00:00:01:14 - 00:00:13:16 Unknown So with that out of the way, I think we will go ahead with our public comment period. I will turn the meeting over to Sidney to introduce this portion of the meeting. 00:00:13:19 - 00:00:26:01 Unknown Hello, everyone. I would like to introduce our zoom coordinator, Angela Driver. She will start the public comment period. 00:00:26:03 - 00:00:42:22 Unknown Good afternoon. Our first commentator is Andrew Wang. Thank you. 00:00:42:25 - 00:01:00:14 Unknown Hi. Thank you so much for having me. My name is Andrew Wang. And thank you for this opportunity to speak to you today. On November 14th, during Apex public comment session, my remarks may have been formally submit as public comments. I have no financial conflicts of interest or fiduciary investments in companies or organizations that produce or manufacture personal protective equipment. 00:01:00:21 - 00:01:25:28 Unknown First, I want to recognize and express my sincere appreciation for all of your time in meaningful work by this committee to provide guidance on the practice of infection control strategies to ensure safe US healthcare settings for our patients and coworkers. Balancing approaches is important when pursuing realistic, idealistic, or practical approaches, but the public trust all of us in the medical community to understand and be aware of the evidence and adopt policies that ultimately enforce approaches that align with the evidence. 00:01:26:00 - 00:01:46:17 Unknown In this meeting, the incoming administration has already announced an individual who has worked to discourage vaccinations. It will be Nami is the Secretary of Health and Human Services. Establishing the highest standards is needed to protect health care and prevent individuals like this who opposes any levels of safe standards and will try to dismantle them. As a public health professional with doctorates and masters of Public Health. 00:01:46:20 - 00:02:05:12 Unknown I'm aware of the challenges in health care and the need for precise and meaningful guidelines. My expertise has been in the areas health disparities as a health service researcher focused on health equity. I serve at a fairly qualified health care center that provides care for underserved and moral populations in Chicago, and I was previously an administrator, an occupational medicine department, and one of the largest academic medical centers. 00:02:05:12 - 00:02:24:22 Unknown And so here I am speaking on behalf of the public with ongoing serious concerns regarding infectious disease, such as Covid, that spread in the air and currently affects the health and well-being of healthcare workers and patients in healthcare settings. The decisions being made today establish a serious precedent for future generations, especially if these standards are not at the highest and most rigorous levels. 00:02:24:24 - 00:02:46:24 Unknown Lowering these standards would result in even putting result in putting health care workers and patients in more dangerous conditions and lead to a fewer allocation of resources for future pandemics, especially at less resource health care facilities that serve the most vulnerable and underserved communities like my own. Ultimately, higher standards ensure that health equity is addressed, allowing lower standards, further worsening disparities. 00:02:46:26 - 00:03:08:03 Unknown Tic TAC has an important role to ensure the most rigorous and higher standards of protection regarding infection control guidelines, because it impacts the health of healthcare workers and patients. The implications of today's to the end politicians are far reaching, including primary and specialty community clinics across the country, the isolation precaution guidelines and health care personal guidelines are pivotal decision point, especially with the incoming new administration. 00:03:08:10 - 00:03:28:26 Unknown Already, persons of color and people with lower income or who face poverty have disproportionately worse outcomes in health care, but also from Covid infections and most likely will develop on Covid. I humbly urge you to strengthen CC's infection control guidance, in line with practices that ensure the highest level of protections against the spread of infectious disease, especially through aerosol transmission. 00:03:28:29 - 00:03:51:15 Unknown First, I ask members and feedback to ensure the highest standards and to prevent and ensure the least number of hospital acquired Covid infections and adopt. The project protects against the spread of any disease. Thank you so much for your time and I appreciate all of your support in this work. Thank you Andrew. We appreciate your comment. Next commenter. 00:03:51:17 - 00:04:01:15 Unknown Our next commentator is Mary Germain. Is. 00:04:01:17 - 00:04:28:06 Unknown Hello. My name is Doctor Mary Germana Savva. And today I'm here speaking on behalf of the people CDC, a CDC watchdog group and health equity group at the people's CDC. We continue to receive comments from our constituents complaining about health care facilities violating the rights to safe health care. These fall into two categories health care workers who refuse to mask with patients or facilities, who refuse to guarantee N95 mask wearing or other reasonable accommodations. 00:04:28:09 - 00:05:01:02 Unknown We have constituents who complain to us about themselves or other ones, other loved ones, catching Covid at the doctor because practitioners refuse to mask. We are seeing again in writing, again and again from our constituents, that health care systems explicitly do not consider N95 mask wearing a reasonable accommodation, even if the patient has to be unmasked. We have many complaints about hospitals refusing people's requests to be in private post-operative rooms, even when those patients again, are unable to be masked themselves, saying that this is too burdensome on the hospital. 00:05:01:04 - 00:05:43:09 Unknown Although up until just last year, hospitals tested patients for Covid upon entry to minimize spread. Now, piggyback is proposing to allow healthcare workers to return to work when they are fever free, even though many people never have a fever at all with Covid. But they are still infectious. The CDC's own data shows that infectiousness varies widely and in isolation should depend on an appropriate isolation period of at least 7 to 10 days and two negative consecutive rapid tests, as attested to by our isolation letter signed by 400 public health experts, not on the whims of employers who need to solve an ever increasing health care employment crisis, exacerbated by untenable working conditions and the increasing 00:05:43:09 - 00:06:06:01 Unknown crisis of long Covid. Now, your draft guidance is implying that health care facilities could determine whether or not workers are allowed to wear n95s in the workplace. We've already heard complaints about this at workers from Mass General Brigham, who made the difficult decision to quit their jobs because they were only required they were only allowed to wear surgical masks once universal masking was lifted in May 2023. 00:06:06:03 - 00:06:38:09 Unknown Again, lifting universal masking was not a decision based on science. Listen to the public comments. Listen to your own scientists at CDC who continue to publish memoirs showing how dangerous Covid continues to be. Just as September, a new memoir showed that infants made a higher percentage of hospital Covid admissions than any other age group except over 75 infants in the study, nearly 1 in 20 required mechanical ventilation, and nine infants died during their Covid associated hospitalizations. 