Monday, May 18, 2009

The Flu: Everybody Please Panic In An Orderly Fashion

We seem to have Swine FluThe Flu Formerly Known As PrinceSwine Flu established in Japan1. We got 3 9 12 32 46 59 96 confirmed cases here in the Kansai region this weekend, and the media is in full disaster feeding frenzy. Every news and commentary program is about this outbreak and they all illustrate their commentary with footage of people wearing paper masks. There's segments about school closings (most victims are high-school students), about the situation in other countries and about how stores are sold out on masks. Solemn university-wide e-mails inform that we're now on Level Two on some scale or another. We should refrain from non-essential travel; contact the university health department if we have any flu-like symptoms; gargle (people are big on gargling here); wash our hands; and of course wear a mask.

People here love masks, and not only during porcine pandemics. You see the masks everywhere during flu season and in spring, when pollen counts are high. They do keep out a lot of pollen, and they stop your coughs and sneezes from bothering others. As a side effect, a mask prevents you from touching your face, a common way to catch infections and the reason we're advised to wash our hands during flu and cold season.

Paper Mask

The typical disposable paper mask most people use here.

But the kind of cheap disposable mask the gentleman above is wearing can't really protect you from a virus; it's really little more than a piece of conveniently shaped tissue after all. A real surgical face mask can protect you against bacteria and it has a minor effect against a virus; for reliable protection, however, you need a mask rated for virus protection (the ratings name differ by country; it's called things like P2 or N95). [Note: I'm no physician, so don't take any of this as the plain truth; read footnote #1 below2.]

Using real masks is not really an option for most people. First, to use an antiviral mask properly you need to know what you're doing: how to put it on so it fits you tightly and correctly; how long to use it before it needs to be replaced; how to take it off without accidentally touching virus-laden surfaces and getting infected; how to dispose of it so it doesn't infect someone else. Do you know how? I certainly don't3. Also, virus-protective masks are pretty expensive and somewhat uncomfortable.

The reality is that most people will wear the mask wrong, will start to use it but soon give up, or use the mask only when they're seen by other people. I sometimes see people wearing paper masks with the nose uncovered, for instance, completely defeating any protection. Or taking it off when talking on the phone, as if the virus would be polite enough to wait until the call is over before it tries to infect you. Overall, even a real mask would be largely (though not completely) ineffective as a large-scale protection measure.

So while there's a minor benefit to wearing a mask, it seems the typical official recommendation is that you use an antiviral mask if you're in close contact with a sick person (if you're nursing a family member for instance), learn how to use it properly and make sure you really do use it all the time. If you are out and about, there is no reason to bother with a mask as the benefit is very minor.

Are masks - cheap unrated masks especially - completely pointless? No, not at all. There's several reasons to use a mask and avoiding infection is only one of them. A cheap mask won't prevent you from becoming infected but it does protect other people from you. As you breathe, cough and sneeze, the water droplets in the air mostly stay in the mask rather than spreading far and wide. And as we saw earlier the mask prevents you from touching your face. If you aren't diligent about hand-washing this can help stop you from infecting yourself.

But the most important thing about the mask is, I think, that it's a security blanket. People may know or suspect that it's nearly useless in practice, but it gives them a way to do something constructive about a scary, confusing situation they have no control over. It lets people control their fear, and it gives them the confidence to go outside and conduct their daily lives without being paralyzed by fear and uncertainty. The mask is also a signal to others. It shows them that you're mindful of the situation, careful and conscientious. You're wearing a mask so you're probably doing all those other protective measures you're supposed to and thus you're safe to be around. Masks may not slow or stop the spread of virus, in other words, but they may well slow or stop the spread of unfounded panic. And that may in the end be more important than the virus itself.


#1 Note those "seems" and "I think" in the text: I'm not a medical professional of any kind. I've never studied medicine and I have no more or better information than the average twelve-year old. I have no idea what I'm talking about. This post does not constitute medical advice. Do not depend on information here for any medical decisions. This post may contain information that is outdated, misrepresented or outright wrong. Do not read this and drive at the same time. Keep out of direct sunlight. If a rash, lower back pain, headache or a serious case of death occurs during reading, please consult your physician. Do not mix with isopropanol. Do not eat. Do not cover. Duck and cover. The satanic messages you think you hear when you read the text aloud backwards are just an illusion. Lift with your knees, not with your back. The backstroke is possibly the most scenic of swim styles. You have to be this tall. Void when wet.

#2 It's the one right above.

#3 See footnote #12.


  1. The gargling has always amused me. I had to contact the The Swedish Institute for Infectious Disease Control (Smittskyddsinstitutet) to get their view. According to them gargling doesn't really help in other way than making your throat not feel dry. The only way they could think of it being slightly useful is if you gargle in some antibacterial liquid, but even that was highly unlikely.

    Most likely the bacteria/virus had already entered your body.

    It would be intersting to hear a Japanese professional virologist view too.

  2. It's not completely ineffective. At least the gargling liquid I've come across is actually antibacterial (iodine-based I believe) and it is supposed to clear the mouth and upper throat pretty well. I've gotten it after dental surgery for instance. And since bacteria and viruses end up all along the respiratory pathway, and as the risk of infection is proportional to the amount that enters your body it does sound reasonable that it would lessen the risk.

    "reasonable" and "established fact" are different things, of course. But a quick literature search does seem to show that preventative gargling lessens the risk of respiratory infections. But see footnote #1.


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