Donovan Slack and Dinah Voyles Pulver

USA TODAY

Reusable respirator masks could be a lifeline for health care workers trying to protect themselves while treating coronavirus patients.

They provide the same level of protection as disposable N95 respirators, which are in short supply around the world. They can be easily disinfected between patients and shifts. And they last for months.

But the nation’s emergency supply of medical equipment never stocked them, despite years of research predicting dire shortfalls of disposable respirators during a pandemic and recommendations to stockpile reusable ones.

The decision not to buy them for the Strategic National Stockpile is inexplicable to Tom Frieden, who led the U.S. Centers for Disease Control and Prevention until 2017.

“You can get one to a health care worker and say, ‘Here's how you clean it and it's yours for the duration of the pandemic,’” Frieden told USA TODAY. “And those are on the market."

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He said the CDC predicted as many as 4 billion disposable masks would be needed in an emergency like the one the country faces now.

An official at the Department of Health and Human Services, which oversees the stockpile, said not buying the reusable respirators was a matter of balancing funding and priorities.

The stockpile has an alternative to disposable masks, the official said: battery-powered, air-purifying masks. But the official, who declined to be identified without authorization, declined to say how many of those are in stock.

Those devices, which blow air into the users’ faces, can be complicated, noisy and costly. They run $500 to $800 apiece – many times more than a reusable respirator, according to a study by researchers at the U.S. Department of Veterans Affairs published in 2015.

Reusable respirators cost between $25 and $50; the disposable ones are 25 to 65 cents each.

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In addition to disposable masks, that study recommended stockpiling reusable respirators over air-purifying devices because they cost less and are easier to use.

Officials running the national stockpile should have bought reusable respirators, said Lisa Pompeii, a researcher at Baylor College of Medicine.

Pompeii is the lead author of a study published last week that concluded health care workers could be quickly fitted for reusable respirators and trained on how to use them.

The need is more urgent than ever. Almost 20% of health care providers surveyed a week ago had no respirators. Another 28% said they were almost out, according to the Association for Professionals in Infection Control and Epidemiology.

“It’s so discouraging, the situation we find ourselves in,” said Ann Marie Pettis, the association’s president-elect. “We’re out there trying to help those who are truly on the front lines to help them be safe and keep their families safe.”

But "so much of what we normally teach is having to be thrown out the window because of the lack of supplies,” she said. “There’s all these weird things we’re telling people they can do,” such as reusing disposable masks.

The Joint Commission, which accredits hospitals nationwide, altered its policy on protective equipment Tuesday to allow the use of homemade masks – an “extreme measure” to be taken only when standard equipment is unavailable.

The death toll from coronavirus topped 9,600 in the United States on Saturday, with the number of confirmed cases rising to 337,000, according to Johns Hopkins University. Worldwide, the virus has killed more than 70,000 people and sickened more than 1.2 million.

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Reusable respirators vs. disposable face masks

Reusable respirators are widely used in manufacturing and other industries to prevent users from inhaling harmful particles, such as those from asbestos. Millions of Americans have them in their garages and on their workbenches.

Researchers specializing in respiratory protection have found reusable respirators, known as “elastomerics,” are also effective in health care settings because they offer the same protection as a disposable N95 respirator mask.

“The logistics are more complicated with the reusable, but the benefits are that we’ve got protection, and you don’t have to worry about it running out,” Pompeii, the Baylor researcher, said.

The masks are fitted for size, just like the disposable masks, to ensure a proper seal. They can be wiped down with hospital-grade disinfectant wipes between patients and fully sanitized between shifts. They have cartridges that trap particles in the air, including nano-sized ones, said Stella Hines, a professor and researcher at the University of Maryland School of Medicine.

“The virus at some point will die on the filter – we’re not exactly sure how long, but within days,” said Hines, who has co-authored several studies on the use of elastomeric respiratory masks in health care.

"And then as long as that filter doesn’t get damaged by being wet, you should be able to use that filter for a prolonged period of time,” she said. One guideline says filters can be changed every three months, she said.

Hines is familiar with the respirators not just through her research, but because employees at the University of Maryland Medical Center use them.

At the beginning of their shifts, workers sign out masks in their size. They clean them with hospital-grade disinfectant wipes between patients. At the end of their shifts, the respirators are sanitized, said Jim Chang, director of safety and environmental health at the medical center.

“They’re washed, basically,” he said. “They’re disinfected, dried, packaged, brought back up to the point of distribution and they’re good to go for the next go-around.”

The medical center used reusable masks during the 2009 H1N1 pandemic, Chang said, and learned a lot about how to make them work. Now, “we’ve put all those lessons back in use.”

Health care industry hasn't adopted reusable respirators

But elastomerics have not been widely adopted in the health care industry. According to some studies, workers say they’re not as comfortable as disposable masks and patients find them scary-looking. In some cases, workers found it more difficult to communicate with patients.

Pompeii noted that manufacturers have modified the respirators to make it easier to speak when wearing them. The masks are made in colors like purplish pink.

But the lack of widespread use may have hampered their inclusion in the Strategic National Stockpile.

Kerri Wizner, an epidemiologist with MDGuidelines and lead author of a 2016 study examining respiratory protective devices and emergency preparedness, said the makeup of any medical stockpile should reflect what’s in use.

“They want to stock the things people are using in hospitals, so they’re not going, 'Use this thing that’s great,’ but nobody’s ever used it,” Wizner said. “In an emergency situation like we’re having right now, you don’t have the luxury of setting up this fancy program.”

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Shortages of masks, ventilators needed to treat coronavirus patients

Officials across the country are venting about shortages of disposable masks, ventilators and other equipment – and spiraling prices as they compete against one another to buy them.

“It’s the wild, wild west of personal protective equipment,” Jared Moskowitz, Florida’s emergency management director, said Thursday.

The state placed orders for disposable respirators more than a month ago, he said, but hasn’t been told when they will arrive. He's now pleading with 3M, one of the manufacturers, to sell directly to the state rather than through a distributor.

“Nobody really understands who has product, where the product is or who represents who,” he said. “Frustration is not the word I would use, but the word I would use, you can’t print.”

But at the University of Maryland Medical Center, they face no such shortage of respirators.

The medical center stockpiled elastomeric respirators before the H1N1 pandemic in 2009. They were used regularly for a number of years before they were put back in storage for an emergency, Chang said. He served on a National Academies of Sciences, Engineering, and Medicine panel in 2017 studying the use of elastomeric respirators in health care, including surge situations.

The medical center ordered more when COVID-19 started to spread across China. When the virus struck the United States, workers were fitted and they were passed out to employees, Chang said.

Chang said leadership is key when making decisions about how to prepare for a pandemic like this.

“It becomes incumbent upon people like myself, other emergency managers, other safety officers, to then sell it to the institution’s leadership team, that hey, this is a real problem, we need to be prepared, and this is what you need to do to be prepared.”