On Friday the Federal Reserve released the transcripts of its discussions in 2007, the year the housing market, the financial markets, and the broader economy began to unravel. Reporters from The Times are sharing their findings on what the transcripts reveal in the blog entries and tweets below.
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Cameron to Outline a Recast European Role for Britain
Label: World
Weighted down by centuries of entrenched wariness in this island nation toward the Continent — and the knowledge that a gallery of his predecessors as Conservative prime ministers saw their tenures blighted by divisions within the party over the issue — Mr. Cameron is heading for Amsterdam on Friday to set out his vision of a sharply whittled-down role for Britain in the affairs of 21st-century Europe.
The speech in the Netherlands, carefully chosen as a country with a strong historical friendship with Britain, is a watershed moment for Mr. Cameron, and for Britain. It could be a deeply jarring occasion, as well, for other European nations, which have grown increasingly impatient, angry even, with Britain’s policy during the crisis in the euro zone. Some European officials have described as blackmail its use of the crisis — one that Britain, with the pound, has largely escaped — to demand a new, “pick-and-mix” status for itself within the 27-nation European Union.
After months of delay, Mr. Cameron is expected to brush aside the warnings of the Obama administration and European leaders and call for a referendum on whether Britain should remain squarely in Europe or negotiate a more arm’s-length relationship, most likely before the next Parliament’s mandate expires in 2018. In a clamorous House of Commons on Wednesday, the prime minister set out his thinking.
“Millions of people in this country, myself included, want Britain to stay in the European Union,” he said. “But they believe that there are chances to negotiate a better relationship. Throughout Europe, countries are looking at forthcoming treaty change, and asking, ‘What can I do to maximize my national interest?’ That is what the Germans will do. That is what the Spanish will do. That is what the British should do.”
For months, Mr. Cameron has been holding off on a promise to explain just what he wants from Europe. As a reformist Conservative pressing ahead with, among other things, a plan to legalize gay marriage, he has scant common ground with the “little Englanders” in his party, the core of about 100 members who make up a third of its representation in Parliament.
But Mr. Cameron can see votes, too, in the strong anti-Europe currents that run wherever people in Britain gather.
In pubs and bars, on radio and in Parliament itself, talk of the European Union tends to center on the bloc’s real — and, in some cases, apocryphal — abuses: its highhanded, bloated bureaucracy, with nearly 1,000 featherbedded officials earning more than Mr. Cameron’s $230,000 salary as prime minister; its endless proliferation of rules on everything from the length of dog leashes to the shape of carrots; the recent claim by a former high-ranking Cameron aide that government ministers spend 40 percent of their time dealing with the mass of pettifogging European “directives,” many of them widely ignored elsewhere in Europe.
Not only has Mr. Cameron been hemmed in by deep divisions over Europe within the Conservative Party — an issue that helped unseat Edward Heath, Margaret Thatcher and John Major as prime ministers — but he has also been wary of stirring a fresh wave of anger among other European leaders, particularly Chancellor Angela Merkel of Germany, a center-right politician and onetime ally in European councils.
Her aides have described her as frustrated with Mr. Cameron’s maneuvering and, as she is said to see it, his bid to take advantage of other European states as they struggle to save the euro and keep the most debt-laden nations, like Greece, Portugal and Spain, from dropping out of the European Union.
Concern about the reactions in Berlin and Paris prompted a last-minute rescheduling of the Amsterdam speech. Germany and France had protested that the original date, next Monday, might overshadow long-planned celebrations that day of the 50th anniversary of the treaty between them, itself a landmark in the building of postwar Europe, that sealed their reconciliation after the wounds of World War II.
Along with this, commentators say, Mr. Cameron has been recalculating the ways in which the European issue can be managed to bolster the Conservatives’ sagging prospects in a general election expected in 2015, in which polls show them lagging as much as 13 percentage points behind the opposition Labour Party. He has also been contending with heavy lobbying by American officials, including President Obama.
The Americans, diplomats say, have told Mr. Cameron squarely in private what made headlines here last week when a senior State Department official, Philip Gordon, who is assistant secretary for European affairs, spoke on the issue with British reporters. Mr. Gordon said a continued “strong British voice” in an “outward-looking” European Union was in America’s interests, and warned specifically against the referendum on Europe that is an important component in Mr. Cameron’s plans. “Referendums,” Mr. Gordon said, “have often turned countries inward.”
