FDA Removes N95 Respirators from Shortage List

I think it’s ironic that about the same time a PLOs One study and news articles came out announcing a new method using 8-inch rubber bands for improving the fit of the surgical mask to approximate that of the N95 respirator, the FDA removed the N95 respirator from the medical device shortage list. This is relevant to help protect people from infection with Covid-19 because even vaccinated older people are getting hospitalized with the Omicron variant of the virus.

I’m not saying that the new rubber band method to tighten the fit of the surgical mask is not an improvement. It might come in handy when there is another shortage of N95 respirators.

The method mainly targets health care professionals. It would be difficult to persuade everyone in the community to adopt the technique. It’s tough enough to get people to wear masks even in crowded buildings in high transmission areas.

This is despite the CDC study showing that the elderly population continue to be at high risk for hospitalization from Covid-19 despite being vaccinated with the initial series and one or more boosters.

I think it’s hard to achieve a good fit even with the N95 respirators. The free ones distributed by the Federal government early this year were not widely available and fit poorly because the straps were elastic (similar to rubber bands, only flimsier) and loosened quickly, even after using only 2 or 3 times. At least the ones I got did. Prior to retiring, I was never able to pass a Fit test at the hospital using that type of mask.

I think my surgical masks fit better than the N95 respirators, especially after using the knot and tuck method to get a tighter seal.

Now the newer rubber band method to get a better seal uses two large 8-inch rubber bands to make the mid-face portion of the mask fit closer to your face. It looks a little easier to do than the earlier 3 rubber band technique developed a couple of years ago. That one was even tested at the University of Iowa Hospitals and Clinics by emergency room health care professionals, resulting in a small published study (the “double eights mask brace”).

All of the rubber band mask braces techniques were a response to the shortage of N95 respirators. What’s interesting to me is that, as the authors of the PLOs One study point out, there is a fair amount of variability in how well the N95 mask fits. Differences in the shape of a person’s face can account for some of this.

And there’s no shortage of N95 respirators—for now, at least according to the FDA.

If a non-health care professional wanted to use a rubber band brace, it would take some practice to get a good seal. There’s a bit of a learning curve even for a pro.

I think it would be difficult to persuade the average person to get the rubber bands and the surgical mask out of a pocket or a purse and fiddle around to achieve a good fit if you’re just going to run into Wal Mart—where I could not find that the big 8-inch rubber bands are even in stock. They’re pretty much a “3-day shipping” kind of item and could cost as much as $20 a bag.

CDC Study of High-Contact & Surface Contamination in Household of Persons with Monkeypox Virus Infection

The CDC study, “High-Contact Object and Surface Contamination in a Household of Persons with Monkeypox Virus Infection-Utah June 2022″ was published as an early release on August 19, 2022 in the MMWR. See the link below for the full article.

Pfeiffer JA, Collingwood A, Rider LE, et al. High-Contact Object and Surface Contamination in a Household of Persons with Monkeypox Virus Infection — Utah, June 2022. MMWR Morb Mortal Wkly Rep. ePub: 19 August 2022. DOI: http://dx.doi.org/10.15585/mmwr.mm7134e1.

No Need to Shout, I Can Hear You

The FDA just announced their final ruling on improving access to hearing aids. You can read the final ruling itself, but by the time you finish it, you’ll be dead and won’t need a hearing aid.

Every time I fail to follow Sena’s directions, I remind her of how a loud rock concert ruined my hearing. It was a Rare Earth concert decades ago in my wasted youth. What do you mean you never heard of Rare Earth?

And if you believe that, I have some prime farm land in the Florida Everglades I can sell you where you can grow all the alligators you want. Prices are slashed literally to the bone of any extra limbs you don’t think you need.

Anyway, I think I do have some hearing loss. And it would be nice to be able to get hearing aids that work without spending an arm and a leg (unless you want to talk about a real estate deal in the Everglades; make me an offer!).

A lot of people who develop hearing loss have a lack of insight into the problem. I think that might be why so many of us at least have the impulse to say things like:

“Speak up!” “Why are you mumbling?” “Quit talking with your mouth full!”

Hearing loss can lead to misunderstandings which can sometimes be hilarious. It’s probably the reason for some mondegreens, which are mishearing words in song lyrics (“Excuse me, while I kiss this guy,” Jimi Hendrix—actually the lyric is “Excuse me while I kiss the sky”).

I’m not sure when hearing aids that are effective, safe, and affordable will be available. Maybe after the aliens finish their human-alien hybridization program, which will make talking unnecessary. We can just read each other’s thoughts. That’s actually scarier than having trouble hearing.

Hepatitis C Testing and Treatment Update from a Retired Psychiatrist

There is a very informative CDC media briefing transcript about why so few Americans are getting tested and treated for Hepatitis C.

I’m a retired consultation-liaison psychiatrist and I used to be the go-to consultant to the hepatology clinic back when the only treatment was interferon-alpha. Because interferon-alpha was associated with neuropsychiatric side effects, notably treatment-emergent depression, I was frequently called to help assess potential treatment candidates and on-going follow-up for some.

A significant number of patients could not tolerate the psychiatric side effects.

Back in the day, interferon-alpha was really the only treatment. Now there are many treatments available and Hepatitis C is a curable disease.

Yet, few Americans are taking advantage of the new curative treatment. There are several reasons why, including the barrier of the high cost of treatment and insurance restrictions. The patients with the highest prevalence tend to be younger than age 40 and struggle with injection drug use, commonly opioids.

A large number of those at risk for Hepatitis C don’t know they have the disease. It’s vital to know where free Hepatitis C testing is available, which can be found at the CDC web site.

Improve Your Sleep!

Listen to the IPR River to River Podcast episode from June 7, 2022 as host Ben Kieffer interviews University of Iowa Hospitals & Clinics neurologist and sleep disorders expert Dr. Eric Dyken who explains sleep disorders and how to get a better night’s sleep.