Credit Wikipedia
# 7834
Although it has been mentioned previously (see last July’s KSA MOH Updates Health Protection Advice For Umrah & Hajj), this week the Saudi Ministry of Health has reiterated their advice to pilgrims going to the Hajj this month to wear facemasks when in crowded areas. While seemingly prudent advice - unless visitors are given some instruction on how to safely don and remove these protective devices, the need for constant good hand hygiene (before and after handling the masks), and how to properly dispose of a mask after use - its actual value may prove more psychological than physical.
Complicating matters will be the incessant heat (forecast today, 108F or 42C) - which will make wearing a mask for prolonged periods of time uncomfortable - the uncertain protective qualities of surgical masks (see The Great Mask Debate Revisited) against the MERS coronavirus, and the need for fit testing (see Survival Of The Fit-tested) for the more protective N95 respirator.
Additionally, facemasks don’t address another potential route of infection, via the eyes (see PPEs & Transocular Influenza Transmission).
Limitations that may at least partially explain why the World Health Organization has not advised travelers to Saudi Arabia to wear masks (see WHO: Interim Travel Advice On MERS-CoV For KSA Pilgrimages), and is instead focusing on issues like good hand hygiene, and avoiding contact with farm animals, and seeking medical attention if they develop `a significant acute respiratory illness with fever and cough’.
First, this report from the Arab News, after which I’ll return with more:
MERS safety: Pilgrims must wear masks
RIYADH: MD RASOOLDEEN
Published — Thursday 3 October 2013
The Ministry of Health advised Haj pilgrims on Wednesday to wear face masks in the holy cities to protect themselves from the deadly MERS virus.
Dr. Nazreen Sherbini, a specialist in infectious diseases and influenza, said MERS is transmitted through droplets from coughing and sneezing.
“Pilgrims should wear protective masks that cover the noses and mouths in crowded places and follow basic health etiquette while sneezing or coughing,” Sherbini said.
She advised pilgrims to avoid people who cough and sneeze incessantly, have runny noses, and temperature over 38 degrees Celsius.
Although it is unlikely that many pilgrims en route to the Hajj will be reading this blog, it is important for everyone to know how to safely don and remove a facemask or respirator in the event of a serious respiratory outbreak. So this morning, a handful of short tutorials on the wearing of facemasks and N95 respirators.
Surgical Facemask N-95 Respirator
First, a short video on donning and removing an N95 respirator from Raffles Hospital in Singapore:
NOTE: You should first be fit-tested to determine the proper N95 style that fits your face.
Next from the CDC/NIOSH, a poster (suitable for framing) on using the N95 respirator (link):
From the San Francisco Department of Public Health, steps for putting on and removing surgical masks.
Note: Surgical masks have traditionally been used to prevent the wearer from spreading germs, and its effectiveness in protecting the wearer has been the subject of some debate.
How to Put on and Remove a Face Mask (Excerpts)
How to put on and remove a face mask
Disposable face masks should be used once and then thrown in the trash. You should also remove and replace masks when they become moist.
Always follow product instructions on use and storage of the mask, and procedures for how to put on and remove a mask. If instructions for putting on and removing the mask are not available, then follow the steps below.
How to put on a face mask
1 Clean your hands with soap and water or hand sanitizer before touching the mask.
2 Remove a mask from the box and make sure there are no obvious tears or holes in either side of the mask.
3 Determine which side of the mask is the top. The side of the mask that has a stiff bendable edge is the top and is meant to mold to the shape of your nose.
4 Determine which side of the mask is the front. The colored side of the mask is usually the front and should face away from you, while the white side touches your face.
5 Follow the instructions below for the type of mask you are using.
- Face Mask with Ear loops: Hold the mask by the ear loops. Place a loop around each ear.
- Face Mask with Ties: Bring the mask to your nose level and place the ties over the crown of your head and secure with a bow.
- Face Mask with Bands: Hold the mask in your hand with the nosepiece or top of the mask at fingertips, allowing the headbands to hang freely below hands. Bring the mask to your nose level and pull the top strap over your head so that it rests over the crown of your head. Pull the bottom strap over your head so that it rests at the nape of your neck.
6 Mold or pinch the stiff edge to the shape of your nose.
7 If using a face mask with ties: Then take the bottom ties, one in each hand, and secure with a bow at the nape of your neck.
8 Pull the bottom of the mask over your mouth and chin.
How to remove a face mask
1 Clean your hands with soap and water or hand sanitizer before touching the mask.
2 Avoid touching the front of the mask. The front of the mask is contaminated. Only touch the ear loops/ties/band.
3 Follow the instructions below for the type of mask you are using.
- Face Mask with Ear loops: Hold both of the ear loops and gently lift and remove the mask.
- Face Mask with Ties: Untie the bottom bow first then untie the top bow and pull the mask away from you as the ties are loosened.
- Face Mask with Bands: Lift the bottom strap over your head first then pull the top strap over your head.
4 Throw the mask in the trash.
5 Clean your hands with soap and water or hand sanitizer.
While a fit-tested N95 respirator is undoubtedly more protective, N95s are far more expensive, bulky, and can be more uncomfortable to wear for extended periods of time than a surgical mask. During any major respiratory epidemic or pandemic, N95s are likely to be in very short supply as well (see Caught With Our Masks Down).
Which means, if all I had available were surgical masks, and I was expecting to be in a potential exposure situation, I wouldn’t hesitate to use them.
As we saw last month in CDC: Infection Control Guidance For Home Care Of MERS-CoV Cases, facemasks are recommended for use (worn by either by the patient, or caregivers) in a home environment. This advice would also apply during any major flu epidemic (including bird flu).
Which means that while supplies are ample, and prices are low, it wouldn’t be such a terrible idea to pick up a box of surgical masks to tuck away with the rest of your disaster and emergency supplies.
