Thursday, January 23, 2020

Caught With Our Masks Down (Revisited)

Credit NIOSH


Just over two weeks ago (although it seems interminably longer), I penned a blog called Hong Kong: Caught With Their Masks Down,  which looked at a run on both surgical and N95 masks in the region following news of a (at the time) unidentified viral pneumonia in Wuhan City, some 900 km to the north.
While the number of cases was small, and China was downplaying the notion that the virus was transmissible from person-to-person, Hong Kong pharmacies were already reporting shortages. 
The wearing of a mask (surgical or N95) in public to protect against respiratory infections is quite common in Asia, and in early December - in anticipation of this winter's flu season - Hong Kong's CHP released a tutorial on the subject (see HK CDW: Surgical Masks For Respiratory Protection).

Figure 2 - How to wear a surgical mask. (Source: The Centre for Health Protection of the Department of Health.
While the `need' for civilians to stockpile N95 masks because of this pneumonia may subject to some debate, the time to prepare for any emergency is before the threat appears; when supplies are ample, and prices are reasonable. 

In my last blog, we looked at Macao's plan to sell residents a limited number of masks. The govt stated they :
. . . will announce a list of 54 pharmacies that can purchase masks. At that time, residents can hold Macao residents' ID cards, and foreign employees can purchase masks at the pharmacy at their own expense with a foreign employee ID card. Each person can buy 10 masks at a time, and they can repeat the purchase after 10 days.
While the price isn't mentioned in this announcement, a report from Beijing News (h/t Shiloh on FluTrackers) indicates that supplies on the Mainland are not only tight, the prices have skyrocketed. 

Mask sales in some provinces are tight, and prices have risen
Affected by the rising number of patients with pneumonitis infected by the new coronavirus in Wuhan, masks have become a popular commodity in various places. On January 21st and 22nd, the Beijing News reporters found that masks for e-commerce platforms and pharmacies and convenience stores in Beijing, Guangdong, Jiangsu and other provinces were selling tightly, and "N95" masks were out of stock. On multiple e-commerce platforms, there are merchants selling N95 masks in 10 packs. The price of each box was close to 1,000 yuan.

Today (January 22), a reporter from the Beijing News learned that for merchants taking this opportunity to increase prices, some e-commerce platforms have made regulations and issued subsidies to prohibit merchants from increasing prices, and launched mask distribution in the same city. In addition, Zhejiang mask makers have paid 3 times the wages to recall employees for overtime production. In addition, Beijing, Guangdong and other provinces' market supervision and administration bureaus have also issued notices prohibiting mask manufacturers and sellers from colluding to increase prices.
         (Continue . . . )

1000 Yuan is roughly $144 USD, or about $14 per mask - which is 14 times the typical cost of an N95 mask in the United States.  Even if the government successfully clamps down on price gouging, having a reasonable price for an unavailable item is not exactly a win.
We've looked at the conflicting data on the effectiveness of surgical masks many times over the years (see here, here, and here), and there is little consensus on their merit in protecting the wearer.  
N95 masks are presumed superior, but are 10 times more expensive, difficult to wear for extended periods of time, should be replaced after a few hours of wear, and each individual must be `fit-tested' (see Survival Of The Fit-tested).

A little over 3 months ago, in The WHO NPI Guidance : Personal Protection, we looked at their recommendations for face masks, handwashing, and respiratory etiquette during a severe influenza epidemic or pandemic.

The WHO sums up their face mask recommendations, reserving public wearing of face masks by asymptomatic persons to high severity pandemics, while supporting the wearing of surgical masks by symptomatic cases in any scenario.

These are, of course, just WHO's recommendations.  And Chinese authorities are insisting people wear masks in public,  when riding in public transportation, or when showing respiratory symptoms.  Their consumption of disposable masks is  growing every day.

Two weeks ago, I cautioned:
While I'm hopeful the Wuhan pneumonia outbreak will be contained, or may recede on its own - as a matter of routine personal preparedness - I always keep a box or two of facemasks, some vinyl gloves, extra hand sanitizer, extra soap, some common OTC flu meds, and a month's supply of essential Rx meds in my emergency stash . . . just in case.
Things you may want to consider adding to your first aid supplies now, while they are still easily affordable, and are in ample supply
Although I had some N95s left over from the 2009 pandemic, I looked them over, and found some of the elastic straps and foam had deteriorated after a decade in  storage, and took my own advice and ordered in a couple of boxes of new masks.  They arrived in 48 hours. 

Tonight, after talking to Sharon Sanders on FluTrackers about the drain on the mask supply in China, I checked Amazon to see if the masks I ordered two weeks ago were still available.   While some brands still are, they weren't, and a great many of the listings carried this warning:

Some of the suppliers who still have masks available are reporting delayed delivery dates.  While it remains to be seen how much of an impact this novel coronavirus will have outside of Asia, by the time that we know that, your options for preparing will be considerably less robust.

In 2017, the CDC released a 16-page Household Pandemic Planning guide, which emphasizes the use of NPIs - or Non-Pharmaceutical Interventions - during a pandemic.
Get Your Household Ready for Pandemic Flu [PDF – 16 pages]
Among their recommendations, the following advice:
Plan to have extra supplies of important items on hand. For example, keep on hand extra supplies like soap, hand sanitizer with at least 60% alcohol, tissues, and disposable facemasks.
If you or your household members have a chronic condition and regularly take prescription drugs, talk to your health care provider, pharmacist, and insurance provider about keeping an emergency supply of medications at home. These supplies can always be used for a different emergency and then restocked.
Whether you are preparing for an earthquake, a hurricane or a pandemic, better to be months or years  early getting prepared than 1 day too late.