# 658
A few days ago, I blogged on the necessity for hospitals, clinics, EMS outfits, and even law enforcement agencies to stockpile masks for a possible pandemic. I pointed out just how quickly we will burn through these disposable supplies, and how unlikely resupply will be during a pandemic wave.
While the need for health care, and other front line workers, to have this protection is pretty clear, one of the unanswered questions is whether the general public should use masks during a pandemic?
The answer to that question is controversial.
You’d think it would be a pretty simple question to answer. If nurses and doctors feel they are protective, then shouldn’t we all wear them?
Unfortunately, nothing in a pandemic is simple, and so we get very mixed messages from officials on the use of masks.
We are told that masks could offer the wearer a false sense of security, that you must know how to properly fit and wear a mask for it to be effective, and that we don’t know how protective they would really be in any event. The value of masks in a pandemic is unproven.
All of these are genuine concerns. And masks are certainly not going to be 100% protective. If you don’t wear one properly, they are unlikely to do much good. And the use of the cheaper, more plentiful surgical masks, provides an unknown level of protection. Some doubt that they offer much protection at all.
Officials have, thus far, been reluctant to endorse masks for the general public. They are `weighing the evidence'.
But there is another compelling reason they haven’t been quick to recommend masks, and that is simply because there won’t be enough of them.
Masks are disposable, and are good only for short-term wear. A few hours at best.
If even 1/3rd of the nation wanted to wear masks, we’d need 100 million masks per day. And that assumes you could get a full day’s wear out of a mask. You'd likely need at least two, per day.
It’s a dilemma for our government, what to do. Even if they believed there was some benefit to wearing masks, how can they encourage that, when there won’t be enough for the population? As a nation we could easily go through more than a billion masks a week.
And we simply don't have them.
Last year, the HHS ordered in 100 million N95 masks to add to the national stockpile. At nearly a dollar apiece (ok, I expect they got a discount in that quantity, but still . . . ) that’s a lot of money. Obviously, the government can’t supply masks to the general population, even the lesser expensive surgical masks. The logistics of storage and distribution alone make that a non-starter.
But the option remains for private individuals to buy their own. At least for now. Once a pandemic begins, they will be nearly impossible to get.
So should you buy some? Even with their limitations, are they worth having in a pandemic?
I can only give you my personal opinion. Luckily, I don’t have to worry about the macro-economic aspects, logistics, or about setting policy for a nation. My readership is too small to make any impact on the supply chain.
I believe having a personal supply of masks makes sense. And yes, I have a supply for my own use; a mixture of N95’s and surgical masks.
Now granted, if a pandemic erupts, I’ll be volunteering to help treat patients, and so my needs may be different from others. But if the anticipated attack rate of 35% is correct, nearly every family will be touched by the virus.
And that means that nearly every family will, at some point, have to deal with an infected family member.
Since the goal is to limit the spread of the virus, even within an individual household, having masks on hand, and latex or vinyl gloves, makes sense.
Surgical masks are most appropriate for an infected person to wear. They help contain the virus when a patient coughs or sneezes. Their ability to protect someone from an infected individual is suspect. Are they better than nothing? We don’t know, but some studies suggest that they are.
N95 masks, sometimes called respirators, are far more protective if worn properly, and are what a caregiver in close proximity to a patient would ideally want to wear.
So yes, I think having masks and gloves are an important part of every family’s preparations. If someone becomes ill in your home, you are going to want to try to stop the spread to other family members. To do that, the caregiver should take precautions.
Will it work? Well, that’s impossible to know right now.
Influenza patients start shedding the virus before they begin to show symptoms. It is entirely possible, but not inevitable, that by the time you realize a family member is sick, everyone else will have been exposed. There are simply no guarantees in a pandemic.
And we honestly don't know how protective masks and gloves will be in actual practice. There are too many variables.
For those who will be out and about in a pandemic, the question becomes, should you wear a mask in public?
Here, the answers become murkier.
Psychologically, wearing a mask will probably instill at least a little hope that one can avoid infection.
But the truth is, you’d have to do everything right, nearly 100% of the time, to avoid exposure in a pandemic. That means always wearing an N95 mask, fitting it properly, removing and disposing of it properly, and disinfecting yourself after every exposure. And your mouth and nose aren't the only route of infection. Eye protection may be needed. And of course, anything you touch could be contaminated.
It’s hard to imagine anyone doing that successfully day-in and day-out for weeks or months on end, although I’m sure many will try.
I personally don’t plan on wearing a mask unless I’m in a situation where I’ll be in close contact with potentially infected people. That’s a personal choice on my part, not a recommendation to others.
I see no reason to wear a mask while driving alone in my car, or walking down a lonely street. If I were standing in line with a group of people, or in an enclosed room with others, I’d probably want to slip one on.
Masks are likely to become a sore point with the public, once they realize how short the supply will really be. It’s hard to know what the reaction of people who do not have masks will be towards those who have them. And that is a genuine concern amongst officials.
Trying to avoid exposure during a pandemic may be fighting a losing battle. Even those of us who have masks and gloves have no guarantee that we will escape that fate. We may be simply deluding ourselves when we don our protective gear.
Still, if I’m face-to-face with someone who may be infected, I want that option to delude myself.
Even if it is a long shot.
