September 02, 2005
France Prepares For Avian Flu Pandemic

France is taking bigger steps than most Western countries to prepare for a potential avian flu pandemic.

French newspaper Liberation said the government had already acquired 5 million doses of the antiviral drug Tamiflu, produced by Swiss pharmaceutical giant Roche, and was planning to raise the level to 14 million by the year end.

France has a population of over 60 million people. Not all the population would get sick. 14 million Tamiflu doses might be enough if many steps were taken to reduce the rate of transmission of the flu virus.

The French government is also negotiating contracts to produce large stocks of flu vaccines. But pre-stocking flu vaccines might not work since the avian H5N1 viruses in birds are still mutating. If a viable strain emerges in humans it might look antigenically very different than any strain used now to base a vaccine on.

The French government is also purchasing a couple hundred million face masks.

The number of protective face masks in stock would be increased to 200 million by the start of next year from 50 million.

One wonders how long these masks would last. The 3M N100 and P100 masks last for 150 hours. However, most masks last for about an order of magnitude less time. Therefore individuals out in public all day would need many masks to get through the length of time of a pandemic.

Share |      Randall Parker, 2005 September 02 01:44 PM  Dangers Natural Bio


Comments
TJ Green said at September 3, 2005 4:27 PM:

Adults are infectious for about six days with influenza (one day before symptoms appear,and five days after). Children remain infectious for two weeks with influenza. We must isolate infected children for at least two weeks.

Factory said at September 3, 2005 5:55 PM:

Hmm the masks are prolly for the high risk population (ie. medical staff), it's prolly far too expensive to get masks for the whole population.

Matt said at September 3, 2005 9:56 PM:

I got 5 NanoMasks here with loads of filters just incase :) heh.

Dave Schuler said at September 4, 2005 5:11 PM:

Randall, I read the CDC study as suggesting that the N100 would not be effective in preventing viral infection. Am I mistaken? Just looking for information, not challenging you.

Randall Parker said at September 4, 2005 6:07 PM:

Dave,

Nothing is 100% effective. If you get coughed on and viruses land on your eyeballs they might get into you that way. I'd also suggest eye protection as well. But I'm curious to know what about your interpretation led you to that view. Their core result section says:

During the tests, the median ambient concentration of 0.02 to 1 µm particles was 7,650/cm3 (range 3,980–29,200/cm3). Results of the filtration capacity of the three devices are shown in the Table. In all tests, the N100 mask filtered significantly more particles than either of the surgical helmet-hoods. During testing, a half-face respirator, such as the N100 mask, should reduce the particle count by a minimum of a factor of 100 (11). This minimum standard was exceeded with the N100 mask for all participants. The greatest particle count reduction achieved with a surgical helmet-hood was a factor of 4.8.

A factor of 100 reduction sounds good to me.

Keep in mind that the immune system does have some limited ability to fight off viruses that it does not have an exact antibody-antigen match for. A decreased dose of virus due to filtering gives your innate immune system and physical barriers such as mucus a greater chance of preventing viruses from becoming established.

Also, you'd still need to wear gloves when in public places and avoid moving your hands to your face and avoid touching any surface that can be avoided.

Dave Schuler said at September 4, 2005 6:42 PM:

Sure. This is the part that made me conclude that the N100 would not be effective for the purpose we're talking about here:


Several caveats need to be applied when interpreting our data. First, we tested filtration of particles, not the coronavirus which causes SARS. In addition, it is impossible to be certain what size of particles the surgical helmet-hoods were failing to adequately filter, nor is it obvious which particle size is most important to filter, since many aerosolized particles will be larger than a naked coronavirus. It is therefore conceivable, but we believe unlikely, that the surgical helmet-hoods would efficiently filter coronavirus-containing particles.

Emphasis mine. Again, this isn't a challenge. I'm just trying to improve my understanding.

dearieme said at September 5, 2005 9:06 AM:

I do hope that you are not trying to solicit a comment that includes the words "France" and "chicken" in the same sentence?

Bob Badour said at September 6, 2005 12:51 PM:

I'm still waiting for the French spokesperson to come out and say: "Avian? Oh, so sorry, we thought you said Evian. Never mind."

gail said at September 18, 2005 6:36 AM:

Hi All,

Im trying to work out what masks work for avian flu (and sars if possible).

