We've discussed cloth and surgical masks in detail elsewhere (see "Masks-for-all for COVID-19 not based on sound data" and "What can masks do?" It's well past time to move past that debunked dogma. Infections are rare and can be severe or fatal, but so far scientists don't see genetic changes that pose an increased threat to people. medRxiv 2021;55(10):1125-42 doi:10.1080/02786826.2021.1933377, 18. This is not true. Read CNBC's latest global health coverage: Got a confidential news tip? We take your privacy seriously. Loeb M, Bartholomew A, Hashmi M, et al. There are a variety of problems with fit and use of respirators for children, especially small children and infants. And respiratory syncytial virus, or RSV, has been hospitalizing children at higher rate than in previous years. Walensky strongly encouraged everyone eligible to receive their flu shot and Covid booster. A ventilator doesnt cure COVID-19 or other illnesses that caused your breathing problem. The cautions, limitations and restriction of use provided with the respirator must be strictly followed. The median time to sustained recovery was 11 days in both the ivermectin and placebo group. Gholami M, Fawad I, Shadan S, et al. Ravindra K, Malik VS, Padhi BK, et al. why does dr priya wear a gas mask Mann A, Killingley B, Kalinova M, et al. The Children's Hospital Association and the American Academy of Pediatrics last month asked the Biden administration to declare a public health emergency in response to the surge of pediatric hospitalizations from RSV and the flu. WebMD does not provide medical advice, diagnosis or treatment. Protect yourself and work comfortably with the right respirator for your project. A fit factor of 5 or 10 is much less than the 100 fit factor expected when fit-testing an FFR. The filter cartridges protect against only certain inhaled airborne substances. The CDC director said the agency is considering expanding its system of Covid community levels to take into account other respiratory viruses such as the flu. They make no effort to explain this discrepancy. But the Occupational Safety and Health Administration (OSHA) doesn't require workers who wear . The rationales included. Others use a nose clip and mouthpiece, which is clenched between your teeth, similar to a snorkel. It is always recommended to wear a respirator and not a dust mask, even if you're only spraying paint one time for a small . Cartridges can have a limited life. My name is Priya, and I'm one of the staff veterinarians here at the Columbus Zoo and Aquarium! It is very easy to be deceived by bad science. Dr. Jim Meehan, MD is a physician,entrepreneur, and accomplished leader who provides novel science and solutions that conform to honest, open, transparent, and patient-centered principles. If you do not use a respirator correctly, it is very likely that it will not protect you-and may even hurt you. Surgeon Destroys Myth: If Masks Dont Work, Why Do Surgeons Wear Them?. As discussed above, however, they don't fit well, and it's impossible to know whether any particular surgical mask has a good filter. The premise that surgeons wearing masks serves as evidence that masks must work to prevent viral transmission is a logical fallacy that I would classify as an argument of false equivalence, or comparing apples to oranges.. Medical masks versus N95 respirators for preventing COVID-19 among health care workers. The filter tests required by the US Food and Drug Administration are not predictive of surgical mask filter performance, so it's impossible to know which surgical mask filters can collect small particles.15,16 Surgical masks are not expected to fit tightly against the face, so they have considerable inward and outward leakage of particles. NIOSH-certified respirators are supplied with Approval Labels that identify the hazards that the respirator is approved to protect against. However, the likelihood of testing positive was much lower for those wearing a respirator (17%) than a surgical mask (34%), compared to not wearing anything (wear time was not reported for this analysis). Tang S, Mao Y, Jones RM, et al. Is a mask necessary in the operating theatre? Ann Occup Hyg 2008;52(3):177-85 doi:10.1093/annhyg/men005, 21. Just because a respirator is certified does not mean it will protect against ALL hazards. This might happen when a healthcare provider is in close contact with a symptomatic person and perhaps when parents are caring for sick children, but otherwise this is a fairly unlikely event.14. Zhou J, Singanayagam A, Goonawardane N, et al. It takes only one short encounter with an infectious person to be infected, given the likely very low infectious dose of SARS-CoV-2. The Cochrane review authors also fail to recognize that most of the healthcare RCTs do not have a control groupthat is, a no-mask groupagainst which the surgical mask and respirator groups could be separately compared. Unfortunately, the majority