I get the impression that there have been no instructions given by the medical staff in the quarantine center about proper use of the N95 masks that the teachers have been told, "wear the mask 24/7" . . . that's all they're hearing.
But here's the problem,
Using a mask incorrectly however, may actually increase the risk of transmission, rather than reduce it. If masks are to be used, this measure should be combined with other general measures to help prevent the human-to-human transmission of influenza, training on the correct use of masks and consideration of cultural and personal values.
(from the WHO website)
And more specifically,
The following information on correct use of masks derives from the practices in
health-care settings4:
• place mask carefully to cover mouth and nose and tie securely to minimize any gaps
between the face and the mask
• while in use, avoid touching the mask
− whenever you touch a used mask, for example when removing or washing, clean
hands by washing with soap and water or using an alcohol-based handrub
• replace masks with a new clean, dry mask as soon as they become damp/humid
• do not re-use single-use masks
− discard single-use masks after each use and dispose of them immediately upon
removing.
(from the WHO website)
If the medical staff are not giving the detained teachers the correct information about how to use their masks, and reviewing the specific hand washing procedure the WHO says is critical to make mask use effective . . . do they themselves even know about the procedures?
The following info (below) is from the WHO website. Misinformation is going to be one of the other major problems foreign teachers are going to face as this virus increases its presence in Korea.
The information below is from the WHO website. There's a lot of info on the H1N1 related pages, so I've put some of the more relevant info here (take this with a grain of salt as I am NOT a doctor) in order to save people time if they're too busy to read through all the stuff at the site itself.
I'm hoping we all hear some positive news from the quarantined teachers soon. They've been told they're not allowed to smoke, and are supposed to stay indoors at all times . . . needless to say the smokers are not having a good time, and . . . the indoor thing has been . . . 'taken under advisement,' lol.
J
Here's the latest update on the WHO site,
23 May 2009 -- As of 06:00 GMT, 23 May 2009, 43 countries have officially reported 12 022 cases of influenza A(H1N1) infection, including 86 deaths.
The breakdown of the number of laboratory-confirmed cases by country is given in the following table and map.
Map of the spread of Influenza A(H1N1): number of laboratory confirmed cases and deaths [jpg 492kb]As of 08:00 GMT, 23 May 2009
Laboratory-confirmed cases of new influenza A(H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005)
1 May 2009
How do people become infected with influenza A(H1N1)?
Outbreaks in humans are now occurring from human-to-human transmission. When infected people cough or sneeze, infected droplets get on their hands, drop onto surfaces, or are dispersed into the air. Another person can breathe in contaminated air, or touch infected hands or surfaces, and be exposed. To prevent spread, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.
What are the signs and symptoms of infection?
Early signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting or diarrhoea.
Regarding study of the first outbreak, have you received any feedback from the WHO team sent to Mexico
Teams are already sending epidemiological evidence but we will know more over the next few days.
Is there any confirmation of transmission between pigs and humans at this point?
No.
Is there any information on the economic impact of the outbreak so far?
No.
Why are we so worried about this pandemic possibility when thousands die every year from seasonal epidemics?
Seasonal epidemics occur every year and we are able to treat the virus with seasonal vaccines. A pandemic is a worldwide epidemic. It is a new virus and one to which the populations will have no immunity.
Related link
Influenza (seasonal) fact sheet
Influenza A (H1N1) outbreaks
Interim guidance
3 May 2009
This document provides interim guidance on the use of masks in communities that have
reported community-level outbreaks caused by the new Influenza A(H1N1) virus. It will be
revised as more data become available.
Background
At present, evidence suggests that the main route of human-to-human transmission of the new
Influenza A (H1N1) virus is via respiratory droplets, which are expelled by speaking, sneezing or
coughing.
Any person who is in close contact (approximately 1 metre) with someone who has influenza-like
symptoms (fever, sneezing, coughing, running nose, chills, muscle ache etc) is at risk of being
exposed to potentially infective respiratory droplets.
In health-care settings, studies evaluating measures to reduce the spread of respiratory viruses
suggest that the use of masks could reduce the transmission of influenza.2 Advice on the use of
masks in health-care settings is accompanied by information on additional measures that may
have impact on its effectiveness, such as training on correct use, regular supplies and proper
disposal facilities. In the community, however, the benefits of wearing masks has not been
established, especially in open areas, as opposed to enclosed spaces while in close contact with
a person with influenza-like symptoms.
Nonetheless, many individuals may wish to wear masks in the home or community setting,
particularly if they are in close contact with a person with influenza-like symptoms, for example
while providing care to family members. Furthermore, using a mask can enable an individual
with influenza-like symptoms to cover their mouth and nose to help contain respiratory droplets,
a measure that is part of cough etiquette.
