# 2046
As mentioned in my last blog, the HHS has released three pandemic planning documents and is seeking public comment on them. One of these documents deals with recommendations on the acquisition and use of masks and respirators by the public during a pandemic.
Veteran readers of this blog already know that I've long advocated that ordinary citizens stockpile reasonable quantities of masks and gloves in preparation for the next pandemic (see Who Was That Masked Man? and Any Mask In A Viral Storm).
Of course, as a blogger, it is relatively easy for me to make such pronouncements. It is not so easy for the HHS or the CDC. If they recommend to 100 million US families that they need to have masks and respirators, it could have serious ramifications.
They have to worry about minor technicalities; such as scientific proof that the masks would work in a pandemic, and that untrained citizens could wear them properly. The science on all of that is, admittedly, weak.
And of course, there is an economic impact to consider, and the effect on the manufacturing and supply chain. Asking a hundred million families to spend say, $50 each, would cost five billion dollars nationally. And for many families, it just isn't in the budget.
So quite understandably, in May of 2007, the HHS only gave a luke-warm endorsement to the idea that private citizens should have, and use, face masks and respirators during a pandemic.
In Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic (PDF - 115.83 KB), the following key points were made.
- Whenever possible, rather than relying on the use of facemasks or respirators, close contact3 and crowded conditions should be avoided during an influenza pandemic.
- Facemasks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others. The time spent in crowded settings should be as short as possible.
- Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must take care of a sick person (e.g., family member with a respiratory infection) at home.
Facemasks and respirators should be used in combination with other preventive measures, such as hand hygiene and social distancing, to help reduce the risk for influenza infection during a pandemic. This interim guidance will be updated as new information becomes available.
Yesterday, in the newly revised interim guidance on facemasks now available for public comment, we get a stronger recommendation.
Wording has changed from `should be considered' to `should use' in several areas. They also offer specific advice on stockpiling of masks and respirators in the home.
Below are excerpts from the new guidance. I've reformatted some of the longer paragraphs, and the bolding is mine.
Interim guidance on the use and purchase of facemasks and respirators by individuals and families for pandemic influenza preparedness
Key messages:
- The first and most important steps in reducing one’s risk of pandemic influenza are to limit close contact with others as much as possible and to practice good hygiene. These measures should be used at all times, regardless of whether a facemask or respirator is worn.
- When a person cannot avoid being in a crowd during an influenza pandemic – for example, because they must commute to work on public transit – but has no specific expectation of encountering a sick person, they should use a facemask.
- When it is necessary to have close contact with someone who is ill with pandemic influenza – for example, to give care to a family member – one should use an N95 respirator or equivalent certified by the National Institute of Occupational Health and Safety (NIOSH) and consider specifically using a respirator model that also is cleared by the U.S. Food and Drug Administration (FDA) for use by the general public in public health medical emergencies.
- Ill persons should use a facemask when they must be in contact with others.
<snip>
Settings where respirators and facemasks should be used will depend on the potential for exposure to infectious persons:
- A facemask is recommended when exposure in a crowded setting occurs with persons not known to be ill. An example would be exposure on a crowded bus or subway while commuting to work during a pandemic. Because ill persons are advised to stay home during a pandemic, contacts in most public settings will be with persons who are not ill. However, it is prudent to wear a facemask because one may encounter people who are infectious but not yet ill.
- A facemask also is recommended for use by ill persons when they must be in close contact with others. The facemask will trap the wearer’s secretions and reduce the risk to other persons. Close contact between ill persons and others should be limited as much as possible. However, such contact will occur when the ill person is being cared for at home or if they need to leave home to access medical care or manage other necessities. Ill persons do not need to wear a facemask when they are not in close contact with others
- A respirator is recommended for use in settings that involve close contact (less than about 6 feet) with someone who has known or suspected influenza illness. In non-occupational settings, the most common use for a respirator would be in a household where someone has influenza. One person should be responsible for taking care of the ill individual and that person should wear a respirator during those contacts. The Centers for Disease Control and Prevention (CDC) will be issuing guidance on home care of an ill person, which will be posted on the internet at www.pandemicflu.gov.
Families can use this guidance as the basis for making decisions about purchasing respirators and facemasks as part of household pandemic preparedness. Although not all households will have someone who becomes ill with influenza during a pandemic, because one cannot predict in which households an infection will occur, it would be reasonable for each household to stockpile some respirators that can be used, if needed, when caring for an ill family member.
With proper precautions, a single caregiver can use the same respirator several times over a day for brief care visits with the same ill person in the household,[2] so a stockpile of 20 respirators per household would be reasonable. Decisions on stockpiling facemasks and the number to obtain would depend on a family’s situation and their expectation of the need for close contact in crowded settings during a pandemic.
Pandemic outbreaks in communities may last 6 to 12 weeks.[3] Persons who cannot avoid commuting on public transit may choose to purchase 100 facemasks for use when going to and from work. An additional supply of facemasks also could be purchased for other times when exposure in a crowded setting is unavoidable or for use by an ill person in the home when they come in close contact with others.[4]
The cost of a box of 20 N95 respirators is about $15 - $30 and the cost of a box of 50 facemasks is about $10 - $20. Therefore, the total cost to a family to purchase the recommended number of respirators and facemasks would be about $35 - $70.
Frankly, these are bold recommendations, and ones I fully support. They are reasonable, and at the same time prudent.
They are also another strong indication about how seriously Federal officials view the pandemic threat.
While there are still unanswered questions regarding just how much protection facemasks and respirators will provide, it is certain they are better than nothing. Probably a lot better. More studies are planned, and more revisions to these guidelines are anticipated.
With most influenza patients destined to be treated in the home by family and friends, simple precautions likes masks and gloves will be essential to slow the spread of the virus. Those who will use public transportation, or will be exposed to the public at work, also will want some protection.
The problem, of course, will be when families decide to stockpile these items. The time is now, while the supply chains are fully operational and there are no shortages. If families wait until a pandemic is on our doorstep, they will be in competition with the rest of the world for a finite supply of masks.
And as we are reminded of in the last paragraph of this document, masks are only part of the pandemic prep needed.
Stockpiling respirators and facemasks can contribute to pandemic preparedness in households but is not the only action that can be taken to prepare. Education on other measures to reduce the risk of being exposed and becoming ill, practicing good habits in handwashing and covering coughs and sneezes, as well as purchasing stockpiles of food and water all are recommended.
For more information, visit www.pandemicflu.gov and their individual prep page at:
