What do you say when you really don't know the answer to the question, "Should I wear a mask to protect me against bird flu if it becomes pandemic?" Here's the CDC answer:
If a super-flu strikes, face masks may not protect you. Even so, the government says people should consider wearing them in certain situations, just in case. The consumer advice issued Thursday reflects the fact that the science behind it is unclear. Whether widespread use of masks will help, or harm, during the next worldwide flu outbreak is a question that researchers are studying furiously. (AP)
I'm not sure exactly how you would study this, furiously or calmly, and I rather doubt there is a lot of work being done. Some, maybe. The key questions aren't easy to answer. But CDC feels pressured to come up with some guidelines and the results are marvels of waffling. Don't get me wrong. I sympathize with them. I probably couldn't do any better. That said, here's my gloss on their attempt.
CDC suggests wearing a surgical mask if:
- You're healthy and can't avoid going to a crowded place.
- You're sick and think you may have close contact with the healthy, such as a family member checking on you.
- You live with someone who's sick and thus might be in the early stages of infection, but still need to go out.
I don't get the first one on the list. No one I know thinks a surgical mask is worth a damn in protecting the wearer. Its use to protect others, item number two, has some plausibility, and so does the third on the assumption that you might be infectious without overt symptoms, although here the rationale is weaker. Use of an N95 respirator if you are taking care of some ill with influenza might be useful (we don't know), but the mask has to be properly fitted. The masks are also not supposed to be reused, so this may not be easy. If you have a beard or mustache, forget it, and remember that you can be infected through your eyes. How often that happens we don't know. The idea that you can become infected by touching a doorknob or railing that has been previously touched by someone whose hands were contaminated with virus also seems plausible but we really don't know how often it happens or if it ever does.
In fact there's an awful lot we don't know, such as how protective is simple hygiene like washing your hands or keeping them away from your eyes and nose. But these are feasible, cheap and highly plausibly protective habits and encouraging them makes sense -- the Pascal's Wager of pandemic prepping. The mask issue is more complicated.
[T]he CDC has wrestled with whether masks would create a false sense of security. Perhaps someone who should have stayed home would don an ill-fitting mask and hop on the subway instead.
[snip]
It's harder to absent-mindedly rub your nose while wearing a mask. Conversely, faces get pretty sweaty under masks. Reach under to wipe that sweat, and users may transfer germs caught on the outside of the mask straight to the nose, [CDC infection control officer Michael]Bell cautioned.
The guidelines are just guidelines, and not at all clear. But as Jeff Levi of the Trust for America's Health observes, "When the CDC says 'consider,' the average citizen is going to respond by saying, 'I really ought to do this.'" CDC's Bell adds to the confusion:
Thursday's guidelines are the first for the general public, and likely will change later in the year as long-awaited results from mask research emerges. Meanwhile, there's no need for personal stockpiles, Bell said, although "if an individual feels more comfortable having a few at home, that's not unreasonable."
Errr, wait a minute. If you use a disposable mask as indicated, a couple around the house isn't going to do the trick. They are not meant to be reused. Unless part of the new guidelines is, "Go ahead, reuse them." But that isn't part of the guidelines.
CDC's main message seems to be, "Stay away from crowds and don't get exposed." Duh.
"And if you decide that you in addition want to have masks and respirators, I think this guidance helps you understand when you might want to use them. I think it's a nice step in avoiding the need for huge supplies if you realize you only need them in discrete circumstances." (Canadian Press)
It does? It sounds more like they are trying to have it both ways. Or all three ways. Or all ten ways. Who the hell knows. CDC doesn't. Nor does anyone else.
Addendum: Helen Branswell has a fuller story today. Her reporting, as always, is top of the heap (h/t Melanie of Just a Bump in the Beltway.
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Revere, your comments echoed my own thoughts. Furthermore, since there isn't any new reearch to base the guidance on, I have to ask why now?
One possibility is that CDC is just engaging in more information management and trying to get in front of the parade. But, that's pretty cynical.
Another possiblity is that CDC does know something about the virus that we don't know and is quietly urging mask purchases even though they admit the guidance may change later this year.
This is higly speculative thinking on my part. But, what's a guy to conclude when self-contradictory information comes from an agency that has lost much of its credibility because of similar information management?
