In the last few months, I’ve noticed that we have had a wave of possible candidates for the next great pandemic. Ebola virus, Middle East Respiratory Syndrome, drug-resistant Tuberculosis, Influenza, and various other diseases can cause large numbers of deaths in susceptible populations. Many of the victims will come from members of the medical community who honor their oaths to care for the sick. It stands to reason, therefore, that few medically trained individuals will be left to serve a group or community in a prolonged outbreak of a contagious disease.
The medically responsible member of the family should make provision against becoming the next casualty of an epidemic or pandemic. The supplies required would include antiseptics, disinfectants, and protective gear such as masks, gloves, eye protection, etc. This article will focus on masks.
If the U.S. experienced a widespread outbreak of, say, Middle East Respiratory Syndrome (MERS), a reasonable estimate of simple disposable masks required would be close to 3 billion; hundreds of millions of advanced masks for caregivers would also be needed.
History of Masks to Prevent Spread of Disease
18th Century Plague Gear
Throughout history, infectious diseases have been part and parcel of the human experience. Ever since the Middle Ages, we have figured out that some infections have the capacity of passing from person to person. Medical personnel have, not unreasonably, made efforts to protect themselves from contracting the disease.
In medieval times, doctors who ministered to patients suffering from the Bubonic or Pneumonic plague wore masks. These masks often had herbs in them which were thought to protect the wearer from contagion. Protective gloves, gowns, and caps made their first appearance as well.
In the year 1897, masks began to be used during surgery to prevent germs residing in medical personnel’s noses and mouths from contaminating the operative field. Secondarily, the mask protected the wearer from blood spatter and other fluids from the patient.
Operating Room, Circa 1900
Masks of that era were made of cloth or gauze which, unfortunately, were poor barriers against microscopic germs. Even these were not always used by all members of the surgical team, as seen in the image above.
Surgical Masks in Modern Times
The basic appearance of the surgical mask hasn’t changed much in the last few decades. I’m sure that you’ve seen photos of people wearing them in areas where there is an epidemic. In Asia, especially, it is considered a sign of good citizenship and social responsibility to wear them in public for prevention. Face masks have an added advantage: They remind people to keep their hands away from their nose and mouth, a major source of the spread of infection.
How Surgical Masks Protect Patients and Doctors
Medical masks are evaluated based, partially, on their ability to serve as a barrier to very small particles that might contain bacteria or viruses. These are tested at an air flow rate that approximates human breathing, coughing, and sneezing. As well, masks are tested for their ability to tightly fit the average human face. The most commonly available face masks use ear loops or ties to fix them in place, and are fabricated of “melt-blown” coated fabric (a significant upgrade over woven cotton or gauze).
Standard medical masks have a wide range of protection based on fit and barrier quality; 3-ply masks (the most common version) are more “breathable”, as you can imagine, than 6-ply masks. The latter, however, presents more of a barrier.
N95 with Exhalation Valve
The upgrade to the basic mask is the N95 respirator mask. N95 Medical Masks are a class of disposable “respirators” that have at least 95% efficiency against particulates larger than 0.3 microns in size. Few people understand just how tiny a micron is. Below is a comparison graphic, magnified 2000 times:
The big circle is the diameter of a human hair magnified 2000 times
The “N” in N95 stands for non-oil resistant; there are also R95 (oil resistant) and P95 (oil proof) masks, mostly for industrial and agricultural use.
N95 masks protect against many contaminants but are not 100% protective. Although used less frequently, N99 masks (99%) and N100 masks (99.7%) are also available. Many masks will have a square or round “exhalation valve” in the middle, which helps with breathability.
None of these masks cover the eyes, so it is important to have protective eye wear in order to prevent infection.
You’ll need both standard and N95 masks as part of your medical supplies. I would recommend a significant number of each as the masks will be contaminated once worn and should be discarded. A simple truth regarding medical supplies in a pandemic: You can never have too many. Any “extras” you might have will be incredibly valuable barter items in times of trouble.
There are no absolute standards with regards to who wears what in the sick room. I would recommend using the standard surgical masks for those who are ill, to prevent droplets from coughing or sneezing (which can send air droplets several feet) and the N95 masks for the caregivers. In this fashion, you will give maximum protection to the medical personnel.
Remember, your highest priority is to protect yourself and the healthy members of your group. Plan out a sick room area and isolate those that might be contagious. Have plenty of masks, as well as gloves, aprons, eyewear, and antiseptics, and pay careful attention to every aspect of hygiene. Your survival may depend on it.
Joe Alton, M.D., aka Dr. Bones the Disaster Doctor