Coronavirus

Health Care Workers Need Masks (and the Rest of Us Need Them, Too)

DIY manufacturers scramble to reduce shortages, as public health officials send mixed messages about the efficacy of broader use.

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"Everyone at this point is kind of on their own, making ready for being able to reuse―especially masks―but also things like gowns and plastic sheets to be able to keep our barriers when we're doing difficult procedures with patients," says Case Newsom, an emergency medicine doctor based in Denver. 

Doctors around the country are running dangerously low on N95 masks, which protocol says they should wear and then dispose of every time they walk out of an infected patient's room. So they're reusing the same masks repeatedly and learning to sew their own surgical masks.

"My colleagues on the East Coast…are facing significant shortages," says Newsom. "So they're busy at work creating UV decontamination ovens on their own because those are expensive and difficult to come by, but easy enough to produce." 

The federal government estimates that medical professionals will need 3.5 billion masks if the worst-case projections come true. The U.S. currently had about 1 percent of that number on hand at the beginning of March.

Charities and major corporations have donated masks to hospitals, and manufacturers like Honeywell and 3M have stepped up production.

New York Governor Andrew Cuomo has asked President Donald Trump to use the Defense Production Act to force companies to start making masks.

And yet official channels likely won't come close to meeting the needs of health care workers, so some technologists are taking matters into their own hands. But will government officials adhere to existing regulations and slow down these efforts? And if mask production increased to serve the entire population, could it hasten the end of the extreme social distancing crippling our economy?

Matt Chisholm is a spokesperson for the Open PPE Project, which is developing a protocol for the production of N95 masks, which experts believe provide fairly reliable protection against COVID-19.

They're planning to open their own factory in Michigan and to develop a manufacturing blueprint that anyone can use.

"Some of the early challenges we've seen are [from] the regulatory state," says Chisholm. 

Masks require Food and Drug Administration approval for sale to medical facilities, though the agency indicated an increased willingness to approve emergency use authorizations in late March.

The National Institute of Occupational Safety and Health, a division of the Centers for Disease Control and Prevention (CDC), regulates filtration mask factories. According to Chisholm, an official with the agency told his team that it will take 45 to 90 days to get approval for a new mask production facility

"That obviously poses some challenges for the current crisis," says Chisholm. "You could theoretically end up with 45 to 90 days' worth of supplies that are in a warehouse instead of out on the frontline saving lives. So we see that as a problem." 

Chisholm suggests accrediting universities that have the testing capabilities to certify the effectiveness of the masks.

Meanwhile, 3D-printing enthusiasts are sidestepping regulatory approval altogether by teaching people how to make their own masks.

The DIY mask approach has taken off in the Czech Republic in particular, where surgical mask sewing efforts are being coordinated over the internet by people providing instructions and tips, as well as mapping facilities and areas where masks are most needed.

"The CDC is stating that we're to be using bandanas if it comes down to it," says Newsom. "I understand that it's not a perfect solution. But, that being said, anything, I think, would be better than the sort of last resort of [healthcare workers] having to [make] their own." 

And some say that ubiquitous mask-wearing could make it safer to end extreme social distancing.

But public health agencies have issued conflicting information about their efficacy.

On February 29, the Surgeon General urged the public to stop buying masks, claiming they're ineffective at stopping the transmission of COVID-19 and could even increase one's likelihood of catching it. The CDC and World Health Organization have recommended mask-wearing only for those displaying symptoms or for those who are in direct contact with infected individuals.

But critics say this is inaccurate and that public health officials may have purposely spread misinformation to discourage people from running out and buying masks, making it even harder for doctors, nurses, and first responders to obtain them.

Mask-wearing is widespread in Hong Kong and Taiwan, which seem to have better controlled COVID-19 without prolonged lockdowns. Hong Kong's public health officials have called for mask-wearing on public transit and in the workplace.

There's some evidence that masks help stop the spread of the flu.

And though strong evidence that face masks prevent respiratory infections is still "scarce" due to a lack of rigorous study, according to a March 2020 paper published in The Lancet, there is a chance that "community transmission might be reduced if everyone…wear[s] face masks."

"We should prioritize the health care workers," says Oxford researcher Elaine Feng, who co-authored the paper. "But that should not be the rationale for telling the public that face masks [are] not effective."

Feng says that with increasing evidence that people showing no symptoms of COVID-19 can transmit the virus, wider adoption of masks in public spaces would be prudent.

"In Asian countries, it's more likely to be a civic duty for people to wear a face mask," says Feng. "We think that a universal face masks policy during a pandemic could help reduce the stigmatization of people [who choose] to wear face masks, if the supply permits."

The Open PPE Project's priority is producing N95 masks for medical workers at the moment.

"I'm probably not in a place to speculate on the role masks will play beyond medical personnel [right now]," says Chisholm. "We weren't prepared for this, and we need to get back to good and make sure we can arm our frontline personnel with the equipment they need. We also have to be ready for what any pandemic in the future could good bring and manufacturing readiness could really help that."

And Newsom asks that anyone with extra N95 masks or other essential medical gear donate them to medical professionals to help adjust to this new reality.

"It's the nature of our work that we are touching patients that have respiratory problems and we really would benefit from those masks in our hands," says Newsom. "I'm literally witnessing colleagues of mine learning how to hunker down and do protective measures. I mean, but I didn't learn any of that in my residency…The fact that this is all happening [at the] point of care when the need arises goes to show the level of unpreparedness."

