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  1. #1
    Forum Member RLFD14's Avatar
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    Default Threat Summary: Influenza Pandemic

    I am surprised that this is not getting more press here. The last (only?) thread on this topic that I could find was in the EMS Forum and has not been posted to since November 30, 2005.

    I am one of the first people to put down over-reporting and over-reacting. Reference the Cheney shooting incident press-orgy... and I am no fan of Dick Cheney.

    However, we are charged with being prepared for everything as much as can be reasonably expected. Reference the public perception of the response to Katrina (first responders actually did as well as could be expected, but the reporting on the response reveals what the public demands of us).

    Plane crashes and refinery fires are not common, but we prepare for them anyway, because they *might* happen in the next five minutes before you finish this thread, right?

    The probability of a global pandemic is increasing dramatically, becoming less of a cry-wolf scenario and more like global warming.... it is coming and it doesn't do much good to deny it.

    I have just reviewed a document from NERC (North American Electric Reliability Council - I work for a power company) regarding the electricity sector's preparation for this threat. A few high points:

    * Even if the H5N1 strain isn't the "Big One", some other strain will cause a pandemic eventually.
    * H5N1 closely resembles the 1918 strain, which infected up to 32 percent of the world's population.
    * The virus has successfully been transmitted from birds to humans hundreds of times in Asia and Turkey, each event is one more chance that it will mutate into the human-to-human variety.
    * The mortality rate of humans infected with H5N1 so far is over 50%.
    * No vaccine is yet developed, and the antiviral drug Tamiflu (which only MIGHT have limited effectiveness) is in short supply.
    * If/when human-to-human transmission occurs, it would spread to north America within three to eight weeks.
    * Infection rates are estimated at 25%, and infected persons would be ill for about a week. Absentee rates could go over 35% while healthy persons attend to sick family members. The pandemic could last for up to six months.
    * Mortality rate estimates vary widely from 0.5% to 12%.

    The questions you need to ask yourself:

    * How will I prepare to respond to medical "sick" calls to minimize the risk of being infected and passing it to my loved ones? What resources do I need that are not already available?
    * On a personal level, are you and your family capable of self-sustained, no-contact living in your home for an extended period of time?

    The questions for your fire and EMS departments:

    * How will your agency handle 35% of the workforce being unavailable? Reduced staffing, or station/apparatus consolidation?
    * Will you enact SOPs on how many personnel will attend medical "sick" calls, to reduce unnecessary exposures?
    * Does your agency have fully compliant resources and SOPs to properly handle infectious materials at this risk level?
    * It's a morbid thought, but in a worst-case scenario with high mortality rates (nightmare scenario is as high as 12%), does your agency have valid hiring lists capable of promptly replacing employees?

    If it never happens, feel free to call me names for pushing the big red panic button, I can take it and I didn't ask any of you to dance anyway. If it does happen and you or your agency weren't ready, you can't say you weren't warned.

    Your thoughts, please.
    Last edited by RLFD14; 02-20-2006 at 12:50 PM.
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  2. #2
    Forum Member Dave1983's Avatar
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    My only thought in regards to the mortality rate is, is it so high due to the level of medical care (or lack there of) in thoese countries? Would it be as high here? Not to say Im not concerned, but I cant imagin it would be that bad for us to lose 12% of our population. Of course, Iv been wrong before.

    You raise some interesting questions on how it would affect emergency services staffing. Ive seen what a normal old flu bug can do to a smaller department (mine). Something on a much greater scale, and involving more staff, could be a big problem.
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  3. #3
    MembersZone Subscriber mcaldwell's Avatar
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    Quote Originally Posted by Dave1983
    My only thought in regards to the mortality rate is, is it so high due to the level of medical care (or lack there of) in these countries? Would it be as high here? Not to say I'm not concerned, but I cant imagine it would be that bad for us to lose 12% of our population. Of course, Iv been wrong before.
    That is usually the case with a normal flu or illness that effects the old and very young. Improvements in health care can often better treat those with immature, suppressed, or weakened immune systems.

    The interesting thing that has been popping up through the H51N research is that the virus is currently hitting the strongest people the hardest. It is literally putting the healthy immune system into overdrive, where it actually beginning to interfere with normal processes, and the body ends up destroying itself.