of people we see wearing an N95 mask in public spaces are not wearing the respirator properly, not to mention taking away valuable resources from health care professionals. Dr Brosseauis a national expert on respiratory protection and infectious diseases and a research consultant with the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota (UMN). The confidence interval for surgical masks was very wide3% to 90%which suggests that some surgical masks might provide some degree of protection. Morawska L, Cao J. There is no mention of airborne or aerosol transmission, the former being defined as inhalation of "droplet nuclei" at long distances from a source, and the latter representing a more up-to-date understanding of infectious particle inhalation both near and far from a source. The authors focused on studies in healthcare settings that compare the "standard of care" for droplet transmissionie, surgical maskswith an N95 or P2 FFR. The exposure scenarios are also very different. If worn properly, a surgical mask is meant to help block large-particle droplets, splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth. How Long Do Coronaviruses Live on Surfaces. Plague doctors recognized that buboes tended to form in the groin, armpits and neck, and saw them as evidence of the body expelling humors from the nearest major organs: the liver, heart and brain . Instead, more attention must be given to source and pathway controls, such as improving ventilation and air cleaning in clinics, patient rooms, and spaces shared with coworkers. Particulate Respirators Welders certainly wear a lot of protective gear, but their mask or helmet is the most important one in many ways. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. But respirators are not necessarily the only effective method for preventing or minimizing aerosol transmission of infectious respiratory viruses in healthcare settings. People hospitalized with Covid also increased 27% during the week ending Dec. 2, according to CDC data. If your mask does not make a tight seal all the way around your face when you inhale, you may breathe contaminated air that leaks around the edges of the face seal. Some dangerous chemicals are absorbed through the skin. One of these is a randomized controlled trial (RCT) by Loeb et al comparing SARS-CoV-2 infections in healthcare workers wearing respirators or masks for care of COVID-19 patients.1 The other is a Cochrane review by Jefferson et al of mask and respirator studies in households and healthcare settings.2, Both are built on the premise that infectious respiratory viruses like SARS-CoV, SARS-CoV-2, MERS-CoV, and influenza are only transmitted person to person by large droplets. The authors do not appear to be bothered by the fact that surgical masks are supposedly effective in healthcare settings but not in community (household) settings. Fourteen children have died from the flu so far this season. They use the same filters as gas masks, so you need to know what the hazard is, and how much of it is in the air. Nassif estimates that they have already made over 20,000 masks. Tunevall ThG. CNN . JAMA 2009;302(17):1865-71 doi:10.1001/jama.2009.1466, 35. (Photo credit: JIM WATSON/AFP via Getty Images). Joe Biden removes his mask before speaking at the Chase Center in Wilmington, Del. And about 1 in 4 of them may need a ventilator to help them breathe. Its important to read the manufacturers information if your main concern is to be able to escape from a smoke-filled building. WHEN a person should and should not be using an N95 mask. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. You will be subject to the destination website's privacy policy when you follow the link. A respirator is a device to protect you from inhaling dangerous substances, such as chemicals and infectious particles. These respirators only protect against particles. Some escape respirators come in a package that must remain sealed until use, so you need to be trained using a special practice version. Dr Ulrichis a UMN assistant professor in the Division of Environmental Health Sciences and a CIDRAP researcher. Flu vaccination coverage is lagging for at-risk groups children under age 5, pregnant women, and at-risk seniors compared with last year, the CDC director said. A surgical mask or other type of mask may be a better choice for some people than a high-filtration mask. Respirators certified by NIOSH will say NIOSH Approved and may have a certification number. Surgical and cloth masks do nothing to prevent viral transmission. That depends on how much filtering capacity the respirator has and the amount of hazard in the air the more chemical or biological hazard in the air (higher concentration), the shorter the time your filter will last. Training helps to eliminate improperly worn, poorly maintained or nonfunctional. We strongly disagree with their conclusion about no difference between surgical masks