The info written here is not so clear to me, and what are nanomasks? I need a mask or masks to protect me for say two weeks of round the clock usage. I am prepared for this, (excluding the mask) but my mum is old and thinks its all a joke. So I need protection to look after her if she ignored my stay at home warnings... and gets it.

Any advice would be great thanks
Gail

Randall Parker said at September 18, 2005 9:34 AM:

Gail,

See my previous post "Avian Influenza May Mutate Into Killer Human Pandemic" where in the comments section we get into a discussion of some mask models. Note how we discuss that some masks last much longer than others. I think the masks such as the 3M N100 and P100 that last 150+ hours are much more appropriate than the more common masks (e.g. the 3M N95) that are suitable for, say, a single session of surgery or a single shift in an intensive care unit.

I'm like to know about more mask models that last a long time. But at this point the only 2 I'm aware of are the N100 and P100 models from 3M.

ms Lea Board said at September 18, 2005 10:34 AM:

I have been hearing and reading about the evian flu for about six months now and I'm really concerned for my children, and everybody else too. What can we do to protect ourselves from getting this flu. Should we stop eating chicken? Should we stop buying pet birds? Should we stop our international travel? Should we all have tamiflu medicine at our disposal? I would be very appreciative if you could send me updated information on this future pandemic. Our world has certainly become a scary place for me. Thank you Ms. Lea Board

Randall Parker said at September 18, 2005 10:53 AM:

Lea,

You are very unlikely to get the flu from eating chicken.

Having some Tamiflu would help.

Right now you do not need to avoid exposure because the virus has not yet mutated into a version that moves easily between people. However, there is a pretty decent chance that it will eventually mutate to transfer easily between people. When that happens the best thing you can do is to reduce the exposure of yourself and your children to other people. Wear facial masks and gloves and avoid touching public surfaces such as hand rails, door knobs, counter tops, and even ATM machine buttons. Your own hands touching some surface and then touching your face is a route by which viruses get into your body.

Children are especially at risk because schools are the biggest location for influenza transmission. The very best thing you could do would be to keep your kids home during an epidemic. If you could afford to home school your kids and stay home and teach them yourself that would do more to protect you and them than anything else you could do.

Rrandy Fecundity said at October 7, 2005 10:25 AM:

Hi. I have read that the H5N1 is a rod shaped virus, not a crown shaped one. This might affect which filtration device works best.

Concerned said at October 8, 2005 11:40 PM:

Hi there,
I was just curious as to what your told your doctor when asking for a preciption for Tamiflu or Rezenal.
Thanks

Lloyd said at October 9, 2005 10:54 AM:

Where can I purchase the N 100 masks and approximately what cost would they be? I would appreciate any advice you may think of. Thank you for your assistance.

Lloyd said at October 9, 2005 11:29 AM:

Incidentally; Is the 8233 N 100 the same as the N 100?

Randall Parker said at October 9, 2005 12:09 PM:

Lloyd,

The best way to find the 3M N100 masks is to look on Froogle Google. Try this search pattern.

JL Brinkerhoff said at October 11, 2005 12:00 PM:

WHAT can be used for children?? Is there any masks made for small folks? I just read that masks must fit to work (that's a duh).

Michael Castello said at October 13, 2005 11:40 PM:

Why are all of you spending $10 to $50 on masks that might not help you. Consider getting a "Positive Air System". Pricey but will stop just about anything. We are talking about %50 mortality rate here you know. http://www.safetycentral.com/pappowairpur.html

Susan said at October 14, 2005 11:23 AM:

I am looking at JL Brinkerhoff's question but don't see a response. I'm wondering the same thing--what mask would be appropriate for a 9 year old child to wear??

ted said at October 21, 2005 11:44 PM:

i'm also interested in what mask might work for a child. What is recommended?

dave the knave said at October 22, 2005 11:27 AM:

it looks like no-one reading this series of comments knows if child masks exist, I would guess they are quite rare as the adult masks are probably normally used for other things.
Try tape or resizing/shaping if need be.

dave the knave said at October 22, 2005 12:54 PM:

i also thought the comment by m.castello was a bit odd/crazy. from what little i've heard, his claim of a 50% mortality rate is hugely exaggerating the lethality of the human form of avian flu. there is an estimate which some people suggest might be an underestimation - 50,000 deaths in a population of about 60,000,000 with 1 in 4 people contracting the virus works out as a mortality rate of less than 0.4% or less than 1 in 250 people who actually contract it. it. i.e. less than 1 in 1000 of the general population.
maybe m.castello has a vested interest in saying 50%? in a normal winter in the UK 6,000 people die of flu and in a bad year 20,000, so that makes this human-bird flu 10 times as viscious as a normal year or 2 to 3 times more viscious than a bad flu year.
considering that few if any precautions are taken by the general population in an average year to avoid catching flu and that if/when the pandemic happens there would be mass precaution taking, personally i don't think it's worth worrying about.