For all his delaying, his aides say, Mr. Cameron is ready now to outline a strategy for renegotiating Britain’s status in the European Union in a way that would keep Britain free from the centralizing forces at work. Other major European states, France and Germany in particular, see a new federal Europe with enhanced powers of fiscal oversight as essential to the long-term survival of the tottering euro.
This article has been revised to reflect the following correction:
Correction: January 17, 2013
An earlier version of this article misstated the year that a referendum approving Britain’s entry into the European Economic Community, the precursor to the European Union, was held. It was 1975, not 1974.
DealBook: H.P. Said to Have Suitors for Two Units
Label: TechnologyHewlett-Packard has received a number of inquiries from would-be buyers for its Autonomy and Electronic Data Systems units in recent weeks, though the technology company is not interested in selling at the moment, a person briefed on the matter said on Wednesday.
The calls from potential suitors and bankers picked up after H.P. filed its annual report with regulators on Dec. 28, said the person, who did not want to be identified because management deliberations were confidential.
In the securities filing, the company said, “We also continue to evaluate the potential disposition of assets and businesses that may no longer help us meet our objectives.”
That is standard legal boilerplate. But H.P. has been struggling with poor performance at both Autonomy and E.D.S., having significantly written down the value of those acquisitions.
The company has also claimed to have found accounting and disclosure issues at Autonomy, and has forwarded findings from an internal inquiry to securities regulators in the United States and the division’s home in Britain.
Shares of H.P. rose 4 percent on Wednesday after The Wall Street Journal reported news of the expressions of interest. Over the last 12 months, the shares have fallen 35 percent.
But H.P.’s management team, led by Meg Whitman, is not interested in selling what it considers to be core businesses. Instead, the company intends to focus on developing its enterprise operations, the person said.
The inquiries may also have been stoked by the sudden flurry of news coverage surrounding a potential leveraged buyout of Dell. That company still appears to be closing in on a potential deal to sell itself to a consortium that includes its founder, Michael S. Dell, and the investment firm Silver Lake, in the biggest leveraged buyout in more than five years.
Advisers to Dell and Silver Lake are still negotiating a number of elements in what is proving to be a complicated deal, though they have made advancements, according to a person briefed on the matter who did not want to be identified because the talks were private. A potential takeover may be priced around $14 a share, valuing the company at more than $24 billion.
Mr. Dell is expected to contribute his roughly 16 percent stake to a leveraged buyout. And Silver Lake has been in talks with potential partners, including sovereign wealth funds like Temasek of Singapore, about contributing additional capital, this person said.
Banks are also working on lining up the financing necessary for a deal, which could reach $15 billion. While an enormous amount of money, bankers are betting that debt investors will clamor for the financing package, hoping to reap yields that are higher than those for Treasury bonds.
Still, this person cautioned that the discussions could fall apart.
Confronting H.P. and Dell is the grinding pressure on both companies’ personal computer businesses, where profit margins have declined in the last few years as competition toughened.
The two tech companies are trying to decrease their dependence on making PCs.
That move had prompted H.P. to buy both E.D.S. and Autonomy, paying more than $20 billion for the pair.
A version of this article appeared in print on 01/17/2013, on page B4 of the NewYork edition with the headline: Two Units Of Hewlett Reportedly Draw Suitors.
Ask Well: Help for the Deskbound
Label: LifestyleOne of the problems with office work is that many of us are using chairs that don’t fit our bodies very well or give adequate support to the back, said Jack Dennerlein, a professor at Northeastern’s Bouvé College of Health Sciences in Boston who specializes in ergonomics and safety. If you are experiencing back pain, you may be able to adjust your chair to increase its lumbar support. A good office chair will have an adjustable seat pan that you can slide back and forth as well as adjustable back and height features. First, sit in the chair so the lumbar region of your back, your lower back, is resting on the back support. At the same time, your feet should be resting comfortably on the ground and the back of your knees should be about three-finger widths from the edge of the chair, said Dr. Dennerlein.