All of us in flublogia, including the reveres, remain on code yellow. The Gerberdinator (to use Randy's coinage) has a post doc in CYA and that is all she is doing here. No, the CDC doesn't know anything we don't know and the best flu news aggregator can be found at Flu Wiki on the news threads in Forum.
this is what heppens when you give PR people and the dumbest kind of health education a "center" at CDC.
I don't know whether CDC has just created a teachable moment. "Masks: the main point about masks is Don't get into crowds!" "Masks: you know some people are already stocking up on food etc - are you? It's not a silly thing to do some simple things to prepare. Those who stock up are not nuts, you know. We take it for granted: some folks are stocking up and it's doesn't look unwise." "Masks: don't rely on masks, will you? There are two kinds of masks, and, well, don't rely on masks, will you?" "Masks: there may be a pandemic in the making and in any case there will be one at some point in time, and you haven't forgotten, have you?" "Masks: we link to a document on closing schools, you know? Stay away from others if you can."
To me, points about masks are appropriately fuzzy. The others are appropriately clear.
But maybe it's just me, and this is more like a Rorschach inkblot test.
(Yes, I had to google for the right spelling.)
Masks are but one of many things a person must do to protect themselves or others.
Yes germs can be picked up from the hands, eyes, nose, etc.
If you believe any of this then buy a mask and try it. The CDC said "must be worn properly." Ok how is that done? Just like driving a car can not be learned from reading a book - properly wearing a mask can not be learned from reading a paper or a poster on the wall.
Do you have your masks? Tried it? Learned how to make it work correctly?
Good - now do your friends and family have their maks so they do not take yours?
Forgive me Revere, I don't want to hi-jack this thread.
But may I ask a question? When referring to the debate on masks, I'm reminded of the debate on global warming, which seems clearly divided along party lines.
You are a scientist. Without regard to your party affiliation do you view Global Warming or a Pandemic as a greater threat than Pandemic Flu?
My contention is, that global warming pales in comparison to H5N1 (or any potential Pandemic, including a mile one). Yet it gets minimal coverage, compared to global warming.
I keep hearing, Pandemics are inevitable. Clearly, in my mind, the spokespeople for "mother earth" should re-evaluate the greater threat to our existence. Would you (or any others) agree?
Patch: I think in terms of overall impact to global health, climate change takes it, hands down. But this isn't a football game. right now I'm looking at public health through the lens of bird flu. But climate change is the bigger long term threat. Just my opinion, which no doubt will be rejected by many who come here because of there special interest in bird flu.
Personally I believe that overpopulation and poverty are at the root of most of mankinds problems.
Sorry about the poorly worded post....that's what happens when I try to do too many things at once!
I appreciate your honestly Revere. That's interesting to me. I would have expected you to go the other way.
I sincerely appreciate your opinion. Not everyone thinks this way...but believe it or not, your opinion helps me to form mine! :-)
For those of you who want to hear the audio you can catch it at the following.
mms://a879.m.akastream.net/7/879/1459/1178285542/video.vdat.com/EncodedMedia/videonewswire/audio/windows/69488_70862.asf
You will need IE6.0 or greater, Mozilla and Windows media player. I didnt try it in a RealPlayer format but give it a try if you want.
Helen Branswell starts off the first question to the Gerberdinator and for once you dont feel like they are hiding something. No reason to. She is actually fairly informative and echoes pretty well what Revere has been saying all along.
I am so glad to here that many believe masks are useless...
...that leaves more for my friends and loved ones.
One thing about these threads on the CDC guidelines is the CDC will certainly have new information to use in their next update. You've got to admit they're lurking all the flu blogs. Where else would they get this knowledge?
Again, back to the Daniel Defoe book. In the book he mentions a nurse taking care of sick patients. The nurse kept herself drenched in vinegar, washed with it and even Snorted It.
Mr. Defoe himself had a honey and molasses mixture in his mouth everytime he went out the door. Sounds good to me.
Lea: Remember, Defoe saw none of this. This book is fiction. It is a novel. It isn't an actual journal.
Yes, still good reading worth contemplating.
Patch, global climate change is just starting to impact us and we haven't seen the worst of it, but pandemic influenza could start tomorrow, (and if they hadn't been handing out tamiflu the way they have, and cordoning off villages and what all, or, if the h-h-h index case, or secondary contacts had happened to have been the kind who took bus train or plane trips, maybe pandemic year would have started already; who knows? But, each human case could be the start and they don't know it isn't until more people don't start getting "hot high, and breathless" a few days later. Indonesia's fatality rate, with antivirals and hospital; care is about 78%. Egypt and other parts of Africa and "don't ask don't tell" China, many places are all rolling pandemic dice, too.
