Any strategy to cope with an influenza pandemic must be based on the knowledge and tools that are available at the time an epidemic may occur. In the near term, when we lack an adequate supply of vaccine and antiviral medication, strategies that rely on social distancing and physical barriers will be relatively more prominent as means to prevent spread of disease. The use of respirators and facemasks is one key part of a larger strategy to establish barriers and increase distance between infected and uninfected individuals. Respirators and facemasks may have a role in both clinical care and community settings. Reusability of Facemasks During an Influenza Pandemic: Facing the Flu answers a specific question about the role of respirators and facemasks to reduce the spread of flu: Can respirators and facemasks that are designed to be disposable be reused safely and effectively? The committee-assisted by outstanding staff-worked intensively to review the pertinent literature; consult with manufacturers, researchers, and medical specialists; and apply their expert judgment. This report offers findings and recommendations based on the evidence, pointing to actions that are appropriate now and to lines of research that can better inform future decisions.

Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. During such crises, hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies and beds could be in short supply; and alternate care facilities may need to be used. Planning for these situations is necessary to provide the best possible health care during a crisis and, if needed, equitably allocate scarce resources. Crisis Standards of Care: A Toolkit for Indicators and Triggers examines indicators and triggers that guide the implementation of crisis standards of care and provides a discussion toolkit to help stakeholders establish indicators and triggers for their own communities. Together, indicators and triggers help guide operational decision making about providing care during public health and medical emergencies and disasters. Indicators and triggers represent the information and actions taken at specific thresholds that guide incident recognition, response, and recovery. This report discusses indicators and triggers for both a slow onset scenario, such as pandemic influenza, and a no-notice scenario, such as an earthquake. Crisis Standards of Care features discussion toolkits customized to help various stakeholders develop indicators and triggers for their own organizations, agencies, and jurisdictions. The toolkit contains scenarios, key questions, and examples of indicators, triggers, and tactics to help promote discussion. In addition to common elements designed to facilitate integrated planning, the toolkit contains chapters specifically customized for emergency management, public health, emergency medical services, hospital and acute care, and out-of-hospital care.

In response to a request from the Office of Science and Technology Policy and the Office of the Assistant Secretary for Preparedness and Response, the National Academies of Sciences, Engineering, and Medicine convened a standing committee of experts to help inform the federal government on critical science and policy issues related to emerging infectious diseases and other 21st century health threats. This set of Rapid Expert Consultations are the first of their kind and represent the best evidence available to the Committee at the time each publication was released. The science on these issues is continually evolving, and the scientific consensus the Committee reaches on these topics will likely evolve with it. The standing committee includes members with expertise in emerging infectious diseases, public health, public health preparedness and response, biological sciences, clinical care and crisis standards of care, risk communication, and regulatory issues.

Protecting the health and safety of health care workers is vital to the health of each of us. Preparing for and responding to a future influenza pandemic or to a sustained outbreak of an airborne transmissible disease requires a high-level commitment to respiratory protection for health care workers across the wide range of settings in which they work and the jobs that they perform. Keeping health care workers healthy is an ethical commitment both in terms of addressing the occupational risks faced by health care workers and of providing for the continuity of patient care and services needed to maintain the health of individuals and communities. During a public health emergency, challenges will arise concerning the availability of respiratory protective devices (i.e., respirators). Reusable respirators (specifically, reusable half-facepiece elastomeric respirators) are the standard respiratory protection device used in many industries, and they provide an option for use in health care that has to date not been fully explored. The durability and reusability of elastomeric respirators make them desirable for stockpiling for emergencies, where the need for large volumes of respirators can be anticipated. However, they are used infrequently in health care. Reusable Elastomeric Respirators in Health Care explores the potential for the use of elastomeric respirators in the U.S. health care system with a focus on the economic, policy, and implementation challenges and opportunities. This report examines the practicability of elastomeric use in health care on a routine basis and during an influenza pandemic or other large aerosol-transmissible outbreak, when demand for respiratory protective devices by U.S. health care personnel may be larger than domestic supplies. The report also addresses the issues regarding emergency stockpile management of elastomeric respiratory protective devices.

#1 New York Times bestseller “Barry will teach you almost everything you need to know about one of the deadliest outbreaks in human history.”—Bill Gates "Monumental... an authoritative and disturbing morality tale."—Chicago Tribune The strongest weapon against pandemic is the truth. Read why in the definitive account of the 1918 Flu Epidemic. Magisterial in its breadth of perspective and depth of research, The Great Influenza provides us with a precise and sobering model as we confront the epidemics looming on our own horizon. As Barry concludes, "The final lesson of 1918, a simple one yet one most difficult to execute, is that...those in authority must retain the public's trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart." At the height of World War I, history’s most lethal influenza virus erupted in an army camp in Kansas, moved east with American troops, then exploded, killing as many as 100 million people worldwide. It killed more people in twenty-four months than AIDS killed in twenty-four years, more in a year than the Black Death killed in a century. But this was not the Middle Ages, and 1918 marked the first collision of science and epidemic disease.

To address approaches to the respirator approval process in the current landscape for both occupational and non-occupational use of respirators, the National Academies of Sciences, Engineering, and Medicine's Standing Committee on Personal Protective Equipment for Workplace Safety and Health convened a virtual workshop, Current Issues in the Assessment of Respiratory Protective Devices: Nontraditional Workers and Public Use on August 4â€"5, 2020. Additionally, the workshop considered gaps in respiratory protection for outdoor workers and the general public. This publication summarizes the presentation and discussion of the workshop.

Healthcare providers, consumers, researchers and policy makers are inundated with unmanageable amounts of information, including evidence from healthcare research. It has become impossible for all to have the time and resources to find, appraise and interpret this evidence and incorporate it into healthcare decisions. Cochrane Reviews respond to this challenge by identifying, appraising and synthesizing research-based evidence and presenting it in a standardized format, published in The Cochrane Library (www.thecochranelibrary.com). The Cochrane Handbook for Systematic Reviews of Interventions contains methodological guidance for the preparation and maintenance of Cochrane intervention reviews. Written in a clear and accessible format, it is the essential manual for all those preparing, maintaining and reading Cochrane reviews. Many of the principles and methods described here are appropriate for systematic reviews applied to other types of research and to systematic reviews of interventions undertaken by others. It is hoped therefore that this book will be invaluable to all those who want to understand the role of systematic reviews, critically appraise published reviews or perform reviews themselves.