Monday, May 14, 2007

Don't Kiss, Keep Your Distance At Work, Don't Shake Hands And Don't Let H5N1-Friendly Children Sneeze In Your Face

US Government Guidelines Vague On Benefits Of Face Masks To Stop H5N1 Infection

Don't Call It 'Quarantine', Call It 'Social Distancing'

Illustration by Joon Mo Kang, from the New York Times

While most other countries are stockpiling vast reserves of paper and cloth face masks in anticipation of a global bird flu pandemic, new guidelines issued by the US Health Department are vague, at best, on whether such masks will actually stop people from becoming infected with the virus.

The guidelines spell out a clear agenda of preparing the state governments and local councils and authorities to get used to the idea that in the event of a pandemic, public spaces - including schools, cinemas, work places, train lines - will be shut down. If state or local councils refuse to do so, President Bush now has the authority to federalise the National Guard to shut down any place deemed to be likely to encourage the spread of the H5N1 virus through the human population.

Further down, you will find excerpts from an early 2006 New York Times article about how Americans will need to stop kissing and shaking hands, if or when the dreaded pandemic breaks out.

From the New York Times :

Part of the hesitation (about recommending face masks), officials said, is that even though common sense says masks protect against flu germs, there is little scientific data proving they do.

“If there were a fail-safe, perfect solution, we’d recommend it absolutely,” said Dr. Michael Bell, chief of infection control for the national preparedness center at the C.D.C. “But there isn’t a crisp, hard guideline. It’s not like a seat belt, something you should wear at all times.”

Also, officials fear that if millions of nervous citizens rush out to buy masks, that will create shortages for health care workers, who need them more.

“I would not like people to stockpile to the extent that they’d cut off the supply to hospital workers,” Dr. Bell said.

The guidelines released yesterday re-emphasized earlier suggestions that in a pandemic, people should shun crowds, avoid close contact with anyone at work or school, and stay home if they are sick, or anyone in their household is sick.

They should also wash their hands frequently, use hand sanitizers and cover their noses and mouths when coughing or sneezing.

Masks are most useful, said Dr. Julie Gerberding, director of the disease control centers, when placed on people who are already sick — to keep in droplets from their sneezes and coughs. They are also important for health care workers or family members tending anyone with flu, especially during potentially dangerous procedures like giving nebulizer treatment to an asthmatic child or suctioning a patient with a chronic breathing problem.

But, Dr. Bell said, “they do provide some protection, for example, during that unfortunate moment in the grocery store line when some little kid sneezes in your face.”

An extremely revealing comment from a Parisian on the psychological benefits of face masks :

Dr. Didier Houssin, chief medical officer for flu at the Paris Hospital Center, said at an avian flu conference in February that his country’s emphasis was “not so much from medical reasons as from psychological and political reasons.”

Political reasons? As in appearing to provide ways of stopping the pandemic spread, when the reality may be that it is very difficult to do so?

Dr. Jeffrey Levi, executive director of Trust for America’s Health, makes a very good point that face masks should be made in smaller, children's sizes, as the 'seal' of the mask over the mouth and nose must be tight to be even moderately effective.

The H5n1 virus has, so far, killed no-one over the age of 40 years old, with children under 10 being particularly vulnerable. At least as far as the reported deaths and infections so far would indicate.

Something I didn't know about the vulnerability of face masks :

...masks can become contaminated by sneezes and soggy on humid days, and it is unclear whether changing them carelessly is more dangerous than not wearing them.
They also require a lot of “social engineering,” Dr. Bell said. If they are recommended only for the sick, for example, everyone may avoid them because it marks a person as infectious.

'Social distancing' is probably the most chilling new term of government-speak I've heard in many years. What does it mean? Exactly what it says. In social situations, keep your distance. No kissing, don't shake hands and stand a few good feet back from your work mates or people in your local grocery store. Which may turn out to be extremely difficult to do. How do you practice 'social distancing' on the subway? You don't. That's why the government will shut them down if, or when, a bird flu pandemic breaks out.

Have you tried out the 'elbow bump' yet, as an alternative to shaking hands?

From New York Times :

To the pantheon of social arbiters who came up with the firm handshake, the formal bow and the air kiss, get ready to add a new fashion god: the World Health Organization, chief advocate of the "elbow bump." If the avian flu goes pandemic while Tamiflu and vaccines are still in short supply, experts say, the only protection most Americans will have is "social distancing," which is the new politically correct way of saying "quarantine."

But distancing also encompasses less drastic measures, like wearing face masks, staying out of elevators — and the bump. Such stratagems, those experts say, will rewrite the ways we interact, at least during the weeks when the waves of influenza are washing over us.

...the social revolution is likely to focus on the most basic goal of all: keeping other people's cooties at arm's length. The bump, a simple touching of elbows, is a substitute for the filthy practice of shaking hands, in which a person who has politely sneezed into a palm then passes a virus to other hands, whose owners then put a finger in an eye or a pen in a mouth. The bump breaks that chain. Only a contortionist can sneeze on his elbow.

...other likely steps will strike at things New Yorkers are loath to give up. Dr. Isaac Weisfuse, the deputy city health commissioner in charge of avian flu preparation, said his first move would probably be to ban Major League Baseball games, Broadway shows, movies, parades and other large gatherings.

Closing schools or shutting the subways might be even more effective, because children are much more efficient than adults at spreading flu, and subways are enclosed spaces where sneezes linger in the air — but doing that would be harder to pull off, Dr. Weisfuse said.

"People talk about 'flu days' like snow days," he said, "and if it was just days or a week, that would be simple. But if it's weeks or months, that becomes another matter." Without mass transit, no one gets to work and the economy collapses, he pointed out, and many poor children depend on the free breakfasts and lunches they get at school.

The government of Taiwan...three years ago during the SARS epidemic...ordered everyone who had a cough or fever, or who cared for a family member or patients who did, to wear a mask if they ventured outdoors. The head of Taiwan's version of the Centers for Disease Control correctly noted that studies showed that masks do much more good if the sick wear them, keeping sneeze droplets in, than if the healthy do.

But masks were rare on the streets, and the mayor of Taipei, the capital city, decided to ignore the data and pay more attention to the psychology. The sick and exposed would never wear masks, he reasoned, if it marked them as disease carriers. So he simply issued a mayoral order: no one without a mask could ride the subway. The next day, everyone in Taipei was wearing them. Within a week, they had become a fashion item, printed with logos like the Nike swoosh, the Burberry plaid and the Paul Frank monkey.

Pictures of the 1918 flu epidemic include much evidence of that sort of mass psychology. In a photograph of ranks of Seattle police officers, all are wearing masks; in one of 45 Philadelphia gravediggers digging trenches for the dead, none wear them. In a photograph of dozens of beds in a military field hospital, almost all of the patients, doctors and nurses seem to have masks — but most in the foreground have pulled them down for the photographers. People act as the group acts.

When a disease seems far away, as avian flu still does, notions like mask fashion and elbow bumping sound like jokes. But when people start dying, panic ensues, and nothing seems too far-fetched to try. In the 1918 epidemic, Prescott, Ariz., outlawed handshaking. Some small towns tried to close themselves off, barricading their streets against outsiders and telling any citizen who left not to plan on coming back. In factories, common drinking cups gave way to a new invention: the paper cup.

When you start seeing characters on popular sitcoms or television dramas bumping elbows instead of shaking hands, you will know you are in the process of being re-educated for the new era of 'social distancing'.

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