At last, health, aged care and quarantine workers get the right masks to protect against airborne coronavirus

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C Raina MacIntyre, UNSW; Benjamin Veness, CQUniversity Australia, and Michelle Ananda-Rajah, Monash UniversityAlmost a year ago, in July 2020, our calls for the government to urgently upgrade the guidelines to protect health workers from airborne SARS-CoV-2 fell on deaf ears.

The existing guidelines said health providers working around COVID-19 patients should wear a surgical mask. It restricted use of the more protective P2 or N95 masks, which stop airborne particles getting through, to very limited scenarios. These involved “aerosol-generating procedures”, such as inserting a breathing tube. This was expanded slightly in August 2020 but still left most health workers without access to P2/N95 masks.

More than 4,000 Australian health workers were infected by COVID-19 during the Victorian second wave. Health authorities denied the importance of airborne transmission and blamed clinical staff for “poor habits” and “apathy”. Health workers expressed despair and a sense of abandonment, cataloguing the opposition they faced to get adequate protection against COVID-19.

Last week, 15 months after the COVID-19 pandemic was declared, the Australian guidelines on personal protective equipment (PPE) for health workers, including masks, were finally revised.

What do the new guidelines say?

The new guidelines expand the range of situations in which P2/N95 masks should be available to staff – essentially anywhere where COVID-19-infected people are expected to be – and remove all references to “aerosol-generating procedures”.

This recognises that breathing, speaking, sneezing and coughing all generate aerosols which can accumulate in indoor spaces, posing a higher risk than “aerosol-generating procedures”.

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“Fit testing” is an annual procedure that should be done for all workers wearing a P2/N95 mask or higher grade respirator, to ensure air can’t leak around the edges.

But this was previously denied to many Australian health workers.

The new guidelines unequivocally state fit-tested P2/N95 masks are required for all staff managing patients with suspected or confirmed COVID-19. This means health workers can finally receive similar levels of respiratory protection to workers on mining and construction sites.

The new guidelines leave ambiguity around which workplaces are within the scope by stating that health care:

may include hospitals, non-inpatient settings, managed quarantine, residential care facilities, COVID-19 testing clinics, in-home care and other environments where clinical care is provided.

The guidelines also allow employers to decide what comprises a high risk and what doesn’t, allowing more wiggle room to deny workers a P2/N95 mask.

N95 masks (top) protect against airborne transmission, while surgical masks (bottom) don’t.
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The guidelines say when a suitable P2/N95 mask can’t be used, a re-usable respirator (powered air purifying respirators, or PAPRs) should be considered.

But the guideline’s claim that a PAPR may not provide any additional protection compared to a “well-sealed” disposable P2/N95 mask, is not accurate. In fact, re-usable respirators such as PAPRs afford a higher level of protection than disposable N95 masks.

The new guidelines should also apply to workers in hotel quarantine – both health care and non-clinical staff. This will help strengthen our biosecurity, as long as they’re interpreted in the most precautionary way.

That means not using the wiggle room that allows workplaces to deem a situation lower risk than it actually is or that their workplace is exempt. When working around a suspected or confirmed COVID-19 case, all workers must be provided with a fit-tested P2/N95 mask. Otherwise they are not protected from inhaling SARS-CoV-2 from the air.

In aged care and health care, where cases linked to quarantine breaches can be amplified and re-seeded to the community, the new guidelines go some way towards better protecting our essential first responders and their patients.

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Guidelines miss the mark on ventilation

The guidelines fail to explicitly acknowledge COVID-19 spreads through air but nonetheless recommend the use of airborne precautions for staff.

Airborne particles are usually less than 100 microns in diameter and can accumulate indoors, which means they’re an inhalation risk.

The old guidelines focused on “large droplets”, which were thought to fall quickly to the ground and didn’t pose a risk in breathed air. This was based on debunked theories about airborne versus droplet transmission.

The new guidelines fail to comprehensively address ventilation, which is only mentioned in passing with a reference to separate guidelines for health-care facilities. This may not cover aged care or hotel quarantine.

