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Pdf Disasters Issue 130 Oct2020 Horwell Supplement on Health Disaster Risk Reduction News and Information for the International Community ISASTERS Preparedness and Mitigation in the Americas October 2020 Issue 130 silicosis [1]. Due to these uncertainties, a precautionary approach is usually taken, so humanitarian agencies will often distribute facemasks to protect communities. Research led by Prof Claire J. Horwell (Durham University, UK) has, for the first time, investigated the effectiveness of dif- ferent forms of respiratory protection for community use in volcanic eruptions. The project, ‘Health Interventions in Volcanic Eruptions’ (HIVE), involved laboratory test- ing of the efficacy of different facemasks and wearability trials in communities affected by volcanic ash. Social surveys and inter- views, in Indonesia, Mexico and Japan, were Photo: Tri Wahyudi, Yogyakarta, Indonesia, Yogyakarta, February Wahyudi, 2014. Tri Photo: Street children were given free masks during the 2014 Kelud eruption. also implemented to explore behavioral and socio-cultural dynamics that influence the Preparing for, and protecting communities use of respiratory protection, and how to from, respiratory exposure to volcanic ash tailor effective messages on protection. An evaluation of the ethics of agencies distribut- round 10% of the world’s population emissions include volcanic ash (particles of ing low-quality respiratory interventions was Alives near a historically active volcano. fragmented magma less than 2 mm in diam- also undertaken. When a volcano erupts, there may be criti- eter), aerosols and gases. The research findings have already influ- cal dangers for those caught in the explosive Inhaling fine-grained ash can cause irri- enced agency decision making in several force of the eruption (for example, lateral tation in the respiratory tract (rhinitis, sore eruptions, including the eruptions of Agung, blasts, ballistic ‘bombs’ and pyroclastic den- throat, cough) and can exacerbate existing Indonesia (2017; see Case Study at the end of sity currents). However, by far the most respiratory diseases like asthma, bronchi- this article), Fuego, Guatemala and Kīlauea, wide-spread hazard is airborne emissions, tis and COPD [1]. It is still not established Hawaii in 2018. A suite of PAHO-endorsed carried by winds over hundreds to thou- whether long-term exposures can trigger public information products, co-designed sands of kilometers from the volcano. These respiratory diseases like lung cancer and with communities, are available online. Editorial ajor explosive eruptions are infre- air over such prolonged periods. airborne ash may add to the acute risk. Mquent, even in countries like Wholesale removal of ash deposits is Inhaling mineral dusts containing crys- Indonesia that are well populated by active essential to reduce exposure in these crises talline silica may worsen the prognosis in volcanoes, yet their ash falls can impact on if only to allow normal life to resume, and pulmonary tuberculosis. Within the last few many thousands of people living in their the huge task will involve the whole com- years, scientific opinion has veered towards vicinity and occasionally much further munity as well as municipal workers and attributing the adverse health effects of afield. Mount St. Helens, in the US, spurred their equipment. Exceptionally high expo- PM2.5 in traffic-related air pollution to all a revolution in risk reduction measures in sures to airborne ash over weeks, and even forms of PM2.5, regardless of its source. volcanic crises when it erupted in 1980, months, are inevitable and individual wear- Epidemiological studies on ash emissions leaving its ash covering central Washington ing of respiratory protection will be needed are too few to know if this applies to vol- State. From that iconic disaster, we learned to protect families and outdoor workers as canic ash, but it will serve to add to public that massive clouds of fine ash mobilized a top priority. anxiety in a crisis. from ash deposits by wind and traffic will Prior to the urgent investigations at the For almost two decades the IVHHN severely limit visibility and disrupt all Mount St. Helens emergency, natural min- (International Volcanic Health Hazard forms of transport for days in the absence eral particles like volcanic ash were thought Network) website has been a worldwide of rainfall, and expose whole populations to be inert. But the finding that 90% of the resource keeping us updated on the latest to dramatically high concentrations of an ash particles were less than 10 µm in diam- research on volcanic ash and the health inhalable mixture of very fine and coarse eter, enabling them to be inhaled into the mitigation measures that are available. This ash particles in the