Some high-end chair brands have adjustable seat pans, including the Steelcase Leap chair, which retails for between $800 and $900 and offers an adjustable seat and plenty of lumbar support.
The Steelcase Criterion chair sells anywhere from $350 to $850 online, depending on the model, and boasts seven different adjustments “to offer support through the full range of dynamic seating postures.”
The HumanScale Freedom chair is the winner of several design awards and also has an adjustable seat pan as well as “weight-sensitive recline, synchronously adjustable armrests, and dynamically positioned headrest.” ($400 to $1,400)
The Herman Miller Aeron chair is also popular because it comes in small, medium and large sizes and claims a PostureFit design that “supports the way your pelvis tilts naturally forward, so that your spine stays aligned and you avoid back pain.” ($680 to $850)
If all that sounds really wonderful and really too expensive, there may be a simpler solution to ease your back pain at work. Invest $15 to $30 in a lumbar chair pillow to make sure your back is getting the support it needs even when you are not sitting in a $900 chair.
Ask Well: Help for the Deskbound
Label: HealthOne of the problems with office work is that many of us are using chairs that don’t fit our bodies very well or give adequate support to the back, said Jack Dennerlein, a professor at Northeastern’s Bouvé College of Health Sciences in Boston who specializes in ergonomics and safety. If you are experiencing back pain, you may be able to adjust your chair to increase its lumbar support. A good office chair will have an adjustable seat pan that you can slide back and forth as well as adjustable back and height features. First, sit in the chair so the lumbar region of your back, your lower back, is resting on the back support. At the same time, your feet should be resting comfortably on the ground and the back of your knees should be about three-finger widths from the edge of the chair, said Dr. Dennerlein.
Some high-end chair brands have adjustable seat pans, including the Steelcase Leap chair, which retails for between $800 and $900 and offers an adjustable seat and plenty of lumbar support.
The Steelcase Criterion chair sells anywhere from $350 to $850 online, depending on the model, and boasts seven different adjustments “to offer support through the full range of dynamic seating postures.”
The HumanScale Freedom chair is the winner of several design awards and also has an adjustable seat pan as well as “weight-sensitive recline, synchronously adjustable armrests, and dynamically positioned headrest.” ($400 to $1,400)
The Herman Miller Aeron chair is also popular because it comes in small, medium and large sizes and claims a PostureFit design that “supports the way your pelvis tilts naturally forward, so that your spine stays aligned and you avoid back pain.” ($680 to $850)
If all that sounds really wonderful and really too expensive, there may be a simpler solution to ease your back pain at work. Invest $15 to $30 in a lumbar chair pillow to make sure your back is getting the support it needs even when you are not sitting in a $900 chair.
Lawmakers Seek Data on Energy Drinks
Label: Business
Three Democratic lawmakers on Thursday sent letters to 14 marketers of high-caffeinated energy drinks requesting data about the products’ ingredients and any company studies showing their risks and benefits to children and young people.
In recent months, the Food and Drug Administration has begun examining the safety of energy drinks following reports of several deaths and numerous injuries potentially associated with the products. The number of annual hospital emergency visits involving the drinks doubled from 2007 to 2011, according to a federal report released last week.
In addition, claims by drink producers that their proprietary “energy” formulations provide consumers with a physical and mental edge are coming under scrutiny. There is little scientific evidence, researchers say, that the drinks provide anything more than a high dose of caffeine similar to that found in a cup of strong coffee.
The letters were sent by Senators Richard J. Durbin of Illinois and Richard Blumenthal of Connecticut and Representative Edward J. Markey of Massachusetts to companies including Monster Beverage, Rockstar, Red Bull and Living Essentials, the distributor of 5-Hour Energy, a small, concentrated energy “shot” drink. Letters were also sent to PepsiCo, which sells Amp; Coca-Cola, which sells NOS; and Dr Pepper Snapple, which sells Venom Energy.
Among other questions in the letter, the lawmakers asked the companies to specify the total amount of caffeine in the energy beverages. Products like 5-Hour Energy that are marketed as supplements do not list the amount of caffeine used and producers use caffeine from a variety of sources such as synthetic caffeine, the guarana plant and tea extracts.