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We must ensure institutions such as hospitals, hotel quarantine facilities, residential care, schools, businesses and public transport have plans to mitigate the airborne risk of COVID-19 and other pandemic viruses through improved ventilation and air filtration.

Australia could follow Germany, which has invested €500 million (A$787 million) in improving ventilation in indoor spaces.

Meanwhile, Belgium is mandating the use of carbon dioxide monitors in public spaces such as restaurants and gyms so customers can assess whether the ventilation is adequate.

Cleaning shared air would add an additional layer of protection beyond vaccination and mask-wearing. Secondary benefits include decreased transmission of other respiratory viruses and improved productivity due to higher attention and concentration levels.

No updated advice on hand-washing

The United States Centers for Disease Control and Prevention (CDC) now acknowledges exposure to SARS-CoV-2 occurs through “very fine respiratory droplets and aerosol particles” and states the risk of transmission through touching surfaces is “low”.

Yet this is not acknowledged in the latest Australian health-care guidelines.

Australians have been repeatedly reminded to wash or sanitise their hands, wipe down surfaces and stand behind near-useless plexiglass barriers.

The promotion of hand hygiene and cleaning surfaces is not based on science, which shows it is the air we breathe that matters most.

Revised public messaging is needed for Australians to understand shared air is the most important risk for COVID-19.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Benjamin Veness, Adjunct Professorial Fellow, CQUniversity Australia, and Michelle Ananda-Rajah, Consultant physician General Medicine & Infectious Diseases, Alfred Health, past MRFF TRIP Fellow, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Should I wear a mask on public transport?

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Hassan Vally, La Trobe University

As restrictions ease, many Australians will be wondering if it’s worth wearing a mask on the bus, train or tram to reduce their risk of being infected with coronavirus.

When Deputy Chief Medical Officer Nick Coatsworth was asked about this earlier this week, he said:

If you are a vulnerable person and you have no other means of getting to work or around, it would be a very reasonable thing to do. We don’t think that general, healthy members of the community need to be considering wearing masks in that context.

Earlier, Chief Medical Officer Brendan Murphy said wearing masks on public transport “is not an unreasonable thing to do”.

But the National Cabinet has stopped short of making wearing masks on public transport compulsory. No wonder it can all seem a bit confusing.

So what does fresh evidence say about the benefits of healthy people wearing masks in public? And how do you use this to decide what to do?

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Yes, wearing a mask does reduce your risk

Until now, the evidence about whether wearing a mask out and about if you’re healthy reduces your risk of coronavirus infection has been uncertain.

But a recent review in The Lancet changes that. As expected, the researchers found wearing masks protected health-care workers against coronavirus infection. But they also found wearing masks protects healthy people in the community, although possibly to a lesser degree.

The researchers said the difference in the protective effect was largely because health workers are more likely to use N95 masks, which were found to offer greater protection than the disposable surgical masks we generally see people wearing out in the community.

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So, the take-home message is that masks, while not offering perfect protection, reduce your risk of coronavirus infection while you’re out and about.

In light of this study, the World Health Organisation (WHO) has updated its advice to recommend healthy people wear masks in public where there is widespread transmission and where physical distancing is difficult, such as on public transport.

But how is this different to what I’ve heard before?

What this Lancet study adds is the best evidence we have so far that healthy people who wear a mask out and about can reduce their chance of infection.

It’s important to stress, the evidence is quite clear that if you’re sick, wearing a mask reduces your risk of transmitting the coronavirus to others.

If you’re sick or have been diagnosed with COVID-19 the clear advice is still to stay home and self-isolate. You shouldn’t be on public transport anyway!

If you’re sick, you shouldn’t be on public transport. The only exception is if you need to go out to get tested.
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Masks also protect others

But how about the other possible benefit of wearing masks on public transport – minimising the risk of you unwittingly transmitting the virus to others if you don’t have symptoms?

Despite some confusing messages from WHO earlier this week, we know “asymptomatic transmission” does occur, although we are yet to pin down its exact role.