Randall Parker said at October 22, 2005 1:06 PM:

Dave The Knave,

Half of the people who have been diagnosed with H5N1 to date have died from it. Hence the 50% figure. Now, you can argue that it has been underdiagnosed and that the vast bulk of those infected and not diagnosed did not die from it. But that is speculation and there is evidence to suggest that is not true (e.g. testing of family members of those infected rarely turn up positive for infection in those who do not show symptoms.

The number in the total population that will get infected during a pandemic will obviously be far less than 100%. So even a virus that will kill 50% of those infected will not kill 50% of a population. But when the term "mortality rate" is used that is usually meant to refer to those actually infected.

As for child masks: Obviously noone who has read this has an answer. Facial masks are made for medical personnel. medical personnel are not children. Hence the vast bulk of the masks out there do not fit really small faces.

Dave the Knave said at October 23, 2005 1:41 PM:

Randall,
my apologies, you seem to have taken offence at my last postings which in no way was my intention but there have been some misunderstandings. I intended them only to be useful to worried parents. I didn't know the mortality rate of the bird flu was 50% but I wasn't talking about people who caught the bird flu, I was talking about the pandemic i.e. the human form of bird flu which is after it has mutated from the bird form in a human to the human form in a human and 'mortality rate' of course refers to those actually infected (obvious from the number calculations in the previous posting which refer to the human form of the avian flu which doesn't exist yet). I remember some relevant medical person on the tv saying that the human form is most likely to be less lethal. So for the pandemic the 50% mortality rate doesn't apply.

Randall Parker said at October 23, 2005 1:59 PM:

Dave The Knave,

No, I was not offended.

As for whether a human-transmissible form would have a lower mortality rate: Perhaps. But then again, perhaps not. The H5N1 strains out there have gotten more lethal to mice injected with them in labs since the first emergence of H5N1 as a possible human threat. Also, Tamiflu lowers lethality in mice less now than it did several years ago.

One line of scientific speculation holds that mutations to H5N1 that would make it transmit would involve lowering its ideal replication temperature so that it could replicate higher up in the respiratory tract where temperatures are cooler. Replication higher up in the respiratory tract would allow more virus to get airborne when a person coughed and hence would get transmitted more easily. The speculation is that the needed mutations would be on an enzyme that is not involved in determining lethality.

Another class of mutation needed for easier transmissibility involves how sialic acid binds to a fat, sugar, and protein. Would a mutation into the alpha 2-6 linkage style decrease lethality as it simultaneously increased transmissibility? Or not? I do not know.

But even a large decrease in lethality could still leave H5N1 as far more lethal than the 1918 H1N1 strain. If the lethality declined to 10% and 30% of the population was infected it would kill 3% of the total population or about 9 million in America or 1.8 million in Britain or France. Those are appalling numbers.

sally-mandy said at November 3, 2005 10:52 PM:

Like many others I've been wondering about a mask that would fit children. Have found the "Nanomask" site that says it fits kids. But this is a commercial site, all the information coming from the manufacturer apparently. It sounds good but I'd like some independent information on it. Does anyone have any?

Daniel Ferrer said at November 14, 2005 4:19 PM:

