Putting a mask on wrong

For some reason the subject of masks evokes great emotion here. I'm not sure why. The idea that masks will help in a pandemic is a strongly held belief that might even be true. We don't know. I venture into mask territory knowing that, like gun control and atheism, I'll get a reaction. But a recent paper in the CDC journal, Emerging Infectious Diseases, brings up once again the difficulties in proper mask use. The subject was N95 Full Face (FF) respirators, the kind you would need in an influenza pandemic if you were to cover your mouth, nose and eyes, the latter because you can be infected with influenza through your conjunctivae, the thin tissue that covers your eye. In the fall of 2005 Louisiana public health officials advised members of the public to wear N95 FF respirators when cleaning residences with mold-contamination after Hurricane Katrina, so CDC took the opportunity to study respirator use among the general public. The results were sobering:

A study evaluating the effectiveness of the public's donning of respirators after Hurricane Katrina shows that three fourths of participants put the masks on incorrectly.

Among the mistakes people made while wearing the N-95 filtering facepiece (FF) respirators, which are worn like masks, included not tightening the nose clip, placing straps incorrectly, and putting the respirator on upside down.


Of the 553 people interviewed, 42% had used a certified respirator and 35% had used an N-95 FF respirator for mold cleanup since Katrina.

Of the 538 people who donned a respirator for the study, 71% did not tighten the nose clip, 52% incorrectly placed the two straps, 22% put the respirator on upside down, and 21% used only one strap, the study found. In addition, while 31% of the participants made one donning error, 34% made two errors, and 35% made three or more. (CIDRAP Source Weekly Briefing)

N95 FF respirators have to be fitted or they don't work and they have to be properly donned or they don't work and they don't work when you aren't wearing them, as CIDRAP Director Dr. Michael Osterholm observes in an accompanying note to the CIDRAP Briefing on the EID paper:

Keep in mind that deciding to provide workers with N-95 respirators or masks is only the start of a respiratory-protection program that your company can activate during a pandemic. While we continue to explore respirator-versus-mask questions regarding preventing transmission of influenza, clearly neither type of device will provide the maximum protection for which it is designed if not used as directed.

Bottom line for business: I am aware that many companies today are wrestling with the decision of whether or not to provide respiratory protection to employees during a pandemic. This is occurring in large part because of the need to purchase and stockpile respirators and masks now rather then risk lack of availability during a pandemic due to surge ordering and reduced manufacturing capacity. However, if your company is seriously considering investing dollars in respiratory-protection devices for employees, it's very important to know that this is just the start in such a preparedness effort. Plans should include training for employees on how and when to use the devices appropriately. While the stockpiling effort clearly poses a major financial commitment for any one company, such an investment will have a relatively limited return without effective employee training and ongoing guidance on correct use. (CIDRAP Briefing)

The authors, themselves, have this bottom line:

In post-hurricane New Orleans, public concern about adverse health effects of exposure to mold was near universal. Yet our investigation demonstrated that, despite this high level of motivation, most of participants did not properly don an N95 FF respirator.


Our results suggest that much of the public may have difficulty achieving a proper fit because of improper donning. Given the observed role of experience in proper donning, and the high frequency of recent experience with respirators reported by our survey participants, one could argue that the overall performance in post-Katrina New Orleans is likely to be superior to that of virtually any other locale.(Cummings et al., Emerging Infectious Diseases, cites omitted)

The paper also estimated that only 3/4 of properly donned masks were fully protective. Fit is critical and even a properly donned mask that isn't properly fit will not protect. It's not just a question of knowledge or motivation. The same thing has been found with health care workers:

An observational study of 62 healthcare workers in 3 California hospitals found that 40 (65%) improperly put on N95 FF respirators before entering the room of a patient in isolation for tuberculosis. Errors included use of only 1 strap, incorrectly placed straps, and presence of facial hair. The results of that study, in terms of the proportion who demonstrated improper donning and the nature of the errors, are similar to our findings. (Cummings et al., cites omitted)

We note the Bush administration and Republican congress suspended the annual fit testing requirement for health care workers in 2005.

Most mask enthusiasts are motivated and knowledgeable. But wearing a respirator takes more than motivation and knowledge. It takes some skill and experience not common in the general public. There is always the thought that even if a mask doesn't work as well as you would like, maybe it works a little. And it couldn't hurt. Maybe. But full face respirators affect breathing, field of vision and sometimes hearing. They interfere with full attention. Depending upon what you are doing while wearing one (driving, for example, or crossing a street), this might or might not hurt you. And depending upon what you believe about a mask's protective power, it might or might not encourage you to take chances you shouldn't.