00:06:38:11 - 00:07:05:21 Unknown Children just at the start of their lives, healthcare workers and patients will be drastically impacted by your recommendations. The public is overwhelmingly asking you to make universal masking the new standard of care, and to acquire healthcare workers to wear a 95. In cases of confirmed or suspected or social transmission, as well as to make N95 masks widely available within healthcare systems, regulate and fund, improve ventilation, and follow the data on isolation protocols, not hospital profit margins. 00:07:05:25 - 00:07:22:12 Unknown Thank you. Thank you, Mary, for your comment. Our next commentator is Jackson Health. 00:07:22:14 - 00:07:44:12 Unknown Hello, my name is Jackson Rizzo, and three years ago I became debilitated by long Covid. I had to shut down my small business that I had worked extremely hard to build and let go of my two full time employees. Each time I have gotten Covid, my disability has gone from bad to worse. We now have studies that demonstrate what I have personally experienced. 00:07:44:15 - 00:08:13:20 Unknown Every time we get Covid, we get worse because of this vulnerability. It is not safe from the access healthcare of any kind. There is no preventative care that is worth the risk of another Covid infection. Today, we have a greater knowledge than ever before of how viruses are spread and how damaging even seemingly mild infections can be. This knowledge was paid for in blood by the lives lost during the public health emergency. 00:08:13:23 - 00:08:40:04 Unknown Yet we consistently fail to implement this knowledge. And so Americans continue to die in overwhelming numbers from hospital acquired infections. Millions of vulnerable patients like myself. Patients with chronic conditions like long Covid or cancer or heart disease need to receive care. But don't because we are all too aware of the crippling power that SARS-CoV-2 still has throughout the day. 00:08:40:05 - 00:09:06:02 Unknown I have listened to your presentations. I've heard your talking points. I have seen your slides. I looked at your charts and graphs and I have read your bullet points. As a patient, I can tell you that you will receive the most fundamental question. Can everyone in the United States access healthcare safely? Yes or no? If the answer is no, then something needs to change. 00:09:06:04 - 00:09:30:07 Unknown The recommendations presented in this meeting do not meet the demands of the moment. They will not make healthcare safe enough to genuinely protect the most vulnerable members of our society. It is beyond time to once again implement mandatory masking in all healthcare facilities. You are on this committee for a reason. What do you want your legacy to be? 00:09:30:10 - 00:09:57:08 Unknown Do you want to be remembered as the ones who halted progress and said fewer deaths are good enough? Or do you want to be remembered as the ones who pushed forward and championed the new age of safer and more inclusive healthcare? The doctors who look to you for guidance soon oath to do no harm. Today we, the patients, ask you to lead them in fulfilling that oath. 00:09:57:10 - 00:10:06:10 Unknown Mask work. We know they work and it is time to make them the standard. Thank you. 00:10:06:12 - 00:10:21:23 Unknown Thank you. Jackson. Our next commentator, Deborah. So-called. 00:10:21:26 - 00:10:49:08 Unknown Hello. My name is Deborah Sokol. An active on pandemic issues with several public health groups. I am, for example, health policy advisor to America. But today, I speak only for myself. I am a long Covid patient cancer survivor and retired health counselor with. I have a vocal cord disability, so I will also submit my comments in writing. 00:10:49:11 - 00:11:14:28 Unknown I. I am aghast at the continued failure to end the health care spread of airborne germs that cause term, disability and death. My mother caught or caught Covid from a caregiver in 2021 and died of it. I caught it from her and still suffer the effects. Like many people I know, I can't risk repeat infection and worse disability. 00:11:15:01 - 00:11:49:28 Unknown So I go without much needed medical care because health care settings pose a threat. Most have abandoned routine tests and social work while infected yet used ask. If I ask medical staff to mask. They also resist the attack, and CDC should call for restoring routine testing and masking year round by all visitors and patients, except the rare patients who cannot, with widespread N95 use. 00:11:50:01 - 00:12:25:28 Unknown I greatly appreciate panelists today who recognized that appalling numbers of patients and staff at Covid individuals care settings that facilities often when surges start that facilities may not know who is infected or high risk and then infection and then action is urgent to strengthen ventilation, sick pay and protections. Besides PPE. But few of your members, recognize those points, and it's disturbing to hear proposals to focus protections on a high risk unit to high risk patients. 00:12:25:28 - 00:12:54:25 Unknown Use all parts at a hospital. Immunocompromised people should not be endangered. It may orthopedist us as. And I worry especially for my relatives whose babies are due next summer. A CDC web page on protecting infants and children notes infants under six months has a Covid hospitalization rate, but offers no help except vaccination in pregnancy. How should hospitals and doctors protect newborns from widespread Covid? 00:12:54:28 - 00:13:31:06 Unknown The need for universal masking is obvious and routine testing of STAT, which should work unless in section three. Sadly, your proposed policies won't protect infants or the rest of us in our contacts with health care. Thank you. Thank you for your comment, Deborah. Our next commenter, Shane, from New York, Shane O'Neill, might make some. 00:13:31:08 - 00:13:53:06 Unknown Hi. Can you hear me? Yes, we can hear you. Hi. I'm senior advocate for patient rights and human rights in the Covid conscious community. Volunteer at the World Health Network and Air Support Project, non profit immunocompromised and apparently not in the picture and likely to be voted to be denied safe health care and thrown to the wayside. The way that things are looking so far at least. 00:13:53:08 - 00:14:10:07 Unknown I read a few questions for you too. After all, listening in on today and getting a small amount of time to go to slides and now be given the grand opportunity of leaving a 5 or 3 minute comment to defend my life before your voting tomorrow, which I'm not even sure is with the legal number identity of entities. 00:14:10:09 - 00:14:26:28 Unknown First of all, who's going to send a memo to all the firefighters that they should start using surgical masks for wildfire smoke? Now, and to the lab workers that work with other infectious diseases like tuberculosis, bird flu, or whatever else pops up, they can spread by the air. Just let them know to put down those papers and any fives go on a baggie. 00:14:26:28 - 00:14:44:10 Unknown Do surgical masks because it probably works just as fine. Who's going to finish the waiver? And wasting their time on tests that certify these respirators, protect from the particle size that infectious diseases like Covid spread on, and just let them know that surgery is a probably just as good, according to a few cited studies that don't agree on outcomes. 00:14:44:10 - 00:15:13:02 Unknown So you decided to ignore the more controlled ones and favoring the ones full of inconsistencies, and then use that to lead to the decision that abandons the entire field of physics and goes against current industry guidelines, because it's just a once in every five year infection control standard for all of our health care facilities, where people who are at their most vulnerable inside of during a time when SARS-CoV-2 is recognized to spread year round and cause long Covid and 25% of infections with reinfections looking worse. 