Panflu could easily kill more people in 25 weeks than AIDS has all the past 25 years. We'll be emmitting a lot less carbon if that happens, as pandemic could last 1 to 3 years, and all sort of collateral damage (reliance on imported meds, food, fuel, functioning medical systems & law enforcement) would lower the population too, even if the panflu virus (or any of the other diseases, once medical care goes down) doesn't make them "most flat".
The transcript of the CDC/media webcast
had all the best stuff the media didn't see fit to put in their inkblot of an article.
This administration and its appointees love to drag scientific studies out until they match policy; why the rush advice? :
..."We wish we had better science to help people prepare. And we are doing the kinds of research studies that are going to give us a lot better information.
But those results aren't going to be available
for quite a few months and possibly even a couple of years in some cases.
And so we didn't want to wait
and decided that right now the best thing for us to do would be to use some common sense and to gather the best experts that we could to create some practical advice for people who are preparing for a pandemic.
And give them some help in making decisions about how to protect themselves and their families.
So I want to emphasize that while this isn't the kind of scientific evidence that CDC usually uses for its guidelines, we think that we have something to offer here that will just be useful to people who are making decisions for themselves and for their families"...
( So, will we have to be making these decisions before quite a few months?? )
As part of an answer to (all hail!) Helen Branswell:
Dr.Gerberding: ..."There is nothing about the H5N1 bird flu right now
that's offering us any reassurance
compared to where we were last year
and in fact
we have some ongoing concerns about the way that virus is evolving ."...
As a physician and a mom, I can only say that when you have a sick kid at home, having some PPE is a good thing. How many parents just KNOW that when one kid gets gastroenteritis or even an URTI, and you spend a sleepless night comforting, settling the cough, and cleaning up vomit, that the chances of you sucumbing are close to 100%. You would think that with all the diseases that a family physician gets exposed to in the course of their work that you'd have some immunity. I don't get sick with all the illnesses that my patients come in the door with. BUT when it comes to my kids, I just know I'm done for. No doubt it is to do with the duration of exposure and the closeness of the contact (yes I do hug and cuddle them when they are sick). SO I've started using the infection control practices at home that we would use if we were looking after a kid in hospital. And if I do that for myself, then why not let my patients know that there is something that they can do to prevent themselves getting ill? They are intelligent, and can quickly be trained in the principles of using PPE and how to use it properly.
I applaud CDC for making an attempt to deal with this difficult subject. I think CDC did their best to strike a balance between the available science on respiratory protection and realism about what to recommend to the general public.
Novice. That post was quite remarkable. Thank you.
I can only hope that you will continue to share your common sense and obvious intelligence.
Novice-I have some other stuff you can definitely use relating to survival of H5N1... Hit me at memphisservices@bellsouth.net and I will email all sorts of files that you can download, reproduce. All of these were tooled up by the local DHS director and I. Now its being sent out as something that everyone can use. MIH has it, Lea, Michael and its a list of stuff that if you have it in the house, you wont feel as bad about going to work each day if it comes.
I'm happy that this CDC mask guidance did not recommend against the use of masks on the part of the public. I'm happy that it acknowledged that the use of N95's by people taking care of ill patients is wise, whether they are HCW's or mothers and others. That in itself was a big relief to see, since most pandemic flu patients will not have the advantage of being cared for in the customary health care surroundings.
That said, this CDC guidance falls short exactly at the point where it ends. If masks are a good thing, and maybe a necessary thing for tending the ill, then we need more of them. If we have 100 million masks stockpiled now, and we see a 30% AR, that'll mean we have, on hand, one mask for every ill individual. CDC says it is in the process of ordering more. When I was last at Disney World, looking out at the vast sea of people, what hit me was just how many more masks we can be expected to need. CDC knows that number. Those purchases need to be advocated, and they need to be advocated by CDC. This is a funding and purchase question now, and that means it's a political question. If CDC doesn't get themselves in front of those who make those funding and buying decisions, there won't be enough masks. Simple as that. CDC needs to gather themselves up, and their courage too, and appear at some hearings where they advocate for additional (and incredibly substantial) mask purchases. If they don't do it, I don't see how it will ever get done.
