CATER Mask Decisions

January 28, 2021

Three Step Mask Strategy Webinar Friday Feb 5 at 10:AM CST

CBS News Also Now Reporting Need for More Efficient Masks

Washington Post Says the Mask Message is Confused

MERV 13 is the New Minimum Normal

Clean Air Curtain with HEPA Filter for Focused Air Cleanliness

Virus Contacts: Agencies and Organizations

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Three Step Mask Strategy Webinar Friday Feb 5 at 10:AM CST

On Friday, February 5 we will discuss the three step plan authored by

• Devabhaktuni Srikrishna is the founder of Patient Knowhow, which curates patient educational content on YouTube. In 2014, he worked on the response to the Ebola outbreak in Guinea. Follow him on Twitter at @sri_srikrishna.
• Joseph Buccina is a director at In-Q-Tel’s B.Next, a strategic initiative focused on biotechnology and national security.
• Dan Hanfling, MD, is a clinical professor of emergency medicine at George Washington University, co-chair of the National Academy of Medicine Forum on Medical and Public Health Preparedness, and a vice president on the technical staff at In-Q-Tel.
• Monica Gandhi, MD, is an infectious disease specialist, professor of medicine, medical director of the Ward 86 HIV Clinic, and director of the Center for AIDS Research at the University of California, San Francisco. Follow her on Twitter at @MonicaGandhi9.
• Donald Milton, MD, is a professor of environmental and occupational health at the University of Maryland School of Public Health. Follow him on Twitter at @Don_Milton.

Sri will provide a brief overview of the plan but we also ask attendees to view details in the January 27 Alert.  We will discuss each of the three steps and  contents below. We encourage you to participate and also to submit evidence, opinions etc. ahead of time. 

As Sri and the other authors point out the three step plan needs to be quickly implemented and “it is up to CEOs, mayors, and governors to implement these three steps to ensure consistent use of the best possible masks for vulnerable groups”.  Here is a proposed agenda of subjects to be addressed.

The three steps are (l) launching an awareness blitz, (2) advise on which masks should be worn and (3) prioritize masks for the vulnerable.

1.      Launch an awareness blitz

a.       roles

                                                              i.      mainstream media including local news outlets

                                                            ii.      role of association and occupational media including business  and medical

                                                          iii.      suppliers from the large validators such as SGS and Eurofin to media suppliers to mask manufacturers

                                                           iv.      CATER Mask Decisions

b.      message

                                                              i.      push - the need to mandate use of efficient masks

                                                            ii.      pull - the advantage of using pull or incentives

1.      the safe bubble with the promise of full occupancy within  the bubble

                                                          iii.      criteria

1.      general and absolute

2.      relative risk reduction as proposed by Mcilvaine

                                                          iv.      product availability

1.      media

2.      masks

3.      timing

4.      geographies

2.      Communicate which type of masks people should wear

a.       N95

b.      CATER

c.       surgical mask with brace

d.      eN95

e.       other

3.      Prioritize masks for the vulnerable

a.       who

b.      location – should this extend to other countries?

c.       how

                                                              i.      vouchers

                                                            ii.      direct distribution

to register for the webinar: https://home.mcilvainecompany.com/index.php?option=com_rsform&view=rsform&formId=92

CBS News Also Now Reporting Need for More Efficient Masks

Sri is doing his part on step #2 . He is quoted this week in a Boston Globe article and in the following article in CBS news.

There has been a big swing in the views of medical researchers and it is reflected in the general media. In our Alert a few days ago CNN published an article indicating that the pandemic would be over if everyone wore an N 95 mask for four weeks.  Here us the coverage this week from CBS.

The Biden administration has issued a mask mandate requiring individuals to wear masks on federal property, and he's encouraging all Americans to wear them in public for 100 days. Face coverings are also required on planes, trains, buses and at airports, renewing questions about which kinds of masks provide the best protection against COVID-19, as well as where to find them. 

