Masks (what kind)? No Mask? Hand washing? There are lots of opinions and now more studies

You watch the news or visit of website and see pictures of people in India in panic over not being able to get a mask.  You then read an article or two that states that masks don’t do anything…another study says masks helps…. what are you to think? With school staring up in the Northern Hemisphere and the associated predictions of a big spike in flu cases, many people are looking for some clear direction.  Guidance is directed at two audiences:  Individuals/Families and Healthcare Workers.

N95 Mask - Suggested For Healthcare Workers
N95 Mask - Suggested for Healthcare Workers

Individuals and Families

What can reduce transmission of the illness in a family with a sick family member? Two recent studies looked at this issue.  An Australian study looked at the use of a surgical masks versus P2 respirators (similar to N95) in Australian homes in which a child had respiratory illness. There was a four-fold reduction in clinical illness for individuals wearing either mask.

Surgical Masks - A Good Choice For Your Family
Surgical Masks - a good choice for your family

A Hong Kong study divided households into three groups.

  • Group One – Given only basic health education
  • Group Two – Instructed to practice hand hygiene with soap and an alcohol hand rub.
  • Group Three – Used hand hygiene and surgical facemasks.

The investigator concluded that “substantial and significant benefits of face masks and hand hygiene if implemented within 36 hours of index case symptom onset.”

The editor of the Annals of Internal Medicine went on to write These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and hand hygiene and facemasks seem to reduce influenza virus transmission when implemented early after symptom onset.

Surgical Masks In Public Are Most Effective When We All Have Them On
Surgical masks in public are most effective when we all have them on

With a contagious illness the average person has several tools in their arsenal albeit they don’t feel like they do much.  They are simple and powerful!

  1. Hand washing
  2. Stop touching your face
  3. Good cough etiquette
  4. Social distancing – six feet apart from others
  5. Personal Protective Equipment (PPE).  PPE in this case would be a mask.  When do you use a mask? When you can’t social distance.

Annals of Internal Medicine –

IOM – Panel 3.pdf

Healthcare Workers – What type of mask?

Healthcare workers remembering the deaths and issues with SARS in Toronto are concerned for their own safety.  In response to a request from CDC and OSHA, an ad hoc committee of the Institute of Medicine (IOM) will conduct a study and issue a letter report to the CDC OSHA by September 1, 2009. The committee will provide recommendations regarding the necessary personal protective equipment (PPE) for healthcare workers in their workplace against the pandemic H1N1 virus. The report will include:

  • The potential for exposure to the nH1N1 virus among healthcare workers
  • Which groups of workers are at risk?
  • Which patient care activities pose a risk of exposure?
  • What degree of risk
  • What is known and what is unknown about transmissibility, severity and virulence of the current virus
  • How transmissibility might change.
Notice The Workers In The Back Of The Photo With The Mask Down Past Their Chin - Not Too Helpful?!?
Notice the workers in the back of the photo with the mask down past their chin - not too helpful?!?

The committee will base its recommendations on the available current state of scientific and empirical evidence about nH1N1 virus, as well its expert judgment. Economic and logistical considerations regarding PPE equipment will not be addressed in this letter report. In determining the appropriate PPE for the U.S. healthcare workforce, attention will be given to the current PPE guidance documents offered by the CDC and by the WHO for novel H1N1 influenza and for seasonal influenza.

It is important that we do what we can to protect healthcare workers – if we don’t, they aren’t coming to work.  During the height of the avian flu outbreak one study discovered that when asked if they would come to work 50% reported “yes”, 42% reported “maybe”, and 8% reported “no”.  The author concluded that staff absenteeism during a pandemic due to fear of contracting an illness may result in a significant personnel shortage. Ensuring worker confidence in adequate personal protection may be more important than financial incentives.


Prehospital and Disaster Medicine