Shortage and wearing a mask: public health warnings from … 2007

The questions of the shortage of masks and the usefulness of wearing one in the community in the event of an influenza pandemic were the subject of an opinion by the National Institute of Public Health of Quebec (INSPQ) in 2007. Already, the organization warned the authorities against the risk of shortage and recommended that the wearing of the mask in the community be considered as a voluntary protection measure “to be promoted at the start of a pandemic”.
In a scientific opinion on “wearing a mask in the community in the event of an influenza pandemic” published in September 2007, the INSPQ pointed out that the avian flu epidemic A / H5N1 had reinforced the “emergency character” To prepare for an influenza pandemic.

“No one can predict when it will happen, what viral subtype will be responsible for it and how many people will be affected. However, the example of past pandemics and more particularly that of the Spanish flu are used as a basis for the development of scenarios in which a significant proportion of the population would be ill with a mortality rate significantly exceeding those found during the ‘annual flu epidemic’, the organization wrote in its introduction.

The INSPQ’s opinion focused on the different types of masks to block droplets and aerosols (procedural, surgical, respiratory type N95, paper, fabric, etc.) as well as their duration. life, their costs and their use depending on the environment. He emphasized that their use in the population, outside the clinical context, is not new.

“In 1918, although without scientific evidence, the mask (which was made of fabric) was imposed on anyone who found himself in public places in San Francisco, under penalty of fine, even imprisonment. Nowadays, in North America, one rarely meets mask users in the population […]. However, this measure has been adopted for a long time in certain countries such as Japan, ”recalled the INSPQ.

When asked “should we recommend wearing a mask in the population”, the INSPQ presented arguments in favor.

“While it is true that exposure to sick people is greater in the healthcare setting, close contact likely to occur in public transport, for example, during a pandemic with symptomatic or non-symptomatic individuals could be a reason to use this means of personal protection minimally. Properly used, the mask should be able to reduce or at least slow the transmission of the virus. This could allow part of the population to escape a first wave and save time in order to receive the vaccine against the pandemic strain, ”wrote the Institute.

Reduce social disruption and impact on the health system

This measure would also have the effect of “reducing the impact of the pandemic on the health system while reducing social disruption if this pandemic was associated with significant morbidity and mortality”.

“Based on the opinion of certain experts, it is estimated that wearing a mask in the community could help reduce transmission,” summarized the INSPQ.

The INSPQ’s recommendations were much clearer and more assertive in 2007 than have so far been those of the national director of public health, Dr. Horacio Arruda, who only recently relaxed his position on wearing mask (non-medical) in the community.

As early as 2007, the INSPQ considered that “wearing a mask in the community should be considered as a voluntary protection measure to be promoted at the start of a pandemic, while recognizing that it does not offer absolute protection”.

But there is more. As early as 2007, the INSPQ pointed out that there were difficulties in supplying masks in Toronto during the 2003 SARS crisis, “making other regions of Canada vulnerable”.

He also recalled that the masks used in Quebec were “all made in the United States, which could compromise supply to Quebec suppliers during a pandemic”.

Sourcing in Quebec

The INSPQ also indicated that Quebec distributors were working on a plan in the event of an influenza pandemic and that they sought its expertise (at the INSPQ) “in order to help them assess the needs of the Quebec population during a pandemic period for each type of mask ”.

“Some distributors are able to build an inventory representing the equivalent of one year to two full years of their sale,” said the Institute.

In 2007, the organization asked the authorities to “study the modalities to ensure that the population will have access to over-the-counter masks during the pandemic”.

“This could be done through discussions with manufacturers and distributors of masks in order to clarify their needs for public health and to know their capacity to meet the demand of the health care community and the general public during a pandemic period. Proposed the INSPQ.

The organization even recommended that steps be taken “with the Minister of Economic Development, Innovation and Export Trade so that it offers financial assistance programs allowing the industry to invest in Quebec in production of masks to ensure an adequate supply during the pandemic ”.

Cloth masks

In the event of insufficient or compromised accessibility to medical masks during a pandemic, the INSPQ obviously recommended prioritizing healthcare settings, but it also suggested considering the use of paper or fabric masks for symptomatic people and “To inform the population on the means of making fabric masks”.

In 2007, therefore, the INSPQ estimated that wearing a community mask during a pandemic was indicated not only in people in close contact with sick people, but also in those in close contact with potentially contagious individuals “because of their work with the public “or in situations of close contact” such as those encountered in public transport “.

Of course, said the Institute, two conditions must be met in order to ensure the protective effect of the mask by uninfected people, namely strict compliance with the modes of use of the different types of masks and the simultaneous use of other measures to reduce the transmission of the virus.

The organization was referring here to frequent hand washing, respect for the respiratory etiquette, disinfection of surfaces and objects as well as limiting the movement of patients. “Social distancing” and respect for the famous two-meter distance between the individuals recommended today were not among the precautionary measures put forward at the time.

INSPQ position today

As has been said, Dr. Arruda has repeatedly been reluctant to recommend the wearing of a (non-medical) mask in the community in order to reduce the risk of transmission of COVID-19. He changed his speech after various authorities in Canada and elsewhere in the world had made this measure an additional tool in the fight against the coronavirus.

The current shortage of masks has led industries and seamstresses to start manufacturing fabric masks. On the internet and social networks, methods of handcrafted masks have started to circulate.

On April 7, the INSPQ published a notice on the wearing of a “face cover” in the general population. It basically reads that “even if there is no evidence to prove that wearing a face covering (non-medical mask, for example a mask made of handmade fabric) in the community effectively protects the person who wears it, it could be worn in public places where it is difficult to avoid close contact with others in the hope that this reduces the risk of transmission of the virus by asymptomatic or mildly symptomatic people (symptomatic people should not exit)”.

“In no case should wearing a face cover replace the physical distancing measures currently in force,” insists the INSPQ.

Neither the INSPQ nor the Ministry of Health have so far made any suggestion or recommendation on the method, material or fabric that should be favored in the manufacture of face covers by the population.

In its opinion of April 7, the INSPQ only addresses the precautionary measures to be taken by people who decide to wear a face cover (adjust it so that it is well glued to his face, avoid touching the mask once in place, avoid touching or rubbing the eyes, change mask as soon as it is wet or soiled, etc.)

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