The goal of the "100 Days Masking Challenge" is to curb the rapid spread of the coronavirus, which has already claimed the lives of more than 400,000 Americans. Indeed, a study published on January 19 in the Lancet Digital Health journal Studies found that increasing mask-wearing across the U.S. by just 10% would significantly curb the transmission of the coronavirus. 

Mask-wearing is even more effective when the face coverings fit properly and efficiently filter aerosol particles, according to medical experts. 

"In addition to filtration, fit is the most important factor," said Devabhaktuni Srikrishna, founder of global-health platform Patient Knowhow, which curates educational health content for the general public.

"Even if you're wearing a high-quality mask, if it doesn't contact your face, it's going to leak all around. The best masks have a very solid, tight seal so that air doesn't leak. Effectively, a low fit equals low filtration," Srikrishna said. 

Megan Ranney, an emergency physician at the Rhode Island Hospital, ranked generally available mask alternatives from most effective to least effective, noting that typically, any kind of face covering is better than none at all. 

N95s provide the most filtration, according to Ranney, followed by so-called KN95 masks. Regular surgical masks are the next best option, followed by double-layer cloth masks with a filter worn in-between the two layers. Double-layer and single-layer cloth masks without filters tend to be the least efficient, she said.

"Anytime you take a step up, you're going to get a little more protection. Within cloth or homemade masks, things that make them better include having two layers of cloth with a filter in between the two layers, like a vacuum bag filter, and having the cloth be tightly woven," Ranney said. 

Dr. Tom Frieden, who was the director of the Centers for Disease Control and Prevention from 2009 to 2017, echoed Ranney's advice in a tweet Sunday. 

"N95 masks are the most protective masks, followed by three-ply surgical masks, then fabric masks. A fabric mask is a lot better than no mask, but we may need to step up our mask game if contagious Covid variants start to spread widely," he said.

An N95 approval rating by the National Institute for Occupational Safety and Health means that a mask has been rigorously tested and verified by the federal government and filters at least 95% of airborne particles.

NIOSH maintains a list of approved respirators by brand. Because N95-approved masks remain in short supply, however, experts still recommend that they only be used by health care providers. 

"I generally ask the public to not purchase N95s because the authentic ones are still in short supply for health care workers," Ranney said. 

Proper fit, meanwhile, which is also key, is difficult for the layperson to achieve. 

"Within health care, before we are allowed to go take care of patients in an N95 or equivalent mask, we have to go through fit testing where they have us move our head around and see if a bitter spray gets through the mask. An average member of the public can't do a fit test, that's why we've been hesitant to recommend that the public wear N95s," Ranney added. 

Brian Wolin, whose work as a chiropractor has slowed since the onset of the pandemic, has been selling NIOSH-approved N95 masks through his company, Protective Health Gear, based in Paterson, New Jersey. Initially, his goal was to help meet hospitals' masks needs. He's now urging the general public to wear the respirators, too. 

We feel it's very important to sell to the general public now. I think if everyone on the planet wore one of these things for 30 days, we would take care of this thing," Wolin said. 

He acknowledged the importance of fit testing in health care settings but insists that regular individuals can easily mold Protective Health Gear's masks to form a tight seal on their faces. A box of 50 respirators costs $199 at protectivehealthgear.com. 

While NIOSH-approved N95 masks are among the most rigorously tested for a variety of factors including filtration, breathability and durability, there are other effective alternatives suitable for general use when N95s aren't available. 

Srikrishna recommends reusable elastomeric masks, which are more durable and cost-effective than disposable N95s. 

Elastomeric masks provide a high level of respiratory protection and can be paired with disposable filters. The masks themselves are made of a flexible material similar to rubber and can be adjusted to fit snuggly across the wearer's face.

A 2020 study published in the Journal of the American College of Surgeons found that of those health care workers who swapped disposable N95 masks for the elastomeric variety — paired with a P100 filter — none returned to wearing an N95 mask. 

"Our clinicians were very comfortable with the fit, knowing it was an equivalent if not superior amount of protection, and that these masks were intended to be reused," Dr. Sricharan Chalikonda, the study's lead author, said in a statement.