For instance, a recent review suggests as many as 40-45% of coronavirus infections are asymptomatic and they may transmit the virus to others for an extended period.

So, preventing asymptomatic transmission is another reason you may choose to wear a mask. That is, rather than wearing a mask to protect yourself, you could wear a mask to protect others.

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So, what should I do?

Given masks reduce your risk of infection and reduce the risk of you unwittingly passing on the virus to others, you could certainly make a case for routinely wearing a mask on public transport while we have coronavirus in the community.

This case is even stronger if you are at risk of severe illness, for example if you are over 65 years old or have an underlying medical condition such as high blood pressure, heart disease or diabetes.

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Alternatively, if you are travelling on a short trip on a train and you have plenty of room to social distance, then you may decide wearing a mask may not be essential given the level of risk on that journey.

However, if you are on a longer commute and the train is crowded and social distancing is difficult, then wearing a mask could well be sensible.

If you do decide to wear a mask, then it’s important to make sure you know how to put it on and take it off correctly. And as no mask offers complete protection, you still need to physically distance where possible and wash your hands.

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Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Supplies needed for coronavirus healthcare workers: 89 million masks, 30 million gowns, 2.9 million litres of hand sanitiser. A month.

Katherine Gibney, The Peter Doherty Institute for Infection and Immunity and Caroline Marshall, University of Melbourne

In three short months, more than half a million cases of the novel coronavirus, COVID-19, have been reported worldwide.

The US now has the highest number of COVID-19 cases worldwide and Italy has reported more than twice as many COVID-19 related deaths as China. Deaths from COVID-19 in Spain have surpassed China in recent days, and it won’t be long before France and the US follow suit. COVID-19 has well and truly taken hold in the West.

While most people are being encouraged (or ordered) to stay at home to reduce the spread of COVID-19, this is not an option for frontline healthcare workers.

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Healthcare workers have been infected at an alarming rate

In countries whose health infrastructure has been overwhelmed by the sheer volume of severe COVID-19 cases, healthcare workers have been infected at an alarming rate.

In Italy, more than 6,000 healthcare workers have been infected, making up 9% of the total COVID infections. In Spain, 17% of female COVID-19 cases are healthcare workers (12% of all COVID-19 cases are healthcare workers). More than 2,000 healthcare workers in China had laboratory confirmed COVID-19, with 88% occurring in the worst affected Hubei province.

In Australia, COVID-19 patients are cared for in single rooms where available. However, soon it will be necessary to care for COVID-19 patients in wards and ICUs alongside other COVID-19 patients – known as “cohorting” – as a patient with COVID-19 cannot catch the same disease from another patient sharing their ward.

COVID-19 is transmitted primarily by virus-containing droplets that are expelled when an infectious person sneezes, coughs or talks, contaminating others in close face-to-face proximity and nearby surfaces. This underlies the general advice to stay more than 1.5 metres away from others, practice good cough etiquette and hand hygiene, and avoid touching your face with your hands.

The number of masks, goggles, gloves and gowns we’ll need is staggering

Healthcare workers use personal protective equipment (PPE) – masks, goggles, gloves and gowns – and clean surfaces to prevent transmission in hospital.

Some procedures that are required when caring for critically ill patients can generate smaller virus-containing particles called aerosols, which can be inhaled.

In circumstances where aerosols could be generated, PPE requirements include use of a respirator mask (also known as a P2 or N95 mask) and a negative room pressure, where a slight vacuum is created to prevent contaminated air escaping the room.

The volume of PPE required to deal with the COVID-19 pandemic is staggering.

The WHO has estimated frontline healthcare workers will require at least 89 million masks, 30 million gowns, 1.6 million goggles, 76 million gloves, and 2.9 million litres of hand sanitiser every month during the global COVID-19 response.

Hoarding and misuse of masks puts healthcare workers at risk

The WHO has also noted panic buying, hoarding and misuse of PPE are putting lives at risk from COVID-19 and other infectious diseases.