See my article:
"Face Masks (Respirators) as a Partial Solution to Pandemics: a Common Sense Approach"
By Daniel Fidel Ferrer. http://personal.cmich.edu/~ferre1df/PandemicsFaceMasks.htm
Reading about the 1918 pandemic clearly gives us an idea of what we are facing.
N-95 worked against SARS. N-95 face mask respirators are recommended for medical personnel by the CDC and WHO, so why not for the rest of us? The main problem with the CDC and WHO is the timeline. Vaccine will never be ready fast enough to protect us all; so face masks respirators, gloves, hand hygiene, etc. is the first line of defense against the pandemic. Nations outside of the USA are stock piling face masks, why is the USA not making practical decisions? Even ready.gov web site should stress the N-95 as the minimum standard for any kind of respirator. A couple of products for your discussion: Crosstex. See “Level Isolator Plus” is rated at PPE 99% at 0.1 microns.
http://www.crosstex.com/products/masks/ and 3M has so many different face masks it is hard to pick the best one. I like the 1835 and the 1860 is one of their standard. Also comes in smaller sizes for children 1860S. A large selection: http://www.allergybegone.com/honfilmas.html Or, the higher level is the 3M N100 8233 Maintenance-Free Particulate Respirator http://www.storesonline.com/site/603595/product/SS-RP8233. Also, we would need to increase personal hygiene. The Center for Disease Control has done a study on hand hygiene (http://www.cdc.gov/handhygiene/). As the Pandemic becomes well known, then more people will be wearing gloves. For hands, use soap for dirty hands and the CDC recommends the use of alcohol-based hand rubs and the use of antimicrobial soap. Decontaminate your hands often. A general rule is not to touch your face with your hands or fingers until after you have decontaminated your hands. You may remember the use of a blue light for storage of combs and scissors when getting your hair cut. These are germicidal ultra violet lights that kill lots of germs and are used in hospitals. These could be use for the decontamination of equipment, clothing etc.
General Notes: Avian flu current 50% mortality rate is for with care in a hospital. In our real world is could be higher or lower. The The current population of the USA is 296,669,368 people. If we lost 3%, then that would 8,900,081 people. The 3% number is the considered a very general morality rate for the 1918 Pandemic. Some additional morality rate numbers for 1918, Philadelphia was high with 7.4%, Boston 5.7%, and Los Angles was 3.3%. Although the number typical given for India was 5% of the population at the time; and hence about 17 million may have died in India during 1918-1919 from the flu. Fiji Islands the morality rate was 14% and that happen in two weeks. In Britain 200,000 died and in France the number given is 400,000, also 400,000 in Germany and in USA about 500,000. British army in India supposedly had a 12 percent morality rate and the Indian army had a 21 percent morality rate. One conclusion we could draw is population density could give us a different morality rate. We need to all keep thinking about what can we do without the vaccine to protect us and our families. I asked my daughter if she could run a bulldozers. Do you think FEMA could locate enough bulldozers? Yes, when you read the accounts of the 1918 pandemic -- burying people was a major problem. === “…often the dead remained unburied for days and even weeks because of the lack of men to inter them. City employees were used for grave digging… teams of horses were used in several cemeteries to plough trenches in which influenza victims were buried in long rows. When 140 unburied bodies crowded Holy Sepulcher Church at once, the city hired laborers — at high wages — to perform the corporal work of mercy.” (Stuart Galishoff, "Newark and the Great Influenza Pandemic of 1918," Bulletin of the History of Medicine, May/June 1964, p. 250).
Also one of the lessions learned from the SARS outbreak was a high percentage of the medical staff and doctors did not report to work. Even if you get to the hospital you might not find alot of medical staff ready and willing to help sick people. The only good news I can tell you is to use face masks respirators and do not come too close to rest of humanity for some months. Or, a very long vacation in northern Canada.


Paul Duke said at November 15, 2005 10:01 PM:

Here is an alternative point of view on anti-bacterial soaps.

http://www.webmd.com/content/article/52/50391.htm

WEBMD has another study on alcohol based rubs that concludes they are not very effective (I can't find it right now)the conclusion is that plain old soap & water is as good or better than alcohol or anti-microbial soaps. One question - the CDC hand hygiene presentation at:

http://www.handhygiene.org/

indicates NOT to use hot water. I assume that is because it opens the pores?? That is the first I've read or heard that. If fact most instructions say to use hot water. Interested if anyone else has more info on this subject.

Child masks: check out the N95 8110S (as in small)

Daniel Ferrer said at December 1, 2005 11:59 AM:

Dear Paul Duke,
I think the hot water is based on drying out the
skin too much. I think this is an issue for people
that wash their hands 40+ times a day.
Not a directly related problem of getting sick.
See what the CDC says -- http://www.cdc.gov/handhygiene/

You might also note that the Canadians are big on hand
hygiene because for documentation on droplets.
"Influenza is spread from person to person through droplets (e.g. saliva, sneezing) and by touching objects and surfaces that are contaminated with the virus (e.g. doorknobs, telephone receivers). The influenza virus may persist for hours in dried mucus and be transmitted by direct contact. It is spread very easily indoors, which is why it is so prevalent in the winter months in northern countries, when people spend more time together inside.
Measures to reduce the spread of influenza include good hygiene practices, such as handwashing after contact with the eyes, mouth, nose or secretions. Avoid handling soiled tissues or objects used by an ill person." http://www.chica.org/flu.html The masks also prevent people from touching their noise with their hands.
Thanks .. Daniel Ferrer.

