Crosstex International, a subsidiary of Cantel Medical Corp., and Prestige Ameritech, two U.S.-based medical mask manufacturers, have joined forces to bring attention to a void in public health research and policy that, if addressed, has the potential to more quickly provide a simple, effective tool to mitigate the spread of influenza and other respiratory-borne viruses.
The awareness campaign comes in response to a new study, “Exposure to Influenza Virus Aerosols During Routine Patient Care,” published in the Journal of Infectious Diseases, showing that influenza viruses may spread as far as 6 feet from a person coughing or sneezing, and that some people, referred to as “super spreaders,” may be more likely to spread the virus. The study, supported by the Department of Health and Human Services with a $600,000 research grant, pointed specifically to concerns for healthcare workers being exposed to coughs from sick patients. Yet government research and policy continues to overlook face masks as a feasible protection measure for both the healthcare industry and the general public.
“There is evidence to show a much better opportunity to protect healthcare workers through infection source control – which face masks can provide – but the research focus is bent toward primary protection," says Matt Conlon, vice president of research and policy at Cantel Medical. "While the CDC recommends the use of face masks by sick patients in healthcare settings to limit the spread of infection, surprisingly, there is no such policy for the general public. At the same time, face masks are recommended for use by the general public during pandemic events, yet the government has no supply preparedness plan to fulfill the demand that may come as a result of that recommendation.”
During the American Medical Association and Infectious Diseases Society of America (AMA/IDSA) recent Policy Forum on Seasonal and Pandemic Influenza Preparedness, Dr. Robin Robinson, director of BARDA, an agency within the Centers for Disease Control (CDC) that is tasked with development of public health emergency countermeasures, confirmed the void. When asked about the government’s plan for U.S. surge capacity for critical items such as medical face masks and respirators, Robinson stated, “…we look for surgical masks two weeks after a pandemic hits and they’re gone because only 5 percent of face masks are made in the U.S. If we don’t incentivize U.S. manufacturers, even (sic) that resource will be gone.”
Mike Bowen, executive vice president of Texas surgical mask manufacturer Prestige Ameritech, says, “We saw it first hand during the H1N1 pandemic. U.S. manufacturers were at full capacity within two weeks. Hospitals that normally depend on foreign sources were calling for masks, and we couldn’t help them. Government officials have acknowledged very clearly that they couldn’t create or support a policy for the use of face masks by the general public because there just isn’t enough domestic manufacturing capacity even for healthcare needs.”
“A production issue – which can be addressed – should not supersede the risk to public health,” Conlon explains. “The remaining manufacturers that still operate in America can help change this. However, the bigger challenge is driving the research that policymakers, healthcare professionals, public health officials, and the public-at-large need in order to make decisions on the potentially significant role that face masks may play in stemming the spread of infection. On the private sector side, we are taking a lead role on mask research and innovation, but it’s not enough. We need a bigger effort to include research and clear policy that can help the general public; cough and sneeze etiquette promoting the use of elbow containment, tissues, and hand washing simply isn’t enough.”
To add to the challenge, the Journal of Infectious Diseases study also suggested that traditional “loose-fitting” surgical masks worn by healthcare workers may not be enough to protect them. While there are no FDA-required standards for fit, manufacturers are beginning to address the issue with a new category of “fitted masks.” According to published research from the Aerosol Mechanics Laboratory of Stony Brook University Hospital, fitted masks provide double the particle filtration as compared to standard loose-fitting masks.
“Face masks are primarily intended to protect others from the wearer, although they also serve doctors and nurses in protecting them against large droplets or sprays from infected patients. In high flu seasons, many healthcare facilities follow CDC source control guidelines by encouraging sick patients to sit apart from others and to wear face masks when they are in contained areas like an ER,” says Dr. Stephen S. Morse, a professor of clinical epidemiology at Columbia University’s Mailman School of Public Health, who also served on the Steering Committee of the Institute of Medicine’s Forum on Microbial Threats, and currently on the National Academy of Sciences’ Standing Committee on the Department of Defense’s Programs to Counter Biological Threats.
“The new findings in the influenza virus aerosols study in the Journal of Infectious Diseases is just another indicator of our long-standing ignorance of something so familiar as the flu – not only how it spreads, but how best to defend against it,” adds Morse. “We do know that these infectious particles originate from the upper respiratory tract and are released through the mouth and nose. Respiratory source control should certainly be an area of research focus and government policy interest.”
Although flu season is winding down in the US, the worldwide public health community has already detected a new SARS-like virus, known as the novel coronavirus (NCoV) – a type that typically spreads like other respiratory infections such as flu, travelling in airborne droplets when an infected person coughs or sneezes. NCoV belongs to the same virus family as SARS, or Severe Acute Respiratory Syndrome, a coronavirus that emerged in 2002 and killed about a tenth of the 8,000 people it infected worldwide.
“With any flu or virus outbreak, there is a middle period – which can be as long as six months – until a vaccine arrives. During that time, there is a serious lack of options for non-pharmaceutical intervention,” says Morse. “Funding more extensive research has the potential to unlock significant answers about what countermeasures work most effectively to reduce illness and death associated with respiratory viruses.”
Source: Cantel Medical