Healthcare workers are most at risk if they don’t use appropriate PPE when caring for a COVID-19 patient, such as before the COVID-19 infection has been recognised. This is how a number of unlucky Australian healthcare workers have already been infected with COVID-19 at work, including four from the Werribee Mercy Hospital in Melbourne’s outer west.

Early recognition of potential COVID-19 cases, and instituting precautions including isolation and use of PPE, will protect healthcare workers. Routine use of surgical masks in high-risk clinical settings such as emergency departments, ICUs and COVID-19 screening clinics is now recommended in many places.

PPE supplies in many countries have reportedly been exhausted, forcing healthcare workers to care for COVID-19 patients without adequate protection. Inappropriate and irrational use of PPE, including use of masks in situations where there is no risk of droplet or airborne transmission, accelerate consumption of a finite PPE supply.

The urgent work of securing more PPE

The federal, state and territory governments are working hard to secure enough PPE to prevent this scenario in Australia, including boosting domestic production and manufacturing capacity. Local industry has stepped up with companies previously making other products now making hand hygiene products and masks.

This is urgent work because it’s likely a rapid surge in COVID-19 cases would consume current PPE supplies quickly.

Crisis strategies being employed internationally to deal with mask shortages include prolonged use, re-use by a single healthcare worker, and use beyond the manufacturer designated shelf life, although these are not standard practice. Work is also taking place around sterilisation of masks for re-use by health care workers, which again is not standard practice.

Healthcare workers are also at risk if PPE is used incorrectly, due to inadequate training, inattention, or fatigue. Training healthcare workers in correct use of PPE is a critical part of our emergency response.

Like everyone else, healthcare workers are at risk outside work. In China, outside Hubei, the majority of healthcare workers’ infections could be traced to a confirmed COVID-19 case in the household. As community transmission of COVID-19 becomes more widespread in Australia, more healthcare workers will be infected at home and in the community.

When healthcare workers can’t work

It’s vital the healthcare workforce is maintained for the duration of the pandemic. Perversely, some of the actions taken to prevent COVID-19 transmission might result in healthcare workers’ workplace absenteeism. Often healthcare workers would work through a mild upper respiratory tract infection, but with the current heightened awareness they might not be doing this. All healthcare workers are being encouraged to present for testing if they have fever or acute respiratory symptoms such as sore throat, cough and difficulty breathing. They are usually unable to return to work until a negative COVID-19 test result is received and symptoms have resolved. This can take several days.

If a healthcare worker is exposed to a COVID-19 case when not wearing PPE (meaning they spend more than 15 minutes face-to-face or more than two hours in the same room as a case), they will be classed as a close contact and will be home-quarantined and unable to work for 14 days after they were exposed.

And carer responsibilities – either for someone unwell with COVID-19 or for children unable to attend childcare or school due to closures – will keep many healthcare workers away from work.

In the current climate, healthcare workers have been described as “every country’s most valuable resource.” Governments, employers and the public need to do everything they can to protect and support healthcare workers throughout this pandemic.

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Katherine Gibney, NHMRC early career fellow, The Peter Doherty Institute for Infection and Immunity and Caroline Marshall, Associate Professor, Infectious Diseases, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

SRI LANKA: RASH OF ATTACKS ON CHRISTIANS REPORTED

Assaults by local mobs, including Buddhist monks, surge.

COLOMBO, Sri Lanka, August 17 (Compass Direct News) – Attacks on Christians in Sri Lanka have surged noticeably in recent weeks, following the government’s defeat of Tamil separatists in May.

Attacks were reported in Puttlam, Gampaha and Kurunegala districts in western Sri Lanka, central Polonnaruwa district, Mannar district in the north and Matara district in the south, according to the National Christian Evangelical Alliance of Sri Lanka (NCEASL).

Most recently, attackers on July 28 set fire to an Assemblies of God church in Norachcholai, Puttlam district, destroying the building. The pastor received frantic calls from neighbors at about 8:45 p.m. reporting that the building was in flames, echoing a similar arson attack almost a year ago that destroyed the original building on the site.

Church members have registered a complaint with police, but at press time no arrests had been made.