For most people, this study strongly suggests masks will not be protecting them.

I know. You are sure you'll do it right.

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It is important to distinguish between a mask and a respirator. Surgical masks are designed to protect patients from any infections the surgeon may have. They are *not* designed to protect the wearer. Respirators *are* designed to protect the wearer. Indeed, wearing N95 masks was shown to be protective for health care workers treating SARS patients. (Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. http://tinyurl.com/28w58t).

It is true that proper fitting of a respirator is important. But this is not so difficult that a layman cannot learn how to do it. You can find a thread discussing the advantages of respirators over masks, the pro and cons of different respirators and advice on proper fit testing at this thread on PFI: "So which is it? N-95s or surgical masks?", https://www.singtomeohmuse.com/viewtopic.php?t=691&start=0 .

The lesson from the Katrina experience is not that we should tell people that respirators are useless, but rather, that they should be offered sufficient education that they can use them properly.

One of my concerns is that some in public health are bit paternalistic and have a low opinion of the intelligence of the average American. They think "Oh, those people will never figure out how to put the damn things on, better to tell them just forget it." This is obviously not an opinion I agree with. Another concern I have is that some may feel it is not ethical to advise the use of a potentially life-saving tool because not everyone will be able to afford it in sufficient quantity. In this ethical framework, it is apparently considered appropriate not to warn anyone that they can buy something that not everyone can afford. I don't agree with this system of thought. IMO, we should try to save as many lives as possible, period.

Revere is right about this one for sure. The little paper masks are not really worth a damn. Full face plate masks are great that cover everything but your ears should have a double edge seal, no facial hair, and be made of silicone. Latex went out with the military masks after lots of people who didnt have allergies to it developed them from extended wear.

Fit is EVERYTHING. The test nowadays is to use it in a CS teargas environment. If you dont smell it then you are okay. Then there is water. In a work environment you have to hydrate and you have to do it often. Some of these for sale suits and masks dont have drinking tubes. But for those who are neophytes, put the mask on (full face plate), hold the mask in full normal eye plane on your face (little vaseline around the seal is good), then pull the two straps at the top tight, then the sides one by one with the first side snug but not tight, then the second and then fine tune it. The the test comes. Plug the hole on the filters with your hands and inhale. If its correct it will snug down on your face. If its not right you either didnt get it right or you just sucked virus into your face around the seal. All hair ladies must be pulled back and tied off. Buzz cuts might be in about this time G.I. Janes. Periodically check the fit with the filter plugging. It will loosen in heat, it will also signal you that your filters are plugging up when it starts to pull down on your face.

Communications are a total bitch. I had my company ones modified with underwater microphones that you could jack a cellphone/telephone into without contamination. One jack per type. How you handle that is up to you. You can talk but not on a phone with most of these.

The damned thing itches too. Forget the OUTBREAK movie hoods and suits unless you want to die. Those are cute and while I do like the helmets and the look the temperature inside one is about four billion degrees. PAPR units need batteries and you are going to get those "where?" You also cant work in one without an airflow that is airconditioned or at the least high volume in a semi-cool environment. If its 40 degrees outside, it will be 60-70 inside the suit just walking around. I have no idea how medical types will be able to work in this stuff without someone to monitor their conditions while they monitor yours.

My guys are now quarterly training in them in four hour bursts, two hours off and then four hours. After that you are toast. Weight loss? Yep, about a pound or two a day mostly from dehydration.

Suits-Need to be sealable and have the seams that are reinforced. One tear contaminates the body. That mask screws up in a bug hot environment and you get sick.

If you buy a mask make sure its N-95 or greater capable. I suggest totally clear with a full field of vision. You'll use a filter or two per week depending on the environment. Dont waste your time after a week or so thinking you could just suit up and take a sick person to the hospital. For one you could be trapped there under an isolation, then next the place would be crawling with bugs and people with them. They might also want your mask really bad and take it away from you. The N100 NIOSH filters are out there but they are a bit redundant. Virus like flu isnt going to penetrate the filter or the mask, it will be you that infects yourself. E.g. paper N95's are okay, but even taped down they will soak up respiration moisture. The latest is that you DONT reuse one after you take one off for any reason. Original thought behind that was that the virus couldnt survive for more than a day outside of a host. So they thought better of it. Anyway, you cant generally get one of those masks off without infection and a lot of it around your eyes, mouth, nose. First inclination is to inhale after you take it off. How you gonna keep it out? The full face plate masks can be worn into a decontamination shower, or you can be sprayed down with a weak bleach solution and then hosed down with water. Thats about the only advantage that you have with those expensive buggers. You can wash the virus down onto the ground or into a drain.

