Re: [TSCM-L] Norovirus from kondrak on 2007-03-18 (file.mbox)

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Subject: RE: [TSCM-L] Norovirus - Face Masks
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<html><div style=3D'background-color:'>This is an addition to the idea o=
f planning ahead re health issues. For those of you who think this should n=
ot be on the list, please ignore and move on. And please, keep your gratuit=
ous snotty remarks to yourself. Some time ago, Toronto was struck by a SARS=
epidemic which aside from killing people, did serious economic damage. Thi=
s is an OP-Ed piece from the New York Times of October 25/=
06. "FACE FACTS
by Lawrence M. Wein
Correction Appended
Stanford, California
Despite all the attention given to anthrax and smallpox and potential we=
apons of mass destruction, pandemic influenza is probably the world's most =
serious near-term public health threat. If a strain similar in affect to th=
e 1918 Spanish flu (which killed tens of millions of people worldwide) emer=
ges in the next several years, it is highly likely that an effective vaccin=
e will not be available during the pandemics first wave, that we won't have=
enough antiviral drugs for large-scale prohylactic use, and hospitals will=
be too overwhelmed to treat most cases.
Consequently, as in 1918, we will need to combine medical efforts with v=
oluntary and forced social changes - closing schools and churches, cancelli=
ng public gatherings, keeping workers at home - to hinder the flu's spread.=
Our government must draw up a plan for educating the public about effectiv=
e nonpharmaceutical interventions like hand washing and face protection lik=
e masks.
A prerequisite for doing so is determining the biggist culprit in spread=
ing influenaa: droplet transmission, in which an infected person sneezes or=
coughs directly into the mouth, nose or eyes of someone who is susceptible=
; contact transmission, in which virus is transferred by hands either direc=
tly, say, through a handshake, or indirectly through an object like a doork=
nob; and aerosol transmission, in which evaporated virus-containing particl=
e are inhaled.
Remarkably, this issue has not been resolved: the Department of Health a=
nd Human Services' Pandemic Influenza Plan states that 'the relative clinic=
al importance of each of these modes of transmission is not known.' As a re=
sult, the government enthusiastically endorses frequent hand washing - whic=
h would reduce contact transmission, and costs nothing - but remains noncom=
mittal  about face protection. While the government says that it might=
be beneficial, it doesn't make respirators or masks available. Yet face pr=
otection would guard against aerosal and droplet transmission, and even red=
uce contact transmission by making it difficult to place fingers into one's=
mouth or nose.
A Stanford graduate student, Michael Atkinson, and I recently performed =
a detailed study of the routes of transmission, using data on influenza and=
on rhinovirus, which causes the common cold. Our findings suggest that the=
dominant mode of transmission for influenza is aerosol - implying that han=
d washing will make little difference. This is consistent with the views of=
leading researchers several decades ago, views that somehow have been forg=
otten by the public health community.
We found that ventilation, like placing a fan in an open window, and hum=
idifiers (most influenza strains survive in the air for much less time when=
the humidity is raised to about 65 percent) can reduce transmission slight=
ly. Sleeping in separate bedrooms (and working in separate offices) can hel=
p even more.
But the single most effective intervention is face protection. And becau=
se roughly one-third of influenza transmissions occur before an infected pe=
rson exhibits symptoms, these precautions should be taken whenever people a=
re in the same room throughout the pandemic period.
There are two kinds of face protenction: N95 respirators, as worn by con=
struction workers, for instance, and surgical masks of the sort worn by den=
tal hygienists. (The respirators cost roughly a dollar apiece, the surgical=
masks 10 cents.) Their efficacy in preventing aerosol transmission depends=
on three factors: the extent to which the face filter prevents virus parti=
cles from passing through, how tightly the device fits and - most important=
- how long people can be coerced into wearing them.
To our surprise, we found that the filters in surgical masks, although n=
ot as good as the filters in the N95 respirators, are still quite effective=
. And although a surgical mask fits much more loosely and allows more leaka=
ge, it's also more comfortable - and therefore likely to be effective becau=
se it's used more.  Wearing nylon hosiery over a surgical mask essenti=
ally eliminates the face leakage, making this combination a practical, albi=
et macabre, alternative. The less comfortable N95 respirators would propabl=
y result in lower compliance.
The government doesn't stockpile masks and respirators, and the manufact=
urers aren't able to produce a huge number of them quickly. But the way for=
ward seems clear: the government needs to build up a supply of respirators =
and masks just as it does with vaccines and antivirals. It should first hir=
e a whiz-bang design company to create, within one month, a surgical mask t=
hat comfortably adheres to the face, and then decide on the appropriate mix=
of respirators and masks. Next, it needs to sign contracts with manufactur=
ers to stockpile masks and respirators, relieving the manufacturers of liab=
ility issues.