Using a mask incorrectly however, may actually increase the risk of transmission, rather
than reduce it. If masks are to be used, this measure should be combined with other
general measures to help prevent the human-to-human transmission of influenza, training
on the correct use of masks and consideration of cultural and personal values.
1 The term “mask” is used here to include home-made or improvised masks, dust masks and surgical masks (sometimes called
“medical masks”). Masks have several designs. They are often single use and labelled as either surgical, dental, medical procedure,
isolation, dust or laser masks. Masks frequently used outside health-care settings may also be made out of cloth, or paper or similar
material. Masks, names and standards differ among countries.
2 Jefferson T, Foxlee R, Del Mar C et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic
review. BMJ 2008; 336;77-80.
2
General advice
It is important to remember that in the community setting the following general measures
may be more important than wearing a mask in preventing the spread of influenza.
For individuals who are well:
Maintain distance of at least 1 metre from any individual with influenza-like symptoms, and:
• refrain from touching mouth and nose;
• perform hand hygiene frequently, by washing with soap and water or using an alcoholbased
handrub 3 , especially if touching the mouth and nose and surfaces that are
potentially contaminated;
• reduce as much as possible the time spent in close contact with people who might be ill;
• reduce as much as possible the time spent in crowded settings;
• improve airflow in your living space by opening windows as much as possible.
For individuals with influenza-like symptoms:
• stay at home if you feel unwell and follow the local public health recommendations;
• keep distance from well individuals as much as possible (at least 1 metre);
• cover your mouth and nose when coughing or sneezing, with tissues or other suitable
materials, to contain respiratory secretions. Dispose of the material immediately after use
or wash it. Clean hands immediately after contact with respiratory secretions!
• improve airflow in your living space by opening windows as much as possible.
If masks are worn, proper use and disposal is essential to ensure they are potentially
effective and to avoid any increase in risk of transmission associated with the incorrect
use of masks. The following information on correct use of masks derives from the practices in
health-care settings4:
• place mask carefully to cover mouth and nose and tie securely to minimise any gaps
between the face and the mask
• while in use, avoid touching the mask
− whenever you touch a used mask, for example when removing or washing, clean
hands by washing with soap and water or using an alcohol-based handrub
• replace masks with a new clean, dry mask as soon as they become damp/humid
• do not re-use single-use masks
− discard single-use masks after each use and dispose of them immediately upon
removing.
Although some alternative barriers to standard medical masks are frequently used (e.g. cloth
mask, scarf, paper masks, rags tied over the nose and mouth), there is insufficient information
available on their effectiveness. If such alternative barriers are used, they should only be used
once or, in the case of cloth masks, should be cleaned thoroughly between each use (i.e. wash
with normal household detergent at normal temperature). They should be removed immediately
after caring for the ill. Hands should be washed immediately after removal of the mask.
3 In settings where alcohol-based hand rubs are available and the safety concerns (such as fire hazards and accidental ingestion)
are adequately addressed, their proper use (rubbing hands for 20–30 seconds) could be promoted as a means of disinfection.
4 Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care WHO Interim
Guidelines (Jul 2007) available at http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html
http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf
What can I do?6 May 2009 (updating content posted 1 May 2009) What can I do to protect myself from catching influenza A(H1N1)?The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:
What about using a mask? What does WHO recommend?If you are not sick you do not have to wear a mask. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards. If you are sick and must travel or be around others, cover your mouth and nose. Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection. How do I know if I have influenza A(H1N1)?You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1). What should I do if I think I have the illness?If you feel unwell, have high fever, cough or sore throat:
What should I do if I need medical attention?
Should I go to work if I have the flu but am feeling OK?No. Whether you have influenza A(H1N1) or a seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others. Can I travel?If you are feeling unwell or have symptoms of influenza, you should not travel. If you have any doubts about your health, you should check with your health care provider. | |
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For more information, call the special media telephone line: +41 22 791 2222 Virtual press briefings
GET LATEST NEWS
REGIONAL INFORMATION ON INFLUENZA A(H1N1)
MORE INFORMATION
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Pandemic influenza prevention and mitigation in low
resource communities
This summary guidance is derived from the WHO document Pandemic influenza preparedness and
mitigation in refugee and displaced populations: WHO guidelines for humanitarian agencies, Second
edition, 2008
Key principles
1. Public health measures taken by individuals and communities, such as social distancing,
respiratory etiquette, hand hygiene, and household ventilation, are at present the most
feasible measures available to reduce or delay disease (morbidity) caused by pandemic
influenza.
