Editors note: An earlier version of this story included research from Stanford University on ways to decontaminate used n95 masks. Since this story was published, the study authors have clarified and updated their findings to advise that home ovens should not be used for this purpose. We have updated our story to include this information.
March 24, 2020 -- The day after their local hospital put out a call for more surgical masks, the owner of a local uniform shop in Evansville, IN, called his four seamstresses and put them to work stitching tightly woven cotton fabric to elastic straps. If the hospital couldn’t find paper masks, Matt Baumeyer figured he could help sew some.
He promised Deaconess Health System 250 of the fabric masks, which are fashioned from a pattern that is being circulated on social media. The hospital even made its own instructional video to guide others who want to pitch in.
The fabric masks aren’t considered personal protective equipment, or PPE. They can’t be used to treat COVID-19 patients. But they could help save the more protective paper masks and respirators for frontline health workers who need them.
Baumeyer says it takes the experienced seamstresses about 10 minutes to make each mask. On Friday, after the team at Siegel’s Uniforms had worked for 3 hours, they ran out of elastic. Someone thought of hair ties. They cut one in half and stitched it to their fabric squares. Baumeyer says he ordered 200 more ponytail holders on Amazon to finish the job.
“We did research. We started talking about how these could be made,” says Pam Hight, public relations manager for Deaconess. Hight says she and several others at the hospital sew. They made a few test masks and put them through the hospital’s sanitary laundry process. It worked. The masks were sterile.
The CDC has even given its blessing for the use of handmade face masks when the regular kind aren’t available. But the agency also cautions that the fabric masks should be a last resort since it isn’t known how well they protect health care workers.
Across the country, volunteers are cobbling together improvised personal protective equipment and supplies for health care workers who are scrounging for protection.
Last week, volunteers met at Providence St. Joseph Health in Renton, WA, to attach strips of foam to marine-grade vinyl to make 500 improvised face shields, which protect health care workers from the spray of respiratory droplets when patients cough and sneeze. The hospital, in a suburb of hard-hit Seattle, was dangerously close to running out of equipment and expected deliveries from the national stockpile to fall short of their need, according to KOMO News.
Fashion designer Christian Siriano tweeted Friday that he would put his full staff to work sewing face masks if New York Gov. Andrew Cuomo needed the help. Cuomo took him up on it.
Early in the outbreak, after store shelves were cleared of hand sanitizer, Tito’s Vodka found itself in the awkward position of warning customers not to try to use its alcoholic beverages to clean their hands, since the product is only 40% alcohol. Hand sanitizers have to be at least 60% alcohol to work well against COVID-19. Now they’re retrofitting their distillery to make actual hand sanitizer, after getting the go-ahead from the Alcohol and Tobacco Tax and Trade Bureau. The company says it has plans to make and give away 24 tons of hand sanitizer to those who most need it.
The Defense Production Act
Experts say that while these acts, which are equal parts generosity and desperation, are worthy of thanks, they aren’t enough to replace sweeping action by the federal government to direct manufacturers to solve shortages. President Donald Trump has that power under the Defense Production Act. Trump has said that the act is in force but that he hasn’t had to use it, since companies are voluntarily stepping up to meet the need.
On Monday, Cuomo called on the president to use his powers under the act to do more to help.
“I get that a lot of companies are stepping up and doing good things. But you can’t run this operation this way,” he said at a news conference.
Cuomo said the act doesn’t nationalize companies, as some critics have argued. Instead, it gives the president the power to order what the country needs.
“You can tell a company, manufacture this many by this date,” he said. “You cannot continue to do these supplies on an ad hoc basis.”
Demand for personal protective equipment, or PPE, has surged in the U.S. just as imports of supplies from China have dropped. The vast majority of medical supplies used in the U.S. are made in China, according to The Associated Press. China temporarily shut down factories and ports in areas that were hard-hit by the new coronavirus. Some of those factories are just coming back online.
“What we’re seeing is a four- to 10- times spike in demand in a major medical center in the Northeast. Normal usage of masks is about four times the normal volume,” says Steve Downey, group senior vice president of Vizient, the largest group purchasing organization for hospitals in the U.S.
Because manufacturers can’t keep up, they are allocating the supplies they have. So if a hospital ordinarily might order 1,000 face masks a week, the distributor is giving them 65% of those, or about 650. But to take care of their workers, what they really need is 4,000 face masks a week.
“People are going through their supply much faster than normal,” Downey says.
Making N95 Masks Available
On March 2, the FDA issued an order allowing N95 respirators made for industrial uses like construction and painting to be used in health care settings. N95 respirators are hard-domed masks that block tiny viruses from reaching the nose and mouth. In response, Downey says, one large building contractor shipped its entire stock of the specialized masks back to Lowe’s so they could be used in hospitals. Across the country, hardware stores like Lowe’s and Home Depot are working to get N95 masks off their shelves and out to workers who need them.
3M, which makes N95 respirators in Minnesota, says it has doubled its output. It is now making nearly 100 million of these masks each month, CNN reported.
To further stretch their stocks, large health care centers are testing ways to sterilize these disposable masks so they can safely be reused.
At Nebraska Medicine, which has a rare biocontainment unit to treat highly contagious patients, infectious disease experts have come up with a way to use UV light to clean N95 masks. The masks are hung on lines with clothespins in the same room with glowing blue rods that emit UV radiation. The radiation kills any germs but maintains the masks’ structure.
“The shortage has forced us to be innovative,” John Lowe, PhD, an assistant vice chancellor at the University of Nebraska Medical Center, said in a news release. “While these items weren’t meant to be used more than once, this is a 100% safe way to extend their useful life. Other major hospital systems in the U.S. have also started to implement this method for the same reason we are.”
Separately, a research team at Stanford Medicine tested various ways to clean used N95 masks --including soaking the masks in bleach and alcohol hand sanitizer and even cooking them in a microwave oven. They found that alcohol and chlorine bleach broke down the fibers in the masks so they didn’t screen small particles as effectively anymore. The study authors cautioned health care workers against trying to clean masks this way. Microwaves melted the masks, making them useless.
The fastest and most effective way to decontaminate a used mask, they found, was to put it in an oven on low heat -- about 158 F -- for 30 minutes. Masks treated this way keep about 97% of their ability to screen out small particles. After the first version of their paper was published, the study authors clarified that home ovens should not be used to decontaminate masks.
Another great way to clean an N95 mask? Steam. Holding the mask over boiling water for about 10 minutes kills germs but also preserves about 95% of the mask’s ability to filter tiny germs like viruses. The study found that UV light also worked.