The right mask can help prevent swine flu

People covered with facemasks are a common sight in news reports from Mexico about the swine flu outbreak. Do people in the U.S. now need to consider wearing masks, and can they really help?

The Mexican government has been handing out face masks to its citizens. In areas where the flu has already reached epidemic proportions, it may be advisable to wear masks in all public places.

In the U.S., where most infections are now clustered in communities, it makes sense to wear a high-grade mask in situations where you’re likely to be exposed to the virus. For example, if you’re sick with the flu, wearing a mask can help prevent spreading it to others. And if you’re caring for someone who is sick, wearing a mask yourself can also help reduce exposure to the droplets from a cough or sneeze that spread infection. If there is an outbreak in your community, masks can be helpful tools to reduce your exposure to the virus in confined or crowded places, like buses, trains, and airplanes.

Not all masks are created equal. To prevent the inhalation of most virus-bearing droplets from a cough or sneeze masks and respirators should be labeled N-95* or higher, which means they have been cleared by the FDA. They may also bear a label from the National Institute for Occupational Safety.

How a mask fits is a big influence on its effectiveness. The mask should fit tightly over your nose and mouth, with no gaps. To get the full protective effect, you’ll need to wear it as long as you’re in a high risk situation and replace it after each use.

Masks can help, but are no replacement for basic preventative hygiene, which can go a long way in protecting you from the flu. Wash your hands vigorously for 20 seconds under warm running water before eating or preparing meals, after the using the bathroom, after blowing your nose, and after other potential exposures to the flu virus. Alcohol based hand sanitizer, like Purell, with an alcohol content of at least 60 percent, can be effective, when soap and hot water aren’t an option.

—Urvashi Rangan, Technical Policy Director, Consumers Union

Read more on whether or not masks can protect you (scroll down to #13).

* Update for November 2, 2009: A 2009 study finding that N-95 respirators were superior to surgical masks at preventing the spread of flu was retracted by the authors after a flaw in the methods was discovered. The authors now say there is no significance difference between N-95 respirators and surgical masks, confirming another recent study that found they were equal.

Comments

[cindy]

I read a great article on h1n1 prevention:

sleep (don't underestimate how it rebuilds the immunity)
water...drink alot of unfluoridated water
Vitamins C & A!!
Green Tea.....antioxidant
Colloidal Silver (natural anti-bacterial agent)
Golden Seal
Oil of Oregano (super anti-oxidant)
Mushrooms (Shitake, maitake,reishi)
Elderberry
Honey and Lemon w/water (drink warm several times a day)
Lemon Balm Tea

20 minutes of exercise a day

[khushboo]

utility of face masks and N95 respirators as a tool for general
protection against H1N1 can't be deplored enough.
Most N95 respirators are designed to filter 95% particulates of 0..3µ,
while the size of H1N1 virus is about 0.1µ. Hence, dependence on N95
to protect against H1N1 is like protecting against rain with an
umbrella made of mosquito net.

Tamiflu does not kill but prevents H1N1 from further proliferation
till the virus limits itself in about 1-2 weeks (its natural cycle).
H1N1, like other Influenza A viruses, only infects the upper
respiratory tract and proliferates (only) there. The only portals of
entry are the nostrils and mouth/ throat. In a global epidemic of this
nature, it's almost impossible not coming into contact with H1N1 in
spite of all precautions. Contact with H1N1 is not so much of a
problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1
infection, in order to prevent proliferation, aggravation of symptoms
and development of secondary infections, some very simple steps not
fully highlighted in most official communications - can be practiced
(instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. "Hands-off-the-face" approach. Resist all temptations to touch any
part of face (unless you want to eat, bathe or slap).

3. Gargle twice a day with warm salt water (use Listerine if you
don't trust salt). H1N1 takes 2-3 days after initial infection in the
throat/ nasal cavity to proliferate and show characteristic symptoms.
Simple gargling prevents proliferation. In a way, gargling with salt
water has the same effect on a healthy individual that Tamiflu has on
an infected one. Don't underestimate this simple, inexpensive and
powerful preventative method.