Although there is very little technological risk involved (masks and res=
pirators are easier to make and safer than vaccines), several issues need t=
o be ironed out. First, the effectiveness of N95 respirators and masks vary=
widely. The government needs to educate the public (the brands are anonymo=
us in the published studies) and should stockpile only the most effective b=
rands.
Also, if respirators and masks are discarded daily, as they are in many =
hospitals, the national demand during a three-month pandemic could be 10 to=
20 billion, and the cost of respirators for a family of four several hundr=
ed dollars. Such waste isn't necessary. The virus does not survive longer t=
han a few hours on the material used for masks and respirators, so they sho=
uld be re-used until they disintegrate.
The government and the public health community must switch mindsets, fro=
m the current perspective of protecting workers paid to do a dangerous job =
everyday, to that of providing ciitizens with the tools best to protect the=
mselves during a pandemic.
It may take 18 months to build a stockpile of respirators and masks, so =
there is no time to lose. The American people's faith in their government w=
ill be seriously undermined if, along with larger measures like school clos=
ings, it cannot provide effective face protection for its citizens during a=
deadly pandemic. Masks and respirators may be our main lines of defense du=
ring a pandemic.
Lawrence M.Wein is a professor at Stanford's graduate school of business=
.
Correction: October 28, 2006
An Op-Ed article on Wednesday, about preventatives during an influenza p=
andemic, incorrectly stated that the government had not stockpiled masks an=
d respirators. The Centers for Disease Control has a stockpile of 74.3 mill=
ion respirators and 45.5 million masks."
Note: In a private communication from Prof.Wein, he stated that a mask o=
r respirator should be worn "[a]ny place where you are in a room with anoth=
er person (unless you've all been isolated for 5 days from the outside worl=
d)."
The end 
<DIV>
<DIV>Reg Curtis/VE9RWC</DIV><=
/DIV>
<BLOCKQUOTE style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #a0c=
6e5 2px solid; MARGIN-RIGHT: 0px">
<HR color=3D#a0c6e5 SIZE=3D1>
From: "James M. Atkinson" <j..._at_tscm.com> Reply-To: TSCM=
-..._at_googlegroups.com To: TSCM-L <TSC..._at_googlegroups.com><=
/I> Subject: [TSCM-L] Norovirus Date: Fri, 09 Mar 2007 13:3=
8:32 -0500 > > >Please read the following: ><BR=
>>A lot of companies in the North-East are having >this hit them r=
ather hard, a lot of security >departments have half their department=
out sick >with this, and several sweep folks have gotten >side=
lined for over a week when this hit them. It >is not the kind of thin=
g that you want to have hit you when your traveling. > >If you =
get this your best bet is to stay home >until it totally clears up, s=
ee your doctor as >quickly as possible, hydrate-hydrate-hydrate, and =
wash your hands=20
often. > >-jma > > > > > >h=
ttp://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-qa.htm > >W=
hat are noroviruses? > >Noroviruses are a group of viruses that=
cause the >=93stomach flu,=94 or gastroenteritis >(GAS-tro-en-=
ter-I-tis), in people. The term >norovirus was recently approved as t=
he official >name for this group of viruses. Several other >nam=
es have been used for noroviruses, including: > >Norwalk-like v=
iruses (NLVs) >caliciviruses (because they belong to the virus family=
Caliciviridae) >small round structured viruses. >Viruses are v=
ery different from bacteria and >parasites, some of which can cause i=
llnesses >similar to norovirus infection. Like all viral >infec=
tions, noroviruses are not affected by >treatment with antibiotics, a=
nd=20
cannot grow outside of a person=92s body. > >What are the sympt=
oms of illness caused by noroviruses? > >The symptoms of norovi=
rus illness usually include >nausea, vomiting, diarrhea, and some sto=
mach >cramping. Sometimes people additionally have a >low-grade=
fever, chills, headache, muscle aches, >and a general sense of tired=
ness. The illness >often begins suddenly, and the infected person =
>may feel very sick. In most people the illness is >self-limiting =
with symptoms lasting for about 1 >or 2 days. In general, children ex=
perience more >vomiting than adults. Most people with norovirus &g=
t;illness have both of these symptoms. > > > >What =
is the name of the illness caused by noroviruses? > >Illness ca=
used by norovirus infection has several names,=20
including: > >stomach flu =96 this =93stomach flu=94 is not rel=
ated >to the flu (or influenza), which is a respiratory >illnes=
s caused by influenza virus. >viral gastroenteritis =96 the most comm=
on name for >illness caused by norovirus. Gastroenteritis >refe=
rs to an inflammation of the stomach and intestines. >acute gastroent=
eritis >non-bacterial gastroenteritis >food poisoning (although=
there are other causes of food poisoning) >calicivirus infection =