Do you even need a suit and mask? Well if cats and dogs are vectors then they go in or out and stay. You can wash your car without one, you can paint the house, get firewood, you can do anything you want with your family as long as no one comes into contact with another person or contaminated feces, dust or dirt. You have to stay around the house and you cant go around shaking hands or visiting the girlfriend/boyfriend, no Church, movies, 7-11. You'll be wiping down every surface in the house every 8 hours with bleach and disinfecting wipes. You'll be plenty busy if you do it right. But you have to have food, water, heat, and electricity and a defensible position AND not live inside of a city. If you do all of this should weather this fine. If you have all of the above but live in a city and fire breaks out your perimeter is in jeopardy instantly. Zero lot line housing has created a very tenous situation for that. The mask will protect you from smoke inhalaton, and possibly during an exodus from a city from the people who would be sick and escaping. But then you are out and could go from exposure to cold or bug. Some terrible decisions might have to be made.

A couple of people down in Australia have done a good job of creating backup postions around Adelaide with secondary supply sources. But then we finally come to the big moment. Assuming all things are equal and you absolutely got a good fitting mask, or a paper one that works 100%, and you are safe from fire and have food, water etc. Now its time to take this stuff off to rest, hydrate, keep from putting flu bug into the car, enter the house.

You have to decontaminate and that is where almost 80% of the people in the biohazard arena get themselves infected. Improper decon will ensure you take your family out, and maybe relatives along with them when they come to help. For me, I recommend a mask for everyone. Revere could be right but I am not talking about the paper masks. Suits such as the SL-Tyveks along with hard soled rubber boots, two sets, and three sets of gloves and about 20 filters (make sure they are NATO threaded) but only IF YOU ABSOLUTELY HAVE TO GO OUT. If you dont have to go out, then dont. You wont need a mask, you wont need a suit. Just all of that other stuff that keeps bouncing around here.

Think optimistically though. It might not come, it might not be high path and not have high CFR's. But as many of my military buddies here will tell you, the minimum that the military will let you go into combat with is a biohazard certified mask. You just have to make a decision who will be right and who wrong. You wont see me wearing an N95 or 100 paper mask if it does come with or without tape.

By M. Randolph Kruger (not verified) on 07 Apr 2007 #permalink

Seems like when I see an article about N95 or N100 masks or respirators, there is rarely a mention of particle size. Isn't the H5N1 virus small enough to penetrate the flitering material of an N95 mask?

And does the material of an N100 mask or respirator completely filter out the H5N1 virus?

The main point raised by the experience in New Orleans is that manufacturers should be working to produce filtering facepiece respirators that are easy to put on and can fit well and seal to the face right out of the box. It is also important to determine what processes can be used to decontaminate these respirators.

EpiF-My friend the director of DHS said that they were told at their little exercise in Mississippi that, get this, "You take the mask and place it into a plastic bag or baggie for 48 hours and then you could reuse it."

Besides the smell of the thing after 48 hours I wouldnt touch it with a stick from my way of thinking. This is the paper type N95s and 100's I am talking about. The baggie would be contaminated, your hands would be contaminated, both sides of the mask would be contaminated. Lets slap it on the face and see what happens. But I also read recently here I think that it would take like four or five billion paper N95-100s to get us thru this with some protection.

Dont know but what I know. Biohazard masks with NBC filters are the only thing that are confirmed not to let it thru. I am sure there are some bugs that could get thru but none that we havent already dealt with and know about, hence the N95.

SSAL-here is a link. I will say that the military only uses N95 filters for NATO ops on their masks. Chances are you would have to use a N100 in a hospital that was loaded with bug.


By M. Randolph Kruger (not verified) on 07 Apr 2007 #permalink

ssal: We've discussed particle size here quite a bit. We don't really know what size infectious particles are involved in influenza transmission, but they are unlikely to be just bare virus (120 nm). N95s reduce 95% of the particles below .3 microns, but 5% of a large number is still a large number. N100s supposedly (under optimal conditions) take out everything above .3 microns but not necessarily below that.

Epi, Randy: The IOM looked into the question of whether masks could be made that are easier to don and concluded there was no obvious way to do this. As Randy says, fit is everything and fit isn't easy. Anyone can learn to do it, but most don't. There is no magic bullet for this one. Not even masks (or if you, insist, Mono, respirators).

