Supply v Science
At the height of the 2009 H1N1 threat, in a conference call between mask and respirator manufacturers and officials from HHS, it was acknowledged by Strategic National Stockpile officials that public health policy must be constrained by commercial supply of masks and respirators and cannot be dictated strictly by the science of infectious disease transmission. This meant that while healthcare supplies were in short supply there could be no consideration of formal CDC recommendations for the use of masks and/or respirators for use by the general public or other non-healthcare segments. There simply wasn’t sufficient supply to support such policies.
In a Homeland Security committee hearing, then New York City Health Commissioner Peter Farley acknowledged that in a pandemic event, public transit systems would not be shut down and that there would likely be infectious transmissions occurring in those crowded settings.
Would mask or respirator use by the general public be recommended in such a scenario today even with scientific evidence to support their use? With limited U.S. supply, regardless of the science, the answer is certainly a resounding “no”. A “Cover your Cough” campaign will be the only defense.
Similarly, the New York City transit authority had previously purchased $1M worth of N95 respirators in preparation for the threat of an H5N1 (bird flu) event. When the H1N1 virus threat emerged, transit officials acknowledged that they couldn’t, or wouldn’t, distribute those respirators to bus drivers, train conductors, etc. because they would spur public panic and further contribute to respirator shortages by driving increased public demand when there was already an insufficient supply for healthcare workers. Again, supply concerns hampered thoughtful policy.