First published on September 29, 2009
Disaster Medicine and Public Health Preparedness, doi:10.1001/DMP.0b013e3181be830c
© 2009 American Medical Association
Disaster Medicine and Public Health Preparedness 2009;3:S203.

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REVIEW

Preventing the Soldiers of Health Care From Becoming Victims on the Pandemic Battlefield: Respirators or Surgical Masks as the Armor of Choice

Lewis J. Radonovich Jr1*, Trish M. Perl 1, Victoria Davey 1, Howard Cohen 1

1 Dr Radonovich is Director, National Center for Occupational Health and Infection Control, Office of Public Health and Environmental Hazards, Veterans Health Administration, US Department of Veterans Affairs; Dr Perl is Director, Hospital Epidemiology and Infection Control, Division of Infectious Diseases, Department of Medicine, Johns Hopkins Hospital; Dr Davey is Acting Chief Officer, Office of Public Health and Environmental Hazards, Veterans Health Administration, US Department of Veterans Affairs; and Dr Cohen is Professor of Occupational Safety and Health, University of New Haven.

* To whom correspondence should be addressed. E-mail: Lewis.Radonovich{at}va.gov.


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Abstract

The respiratory protective equipment necessary to protect health care workers from the novel swine-origin influenza A (H1N1) virus is not known. The knowledge gap created by this unanswered question has caused substantial debate and controversy on a global scale, leading public health organizations to feel pressured into issuing decisive recommendations despite a lack of supportive data. Changes in clinical practice caused by public health guidance during such high-profile events can be expected to establish a new standard of care. Also possible is an unforeseen gradual transition to widespread N95 respirator use, driven by public health pressures instead of science, for all outbreaks of influenza or influenza-like illness. Therefore, public health organizations and other influential institutions should take care to avoid making changes to established practice standards, if possible, unless these changes are bolstered by sound scientific evidence. Until definitive comparative effectiveness clinical trials are conducted, the answer to this question will continue to remain elusive. In the meantime, relying on ethical principles that have been substantiated over time may help guide public health and clinical decisions.