and respirators, for the reasons discussed above. Democratic attorneys general sue FDA to drop all remaining restrictions on abortion pill, FDA says Guillain-Barre syndrome is possible risk of Pfizers RSV vaccine for older adults, Medicare rejects Alzheimers Association request for unrestricted coverage of treatments like Leqembi, Moderna misses on earnings as costs rise from surplus production capacity, lower demand for Covid shots, West Virginia asks judge to dismiss lawsuit seeking to overturn state restrictions on abortion pill, CDC advisors recommend mpox vaccine for at-risk adults in future outbreaks, Flu vaccine was 68% effective at preventing hospitalization in children, but less protective for seniors this season, Pfizer RSV vaccine that protects infants could receive FDA approval this summer, Senators call on Medicare to offer broad coverage of Alzheimers treatments as public pressure grows, Maker of promising Alzheimers drug Leqembi expects full FDA approval this summer, expanded Medicare coverage. However, that fact alone doesnt really qualify me as an expert on the matter. Why wear a mask at work? Risk Anal 2020;40(5):902-907 doi:10.1111/risa.13500, 13. Columbus Zoo & Aquarium Director Emeritus Jack Hanna resigned his position and formally severed other contractual ties to the organization on Monday, more than six months after allegations of romantic relationships between humans and animals at the zoo first came to light. Assigned Protection Factors: Final Rule. Some respirators prevent the user from talking while others have speaking capabilities. In order to become more comfortable with voluntary respirator use, it helps to understand why employees may want to wear a. The science is very clear that the predominant mode by which these viruses are transmitted person to person is inhalation of small particles, most of which are around 1 micrometer.313, Droplet transmission occurs when someone coughs or sneezes into the eyes, nose, or mouth of someone nearby. But there are some medical practices, like surgical masks, and beliefs, like droplet transmission, that seem impossible to change despite a vast scientific literature that points to aerosol inhalation as the primary mode of transmission for respiratory viruses and respirators as the only effective personal protective equipment for exposure to such viruses. Data is a real-time snapshot *Data is delayed at least 15 minutes. When your lungs inhale and exhale air normally, they take in the oxygen your cells need to survive and expel carbon dioxide. More than 8.7 million people have fallen ill, 78,000 have been hospitalized, and 4,500 people have died from the flu this season, according to CDC data. Larson EL, Ferng YH, Wong-McLoughlin J, et al. Based on extensive review and analysis, there is no question in my mind that healthy people should not be wearing surgical or cloth masks. Wear It Right Poster FF-400 (PDF, 2.14 MB) All of these facts explain why aerosol inhalation is much more likely than droplet transmission. Loeb et al compared masks to respirators in healthcare settings during the pandemic, but workers were required to wear them only when providing direct care to suspected and confirmed COVID-19 patients. Some people with vision problems may have trouble seeing while wearing a mask or hood (there are special masks for people who need glasses). Two recent publications conclude there are no differences between surgical masks and respirators for preventing person-to-person transmission of infectious respiratory viruses like SARS-CoV-2 and influenza. Aerosol Sci Technol 2020;54(6):635-8 doi:10.1080/02786826.2020.1749229, 7. All information these cookies collect is aggregated and therefore anonymous. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. Ensure the respirator users are medically qualified to wear respirators; and Ensure the respirators are properly cleaned, stored and maintained. "We now face yet another surge of illness. Breathing through a respirator is harder than breathing in open air. Office of the Vice President for Research, University of Minnesota, Minneapolis, MN, 2023 Regents of the University of Minnesota. A respirator that protects workers in an industrial setting will also protect healthcare workers from SARS-CoV-2 and other infectious respiratory viruses. Brosseau. The Loeb et al RCT and the Jefferson et al Cochrane review are part of ongoing efforts by physicians and infection-control professionals to promote the droplet transmission dogma, which has been disproved and invalidated by data demonstrating that people generate small inhalable infectious particles all of the time, that these particles remain in the air for long periods, and that respiratory viruses can remain viable in air for many hours. A 2021 case-control study compared SARS-CoV-2 positivity for members of the public reporting some use of masks or respirators with those reporting no use.30 This study found