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CIDRAP – Center for Infectious Disease Research and Policy suggest respirators for all Ebola healthcare workers – aerosol transmissibility of virus in question
Today's commentary was submitted to CIDRAP by the authors, who are national experts on respiratory protection and infectious disease transmission. In May they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago.
The precautionary principle—that any action designed to reduce risk should not await scientific certainty—compels the use of respiratory protection for a pathogen like Ebola virus that has:
-No proven pre- or post-exposure treatment modalities
-A high case-fatality rate
-Unclear modes of transmission
We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.
We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.
How are infectious diseases transmitted via aerosols? Medical and infection control professionals have relied for years on a paradigm for aerosol transmission of infectious diseases based on very outmoded research and an overly simplistic interpretation of the data. In the 1940s and 50s, William F. Wells and other "aerobiologists" employed now significantly out-of-date sampling methods (eg, settling plates) and very blunt analytic approaches (eg, cell culturing) to understand the movement of bacterial aerosols in healthcare and other settings. Their work, though groundbreaking at the time, provides a very incomplete picture. Early aerobiologists were not able to measure small particles near an infectious person and thus assumed such particles existed only far from the source. They concluded that organisms capable of aerosol transmission (termed "airborne") can only do so at around 3 feet or more from the source. Because they thought that only larger particles would be present near the source, they believed people would be exposed only via large "droplets" on their face, eyes, or nose.
originally posted by: cmdrkeenkid
a reply to: negue
PAPRs are expensive! I'm sure buying I'm bulk would take them down below the $1200+ price range per unit (for a cheap one), but still quite pricey. Why not just stick with the disposable N95/99/100 respirators? You could buy a whole boatload for $1200.
Experimental work has shown that Marburg and Ebola viruses can be isolated from sera and tissue culture medium at room temperature for up to 46 days, but at room temperature no virus was recovered from glass, metal, or plastic surfaces.23 Aerosolized (1-3 mcm) Marburg, Ebola, and Reston viruses, at 50% to 55% relative humidity and 72°F, had biological decay rates of 3.04%, 3.06%. and 1.55% per minute, respectively. These rates indicate that 99% loss in aerosol infectivity would occur in 93, 104, and 162 minutes, respectively.23
Unlike past outbreaks, the current outbreak of EVD has not been contained and has resulted in social unrest, breakdown in law and order, shortages of personal protective equipment (PPE) and depletion of the healthcare workforce, with over 240 healthcare workers (HCWs) becoming infected and 120 HCW deaths as of 25thAugust 2014 (World Health Organization (WHO) 2014c).
Current evidence suggests that human to human transmission occurs predominantly though direct contact with blood and body secretions, (World Health Organization (WHO) 2014a) and this is the basis of the WHO and the CDC recommendations for facemasks to protect HCWs from EVD. When determining recommendations for the protection of HCWs, guidelines should not be based solely on one parameter, the presumed mode of transmission.
There appears to be a double standard in recommendations for laboratory scientists working with EV, who must adhere to the highest level of biocontainment (BSL4) when working with the virus. (Center for Disease Control and Prevention (CDC), Department of Health and Aging Australia, 2007) Further, in contrast to HCWs, laboratory workers are exposed to the virus in a highly controlled, sterile environment in which there is less risk of transmission than in the highly unstable, contaminated and unpredictable clinical environment. The perceived inequity inherent in these inconsistent guidelines may also reduce the willingness of HCWs to work during an EVD outbreak.
Further, numerous HCWs have succumbed to EVD during this epidemic, including senior physicians experienced in treating EVD and presumably less likely to have suffered lapses in infection control (World Health Organization (WHO) 2014).