# 3219
Time Magazine this morning has a long, detailed article about a subject that has been covered ad nauseum in this and other flu blogs for several years: the nation’s lack of adequate quantities of protective gear (PPE’s) during a pandemic.
First the article, then some discussion.
A New Pandemic Fear: A Shortage of Surgical Masks
By Bevan Schneck Tuesday, May. 19, 2009
A man wears a medical mask during the morning commute in New York City, April 29, 2009.
Brendan McDermid / Reuters
The surgical face mask has become perhaps the most recognizable symbol of the H1N1 pandemic threat, but if the currently circulating flu virus does in fact reach full-fledged pandemic proportions, U.S. health officials say there won't be enough face masks to go around.
The Department of Health and Human Services (HHS) says the nation would need more than 30 billion masks — 27 billion of the simple surgical kind, which can be worn safely for only about two hours before needing replacement, and 5 billion of the sturdier respirator variety, which also requires regular replacement — to protect all Americans adequately in the event of a serious epidemic. But the Centers for Disease Control and Prevention (CDC) Strategic National Stockpile currently contains only 119 million masks — 39 million surgical and 80 million respirator. That's less than 1% of the goal health officials set in 2007 following the devastation of Hurricane Katrina, which highlighted the country's shortages of vital medical gear.
The U.S. mask gap stands in stark contrast to what other nations have on hand: the U.S. has one mask for every three Americans (masks are not supposed to be shared), while Australia has 2.5 masks per resident and Great Britain boasts six.
A little over a year ago I did some back-of-the-envelope calculations on the number of N95 respirators we’d need for a single pandemic wave.
I based my estimates on this OSHA chart, which estimated that the average health care worker (HCW) would need 480 N95 respirators over a 12-week period.
If there are 8 Million HCW's providing direct care during a pandemic, and each requires 480 N95 masks, then we'd better have another 4 Billion masks in the storeroom.
Not so far off from the 5 Billion estimate in today’s Time Magazine article. And my number only counted HCW’s.
Not that anyone should be overly impressed, this is 3rd grade math at best.
You can find more on the issue of stockpiling PPE's, particularly for hospitals, clinics, and first responders here, here, and here.
Whether HCW’s will continue to work during a pandemic should proper PPE’s no longer be available has been an ongoing discussion in this blog as well – most recently here.
Since 90% of the consumables, like masks and gowns, used in this country are manufactured offshore – our ability to resupply during a pandemic becomes highly suspect.
And none of this should come as any surprise to the health care industry, as this report from CIDRAP News shows.
Hospital pandemic drill reveals major supply challenges
Robert Roos
News Editor
Nov 25, 2008 (CIDRAP News) – Hospital workers who followed official infection control guidelines for pandemic influenza for 1 day used 10 times as many gloves as usual, generated three times as much clinical waste, and found that many tasks took longer than normal, according to a new report.
Unfortunately, while there has been a great deal of talk over the past few years about the challenges of providing adequate PPE’s to HCW’s during a pandemic, there doesn’t appear to have been much progress made.
You can expect to hear a lot about the limited value of facemasks for the general public in a pandemic over the summer, and in truth, the science on this issue is pretty thin.
The Australian Study, released earlier this year, indicated that families that wore facemasks when someone in the household was ill with a respiratory virus cut down transmission to other family members by 75%.
But test subjects had to be rigorous in their protective efforts, and that is something that the public may not be willing (or able, given the mask shortage) to do.
Since the science is still inconclusive, and the shortages are destined to be profound, it is easier to try to discourage facemask usage by the public.
And I understand the dilemma.
It is hard to extol the virtues of protective gear to the general public when most people won’t be able to obtain them.
And right now, the priority for PPE’s ought to go to health care workers, who will be most vulnerable to infection.
Ironic that nearly a year ago the HHS advised all Americans that it would be prudent to add a small quantity of surgical masks and N95 respirators to their emergency supplies.
Something to have on hand in case a pandemic erupted.
Not that that would ever happen.
Nothing drastic, mind you.
They recommended a hundred surgical masks, and perhaps 20 or so of the N95 respirators. An investment of about $35 for the average family.
Don’t believe it?
Of course, unless you routinely visited the HHS pandemicflu.gov website, or this flu blog, you probably didn’t hear much about it.
The mainstream media, which could have elected to educate the public on these recommendations, chose not to.
In Switzerland, two years ago, the public was urged to stockpile masks – but once again, there is little evidence that the advice was taken seriously by the public.
I’ve no grand solution at this point. I wish I did.
Obviously, there will be attempts to bolster our stockpiles (national and privately held) of supplies over the summer. But now, everyone will be trying to do the same, which means that supplies may run short in a hurry.
The time to have started was years ago.
SophiaZoe, at A Pandemic Chronicle, has kept the idea of a home-made mask at the top of her blog. She offers it without recommendation, as do I.
Emerging Infectious Diseases Volume 12, Number 6, June 2006
Virginia M. Dato,* David Hostler,* and Michael E. Hahn*
*University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Please see original post here if you are interested in more detail, or Simple Respiratory Mask for the original paper.
While I’m not terribly concerned over a lack of facemasks for the public as long as the A/H1N1 virus stays at roughly the same severity, should it pick up virulence, this might be an option to consider. - MPC
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