    I think we don't always analyze the death rates adequately either, because even if the flu only kills 1 or 2 %, there will be many more people who die from peripheral results. The flu will not only affect health care workers, but manufacturing (i.e. prescription drugs), and shipping, as well as the number of hospital beds taken by the very sick that are unavailable for normal critical injuries and illness. How man hospitals are refusing pt's today, with the system running at supposedly peak efficiency?

    There is another element that we didn't have to deal with in 1918. Today, most businesses (health care included), operate on the "just-in-time" model, where products are shipped same day, and no inventory is kept. Hospitals don't have adequate storage facilities anymore for emergency medicine stock piles, in the event of a supply shortage. As well, drug manufacturers can be forced to halt production by just one ingredient being short-shipped.

    I'm not running out and building the bunker just yet, but it is certainly one more reason to promote emergency preparedness both in the home, and your emergency service.
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    Frankly, trying to plan for a scenario like that can be likened to

    "How do we evacuate the East Coast when we know a Tsunami will hit in 2 hours?"

    or

    "How do we protect the population in the event of nuclear war?"

    The simple answer is you don't.

    Any planning and such at best is an academic exercise.

    Even a totaleterian state wouldn't have the government resources and discipline to force people to obey any kind of organized plan, even if such plan could be designed.

    After 9-11, one of the things proposed was "We should have a plan how to ground all aircraft so we're not flying by the seats of our pants next time!"

    It quickly became apparantent (and is the plan today) that there is no written plan -- the air traffic controllers can do it faster by doing it by gut feeling than trying to obey written rules & procedures.

    What ever happens, if the pandemic happens, is going to be fought as a series of individual problems and unique situations handled region by region, city by city, block by block, and person by person.

    It does mean you talk in advance about some things -- infection control procedures, stockpiling of extra food & supplies, stockpiling of medications, etc. Even general thoughts & basic plans (like a one or two page document).

    Unlike an airplane crash or refinery fire that can be reasonably planned for, the impact of 12% mortality or 35% out ill on society in general will be so great and profound there is no way to plan in advance for it -- you're going to need to be there and react to the situation as it unfolds.
    Last edited by Dalmatian190; 02-20-2006 at 02:56 PM.

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    Dave -- the other thing that could be factoring in on a 50% mortality rate is a low sample size.

    Most likely they're only testing for the H5N1 when someone dies. It might be you have other people/families that get infected, no one dies, and the 3rd world health service never tests them and thus doesn't count them in that sample of 50%.

  6. #6
    Forum Member RLFD14's Avatar
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    Quote Originally Posted by Dalmatian190
    Frankly, trying to plan for a scenario like that can be likened to

    "How do we evacuate the East Coast when we know a Tsunami will hit in 2 hours?"

    or

    "How do we protect the population in the event of nuclear war?"

    The simple answer is you don't.
    You're both missing my point and making my point. The questions I put forward are (1) How are you personally going to prepare, and (2) How is your agency going to prepare. I am not proposing that you alone or your agency evacuate the East Coast or prepare for a nuke. You said it yourself, it will be handled on a case-by-case, region-by-region, city-by-city, block-by-block basis. So..... what has been done or will be done by you or your agency to prepare?
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    MembersZone Subscriber mcaldwell's Avatar
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    Well around here we start with the basics, just like we did during the SARS scare.

    At the hall;

    -Staff training and education on pathogen spread, decontamination procedures, and methods of personal and area protection.
    -Stockpiling of personal protective equipment like N95 masks, hand cleanser, first aid supplies, and other essential equipment.
    -Stockpiling of some basic reserves like bottled water, and maybe some emergency rations for those who get stuck pulling long shifts.
    -Training the guys to work shorthanded. It is easy to talk about, but better when you drill on running an entire incident with a 3-5 man response.

    At Home (the basic emergency preparedness list)

    -Maintaining a week or two worth of food (more in dry goods) and bottled water.
    -Maintaining a reasonable amount of cleaners, disinfectants, and laundry soap, etc.
    -Teaching your kids about general cleanliness, hand-washing, and personal hygiene.
    -Maintaining your power outage stockpiles of candles, lights, batteries, etc.
    -Updating your contact lists regularly so you have a means to communicate and keep in touch with your family if separated during any emergency.
    -Keeping your prescriptions up, and not waiting until the last day to refill them.

