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Pandemic mask guidance frees up N95s for hospitals
CDC: Use masks for all but HCWs
If an influenza pandemic strikes, the public can use standard surgical masks, "social distancing" and hand hygiene to protect against community transmission, the Centers for Disease Control and Prevention (CDC) announced. That recommendation clears the way for businesses to stockpile less expensive and more abundant surgical masks — and to leave the N95 respirators for hospitals and other health care facilities.
Already, the respirator supply has loosened, says David Naylor, vice president of sales at Aramsco, of Thorofare, NJ, the world's largest distributor of N95 respirators. Some hospitals had experienced delays in receiving their respirator orders as large customers ordered respirators for pandemic stockpiling.
"The surgical mask decision by CDC finally gave some direction to the pandemic preparedness market," says Naylor, who is knowledgeable about the health care market but does not supply hospitals. "Whether accidentally or intentionally, it will have a big relief on hospital supplies."
Respirators or masks are considered a key protective measure in the event of pandemic influenza. Public health authorities acknowledge that it will take months, at least, to develop a strain-specific vaccine.
Last year, the CDC reversed its previous guidance and said that N95 respirators would be "prudent" for health care workers during "direct care activities involving patients with confirmed or suspected pandemic influenza."
Yet massive worldwide stockpiling by corporations, utilities, and public health agencies caused spot shortages of N95s even for hospitals' everyday use.
Now, the CDC is urging those businesses and individuals who are doing personal pandemic planning to rely primarily on surgical masks. N95 respirators, which require fit-testing in order to have the proper protective factor, "have a very limited role in pandemic planning," CDC director Julie Gerberding, MD, MPH, said in a press conference.
"No mask or any facial protection alone is going to be enough to completely eliminate the risk of a pandemic," she said. "So people have to always remember that what they're doing about their protection has to be done in context of [other] steps."
Gerberding acknowledged that the community-based mask guidance wasn't based on scientific evidence, and that more research is needed on the protective value of masks and respirators. But she added, "we think that we have something to offer here that will just be useful to people who are making decisions for themselves and for their families."
The CDC does recommend that family members caring for a sick person at home wear a respirator, if one is available. Gerberding also discouraged businesses outside of health care from stockpiling. "Masks may be an extra margin of safety for businesses, but I don't think any of the masks that we're talking about today are going to make a very big difference in what a business would need to be doing during a pandemic," she said. "So at this point, I would say that stockpiling masks of any kind is really an option that some businesses may consider, but it wouldn't be our priority in terms of overall preparedness."
The national stockpile contains about 52 million surgical masks and 100 million N95 respirators. While business sites generally do not need to worry about N95 stockpiling, hospitals need to pay greater attention to their supplies, advises Naylor. Most hospitals function with "just-in-time" inventory, maintaining just three days supply of respirators and other products. They count on vendors to maintain a stockpile for emergencies.
"It gives them this artificial feeling of security," says Naylor. "Keep in mind this is not a government-owned stockpile. This is owned by private entities. Don't expect your contract holder of your three-day predictable usage to be able to handle a surge that is nationwide."
Instead, hospitals should purchase a stockpile and contract with a third party to store respirators, advises Naylor. Excess government warehouse space is available around the country at low rates, he says. "Your agreement should be that you can come in without notice and inventory your material."