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.)