00:15:13:04 - 00:15:37:04 Unknown But maybe your health care workers aren't the ones spreading it to them, it's just their visitors. Because you all are magical. And oh well. We couldn't ask the visitors to wear respirator masks. That's rude. These people in a hospital just need to deal with being repeatedly infected when seeking health care in their vulnerable position. It's a risk you are willing to take today, and somehow you've been put in this position to decide for us, that's not the precautionary principle. 00:15:37:06 - 00:16:06:13 Unknown The only way to address the reality of this breadth admitted aerosol spread shorten, far distance traveling, infectious, lingering, extremely contagious, quickly evolving vaccine and immunity evading your own pathogen of Covid 19 and its often long term severe counterpart, long Covid is to make aerosol filtering, face conforming respirator masks like N95, their equivalents or, better standard precaution in health care facilities. 00:16:06:15 - 00:16:26:22 Unknown Anything less will not work. And don't worry, you don't have to stay up all night to rewrite what you just did today. I'm pretty sure the World Health Network sent you the correct answers to CDC for questions. It's in your inbox, and I'm pretty sure they're okay with you using them verbatim. Thank you for your time. Thank you for your time, Shea. 00:16:26:25 - 00:16:36:15 Unknown Our next commenter, Caitlin Shanley. 00:16:36:17 - 00:17:03:24 Unknown Wrote evens Caitlin Findling I am an MD, PhD, physician, scientist, and pathologist in Wisconsin. I have no conflicts to disclose. I am a volunteer with the people CDC and Wisconsin Community Health Action. Although I am not speaking on behalf of any group, I am commenting in support of universal masking and strengthening infection control policies. Infection control begins with the basic assumption that infections are worth preventing. 00:17:03:27 - 00:17:28:13 Unknown Healthcare workers need strong guidelines from the CDC to ensure best practices are followed. I hope we can all agree that it should not be up to individual health care workers to decide whether hand-washing is needed, whether exam rooms should be clean, or whether gloves should be worn during procedures. Masking is no different. This committee needs to decide, is aerosol transmission a personal belief or a scientific fact? 00:17:28:16 - 00:17:55:11 Unknown All healthcare settings pose risks of aerosol transmitted infections diseases such as tuberculosis, Covid, seasonal influenza, avian influenza, measles, and so on. Many health care settings have implemented fall to winter universal masking without adverse impacts to operations. Covid spreads year round and year round. Universal masking, as a standard precaution, is the only sensible solution to prevent health care acquired infections. 00:17:55:13 - 00:18:29:20 Unknown Masking should not only be a reactive approach that comes after preventable exposures have already occurred. Mask bans have been enacted in multiple locations, creating a dangerous situation in our communities. Meanwhile, health care crisis standards enacted during PPE shortages risk becoming permanent policies. This committee must fully address the very real instances where health care workers and patients have not been allowed to wear respirators, and where health care policies have been used to deny patient requests for staff to wear respirators. 00:18:29:23 - 00:19:10:19 Unknown As the foremost authority on infection control, you have the opportunity to combat stigma and make it misinformation about masking by recognizing the need for universal masking in health care, and that respirators, at minimum N95, are the only appropriate respiratory protection against aerosol transmitted pathogens. Regarding the Health Care Personnel Guidelines shortening Covid isolation for health May 2024 as Mary mentioned, the people CDC submitted a letter to the CDC with over 400 expert signatures supporting that Covid positive workers must isolate at home for at least 7 to 10 days and should test negative before returning in person. 00:19:10:21 - 00:19:40:07 Unknown Universal masking in healthcare with broad use of N95 respirators is necessary for safe patient care and workforce protection. Please use your authority to strengthen infection control using a multi-layered precautionary approach. Thank you. Thank you for your comment, Kaitlin. Our next commenter. Don Ford. Yeah. 00:19:40:09 - 00:19:44:22 Unknown Don, are you on the line? 00:19:44:24 - 00:20:02:24 Unknown Hi. Can you hear me now? I can hear you. Perfect. Hello. My name is John Ford, and I'm no conflicts of interest. I spoke at last year's meeting on this issue and primarily focus on helping rewrite our vaccine policy for a pack of ACIp. Before I get started, I want to point out the people on this committee who were able to limit transmission and create safe healthcare spaces are using a layered approach. 00:20:02:27 - 00:20:19:27 Unknown And and yet I hear other members of the committee locking onto individual assets of their approach, as if that single mitigations alone and excuse me is enough alone. When you consider that it's not an individual item protecting folks, then you have to remember that splitting hairs over symptoms is completely pointless, especially when a large portion of transmission is asymptomatic. 00:20:19:29 - 00:20:38:00 Unknown Rather than chopping up complex guidelines that are easily misunderstood, this demonstrates it should be at least masking all the time and using respirators when they're concerned about symptoms or having had exposure. This debate has ignored the obvious solution of different quality masks for different environments, and if folks are symptomatic, then they should be home until they are not symptomatic. 00:20:38:02 - 00:20:57:11 Unknown 3 or 5 days does not handle the issue. I hear the committee discussing what is best for hospital management when your role is to determine what is best health care practices. The group is now called Hospital Management Practices. Its health, healthcare, infection control practices Advisory Committee. You're supposed to be speaking to what is best for the patients and the health care workers providing care, and the hospitals are supposed to then fit into those regulations. 00:20:57:18 - 00:21:16:24 Unknown We are not supposed to fit patients and the demands of the hospitals are why even have this committee in the first place? And the workgroup discussion about endorsing voluntary masking means that these rules are already being used against workers to prevent nasty. You're putting undue requirements on the facilities and the workers. This confusion alone shows that is too complicated not to have a flat recommendation. 00:21:16:26 - 00:21:38:22 Unknown The current recommendation already lowers the level of care available. This has led to misinformation coming from health care providers themselves that masks do not protect them enough, or that they don't need to wear them. At least the policy of any mask is better than no mask needs to be recommended by this committee. If you're not going to have a full time recommendation, though, respirators should be required for any suspected pathogen that travels through the air in line with Who changes to airborne. 