Getting the fit right is important for the individual wearer, but what about an epidemiologic viewpoint? If an improperly fitted mask has SOME (as opposed to zero) effect, couldn't their use still help keep an epidemic under control?

I'm actually inclined to think in terms of less than great industrial design work on part of the mask as well. There's more to design than "make it easy". A mask may well require good, adjusted fit to be efficient, but then why is it not designed so that a bad fit - or use of only one strap, or not clamping the nose - is not made much worse and totally obvious to the wearer? If the mask keeps slipping off with only one strap, everybody will use both. If air is merrily whistling past the nose unless you actively fit the nose bridge, peoploe will notice, worry, and do it.

And if facial hair (and by extension, lumpy facial features in general) prevents them from working, why do they stop around the face? How about a full hood you pull down that seals around your throat?


Sometimes it is important to be a stickler. Masks are unlikely to be of much use and are not designed to protect anyone. Respirators have been shown to be protective against a virus of approximately the same size as H5N1 (SARS). There are a variety of different types, some of which are easier to wear than others.

There are no magic bullets, I agree. But because we cannot guarantee 100% success with any particular method is not a reason not to use tools that have a reasonable chance of decreasing risk of infection and/or death. Respirators are simply one such tool.

0.3 microns is considered the most penetrating particle size and this is why respirators are tested against particles of this size. Particles both larger and smaller than this size are collected with greater efficiency.

Mask (general term that can be used for all kinds of masks and respirators, and used that way below)

A tool in untrained hands is not a tool, but a dangerous illusion about safety. Possibly the emotional reactions about masks stems from the general helplessness and the easy (looking, but not being easy) concept about protecting oneself.
Some of the numbers given showed that even the small sample of healthcare workers observed, 65% (!) failed to properly put on N95 FF respirators.
Assuming that untrained people will perform a lot worse and not a lot better than trained healthcare workers seems bad news, but more realistic than proposing the opposite.
Which some people without any medical experience do.

Simply stocking up on masks and trying them on a few times will not add the experience needed. Simple training or reading websites will not be enough either.
Let us face it: most of the mask enthusiasts can only be enthusiasts because they have zero medical experience and never observed the skilled/educated/trained people being uncapable to use masks properly.

By AnonymousDoc (not verified) on 07 Apr 2007 #permalink

Please read the first comment above by Monotreme again. I agree with all Monotreme said. I cannot reach the mask discussion link Monotreme provided.

However, here is another link to the mask discussion. It tells you everything you want to know, and more, about this mask issue---14 pages worth:


The CDC article about Katrina mask use is so
pitiful. Here is how I REWRITE it:

No education was provided to Katrina victims in respirator use. Instead of helping people protect their health, we went around with clipboards checking for proper respirator use.

We found improper respirator use!!!!!!!!!!

Quoted from Post above by Revere:
"Of the 538 people who donned a respirator for the study, 71% did not tighten the nose clip, 52% incorrectly placed the two straps, 22% put the respirator on upside down, and 21% used only one strap, the study found. In addition, while 31% of the participants made one donning error, 34% made two errors, and 35% made three or more."

Many of the respirators failed fit testing because they were soaked with tears or sweat.

The tears began when we interrupted people cleaning up their mold encrusted homes and belongings----WITHOUT any public or government assistance.

Only the cheapest and crappiest respirators were available to these people. They had no exhale valve---it was 90 degrees and 100% humidity---and they could not breathe with these respirators in place for more than 6 minutes.

The respirators became choked with particle debris very quickly, as the people tore down destroyed drywall. No one had given them any instructions on respirator use or availability. We checked---and it is not in CDC's Mission Statement. Respirators are OSHA responsibility--we think.

Many people put the respirator on wrong as a joke because they think public health and assistance in America has become a JOKE!!!!

We have concluded from this very poorly designed study that
masks and respirators are quite silly and useless.

Remarkably--the N95 respirators we wore protected us from any infection or debris.


The American Journal of Public Health has a new article about masks and UV light:



They think sealing the mask edges with Vaseline (petroleum jelly) or other products will solve the fit issue---but the caveat again----"further study is needed".

The authorities have had YEARS to study mask and respirator use---I am tired of the lack of definitive information.