They also asked why the companies chose to market their energy product as either a beverage or a dietary supplement. The two regulatory categories have separate rules about ingredient disclosures and reporting of potential health risks.
The lawmakers also asked the companies to provide any studies that they have run or underwritten that examine the effect of energy drink use in children or young adults.
The few studies cited by energy drink companies to back their marketing claims have taken place among adults and have compared the effect of an energy drink to that of a placebo like flavored water.
Other public officials are looking into marketing claims of energy drink makers, including the attorney general of New York State and the city attorney for San Francisco.
French and Malian Ground Troops Confront Islamists in Seized Town
Label: World
Eric Feferberg/Agence France-Presse — Getty Images
French soldiers rode in armored vehicles as they left Bamako and started their deployment to the north of Mali on Wednesday.
BAMAKO, Mali — French soldiers battled armed Islamist occupiers of a desert village in central Mali on Wednesday, a Malian army colonel said, in the first direct ground combat involving Western troops since France launched its military operation here last week to help wrest this nation back from an Islamist advance.
The Malian colonel said his army’s ground troops had joined the French forces and ringed the village of Diabaly, which Islamist fighters had seized the day before. Now, he said, they were engaged in fighting to extricate the militants, who had taken over homes and ensconced themselves.
“It’s a very specialized kind of war,” said the colonel, who spoke on condition of anonymity. “The town is surrounded.”
The ground fighting expanded the confrontation between the Islamists and the French forces, who had previously conducted aerial assaults after President François Hollande of France ordered an intervention in Mali last Friday to thwart a broader push by Islamist rebels controlling the north of the country.
The battle in Diabaly came as news reports from the region said that Islamist militants affiliated with Al Qaeda in the Islamic Maghreb had seized a foreign-run gas field near the Algeria-Libya border, hundreds of miles away, and had seized foreign hostages, including Americans, in retaliation for the French intervention in Mali and for Algeria’s cooperation in that effort. The Algerian state-run news agency quoted regional government officials as say ingthat about 20 foreigners had been seized, including American, British, French, Norwegian and Japanese citizens. It also said that two people had been killed, at least one of them British.
The number of hostages and their nationalities could not be confirmed independently. Japanese officials acknowledged that Japanese citizens were involved in the hostage situation, and the Irish foreign ministry said one Irish citizen had been kidnapped. The British foreign office also said in a statement that “British nationals are caught up in this incident,” which it described as “ongoing.”
The developments underscored an earlier acknowledgment from the French defense minister, Jean-Yves Le Drian, that the military campaign to turn back the Islamists and drive them from their redoubts in northern Malian desert would be a protracted one.
“The combat continues and it will be long, I imagine,” he said Wednesday on RTL radio. “Today the ground forces are in the process of deploying,” he said. “Now the French forces are reaching the north.”
Adm. Edouard Guillaud, the French chief of staff, told Europe 1 television that ground operations began overnight.
He accused jihadists of using civilians as human shields and said, “We refuse to put the population at risk. If there is doubt, we will not fire.”
In Paris, Mr. Hollande said Wednesday that he took the decision to intervene last Friday because it was necessary. If he had not done so, it would have been too late. “Mali would have been entirely conquered and the terrorists would today be in a position of strength."
On Tuesday, witnesses in Mali reported, the insurgents had regrouped after French airstrikes and embedded themselves among the population of Diabaly, hiding in the mud and brick houses in the battle zone and thwarting attacks by French warplanes to dislodge them.
“They are in the town, almost everywhere in the town,” said Bekaye Diarra, who owns a pharmacy in Diabaly, which remained under the control of insurgents. “They are installing themselves.”
Benco Ba, a parliamentary deputy there, said residents were fearful of the conflict that had descended on them. “The jihadists are going right into people’s families,” he said. “They have completely occupied the town. They are dispersed. It’s fear, ” he said, as it became
clear that airstrikes alone will probably not be enough to root out these battle-hardened insurgents, who know well the harsh grassland and desert terrain of Mali.
Pushing France Onto the Digital Stage
Label: Technology
PARIS — When the most prominent new face in France’s effort to oversee the new economy speaks, her pronouncements may be followed almost as closely in Silicon Valley and Seoul as in Paris.