4. Similar to 3 above, clean your nostrils at least once every day
with warm salt water. Not everybody may be good at Jala Neti or Sutra
Neti (very good Yoga asanas to clean nasal cavities), but blowing the
nose hard once a day and swabbing both nostrils with cotton buds
dipped in warm salt water is very effective in bringing down viral
population.

5. Boost your natural immunity with foods that are rich in Vitamin C
(Amla and other citrus fruits). If you have to supplement with Vitamin
C tablets, make sure that it also has Zinc to boost absorption.

6. Drink as much of warm liquids as you can. Drinking warm liquids
has the same effect as gargling, but in the reverse direction. They
wash off proliferating viruses from the throat into the stomach where
they cannot survive, proliferate or do any harm.

All these are simple ways to prevent, within means of most households,
and certainly much less painful than to wait in long queues outside
public hospitals.

[Tudor]

In addition to above comments, people must be aware that these masks, as good and protective as they can be, could become a disease propagation vector if someone doesn't dispose of it in appropriate location.

Among some seach I did about face masks,I've heard of one face mask technology that seems to be serioulsy proven efficient against H1N1, and furthermore, being impregnated with antimicrobial agent, it actually stops and kill the viruses, which solves the disposal issue as well. Noveko N99 face mask seems to be the right one according to me.

[Julival Ribeiro]

a) Will it the necessary to dispose of the respirator N-95 after seeing a patient who is suspicious/case of the swine influenza (H1N1) or can I use the respirator N-95 to see several other patients who might have the same possible situation?

b) Just in case I have close contact with a patient who has swine influenza (H1N1) and I need to take a nose/throat sample (swab)/ or an intubation in this patient, are there any specific procedures I need to follow to dispose of the respirator N95 ?

I would like to receive the article about the commentthat was posted by JE Mage about Respirator N-95: "these masks lose their efficacy after 4 hours of wear. "

Thank you so much for your attention, Julival Ribeiro

[GD]

I don't really understand that "wash your hands often" thing... Does that mean I have to set my alarm clock up to wake me up several times at night to wash my hands?? Or is it "wash your hands everytime you may have touched a contaminated surface, to avoid spreading the virus to others, to other places, or infect youself???"

[KL]

Again, unless you must be in an enclosed space (elevator, airline) face masks are probably not necessary for most Americans at this time. And, as always, the MOST effective prevention is WASHING YOUR HANDS FREQUENTLY - with regular soap & water for AT LEAST 20 seconds. Like the Jeopardy tune, or the Happy Birthday song. I think it might be prudent to remind others of this. Even strangers in the public restrooms and wait personnel at food service locations. My job requires that I wash my hands at least 20 times a day. It's not that difficult to take a few extra seconds to be safe and sanitary. And remember, this is the flu, not ebola.

[zv]

A mask doesn't conform to the face, it's a rectangular piece with strings. It may be surgical and N95 rated, but it only protects others, somewhat and if used properly, from the person wearing the mask, if that person sneezes or coughs. I think this is one of the reasons why the flu is spreading so much in Mexico. Most of them are wearing masks. A respirator is a mask that conforms and seals against the face. It protects the wearer from other people's sneezes and coughs. Respirators are like the ones used in Asia. There are disposable (looks like a round or oval mask) and non-disposable respirators (the regular plastic body respirators with 1 or 2 cartridges/the filters). If the respirator has a valve, then, it shouldn't be worn by an ill person because the virus comes out thru the valve. But if you are not ill, the respirator with the valve may be the best because the valve helps to breathe. The masks and respirators are available at pharmacies and internet, but they are getting harder to find. If you get one at the hardware store, it has to be N95 (or better N100, P95, or P100; 95 is 95% particles filtered). N is not resistant to oils, P is. The surgical respirators approved by the FDA (in addition to OSHA for the N95 rating) are fluid resistant, meaning that the filter will not get damaged by human fluids (blood) directly thrown to the filter. However, most N95 respirators are fluid resistant to some degree. Most disposable respirators are single use. Some sellers claim that some disposable respirator types have a longer life, but that's not what the manufacturer sheet says. The life is how long the filter is effective. As other people said already: Respirators increase protection, but are not 100% perfect. The fit is extremely important. Don't rely entirely on them, wash your hands, use caution, try not to stay in close contact with people who seem to have the flu, mostly in public areas. But people can have the flu and be contagious, and yet not show symptoms for 24 hrs. So, wash your hands very often and for 20 seconds (the length of the happy birthday song) with soap, or use disefectant with at least 60% alcohol, and if you must cough and sneeze, do so into tissues or your elbow.

