Name: How far would a million N95 masks go? It’s complicated, and this is why.
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How far would a million N95 masks go? It’s complicated, and this is why.

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On April 2, the New England Patriots’ team plane with mundane but suddenly precious cargo: 1.2 million N95 respirators, a critical type of mask that protects health-care workers treating patients who have infectious diseases.Was that a big stash?In normal, pre-covid-19 times, the answer would be yes. Most hospitals buy just a few thousand N95s per year, according to a company that negotiates purchasing contracts.In the frenzied weeks of March and April, when the trickle of covid-19 patients suddenly grew into a deluge, the answer was a hard no. Health and Human Services Assistant Secretary Robert Kadlec had in February that the United States would need 3.5 billion N95s in a serious pandemic.By March, hospitals in areas with large outbreaks reported burning through the one-time-use masks at up to 10 times their normal rates.Now in mid-May, as emergency supply lines have begun to kick in and reuse of hospital garb has become common, the answer is somewhere in between.[]N95s are key pieces of armor for front-line health-care workers who are battling an infectious respiratory disease. They are fitted to form a tight seal on the user’s face, and electrically charged fibers grab at least 95 percent of particles out of the air that passes through the mask.Typically, 15 million to 20 million N95s would supply more than 3,000 hospitals for a year, said Cathy Denning, a senior vice president at Vizient, which negotiates health-care purchasing contracts for more than half of the roughly 6,100 U.S. hospitals. That averages out to about 5,000 to 6,600 per hospital per year, and many hospitals would stock far fewer.Then came covid-19, and facilities near large outbreaks suddenly found themselves overwhelmed with patients and churning through N95s. During a nine-day stretch in late March and early April, New York City alone was averaging more than 1,500 new covid-19 hospitalizations per day, according to the city’s .“If you look at New York-Presbyterian, for example, we heard that they were using 10 to 15 times their normal burn rate,” Denning said.Using a few clues, we can figure out a rough idea of how many N95s would’ve been used if they were plentiful and hospital workers could wear and dispose of them after one use, according to pre-covid-19 best practices.Denning said hospitals she works with have reported using 35 to 40 isolation gowns per covid-19 patient per day. If N95s were plentiful, they probably would be replaced as often as gowns.According to the CDC, the median hospital stay of a surviving covid-19 patient is 10 to 13 days. That works out to between 350 and 520 N95s per patient.Not all states report numbers of people hospitalized, but New York does, and on April 13, the state’s hospitals held 18,825 covid-19 patients. If caregivers used 35-40 N95s per patient, they would’ve used between 659,000 and 753,000 N95s that day. That would amount to more than half of the Patriots' planeload.Caring for just those patients through their entire hospital stays would’ve required between 6.6 million and 9.8 million N95s, the equivalent of half to three-quarters of the that were in the federal government’s emergency stockpile at the beginning of the outbreak.Of course, we know that N95s were not plentiful — and still aren’t in many places.“Extremely scarce” is how New York-Presbyterian’s chief of surgery, Craig R. Smith, described his medical center’s N95 situation in a March 20 .In a late March letter to the White House, Rep. Scott R. Tipton (R-Colo.) said a shipment of supplies that included 49,000 N95s would be “enough for only one full day of statewide operations.”[] and an influx of muddied the market, which of desperate states, jurisdictions, health-care organizations and countries bidding against one another and sometimes against private individuals looking to hoard or resell personal protective equipment.China, where the virus first emerged, produces about half of the world’s medical-grade masks. Production couldn’t meet the sudden demand.[]Researchers know that covid-19 spreads through droplets infected people emit when coughing, sneezing, talking or breathing; they don’t know whether it also .[]The CDC recommends that health-care workers who work very closely with covid-19 patients wear these pieces of PPE:A properly fitted N95 respirator protects against droplets and filters out more than 95 percent of small particles that could contain viruses. N95s typically cost about 50 cents each and are made to be discarded after a single use.An isolation gown is a type of surgical gown that has fluid-resistant panels covering the front and arms. They are usually used once and either discarded or laundered.Gloves are also disposable and are usually made of vinyl, nitrile or latex. A caregiver for a covid-19 patient may wear two pairs at once.Eye protection such as a face shield would be worn over an N95 to protect the eyes.Hospitals use other types of masks as well.Surgical masks are the most common. They are disposable and come in three protection levels. A surgical mask blocks droplets but not small particles.The elastomeric half- or full-face respirator is reusable. Depending on the type of filter used, it can protect against 95 to 100 percent of very small particles and possibly vapors and gases. It doesn’t filter outgoing air, so it’s not suitable for a surgical setting, but the CDC's covid-19 guidelines say it can be an N95 alternative.The most protective mask is a powered air-purifying respirator. With the correct filter, it blocks all particles and creates a personal fresh-air bubble. National Nurses United says these should be worn by people doing procedures that generate aerosol particles, such as intubations.Faced with dwindling numbers of N95s and no reliable assurance of more in the immediate future, hospitals had to find ways to use fewer. Caregivers go from room to room wearing the same masks. Sometimes they wear the same masks for multiple shifts. Some places are attempting to decontaminate N95s for reuse.Federal agencies such as the Food and Drug Administration and Centers for Disease Control and Prevention put out on how to get by with less, including grouping covid-19 patients together and allowing for the reuse — and, ideally, resterilizing — of “disposable” items, especially N95s.National Nurses United, a union representing more than 150,000 U.S. registered nurses, says the new guidelines are too relaxed, and it has condemned widespread use of decontamination systems as “When employers require nurses to reuse the same N95 multiple times or for multiple shifts, they place the nurse and the patients at increased risk of exposure to SARS-CoV-2 as well as other pathogens that might be present,” said Jane Thomason, the union’s lead industrial hygienist, in an email. (SARS-CoV-2 is the official name for the coronavirus.)