Three patients presented with a milder form of lung disease, responding well to NIV, and with progressive improvement of hypoxemia. There is some controversy around the clinical Annals of Oncology original article efficacy of NIV in novel influenza A (H1N1) infection. Whereas NIV may be considered as a mode of ventilation for hypoxemic respiratory failure, there are concerns about its usefulness in an infectious epidemic [24] . In the Canadian experience, 30% of patients were noninvasively ventilated on admission, but 85% of these patients required subsequent intubation and invasive ventilation [6] . In addition, NIV machines have no bacterial or viral filters and do generate aerosols. There are often leaks from the mask, and it has to be removed sometimes for nursing care [24] . During the pandemic, NIV was associated with transmission of disease to health care workers [25] .