Fleur Pellerin, a deputy finance minister, is the point woman in President François Hollande’s campaign to stimulate innovation. But in trying to put a French imprint on the digital economy, she has been drawn into a growing number of disputes with U.S. technology companies like Google, Twitter and Amazon.
In South Korea, it is Ms. Pellerin’s personal story that fascinates. Abandoned on the streets of Seoul as a newborn, she was taken in by a French family who raised her in the suburbs of Paris. While more than 150,000 South Korean children have been adopted by foreign parents since the Korean War, only one, Ms. Pellerin, has risen to the top ranks of the French government.
In one of the clearest signals yet from the French Finance Ministry that the government is intent on making the Internet conform to French law and custom, Ms. Pellerin last week waded into a dispute involving Google, whose advertising had been blocked by a French Internet service provider, Free.
The move was widely seen as an attempt by Free to force Google to pay for network access. As a preliminary step, Ms. Pellerin ordered Free to restore full service, but she made it clear that she thought the French company had a legitimate grievance.
The appointment of Ms. Pellerin last May, after Mr. Hollande’s election, prompted talk of a new orientation in French technology policy, where mistrust of foreign companies has sometimes been the guiding principle.
Ms. Pellerin, 39, is the first French government minister of Asian extraction. Although she has never visited the land of her birth, in French technology circles her rise fostered a perhaps naïve hope: Might Ms. Pellerin transform France into a European version of South Korea, where ultrahigh-speed broadband is ubiquitous and electronics giants like Samsung and LG have become world-beaters?
“I would like to make France one of the top nations in terms of digital innovation,” Ms. Pellerin said during a recent interview in her office at the Finance Ministry, which juts out over the Seine in eastern Paris like a giant, modern version of a medieval river toll barrier. “If we don’t act in the next few years it will be too late.”
Yet anyone expecting a drastic break with French governing traditions might be disappointed by Ms. Pellerin. After her unusual arrival in France, her upbringing and rise through the system were largely indistinguishable from that of many native-born members of the French administration.
Raised by middle-class parents — her father, who has a doctorate in nuclear physics, is a small-business owner — Ms. Pellerin grew up in two Paris suburbs, gritty Montreuil and wealthier Versailles. A promising student from the start, she was educated at elite institutions, including Sciences Po and the École Nationale d’Administration, which serve as finishing schools for the country’s ruling class. Before joining Mr. Hollande’s government, she was a magistrate at the Cour des Comptes, a body that audits the public finances, and worked in public relations.
Ms. Pellerin’s husband, Laurent Olléon, is also in government service, as an official in the office of Marylise Lebranchu, the minister for the reform of the state and decentralization. Ms. Pellerin has an 8-year-old daughter from a previous marriage.
In her new role in government, Ms. Pellerin has become the central figure in Mr. Hollande’s drive to establish “digital sovereignty” — the principle that French rules should apply to international Internet companies, which sometimes hover elusively beyond the reach of the national authorities. This has prompted clashes with a growing number of American technology companies.
Overseeing investigations of these companies on taxation and other matters, even while wooing them to invest in France, is a balancing act, Ms. Pellerin acknowledged.
“It’s not a crusade against Americans,” she said. “We are just trying to put everyone on a level playing field.”
The New Old Age: In Flu Season,Use a Mask. But Which One?
Label: LifestyleFace masks help prevent people from getting the flu. But how much protection do they provide?
You might think the answer to this question would be well established. It’s not.
In fact, there is considerable uncertainty over how well face masks guard against influenza when people use them outside of hospitals and other health care settings. This has been a topic of discussion and debate in infectious disease circles since the 2009 H1N1 flu pandemic, also known as swine flu.
As the government noted in a document that provides guidance on the issue, “Very little information is available about the effectiveness of facemasks and respirators in controlling the spread of pandemic influenza in community settings.” This is also true of seasonal influenza — the kind that strikes every winter and that we are experiencing now, experts said.
