Swine Flu: Do I Need a Mask?

Whenever there is an outbreak of a particularly frightening communicable disease, people want to know how they can protect themselves. At times like this all sorts of companies pop up offering supplies to families and individuals. Unfortunately, a lot of the products are expensive and unnecessary. Some can even result in harm if used incorrectly. Individuals trying to stockpile medical supplies also create both an inflated demand which can drive costs up, while simultaneously depleting stocks that health care facilities and government agencies need to care for those who are ill.

Effectiveness of Surgical Masks to Prevent Spread of Swine Flu

According to the New York State Nurses Association, flu is transmitted three ways: 1) droplets between five and ten microns in size; 2) airborne aerosol composed of particles smaller than five microns; 3) contact. ("An open letter...") The aerosol route is particularly emphasized with H1N1 influenza. ("Protect nurses against H1N1")

American and Canadian health agencies have both stated that otherwise healthy individuals need not wear a surgical or examination type mask at work or in the community. These masks do not provide a barrier against the aerosol particles that are strongly implicated in transmission of H1N1, and so would be ineffective in reducing risk of infection. Because wearing a mask gives a false sense of security, and because it is actually possible to contaminate oneself in handling the mask, wearing a surgical mask can increase an individual's risk of getting H1N1.

For individuals who are at particularly high risk of complications should they become infected, the best advice is to discuss preventative measures with a health care provider. The best means of prevention remains regular washing of hands and surfaces, and vaccination against H1N1 as directed by the health professional.

Masks for Infected People

If you have influenza or any influenza-like illness (ILI - fever accompanied by cough or sore throat, possibly with other symptoms) wearing a mask is recommended of you must go out. This helps to reduce the amount of virus you are transmitting to health care workers and others around you. Ideally, however, you should stay home while you are ill. With H1N1 doctors suspect we are contagious from about 24 hours before the onset of symptoms to seven or more days afterwards. The best rule of thumb is to wait until 24 hours after fever has disappeared.

Respirators for Health Care Workers

People who work in health care settings, especially those who are likely to come into contact with H1N1 patients, are encouraged to maintain a distance of six feet from the patient, as much as possible. When this is not possible the patient wearing a mask helps somewhat, but it is preferable for staff to wear a fit-tested particle respirator that meets the NIOSH N95 standards. "N95" means that the mask blocks 95 percent of particles, but will not protect against oil-based substances. N95 respirators protect against a number of infectious diseases, from H1N1 and H5N1 forms of influenza and SARS, to smallpox and tuberculosis.

Health workers should be evaluated for ability to wear the respirators, and should go through fit-testing and education on how to use the respirator. This process must be completed at least once a year, or any time there is a change (e.g. new brand or size of mask) that might affect the ability to form a proper seal. Bearded individuals will likely not be able to form that desired seal, and will have to look into alternative protection if they wish to maintain the beard. Respirators are also not recommended for use by children, due to issues around proper fitting.

Health care workers who are at elevated risks for complications from influenza may wish to consider reassignment during a flu outbreak.

Respirator Use By Individuals in the Community

Respirators are not generally recommended for use by individuals in the community at large, even when there is an infected person in the neighbourhood or household. The CDC recommends a person who is in a risk group should wear either a mask or respirator if caring for a sick person or if they must be in a crowded place during a confirmed H1N1 outbreak, but this is on a voluntary basis. Emphasis is placed on avoiding crowds, and on infected individuals reducing risk through proper handwashing and coughing etiquette, as well as wearing a mask.

Emergency Kits

Respirators and masks need not be bought as part of an emergency preparedness kit. Some suppliers are currently out of stock due to increased demand stemming from the fear of H1N1. Masks do little to help a healthy person stay healthy. Respirators are not terribly effective unless fit-tested, a procedure not likely to be offered by your supplier or local health care facility unless you have been instructed by a doctor to use a respirator.

Please remember that the stock is needed to keep our health care workers and first responders safe. If they become infected, as was the case with the SARS outbreak in Ontario, we have fewer qualified professionals to care for those who become ill.

A good emergency kit will be stocked with mild liquid soap and paper towels for handwashing; alcohol based hand sanitizer; acetaminophen or ibuprofen for fever; an accurate thermometer; a week's supply of food so nobody from the household will have to go out during the infection; fluids, including electrolyte solution or ingredients to make it, in case of diarrhea; plenty of tissues; bleach and vinegar or a bleach-based household cleaner, gloves and plenty of garbage bags for clean-up. A few surgical masks may be added to the kit, for the infected person to wear during close contact or if going out is unavoidable, but these should not be worn by otherwise healthy caregivers.

Sources:

"Information - Public Health Agency of Canada recommendations on use of masks in public settings to prevent transmission of the H1N1 flu virus (Human swine flu)" Public Health Agency of Canada (PHAC)

"Interim recommendations for facemask and respirator use to reduce novel Influenza A (H1N1) Virus transmission" Centers for Disease Control and Prevention (CDC)

"NIOSH-Approved disposable particulate respirators (filtering facepieces)" National Institute for Occupational Safety and Health (NIOSH)

"An open letter to New York State Commissioner of Health Richard F. Daines and administrators of healthcare facilities/agencies in New York State" New York State Nurses Association (NYSNA)

"Protect nurses against H1N1" NYSNA

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