Masking the flu - could it go viral?
As I sit in a coffee shop amongst the coughing, sneezing and spluttering, I am wondering whether they realise they are acting as vectors for a range of undesirable and dangerous germs.
With the Australian H3N2 virus being the latest threat, the number of cases of people suffering from this nasty pathogen is beginning to swell.
According to UK government data there were 1,111 confirmed diagnoses in the last week of December (mostly H3N2). This strain mainly affects older people, those with long-term health conditions, pregnant women and children a.k.a. vulnerable groups. Hospitals are now reporting near full bed capacity as the number of cases rose by 67% between Christmas and New Year bringing the number of symptomatic adults to over 3 million. Alarmingly the current flu vaccination does not appear to be effective in the over 75 age group.
The incidence of influenza like illnesses (ILI) can be tracked using FluSurvey from Public Health England and the London School of Hygiene and tropical medicine.
The rates of infection and the effect on health services is considerable. A report from GSK identified that ‘seasonal influenza affects all age groups and causes considerable morbidity and mortality (UK):
- 779,000 – 1,164,000 GP consultations per year
- 19,000 – 31,200 hospital admissions per year
- 18,500 – 24,800 deaths per year
So, anyone going into a public space knowing that they are a biologic hazard is being less than responsible. The use of a handkerchief seems to be considered an act of weakness; much better to disperse germ laden phlegm around with a randomly aimed sneeze or via transfer from an insignificant barrier such as a hand.
It would be nice to see more proactive behaviour to reduce the spread of influenza (and other respiratory damaging agents). Getting a flu shot is a start, especially as it is free to most people (those at risk need to be prepared against inconsiderate fellow humans, pigs, chickens, birds etc.), mandatory use of handkerchiefs (clean) and self isolation at the first signs of infection. But having a flu jab does not mean one cannot spread the virus. So, caution needs to be maintained.
Our NHS is under severe pressure both in primary and secondary care. This problem is exacerbated with the annual influenza burden.
The burden on society of flu driven respiratory illness is considerable. Consider the follow:
- Impact on individual and family suffering – morbidity and mortality
- Direct and indirect costs to the health service
- Impact on organisations and businesses of absenteeism due to infection – from the workplace or elsewhere – and the consequential loss of productivity
I was particularly struck when visiting Japan, just how normal the sporting of face masks was. Here is a truly considerate society.
The simple act of wearing a surgical mask is culturally acceptable. Indeed, not to do so when possibly infectious, is considered seriously anti-social. Antithetically the mortality rate of influenza and pneumonia (a complication of flu) in Japan (ranked 84th in the world with 32.07 deaths per 100,000 people) is higher than in the UK (ranked 102nd in the world with 23.43 deaths per 100,000). [Source WHO]. Why this so I know not, but population density may play a role. But….
Masks work
A trial published in 2008 in the International Journal of Infectious Diseases showed that:
‘In an adjusted analysis of compliant subjects, masks as a group had protective efficacy in excess of 80% against clinical influenza-like illness.’
Source: https://www.ijidonline.com/article/S1201-9712%2808%2901008-4/fulltext
Note the word ‘compliant’. Apparently, we don’t understand how to use masks effectively. Come on people, get a grip.
In another study published in the Annals of Internal Medicine in 2009, the authors concluded that:
‘Hand hygiene and face masks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that non pharmaceutical interventions are important for mitigation of pandemic and inter pandemic influenza.’
https://annals.org/aim/fullarticle/744899/facemasks-hand-hygiene-prevent-influenza-transmission-households-cluster-randomized-trial
What could we do?
Anti virus face masks are cheap and no doubt the NHS could get a good deal on, say, 30 million of them. Getting people to wear them (and wear them properly so that they are effective), might be a bit harder. I suggest three things could be done to minimise the transmission of harmful pathogens.
- Start shaming people into wearing a mask if infectious. Use social media to encourage the wearing of surgical masks. Young people (some of the worst vectors) like to be different and are mostly unencumbered by social embarrassment. They are willing to engage in causes and can aim to permanently normalise this cultural shift. So, let us encourage them to be the anti-snivelling vanguards. Encouraging the young to sport surgical masks at home, at work, at schools and on university campuses would be a start. A programme to attract sponsorship from businesses and organisations could help cover costs and demonstrate corporate responsibility.
- Encourage organisations responsible for public places (airports, stations, shops) and workplaces to provide free face masks to employees and visitors. Businesses and organisations stand to benefit considerably if a reduction of absenteeism and productivity loss can be achieved.
- Take it to the people. Over 10 years ago the UK government organised the ‘Ask About Medicines’ campaign. For one-week pharmacists were lured onto train stations to encourage commuters, axiomatically, to ask about their medicines. Repeating this model in the run up to the flu season, using volunteers and students to distribute sartorial surgical masks at train stations and airports may help reduce spread of infection.
The educational value of such an exercise would also be valuable; to educate folk on what they are doing when they spread respiratory viruses. Free flu jabs could even be offered at the same time.
Ideally we need to get to the tipping point where conducting germ warfare is seen as socially irresponsible.
We could start at major train stations around the UK (and in Australia please) especially Waterloo station in London. Mostly because I go there often and the contamination on inbound trains is palpable.
So, if you know anyone at the Department of Health, Public Health England the NHS or know the Chief Medical Officer or Chief Pharmaceutical Officer, perhaps you could offer up this suggestion.
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Resources:
FluSurvey: https://flusurvey.org.uk/en/results/
Mortality statistics: https://www.worldlifeexpectancy.com/cause-of-death/influenza-pneumonia/by-country/
Merck Manual: https://www.msdmanuals.com/home/infections/viral-infections/influenza-flu
NHS Choices: https://www.nhs.uk/conditions/Flu/
Keep Me Informed: www.keepmeinformed.eu
Information on flu impact: https://hcp.gsk.co.uk/therapy-areas/influenza/disease-burden.html