00:21:38:24 - 00:21:57:15 Unknown We dealt with this in the RNA vaccine recommendations this year, and a year later we're unwinding that rules with the right answer was the whole time, with the recommendation for at least two boosters a year instead of one. But unlike Vopak, this committee does not meet over the same issues year after year except this exact issue, because it got kicked back by the CDC for not doing what was best for missing ministering care. 00:21:57:20 - 00:22:13:24 Unknown And now you're making the same mistakes today. And yet everyone on the committee remember that we are going to be back here next year under a Trump presidency, still trying to make this work because the same people who are commenting right now are the same people who got this issue kicked back in the first place. So you have to make it very clear right now. 00:22:13:25 - 00:22:38:23 Unknown Also, in discussing three versus five days, many of you included incubation as part of the two days, which is not the right time for that isolation. If you're so concerned about workers being out sick and putting masks on them all the time and upgrade the mask, different levels of exposure and then making respirators available to all staff work with the ease of ease of use and new standards, and from there create work groups to handle these other mitigations UVC, air filtration and other sterilizing methods. 00:22:38:25 - 00:23:00:05 Unknown This will be added to the list and you should get ahead of it now. Thank you. Thank you, Don for your comment. We can move on to our next commenter, James Norris. 00:23:00:07 - 00:23:24:06 Unknown Hello. We can hear you. This. Thank you. I will start by saying, that I, I work at. I do have a potential conflict to share. I have worked at multiple pharmaceutical companies in the past, but my comments are entirely my own. And are not connected to any company or organization I am a member of or have worked with. 00:23:24:08 - 00:24:09:05 Unknown My background within pharmacy industry, we are regulated by the FDA has a significantly different approach to what is being done here and in health care facilities. The same arity of the regulations in the consequences of failure to follow than in the pharmaceutical industry are so severe that it's common practice for pharmaceutical companies to go above and beyond the regulations to be absolutely certain there are no compliance issues, nor are there any problems they could even be suspected of such. 00:24:09:07 - 00:24:56:25 Unknown The fact that you are even discussing many of the topics that are here today are things that are beyond the scope of even imagination or consideration within the pharmaceutical industry. And because of that, it is, quite frankly, is a difficult, if not impossible thing to imagine, even changing the minds of many of the people on this committee. Because the ability to take a proper perspective on here seems to be beyond even the point of consideration. 00:24:56:27 - 00:25:28:16 Unknown And because of that, I have little hope that this committee will change the way to take a more conservative approach to what should be done. As has already been mentioned by the previous commentators, and the main point is more needs to be done and currently is to minimize and reduce and mitigate infections. It's not being done. There's a rush at most health care facilities to do the absolute minimum. 00:25:28:18 - 00:25:59:13 Unknown Whatever guidance there is that is being the actual target that's done. And so the failure to even have a substandard recommendation is a failure of this committee. Thank you. Thank you, James, for your comment. We can move on to our next commenter, Deborah Gold. 00:25:59:16 - 00:26:11:00 Unknown Hello. Thank you for the opportunity to comment at this meeting. Can you hear me? We can hear you. 00:26:11:02 - 00:26:17:07 Unknown We can hear you, Deborah. 00:26:17:09 - 00:26:48:08 Unknown I think you've muted yourself. We'll wait for a second. Okay. Can you hear me now? I can hear you. Okay. Thank you. Thank you for the opportunity to comment. I had retired from Cal OSHA deputy chief for health in 2014, but was recruited back to provide technical help in March of 2020, when Covid 19 was beginning to blaze through health care, congregate living in prisons, the incorrect information that Covid 19 would not spread to the ER, and the lack of appropriate precautions allowed Covid 19 to overwhelm long term care facilities and prisons. 00:26:48:10 - 00:27:08:00 Unknown I again left Cal OSHA last year and I'm not speaking for the agency. At least 13 people died during the first outbreak at San Quentin Prison, which started at the end of May 2020. 122 people were transferred in a ten hour bus ride from Cal from the California Institute for men, where 500 people were sick and 900 died on arrival. 00:27:08:00 - 00:27:33:08 Unknown The men were placed on the upper floors of the Five Care Badger Building. 1457 people incarcerated San Quentin were infected in a two week period. The judge's tentative ruling said. Broomfield testified that he believed Brett Badger was an appropriate and safe place to quarantine the sick transferees because he believed Covid 19 could only spread through droplets or contact from hard surfaces, not through air crystallization. 00:27:33:10 - 00:27:58:05 Unknown Staff were generally not using respirators and served as a vector for Covid 19 to different areas of the prison. Many employees were infected and at least one died in Marin County, public health officer was concerned the prison outbreak had spread to the community. Ultimately, the state health department set up an emergency operation center to institute controls such as source controlled testing, physical isolation, air filtration, respirator use. 00:27:58:07 - 00:28:22:05 Unknown This illustrates the importance of the differences between scenarios outlined in the workgroup presentation in scenario A captures what happened in late May in May in San Quentin, which followed their past practices, which diseases such as mumps and chicken pox. The built environment encouraged transmission of Covid 19. Simple masks were initially provided, and respirators, when provided, were not used consistently or correctly. 00:28:22:07 - 00:28:49:05 Unknown Scenario B recognizes the importance of preventing both short and long range inhalation and reflex, with the CdPH implemented at San Quentin to stop the outbreak, screening, source control, ventilation, and other engineering controls must be used to limit the areas in which infections aerosols may be present and reduce their concentrations where infectious aerosols may be present, employees must effectively use nine approved respirators, including respirators more protective than N95. 00:28:49:08 - 00:29:14:10 Unknown Clinical studies of infectious pathogens, laboratory studies, and 100 years of respirator use in various industries, and found repeatedly that only respirators that fit the face will prevent inhalation of aerosols, including infectious aerosols, where health care workers have additional personal risks such as pregnancy or immune compromised housemates. Even when policy does not require respirator use, the employer should provide employees and allow them to use fit tested respirators. 00:29:14:11 - 00:29:45:28 Unknown Thank you. Thank you Deborah. We can move on to our next commenter, Chloe Humbert. Hello. The ukulele. I'm. Hi, I'm Chloe Humbert. Samuel is known for his campaign for hand-washing standards. He was attacked by contrarians until his death. Today is vindicated. Yet respiratory hygiene is the science denier flavor of the day. It's not okay that doctors and nurses are maskless, breathing directly on patients who then get infected. 00:29:46:00 - 00:30:10:25 Unknown Now is the chance for those in positions to do so, to set a precedent for deserved protection of worker and patient safety. To be on record, giving evidence based practitioners something to hang on to. We are going back. The only question is how far back people in medical leadership are willing to sign on to the announced incoming Department of Defense Secretary is someone who said on national TV that he doesn't wash his hands. 