Let’s jump to the bottom line for older people and caregivers before getting into the details. If someone is ill with the flu, coughing and sneezing and living with others, say an older spouse who is a bit frail, the United States Centers for Disease Control and Prevention recommends the use of a face mask “if available and tolerable” or a tissue to cover the nose and mouth.
If you are healthy and serving as a caregiver for someone who has the flu — say, an older person who is ill and at home — the C.D.C. recommends using a face mask or a respirator. (I’ll explain the difference between those items in just a bit.) But if you are a household member who is not in close contact with the sick person, keep at a distance and there is no need to use a face mask or respirator, the C.D.C. advises.
The recommendations are included in another document related to pandemic influenza — a flu caused by a new virus that circulates widely and ends up going global because people lack immunity. That is not a threat this year, but the H3N2 virus that is circulating widely is hitting many older adults especially hard. So the precautions are a good idea, even outside a pandemic situation, said Dr. Ed Septimus, a spokesman for the Infectious Diseases Society of America.
The key idea here is exposure, Dr. Septimus said. If you are a caregiver and intimately exposed to someone who is coughing, sneezing and has the flu, wearing a mask probably makes sense — as it does if you are the person with the flu doing the coughing and sneezing and a caregiver is nearby.
But the scientific evidence about how influenza is transmitted is not as strong as experts would like, said Dr. Carolyn Bridges, associate director of adult immunization at the C.D.C. It is generally accepted that the flu virus is transmitted through direct contact — when someone who is ill touches his or her nose and then a glass that he or she hands to someone else, for instance — and through large droplets that go flying through the air when a person coughs or sneezes. What is not known is the extent to which tiny aerosol particles are implicated in transmission.
Evidence suggests that these tiny particles may play a more important part than previously suspected. For example, a November 2010 study in the journal PLoS One found that 81 percent of flu patients sent viral material through air expelled by coughs, and 65 percent of the virus consisted of small particles that can be inhaled and lodge deeper in the lungs than large droplets.
That is a relevant finding when it comes to masks, which cover much of the face below the eyes but not tightly, letting air in through gaps around the nose and mouth. As the C.D.C.’s advisory noted, “Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing them. They are not designed to protect against breathing in the very small particle aerosols that may contain viruses.”
In other words, you will get some protection, but it is not clear how much. In most circumstances, “if you’re caring for a family member with influenza, I think a surgical mask is perfectly adequate,” said Dr. Carol McLay, an infection control consultant based in Lexington, Ky.
By contrast, respirators fit tightly over someone’s face and are made of materials that filter out small particles that carry the influenza virus. They are recommended for health care workers who are in intimate contact with patients and who have to perform activities like suctioning their lungs. So-called N95 respirators block at least 95 percent of small particles in tests, if properly fitted.
Training in how to use respirators is mandated in hospitals, but no such requirement applies outside, and consumers frequently put them on improperly. One study of respirator use in New Orleans after Hurricane Katrina, when mold was a problem, found that only 24 percent of users put them on the right way. Also, it can be hard to breathe when respirators are used, and this can affect people’s willingness to use them as recommended.
Unfortunately, research about the relative effectiveness of masks and respirators is not robust, and there is no guidance backed by scientific evidence available for consumers, Dr. Bridges said. Nor is there any clear way of assessing the relative merits of various products being sold to the public, which differ in design and materials used.
“Honestly, some of the ones I’ve seen are almost like a paper towel with straps,” Dr. McLay said. Her advice: go with name-brand items used by your local hospital.
Meanwhile, it is worth repeating: The single most important thing that older people and caregivers can do to prevent the flu is to be vaccinated, Dr. Bridges said. “It’s the best tool we have,” she said, noting that preventing flu also involves vigilant hand washing, using tissues or arms to block sneezing, and staying home when ill so people do not transmit the virus. And it is by no means too late to get a shot, whose cost Medicare will cover for older adults.
The New Old Age: In Flu Season,Use a Mask. But Which One?
Label: HealthFace masks help prevent people from getting the flu. But how much protection do they provide?
You might think the answer to this question would be well established. It’s not.
In fact, there is considerable uncertainty over how well face masks guard against influenza when people use them outside of hospitals and other health care settings. This has been a topic of discussion and debate in infectious disease circles since the 2009 H1N1 flu pandemic, also known as swine flu.