>How serious is norovirus disease? > >People may feel very s=
ick and vomit many times a >day, but most people get better within 1 =
or 2 >days, and they have no long-term health effects >related =
to their illness. However, sometimes >people are unable to drink enou=
gh liquids to >replace the liquids they lost because of vomiting &=
gt;and=20
diarrhea. These persons can become dehydrated >and may need special m=
edical attention. This >problem with dehydration is usually only seen=
 >among the very young, the elderly, and persons with weakened immune=
systems. > >How do people become infected with noroviruses?<BR=
>> >Noroviruses are found in the stool or vomit of >infected=
people. People can become infected with >the virus in several ways, =
including: > >eating food or drinking liquids that are contamin=
ated with norovirus; >touching surfaces or objects contaminated with<=
BR>>norovirus, and then placing their hand in their mouth; >having=
direct contact with another person who is >infected and showing symp=
toms (for example, when >caring for someone with illness, or sharing =
foods >or eating utensils with someone who is ill). >Persons=20
working in day-care centers or nursing >homes should pay special atte=
ntion to children or >residents who have norovirus illness. This viru=
s >is very contagious and can spread rapidly throughout such environm=
ents. > > > >When do symptoms appear? > &g=
t;Symptoms of norovirus illness usually begin about >24 to 48 hours a=
fter ingestion of the virus, but >they can appear as early as 12 hour=
s after exposure. > >Are noroviruses contagious? > &gt=
;Noroviruses are very contagious and can spread >easily from person t=
o person. Both stool and >vomit are infectious. Particular care shoul=
d be >taken with young children in diapers who may have >diarrh=
ea.How long are people contagious? > >People infected with noro=
virus are contagious >from the moment they begin feeling ill to=20
at >least 3 days after recovery. Some people may be >contagious=
for as long as 2 weeks after recovery. >Therefore, it is particularl=
y important for >people to use good handwashing and other hygienic<BR=
>>practices after they have recently recovered from norovirus illness.<B=
R>> >Who gets norovirus infection? > >Anyone can becom=
e infected with these viruses. >There are many different strains of n=
orovirus, >which makes it difficult for a person=92s body to >d=
evelop long-lasting immunity. Therefore, >norovirus illness can recur=
throughout a person=92s >lifetime. In addition, because of differenc=
es in >genetic factors, some people are more likely to >become =
infected and develop more severe illness than others. > >What t=
reatment is available for people with norovirus=20
infection? > >Currently, there is no antiviral medication that<=
BR>>works against norovirus and there is no vaccine >to prevent in=
fection. Norovirus infection cannot >be treated with antibiotics. Thi=
s is because >antibiotics work to fight bacteria and not viruses. =
> >Norovirus illness is usually brief in healthy >individual=
s. When people are ill with vomiting >and diarrhea, they should drink=
plenty of fluids >to prevent dehydration. Dehydration among young<BR=
>>children, the elderly, the sick, can be common, >and it is the m=
ost serious health effect that can >result from norovirus infection. =
By drinking oral >rehydration fluids (ORF), juice, or water, people<B=
R>>can reduce their chance of becoming dehydrated. >Sports drinks =
do not replace the nutrients and >minerals lost during this=20
illness. > >Can norovirus infections be prevented? > &=
gt;You can decrease your chance of coming in contact >with noroviruse=
s by following these preventive steps: > >Frequently wash your =
hands, especially after >toilet visits and changing diapers and befor=
e eating or preparing food. >Carefully wash fruits and vegetables, an=
d steam oysters before eating them. >Thoroughly clean and disinfect c=
ontaminated >surfaces immediately after an episode of illness >=
by using a bleach-based household cleaner. >Immediately remove and wa=
sh clothing or linens >that may be contaminated with virus after an<B=
R>>episode of illness (use hot water and soap). >Flush or discard =
any vomitus and/or stool in the >toilet and make sure that the surrou=
nding area is kept clean. >Persons who are infected with norovirus=20
should >not prepare food while they have symptoms and for >3 da=
ys after they recover from their illness (see >food handler informati=
on sheet). Food that may >have been contaminated by an ill person sho=
uld be disposed of properly. > > > >---------------=
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ne: (978) 546-3803 > Granite Island Group Fax: (978) 546-9467 >=
127 Eastern Avenue #291 Web: http://www.tscm.com/ > Gloucester, MA 0=
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Received on Sat Mar 02 2024 - 00:57:27 CST

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