00:30:10:27 - 00:30:36:19 Unknown We know what can happen because of what has happened before. In the 1850s, Florence Nightingale went to the Crimea and wore a hospital in Constantinople. That's Istanbul now. And that situation was no Turkish delight on a moonlit night. She arrived at a British military base atop a cesspool where patients lay in their own feces. Among rodents, and more soldiers died from infectious diseases than injuries in battle. 00:30:36:22 - 00:30:57:12 Unknown Under Nightingale, the place was scrubbed and she reduced the facility's death rate by two thirds. We might go further back. The Dark Ages was called that because society moved backwards from the technological advances that had come before the fall of the Roman Empire was marked by elites who cared only about the status quo. They could have developed a steam engine as far back as Herrin in 15 B.C., but didn't bother. 00:30:57:19 - 00:31:26:02 Unknown Going forward is a choice. In an article in the Journal of Infectious Diseases and Preventative Medicine, there's a description of what happened back then. Quote, in medieval times, hospitals were hazardous places. Epidemic infections killed large numbers of hospital patients during this period. Hospital infection and death rates were high. When a sick person entered a hospital, his or her property was disposed of, and in some regions a requiem mass was held as if he or she had already died, unquote. 00:31:26:04 - 00:32:01:16 Unknown Going backward is a choice. We know better now. We use surgical gloves, autoclaves, disinfectants, checklists, and yes, respirator masks to exist. But big healthcare corporations don't want to pay for that. They lock up PPE for nurses to work without sick leave at hospitals, and make patients beg for reasonable accommodation. Going forward is a choice. Let this not be a case of rearranging deck chairs on the Titanic, but at a time when serious health care professional leadership takes a stand for sanitary conditions in health care and makes respirator masks, and the precautionary principle, the standard of care instead of doing with masks. 00:32:01:22 - 00:32:16:09 Unknown What would be like calculating whether you should wash your hands after the toilet based on age or health status? Thank you. Thank you, Chloe, for your comment. We can move on to our next commentator. 00:32:16:11 - 00:32:30:23 Unknown Amanda Finley. 00:32:30:25 - 00:32:51:15 Unknown I'm very much for the opportunity to speak today. My name is Amanda Finley, and I lead Covid 19 long Haulers discussion group. I did with long Covid since March 6th, 2020. And I'm here today to beg you to stop adding to our ranks and mandate universal masking and healthcare at the beginning of the pandemic. I followed the CDC's equity recommendation. 00:32:51:17 - 00:33:08:21 Unknown We had no other sources to rely on, so we relied on the experts. Over time, it became apparent that what we were seeing on the ground was not being reflected in guidance. And over time, I lost all faith in the CDC. I also lost my home, and I was too sick to work and wound up living in a tent. 00:33:08:24 - 00:33:32:23 Unknown I got sick with Covid again before vaccines were available. And yet again, one month after the pandemic was declared over and after receiving every booster, the vaccine only approach has failed us in life altering and lethal ways. Many are losing everything partners, jobs. When someone in my long Covid cohort goes quiet and doesn't respond to messages or calls, I start checking obituaries where I often find them. 00:33:32:26 - 00:33:52:05 Unknown Some have even ended their lives because existence is medically too unbearable. Yet when we go in to see our litany of medical experts, we do so at great peril. Almost none of them protect us by wearing something as simple as a good mask. We're even mocked by staff for taking precautions. The science is clear. One. Masks work. Two. 00:33:52:10 - 00:34:10:24 Unknown The only prevention for long Covid is not to get Covid. And three. Vaccines, while a necessary tool of public health, do not prevent Covid. We clean water before we drink it. We cook food to eliminate the risk of most pathogens. We wash our hands for fomite spread. Why are we not doing the same with the air we breathe? 00:34:10:25 - 00:34:38:13 Unknown When the risks are so evident, how many people have suffered needlessly because they put off care, knowing their providers would not mask? In December 2023, when you see Marge of Kansas City, also a Covid long hauler with a pulmonology appointment masked where she again contracted Covid, none of the office wear masks. She has been primarily bedbound since. As you stare down the barrel of an H5n1 pandemic and an impending administrative change, it is imperative that we learn the lessons of Covid. 00:34:38:15 - 00:35:05:04 Unknown We must protect our most vulnerable. Protect the people who care for the most vulnerable. Protect people from becoming the most vulnerable. We demand masks and health care. We demand proper examples to follow. And we demand true leadership. Please stock up and fulfill the public mandate in your very name. The centers for Disease Control and Prevention. Thank you. Thank you, Amanda, for your comment. 00:35:05:07 - 00:35:17:20 Unknown We can move on to our next commenter, Peg seminarian. 00:35:17:22 - 00:35:57:22 Unknown Hello? Can you hear me? We can hear you. Thank you. My name is Peg Seminary. I'm an industrial high humanist and served for 30 years as the safety and health director at the AFL CIO until my retirement. I worked on many infectious diseases, regulations and guidelines for health care workers, including bloodborne pathogens, TB and Covid 19. Unfortunately, for decades, we had to fight CDC and many infectious disease professionals and the healthcare industry to recognize TB, SARS-CoV-2, and other respiratory diseases in aerosol transmitted diseases that required engineering controls. 00:35:57:22 - 00:36:23:22 Unknown Operation 90 proof respirators to protect workers. Now, given the experience we've had with Covid pandemic and all of the evidence we now have on years old transmission, there should be no disagreement. And existing infection control guidelines and policies are inadequate to protect patients and health care workers from infectious pathogens. The posing relation hazards in that these measures need to be strengthened. 00:36:23:24 - 00:36:49:15 Unknown But you know, with Covid, many downplaying the pandemic is over and protections are no longer needed. But as you heard today, the serious health risks continue. There's Ebola workers and residents are getting sick. Workers, individuals suffering with long Covid are getting in for additional actions which make them sicker. And then millions of people have health conditions that put them at high risk. 00:36:49:17 - 00:37:11:00 Unknown So the weaken inadequate protections in health care settings are causing many people to get very sick. And I can speak to you for my own personal experience, and I'm somebody who knows about Covid and knows about protection. I got a really bad case of Covid this past February. It was my first infection, despite being extremely careful about getting exposed. 00:37:11:03 - 00:37:35:29 Unknown I'm at high risk and my husband has very severe lung disease. It is very high risk. And the only place I spend any time indoors are at doctor's offices. The grocery store and I always were in 95 or K-25 place before I got sick. I had a doctor's appointment at a large, crowded health care facility. I wore my clothes except for the time I was in triage room getting my Bibles checked. 