Produced by Zach Weissmueller, additional graphics by Josh Swain

Music: "Environmental Disaster Zone," "Trees in the Wind," and "Call Me" by Daniel Birch licensed under a Creative Commons Attribution License

Photos: medical workers putting on protective gear, Eddie Siguenza/Us Army/ZUMA Press/Newscom; worker delivering masks, Ron Adar/Zuma Press/Newscom; doctor putting on mask, Sara Eshleman/U.S. Navy/Zuma Press/Newscom; social distancing outside Whole Foods, Richard B. Levine/Newscom; masks on public transit in Hong Kong, Tang Yan/Zuma Press/Newscom; masks at airport in Hong Kong, May James/SOPA Images/Sipa USA/Newscom; Andrew Cuomo Giving Presser, SteveSands/NewYorkNewswire/MEGA/Newscom; ID 173833922 © Sopone Nawoot | Dreamstime.com

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  1. Just get a damn SCUBA tank and mask, and walk around in it. You’ll look like an idiot, but you’ll worry the hell out of the neurotics that worry they’re not doing enough to protect themselves.

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    1. Along those lines, (I am not making this up) breast pumps are being modified into respirators.

      1. Guidance from the WHO and public health officials in Canada say masks not necessary for asymptomatic people https://www.cbc.ca/news/politics/covid-19-pandemic-coronavirus-masks-1.5515526

        1. “Guidance” from the WHO said China didn’t have a major problem until the number of cases per day jumped from 2000 to 12000 in the middle of January. The WHO has jumped the shark in the matter of “guidance.”

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  2. there is a meme on FB showing a a bunch of asian workers not wearing mask while making mask and they all land on the floor to be trampled on before being boxed up. Feel safe with those mask NOT.

    BTW Newsom is trying to act gregarious by sending items to other states as if the federal government wasn’t already doing that.

    also no need to force the manufactures to make whats need they already are and can only make them so fast

  3. One reason I have heard for mask usage in Asia that I don’t often see discussed in the US: if you already have a virus, the mask reduces the likelihood that you will spread it. Many of the droplets produced when sneezing, coughing or talking will be confined by the mask you wear.

  4. Fauci has said they’ll be another ouutbreak thus fall so why are we doing this? It’s time for everyone to go back to work and deal with any deaths. At least that way we’ll have some herd immunity by November.

    1. We are doing this to protect your parents, protect you and protect your kids. Greetings from NY. I work on an ambulance. I have thus far transported a month old infant back home +covid, so she can live out her life, hopefully her mother who was also positive didn’t die. I’ve transported a 29 y/o with not medical history prior to covid, on a ventilator, going for ECMO because his lung profusion wasn’t transferring enough oxygen to keep his body working, and I’ve transported dozens of people in between. Some shouldn’t be going to the hospital, some should. What I do know is there are refrigerated semi- trailers where they are putting biddies and hospitals are doing triage outdoors in tents before letting patients in. We are doing this so it stops before it gets to whatever southern or western town you are in that has a 10 room ER and can’t handle more than a 2 person car accident. That’s why. Hopefully you don’t loose anyone in your family from this.

  5. I have run my 3-d printer until I ran out of filament printing visors for conversion into facemasks. Delivered through out Iowa to whoever needs one. We sent out 800 Monday and they need 800 more. Small nursing homes, independent health care workers, etc. want the facemask protection and getting them is not always possible. I was able to print about 10 a day so I have made 30 of these so far. Waiting on 3-d printing material now.

  6. There are two kinds of masks: those that fit your face and those that don’t. A standard rectangular surgical mask cannot be made to fit your face. It is made to protect a surgical patient from the surgeon and surgical staff. It does not prevent virus particles from being inhaled from around the edges of the mask. An N95 type mask can be made to fit your face but should be used for personal protection only after being tested. Testing is easy. Put on your mask and then open a bottle of mint oil or other pungent oil a foot or so in front of your nose. If you can’t smell it, your mask fits properly. If you can, you might as well trash it. The mask will become wet from your breath and oral and nasal secretions after a while and will become an effective wick for viruses to move from the outside surface of the mask to within.

  7. Well crap – I was told Obamacare was going to supply “affordable” everything medical related to everyone!!! It’s almost like it was a crappy lie to monopolize and short-stick healthcare facilities and actually charge us to do it.

  8. There are effective alternatives to the N95 mask that won’t interrupt the supply chain for hospitals and “front line” medical workers. As a private citizen you don’t need them certified by the FDA or NIOSH.

    A 3M full face respirator, or half face with goggles, equipped with an organic vapor filter and cotton pre-filter will do a darned good job protecting you from airborne droplets. It also keeps you from touching your face.

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    1. I guess you mean by making face masks?

  10. “It’s the nature of our work that we are touching patients that have respiratory problems and we really would benefit from those masks in our hands”
    I don’t think you’re using the masks correctly.

  11. Are lap dancers able to get masks?

  12. Check. Banning hijabs may inadvertently had made this virus
    efficient spread possible … Now back in fashion, except they look like the “perfect person’s” hijabs.

    Got it!!

    Doctors invent baseless ideas that prevention equipment don’t work so as to ensure they get the lion’s share of medical equipment.

    Got it!!

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  14. Health workers facing critical shortages of masks in the US and other countries are searching for evidence on their use. here

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