Women, racial minority health workers struggle to find respirators that fit
Most respiratory protective equipment (RPE) used in healthcare is not designed for women or racial minorities amid a dearth of research into how facial dimensions across sex and race affect respirator performance, according to a systematic review and meta-analysis published late last week in BMJ Global Health.
Researchers at the University of Southampton in England led the study, which involved analysis of 32 studies and anthropometric data (measurements and proportions of the human body) from 15 studies.
Studies were included if they evaluated half- or quarter-size filtering facepiece respirators meeting N95/PPF3 standards of any brand, design, model, size, or disposability. The investigators noted that PPE must be "fit-tested," or assessed for a good seal, to reduce inward leaks of aerosolized viruses such as SARS-CoV-2.
They found that most RPE has been developed for men and White people, who don't make up the largest proportions of National Health Service (NHS) staff in England. And 63% of COVID-19 deaths among NHS staff have been of Black and other racial minority staff, although they account for only 20% of the workforce.
The anthropometric analysis showed that women's faces are significantly smaller than men. But while 12 studies reported worse face mask fit for women than for men, 10 reported no difference by sex.
Trends observed in studies that included racial minorities were similar, although few studies focused on fit-testing differences among races. In 12 studies, low or moderate numbers of racial minorities were able to find a respirator that fit them.
The small sample size and lack of justification, inclusion and exclusion criteria, and power calculations was a concern in many studies, the authors noted. "Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance," the researchers wrote.
In a University of Southampton press release, lead author Jagrati Chopra called for more research into proper design of face masks and other personal protective equipment: "The high rate of BAME [Black, Asian, and minority ethnic] healthcare workers affected by the pandemic has shown how important it is to have enough respiratory equipment to suit everyone, regardless of gender or background."
Nov 12 BMJ Glob Health study
Nov 12 University of Southampton press release
Depressed patients visited ED more often for anxiety, chest pain in pandemic
Depression and anxiety during the COVID-19 pandemic drove more patients to seek care at an emergency department (ED) for treatment of anxiety and chest pain, according to a news release on a study to be presented tomorrow at the virtual American Heart Association's 2021 Scientific Sessions.
Researchers at Intermountain Healthcare in Salt Lake City examined 4,633 patients who completed a routine depression screening before (Mar 1, 2019, to Feb 29, 2020) and during (Mar 1, 2020, to Apr 20, 2021) the pandemic.
Nearly 40% of patients said they had new or continuing depression symptoms in the first year of the pandemic. Among depressed patients, screening scores were higher during rather than before the pandemic. The odds of visiting an ED for treatment of anxiety was 2.8 times higher for depressed versus nondepressed patients and 1.8 times higher for anxiety accompanied by chest pain.
Principal investigator Heidi May, PhD, said in the release that longer-term follow-up is needed to identify possible long-term effects of the pandemic on mental health, because depression is a strong risk factor for cardiovascular disease.
"If people are becoming more depressed because of the pandemic, in a few years, we could see a higher incidence of cardiovascular disease," she said. "Clinicians should be acutely aware of their patients' mental health so that it can be addressed and treated immediately to improve the overall quality of their lives, and hopefully avoid the development of subsequent health problems in the future. This is vital, because the pandemic is still not over."
Nov 13 Intermountain Health news release
Norway, UK, Japan report more H5N1 avian flu in poultry
Norway reported its first-ever highly pathogenic H5N1 avian flu outbreak in poultry, and United Kingdom and Japan reported more detections of the virus, according to official and media reports.
In Norway, the outbreak began on Nov 10 at a farm in Rogaland County on the country's southwest coast, according to a notification from the World Organisation for Animal Health (OIE). The outbreak also marks the first appearance of H5N1 in Norway.
Elsewhere in Europe, the UK's Department for Environment, Food, and Rural Affairs (DEFRA) reported two more H5N1 outbreaks, one at a facility in North Yorkshire and another at a location in neighboring Lancashire. Both are in northern England.
Meanwhile, Japan reported its second avian flu outbreak in poultry, this time at a farm in Kagoshima prefecture, according to a government statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. A media report quoting an agricultural official said the subtype is H5N1.
In an update from OFFLU, the animal influenza expert network from the OIE and the UN Food and Agriculture Organization, the group said 41 countries in Asia, Europe, and Africa have reported detections in wild birds and poultry since May, with most viruses falling in the 126.96.36.199b HA clade. Genetic sequencing of recent H5N1 viruses from Europe suggests they are related to recent H5N5 and H5N1 strains found in Europe and Africa in late 2020 and early 2021, all of which link back to H5N8 circulating in Eurasia.
Nov 12 OIE report on H5N1 in Norway
Nov 15 DEFRA update
Nov 15 AFD post
Nov 12 ProMED Mail post on OFFLU statement