00:37:36:01 - 00:38:03:23 Unknown There was no mandatory masking policy at the health care facility. Even though flu levels in Covid wastewater levels were very high. And none of the nurses were masked. A couple of days later, I started having symptoms. I tested positive. I isolated interpersonal with. But I was sick for over a month and tested positive for the same time. Even worse, I infected my husband, who now is very, very, very sick, which greatly worsened severe lung condition. 00:38:03:28 - 00:38:29:26 Unknown And he also developed pulmonary embolism that I've yet to resolve. It continues to have other effects. Patients and health care workers need stronger infection control guidelines and protections that require N95 respirator source control and voluntary use for inhalation hatches, not a continuation of the weak measures that are only making people sick. Thank you. Thank you for your comment back. 00:38:29:28 - 00:38:39:11 Unknown We can move on to our next comment. Your new barium. 00:38:39:13 - 00:39:03:02 Unknown Hi. Can you hear me? I can you. Great. Thank you. My name is John Newberry and I'm the president of the Maryland Complex Systems Institute and co-founder of the World Health Network. I'm here not to address people directly, but to speak to those listening to healthcare professionals, patients and advocates who are committed to public health and so committed to public health and safety. 00:39:03:04 - 00:39:31:26 Unknown Let me highlight several critical concerns. Members reflect back in the organizations they represent has significant financial conflicts of interest. This issue, documented in a complaint submitted to the HHS Office of Inspector General, raises serious questions about the integrity of their guidance. Additionally, pickpockets operate in secrecy with the work we do is close to public scrutiny. This violates the Federal Advisory Committee Act, which mandates transparency. 00:39:31:28 - 00:40:01:02 Unknown Such closed door decisions erode trust and undermine acceptability. It also lacks the legally required number of voting members, further undermining the legitimacy of its recommendations and decision making process. Most importantly, the science of airborne transmission is essential for understanding diseases like Covid 19 and tuberculosis is glaringly absent from Bloomberg's guidance. Ignoring the science compromise the safety of both patients and healthcare workers. 00:40:01:04 - 00:40:29:09 Unknown Compounding this issue, the voting members of Hyde Park lacked the necessary expertise in airborne transmission. While they may consider themselves infection control experts. Their opinions on this critical topic cannot be treated as expert input. Input science must drive policy. It provides the evidence necessary to inform decisions about safety and prevention. When science is sidelined, lives are put at risk. 00:40:29:12 - 00:41:00:09 Unknown One actionable step is for humans to add Covid 19 and other airborne infections to the list of health care acquired infections, through which treatment is not reimbursed. This would align with existing policies and create a powerful incentive for hospitals to implement necessary precautions. Far too many have suffered illness, acquired in health care, become disabled with long Covid, or died from preventable infections far too many have avoided necessary care due to these risks. 00:41:00:11 - 00:41:31:03 Unknown Every preventable case is a tragedy and a failure of the system. Please call the HHS Office of Inspector General and ask them to investigate our complaint against the HHS Secretary, CDC director, designated federal officer for gross misconduct regarding kickbacks, violation of the law. The inspector General's office is very receptive. The direct phone number is two. Thank you. You near your time. 00:41:31:06 - 00:41:37:29 Unknown And thank you for your comment. We can move on to our next commenter. 00:41:38:01 - 00:41:47:23 Unknown Paul Hennessy. 00:41:47:25 - 00:42:11:00 Unknown I know conflict of interest has briefly fed the public with your draft recommendations with which must be redone and the vote needs to be delayed. And precautions for airborne illnesses are especially antiquated. So let's start there. Your updated infection control guidance must follow the precautionary principle. You need to consult with aerosol experts and may clean air protections in hospitals such as Ashrae two for one standards or better, as recommended by the EPA. 00:42:11:02 - 00:42:33:11 Unknown Your updated guidance must include isolation, low pressure rooms, frequent testing for Covid in H5n1, improving ventilation and air purification, and broad masking requirements. He discussed exceptions and who should be masking and what times, and justifying your reasons to gamble on infectious periods. But it's easy. Everyone should be required to wear high quality respirators. Staff, patients and visitors. Also, Covid is infectious for ten days or more. 00:42:33:12 - 00:42:57:21 Unknown Not three, not five. You return to work. Policies for Covid and flu are dangerous and force health care workers back to work while still infectious. This guidance must make clear obligations for employer protections, not exceptions based on profit margins. Worried about pushback from health care facilities? Elastomeric respirators are reusable, more economical, and even more protective and N95. These need to be reclaimed for all pathogens, and it's no practice to do anything less. 00:42:57:24 - 00:43:19:01 Unknown Covid, TB and H5n1 can all transmit Asymptomatically and without strict infection control measures, you are allowing illness to spread to vulnerable people seeking medical care. You need to go above and beyond for infection control and medical settings. That includes outpatient care centers. Why are you talking about when employees should be allowed to sneeze without a mask? You sound like doctors in the 50s who recommended smoking. 00:43:19:04 - 00:43:38:18 Unknown Covid vaccines have limits. They do little to prevent transmission, and repeat infections lead to immune damage and brain damage. Prevention must be paramount in medical settings for the good of patients. Staff and guidance must also recognize the science on airborne transmission of Covid when using the air like smoke, and no amount of hand-washing or surface cleaning will stop that. 00:43:38:20 - 00:43:56:04 Unknown Masking and clean air need to be a part of health care in the same way that gloves are. Would you want to share a room with a Covid patient, or see a maskless doctor who has just been treating Covid patients? The CDC must also review its flawed evidence review comparing N95 to surgical masks, which you are not the same, and baggy blues do little to prevent airborne spread. 00:43:56:07 - 00:44:15:29 Unknown He has failed to engage with the public or listened to past comments or provide transparency. Your e-mail comment system makes it impossible to see the public record going forward. Comment periods must be available and regulations.gov. So the public's comments can be accessible and we can hold you accountable for ignoring us for the next four years. The Trump administration will promote anti-science rhetoric. 00:44:16:04 - 00:44:36:28 Unknown The further minimizing of Covid and H5n1. Less funding and fewer protections for the medically vulnerable. But you all have ushered that in by stubbornly denying the science of airborne transmission and failing to improve upon prevention measures. It's time to put better airborne protections in place now. Mandate masks across the board and prepare medical settings for the best possible infection control measures. 00:44:37:01 - 00:44:58:10 Unknown Until then, reading the draft and debate about thank you. Thank you Paul. We appreciate your comment. The next commenter. Esther Freeman. 