A Tiny Hospital in Texas Might Help Solve the Mask Shortage

For decades, staff have used a mask that’s much more effective than the N95, and is reusable

Photo: Honeywell Safety

On the southeast side of San Antonio, Texas, a small hospital that faces a shopping mall on what used to be an air force base is suddenly fielding a flurry of calls about a possible solution to the N95 mask shortage.

There, at the Texas Center for Infectious Disease (TCID), staff receive a special mask on the first day of their orientation — it’s theirs to keep and maintain throughout the year. The mask, known as an elastomeric respirator, is made of durable plastic and has a facepiece that goes over the mouth and nose attached to two cartridge filters that attach on the left and right sides.

The durable masks given to hospital workers at TCID are called North 7700 respirators and they’re much more effective than N95 masks.

Over the last month, the coronavirus has wreaked havoc in the United States and caused massive shortages of the N95 respirator masks that health care workers rely on. Some hospital suppliers have reported delays of three to six months for these supplies. Prices of N95 masks have skyrocketed so much that one hospital CEO says that they are paying $7 for these masks rather than the typical cost of 58 cents. The shortage is so severe that the U.S. Centers for Disease Control and Prevention (CDC) has gone so far as to say that staff at hospitals can wear bandanas in certain circumstances when mask supplies are low. So it’s perhaps no surprise that in recent weeks, TCID, which mainly treats people with tuberculosis, has fielded inquiries about its alternative approach from Maryland, Connecticut, Georgia, Canada, and more. “Word has just spread like wildfire about the things that we’re doing,” says Jessica Gutierrez-Rodriguez, TCID’s hospital administrator.

The durable masks given to hospital workers at TCID are called North 7700 respirators and they’re much more effective than N95 masks. Unlike N95 masks, which filter 95% of particles larger than 0.3 microns in diameter, the P100 cartridges used in the North 7700 masks at the Texas hospitals filter out 99.97% of particles. In fact, there is a strict policy against wearing N95s at the hospital unless you are a visitor.

“In industry, N95s are affectionately known and dismissed as dust masks. But they’ve reached holy grail status in health care for whatever reason — maybe because they are cheaper and more disposable”

“The elastomeric material and design fit much better against your face,” and they are cleanable and washable, says Lisa Brosseau, a respiratory protection and infectious diseases scientist at the University of Illinois, Chicago. “Especially in pandemic situations, why not give everyone an elastomeric respirator, fit-test them, and they’ll have it forever?”

Moving toward elastomeric cartridge masks is a smart move, according to Nancy Johnson, a retired health and safety specialist who worked for the Ontario Nurses’ Association during the SARS outbreak in Canada in 2003. Johnson says that N95s are “the bottom line of respirators” despite the fanfare about them. “In industry, they’re affectionately known and dismissed as dust masks. But they’ve reached holy grail status in health care for whatever reason — maybe because they are cheaper and more disposable,” says. She adds that surgical masks — which consist of a loose material over the face and are not technically respirators — perform even worse.

Elastomeric respirators are made by a few manufacturers, including Honeywell. They are intended for people who need protection against hazardous vapors, gases, and particulate matter, and are more likely to be used in factories than in hospitals. “I use mine on the farm when moving grain,” says one Amazon reviewer.

One of the reasons experts speculate they are not yet being used widely is because they require cleaning between use. They can’t simply be thrown out after a shift, and convenience is key for many health workers right now. But having a reliable and more effective product may be a good solution, and based on TCID’s call volume, more hospitals are considering them.

Reduce and reuse

Health workers at TCID have the choice of carrying the masks around with them in a tote or leaving them in their lockers. At the end of a shift, they can either wipe the respirators down with a 70% alcohol solution or submerge them in soap and water, but if they do the latter they must make sure to take out the cartridges since those are not meant to get wet. The filters in the respirators are changed every year, and the staff at TCID keep a spreadsheet to notify workers when they are due for this to happen. The cost savings, according to the hospital, are significant. TCID pays $34.52 for the elastomeric masks with filters, and 67 cents for N95s, but the former are cleaned and reused. Whereas providing 170 employees with N95 masks daily would cost more than $44,000 per year, the total cost of having them use the elastomeric cartridge masks amounts to around $2,000 per year.

A couple of years ago, Brosseau visited TCID and was impressed by the staff’s enthusiasm for the elastomeric respirators. “I asked them, ‘What do you think about these respirators?’ and they said they thought they were the best thing that had ever happened to them,” she says. “I’d never heard a health care worker say they loved a respirator.” Brosseau says the staff like the respirators because they are their own, they always have them, and they know they fit.

A demonstration of the fit testing of the elastomeric respirator with smoke shown by respiratory therapist Prakash Shahi at TCID. Photo: Salena DeAnda

Honeywell, the company that makes the North 7700, says it sells the product through a network of over 2,500 distributors in North America. Whether there’s enough for the thousands of health workers who need them is not yet clear, but researchers at Baylor are also advocating for hospitals to consider embracing them.

TCID was founded in the 1950s to treat tuberculosis, and its 75-bed facility, opened in 2010, is the last freestanding specialty hospital for the disease in the United States. The hospital takes in people with tough-to-treat tuberculosis, a handful of whom are court mandated to be there so that doctors can ensure that their disease is treated appropriately. In 1996, the hospital began a new mask policy in which staff were assigned a reusable mask. Since then, not a single member of the staff — which includes a chaplain and a full-time psychologist — have become infected with tuberculosis.

The doctors at TCID say that the elastomeric masks should be an alternative to the N95s in the current pandemic. “It would definitely be useful in a situation like this,” says Annie Kizilbash, medical director at TCID. “As long as these devices are disinfected between patients, it could definitely serve as a really good backup to fill in the deficiencies that are because of the lack of N95s.” She cautions that the coronavirus that causes Covid-19 appears to be more readily spread by droplets than tuberculosis, so health workers treating people with the former would have to pay extra attention to cleaning their masks thoroughly.

The elastomeric masks must be fit-tested to snuggly sit on a person’s face, just like N95 masks. However, once the elastomeric respirator is fit it is more reliably snug than the N95 mask over the course of a work shift. In both cases, the fit of a mask is sometimes tested by exposing the air around the person to saccharin or Bitrex, which are sweet and bitter, respectively. If the person detects either, the respirator is refit. But TCID found that some staff didn’t have perceptive enough taste buds, so they have switched to filling the air around a person in a fit-test with a smoke irritant that makes a person cough if it is able to get inside the mask.

The demand for information about TCID’s elastomeric respirator approach is so great that the hospital has assembled a series of primers that it emails to people and hospitals that reach out about them. Salena DeAnda, a respiratory therapist at TCID, sends out the message. Her emails always include words of encouragement: “I hope this information helps you and your team!” she writes.“Thank you and please stay safe during this trying time for our country.”

Update: And earlier version of this story stated the cost comparison between N95s and elastomeric respirators on a monthly basis instead of an annual basis. The sentence has been corrected.