Keira said at January 31, 2006 5:15 PM:

Bird flu masks for children are available from a company called SurviveAll in the UK. They are FFP3 (N100) and suit 3-10yrs of age.

http://www.surviveall.co.uk

Daniel Fidel Ferrer said at May 5, 2007 8:46 AM:

CDC has changed its mind on face masks.
Although they say, "Very little is known about the benefits of wearing facemasks and respirators to help control the spread of pandemic flu. In the absence of clear science, the steps below offer a "best estimate" to help guide decisions. They will be revised as new information becomes available."
A lot of information is known about farmers and medical works to wear respirators - why it is just a leap of 'faith' to think that respirators will protect the citizen of the world - it is beyond me. Reasoning from a medical person taking care of SARs patient or someone with flu as it is now to the jump that respirators will help the public. I do not think this is a big jump. In Hong Kong during the SARs outbreak over 50% of the public were wearing some kind of mask. Is this some secret information? No, I do not think so. The problem is that is a respirator is a good thing, and then they have deal with the problem of getting them to the citizens. That is like telling people they need to use less gasoline. True but not good news.
The 3M Particulate Respirator - 8293 P100, for example is rated now for "40 hours of use or 30 days, whichever is first" according to 3M's web site. So, that might be better than using the N-95 or N-100 that are disposable. The CDC continues with the advice, “Neither a facemask nor a respirator will give complete protection from the flu. That is why it is important to wash your hands often, cover your coughs and sneezes with a handkerchief or your arm, and avoid crowds and gatherings during a pandemic. To learn more about these and other issues relating to pandemic influenza, visit http://www.pandemicflu.gov” Wash your hands with alcohol hourly.
You can also us ultraviolet light bulbs (UV-C) to kill germs, viruses, mold, spores, fungi, and bacteria as well. UV-C is a proven form of sanitation (Germicidal Irradiation). 254 nanometers is the best. Harmful to look at UV light and UV light cannot pass through glass. Do your own research but using UV-C to clean clothes or food before you bring them into your house might not be a bad idea if people are dying around you. Wash them in to water and some alcohol too. I am not sure on the distance from the light you need to be. If you have HEPA air filters in your house (common with allegories suffers), why not leave them on all of the time until you get vaccinated. CDC speaking about “complete protection” but even vaccines will not give everyone complete protection (remember it may take up to 6 months to produce vaccines). Current vaccines for most diseases are never 100% protection. The whole point is to do whatever you can to protect your family. A combination of ways of protecting your family reduces the overall risk – perhaps it is 1% that makes the difference between your loves ones getting sick from a pandemic and not getting sick or dying. Let us hope we never have to find out how well these different types of protection work against a pandemic. On the other hand, there is some risk and so why not be prepared.
Remember in 1918 in some places it took over a week to bury people. During the Tsunami people were using bulldozers to bury people. I wonder if CDC would tell you to wear a respirators then or would they wait for a study to confirm it is a good idea. Do your best to stay protected. Daniel Ferrer.

Randall Parker said at May 5, 2007 11:55 AM:

Daniel Fidel Ferrer,

I think the CDC chose a really poor way to word their face mask advice.

Obviously face masks capture a large fraction of airborne water droplets that contain viral particles in them. So they will provide some protection.

Just as obviously, how well one handles and uses face masks will make a big difference in how much face masks help. But just because some people will handle face masks unwisely (e.g. wear one too longl touch the outer surface of the face mask while taking it off and them touch one's face with the contamination) does not mean that all will. Those willing to take professional advice and follow that advice on face mask use will reduce their risks of infection.

Now, face masks are not the only or the most important way to protect yourself from pandemic influenza. Best to stay away from other humans outside of a small group that you quarantine yourself with at the start of a killer pandemic. Also, do not touch public surfaces that others touch and wear surgical gloves in public places. But face masks will help if you have to come into contact with strangers.

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