[]More than 1,000 health-care workers have died of covid-19 worldwide as of May 12, according to data.Decontamination technology is promising but new, and research on its effectiveness against the coronavirus is sparse. A studying decontamination practices advises that N95s may retain their effectiveness after being decontaminated somewhere between two and 20 times, depending on the method and the make and model of the mask.Even with all the conservation and reuse, Denning said most hospitals are still going through N95 masks at four to five times their normal rates.Fortunately, the virus did not strike everywhere at once, and strategies such as have bought desperately needed time for many hospitals.Manufacturers are stepping up U.S. production of N95s to try to meet the demand, both for now and for a potential second wave. For instance, 3M, the largest maker of N95s, said that it has doubled its worldwide production rate since January to 1.1 billion per year. Two U.S. Honeywell factories will produce 20 million N95s per month.As of May 14, the Federal Emergency Management Agency had shipped nearly 92 million N95s; a White House initiative called that began at the end of March distributed another 768,000 by early May.[]To get supplies from manufacturers to places that need them, the American Hospital Association is conducting an effort called the , which began mid-March in Washington, the first state to see a covid-19 outbreak.Organizers are venturing outside the traditional supply chain and even providing specs to companies that want to start production, said Priya Bathija, the AHA’s vice president of strategic initiatives.As covid-19 surges into new areas, it has plateaued in some places that were in crisis a month ago.Smith, the New York-Presbyterian surgeon who had written about the critical shortage of masks at his hospital in March, included a striking line in his : “Today PPE is abundant.”Related“I’ve been using the same mask for like three weeks now, maybe even longer,” said Mawata Kamara, a registered nurse who works at two Northern California hospitals.Three days a week, Kamara works in the intensive care unit of a privately funded hospital, which has been divided into covid-19 and non-covid-19 sections. She says that on the days her 12-hour shift is spent with covid-19 patients, she is still using the N95 respirator that she was issued in April.“We have our mask and our face shield that we put in a brown paper bag — it looks like a brown paper bag that your mom would put lunch in — and we reuse it many times,” she said.Another day or two each week, she works in the emergency room of San Leandro Hospital in Alameda County, a public hospital. There, she said, she is issued a new N95 when she arrives, and she throws it out when she leaves, putting it on to treat covid-19 patients and removing it to attend to others during the shift. (Alameda Health System did not respond to a request for confirmation.)Bay Area hospital systems they are conserving protective gear such as N95 respirators, standard masks for front-line workers who are caring for covid-19 patients. The Centers for Disease Control and Prevention put out on extending the use of the masks, which until now had been thrown out after each interaction with an infected patient.Kamara, a nurse since 2008, said she had never re-worn an N95 until early this year. In fact, hospitals had always been extremely conscientious about infectious disease protocols, she said. “Then all of a sudden covid comes along, and everything’s out the window.”Covid-19 patients are not all sedated, Kamara said. They cough, they yell, they get anxious, they struggle, they gasp for breath. All the while, they are spewing virus-filled droplets into the air.Nurses are often in a hurry, rushing between patients, putting protective gear on and taking it off.“It’s very easy to touch a mask that you’re reusing the wrong way,” Kamara said, which could mean contaminating herself or someone else. She worries about bringing the disease home to her 4-year-old daughter.At the end of her 12-hour shift in the ICU, the mask and shield go back into the bag, which sits on a table in a room with other nurses’ bags until she returns. She said there is no decontamination process.Nurses wear masks “until they wear out,” she said, which could mean something is spilled on it or a strap breaks, which is common because the masks are designed to be used for minutes or hours, but not days.Kamara knows she is outspoken about this issue, and she has told this story before, although health-care workers in some places for raising safety concerns.“I tell other nurses, ‘Don’t let hospitals normalize this,’" she said. “It’s not okay. It’s not safe at all.”Chiqui Esteban and Brandon Ferrill contributed to this report.A previous version of this piece contained illustrations showing a type of N95 that has an exhalation valve, which would not filter exhaled air and would not be appropriate for some healthcare settings.Most Read

On April 2, the New England Patriots’ team plane with mundane but suddenly precious cargo: 1.2 million N95 respirators, a critical type of mask that protects health-care workers treating patients who have infectious diseases.Was that a big stash?In normal, pre-covid-19 times, the answer would be yes. Most hospitals buy just a few thousand N95s per year, according to a company that negotiates purchasing contracts.In the frenzied weeks of March and April, when the trickle of covid-19 patients suddenly grew into a deluge, the answer was a hard no. Health and Human Services Assistant Secretary...

How far would a million N95 masks go? It’s complicated, and this is why.

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