The elastomeric mask shell is sold separately from the filter. Srikrishna recommends pairing the masks with a P95 filter, as opposed to a P100 filter, for easier breathability. Another plus to elastomeric masks: They are relatively easy to find. A 3M version is available for $15 on Amazon, as are P95 particulate filters — sold separately. 

The Centers for Disease Control and Prevention also approves the use of elastomeric masks, calling them "equivalent protection" to N95 masks. 

KN95 masks look similar to N95 masks but meet completely different standards. Whereas N95 masks are NIOSH-certified, KN95 masks meet the Chinese government's standards for certification. 

Given that the quality of KN95 masks is wildly inconsistent, experts in the U.S. are leery of them, particularly those sold on platforms like eBay and Amazon. A September report from ECRI, a nonprofit health care safety organization, found that up to 70% of KN95 masks did not meet U.S. standards of effectiveness. In other words, they did not filter 95% of aerosol particulates, as their name suggests. 

Of course, average consumers are unlikely to have the time and tools to inspect the masks themselves. 

"In health care we generally avoid the KN95s at this point," ER physician Ranney said. Ranney is co-founder of GetUsPPE.org, a site that provides donated PPE to frontline workers and under-resourced communities. 

Ranney said her organization received batches of donated KN95s, a number of which failed the group's inspection process. "Cloth masks that fit really well and have a filter in between layers are going to be more dependable," she said.

The Food and Drug Administration does however provide a list of KN95 masks it authorizes for emergency use by health care professionals. 

Among them are KN95 masks from Chengde Technology, which cost $15 for a pack of 10.

Powecom KN95 masks are also FDA-approved for emergency use. Office Depot sells a 10-pack for $10.

Where to find an N95 or high-filtration mask for Biden's 100-day challenge - CBS News

Washington Post Says the Mask Message is Confused

“The existence of more-transmissible viruses emphasizes the importance of us upping our game and doing not more of the same but better of the same,” said Tom Frieden, former director of the Centers for Disease Control and Prevention. Frieden has called for people to wear higher-quality masks. “Yes, that is confusing to people, but the key is to share what we know when we know it and be frank about what we don’t know.”

Anthony S. Fauci, the nation’s top infectious-disease expert, touted double-masking during a Monday appearance on the “Today” show, saying two layers “just makes common sense that it likely would be more effective.”

But on a Wednesday town hall appearance on CNN, Fauci appeared to reverse course and instead stressed following CDC guidance, which does not call for wearing two masks or N95s. New CDC Director Director Rochelle Walensky, appearing alongside Fauci, also warned that N95 masks are uncomfortable to wear and may dissuade consistent use if expanded to the general public.

The CDC encourages Americans to choose well-fitting masks with “two or more layers of washable, breathable fabric” and to avoid surgical masks and other face coverings meant for health-care workers.

President Biden has embraced masks as a core strategy for ending the pandemic, mandating face coverings on planes, in airports and in all federal buildings. But he has not called for a medical-grade-mask mandate or mass production of high-quality masks.

Some public health experts said the federal government should have prioritized certifying or manufacturing better masks earlier so Americans do not have to fend for themselves to avoid counterfeits or upgrade their own. 

Abraar Karan, a physician at Brigham and Women’s Hospital and Harvard Medical School has, since last spring, called on government and industrial leaders to mass-produce comfortable, effective masks. He said the country could have avoided its current situation, with Americans learning how to better protect themselves largely alone.

https://www.washingtonpost.com/health/2021/01/27/double-mask-variants-guidance/

MERV 13 is the New Minimum Normal

Chris Plotz, director of education & technical affairs at INDA, provided insights on air filters in the most recent IFN issue

“There are some complications relating to the installation of MERV 13 filters in systems with 1” and 2” filter racks, as MERV 13 filters are typically deeper to minimize pressure drop. A basic switch to a MERV 13 from a lower-rated filter in a 1” or 2” system presents unintended consequences, which result in a cascade of increases within the HVAC system. These manifest in higher resistance, increased pressure, as well as increases in energy use in the system. This can cause airflow reductions, freezing of the air conditioner coil and, potentially, damage to the compressor. A workaround could be to retrofit a larger rack to accommodate a deeper filter with significantly more filtration media. This is not a simple or cheap task. Cost is not the only factor though, as a retrofit would also require steps to ensure the enlarged filter rack is as airtight as possible to prevent air bypass or depressurization effects from occurring.