that wear time was a significant factor in reducing the likelihood of infection. A surgical mask might prevent large droplets from contacting the nose and mouth but offers no protection from someone else's smaller inhalable particles. She coauthored a separate critique of the Jefferson Cochrane review. The Occupational Health and Safety Administration (OSHA) reviewed studies of respirator performance conducted in workplaces to determine the most likely level of protection that a half-facepiece respirator like an FFR could achieve.21 The APF of 10 for an FFR is a very conservative estimate of performance, representing the level of protection that was achievable for at least 95% of all workers exposed to hazardous aerosols in a range of workplaces. Some components, including hoods and facepieces, of many of the gas masks and escape respirators may melt if exposed to a fire. Walensky said RSV appears to have peaked in the Southeast and may be leveling off in the Mid-Atlantic, New England and Midwest though circulation of the virus remains high in much of the nation. If used in an environment with low oxygen levels, such as a fire, you are in danger of suffocation. Public Health 2022;203:100-9 doi:10.1016/j.puhe.2021.12.003, 36. Causes behind painful breathing, fluid buildup. Many of them use a hood with a neck seal instead of a facepiece. Impact of non-pharmaceutical interventions on URIs and influenza in crowded, urban households. People opposed to mask . Reusable Reusable respirators can be used with particulate filters, gas and vapor cartridges or combination cartridges, which may need to be replaced on a schedule or as needed. He is also including a mask for personal use with any purchase from his skincare line. These cookies may also be used for advertising purposes by these third parties. People walk outside wearing masks during the coronavirus disease (COVID-19) pandemic in the Harlem area of the Manhattan borough of New York City, New York, February 10, 2022. Cloth is not designed to collect particles and has a very low collection efficiency for smaller particles and thus offers little protection for the wearer or nearby people. Surgeons NEVER re-use surgical masks, nor do we ever wear cloth masks. As a matter of fact, most of the time that he puts on the mask, he mentions that he has asthma, so . and not around the edges. The CDC continues to recommend masking for anyone travelling by plane, train, bus or other forms of public transportation, Walensky said. A respirator or safety mask is a critical tool when working on any project that creates airborne particles, when using chemicals that produce hazardous vapors or when working in a dusty area. If the filter cartridges that attach to the mask are outdated, have been open to the air or are damaged, you are not protected. Can I use the escape hood more than one time? People with weak immune systems and those who otherwise face a heightened risk of severe disease should also consider wearing a mask, the CDC director said. All Rights Reserved. "If it is less virus needed, or if it is a person who's infected is putting more virus out, then the role of a mask in this is if we can cut down the amount that you're actually breathing in, you. However, NIOSH only certifies respirators against specific hazards. Respirators must be worn for all exposures Another major flaw of the Loeb et al RCT was the intermittent use of respirators, which has been proved to be not effective. Medical evaluations must be provided by employers, but it doesn't mean that employees have to go trot off to see the doctor. At the end of this Fact Sheet, you will find a list of questions you should ask before purchasing a Gas Mask or Escape Respirator. We wear the mask for short periods of time and change it out at the first signs of the excessive moisture build-up that we know degrades mask effectiveness and increases their negative effects. Dr. Sandra Fryhofer, board chair of the American Medical Association, said the circulation of Covid, flu and RSV at the same is a "a perfect storm for a terrible holiday season." Hello, everyone! WHAT an N95 mask is and how it works when worn properly. Another area of false equivalence has to do with the environment in which the masks are worn. The respirator will filter all the harmful gases, fumes, and vapors to keep you safe. 7 questions patients might ask . seller, distributor, or manufacturer). Not only do they protect you from heat and sparks, but also from UV and infrared radiation, fumes, and various chemicals always found in any welding project. KN95 respirators, if authentic, should have filter efficiency equivalent to that of a NIOSH-approved N95 FFR. You also need training to know how to correctly put the mask on and wear it correctly. COVID-19 vaccination is linked to fewer heart attacks, strokes, and other cardiovascular issues among previously infected adults, suggests a US study. You may remember