air. Invariably, such upper and lower airways, created alarm Supplement is a summary of the first inter- high exposures continuing over weeks or over the potential to exacerbate pre-existing national study to evaluate different masks even months, 24 hours a day, after explo- lung disorders such as asthma and bronchi- and other face coverings in filtering out sive eruptions, not only interfere with every tis and to harm sufferers with chronic lung fine ash particles, together with findings aspect of indoor and outdoor living, but disease. The concerns bordered on panic on their wearability and acceptability in raise major anxieties concerning the harm when the mineral crystalline silica, the different cultural settings. Accompanying to health from breathing the contaminated cause of the occupational disease silicosis, educational materials published by IVHHN was found to be present with implications include leaflets available in several lan- for the risk of exposure to children and guages showing how to fit a facemask and adults in the community. In the eruption of advice on the gamut of measures to protect the Soufrière Hills volcano, on the island of against exposure to volcanic ash and not to Montserrat, which began in 1995 and lasted rely on mask wearing alone. over ten years with intermittent ash falls, Finding the right respiratory pro- the concentration of the mineral was high tection has risen to public prominence in enough to be a factor in decision making other health crises stretching from wildfires on whether or not to evacuate the island in California to forest burning in Indonesia, community. not to mention the COVID pandemic. This Globally, childhood mortality from project could not be more timely. pneumonia is elevated in many low-income Peter J. Baxter MD, Cambridge Institute Photo 81641053 © Etvulc | Dreamstime.com Photo countries and grossly raised exposures to of Public Health. University of Cambridge, UK. 2 October 2020 Issue 130 To test the effectiveness of different The effectiveness of respiratory protection types of respiratory protection at filtering volcanic ash, laboratory tests of filtration efficiency (FE) and ‘total inward leakage’ (TIL) (a measure of mask filtration and fit, on volunteers) were conducted at the Insti- tute of Occupational Medicine, Edinburgh, UK. Seventeen different types of protective materials were sourced from communities living near volcanoes, ranging from indus- try-certified (N95/N99-equivalent masks – FFP2/3) to hijabs, shawls and bandanas. The most effective facemasks for filter- ing ash, and for fit, were shown to be N95/ N99-style masks [2, 3] (Figures 1 & 2). Sur- gical masks, often provided by responders Figure 1. Results from FE tests showing that industry-certified masks offer almost 100% FE whereas sin- [4], had good filtration but did not seal well gle-layered cloth offers much less filtration. The amount of filtration also depends on the types of particle: Sakurajima and Soufrière Hills are different samples of volcanic ash; Aloxite is a non-toxic analogue dust to the face [2, 3] although adding an extra also used later in the TIL volunteer trials. layer of cloth (a bandage, in this study), tied around the head on top of the mask to Mask Type Mask Type Features Leakage Filtration Notes better secure it to the face, did reduce the Nose clip, elasticated Industry-certified Not very leakage. Many cloth materials provided lit- head- straps, < 10 % > 99% (N95/FFP2) comfortable tle to no protection [2]. foam/rubber edge seal The laboratory studies also showed that No way of folding cloth into several layers increased adjusting fit Very ‘Flat-fold’ (‘3D’) and not clear filtration (but not to the level of a surgical 35% > 98% comfortable mask (Japan) which orienta- but ‘flimsy’ mask) but that wetting cloth/masks did not tion it should be worn help with filtration [2] (Figure 1). The laboratory volunteers, and local Cheek and chin ‘flaps’ which PM2.5 surgical Quite volunteers who tested mask wearability, fold out. Nose 22% 98% mask (Japan) comfortable clip, stretchy near Sinabung volcano, Indonesia, agreed ear loops that N95-equivalent masks were not very Nose clips, comfortable to wear [3, 5]. Poorly-fitting Quite Surgical mask stretchy ear 35% ~ 90% comfortable (and, hence, less effective) masks were con- loops sidered more comfortable but the addition Closes gaps of a piece of cloth, to help with facial seal, Surgical mask + Not around the face 24% ~90% + ? bandage comfortable was not comfortable. There is, therefore, a balance to be struck between the effective- Figure 2. Summary table of filtration efficiency (see figure, above) and Total Inward Leakage. The most ness and comfort of facemasks. efficient mask had the lowest leakage. October 2020 Issue 130 3 Photo: Boy Harjanto,
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