The worldwide COVID fight means we need to conserve PPE everywhere
By: Jonathan Toomim
Tags: Covid 19, Masks4all, Conservation, Masks, Healthcare

Over the last 32 hours, I drove through Southern California, visiting hospitals, urgent care centers, and the homes of health care workers in the Santa Barbara, Los Angeles, Glendale, and San Bernardino areas. I visited over a dozen different facilities. As part of the Masked Protectors, a group I started to , I brought them a total of 900 surgical masks and 140 FFP2 (N95-equivalent) respirators, and heard some stories and viewpoints and saw some emergency department triage tents and lobbies. I can’t share everything I learned, and definitely cannot name names, but here are some observations I think I can share.

Overall, things were pretty calm and relaxed. Nurses were working long hours — 12 hour shifts were typical — but were not hurried. I never saw a triage tent with more patients than staff. I never saw a line with more than 3 patients. I almost never even saw a line. At most of the hospitals I visited, the triage tents had a handful of nurses and security guards just hanging around and waiting. The nurses did mention that they had gotten some bursts of patients before, especially last week, but nothing overwhelming. One hospital mentioned they have a few dozen COVID patients, and about twice as many staff taking care of them. One triage nurse said that things seemed quieter now than even a few days before. Right now, it seems we might be beating the virus. Good work, California. I’m proud of you.

Even so, not everything is rosy. The PPE supply shortage is very real. It appears that over the last few weeks, many California hospitals have been burning through PPE at a normal rate (e.g. changing masks after visiting each patient) expecting fresh shipments to come, and those shipments just never came. The PPE supply chain in the USA has been thoroughly disrupted. One hospital had to shut down their surgery wing entirely due to lack of N95 respirators. Many nurses are being forced to improvise their own masks. Some are given none at all. So even though the patient load itself is reasonable, California’s hospitals are struggling because the rest of the world is struggling.

This nurse improvised her own mask, and was volunteering by checking people’s temperatures at an urgent care facility. This was one of two times I was screened for infection before having contact with hospital staff, and the only time my temperature was ever checked. In Asia, temperature controls are everywhere — at subway entrances, grocery stores, and schools — but the USA hasn’t picked up on this idea yet.

Part of the problem seems to be that hospitals and the CDC aren’t talking openly and directly with each other about how to conserve PPE. The CDC has issued guidelines for PPE conservation in terms of “Conventional”, “Contingency”, and “Crisis” capacity conditions, but has not said what our *current* conditions are. As a result, each hospital is making a separate determination for themselves for each type of PPE. A hospital with plenty of surgical masks but no isolation surgical gowns might be forced to use trash bags (yes, this is happening) instead of gowns, or to wash and reuse the same gown for weeks on end while also using a fresh mask when visiting each patient. Another hospital might have plenty of gowns but no surgical masks, and might be asking their staff to use cloth masks or to use the same surgical mask for days or weeks on end while using up 20 gowns per HCW per day. When I told the nurses and managers about the conservation methods that doctors in harder-hit areas are going through — one owner of a private practice in Louisiana asked me for three N95s per doctor/nurse to get them through the next MONTH — they were shocked. And at that point, they began to listen to my advice on mask disinfection and reuse a lot more seriously.

California’s HCWs need to start treating this crisis the same way we treat a drought: with conservation. Use as much water as you really need to, but no more. Don’t leave the tap running. If it’s yellow, let it mellow; if it’s brown, flush it down. Keep in mind that everyone on this planet is struggling with the same limited pool of PPE. Conserving PPE doesn’t mean avoiding the use of PPE. On the contrary, it means using each piece of PPE as much and for as long as possible. Every mask that you reuse and don’t discard is a mask saved for someone else.

I think we need standardized national guidelines on PPE conservation. No HCW should be using 10 masks per day as long as any HCW is forced to go without. Everyone should be making the same tradeoffs.

Mask decontamination is a thing. Killing coronaviruses is very easy to do in any household oven or toaster oven. All it takes is 60°C for 60 minutes. (That’s 140°F for those of you unfamiliar with Science units.) This works on surgical masks and N95s alike. It isn’t enough to kill all pathogens, but it kills the one we’re most worried about now, and it kills the ones that are most likely to be airborne and found on masks in the first place. Many hospitals also have other methods available like UV or ozone for full sterilization.

Mask filters do eventually get clogged with particles. Modern masks have filters with an electrostatic charge that can get neutralized with exposure to liquids

As such, I am recommending to all HCWs that for now they reuse a mask until either the mask becomes difficult to breathe in, is exposed to liquids (which neutralize the charge and ruin the filtration efficiency), or until the mask has been soiled or otherwise made unsafe or ineffective. Under these guidelines, N95s can last for a week or longer on average, and surgical masks can last several days.

We all need to conserve masks as if we were in New York. Use them, reuse them, and hand one to your neighbor if they are maskless.

If we all do our part to stretch our supplies, then nobody will have to do their part without supplies.

P.S.: All photos with HCWs were taken with their permission. I forgot to ask permission at most facilities, and many of the others refused permission, so most donations were both selfless and selfieless.

P.P.S.: The Masked Protectors is an organization I started a few weeks ago with the goal of importing masks and other PPE from Asia and China to help with the fight against COVID. We believe that masks are the most effective tool we have in our fight against COVID, and are likely to be about 68% or 74% protective against infection both by the wearer and for bystanders. So far, we’ve delivered a total of 2,198 surgical masks and 459 FFP2 respirators to front-line workers. We have another 5,000 FFP2 respirators being shipped, and are trying to scale up our work as quickly as we can. Currently we’re operating out of my own pocket, but we will soon be asking for financial contributions to help us help others.