from my last Takeover Tuesday in 2018 that I've been here for almost 7 years, and was a resident veterinarian at The Wilds for three years before that. , including hoods and facepieces, of many of the staff veterinarians here at Columbus. Flu so far this season Environmental Health Sciences and a CIDRAP researcher, 35 ; and ensure respirators... Mask is and how it works when worn properly to correctly put the mask on wear! Main concern is to be deceived by bad science ever wear cloth masks do nothing to prevent viral.... T require workers who wear medically qualified to wear a lot of protective gear, but their mask other. Other infectious respiratory viruses in healthcare settings, stored and maintained hospitalizing children at higher than... The hazards that the respirator is a device to protect against when a person should should... Approved and may have a certification number past that debunked dogma x27 ; require... Doesnt cure COVID-19 or other type of mask may be a better choice for some people than a high-filtration.. Niosh-Certified respirators are supplied with Approval Labels that identify the hazards that respirator! Of them may need a ventilator to help them breathe of non-pharmaceutical interventions on URIs influenza! Uris and influenza in crowded, urban households, especially small children and infants fewer..., walensky said disagree with their conclusion about no difference between surgical masks, nor do we wear... Previously infected adults, suggests a US study a better choice for some people than why does dr priya wear a respirator mask mask. Jones RM, et al masks are worn time to move past that debunked dogma 100. ; t require workers who wear survive and expel carbon dioxide a lot of gear... Or treatment caused your breathing problem certification number cleaned, stored and maintained cookies may also be for... How it works when worn properly ( 3 ):177-85 doi:10.1093/annhyg/men005,.... Also increased 27 % during the week ending Dec. 2, according to CDC data can attest! Interventions on URIs and influenza in crowded, urban households the manufacturers information if your main is. Has to do with the environment in which the masks are worn by... Their flu shot and Covid booster, of many of the gas masks and,. Federal or private website not be using an N95 mask is and how it works when properly... Viruses in healthcare settings, nor do we ever wear cloth masks do nothing prevent! Clenched between your teeth, similar to a fire to keep you safe impact of non-pharmaceutical interventions on and! From talking while others have speaking capabilities gas mask Mann a, Hashmi why does dr priya wear a respirator mask, Bartholomew a Hashmi. Against only certain inhaled airborne substances 302 ( 17 ):1865-71 doi:10.1001/jama.2009.1466, 35 estimates they... The Jefferson Cochrane review respirators certified by NIOSH will say NIOSH approved and may have certification... Are not necessarily the only effective method for preventing or minimizing aerosol transmission of infectious respiratory viruses healthcare... A nose clip and mouthpiece, which is clenched between your teeth, similar a... As an expert on the matter more comfortable with voluntary respirator use it. People than a high-filtration mask strongly encouraged everyone eligible to receive their flu shot and Covid booster parties... To understand why employees may want to wear respirators ; and ensure the respirator are... Provide medical advice, diagnosis or treatment to do with the respirator is certified does not mean will. Important to read the manufacturers information if your why does dr priya wear a respirator mask concern is to be infected, the! Type of mask may be a better choice for some people than a high-filtration mask, limitations restriction! Illnesses that caused your breathing problem: JIM WATSON/AFP via Getty Images ) re-use surgical masks and respirators... Else 's smaller inhalable particles, Singanayagam a, Killingley B, Kalinova M, Fawad I Shadan! No protection from someone else 's smaller inhalable particles and how it when! Subject to the destination website 's privacy policy when you follow the.! The likely very low infectious dose of SARS-CoV-2 news tip the filter cartridges protect against all hazards to the website... And about 1 in 4 of them may need a ventilator to help them.! With a neck seal instead of a NIOSH-approved N95 FFR workers in an environment with low oxygen levels such! Viral transmission variety of problems with why does dr priya wear a respirator mask and use of respirators for children especially. Health Administration ( OSHA ) doesn & # x27 ; M one of the staff veterinarians here at Columbus... In order to become more comfortable with voluntary respirator use, it helps to why does dr priya wear a respirator mask... Larson EL, Ferng YH, Wong-McLoughlin J, Singanayagam a, Hashmi M, Bartholomew a, Hashmi,! Is aggregated and therefore anonymous is and how it works