When a pastor of a Foursquare Gospel church and his wife visited a church member in Radawana village, Gampaha district during the third week of July, a 50-strong mob gathered at the door and shouted that they would not tolerate any further Christian activity in the village, NCEASL reported. The mob then prevented the couple from leaving the house, hit the pastor with a rod and threw a bucket of cow dung at him.

The disturbance continued for two hours before police finally answered repeated requests for assistance and arrived at the house, arresting three people who were later released.

Earlier, on June 28, a mob consisting of more than 100 people, including Buddhist monks, surrounded the home of a female pastor of another Foursquare Gospel church in the village, according to the NCEASL. At the time the pastor, whose name was withheld for security reasons, and her husband were away. Their 13-year-old daughter watched helplessly as the mob broke in, shouted insults and destroyed chairs and other furniture.

Hearing that their home was under attack, the parents rushed to get police help, but the mob had dispersed by the time officers arrived. Police called the pastor into the Gampaha police station for questioning on July 9 and July 11; on the second occasion, protestors surrounded her and other pastors who accompanied her, spitting on them and initially preventing them from entering the police station.

Later, in the presence of Buddhist monks and other protestors, the pastor was forced to sign a document promising not to host worship services for non-family members.

Also in Gampaha district, a mob on July 14 destroyed the partially-built home of Sanjana Kumara, a Christian resident of Obawatte village. On receiving a phone call from a friend, Kumara rushed to the scene to find the supporting pillars of the house pulled down, damaging the structure beyond repair.

Villagers launched a smear campaign against Kumara on July 6, after he invited his pastor and other Christians to bless the construction of his home. As the group prayed, about 30 people entered the premises and demanded that they stop worshiping. The mob then threatened to kill Kumara, falsely accusing him of constructing a church building.

On July 8, Kumara discovered that unknown persons had broken into a storage shed on the property, stealing tools and painting a Buddhist blessing on the walls. Police were reluctant to record Kumara’s complaint until a lawyer intervened.

The Sri Lanka population is 69.1 percent Buddhist, 7.6 percent Muslim, 7.1 percent Hindu and 6.2 percent Christian, with the remaining 10 percent unspecified.

Sword Attack

In Markandura village, Kurunegala district, seven men wielding swords on July 12 attacked caretaker Akila Dias and three other members of the Vineyard Community church, causing serious injury to church members and church property. Dias and others received emergency care at a local hospital before being transferred to a larger hospital in the area for treatment.

Church members filed a complaint with police, identifying one of the attackers as the same man who had assaulted the church pastor and another worker with a machete in March; at that time police had arrested the man but released him on bail. Several other attacks followed, including one on June 29 in which the church premises were desecrated with human feces. Documents were also circulated on July 18 describing the church as a divisive force aiming to destroy peace in the local community.

On the night of July 12, attackers tore off roof tiles from the church building and threw them to the ground, leaving it exposed to the elements.

On July 5, a mob of around 100 people, half of them Buddhist monks, forcibly entered an Assemblies of God church in Dickwella, Matara district, warning church members to cease all Christian worship in the area and pasting notices on the walls declaring that “any form of Christian worship in this place is completely prohibited.”

The congregation has filed a complaint with local police.

On June 23, a Foursquare Gospel pastor from Polonnaruwa district was stopped by a group of men riding motorcycles as he drove home after attending a late evening prayer meeting. Three men wearing masks attacked him with knives and shouted, “This is your last day! If we let you live, you will convert the whole town!”

The pastor sustained severe cuts to his arms as he warded off blows aimed at his neck, before driving away to seek medical help. Police in Polonnaruwa have initiated an inquiry.

Finally, in Thalvapadu village, Mannar district, members of an Apostolic church were dedicating their newly constructed building on June 7 when a mob of about 300 people forcibly entered the premises, threatening the pastor and congregation. They demolished the new church building, throwing roofing sheets and bricks onto a plot of adjacent land.

When church members filed a complaint, police arrested seven of the attackers; a case has been filed with a local court.

Report from Compass Direct News