Unmasking the Mask Problem

Frightened citizens of the world have been responding to the coronavirus (COVID-19) pandemic in a multitude of ways: some are blessed with the opportunity to continue their lives as normal and work from home, while many others have dedicated their life savings to panic-buying essential goods like hand sanitizer and toilet paper. Another notable essential good is the face mask, which has received a lot of attention because of its ability to prevent the exposure to and spread of the coronavirus. While it seems logical for everyone to purchase a stockpile of masks, the manner in which both the government and the general public have dealt with them is clearly disorganized. Due to the skyrocketing demand for masks, mask shortages have become increasingly common. The problems that this brings not only affects our wellbeing, but also that of those more vulnerable to the disease. Thus, it is critical that we have the knowledge, both scientifically and strategically, to deal with the mask situation and subsequently the pandemic as a whole.

There are two main types of masks: the traditional surgical mask and the highly sought after N95 mask. Ideally, N95 masks are favorable because they are tightly-sealed respirators, designed to fit snugly around the mouth and nose to block out 95 percent of all 0.3-micrometer particles. In comparison, droplets created during talking, coughing, or sneezing are on average five micrometers in size. These masks are harder to manufacture than typical surgical masks because their structure is much more elaborate, and the active fabric in them, polypropylene, is in short supply. The filter is made by interlacing layers of polypropylene fibers so that pathogens have a high chance of getting stuck in between two fibers. Additionally, the World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) state that surgical masks only marginally protect healthy individuals from being infected because of their loose fit.

Before the virus, China was the world’s main face mask manufacturer, producing half of the world’s supply of masks, and it has since expanded production by over 12 times, now boasting the production of 115 million surgical masks and two million N95 masks per day. Unfortunately, a majority of these masks didn’t make it to the U.S. because China needed to utilize that increased supply for its own population, given that it was the world’s first COVID-19 epicenter. Masks from around the world were gifted mostly to them, and a majority of mask purchases were made by their anxious citizens. Consequently, many of the masks produced in China are distributed domestically, and only a small fraction is exported. Even though China is no longer the epicenter of the virus, its citizens have not lowered their guard, and exports to other countries remain low. As such, the prices of masks in the U.S. are still record-breakingly high. However, we should be mindful not to criticize and pressure China’s decisions because they are still trying to recover from the virus, and there is still the possibility of relapse. China is also sending goodwill packages to countries that donated masks to them, and small companies are finally starting to resume exports of masks.

In the U.S., the WHO and CDC maintain that masks should be reserved for those who are sick and for health workers who are routinely working closely with infected patients. The CDC states that masks are more effective in stopping droplets from being discharged from the wearer’s nose as opposed to preventing infection in the first place. On the other hand, Asian countries are encouraging people to wear masks as a way to reduce overall community transmission and as an attempt to reassure the public that the government is handling the situation with poise. In fact, a new development in some regions requires anyone who goes outside to wear a mask. Otherwise, they may get arrested. Masks are a visual statement to those oblivious to the global pandemic; by wearing them, you are acknowledging that business is no longer as usual and that you are on board with any precautionary measures to stop the spread of the virus, including raising awareness about it. Many COVID-19 patients are asymptomatic and having everyone wear a mask reduces viral transmission from those who are unaware that they are infected. As such, China feels obligated to hold onto the masks, meaning that other countries are getting fewer masks. Of course, this is not beneficial to the U.S. because of the mask shortage.

Many hospitals, care centers, and other medical facilities throughout the nation are fighting “a war without ammo,” as many doctors put it. They are treating patients with an inadequate number of masks and other protective supplies, desperately struggling to purchase and locate them while sending appeals to state and local health authorities to no avail. Our healthcare providers cannot deal with the crisis at hand without personal protective equipment (PPE) and cannot see patients if they are endangering themselves as well.

Many doctors and nurses are limited to a handful of masks per shift; some are even given just one mask to use indefinitely and are instructed to spray it down with Lysol or wipe it off in between patients. No one knows how effective this is. It’s like performing a biology experiment without ever changing micropipette tips. How good can you expect your results to be? Protecting our health workers from the virus is essential to managing the pandemic, as it ensures that the workforce of our medical facilities can handle the inevitable waves of new patients.