Pixie,
Are you suggesting that the CDC stockpile masks for the use of the public? Or for HCWs?
Because if it's the former, I'm sorry, I can think of plenty of other things that your government ought to be spending money on that has more effect on saving lives and has more leverage than one patient at a time.
When you say 'need', my question is according to whom? And by what standard? Like the discussion on global warming above, it all depends on who you're asking.
If you ask me, for example, spending public money on masks for the public would go very very low on my list.
N95 or higher protection PPE for HCWs, now, that's a different story. You need to get as many as the HCWs think they need.
Let me repeat: between the government and the various healthcare providers in your country, they should be getting WHATEVER HCWs BELIEVE they need for them to be willing to turn up for work.
It is a longer discussion than is appropriate here, but I see that as one of the weakest link in all of the pandemic plans, at this point, for the US.
Every N95 mask buys one more HCW turning up for a day. Potentially.
Think how much leverage that amount of money produces!
SusanC - as I mentioned, I view N95's as a wise choice for those who are caring for ill individuals, whether they are HCW's, mothers, or others. The quantity of masks should be apportioned appropriately and in proportion to the quantity of patients cared for. Those in hospital settings get far more masks than volunteer nurses going door to door in a small town - that just makes sense.
In my health district, there are very few medical offices (almost none) and no hospitals at all. However, we will have 30,000 people to care for, and with an AR of 30%, 10,000 people can be expected to become ill. Expecting to be cared for in the nearby bigger cities will be unreasonable. The people who care for those who are sick in this area will, then, likely be volunteers and family members. If PPE is appportioned only to traditional HCW's and to traditional medical facilities, this district and the individuals who will be providing the care here will be doing so without protection if they are not included in the calculations ahead of time. As I said above, I doubt that the majority of individuals will have the benefit of being cared for in traditional health care surroundings during a pandemic.
For those HCW's who work in traditional health care surroundings, I could not agree with you more. They need to be provided with whatever they need, and those realistic calculations should be made now.
I don't advocate the casual use of masks for the public, and no, the government should not be spending its resources to stockpile for them. Should those members of the public find themselves taking on the role of HCW in some capacity or other, that's another story.
Pixie, I can tell you that the USGOVT and the states are doing just that. Stockpiling the masks. But in truth they should be stockpiling the full face plate masks with the NBC filters. Dont look for that to happen though because of the costs.
As for health care in general, I was told that a survey of docs, nurses, HCW's and the general plant operations staff of five of the biggest hospitals here revealed that almost 1/2 will not show up for work until its over. Doctors outside of the GP, ER were the biggest respondents for that category. My ortho lady doc said she was surveyed and she responded in a comments section that she was a bone doctor and hadnt done general medicine for 15 years. Said she might kill someone if she tried to help them and cited her malpractice insurance might also prevent her from doing anything at all, including doing bone work during that time. Has her worried pretty good. She has a mortgage to pay like everyone else.
My feel is that we are going to be nearly on our own.
why can't they figure it out whether/how much masks/filters
protect for flu ?
How much could it cost ? Is there a political reason ?
They should have done this research long ago.
SusanC, you said, "they should be getting WHATEVER HCWs BELIEVE they need for them to be willing to turn up for work."
The officials and CEO's should have been buying and stockpiling
Whatever Will Actually Keep
HCW/doctors From Getting Infected,
and, from bringing infection home to their families,
and well as whatever other support/security/supplies for their families they need to be able to leave them.
Maybe they can do neighborhood non-flu health clinics, too, with PPE.
(And yeah, the bone doctor would know more than the hospital administrator would, whom I'd also like to put to panflu patient/triaged-out-to-die care, since hospitals have failed to warn their communities they serve to properly prepare for panflu year.
Only people getting "sued" post-pandemic
should be the officials who chose to keep the public ignorant and unpararing.
(Quite a list, pre-pandemic.)
Of course it isn't going to be business-as-usual; how can anyone sue an individual Dr. who shows up to help, over lowered standards of care? Do we sue firefighters for trying to find any survivors inside a burning building?
Do we sue teachers for not keeping students alive when a shooter walks into class? What about Good Samaritan laws?
Find tort lawyers something else to do during and pos-pandemic; I see a great need for sorting out the legal mess after a depopulating event.
(Heck; "planners"/communities probably still need help with the death certificate paperwork. Also, too many people don't have wills, and next-of-kin don't know where those would be, anyway.)