CIDRAP – Center for Infectious Disease Research and Policy suggest respirators for all Ebola healthcare workers – aerosol transmissibility of virus in question

Ebola Contagion TEP
September 2014HEALTH – Healthcare workers play a very important role in the successful containment of outbreaks of infectious diseases like Ebola. The correct type and level of personal protective equipment (PPE) ensures that healthcare workers remain healthy throughout an outbreak—and with the current rapidly expanding Ebola outbreak in West Africa, it’s imperative to favor more conservative measures. The precautionary principle—that any action designed to reduce risk should not await scientific certainty—compels the use of respiratory protection for a pathogen like Ebola virus that has: •No proven pre- or post-exposure treatment modalities. •A high case-fatality rate. •Unclear modes of transmission. We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks. The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering face-piece or similar respirator, being more protective, comfortable, and cost-effective in the long run. We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola throughout Africa—and beyond.
There has been a lot of on-line and published controversy about whether Ebola virus can be transmitted via aerosols. Most scientific and medical personnel, along with public health organizations, have been unequivocal in their statements that Ebola can be transmitted only by direct contact with virus-laden fluids2,3 and that the only modes of transmission we should be concerned with are those termed “droplet” and “contact.” These statements are based on two lines of reasoning. The first is that no one located at a distance from an infected individual has contracted the disease, or the converse, every person infected has had (or must have had) “direct” contact with the body fluids of an infected person. This reflects an incorrect and outmoded understanding of infectious aerosols, which has been institutionalized in policies, language, culture, and approaches to infection control. We will address this below. Briefly, however, the important points are that virus-laden bodily fluids may be aerosolized and inhaled while a person is in proximity to an infectious person and that a wide range of particle sizes can be inhaled and deposited throughout the respiratory tract. The second line of reasoning is that respirators or other control measures for infectious aerosols cannot be recommended in developing countries because the resources, time, and/or understanding for such measures are lacking.
Although there are some important barriers to the use of respirators, especially PAPRs, in developing countries, healthcare workers everywhere deserve and should be afforded the same best-practice types of protection, regardless of costs and resources. Every healthcare worker is a precious commodity whose well-being ensures everyone is protected. If we are willing to offer infected US healthcare workers expensive treatments and experimental drugs free of charge when most of the world has no access to them, we wonder why we are unwilling to find the resources to provide appropriate levels of comparatively less expensive respiratory protection to every healthcare worker around the world. –CIDRAP
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11 Responses to CIDRAP – Center for Infectious Disease Research and Policy suggest respirators for all Ebola healthcare workers – aerosol transmissibility of virus in question

  1. Paul Magnus says:

    of course it is… if you can get it from blood, if that blood is airborne you can get it from aerosol


  2. John says:

    This is a well written article. Alvin, did you write this? I know that your talks on YouTube are at the highest level of communication. Anyhow, Is it possible for an ebola infected person to wipe the sweat off of their skin onto a hand towel, or some kind of cloth, and then a second unsuspecting person touch that sweat on the cloth and then they become infected also?


    • No, I did not write the article John. However, the answer to your question is yes. Ebola can be transmitted this way. In epidemiology, this is known as fomite transmission, or infection from an inanimate object.

      As always, thanks for your abiding interest


  3. George says:

    America is about to send 3,000 of our finest to Africa to fight Ebola. It’s not going to work.


  4. skywalker says:

    the 3000 are not going to fight the outbreak , they are going to help set up treatment facilities for the infected people to be treated in by the professional health care workers, hopefully they will not come into any contact with the infected people. but we shall see as the weeks unfold, they could be the potential carriers that bring this plague back home when they return.


  5. DJ says:

    Of course Ebola is more contagious than officials say… and I think they know it. They could at least say, aerosol transmission can not be ruled out… it could save a lot of lives.
    Queensland University of Technology studied the way droplets carry viruses when people speak and breathe… they spread far and wide.
    from Science Daily 2007
    As part of the study QUT designed and built a machine to measure the distance a droplet travels in the air prior to drying.

    “This droplet could potentially be carrying a virus,” she said. “The significant part of our research has found that rather than the droplet falling directly to the ground after leaving the mouth, the liquid component of the droplet dries in the air and the dry residue travels large distances.

    “When a droplet dries in the air the residue is carried in the air, and therefore there is a risk that people can inhale that air and become infected.”

    Professor Morawska said a droplet drying on a surface could be infectious but the greater danger was droplets drying in the air. “A droplet can travel for 10cm before it dries in the air, it doesn’t immediately fall to the ground.”

    She said the study, funded by the Australian Research Council, was motivated by an outbreak of SARS in Hong Kong where more than 300 people were infected within the space of a few hours. “We wanted to know how this virus was able to travel from building to building in such a short time,” she said.


  6. Satori says:

    US ARMY Says EBOLA = FLU in Airborne Stability, Needs Winter Weather To Go Airborne


  7. niebo says:

    According to this document from the CDC, BOTH of the two types of isolation “laboratories” (cabinet and suit) require HEPA filtration on the intake and exhaust (cabinet) and “Positive Pressure” (powered by motorized blower) HEPA filtration units (suit). See pages 45 and 51 (as marked in the document) for more on the protocols for suits.

    Click to access bmbl5_sect_iv.pdf

    So . . . if these knuckleheads are not ALREADY wearing filtration systems they are ALREADY violating CDC protocol for exposure to level 4 biohazards. And, if the CDC knows to have this policy, why is it not also standard procedure for CIDRAP?


  8. niebo says:

    Oh, but wait. CIDRAP is not a governmental agency nor a “governing body” for medical professionals; they are part of the University of Minnesota:

    And here’s more on the “positive-pressure” PAPR filtration units that are mentioned in the article (prepare for “sticker shock”):


    • Janice says:

      Why didn’t the CDC issue an “aerosol” precautionary alert months ago? Is the CDC a government agency? EVERYONE knows the common, ordinary sneeze contains bodily fluids. We’ve all experienced someone accidentally spraying our face with droplets at some point. According to various ” sneeze” websites, the following:
      Sneezes can travel 39-100mph…at distances of 15-100 feet. Up to 100,000 bodily fluid bacteria droplets can be dispersed in a sneeze “cloud”. Sneeze bodily fluid bateria can enter ventilation systems. If this is true from generic sites about sneezes…surely the CDC knew Ebola sneeze aerosol contagion transmission was possible? Why no high profile articles/alerts from ANYBODY about this possibility much, much earlier on?


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