Earl-There is really only the one discussion. Either masks/respirators work or not. The question is whether you believe that they will work at all. The military assumes 5% casualties right off the bat in a chemical attack due to improper mask fit or poor use. Thats definitive. I dont think that they have first enough masks to do the trick, I dont think they have enough respirators either. It would appear though that they are working on it. Funding for either would be very cost prohibitive and give up about a billion dollars if they go for 25cts each. Then does it work? Full masks are about 120 a pop, plus replacement filters of the NBC variety. Negotiated price to about 5 bucks a piece would be several hundred billions. Then theres the manufacture, storage, distribution in the middle of a pandemic for either. If its a four month event you might get 1/3rd of the population covered. How would you train them to use it and on and on.

I dont think further study is needed. I think that is what Revere is stating as well. Due to time, money, etc. it will be over before we ever get started.

By M.Randolph Kruger (not verified) on 08 Apr 2007 #permalink


Please check the link Earl E. provides. You will make several discoveries. First, there is extensive discussion of the various advantages and disadvantages of different types of respirators. As Earl E. points out, models with exhalation valves are *much* more comfortable to wear than others. Second, "docs" aren't the only professionals who use PPE. There are others who have jobs that depend on using these properly (your assumptions provide evidence for some of the opinions expressed in my first post). Third, on the thread referenced by Earl E., people are strongly recommended to try out respirators in real-life situations, contrary to your suggestion that no-one on the flu boards appreciates the difficulties associated with using respirators for extended periods of time. Fourth, the elaborate fit-testing contraptions that are currently recommended were not used by very many HCWs until very recently. Much simpler methods were considered fine for a long time. Fifth, I provide empirical evidence that respirators can decrease the rate of infection in a real world situation - the SARS outbreak (check my first post for reference).

In the end, everyone will have to make there own choice. Those who do not trust their own abilities and are relying on self-appointed experts who tell them don't bother, well, it's your life. For those who do trust in their own intelligence, please join the flu forum of your choice and feel free to ask any questions you wish. You'll be amazed at breadth and depth of expertise available there.

Mono: TB, SARS and flu are different. Respirators also failed in SARS, even though the wearers thought they were protected. use of terms like "self-appointed" experts seems inappropriate to me. You have appointed yourself a respirator expert, and maybe you are, but that doesn't mean you are correct. Those of us with experience with respirators have also given our experiences and people can read various things here and make up their own minds. No one really knows at this point. It is my opinion, FWIW, the efficacy and practicallity of respirator use have been over estimated. It's just my opinion. I'm not appointing myself as anything other than what you can see here after reading here for several years.

Some people may also be overconfident in their own abilities to fit and use a mask properly, as in the NOLA case. So sometimes trust in oneself is misplaced.

Respirators make me so claustrophobic that they literally cause panic attacks (and having a panic attack with a respirator on is seriously unfun.) I'll be social distancing.

I am surprised that no one is surprised that professional healthcare workers were obviously not taught to fit masks properly...

...these are simple concepts...anyone can learn and there are many non-professionals that work in hazardous conditions every day who depend on the proper fitting of masks.

"Some people may also be overconfident in their own abilities to fit and use a mask properly, as in the NOLA case. So sometimes trust in oneself is misplaced."

Some people may also be overconfident in the usefulness of antivirals and vaccines in a pandemic...

...masks are a proven technology and hepa filters are one of the greatest technological advances of the past thirty years...ask anyone with allergies.

Melanie dont feel like the Lone Ranger. I spent a week in one once and had to throw it away afterwards. I dont know that hoods are any better but they are out there. I lasted longer than most and less than some.

Sent you a link for the hood.

By M. Randolph Kruger (not verified) on 08 Apr 2007 #permalink

Revere, I find myself surprised to be disagreeing with you, but there is a difference (at least in my mind) about the use of respirators by healthcare workers and by the general public. We must protect our healthcare workers in a pandemic to the best of our ability or we will not be able to avail ourselves of their services. Wearing a respirator will most likely offer more protection than not wearing one, if there is even a little bit of education on donning and doffing.

As for your comment about respirators failing in SARS: the most widely reported situation where this appeared tot happen involved nine HCWs who were infected during a very difficult patient intubation. Although it was reported that these workers were wearing Kimberly Clark respirators, they were in fact, not respirators, but masks. Also (from memory), the workers had not been trained or fit tested and one of the infected workers had a beard.

epifreek: I'm not sure we are disagreeing. The NOLA study was for non-occupational use, in the case of a pandemic by the general public or by employees given N95s by an employer but not engaged in patient care or other obvious high risk exposures. In other posts I have suggested use of respirators be mandatory for any HCW engaged in aerosol generation activities with flu patients and perhaps others. However for general environmental hygiene, even in health care facilities, I think ultraviolet would be better, although we haven't tested it very well. Bear in mind that in a pandemic situation most people who will try to use N95s for protection will not be fitted or trained. It will be a lot like NOLA, but worse.