HVAC filtration can be augmented by a number of additional control elements to clean pollutants and contaminants out of the air. When used properly, ultraviolet light, room air cleaners and humidity control can be part of a plan to reduce the potential for airborne transmission of COVID-19 indoors. Ultraviolet light purifiers utilize short-wave UV-C light to inactivate airborne pathogens and microorganisms. As air is forced through the device, it passes over UV lamps, which disinfects via irradiation.

“I see indoor filtration at MERV 13 levels as the new minimum normal for filtration systems going forward. Just prior to the pandemic, California enacted the “Title 24” Energy Code, which requires this level of filtration for all construction and renovation. This is being adopted by many states and is quickly becoming de facto. This is also being recommended by the American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE), and the U.S. Environmental Protection Agency and the CDC.

The COVID-19 pandemic has significantly educated the public about indoor air quality, and with many upgrades and new laws being enacted or proposed, it looks like we will be getting a breath of clean, fresh air long into the future.”

Clean Air Curtain with HEPA Filter for Focused Air Cleanliness

The Clean Air Curtain from Air Cleaners Inc combines HEPA filtration--as is used in hospital surgeries--with UVGI to create a “trap and kill” effect. Clean air comes from the device in a high-speed vertical “curtain” of air. The Clean Air Curtain provides separation between air spaces in a room, and rapidly--and uniformly--reduces the concentration of airborne pathogens in the room. Managing the cleanliness of the air is more important than the cleaning of surfaces, especially in schools.

The Clean Air Curtain can be connected in series to create a protective wall that blocks aerosols and droplets and cleans the air up to ten times per hour.

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Features include

§  High-velocity air curtain plume: The Air Curtain provides two primary benefits by both creating an air barrier that protects one person from another, and the resulting high-speed plume of air forces rapid dilution of pathogens in the room.

§  ‘Trap and Kill’ design: Air is returned to the device and forced at high pressure through a true HEPA filter. UVGI is deployed in the supply plenum and directed onto the filter constituting a “trap and kill” design. Pathogens are trapped against the HEPA filter and killed by the UVGI light.

§  Small portable “desktop” package: The Clean Air Curtain is a small desktop unit that measures only 24 x 12 x 8 inches and can therefore fit onto a countertop or desktop. The unit is portable and weighs approximately 30 pounds. It can therefore be added to an environment for a period of time, and then moved as appropriate to a new location.Virus Contacts: Agencies and Organizations

A Resource Guide for the Practitioner and Traveler by Ann Marie Flynn, PhD, R. Ryan Depont, PhD, Lila Theodore, Emma Parente, Louis Theodore, DEngSc.  Publisher:  Amazon ($7.99)

As the title implies, Virus Contacts: Agencies and Organizations - A Resource Guide for the Practitioner and Traveler can be used to obtain detailed and pertinent contact information on viruses.  Concise and easy to use, this Guide brings together a wealth of hard-to-gather information in one compact book and offers general information and contacts of state public health agencies, international health agencies, and research centers.

The Guide has been written for technical individuals who not only work in the health area or in health-related fields but also travelers here and abroad.  It is a quick reference tool that may be used whenever and wherever information about viruses is likely to be sought. It is a must for those working in the health field and those involved peripherally with viruses.

Following a brief introduction, Part I provide detailed information on state public health agencies.  In addition, each state/organization profile includes the authors’ evaluation of both the quality of their webpage and an analysis of their virus activities. The last two parts, Parts II and III provide information on international and pharmaceutical research agencies, respectively.

In summary, this book provides a handy reference to the burgeoning wealth and maze of virus and virus-related information from state, international, and research center health agencies that have found a depository on the Internet and World Wide Web.