00:44:58:13 - 00:45:30:08 Unknown Interviewee. I can hear you. My name is Esther Herrera. I'm the executive director and administrator of a nursing home and senior living organization. But more importantly, I'm a family member of a nursing home resident. I'm speaking today on behalf of the 101 nursing home residents I have the privilege to care for, as well as for the thousands I have cared for in the past 30 years, along with their families and the staff who provide that care on behalf of these individuals. 00:45:30:11 - 00:46:07:07 Unknown I really request to decrease the isolation requirement for nursing home residents who test positive for Covid from the current requirement of ten days to five days. Why? First of all, nursing homes are their homes. They live here. This is not a hospital where they go for a couple of days. Second, this outdated requirement forces caregivers to choose between doing what is required by a CDC directive last updated almost three years ago, when Covid was drastically different and doing what is ethically and morally right for our residents. 00:46:07:09 - 00:46:40:10 Unknown A nursing home room is required to be at least eight by ten feet, which is 80ft². How would we all feel about being involuntary secluded for ten days in 80ft² when we're not sick? Inappropriate isolation causes physical decline, including the loss of strength, functioning, and mobility. It causes cognitive decline when a resident is not allowed to enjoy their typical routine, interact with their friends, have a change in scenery, or participate in music or social programs. 00:46:40:12 - 00:47:09:17 Unknown This reduces mental stimulation and places residents at risk for cognitive loss. It causes emotional and psychological distress in decline, including apathy, depression, anxiety, reduced connection with reality, discouragement, and residents who just want to give up. And these are not temporary declines. And this is not theoretical in nature. Recently, we had several residents who contracted Covid when told they had to remain in their room for ten days. 00:47:09:19 - 00:47:33:05 Unknown I heard statements such as I'm not even sick. Why do I have to stay in my room? I'm going crazy. I need to get out. How is it possible that I have to be in here for ten days? Not again. This feels like I'm in jail. One resident was so upset she hit the wall, repeated with her hand, and was inconsolable as she cried in a panic getting out of isolation. 00:47:33:06 - 00:47:55:14 Unknown Another came into my office saying, I'm free and finally free. As healthcare providers, we are required to do no harm to weigh the risks versus benefits and to provide holistic care in a homelike environment. No one else in the United States is required to isolate for a minimum of ten days. I love and serve my residents and it's my honor to magnify their voices. 00:47:55:16 - 00:48:20:21 Unknown It is past time to decrease the isolation requirements so we can provide ethical and medically appropriate care to the people who so for so many years have served and cared for us. Thank you. Thank you, Esther, for your comment. We can move on to our next commenter, Brittany Davis. 00:48:20:23 - 00:48:57:04 Unknown I just wanted to thank everybody for letting me speak today. So I just want to say I'm a dentist in the state of Georgia and ready to provide a little bit of perspective from the healthcare provider aspect of things. So I finished my training as a dentist at Columbia University College of Dental Medicine, and I was a student between the years of 2019 and 2021, when the Covid 19 outbreak first became introduced to the US. 00:48:57:04 - 00:49:24:18 Unknown Essentially. And so if you don't remember New York being one of the first states that was hit incredibly hard by this pandemic and then also working in a dental clinic, we were determined to be one of the highest risk spaces in the hospital for some reasons, as dentists using drills and other tools that are generating aerosols within the patient's mouth. 00:49:24:20 - 00:49:59:29 Unknown And of course, they are in very close proximity to our patients and face to face within just a few feet. And we are in close proximity for an extended period of time, upwards of potentially 2 or 3 hours, giving a particularly long term treatment plan. And so during this time, our school initiated mandatory in 95 respirators, PPE, routine Covid testing of both ourselves as student providers and of patients. 00:50:00:00 - 00:50:29:25 Unknown And it was a very rigorous, sort of precaution protocol, and it was highly effective. During those years, we had no documented cases of any Covid spread between or from as a student providers to our patients, or vice versa, from a patient to students. And so having this mandatory in 95, respirator mandate, it kept us as provider safe. 00:50:29:27 - 00:51:01:10 Unknown It kept patients safe. You know, if a student were to be asymptomatic and have Covid, fortunately, we are minimizing the risk of spreading it to upwards of hundreds of patients over, you know, extended period of time. It's also keeping safe our clinic staff and our immediate personnel, and all people who are just really essential to running a clinic effectively. 00:51:01:11 - 00:51:36:28 Unknown And so ultimately, I just would say I'm in favor for increasing universal precautions, including, in any time, respirator wear. In healthcare establishments, just for all of our safety. Essentially. Thank you. Thank you for your comment, Brittany. We can move on to our next commenter, Lisa Foreman. 00:51:37:00 - 00:51:43:25 Unknown Lisa, can you please come off mute? 00:51:43:28 - 00:52:10:08 Unknown Okay. Thank you. My name is Lisa Foreman. I'm a nurse practitioner with over 20 years of clinical experience and no conflicts of interest. I want to address the need for continuous universal respirator use in health care. We know that Covid 19 and many other pathogens are primarily airborne, and that breathing is an aerosol generating procedure. Five years into this pandemic, the risk is no longer limited to the acute phase. 00:52:10:11 - 00:52:36:09 Unknown Covid affects every organ and system of the body. It is not primarily a respiratory infection, but an airborne vasculitis. Therefore, it shouldn't be categorized with most other common respiratory pathogens. With repeated infections and increasing percent of the population will develop long Covid. Early on, we heard the claim that Covid would be a mass disabling event. Unfortunately, the data shows that this is precisely what is happening. 00:52:36:12 - 00:53:02:19 Unknown Currently, we're facing the very real prospect of an additional pandemic with avian influenza and likely others within our lifetimes. Minimum standard PPE in healthcare should be the N95. We don't need RCTs to evaluate their efficacy because respirators rely on principles of engineering and physics. Surgical masks work for splashes, but they otherwise offer very little protection to the patient or the worker. 00:53:02:21 - 00:53:26:25 Unknown I have directly measured this in my own home with a porter count testing machine, and my results were typical. The air inside a surgical mask contains about half the number of particles of sphere outside the net. Compare this to a well-fitted N95 with at least 100 times fewer particles inside. Even a non fit tested respirator provides overall better protection due to the quality of the filter. 00:53:26:27 - 00:54:00:25 Unknown There's simply no comparison. We know that over half of Covid infections are asymptomatic, and that many health care workers go to work while actively infected. Covid infections are not seasonal, so respirators and healthcare shouldn't be either limiting respirator use to voluntary policies and local transmission metrics as mainly one outcome. It avoids overloading hospitals, but the reality now is that surgical masks and bare faces indoors with others are not safe, especially in healthcare facilities. 