Perhaps I should be more clear. I do not consider myself an expert on respirators. Nor I am confident that a respirator will protect me during a pandemic. My preferred strategy will be to shelter-in-place. However, I have purchased respirators in case I need to go outside. Given the option, I would gladly get training and fit-testing from the experts. Sadly, the public health establishment has failed the public in this respect and has made no efforts to provide such training or fit-testing.

The moral from your story is that the public health establishment failed the people of New Orleans. Note, I don't blame the public health personnel in NOLA proper. By all accounts, many of them behaved in an heroic manner and were likely overwhelmed in the aftermath. But the public health authorities at FEMA and other national institutions (CDC, etc) could have gone down to NOLA and helped train the people in how to use respirators properly. Their failure to do so followed by making fun of people's best efforts to "wing it" is offensive to many.

But then this a problem I have with many in public health more generally. They belittle the laymen's attempts to prepare themselves but do nothing to help them prepare. If they were truly concerned about people using respirators correctly, they would be setting up fit testing and training centers all around the US. Instead, they just ask for money to "strengthen public health", whatever that means.

I think Epifreek covers the respirator efficacy issue. I'll only add that my recollection is that the Canadian HCWs did not use NIOSH approved respirators. Hospital administrators were trying to save a few pennies. Most people on the flu boards emphasise quite strongly that only NIOSH-approved respirators should be purchased.


I agree with you that "the efficacy and practicallity of respirator use have been over estimated", but I'm concerned that the balance of news or studies or propaganda, depending on how you look at it, in recent months has been to down-grade the expectations that respirators help to reduce infections.

No one ever said they were 100% effective, it's just that no one has done controlled studies that tells us what is the percentage reduction in HCW infections with respirator use over time! I'd like to think I'm far less of a conspiracy theorist compared to most people on flu boards, but I can't help thinking this over-kill of 'sobering' news about respirators not working comes suspiciously close to the time when the CDC is putting out guidelines for respirator use during a pandemic.

Here is my bottomline about respirator use: do they do more harm than good? There are those who will say that incorrect use breeds complacency and therefore may be more harmful, which, in the context of HCWs, given the alternative of NOT using them, I fail to see how being vigilant (ie not complacent) but not wearing a respirator during a pandemic is better.

Maybe it's just me, but doesn't this remind you of those who would tell teenagers to be careful, but don't use condoms cos they don't protect you?

The only difference, of course, is HCWs can't abstain in a pandemic. Or maybe they can, by just going AWOL...

Susan: You make a good point (as always), but my cautions about mask use have always been regarding general use, not HCW, where I think they are appropriate in situations with high exposure risk. The NOLA study is the first of general use, and is sobering from that perspective.


I understand it is commenting on the use by the public. But, I don't even think the idea of 'more harm than good' can stand even for the public, since N95's are not cheap nor easily obtainable. It would be reasonable, IMHO to assume that those who have managed to stockpile them ahead of time to be used in a pandemic would hardly be the complacent types to start with!

It is of course important to caution against complacency and ignorance. I am, however, more inclined towards empowerment of the lay public, as far as is practicable. I admit I also have some natural abhorrence of patronizing attitudes from professionals and officials (present company excepted, of course) who seem recently to be more interested in discouraging people from preparing and educating themselves than helping them. At least for some sections of those in public office.

Susan: I admit my attitude is colored by my judgement that this is a more harm than good strategy. I don't think this is a practical way for the public to protect itself, not because they are stupid but because it won't work and will do more harm than good. That's a judgment, but one I am arguing here. Many people clearly disagree, but it isn't because I think poorly of people but because I think poorly of this technology.

revere: "but it isn't because I think poorly of people but because I think poorly of this technology."

Agree. But the solution may be more education and not discouragement, in the absence of anything better that we can offer to the public.

I still don't see where is the harm though, assuming we do our best to inform the public. Buyers' beware, that's all. In matters of life and death, potentially, people should have more freedom to choose, particularly if the choice does not bear negative consequences for others. (Some might count shortage of respirators due to 'hoarding' as negative for others, but that is a function of availability of resources, not the technology itself.)

