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Science & the Public

H1N1: Call to revise flu-mask policy

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Three groups of healthcare professionals sent a letter to President Obama yesterday asking that he instruct his administration to revise federal flu-mask guidance. What these groups want: formal recognition that two studies last month showed conventional surgical masks are about as protective as the fancy — but much more expensive — N95 respirators in limiting H1N1 infection.

Currently, the Centers for Disease Control and Prevention, the Occupational Safety and Health Administration, and the Institute of Medicine all advocate that people — well, at least healthcare workers — don N95 masks where exposure to pandemic swine flu germs is likely.

The new letter was drafted on behalf of the Infectious Diseases Society of America, which represents more than 9,000 infectious diseases physicians and scientists; the Society for Healthcare Epidemiology of America, a group of 1,700 physicians, infection-control specialists and other healthcare professionals; and the more-than-12,000-member Association of Professionals in Infection Control and Epidemiology.

At the annual meeting of the last of those groups, last week, researchers from Australia reported a reanalysis of data from a study in China. It found no significant difference between the two types of masks in protection against flu infection. Its findings mirrored ones reported Oct. 1 in the Journal of the American Medical Association.

As recently as September, however, the Obama administration has advocated N95 respirators — tight fitting masks with especially tiny pores — for healthcare professionals working around people infected with the H1N1 virus. That recommendation’s “disconnect” with newly emerging scientific data has “engendered significant confusion among healthcare professionals and facilities’ administrators; the misallocation of scarce resources to the detriment of both patient and healthcare worker protection; and the creation of skepticism toward federal public and occupational health decision-making,” the groups charge in their new letter.

Bottom line: Hospitals and clinics now feel compelled to ante up big bucks for the pricy masks — even as they’re reading that doing so won’t afford their staffs and healthy patients improved protection from infection.

But the three groups aren’t just concerned about cost. “Indeed,” they argue, “requiring the use of fit-tested respirators for routine evaluation and care of all suspect cases of H1N1 influenza could lead to unintended adverse consequences for patients and healthcare workers,” such as the unnecessary referral of patients to already overloaded emergency rooms and an exacerbation of an existing shortage of respirators. “In addition,” the groups charge, “because the respirators are cumbersome and make it more difficult to breathe and talk, healthcare workers may avoid their use or limit the time they spend with influenza patients.”

To provoke the maximum discussion on this topic, the three groups cc’d their letter to a host of administration notables, including Health and Human Services secretary Kathleen Sebelius, Centers for Disease Control and Prevention director Tom Frieden, NIH director Francis Collins and the National Institute of Allergy and Infectious Diseases director Anthony Fauci.

I’m betting that there surely will be significant chatter between agencies on the matter since the new studies strongly flaut what had been the conventional wisdom. Moreover, as commenters to the recent JAMA study wrote in an invited editorial, there still is a paucity of data from which to synthesize sound flu-mask policy. As of Oct. 1, they pointed out, the JAMA study being released that day constituted “the first and only published randomized trial assessing respiratory protection for preventing influenza transmission.”

And now there are two studies. Still not a reassuring number on which to set health policy.

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