Press Releases
7.8.09 - What to Say When a Pandemic Looks Imminent: Messaging for WHO
What to Say When a Pandemic Looks Imminent: Messaging for WHOImminent Pandemic Standby Message #14Like washing your hands, wearing a facemask may help a bit. But it has more downside than washing your hands.Just as hand-washing may help reduce transmission via touch, facemasks may help reduce transmission by droplets. If you’re infected, masks can help keep you from giving the flu to others when you cough or sneeze. If someone else is infected, masks can help keep you from catching the disease.
The kind of facemask called an N-95 mask (more properly called a respirator) is more effective than an ordinary surgical mask. Because it filters out even small particles, it works against aerosols as well as droplets. But N-95 masks have four big disadvantages: (a) They’re expensive; (b) They’re likely to be in short supply; (c) They’re difficult to fit properly; and (d) They’re uncomfortable to wear. N-95 masks are impractical for everyday use, even in a pandemic. But if you have to go to the hospital or care for a family member with the flu, they’re worth considering – and learning how to use correctly.
Surgical masks cost less and are more readily available, though they too may be hard to find during a pandemic. They are less uncomfortable and easier to use. They work fairly well against droplets, but not nearly as well against aerosols. Research on the relative efficacy of surgical masks and respirators (properly worn) shows that respirators are better – but how much better is still hotly debated. Surgical masks were extensively used during the 1918 pandemic, and they’re likely to be in demand again if we face another severe pandemic.
When the pandemic arrives, masks of one kind or another will sometimes be required or strongly recommended. Other times, it will be up to you … if you can find any. If masks are unavailable, experts may recommend covering your face with a bandanna or a home-made mask. Even the “wrong” kind of mask may remind you not to touch your face, and that in itself helps reduce the spread of flu. And if you have no mask of any kind, coughing into your elbow is thought to be better respiratory hygiene than coughing into the open air.
Unfortunately, no mask or “cough etiquette” practice will provide perfect protection for any of us. We will have to make do with what we can find. Recommendations about masks are likely to change as the experts learn more about what works – and what’s available.
All used facemasks should be considered dangerous objects. After all, if a mask has stopped some flu-containing droplets or aerosols (on the way in or on the way out), then for some period of time the mask itself can give someone the flu. So if you’re going to use facemasks, you need to change them often; you need to dispose of them properly or wash them carefully (if they’re reusable); and you need to wash your hands thoroughly after touching a used mask.
The very same sources who have oversold hand-washing have often refused to recommend facemasks at all, except for healthcare professionals. When asked why, they sometimes say they’re worried that wearing a mask, especially a surgical mask, will give people a false sense of security – an objection they never voice with respect to hand-washing. During the SARS outbreaks, paradoxically, officials in Toronto opposed mask-wearing on the opposite grounds; they thought seeing other people in masks would be unduly scary to the public.
Some experts also argue, accurately, that masks aren’t completely effective. But of course hand-washing isn’t completely effective either. The difference between the two isn’t that hand-washing has been proved more effective than mask-wearing; it’s that hand-washing has no significant downside, while mask-wearing has several real drawbacks.
The sound risk communication response, of course, is to tell people the drawbacks and let them decide for themselves. It is understandable that officials promote readily available hand-washing more than hard-to-get and hard-to-use masks. But it makes very little sense that so many sources of pandemic information have expressed outright opposition to the public use of masks.
Part of what’s going on is competition. Both kinds of masks, but especially N-95 masks, are already in short supply. Public stockpiling competes with healthcare stockpiling, and with ordinary use in healthcare settings. Fair enough. So tell people masks are in short supply and may not be available. Don’t tell them masks won’t be useful in crowded public places – and then expect to be trusted when you explain that people can transmit the flu before they have symptoms, when you advise social distancing and voluntary self-quarantine, and when you require mask use in hospital waiting rooms.
As a possibly severe pandemic approaches, people will be desperate for ways to protect themselves and their loved ones. Knowing that there are potentially useful things you can do – that is, feeling efficacious rather than impotent – is a key to coping well in crisis situations. Busy, efficacious people can bear their fears better; people who see themselves only as victims are likelier to sink into apathy or denial. So in addition to being useful on practical grounds, it is also useful psychologically to give people things to do.
Better still: Give people choices of things to do, so they’re not just blindly following your instructions, but also thinking through how best to act. People with choices to make learn more, feel more efficacious, and follow through better on the choices they end up making.
Of course the psychological value of “things to do” doesn’t mean the experts should oversell any precaution – be it hand-washing or mask-wearing. Precautions that look likely to do more harm than good should be discouraged. But if wearing a facemask looks likely to do more good than harm, it should be encouraged, with appropriate attention to its downsides.
This isn’t just about masks. It is about people’s attitudes as they face a potentially severe pandemic – and our attitudes as we prepare to guide them through it. It’s a serious mistake for authorities to head into hard times believing that they should recommend only perfect precautions with no disadvantages. And it’s a serious mistake for authorities to head into hard times believing that all precautions should be either forbidden or required, and that all decisions should be made by professionals. We will need people to be (and feel) informed and self-reliant, able to choose their own precautions after hearing our advice. And we will need people to accept that imperfect precautions are all we’ve got. (That will include the eventual, longed-for, imperfect vaccine.)
http://www.psandman.com/col/panflu4-3.htm#msg14
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