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Summer 2006 Vol. 6 No. 2



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Passengers wearing protective facemasks on flight to Singapore during 2003 SARS outbreak, ©Reuters/Corbis Facing the Next Flu Pandemic


Whether looking at photos taken during the influenza pandemic of 1918 or watching news footage about the 2003 SARS outbreak, one common feature stands out in all the images: medical masks. Wearing some kind of face covering seems to be a given during the outbreak of a respiratory disease.

Now that the specter of a new flu pandemic has nations across the globe scrambling to develop response plans, government agencies, corporations, and individuals are stockpiling basic, disposable medical masks and respirators. Concerned that supplies would be depleted if a pandemic does strike in the near future, the U.S. Department of Health and Human Services asked the Institute of Medicine to convene a panel of experts to determine if there is a way facemasks designed for one-time use could be reused.

The answer in the case of medical masks is no. And in the case of government-certified N95 respirators, it is a qualified yes. A person could extend the use of an N95 respirator by wearing it covered with a medical mask or a face shield to protect against external surface contamination and by handling and storing it very carefully. There are no data on how long these measures would be effective.

But whether disposable facemasks can be reused raises the question of whether these devices protect against flu viruses in the first place. The committee noted that scientists have not definitively pinpointed to what extent the flu is transmitted through contact with contaminated surfaces, by inhaling the droplets expelled when infected people cough or sneeze, or via inhalation of viruses floating in the air. Fluid-resistant, loose-fitting medical masks could potentially protect against droplet-borne viruses, while snug-fitting N95 respirators may protect better against aerosolized viruses. No form of face covering has been tested specifically against flu viruses, the committee stressed.

Health care providers in other countries often use washable, woven cotton medical masks as a cost-saving measure. The committee neither recommended nor discouraged the use of these masks or of face coverings improvised from towels, sheets, or other cloth. However, the effectiveness of woven masks and improvised coverings against flu is not known.

The bottom line, committee co-chair John C. Bailar said, is that "the use of face coverings is only one of many strategies that will be needed to slow or halt a pandemic, and people should not engage in activities that would increase their risk of exposure to flu just because they have a mask or respirator."   -- Christine Stencel


Reusability of Facemasks During an Influenza Pandemic: Facing the Flu. Committee on the Development of Reusable Facemasks for Use During an Influenza Pandemic, Board on Health Sciences Policy, Institute of Medicine (2006, approx. 112 pp.; ISBN 0-309-10182-4; available from the National Academies Press, tel. 1-800-624-6242; $26.50 plus $4.50 shipping for single copies).

The committee was co-chaired by John C. Bailar III, professor emeritus, University of Chicago, Chicago, and Donald S. Burke, professor of international health and epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. The study was funded by the U.S. Department of Health and Human Services.



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Copyright 2006 by the National Academy of Sciences