2. In the case of mild illness, patients should be provided with supportive care at home by a
designated caregiver and only referred to health care facilities if they deteriorate or
develop danger signs. Separation of sick from well individuals, with rigorous respiratory
etiquette and hygiene measures should be practised.
3. In health-care settings, a system of triage, patient separation, prioritization of use of
antiviral medicines and personal protective equipment (PPE) according to risk of
exposure, and patient management should be in place to focus efforts on the most
effective interventions to reduce mortality and any further morbidity.
1. Key prevention measures for individuals and communities
Social distancing (keeping at least an arm's length distance from others, minimizing gatherings),
respiratory etiquette (covering coughs and sneezes), hand hygiene, and household ventilation,
are likely to be the most effective public health measures and are highly recommended.
Once cases of pandemic influenza in a community are widespread, evidence and experience
suggest that interventions to isolate patients and quarantine contacts would probably be ineffective,
not a good use of limited health resources, and socially disruptive.
Ill people should as far as possible be cared for at home by a designated caregiver (with appropriate
home-care instructions communicated in advance) and advised not to attend health-care facilities
unless they deteriorate or develop danger signs so as not to overwhelm health facilities (see
guidance note below). Supportive care entails bed rest, fluids, medication for fever, antibiotics if
prescribed, and good nutrition.
WHO recommends that mask use should be based on risk, including frequency of exposure and
closeness of contact with potentially infectious people. Recommendations for mask use by health
and other essential staff, and for home care are described in parts 2 and 3 below. Routine mask use
in public places should be permitted but is not expected to have an impact on disease prevention.
2. Management of patients
• The objectives of patient management are to provide supportive health care to decrease
mortality and to minimize disease transmission.
2
• Given limited resources, it will be necessary to triage patients for treatment during a
pandemic to maximize the impact of available treatment capacity.
• Essential medical services should be continued, while elective and non-essential medical
services should be temporarily suspended.
• Patients are most likely to be managed in two distinct settings: in the health-care facility
and at home.
Patient management in the health-care facility
_ Admission criteria may change depending on bed availability, but should be reserved for
severe cases most likely to benefit from treatment.
_ For milder cases presenting to the outpatients department, a caregiver, preferably an
available family member, should be identified if possible to manage care of the ill patient
in the home if the patient is being discharged.
_ Health facilities should anticipate a very high demand for treatment with supportive care,
and should plan accordingly. Based on current estimates, agencies should anticipate that
up to 10% of those who fall ill may require inpatient treatment. In a population of 10 000,
this could mean 500–600 persons requiring inpatient care for influenza alone over a
period of 2–3 months, or approximately 6–10 patients per day. These figures are an
average to assist calculations. Note that the number of patients affected per week may
not be constant over the pandemic period: it is likely that there will be increasing numbers
affected per week, reaching a peak in the middle of the pandemic (weeks 4–8) with
decreasing numbers thereafter.
Ensure:
_ separation of patients with respiratory symptoms from those presenting with other
symptoms at both the outpatient and inpatient level;
_ availability of admission and discharge criteria (these may change depending on
treatment capacity);
_ availability of case-management protocols;
_ referral protocol, if feasible (with appropriate infection control during the transfer);
_ confinement in a separate respiratory ward for patients admitted with suspected
pandemic influenza;
_ maximum separation of beds and head-to-toe positioning of patients in inpatient wards if
space is limited;
_ good ventilation of outpatient and inpatient areas;
_ adherence to Standard and Droplet Precautions;
_ use of PPE according to risk of exposure.
Inpatient treatment in low resource settings should include:
_ treatment of dehydration with IV or oral rehydration fluids;
_ supplemental oxygen therapy (if available) by face mask rather than nasal prongs;
_ antibiotics (oral or parenteral) for secondary bacterial infections;
_ non-aspirin antipyretics for pain and fever;
_ nutritional supplementation as needed.
3
Note: in HIV-infected individuals, a distinction between opportunistic pneumonia and secondary
pneumonia from pandemic influenza may be difficult.
Antiviral medicines decrease the duration of virus excretion and the severity of illness when
used for treatment of ill patients, and may also prevent illness when used for prophylaxis. If
only limited quantities are available, prioritization of use should be in place according to
national protocol.
In general, the order of priority for antiviral use should be:
_ treatment of sick health-care and other essential staff;
_ treatment of sick individuals from the community;
_ post-exposure prophylaxis for essential staff with unprotected, high-risk exposure;
_ pre-exposure prophylaxis for critical staff with anticipated high-risk exposure.
.
