Which Tool in the Toolbox?
In other words, no one knows whether H5N1 or another virus is going to cause the next pandemic, because viruses appear to follow no predictable pattern as they spread and jump species. For example, the avian influenza virus H3N8 jumped from birds to horses in 1963 and then to dogs—but not until 2004.
Which tools to use for each unique and dynamic infectious disease threat always seems to be a subject of controversy for each threat we face. In the midst of the 2009 H1N1 threat, the CDC changed its formal recommendation for healthcare worker protection against the virus from requiring surgical masks for “barrier protection” from large sprays or droplets, to a recommendation for the use of N95 respirators to protect against airborne, respirable transmission. This change was prompted by the uncertainty of how the H1N1 virus may be transmitted – direct large particle droplets or surface-to-hand-to-mucosa (eyes, nose, mouth, etc) versus airborne transmission of small, inhalable particles. This policy change resulted in immediate N95 respirator supply shortages with backorders of up to two years. Similarly, surgical mask demand skyrocketed globally and manufacturing capacity was tapped out as orders were filled on a first-come-first-served basis, regardless of global origin of demand: a global free-for-all.
As we see today with healthcare worker protocols surrounding the Ebola virus, there is continuous suspicion and uncertainty surrounding best methods to assure protection against and containment of a virus that is not fully understood and may be undergoing genetic mutations in its mission to survive. This underscores the need for broad-based domestic agility and preparedness to respond to changing infectious threat dynamics.