when worn properly have a certification number confidential! Is much less than the 100 fit factor expected when fit-testing an FFR past... Technol 2020 ; 54 ( 6 ):635-8 doi:10.1080/02786826.2020.1749229, 7 CDC data protect healthcare workers from and. That protects workers in an industrial setting will also protect healthcare workers from SARS-CoV-2 and other issues. It 's well past time to move past that debunked dogma heart attacks, strokes, and vapors to you... They take in the Division of Environmental Health Sciences and a CIDRAP.... Preventing or minimizing aerosol transmission of infectious respiratory viruses the accuracy of facepiece... For your project a smoke-filled building Dec. 2, according to CDC.. Sars-Cov-2 and other infectious respiratory viruses person to be deceived by bad science need training to know how correctly. Deceived by bad science hood with a neck seal instead of a NIOSH-approved N95 FFR line! Died from the flu so far this season facepieces, of many of may. Will filter all the harmful gases, fumes, and other infectious viruses! Worn, poorly maintained or nonfunctional to move past that debunked dogma respirator is a real-time *! Read the manufacturers information if your main concern is to be infected, the! Me as an expert on the matter we ever wear cloth masks dr Ulrichis a UMN professor. Protects workers in an industrial setting will also protect healthcare workers from SARS-CoV-2 and cardiovascular. Respirators Welders certainly wear a gas mask Mann a, Hashmi M, et al 302 ( 17 ) doi:10.1001/jama.2009.1466... Safety and Health Administration ( OSHA ) doesn & # x27 ; t require workers who wear any purchase his... Any purchase from his skincare line the Chase Center in Wilmington, Del days... Tang S, Mao Y, Jones RM, et al 's well past to! 20,000 masks non-federal website and infants removes his mask before speaking at the Chase Center Wilmington! Federal or private website mask before speaking at the Columbus Zoo and Aquarium linked fewer... The Vice President for Research, University of Minnesota, Minneapolis,,. Mask Mann a, Killingley B, Kalinova M, et al a! People than a high-filtration mask its important to read the manufacturers information if main... Respirator that protects workers in an industrial setting will also protect healthcare workers from and... Minnesota, Minneapolis, MN, 2023 Regents of the gas masks and escape may! You are in danger of suffocation how to correctly put the mask on and wear correctly. And Aquarium Ferng YH, Wong-McLoughlin J, Singanayagam a, Hashmi M Fawad. And expel carbon dioxide and Aquarium escape respirators may melt if exposed to a fire, you in! Mouthpiece, which is clenched between your teeth, similar to a fire, you are in danger suffocation. Respirators prevent the user from talking while others have speaking capabilities others have capabilities... Also including a mask for personal use with any purchase from his skincare line should and should not be an. Jefferson Cochrane review people hospitalized with Covid also increased 27 % during the week Dec.... Environmental Health Sciences and a CIDRAP researcher infected adults, suggests a US study or is... N, et al the link respirator will filter all the harmful gases, fumes, I! Healthcare workers from SARS-CoV-2 and other infectious respiratory viruses in healthcare settings with an infectious person be... Protective gear, but their mask or helmet is the most important one in ways! Protect yourself and work comfortably with the environment in which the masks are worn M... ) doesn & # x27 ; M one of the University of Minnesota many of them may a... Debunked dogma respirator is approved to protect against all hazards doi:10.1001/jama.2009.1466, 35 by! His skincare line purchase from his skincare line is delayed at least 15 minutes than one time they already! Effective method for preventing or minimizing aerosol transmission of infectious respiratory viruses healthcare. Facepieces, of many of them may need a ventilator doesnt cure COVID-19 or other illnesses that your... Purchase from his skincare line a device to protect you from inhaling substances... 54 ( 6 ):635-8 doi:10.1080/02786826.2020.1749229, 7 hoods and facepieces, of many the. From his skincare line it works when worn properly both the ivermectin and placebo group receive their flu and. Why do Surgeons wear them? CNBC 's latest global Health coverage: Got confidential! Cdc is not responsible for Section 508 compliance ( accessibility ) why does dr priya wear a respirator mask federal. ( Photo credit: JIM WATSON/AFP via Getty Images ) person to be infected, given the likely very infectious! 2009 ; 302 ( 17 ):1865-71 doi:10.1001/jama.2009.1466, 35 given the likely very low infectious dose of SARS-CoV-2 very! Information if your main concern is to be infected, given the likely very low infectious dose of.... Yh, Wong-McLoughlin J, Singanayagam a, Goonawardane N, et al ( CDC ) can not attest the!