CDC to College Students: Smooch With Surgical Masks to Curb Swine Flu

Aug. 21, 2009— -- When it comes to swine flu, John Genovese of Scottsdale, Ariz., said he's not taking any chances as he settles in the dorm for his freshman year at Arizona State University.

"Swine flu is a pretty serious thing, so I'd adhere to whatever the CDC advises," Genovese, 18, said.

But even Genovese said that a new piece of advice issued Thursday by the U.S. Centers for Disease Control and Prevention in Atlanta seems a bit strange. It's a recommendation suggesting that if college students are ill, they should refrain from kissing but, if they must, wear a surgical mask while doing the deed.

"I studied abroad in Costa Rica when swine flu broke out over there and we had to wear masks for a while," he said. "But I don't think I'd kiss with a surgical mask."

At least one of Genovese's classmates said he would, although he did add that he imagined kissing with a surgical mask wouldn't be comfortable.

"It just seems a little crazy and weird," said 18-year-old freshman Jordan Wilhelmi of Rosemont, Minn. "But I'd wear a mask if someone asked me to."

The recommendation is just one of several that federal health officials posted online in a document titled "CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009-2010 Academic Year."

The tips are aimed at dorm-residing college students and, for the most part, they are the same well-worn guidelines that the agency has promoted in light of the swine flu pandemic, mainly involving social distancing and proper hand-washing technique.

But one of the "recommended strategies under current flu conditions" has raised eyebrows.

"If close contact with others cannot be avoided, the ill student should be asked to wear a surgical mask during the period of contact," the recommendation reads. "Examples of close contact include kissing, sharing eating or drinking utensils, or having any other contact between persons likely to result in exposure to respiratory droplets."

CDC spokesperson Tom Skinner acknowledged that the language of the recommendation was confusing and that the agency would "look at rewording" the guidance.

"We're not telling them to wear a mask when they kiss," Skinner said. "What we're trying to do is give examples of 'close contact.'"

Some infectious disease experts agreed that despite the seemingly odd piece of advice, the overall intent of the guidelines is reasonable.

Mask Advice Is Strange, Doctors Say

"I believe the intent of the writer was to avoid close contact, including the examples cited, and to wear a surgical mask if close contact cannot be prevented such as when [you're in a] in room coughing and hacking with your roommate," said Dr. Christopher Ohl, associate professor of medicine at the Wake Forest University School of Medicine's Section on Infectious Diseases, in Winston-Salem, N.C. "Obviously, kissing with a surgical mask on is a bit technically difficult. I don't think the writer was insinuating that 'If you have to kiss, put on a mask.' The verbiage could have been clearer."

But others said the guidance, regardless of intention or verbiage, is simply unrealistic.

"It falls into that category of, 'It's the right advice, but impractical and hence not going to be followed,'" said Dr. Gregory Poland, director of the Mayo Vaccine Research Group at the Mayo Clinic in Rochester, Minn. "I think telling two college students in love not to kiss is neither practical nor informed about human behavior -- don't tell my grad student daughter I said the latter -- and therefore less helpful than explaining the virus is transmitted by the respiratory route: sneezing, coughing, oral contact, etc."

Dr. Pascal Imperato, dean of the SUNY Downstate Medical Center School of Public Health in Brooklyn, N.Y., was less charitable.

"Implying that kissing through a mask is fine probably refers to kissing on the cheek, not the sort of kissing college students usually have in mind when they think of kissing," Imperato said, adding that in his view, even a kiss on the cheek through a mask would not be wise.

"I suspect that whoever drafted the wording for this recommendation may never have kissed while in college, nor anywhere else for that matter," he said. "They really need to revise this statement."

Meanwhile, Philip Alcabes, author of "Dread: How Fear And Fantasy Have Fueled Epidemics From The Black Death To Avian Flu" and associate professor of Urban Public Health at Hunter College of The City University of New York, said that the recommendations will likely do little to curb the spread of the flu -- and much more to spread fear.

"Of course, it isn't crazy to tell people that kissing could spread flu virus," he said. "But [Thursday's] CDC guidance -- with masked kissing, flu buddy schemes, and shirt-sleeve sneezing -- is further evidence that panic has set in among officials.

"Probably, our officials are well meaning and concerned with the public's health. But it often seems like their overriding concern isn't real programs to stop disease, it's that they'll be criticized for doing too little. And since there's nothing to be done right now, they just say something. Anything. 'Masks.'"

Can Masks Cut the Spread of Swine Flu on Campus?

It's not just the kissing guidelines that may pose a problem, SUNY's Imperato said. Specifically, sharing of utensils is something that should never be done with an ill friend -- regardless of whether they happen to be wearing a mask or not.

"What is additionally odd is that it implies that such students can share eating and drinking utensils with well contacts, provided that they, the ones ill with the flu, wear a mask," Imperato said. "The bottom line here is that students ill with the flu should not be kissing other people nor sharing eating and drinking utensils with them."

"I guess a mask is better than duct tape," noted Charles Gerba, a microbiologist at the University of Arizona whose work on microbes has earned him the nickname "Dr. Germ."

"Some barrier is better than [none] at all, but I would just avoid kissing altogether and sharing utensils, or at least wash them," he said. "I was trying to figure out how you drink or eat with a face mask on. I think they must mean if you are in a room where someone is eating or drinking."

Eating and drinking aside, at least one student -- a nursing major no less -- appeared to agree wholeheartedly with Gerba's advice.

"I'm a bit germaphobic in general, so I'd definitely wear a surgical mask, but not for kissing." said Anna Salinas, 19, from Goodyear, Ariz. "It's better to wait until you're better."