Monotreme: I chose to read the study again, kindly provided by revere. http://www.cdc.gov/eid/content/13/5/06-1490.htm
Is it not remarkable, that you complain about the patronizing and belitteling of laymens`s attempts and actually try to tell me exactly what to read and what discoveries to make (not related to anything I wrote, most of them obvious but to the most oblivious, or not related to the subject) and go as far as complaining about "self-appointed experts" (are you seriously calling the revere´s that?) as well?

You might agree in an instant that overconfidence is dangerous for experts. There is indeed nothing worse and more dangerous than that.

In all fairness it would also be nice if you could agree that overconfidence by those with no education or practical training in anything related to medicine, could have downsides too. In flublogia, they are the most verbal about all and anything.

This article and the comments are a good reminder of the serious issue we have to face:

At least a hundred decisions all made in uncertainty.

That needs brain, not blame. I am thankful to all those, who help to nuture the first.

By Anonymousdoc (not verified) on 08 Apr 2007 #permalink

The possible harm?

Foremost: funds. Let us assume that available funds to protect the public are not unlimited. Not the individual budget for preparations nor the state funds. That can be argued and funds could be increased but let us assume they are not.
Ruling out or warning of inefficient methods makes those funds available for better allocation.

More: with a false sense of protection people might take many more risks that they would not without.

By AnonymousDoc (not verified) on 08 Apr 2007 #permalink


It is time to decide. Am I going to trust my life and my family's life to others' opinion or advice?

AnonymousDoc---FUNDS are NOT the issue. FUNDS APLENTY are laying in accounts everywhere---corporate, non-profit, government, millionaire and billionaire accounts. BILLIONS AND BILLIONS of dollars held by FEW.

There are enough FUNDS to feed the whole world and protect them as well.

BUT.......people are not a priority in America. People are not a priority worldwide!!! Pets in America have more to eat than most people living now in this world.

The priority in America is GREED and KEEPING all the money.

The priority WORLDWIDE is GREED and KEEPING all the money.

The problem is not money. The problem is GREED. There is not enough of everything to go around---there NEVER has been, because of GREED.

ANYTHING of value (including masks) in a pandemic situation will be KEPT and HOARDED by people who have MONEY and POWER.

Will a pandemic solve itself if it is ignored? It is human nature to deny problems.

It is time to realize survival depends on yourself. It is time to accept responsibility for yourself and others as best you can. We cannot change GREED, but we have to accept it is the motivator for others' actions.

No one in authority is looking out for you. You have to be your own lookout.

Even if poorly fitted, which a half-effort at training will avoid, the masks will provide some protection.

In my opinion, there could be nothing worse then healthcare workers either vaccinated or treated with anti-virals that won't or can't work...

...in this case, they will act as vectors accelerating the spread of the disease within a community.

I would like to see packages that could be picked up at seconded fast food take-out windows supplying masks, gloves, disenfectants...broadspectrum antibiotics, oral electrolyte powders, anti-fever medications and the anti-shock medication prednisolone.

This investment, in my opinion, would be far better than only investing in two technologies that won't work for various reasons.

Tom-When you go into a possible vet related bug environment do you wear a mask and what kind if and when you do? Its for my information only. My local vet since I live in the boonies has seen everything from hanta to rabies and recently. He suits up and has a kevlar version of Tyvek (didnt even know they made it) and a full face mask with dual filters (MSA I think). He says you just cant be too careful and that if BF shows in the US that he thinks it will be in birds first rather than humans since so far the jumps have been B2H rather than H2H.


By M. Randolph Kruger (not verified) on 09 Apr 2007 #permalink

Here is a link that you should all read. Its too big to post up but its OSHA's latest for bird flu and how businesses should be prepared. It will cost a business about 200 per employee if they plan to stay open during a pandemic and masks are on the list. So is the training requirements.

First the link=> http://www.osha.gov/Publications/OSHA3327pandemic.pdf

REALLY good stuff there.

Even better is the fact that the employer if they require you to work in a pandemic environment MUST provide you the equipment and training.

And here is the law=> http://frwebgate4.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=

If you cant access it then hit the Code of Federal Regulations, title 29, and then search under PPE.

This will render most future discussions on this as being moot. If they want you to work you need to tell them now so they can give you the equipment and training required under the law.

By M. Randolph Kruger (not verified) on 12 Apr 2007 #permalink

Howdy Randy!

By Jon Singleton (not verified) on 13 Apr 2007 #permalink

Randy. To become a veterinarian, I spent forty hours in class, 5 days a week, for four years.

The total time spent studying zoonoses involved I believe, about three or four lectures during a one week period in fourth year (3-4 hrs).