    You can't pack up and move to the mountains because the flu has extensive reach. And just like during any threat (i.e. terrorism, etc.) you can't live in fear and allow it to effect your outlook and daily routine.

    You can give yourself a little piece of mind though by making sure your home and hall is the model of emergency preparedness, and that alone will keep you one step ahead of the crowd if and when the disaster strikes.
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    By me personally? Nothing.

    Then again I can be self sufficient for heat, water, and protein on my own property.

    By my organization? Don't know.

    But what do want us to plan for?

    Remember, the scenario you laid out to make your "points" went as high as 12% mortality and 35% of the population being sickened.

    You can't plan for that high end, because the profound affects on society in general will be so disruptive as to render any pre-determined plans moot since sure as the sun will come up tomorrow, the conditions and assumptions those plans where made on will no longer exist.

    If the scenario is less then world-ending, how does it differ from what we do on a regular basis?

    Take universal precautions, wear hepa masks if your concerned, keep the rigs clean. Remember in the days before Hepa quality masks existed, simple cotton was used, and we might have to resort to the use cotton, paper, or simple bandanas again, especially when out in public for general business, and preserve the Hepas for when dealing with the known ill at the risk is highest.

    It's not a belittle it, and it's a great question to ask...I just think the answer comes down to there being far too many unknowns in any of the situations to make any specific plans.

  9. #9
    MembersZone Subscriber mcaldwell's Avatar
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    Quote Originally Posted by Dalmatian190
    You can't plan for that high end, because the profound affects on society in general will be so disruptive as to render any pre-determined plans moot since sure as the sun will come up tomorrow, the conditions and assumptions those plans where made on will no longer exist.

    It's not a belittle it, and it's a great question to ask...I just think the answer comes down to there being far too many unknowns in any of the situations to make any specific plans.
    You are right in one regard Dal, in that the first caualty of war is always the plan. But, even if the plan cannot be salvaged, the process you used to create it is often more valuable.

    The planning process will force you to examine alternatives, and identify challenges that you may encouter before you face that emergency. We do this in our day to day life, by pre-planning buildings. You know that the details of that pre-plan may vary with renovations, occupancy, and contents, on any given day, but the system of documenting and analyzing the structure and it's unique hazards, combined with defining some basic strategies and tactics will often make you more confident and prepared in the end.

    The same goes for pandemic preparation. Have you thought about how to manage multiple runs with 50% of your staff? If you can only find enough staff to run 2 out of 5 trucks, how do you staff and equip them to ensure you have what you need? Are you sure your mutual aid will work when your neighbour is in the same boat? If not, it will affect your plan of attack in that situation.

    I agree that you can't plan for everything, and you will never be fully prepared for the hundred year storm, but the planning process will allow you to identify alternatives, resources, and raise awareness of your limitations when it hits. That way, when you find yourself in that situation, you hopefully won't be forced to solve every problem from scratch.
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    I hear you McCaldwell..

    But there is a galaxy of difference between pre-planning for an incident such as a building fire, or an aircraft crash, or a refinery fire...and a worse case pandemic scenario.

    Even if you look at severe natural disasters such as hurricanes, earthquakes, or ice storms you're on your own for 48, 72 hours and then assistance from outside of the region can help to start taking over.

    In the bad to worse case pandemic scenarios, there is no help. There is no mutual aid, there is no FEMA, there is no NATO, there is no one coming for weeks or months since it will outstrip our resources simultaneously across the nation and world.

    Planning for how you operate short-handed due to multiple calls or weather conditions limiting outside assistance is something we should already be doing so to address the staffing issues, it's a recognition you will be in the those low-manpower & equipment situation for an extended time instead of a handful of incidents.

    Knowing how to handle airborne pathogens has been an integral part of the fire service for 15+ years.

