Influenza - a politician's honeypot?

The Thai government has, in their kindness, decided to give cloth face masks to every school student in the country. This is supposed to be a preventative measure against the 2009 Influenza pandemic. Unfortunately it appears to be a chance for the politicians to earn a little, (or a lot) of extra gravy because the Thai government has not seen fit to provide the training or resources necessary to make best use of the masks and the masks are not fit for purpose in any case.

Let us look at a little bit of information about the 2009 Influenza pandemic, frequently referred to as Swine Flu or H1N1.

The pandemic is believed to have originated in a giant pig feed lot at La Gloria village, Vera Cruz, Mexico. The lot is owned and operated by Granjas Carroll, a subsidiary of the giant US pork producing corporation Smithfield Foods Inc. (Smithfield moved much of their pork production to Mexico to evade considerably more stringent health and safety regulations in the USA.)

The La Gloria pig lot produces almost 1 million pigs per year. These pigs produce so much faecal effluent that it can not be properly treated on site. It has to be kept in giant lagoons that frequently overflow, polluting local water supplies. The amount of effluent is so great that the company has at times resorted to atomising the faeces and pumping them into the atmosphere, frequently spreading respiratory and other infections to local communities. Our new pandemic is believed to have started as a direct result of just such an episode following a spate of pig deaths at the lot.

The first known, index case of the pandemic was a four year old boy named Edgar Hernandez from La Gloria village. Edgar recovered, but since then almost 100% of the population of La Gloria have caught the disease.

The virus is particularly virulent, easy to catch, and is spread by inhalation or contact with mucous membranes. Most sufferers have fairly mild symptoms, a fever, sore throat, a cough and sniffles. However some, with previously compromised immune or health systems, will unfortunately die. The mortality rate for people who are confirmed sufferers from H1N1 varies from country to country. Some countries report mortality rates as high as almost 4% while the world average is a little under 0.5%. The higher mortality rates are presumed to be due to most mild attacks of the flu going unreported, this is true everywhere. Overall true mortality is likely to be somewhere between 0.1 and 0.2%. Thailand currently reports mortality of almost 2%.

The H1N1 influenza virus is a particle approximately 0.12 microns diameter, and it can survive for up to 24 hours outside a host body, either in the air or on a surface, as long as it is in a moist or humid environment. When it is expelled from the host, by a cough or a sneeze, the virus is generally carried in a drop of sputum that can range in diameter from 0.3 to 20 microns or more. The size of the sputum drop is important because it affects the manner in which the spread of the influenza can be controlled.

Influenza protection

To best ensure safety from influenza in a school, or other community, the following precautions should be taken:

• General measures.
  Proper hand washing is the most important factor in preventing transmission of disease. Hands can be washed with water and antimicrobial hand soap. If hands are not visibly dirty, an alcohol based hand cleaning solution or hand wipes can be utilized. Hands should be washed at least once per hour, before and after performing cleaning tasks and every time a person coughs or sneezes.
  Avoid touching eyes, nose, mouth or genitals. Wash hands if you do so.
  A constant supply of tissues is essential. If anybody coughs, sneezes or needs to clear their throat or nose it should be done into a tissue and the used tissue immediately discarded into a receptacle reserved for the purpose. Hands should be washed immediately afterwards.

• Face Masks.
  Face masks are of very little use as general protection against the influenza virus and may well increase the danger of passing it. All masks have a very limited effective usage period, ranging from about 30 minutes or so for the standard cloth mask up to a few hours for an N95 certified mask with activated carbon filter. (N95 are so called because they are certified to catch approximately 95% of particles of 0.3 microns.) For best safety, all masks should be N95 certified. Unfortunately most cloth masks, unless they are three layer finely woven silk with cotton filling, are little use unless the particles are 50-100 microns or so in size.
  Masks need to be used correctly if they are to have any efficacy. They should only be used if an infection is suspected and should be replaced before their period of efficacy is over.
  A damp mask, or one used past the safety period will become a reservoir of infection to be passed to anybody who touches it. Used masks need to be handled with care, using latex gloves, and disposed of under biohazard safety conditions, or sterilised for re-use with boiling water or a soak in antimicrobial solution containing alcohol or bleach

• Body temperature.
  All pupils or community members need to have their body temperature monitored on a regular basis. This is most easily and safely done in a large community by using standard infra red technology however any workable method should be used.
  If somebody shows an abnormal rise in body temperature, he/she should immediately be quarantined in a room set aside for the purpose and be taken to visit a doctor as soon as circumstances permit.
  When in quarantine, the pupil should wear an N95 certified face mask to catch sputum droplets. Any person entering the room or coming within 1 meter of the patient should also wear an N95 certified face mask, latex surgical gloves, eye protection and a disposable plastic coat.

• Premises.
  All surfaces likely to be touched by community members need to be sterilised on a regular basis by spraying and wiping with an antimicrobial solution containing alcohol or bleach. These include counter tops, door knobs, stair banisters, tables, chairs, desks, elevator buttons and panels etc. Computer keyboards and other sensitive equipment should be fitted with plastic covers that can be sprayed and wiped.

• Air conditioning.
  Rooms with air conditioning should be fitted with N95 certified sheet filters and have the temperature set low. Virus particles will be caught by the filter, and if they pass through, will be taken out of the air by the dehumidifying process of the air conditioner and will be pumped safely outside and away with the drops of water and sputum removed during the cooling and dehumidifying process. A cool room temperature will also help in early identification of those with a rising fever.

The Thai government must be fully aware of all these measures as promoted by the WHO, the CDC and health authorities throughout the developed world. Why have they thrown them out of the window and reccommended almost the exact opposite behavior. Could it be that a member of said government has a fiscal interest in the face masks that are being distributed. Thailand's history of "transparency" would seem to indicate the probability that this is the case. We await the scandal likely to erupt in a few months time.

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Note: Several companies manufacture N95 certificated filter masks and rolls of filter material. 3M is possibly the most widely distributed, but Japanese and European companies are competing in the market. A good 3M disposable N95 certified mask sells for about US$1.00 and can be sourced directly from 3M or found on sale at many home improvement centres.