00:54:00:27 - 00:54:26:24 Unknown Many people have put off all non-emergency health care for years because they can't safely access it, and there is an imbalance of power that makes self-advocacy difficult. Often when patients ask their health care workers to mask, they are told, CDC says we don't have to. And the Ada accommodations are often infected. Patients depend on us to protect them, and we are morally obligated to do that. 00:54:26:26 - 00:54:50:06 Unknown We should not be giving them one disease while treating them for another. It is wrong to ask patients to assume a 10% mortality risk from a hospital acquired Covid infection. We can't ignore what they need because it's uncomfortable or expensive. We know what should be done and it's doable. My spouse and I are health care providers and we do it every day. 00:54:50:08 - 00:55:08:25 Unknown Please give our patients the safer health care they need. Thank you. Thank you, Lisa, for your comment. We can move on to our last commenter, Barry Hunt. 00:55:08:27 - 00:55:32:04 Unknown Thank you. I have no conflicts. This is a turning point in the history of disease transmission and infection control. We already face an unprecedented challenge of pathogens that transmit through the air with even more serious, highly pathogenic threats on the horizon. The need for engineered infection prevention and universal air precautions is becoming more imperative by the day. Today, there's a teenager in critical condition in ICU. 00:55:32:06 - 00:56:09:27 Unknown Canada's first known case of the highly pathogenic strain of H5n1. It will be the last. Here's what's happening in Canadian standards because respirators are too hard to breathe through. Canada created the world's first easy breathing category less than 100 pascals, significantly easier breathing than the nine standard of 245 pascals. National standards now in development include universal respirator use and health care papers for energy for pathogens by orders for respirators with breathing resistance as low as 25 pascals, and engineered infection prevention technologies like auto you leave far, you be an upper enemy. 00:56:10:00 - 00:56:42:10 Unknown My recommendations to this committee one. Specify easy breathing in 95 less than 100 pascals. Two. Encourage nine hours to create a biracial respirator standard with breathing resistance as low as 25 pascals. Three specify and encourage adoption of engineered infection prevention, including engineered data protection. Reads a minimum of six urging to spur from ventilation in the equivalent of 30 additional layer changes per hour from up or up for UV air purifiers or displacement annotation for specified new precautions. 00:56:42:10 - 00:57:14:10 Unknown Categories. One Universal Air Precautions respirators two. Engineered air precautions for respirators plus engineering controls for energy 3 in 3 isolation air precautions so peppers engineering controls and airborne isolation rooms for RG force. Over the past ten years, it's quite possible that engineered infection prevention plus universal health precautions could have prevented some 10 to 20 million hospital acquired infections to annoying us, and saved a trillion or so dollars. 00:57:14:12 - 00:57:41:09 Unknown All right, we're almost ready. Disease transmission hospital continues to get worse, not better. It used to be that 5% of infections were acquired in mice, but now it can be 10 to 20% for some diseases. It used to be HIV mortality was 5%. Now it can be 10% or even higher for some diseases. But one time capital cost to deploy engineered infection prevention across 1 million beds in the US and Canada together would be about $50 billion. 00:57:41:12 - 00:58:11:23 Unknown The net return, though, could be $50 billion per year every year, a smart investment that could pay dividends for years to come. Every journey begins with a first step. Let's take that first step now by recommending engineered infection prevention and universal airborne precautions. Thanks. Thank you, Barry, for your comment. We appreciate it. And I would like to thank all those who had the opportunity to have oral, to have a comment during the oral comment period, public comment period, and those who have submitted written comments as well. 00:58:11:25 - 00:58:53:15 Unknown I'm going to hand it over to our chair, Michael, in explaining and thank you to everybody who contributed to the public comment, period. I'll now go ahead and summarize the meeting for today. Today we welcome one new pack member, Leah Looper, and three new ex-officio members, Scott Copper, Savannah White and Kristen Dillon. We heard updates from the CDC's Division of Health Care Quality Promotion regarding activities related to broadening the scope of Group E to include rural health expertise, long term care, pediatrics and maternal care, dialysis centers, and home dialysis and outpatient areas. 00:58:53:17 - 00:59:24:07 Unknown We heard about technology such as cleaning and disinfection and sterilization, related to environmental cleaning and the need to communicate these types of new technologies to frontline personnel. Through better education. I also heard a little bit about AI technology and its potential impact on infection prevention. And lastly, I've heard about integrated health care system, approaches for surveillance and data sharing, how to integrate these types of approaches into a functional whole that is both comprehensive and resilient. 00:59:24:09 - 00:59:51:09 Unknown We had a discussion regarding four CDC questions posed to CDC regarding updates to the Isolation Precautions guideline. The discussion was led by Sharon Wright and myself. The four key questions touched on topics related to control of pathogens that transmit by air, including the role of masks for infection prevention, clarification of approaches to application of transmission based precautions, voluntary use respirators and the use of masks, source control and health care facilities. 00:59:51:11 - 01:00:14:17 Unknown The discussion will continue tomorrow session with a vote anticipated to provide responses from back back to CDC. I want to emphasize that the vote will be regarding the responses to the four CDC questions to provide direction to the draft guideline development. And the vote will not be on any specific language contained in the draft guideline itself or any of its recommendations. 01:00:14:20 - 01:00:44:14 Unknown Today we also had a discussion regarding recommendations for healthcare personnel guideline. Chaired by Connie Steed and with input from DFL David Cooper. We heard a presentation regarding the rationale, considerations, evidence and proposed draft recommendations pertaining to work restrictions for healthcare personnel in two scenarios. Asymptomatic healthcare personnel who have had an exposure to influenza or SARS-CoV-2 infection, and and to patients or people with SARS-CoV-2 infection, influenza. 01:00:44:16 - 01:01:04:07 Unknown And number two, healthcare personnel who are not moderately or too severely immunocompromised and with mild to moderate suspected or confirmed influenza or SARS-CoV-2 infections. The discussion and feedback heard today will inform a vote for tomorrow on these healthcare personnel work restriction recommendations. 01:01:04:09 - 01:01:26:02 Unknown And we had a public comment period during this meeting and we appreciate the oral comments raised. We also have received written comments submitted to the committee. I want to sincerely thank members, ex-officio liaisons, CDC staff and the general public for your attendance today. The committee will reconvene tomorrow at 8 a.m. Eastern time. Thank you.