    Being prepared for operations without electrical power over a wide area (such as the result of hurricane or ice storm) should be something the fire service has planned for. That includes things like adequate local fuel supplies at the fire station or municipal garage along with generators to power the pumps. Having buffers of supplies such as fuel will help get through supply chain disruptions in a pandemic (which is why industry fears the hell out of it since just-in-time leaves them no meat on the bones to buffer wide scale impacts).

    Basic disaster preparations for mass casaulty, operating short handed, operating without outside supplies for days to weeks should be something we do anyway, danger of flue or not.

    And those form the core of how you'd react to a pandemic.

    But frankly, much beyond that, go practice stretching lines and basic fire tactics because that is something all of us actually do see, and can excel at if we pay attention to it.

    Pandemic response will be FUBAR no matter how much time and attention you pay to preparing for it. So beyond some real basic plans, that should primarily emphasize what we already have in place, I just don't think it's a good use of time.

  11. #11
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    I got a chuckle from this paragraph in an article about industry planning for bird flu in today's Worcester Telegram:

    Four thermal imaging devices — one for each plant in China — have been ordered, with the devices capable of nearly instantly measuring a worker’s body temperature to see if fever, a symptom of flu, is present, he said. If a worker had an elevated temperature, the next step would be medical screening to determine why. In a case of bird flu, the company would follow medical recommendations in deciding whether to send the person home, he said.

    I don't think our TICs are sensitive enough...does make you wonder though!

  12. #12
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    The full article:

    (BTW, the "telecommuting" plans are an absolute joke. Telecommuting is fine if you have to work around the loss of a single facility. They work with degraded performance with regional situations like snow storms. The nation's infrastructure isn't sufficiently robust when everyone signs into GoToMyPC simultaneously -- you'll see telecommuting resources slow to a crawl. The Cable & DSL lines aren't setup to handle that much simultaneous traffic; and most companies don't have that much bandwidth even if the ISPs did.)

    Sunday, March 5, 2006
    Crisis planning

    Threat of bird flu pandemic prompts area employers to prepare for staff shortages

    AVIAN FLU

    By Martin Luttrell TELEGRAM & GAZETTE STAFF
    mluttrell@telegram.com


    As bird flu spreads from Asia and the Middle East into Africa and Europe, billions of dollars are being spent to track its progress and prepare emergency plans and a vaccine, should it mutate into a virus that can be passed from human to human.

    More than 170 people have been infected, with roughly half dying. So far, human-to-human spread of the illness has been rare and not continued beyond one person, said the federal Centers for Disease Control and Prevention.

    While health officials hope a vaccine will be ready in the event of a pandemic, businesses are developing plans to stay in operation if their employees get sick and transportation is curtailed. Health officials and business continuity experts say companies should be prepared to have as many as 50 percent of their employees absent for about two weeks each.

    “The hardest part is that it’s a waiting game to see how serious this might turn out to be,” said Kathleen M. Plourde, an occupational health nurse at Morgan Construction Co., which employs 380 at its Worcester headquarters and 400 in China, where animal cases of the H5N1 bird flu strain have been reported since 2003.

    Morgan Construction, a manufacturer of steel processing equipment, had a plan in place after the Severe Acute Respiratory Syndrome outbreak and is tailoring a plan for bird flu.

    It is not alone among companies in Central Massachusetts, especially those with global operations.

    Nypro Inc., a Clinton-based plastics injection molding company, has put together a plan to keep its U.S. and China operations running even with a significant worker absence. Nypro has 8,000 employees in China and 15,000 worldwide.

    “That’s our objective,” said Nypro spokesman Alfred J. Cotton. “There are doomsday scenarios with the bird flu. We did make it through SARS, though it brought the country (China) to a stop.”

    Steven J. Ross, director of business continuity for Deloitte & Touche USA in New York, said companies cannot afford to depend on the government to come to the rescue, especially in the first days of a health catastrophe. Planning before a crisis is critical, he said.

    “Dependence on government has to be taken with a grain of salt,” he said. “They’ll be overwhelmed.”

    The biggest risk “is waiting until it’s time, then figuring it out,” he said. “You realize that you and a third of management won’t be there. So why would you leave these decisions in a time of crisis to people you wouldn’t leave them to now?”

    Brian R. Gilmore, executive vice president of public affairs for the Boston-based trade group Associated Industries of Massachusetts, said large companies are generally showing more initiative in planning than smaller ones.