We discussed Rabies, Brucellosis, Leptospirosis, Erysipelas and a few others. Avian influenza was not mentioned...

...the bottom line is that in 1982 zoonoses were not an issue. There was very little risk of a veterinarian becoming sick in this way. I did not use a mask or gloves or take any other step to prevent becoming infected from an animal with the exception of potential rabies cases.

The wake-up call came in the early 1990's when workers and I think a veterinarian died in Australia from an unknown virus in horses that later became the first identified cases of Nipah-type virus (not sure of the family name). That was a shock and got everyones attention.

The situation that we have found ourselves in since the early 1990's, in relation to disease crossing the species, barrier is absolutely, unprecedented in history...

...and I still say that there is an unknown environmental pressure, pushing the mutation of existing diseases and the emergence of novel diseases.

The generalized increase in mutation rate leading to increased virulence is occurring in bacteria, viruses and parasites in geographically distinct areas of the world.

There is not a shadow of doubt in my mind...whatsoever... that a pandemic caused by H5N1 is imminent. I am just not sure what 'imminent' is in Nature's time.

I would like to attempt to clarify the issue for those that might have an interest in masks in a pandemic but may be a little confused at the moment.

There are three basic types of masks: N95's...think of a one use disposable mask, plastic half-masks that cover your nose and mouth but leave your eyes exposed, and full face masks.

Pandemic influenza viruses have one trait in common. They replicate at astoundingly high levels. This makes the number of viri (individual virus units) you are infected with, critical to your chances of survival...

...even if a mask does not fit perfectly, it will decrease the viral load and could make the difference between surviving or not.

As far as the fit on an N95 masks, they are very similar to dust masks that are used every day and about as easy to fit. The problem with them is that they don't last very long (a few hours) and are hard to breathe through.

There is an effective, economical alternative. Half-masks are easy to use, easy to fit, and far easier to breath through and most importantly far cheaper than N95 masks...

...The reason they are easier to breath through and last for approx. a week with eight hours usage per day...is because their filters have a much greater surface area then N95 masks...and they tend to be perpendicular to the contamintation vector (the person coughing on you).

I have worn half-masks routinely for eight or more hours a day for seven days a week without having to change the filters in a contaminated environment to avoid an acute allergic reaction.

The mask that I have found the easiest to use is the 3M with hepa filters (pink). However, there are many other companies such as North etc. that also carry economical half-masks and filters.

The hepa filters are N100 rather than N95. The mask costs approx. 15 dollars and the filters approx. seven dollars...so you can have at least some protection for seven dollars a week.

There are three face sizes for these masks and you should visit a safety supply company. The workers are trained to provide you with the right mask for your particular face.

I have also used full face masks but they are also difficult to feel comfortable in.

It should be remembered that the you can be infected with influenza through the eyes...so googles or at least some form of glasses should be worn to avoid direct infection.

If you would like more information...go to Pandemic Flu Information Forum and look up the...So which is it? N95's or Surgical Masks thread. Any other questions have been answered those with a great deal of personal experience in this area of study.

Nothing in life is 100 percent. We are not asking for 100 percent protection in a pandemic. We are asking for enough protection to lower the viral load that we might be infected with and masks and gloves and hand washing will do exactly that. However you will not wear a mask that you cannot breathe through and the N95 masks and full face masks are uncomfortable in my opinion.

If none of the above is avaliable a homemade cotton mask will also provide some protection.

Tom and others: This is Tom's view. He is a proponent of masks. Most professionals are not as optimistic about fit and efficacy as he is. No one really knows for sure, so you'll have to make up your own mind, but the statement that nothing is 100% effective I believe to be misleading. There is a difference between 99% and 5% and that difference can be fatal if it leads a person to take a chance they would not othewise take or venture into areas they would not otherwise go. If you are engaged in high risk exposures (a health care worker doing intubation, suctioning or close contact with people sick with flu) I think a respirator is needed. Other than that, there are major questions and advising cheap-o N95s for the general public is going way beyond what we know, costly on a population basis and of unknown consequence, including possibly making things worse.

Tom is entitled to his (always strongly stated, or in my view, overstated) opinions and I am glad to let him say them here. I believe he is in a small minority with many of them, but I have never taken a poll to find out, so that's just my opinion again.

Like everything here, caveat lector.


"There is a difference between 99% and 5% and that difference can be fatal if it leads a person to take a chance they would not othewise take or venture into areas they would not otherwise go."

I completely agree...and the same goes for statins, vaccines and antivirals.