Every year public health officials encourage people to do two things to reduce the risk of catching the flu. 1) Get a flu shot. 2) Wash your hands! We rarely, if ever, see or hear messages about wearing a face mask to prevent the flu. It’s not something American health professionals promote. When people see someone wearing a surgical mask they shy away. It makes them a bit uncomfortable. Yet in Japan or China wearing a face mask is considered culturally acceptable, even desirable during an influenza epidemic.
Why Do People in Asia Feel Comfortable Wearing a Face Mask?
According to an article on Nippon.Com (Feb. 11, 2016), the custom of wearing a face mask got started during the worldwide Spanish flu pandemic of 1918. Over 20 million Japanese people were affected and nearly 400,000 died (Emerging Infectious Disease from the CDC, April, 2007). Although the custom of wearing a face mask got started during that time, it wasn’t until the last couple of decades that it really caught on.
In Japan it is considered polite to wear a surgical mask if you come down with the sniffles whether from a cold, the flu or spring pollen allergies. People do not shy away from someone wearing such a mask. They are grateful. It is estimated that nearly one third of the population wears a mask during the height of flu season.
Our Readers Want to Know: Does Wearing a Face Mask Work?
Here is a question from a visitor to this website:
Q. I read that just breathing can spread influenza virus. Does a facemask help prevent transmission? If so, what should I look for?
A. New research suggests that an infected person can spread viral particles simply by breathing (PNAS, Jan. 2018). When hand washing is combined with facemask use, the protection from influenza is enhanced (Epidemiology and Infection, May 2014).
Here is what the investigators had to say:
“The combination of hand hygiene with facemasks was found to have statistically significant efficacy against laboratory-confirmed influenza while hand hygiene alone did not.”
Hand Washing Was Not Shown to be Effective:
Did you understand what these authors were saying? Need some clarification? Here is a more complete description of what they found:
“We examined the efficacy of hand hygiene interventions in preventing influenza virus transmission in the community. The subgroup analysis from developed countries suggested that a combined intervention consisting of hand hygiene with facemasks is an effective strategy to prevent influenza, but we did not confirm the efficacy of hand hygiene alone for reducing influenza illness. This is consistent with evidence on the important role of aerosol transmission of influenza, such that interventions against contact transmission alone like hand hygiene may not be sufficient to control influenza transmission in the community.”
Still not convinced? Read on:
“The findings of this review have implications for the recommendations and guidelines of hand hygiene and facemask use in the future. Given the lack of substantial efficacy of hand hygiene identified in our review, and the increasing evidence supporting a role of aerosol as a mode of influenza virus transmission, further public health initiatives may need to re-examine the control measures for aerosol transmission. In particular, measures such as hand hygiene that focus on reducing one mode of transmission (i.e. contact) may not be sufficient to control transmission…”
People’s Pharmacy Perspective:
We apologize for belaboring this message, but it is one that seems to have eluded public health officials. Hand washing by itself is not a great (or even a very good) way to avoid catching the flu. But hand washing combined with wearing a face mask can be helpful. That’s because breathing in air is how a lot of people catch influenza.
University of Maryland researchers report that people with influenza can spread flu viruses into the air without coughing of sneezing. Just breathing is enough to “generate infectious aerosols.” If you happen to walk by and breathe those suspended tiny droplets you could catch their flu.
Which Face Mask to Buy?
Face masks are not perfect. But they are better than nothing. How do you find a good product? A surgical mask rated level three offers the best protection. In one study, nurses wearing a face mask were just as protected against the flu as nurses using an N95 respirator (JAMA, Nov. 4, 2009).
Level three surgical masks can be purchased online for a reasonable price.
Share your own experience with wearing a face mask in the comment section below. Is this something you would consider? If not, why not? Do you think we will ever embrace the Japanese style of waring a face mask as a polite thing to do?