    “For small- to medium-sized businesses, this is not on their radar screens,” he said. “It probably should be.”

    The U.S. Department of Health and Human Services projects that up to 1.9 million Americans could die in a severe flu pandemic. One industry likely to take a hit would be insurance. The Insurance Information Institute estimated that a severe pandemic could result in $133 billion in additional death claims. The Congressional Budget Office estimates that a pandemic could have an economic effect similar to a recession, with a loss of 5 percent of the gross domestic product.

    A severe pandemic could close restaurants and limit food sources, said Thomas E. Cavanagh, senior research associate at the Conference Board, a New York business research group. Quarantines could force healthy people to stay home, temporarily lowering consumer demand. “We could see a sharp impact on the economy from that,” he said.

    Ms. Plourde attended a seminar on pandemic planning offered by the Massachusetts Department of Public Health, and has used information from the CDC and World Health Organization in her work.

    “We were talking about if we should take our people out” of China, she said. “The CDC has information on leaving them there, and not to expose them to people on an airplane, not expose them to (the) social environment.”

    Russell H. Vanderbann, vice president for human resources at Morgan, said there is no plan for keeping the company running if a third or more of the work force is absent. “If that comes to be, the world is in a serious situation,” he said. “If that were to happen, there would be major issues going on in this country.”

    During the SARS outbreak in 2002, Morgan restricted travel to China and set a two-week quarantine for those returning from China. The company employs 400 at a plant in Shanghai, and two more in a Hong Kong office, he said.

    Nypro’s Mr. Cotton said training seminars on bird flu are being given to all employees in China, and other measures employed during the SARS epidemic, including distribution of masks and hand sanitizer, are being prepared, he said.

    Other simple measures, such as keeping the buildings clean and orderly, will help prevent the spread of disease, he said.

    Four thermal imaging devices — one for each plant in China — have been ordered, with the devices capable of nearly instantly measuring a worker’s body temperature to see if fever, a symptom of flu, is present, he said. If a worker had an elevated temperature, the next step would be medical screening to determine why. In a case of bird flu, the company would follow medical recommendations in deciding whether to send the person home, he said.

    Nypro is also reviewing its insurance to make sure that workers traveling overseas will have coverage for any health care they may need, he said.

    Intel Corp., which employs about 2,000 at its Hudson computer chip manufacturing plant and thousands overseas, also said it will use what it learned from the SARS epidemic in drafting a plan for a possible bird flu pandemic.

    The company has a management review committee that includes representatives from human resources, occupational health, business continuity and other departments and meets weekly to review strategy and progress, said Gary Niekerk, manager of corporate responsibility, based in Arizona.

    “SARS was a wake-up call for a pandemic, that these things can happen,” Mr. Niekerk said.

    Intel’s business continuity plan will help determine how to make up for an operation that may go out of service anywhere in the world, he said. To lessen likelihood of a plant shutdown, Intel has ordered more cleaning supplies, masks and hygiene items.

    He said the company’s information technology staff is looking at how it can prepare for more people telecommuting.

    “The challenge is in manufacturing and testing, because you have to be there,” he said. “For the employees that need to be there, we need to create an environment that minimizes the potential spread.”

    Data storage maker EMC Corp. of Hopkinton, with more than 25,000 employees worldwide, is working on a plan that addresses a range of issues from basic hygiene to business continuity, said spokeswoman Anne Pace.

    “It’s something we’ve been working on for a while,” she said. “We have more than 25,000 employees worldwide, and a pandemic of this nature would affect both our employees and customers.”

    UnumProvident Corp., the nation’s leading disability insurer, has already done some emergency preparedness, and a plan for a pandemic would involve modifications of that, said spokeswoman M.C. Gunther.

    “The concentration for us is system operations, having sufficient personnel to the keep company running.”

    UnumProvident, which has operations in Worcester, is working on a corporate white paper on how to deal with a pandemic, she said, but details won’t be complete until later this month. The plan will address, among other things, allowing employees to use flex time when they are sick or caring for a sick family member, providing information and flu vaccines to employees and how to continue providing service to clients.

