Not the Batman kind--the influenza kind.
I received a questionnaire yesterday from ABC news. Apparently, they're doing a story on pandemic influenza preparation. Included were questions like, "What would you recommend to those individuals who are trying to obtain antiviral medications for their own personal preparedness? When should they start taking them?" and "What would you recommend to individuals who are trying to obtain face masks for their own personal preparedness? When should they start wearing them?", as well as questions about food and water stockpiling and going to work/school. (More below...)
I made it clear that I think antiviral stockpiling is a bad idea, but the mask question is a bit trickier. 
Of course, images of people in masks are what many of us think about when images of 1918 come to mind. Unfortunately, there's no good evidence that they helped reduce the spread of the virus--for every city with mask laws that seemed to have a milder epidemic, there's another one where disease was as severe as areas that had no such law. Similarly, there have been many published studies supporting the idea that the most popular type of masks used in healthcare outbreak situations--the N95 mask--helps to protect healthcare workers, but would that extend to the general public?
The thing is, influenza virus isn't only contracted via inhalation. The masks--if fitted and used properly--can probably decrease this risk. But influenza can enter the body in other ways, such as rubbing your eyes with contaminated fingers. Do masks provide a false sense of security, causing people to be more lax in other ways (such as face-touching, or handwashing?) This is my worry, and this is why I don't universally recommend masks. (Revere at Effect Measure says much the same, with ample additional information). Of course, as noted,
Suffice it to say nothing said here or by CDC or anywhere else is likely to stop people from wearing N95 face masks or stop vendors form selling them on the basis they will protect you and your family from influenza. Whether they will or won't, whether they can be reused or not, whether they will have other untoward side effects (interference with hearing, vision or breathing) remains to be seen.
And this is what concerns me: people who are scared and think, "hey, it can't hurt," and get lulled into that false complacency. This is addressed in this article (dealing more with a bioterrorist event than a natural pandemic, but the sentiment holds:
Even in a biological attack, the masks have major shortcomings. Like fit.
"Does it have a nose piece like a metal clip you can bend over your nose? That's a better model because the big kicker here is getting a good fit," Utgoff says.
Bad fits are deadly. Contaminated air breathed from around the unfiltered edges instead of through the N95-rated material undermines the purpose of a mask.
And, got a beard? "Shave it," says Breysse, who recommends duct-taping the mask to your face to make a good fit.
"For you to take a respirator and put it on without any training or fitting probably wouldn't give you the protection you are expecting," says Ron Herring, general manager of the Safety Products Division at Pittsburgh-based MSA.
Another huge shortcoming is that you don't know when to wear a mask. There are no reliable early warning signs that a biological agent has been released. No big air-raid warning horn goes off. News reports will be after the fact. "So here I am, I've got a mask, and I don't know when to use it," Utgoff says.
Obviously you may know when pandemic influenza is in your geographic area, so it's not quite as random as a biological warfare attack, but what then? Do you wear it all the time? Only around people you know are infected, or in public? Will that be enough to protect you?
Another problem is that the single-use masks don't last. "They are disposable because they deteriorate with sweat and wear and age," Breysse says.
And this is something Revere addresses as well--we don't really know how many uses a disposable N95 is good for. Best bet would be to throw it away and get a new one each time, but that certainly gets expensive after awhile. Recall that a regular influenza season can last 6 months from beginning to end, and for a pandemic, all bets are off.
Like Revere, I don't own any masks. My husband couldn't wear one now as it is due to facial hair, and I too am not convinced that they'll work in the community. Should H5N1 or another pandemic virus surface here, perhaps I'll get one on the chance that I need to visit someone I know is ill, but I don't see myself wearing them out on a daily basis (especially duct-taped!). I'm already a hermit, and that quality would likely be amplified in the event of a pandemic.
(Image from here.)