As the government noted in a document that provides guidance on the issue, “Very little information is available about the effectiveness of facemasks and respirators in controlling the spread of pandemic influenza in community settings.” This is also true of seasonal influenza — the kind that strikes every winter and that we are experiencing now, experts said.
Let’s jump to the bottom line for older people and caregivers before getting into the details. If someone is ill with the flu, coughing and sneezing and living with others, say an older spouse who is a bit frail, the United States Centers for Disease Control and Prevention recommends the use of a face mask “if available and tolerable” or a tissue to cover the nose and mouth.
If you are healthy and serving as a caregiver for someone who has the flu — say, an older person who is ill and at home — the C.D.C. recommends using a face mask or a respirator. (I’ll explain the difference between those items in just a bit.) But if you are a household member who is not in close contact with the sick person, keep at a distance and there is no need to use a face mask or respirator, the C.D.C. advises.
The recommendations are included in another document related to pandemic influenza — a flu caused by a new virus that circulates widely and ends up going global because people lack immunity. That is not a threat this year, but the H3N2 virus that is circulating widely is hitting many older adults especially hard. So the precautions are a good idea, even outside a pandemic situation, said Dr. Ed Septimus, a spokesman for the Infectious Diseases Society of America.
The key idea here is exposure, Dr. Septimus said. If you are a caregiver and intimately exposed to someone who is coughing, sneezing and has the flu, wearing a mask probably makes sense — as it does if you are the person with the flu doing the coughing and sneezing and a caregiver is nearby.
But the scientific evidence about how influenza is transmitted is not as strong as experts would like, said Dr. Carolyn Bridges, associate director of adult immunization at the C.D.C. It is generally accepted that the flu virus is transmitted through direct contact — when someone who is ill touches his or her nose and then a glass that he or she hands to someone else, for instance — and through large droplets that go flying through the air when a person coughs or sneezes. What is not known is the extent to which tiny aerosol particles are implicated in transmission.
Evidence suggests that these tiny particles may play a more important part than previously suspected. For example, a November 2010 study in the journal PLoS One found that 81 percent of flu patients sent viral material through air expelled by coughs, and 65 percent of the virus consisted of small particles that can be inhaled and lodge deeper in the lungs than large droplets.
That is a relevant finding when it comes to masks, which cover much of the face below the eyes but not tightly, letting air in through gaps around the nose and mouth. As the C.D.C.’s advisory noted, “Facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing them. They are not designed to protect against breathing in the very small particle aerosols that may contain viruses.”
In other words, you will get some protection, but it is not clear how much. In most circumstances, “if you’re caring for a family member with influenza, I think a surgical mask is perfectly adequate,” said Dr. Carol McLay, an infection control consultant based in Lexington, Ky.
By contrast, respirators fit tightly over someone’s face and are made of materials that filter out small particles that carry the influenza virus. They are recommended for health care workers who are in intimate contact with patients and who have to perform activities like suctioning their lungs. So-called N95 respirators block at least 95 percent of small particles in tests, if properly fitted.
Training in how to use respirators is mandated in hospitals, but no such requirement applies outside, and consumers frequently put them on improperly. One study of respirator use in New Orleans after Hurricane Katrina, when mold was a problem, found that only 24 percent of users put them on the right way. Also, it can be hard to breathe when respirators are used, and this can affect people’s willingness to use them as recommended.
Unfortunately, research about the relative effectiveness of masks and respirators is not robust, and there is no guidance backed by scientific evidence available for consumers, Dr. Bridges said. Nor is there any clear way of assessing the relative merits of various products being sold to the public, which differ in design and materials used.
“Honestly, some of the ones I’ve seen are almost like a paper towel with straps,” Dr. McLay said. Her advice: go with name-brand items used by your local hospital.
Meanwhile, it is worth repeating: The single most important thing that older people and caregivers can do to prevent the flu is to be vaccinated, Dr. Bridges said. “It’s the best tool we have,” she said, noting that preventing flu also involves vigilant hand washing, using tissues or arms to block sneezing, and staying home when ill so people do not transmit the virus. And it is by no means too late to get a shot, whose cost Medicare will cover for older adults.
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