[LSLeitner]

It is very highly unlikely that any viri would be airborne and not in, or on, a much larger droplet or particle that would be far larger than could get through an N-95 mask. Even the CDC is only recommending N-95s for healthcare workers dealing with infected patients in isolation. Finally, N-95 masks are easily adjusted for a proper fit -- even more sophisticated masks can have gaps if the user does not take the necessary steps to insure a good fit.

[Lynn]

I heard on NPR today that this virus mainly affects the upper respiratory system and not the lungs, which would be more dangerous. The worry is that it may mutate and could be a more dangerous variety in the fall. I think the reason for all the attention (after all, around 30,000 people each die of other flues) is that the population has not been inoculated for this one. Let's hope there is a vaccine by then. I bought an N95 mask in Home Depot a couple of years ago, and it was under $4 at that time. I'm travelling soon by plane and will have a couple of these masks with me. The good news is that this is treatable with anti-virals, such as Tamiflu, -and preferably within 48 hrs. of symptoms for maximum effect. (Mexico sells antibiotics over the counter, and people may think they are doing the right thing. They are not, as this is not a bacterial infection and antibiotics should never be used without determining that a bacteria is the cause - that is why bacteria are building up immunities to antibiotics and some are now useless for a superbug).

[CJ]

For healthcare workers, the minimum standard for masks is ridiculous. Unfortunately, the N95 "respirator" mask is the minimum standard advocated by the gov't for known infectious environments for health care workers. The problem is that these "respirators" must be fit tested in the hospital. That is a rule. But if you talk to hospital personnel you will quickly find out that the N95 mask fit testing is a joke. Because not only is it expensive to do the proper testing on each and every worker, the hospital employee with facial hair is excluded from wearing the N95 mask. Basically, it can't be fit tested because getting a proper seal is impossible. So, there you have it--a "respirator" that is impractical and for many who cannot pass the fit test, it is worthless--cannot use. There are other disadvantages to the N95 "mask" (calling it a respirator implies a superior level of protection to me) including but not limited to the difficulty to breathe through the heavy filter for the user, and it still leaves ones eyes vulnerable for contamination and infection. I can't believe the CDC drops the ball when it comes to clearly defining masks vs respirators. What we have is a standard that's barely minimum in terms of personal respiratory protection.

[n/a]

Anyone can purchase N95's at hardware stores like Lowes and Home Depot.

I agree with JE Magee, you should only wear a mask if you cannot avoid a situation in which you might be exposed, but even the mask will not give you 100% protection.

[n/a]

National Institute for Occupational Safety AND HEALTH. (NIOSH)

Please visit the NIOSH page for accurate information on respirators: http://www.cdc.gov/niosh/npptl/topics/respirators/

[LMcKinney]

In addition to the above comments, it's also important to note that the general public cannot walk into a store and buy an N95 mask. My understanding from our Emergency Management Agency is that they have to be bought by EMA or other health agency personnel via special process.

[JE Magee]

The compliance labeling of the N95 and N100 disposable surgical masks are evaluation ratings for their ability to filter out “particles” of 300 microns or greater in diameter. ALL of the influenza A viruses (N1H1, et al) are magnitudes smaller than the test standards particles. Additionally, these masks lose their efficacy after 4 hours of wear. They are effective during that time for filtering out “large” droplets from individuals talking or sneezing, but their large filtration openings and generally loose fit will provide little if any protection in an enviroment of truly airborne viruses. I am concerned that the Pandemic could be made worse by people believing they’re protected, exposing themselves, then taking the viruses back to family members and close associates.

[Swine Flu FAQ]

This is a very informative article. I have heard that this dreaded disease has caused lots of panic among people in US & Mexico. Its being spread to NZ & Spain. Pls let people more about that part as well and pls let people know whether its going to enter Asia continent or whether its under control now.