Patient management at home
_ During a pandemic, very high numbers of patients presenting to the health-care facility
will necessitate home treatment. Trusted community leaders should be identified in
advance for crowd control at the health-care facility and to address concerns among
health-seekers and their caregivers.
_ Ill people not exhibiting severe symptoms and signs of influenza should be encouraged
(through health messaging) to stay at home, institute respiratory etiquette (cover coughs
and sneezes or cough/sneeze into sleeve) and hand hygiene, and restrict close contact
(within approximately 1m) with others as much as possible.
_ Home confinement of ill people in crowded settings may not be practicable. However,
restricting contact with others should be encouraged as much as possible.
_ Adequate supervision within the household of the ill person should be ensured with
preferably only one caregiver to limit potential exposure.
_ Patients and caregivers should be trained to wear and dispose of masks during the
infectious period of the patient, if supplies are available. Where supplies are limited, it is
more important in the home that the patient wears the mask than the caregiver. The mask
need not be worn all day and only when close contact (within approximately 1m) with the
caregiver or others is anticipated. Masks should be disposed of safely if wet with
secretions. Tightly-fitting scarves or a reusable mask made of cloth covering the mouth
and nose could be used if masks are unavailable. They should be changed if wet and
washed with soap and water.
_ If enough masks are available, caregivers should also use them to cover their mouth and
nose when in close contact with ill persons.
_ The caregiver should always wash hands after patient contact.
_ General support and advice should be given to caregivers on the use of antipyretics
(acetylsalicylic acid should be avoided in children), oral fluids, nutrition and bed rest.
_ Instructions must be provided on the use of antibiotics (if necessary) for bacterial
complications of influenza when prescribed.
_ Instructions for further care in case of deterioration (if capacity exists) should be given (i.e.
when there are symptoms of severe illness or dehydration – see guidance note below).
_ Those who have recovered are no longer infectious and can be considered immune
(usually 2–3 weeks after the onset of illness).
_ Proper respiratory etiquette and hand hygiene must be promoted for all household
members.
4
_ Keep windows open and allow ventilation of the room/tent.
_ Household surfaces should be cleaned regularly with soap and water or disinfectant.
GUIDANCE NOTE
Referral to health-care facilities
_ The majority of influenza cases may be cared for at home with the simple
supportive care outlined above.
_ However, if there is deterioration or severe symptoms, then patients may
need to access a health-care facility.
_ These symptoms may include: weakness/not able to stand, lethargy,
unconsciousness, convulsions, very difficult/obstructed breathing or
shortness of breath, inability to drink fluids and dehydration, high fever.
_ It is important that specific instructions are provided according to the local
context.
3. Protection of staff
Rigorous attention to Standard Precautions (basic measures to minimize direct unprotected exposure
to blood and body fluids) and Droplet Precautions (medical masks when close to patients with
respiratory symptoms) is required to reduce the opportunities for transmission in the health-care
setting. Mechanisms for procuring (and/or stockpiling) antibiotics, PPE, antiviral medicines and
vaccines (when/if available) should be considered, with protocols and prioritization for their use.
Priority recipients will include those involved in direct clinical contact with patients, and
those staff required to maintain essential functions who anticipate close contact with
potentially ill people.
Source control (i.e. of the ill person) is crucial, as this can prevent opportunities for
transmission; the patient must be encouraged at all times to cough/sneeze into a
tissue/cloth or into their sleeve and to practice frequent hand hygiene.
Masks
Use of masks should be prioritized to ensure that those at highest risk of exposure have access to
available protection. Masks do not have to be worn at all times as they may become uncomfortable,
particularly in hot climates. They should be worn as a priority by health-care workers and caregivers,
and other essential staff when in close contact (within approximately 1m) with sick patients.
Antibiotics and antivirals
Antibiotics. Consideration should be given to stockpiling quantities of antibiotics sufficient to treat
secondary bacterial pneumonia in at least 5–10% of total staff and dependents.
Antivirals. If feasible and where quantities are available, agencies should stockpile sufficient
oseltamivir to provide treatment of ill staff and post-exposure prophylaxis of essential staff.
Self-monitoring
Health staff should monitor their temperatures twice daily. Fevers should be reported and the staff
member should confine themselves at home. If a staff member becomes unwell, treatment with
antivirals as well as supportive care as for other patients should be provided at home by a caregiver
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![Map of the spread of Influenza A(H1N1): number of laboratory confirmed cases and deaths [jpg 492kb]](http://www.who.int/entity/csr/don/ah1n1_20090523_8AM.jpg){kind=link}
1 comment:
I just found this video on You Tube that really shows how germs and viruses spread. It is so cool. It's meant for kids but I even learned a lot!
http://www.youtube.com/watch?v=56mq1t1BqfY
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