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I liken this situation to what we find in automobiles. Cars are much safer now than they were in the past thanks to strict regulations, airbags, seatbelts, ABS systems, better road maintenance, etc. Granted there are some drivers who overestimate their safety and get lulled into a false sense of security. The end result is people still driving recklessly, distracted, drunk, sleepy, etc., and people still dying in car wrecks. But on the whole, I think the safety precautions are for the better.
The same would hold I believe in the case of a potential epidemic. Certainly there will be those who overestimate the protection masks offer, and some will pay the price. But thanks to education and good habit forming, I think they would be a net positive.
Hopefully we never have to be put in such a position.
Oh, and I read in NewScientist today that a bacterium called Microbispora apparently survived the Columbia disaster at temps exceeding 175degC. I'm not sure I'm convinced. Since that wasn't one of the bacteria sealed it may have contaminated the sample after it touched down. It's easy enough to check...take some Microbispora and cook it to see what happens. I think thermophiles have been found in temps as high as 115degC.
I've seen it suggested that masks provide very little protection from airborne, but what they do do is keep people from unconsciously touching their mouth and nose with their fingers -- a much more common route of infection. Made sense to me.
I'm not sure about even protection from that. Have you ever watched people without much training wear a mask like that? They just push it up to itch their nose, etc.
I think encouraging people to wear masks in the event of a flu epidemic or pandemic would just create hysteria, raise stress levels ( a factor known to negatively affect immune systems) cause panic behaviour and generally make matters worse.
One Mask may do the job its call Nanomask
The NanoMask is the first face mask in the world to utilize nanotechnology enhanced
filter media to effectively isolate and destroy viral and bacterial contaminants. Nanoparticles enhance
the intrinsic filtration efficiency of the media by acting as a destructive absorbent to kill virus and
bacteria that come in contact with the filtration system.
http://www.emergencyfiltration.com/Products/NanoMask.htm
That NanoMask add just has me imagining tiny robots crawling around on a piece of filter paper, tiny lasers zapping incoming germs. My imagination frequently reverts to cartoon-mode, so of course the laser beams are visible and red, and the germs look suitably ugly (nasty brown colours, lots of flagella, etc).
I also like the advertising copy:
One Mask may do the job its call Nanomask
Um, shouldn't there be a few more letters in there? Like an "e" and a "d" at the end of the penultimate word? I suspect a comma may be useful, as well.
oops. It's an "ad", not an "add". I guess I just couldn't stop thinking about the missing "ed".
So we need to collect the positives (and stick numbers to them), the negatives (ditto), and the unknowns (get creative). Then find out in whatever way we can - both before the event and when the beast has started to run wild.
Positive:
- Masks will fit some faces. How many?
- Masks will remind some people about not touching their face. How many?
- If a mask reduces R-naught from 3.2 to 3.1 that may still be good. How much might they reduce it?
- What else is positive about masks?
Negative:
- Masks have a cost.
- Masks may provide a sense of complacency.
- What else is negative about masks?
Creative:
- Could we have most of the effects of masks with other things? Bandanas have been suggested on http://www.fluwikie.com
- Also, note the "may" parts. Maybe we need to add something to the mask to make up for the shortcoming? I mean, if masks provide a sense of complacency we might print drawings of hands on them so that people will be reminded to be careful in the other elements of prevention.
Having lived in Japan for a number of years, It is quite common to see people with faces masks in public during the flu and allergy seasons. The Hakujuji Company which is in the face mask business has sales of 10 Billion Yen per year. I've never been convinced it helps much.
I'm afraid the essay above is consistent will all the other public and private information concerning bird flu preparedness.
Do nothing because some idiot or idiots out there are going to mess up and blame the advice. The "lowest common denominator" argument. Nevermind the huge numbers who won't mess things up and might actually benefit from sound common sense advice. It all makes me weary.
Take the issue of stocking food and water at home. How preverse! How fightening. The fact that the last fifty years are the only years is history where people, in this country and abroad, HAVE'NT put up preserves and dry goods etc. for the winter, doesn't play for some reason. I mean, not being able to hop in the car and drive to the store for anything at any time. How barbaric!