Luckily, mask supplies from previous epidemics and generous donations have helped the U.S. remain afloat. Over seven thousand masks were stored in the Washington National Cathedral since the 2005-2006 avian flu outbreak. Companies also pitched in. Goldman Sachs donated four hundred thousand masks to hospitals in New York and New Jersey. Nasdaq donated 12 thousand masks to the Greater New York Hospital Association. Facebook donated its emergency reserve of 720 thousand masks purchased in preparation for the recent wildfires in California. Apple donated over 10 million masks. However, people question why these private companies have such huge piles to donate when the government is just scraping by with its strategic reserve. Quality checks and quality assurance are needed to check for expiration and contamination before distribution.

These aforementioned masks are designed to be single-use items, but as shortages become more and more commonplace across the nation, local administrations are starting to take matters into their own hands by becoming more creative. At the University of Nebraska Medical Center, doctors have started using ultraviolet (UV) light decontamination and reuse. This, though against the CDC’s regulations and arguably a bad example for the rest of the country, is the “best of bad choices” since the alternative is not using respiratory protection equipment at all. The doctors at the medical center say that resorting to reusing is not ideal and shouldn’t be done if there are enough masks. Before other medical facilities buy into this idea to save money, they should take stock and figure out how long their supply of masks will last them.

As for the practicality of this method, there is a precedent set by UV decontamination during the Ebola outbreak that proves decontamination is a normal practice for sterilizing rooms with patients that have contracted a rare infectious disease. Additionally, studies done by the medical center show that UV radiation can kill and inactivate viruses without damaging the mask or its effectiveness. The problem with this claim is that these studies, done to confirm suspicions, are small, and everyone is on a time crunch because this research was only started during major outbreaks. Even so, funding for preventive studies is not prioritized over funding to find a cure in the midst of outbreaks, meaning that more people will be infected in the long run.

Still, there are not enough masks to go around, as the Department of Health and Human Services estimates that the country would need 3.5 billion masks if the pandemic lasts for a year. This isn’t totally unreasonable, as no official organization has made predictions as to when the pandemic may start dying down. Therefore, engineers have turned to 3D printing in an effort to find a way to mass-produce even more masks. In just a few days, a team of biomedical engineers at the Medical University of South Carolina (MUSC) developed the Self-Assembly Filtration for Emergencies Cartridge System, which is a filtration system that can be fitted onto hospital masks. Instead of attempting to recreate N95 masks, the team designed a two-part solution: a reusable 3D printed mask that will work alongside a 3D printed disposable filter cartridge. In order to prevent outside air from entering when the wearer inhales, the team attached a rubber valve that shuts immediately after the wearer exhales. The team has already been printing and fit testing masks at MUSC. The main obstacle now is the time it takes to create the masks: it takes four to five hours to print and another hour to assemble each mask. Because of this issue, the team has released the plans to allow anyone with a 3D printer to produce the masks. Even the Stuyvesant robotics team has considered 3D printing masks, but the team’s advisor, Mr. Blay, decided against going into the school to do so.

Large companies such as HP Inc. have also been mobilizing their teams to create 3D printed protective gear. HP has already delivered over one thousand 3D printed parts to local hospitals, and these parts have already been used to create hands-free door openers, mask adjusters, and face shields. The door opener allows the user to open doors using only their elbow, and the mask adjuster alleviates the ear pain that comes with wearing face masks for an extended period of time. Face shields are among the most important personal protection items, and they can block larger particles from reaching the wearer’s face. HP is still testing other types of face masks as well as field ventilators, which will provide short-term emergency ventilation for COVID-19 patients. Like the MUSC team, HP has also made its parts available for public download.

Even though 3D printing PPE seems promising, it still has its limitations. One main challenge for engineers and companies is whether their machines, which are not created for mass production, will be able to keep up with the rising demand for protective gear. Some hospitals require thousands of pieces of PPE each day, and 3D printing will not be able to meet that demand. Another issue that arises with 3D printed PPE is the risks involved with using those pieces. Many of the parts are not medical grade, and the plastics used by 3D printers may trap virus particles and increase the risk of exposure.

The fact that the coronavirus has spread so much in the world calls for us, as individuals, to take action. Even just one person can do much to help stop the spread of COVID-19 by doing things like donating stockpiles of masks to hospitals, maintaining social distancing, and staying alert in our current situation. Instead of panicking and trying to hoard PPE, everyone needs to be more considerate of those battling tirelessly against the virus. There is a distinct line drawn between what it means to be prepared and what it means to be overprepared. Nevertheless, knowing how to deal with the pandemic and finding clever solutions, such as 3D printing, will help slow down the disease that has taken the world by storm. Whether it be through awareness or through innovation, planning and being proactive is how we can do our part in the war against COVID-19.