    For employers that provide essential services, such as utilities and medical care, having a pandemic plan is critical. Gina Smith, a nurse and emergency preparedness coordinator at UMass Memorial Medical Center in Worcester, said a pandemic would increase the number of patients needing treatment and affect the hospitals’ resources to treat them.

    “Everyone hopes that there will be a solution or remedy,” she said. “We have to plan in the event that we might not have that right away.”

    In the plan that the UMass Memorial and University campuses are devising, along with St. Vincent Hospital, officials are considering how to utilize a reduced staff and what procedures to retain. Dr. Richard T. Ellison III, epidemiologist for UMass Memorial Medical Center, said essential acute and chronic care would be a priority, while checkups and physicals would probably be deferred.

    He said one option would be to temporarily transfer staff outside their normal departments to others that are severely in need. That would help in the short term in dealing with an influx of patients.

    “There is a surge plan to deal with an increase in patients,” Ms. Smith said. “Where do you put them? Do you have enough beds, linens and medications?

    “We have considered keeping people (staff) here. We may have to make provisions to take care of them as well.”

    The city’s hospitals have used grants from the Health Resources and Services Administration of the U.S. Department of Health and Human Services to obtain extra supplies, she said.

    Westboro-based National Grid USA, which has 3.3 million electric customers and 565 natural gas customers in Massachusetts, New Hampshire, Rhode Island and New York, recently completed a contingency plan that would allow the utility to continue service if up to 35 percent of its 8,400 employees were sick, said spokesman David Graves.

    “We are making sure we can continue to provide electric service and make repairs,” he said. “Supervisors would be put on line crews for repairs if needed. It could mean movement between Massachusetts and New York.”

    Contact business reporter Martin Luttrell by e-mail at mluttrell@telegram.com.

  13. #13
    FossilMedic
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    Default Avian Flu pandemic resources

    Here are some places to go to get fire/rescue oriented information about this issue.

    Dr. Bryan Bledsoe, Powerpoint handouts from his presentations:
    http://www.bryanbledsoe.com/handouts.html

    International Association of Fire Chiefs
    http://www.iafc.org/displaycommon.cf...articlenbr=191

    International Association of Firefighters
    http://daily.iaff.org/013006flu.htm

    Going to the source:

    Centers for Disease Control
    http://www.cdc.gov/flu/avian/index.htm

    Mike

    http://home.gwu.edu/~mikeward/
    Last edited by MikeWard; 03-06-2006 at 06:26 PM.

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    Experts Debate Using Face Masks During Flu Pandemic

    POSTED: 7:55 am EST March 7, 2006

    WASHINGTON -- How much protection would a face mask offer during a worldwide flu epidemic? And would people need a fresh one every day or even every few hours?

    There aren't clear answers, public health experts said Monday as the Institute of Medicine grappled with what advice to offer the federal government.

    Health workers use masks -- simple surgical masks or better-filtering ones called N95 respirators -- to prevent infection while caring for sick patients. But the public undoubtedly will turn to masks as well if a flu pandemic strikes, and experts say supplies will quickly run short.

    Both types of masks are supposed to be used once and discarded. So federal health officials asked the IOM, a prestigious group of independent scientists, to determine if there are ways that health workers could reuse their N95 masks - and if average citizens need reusable masks, too.

    The IOM will issue its report this spring.

    At a public meeting Monday, health experts cited a host of questions. Among them: how long the masks work once donned; whether reused masks could be contaminated and spread infection; how to ensure they're worn correctly -- N95 masks have to be fitted to the user's face and are hard to breathe in for long stretches.

    And would wearing a mask on, say, the subway protect people enough, or should they have driven or stayed home? Linda Chiarello of the Centers for Disease Control and Prevention said if masks eventually are recommended for the public, the advice must not create a false sense of security.

    "The lack of clear data ... is a dilemma for those of us on the front lines," said Dr. Jeff Durchin of the Seattle-King County Health Department, adding that people already call health departments to ask what masks they should personally stockpile.

    "We should not be talking about the reusability of masks or other devices until we know whether they actually work to begin with," said Jeffrey Levi of Trust for America's Health, a nonprofit health advocacy group.

    Copyright 2006 by The Associated Press
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