do so, according to the Public Health Agency of Canada.

Some of the nurses said concern about infecting a relative may be enough to tip the balance between their commitment to nursing and their family responsibilities.

. Some nurses reported that managers and other nurses kept their distance from front-line SARS workers, leaving them feeling angry, demoralized and abandoned.

"In our hospital, we were told that our hospital would be a SARS hospital, and within two weeks all the management offices were moved to another location - another hospital." said one participant.

"We were told it was all because of amalgamation and it was going to happen anyways, but it sent a strong message."

Another noted that no one would talk to emergency nurses.

"Co-workers stigmatized each other - and moved to the next table."

Ms. Amaratunga said her research team was impressed by the high degree of professionalism of Canada's nurses.

"They care a great deal about their profession, but they are caught in divided loyalties," she said.
The report will be sent to occupational health and safety committees at hospitals, as well as being posted on the Canadian Policy Research Networks website.

There had been a significant investment in emergency preparedness since SARS. The gaps in the system can be fixed, but they need attention, said Ms Amaratunga.
"We can do better and we should do better," she said.

SARS came to Canada five years ago this spring, noted Ms. Amaratunga. "This is a good time to reflect back on our progress."


In their own words:

Some of the comments made by participants surveyed as part of a broad-ranging University of Ottawa study that asked front-line health workers about their ability and that of the system to cope with large-scale health crises:

"Isolation, abandonment - friends, family, bus passengers, co-workers, community, management - it's like the plague, like a mark on your door, because everyone in the neighbourhood knows you work at the hospital."
.
"Anticipate that not all of your health care workers are going to work - you need to know who's going to stay on board, and need to figure this out at the very beginning."
.
"A warm body isn't much use if they don't know what needs to happen."
.
"Lots of guilt - should I have chosen a profession that would have protected me better? The guilt stays. If I bring it home and they (my family) get sick, it's because of me."
.
"In terms of going to work - I don't have the right to make those decisions on behalf of my children and my husband."
.
"We need preventative medication and vaccines for the whole family, not just the health care workers."
.
"You're probably going to get me coming to work if I know my children are vaccinated."
.
"I want to be able to change and decontaminate before I go home."
.
"During SARS, people were making decisions up high and you were sort of there in the trenches."
.
"I called up infection control and asked someone to come and watch activity response and was asked, 'Can we do it in September?'"

? Ottawa Citizen 2008

[gullwing]

Re: Will Nurses Work During a Pandemic?

As a health care worker with some 20+ years of ER experience I thought I would put in my two cents re: the issue of "Will Nurses Work During a Pandemic"

I will use my local hospital as an example. We have a 150 bed hospital in this town (my hospital) and a 400 bed hospital (other). I am intimately familiar with my hospital so I will give some observations.

Our ER is staffed by 1 physician 7am-7pm and one 7pm-7am
one Physician's assistant 12noon to 12 midnight

We have anywhere from 3-7 nurses working in the ER depending on time of day. There are 15 ICU beds that are all full 90% of the time. There are 6 ventilators, 4 are in use 90% of the time.

If 10% of our nurses or the PA do not show up for work due to A) illness B)fear that they may get illness C)fear that they may bring illness home to family D)fear that they are sick and don't want to infect community E) fear of violence
then we could continue seeing out usual patient load (no influenza, not even seasonal).
A)If 20% of the nurses don't show up
B)one doctor

then the ER closes!
the volume of patients goes up 40% (seasonal influenza or drunken holiday)
the ER goes on diversion (closes)

If the ICU gets full (approximately 2 more critical patients)
the Hospital goes on diversion

If we have 3 new patients on a ventilator or if one of the approximately/Pulmonologists are out sick
the Hospital goes on diversion

The point being is that in my small city in a sophisticated country with the availability of all the medicines, supplies, expertise etc. it will take almost anything to bring the system to a halt.

So it almost doesn't matter if the nurses are brave, heroic, dedicated or wise and scared. This machine will come to a halt very quickly. I don't think this would change if 100% of the hospital staff wore a Bio-hazard suit with an oxygen tank. They will still be vulnerable at home, coming to work, shopping etc.. If 100% of the staff had a 100% effective vaccine the system will still crash and burn if more then 3 critical patients come in or a >40% increase in ill patients. Then what happens?

If our hospital is on diversion then most likely we are a mirror to what is going on throughout the state. Patients will come to the ER anyway because that is there only option. When the ER is full and people are refused care violence will ensue. No one wants to talk about it but that is what will happen. If a family sits in the waiting room meant for 30 and there are 100 people all ill or scared it is like dry kindling. If a 5 year old coughs up blood in the waiting room or turns blue I can guarantee that the family will push their way in (I would, wouldn't you?). Then what?

Once there is a breach then the dedicated staff will either no longer show up for work or the hospital will lock down. No one in or out.

I think it is not a matter of if but when. My thoughts are how do we save as many as possible? If we retreat do we have a fall back position? or will it be a route? If the hospital closes for a week or two can it ever re-open? If we pull back our trained staff to save them will there be any equipment? Will the hospital be looted? Will the medical staff who "left" be sanctioned or applauded?

I would like to know if anyone in any medical community has a fall back position where the staff can rally and rebuild?

[sharon sanders]

Re: Will Nurses Work During a Pandemic?

Welcome Gullwing. Excellent post.