The fact that the economy will be devasted if inventories aren't stored on semi's perpetually on the road doesn't reflect a dangerously fragile economy, it just makes the bird flu that much more scary.
So don't bother with masks because somebody won't pinch the nose piece, or think an old scarf will do the job.
I'm sorry. I guess I've really messed up. I've done all those things.
See you after the pandemic.
Hi Weary,
Actually, if you note previous posts of mine on preparedness, I advocate for a lot of the things you mention. I've never said "do nothing," and I'm sorry if you got that as my position above. Thing is, we simply don't know how effective masks would be in the event of a pandemic, and I don't think it's wise to advise the public in general to stock up on them for the reasons I mentioned.
I'll be wearing one of THESE. It's gotta do something.
Way back last summer, when this bird flu thing was barely on the horizon for most of us, I first became weary by trying to convince my local congressman to distribute a little doc I wrote for the district. I was led to believe it was a real good idea, until the Chief of Staff kiboshed the whole thing do to liability fears.
Apparently it's okay for millions to die because one might sue.
(It's under 1000 words if you'd like me to post it).
I looked over some of your recommendations. Hand washing, eye rubbing. But no gloves. I've got a box of exam gloves in my kit.
No gloves for the same reason as masks. Have you ever seen people wear them when they're not trained? They go about their business thinking the gloves alone will protect them or something, and it doesn't matter if they rub their face, or touch something else with the gloves, etc. I don't know they'd necessarily be helpful.
My concern about masks and gloves and the general public is based in part on the number of health care workers in Toronto and Hong Kong who contracted SARS during the SARS outbreak. These were people aware that they were dealing with a highly contagious disease and presumably trained in using protective gear. They still became infected.
In the event of an epidemic/pandemic I plan to do plenty of hand washing, keep my hands away from my face and avoid large crowds in confined areas as much as possible.
Men need razor blades to shave. Electric shavers won't cut it. Many men cannot shave because their hairs grow sideways and they get ingrown hairs.
You can't be 67074 serious?!?
It's strange, I really don't trust my eyes when I read this stuff about people taking the avian flu hype seriously. Masks? You truly consider to wear MASKS? You're all kidding, aren't you?
Like when you discuss that good ol' SRAS pandemic. That very special coronavirus, active in Hong Kong and Toronto solely. Let's think about that. An exlusively O-vowels city virus, does that make sense? A pandemic limited to a couple of hundred hypothetical cases in two cities on approximately opposite places on the globe, does that make sense?
Maybe it does, but I can't figure how.
Wow, jspreen ... your comment about SARS just shows your ignorance with everything to do with public health and current issues, never mind your obvious lack of understanding in infectious diseases...
do your homework before you make any nonsensical statements..
if you are too lazy to go to the library and flip thru resources ... try this one, it's simple, one click will do
http://en.wikipedia.org/wiki/SARS
Happy reading, and pls don't make a fool of yourself with nonsensical blabbers like
I quote (Posted by: jspreen | July 24, 2006 05:55 PM) " An exlusively O-vowels city virus, does that make sense? A pandemic limited to a couple of hundred hypothetical cases in two cities on approximately opposite places on the globe, does that make sense "
Cheerio
Dale, I think the SARS victims among health workers were aware. Anecdotally, many complained bitterly that the 'authorities' failed, for whatever reasons, to provide appropriate information and supplies.
They were as much victims of government as of virus.
Apparently, the military has all this wrong. They require all men to shave, and somehow we all manage without significant amounts of ingrowns, and they require us to learn how to wear protective masks against chemical weapons, and a different mask against chemical contaminants in the workplace, and another one against dust and debris and another one against sandstorms, and...
And somehow, we all manage to do it, and stay alive, and not panic.
I'd also point out that "might not help" = "might help." It certainly can't make it worse to filter the air you're breathing. I don't see any need to at this point. On the other hand, I don't see any need to spray my fire extinguisher at this point, but I have one. It might not help in a big fire. On the other hand, it might.