Mask Skirmish Marks New Front In Swine Flu Battle

So when the swine flu hits, should the doctors and nurses at your local hospital make do with regular old surgical masks to keep the new H1N1 virus at bay or go with a beefier and more costly respirator?

The question has sparked heated debate between health-care workers and infection control specialists. The dispute centers on N-95 respirators.

They look a lot like ordinary surgical masks but they're thicker, they fit tighter and they filter out at least 95 percent of all viruses. The fancier masks also cost more. And they're in increasingly short supply.

Front-line health care workers and their unions want personnel to be fitted with N-95s. Now the Centers for Disease Control and Prevention has sided with them. The public health gurus just posted new advice on the best ways to protect health care workers against the new H1N1 flu virus and recommends the N-95, or equivalents, for people workig closely with "patients with suspected or confirmed 2009 H1N1 influenza."

 

On the other hand, many infection control experts say N-95 respirators aren't necessary on a routine basis. A recent Canadian study comparing N-95s with simple surgical masks showed no difference in flu infection rates among health workers.

"In those early scary days of the new H1N1 influenza, when we were hearing death reports from Mexico, it seemed to make sense that we would take extra precautions with this virus," says Dr. Mark Rupp, president of the Society for Healthcare Epidemiology in America. "But as we've become more experienced with it and realize that it behaves just like seasonal influenza, it doesn't make as much sense to us anymore."

Whoever is right, the question may be academic if hospitals start running out of N-95s. Rupp, who works at the University of Nebraska Medical Center, says "like most places" it's having trouble getting enough. "In the spring we turned in an order that has yet to be filled," he says.

The new CDC guidance acknowledges that "some facilities are currently experiencing shortages of respiratory protection equipment and that further shortages are anticipated."

The federal government stockpiled 104 million N-95 respirators earlier this year. When the pandemic began, the government released 25 million. There are no plans to replace them, according to the Center for Infectious Disease Research and Policy.

And it's not clear that even the government could get more N-95s, even if it wanted to.

Masks really are the last line of defense. Everybody agrees that the most effective protection comes from keeping flu-infected people out of hospitals whenever possible, segregating them if they get in, and scrupulous attention to things like hand-washing and disinfection.