Avoiding Cross-infection during a Disease Epidemic

We talk about a range of possible disasters at Prep-Blog, from everyday emergencies, to natural disasters, to long-term SHTF situations. But most prudent and reasonable preparations that you make for any situation will be helpful across a wide range of potential disasters, small or large. That is true also in preparing for a disease epidemic. Preparations that work for a relatively minor ‘epidemic’, such as the typical flu outbreak that occurs yearly (in winter) in the U.S., will also work for a major disease epidemic.

How bad could it get? The CDC keeps a Seasonal Influenza, Flu Activity & Surveillance Page here. The winter of 2009-2010 was particularly bad, due to the H1N1 influenza virus, with 282 pediatric deaths (just the kids who died of flu), whereas the most recent completed winter of 2011-2012 had only 34 flu-related pediatric deaths. If the yearly flu season becomes worse than usual, you can check the CDC for the most recent information on which States have the most cases and how many persons are affected.

What is the most severe disaster that is most likely to occur in any nation? I would suggest that it is a severe disease outbreak. In my previous post, Which Natural Disasters Are The Most Deadly?, I point out that, in recorded human history, communicable diseases have killed more persons than all other natural disasters combined. And in the last 100 years, disease epidemics have killed more persons than any other type of natural disaster.

How might we prepare?

The biggest issue is avoiding cross-infection. If the latest version of the flu (influenza) is particularly deadly, your first defense is not to catch it at all.

“Influenza virus may be transmitted among humans in three ways: (1) by direct contact with infected individuals; (2) by contact with contaminated objects (called fomites, such as toys, doorknobs); and (3) by inhalation of virus-laden aerosols.” (Influenza virus transmission)

The most effective ways to avoid infection are relatively simple and inexpensive:

1. Hands

Avoid touching any objects that might also have been touched by someone who is infected. Shaking hands is a polite greeting, but perhaps if there is a disease epidemic, you might politely decline. Now I’m not suggesting that you turn into a real-life version of the fictional detective ‘Adrian Monk’. But if and when the next severe flu or other communicable disease outbreak occurs, be reasonable and prudent. Survival takes precedence over social convention.

Wash your hands repeatedly throughout the day. You don’t necessarily need to use anti-bacterial hand soap (though I would), because a thorough washing with ordinary soap will be sufficient. Avoid drying your hands on a towel used by other persons, who might be infected. If hand washing is not an available option, use an alcohol-based hand sanitizer.

Is it really true that hand washing will prevent infection? Or is this the unsubstantiated opinion of preppers? Well, the U.S. Centers for Disease Control has a web page that I think answers the question quite definitively: Handwashing: Clean Hands Save Lives.

“Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others. Many diseases and conditions are spread by not washing hands with soap and clean, running water. If clean, running water is not accessible, as is common in many parts of the world, use soap and available water. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands.”

See the CDC webpage for some instructions on how to wash your hands properly to avoid infection.

2. Breathing

Another common mode of infection is by air-borne disease. A sick person coughing will expel some bacteria- or virus-laden particles. You can become infected by simply being in the same room as the sick person. The longer your exposure time, the more likely you will contract the disease, if it is a type that is spread by air.

In some Asian nations, wearing surgical masks is fairly common. People who have an illness that is air-borne, like the flu, will wear the mask when they go out in public, as a courtesy to others. This social convention is very helpful in crowded cities, where diseases spread more easily. The more people who live and work in close proximity to one another, the faster a disease will spread.

However, common surgical masks really only help if the person wearing the mask is infected. It does little to prevent the wearer from becoming infected by someone else. For that, the type of mask to buy is called “N95.” This type of mask is not called a surgical mask, but a “particulate respirator.” The N95 is designed specifically to protect the wearer against airborne diseases from other persons. So if there is a disease epidemic, and you wish to decrease your risk of airborne infection, this is the type of mask to use, not the surgical type. Buy yours now, before a disease outbreak. When the H1N1 was a well-publicized threat in 2009, stores sold out of N95 masks fairly quickly.

Unfortunately, the N95 mask is uncomfortable to wear. It is a rigid mask that fits over the mouth and nose. Air does not move as easily through this type of mask, which is what makes it effective as well as uncomfortable. So you are storing that item for use in severe cases, during a particularly unusual and deadly outbreak. Otherwise, the better option is for anyone in your family who is infected to wear the soft and comfortable ordinary surgical mask, to decrease the possibility of cross-infection of an air-borne disease to other persons.

3. Proximity

The amount of time you spend in close proximity to other persons, especially outside of your immediate family (or roommates), and the number of persons, have a strong effect on how likely you are to contract the flu or another air-borne communicable disease. If one in 1000 persons are infected with a version of the flu, and you are exposed to 25 different persons per day — such as on the subway or in crowded public locations — your risk of infection rises steadily as the days and weeks pass. Reducing your exposure to other persons, especially random strangers in public, will reduce your risk.

This measure can be difficult to implement. If your job requires contact with the general public, you are at much greater risk than if you work at home or in a small office setting. If you have to travel on the subway to work, you have no way of knowing if some of the persons around you are infected. Crowded indoor locations are the most likely places for disease transmission. You are better off outdoors, walking on a busy sidewalk than on a subway. This highlights one of the points that Butch and I frequently mention: city living is more dangerous in almost any SHTF situation. You are better off in a suburb or a rural area.

In any case, you can probably reduce your exposure by going out to public places as little as possible, as long as the outbreak continues. Eat at home or brown-bag it to work, rather than going to a restaurant; you don’t know if any of the cook or wait staff are infected. Make a list of shopping items needed, and only go out shopping once a week (or less). Of course, if you have stored food and other resources, you can further limit the time you spend in public buying food and other goods.

If you are infected…

…be considerate of others. Wear the soft surgical mask to avoid air-borne cross-infection. Wash your hands, and don’t share towels, food, or dinnerware with others. And avoid going out in public, especially in crowded locations.

Gatoraide and similar sports drinks are good for hydration when you or a family member is ill and a doctor recommends plenty of fluids. Keep a supply of OTC medications for colds and flu. Make sure you have the resources to remain home for a week or two, if necessary, without venturing out for food or other supplies.

Keep up-to-date on the latest information about influenza (or whatever other disease is a particular concern). See your physician and follow his/her medical advice.

– Thoreau

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