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Where Are All the Masks? Where Are All the Masks?
(2 days later)
As the heath care system strains to accommodate the unprecedented challenge of the coronavirus outbreak, many medical professionals on the front lines do not have adequate protection.As the heath care system strains to accommodate the unprecedented challenge of the coronavirus outbreak, many medical professionals on the front lines do not have adequate protection.
Some are reusing masks and gloves. Others have taken to social media with public pleas for help using the hashtag #GetMePPE, an acronym for personal protective equipment. Without proper covering, every new bedside visit might prove fatal, especially for older physicians and their families.Some are reusing masks and gloves. Others have taken to social media with public pleas for help using the hashtag #GetMePPE, an acronym for personal protective equipment. Without proper covering, every new bedside visit might prove fatal, especially for older physicians and their families.
And already, dozens of health care workers across the country have fallen ill. Hundreds more have been forced into quarantine.And already, dozens of health care workers across the country have fallen ill. Hundreds more have been forced into quarantine.
“The sky is falling,” one doctor wrote in an opinion piece for The New York Times.“The sky is falling,” one doctor wrote in an opinion piece for The New York Times.
“We’re heading into the abyss,” wrote another.“We’re heading into the abyss,” wrote another.
The short supply of masks in particular is dire.The short supply of masks in particular is dire.
The coronavirus is transmitted by droplets from coughing or contaminated surfaces, so properly applied protective gear can go a long way toward keeping doctors safe.The coronavirus is transmitted by droplets from coughing or contaminated surfaces, so properly applied protective gear can go a long way toward keeping doctors safe.
At minimum, doctors should be wearing gloves, gowns, eye gear and masks. But for weeks, hospitals have been running dangerously low on essential supplies.At minimum, doctors should be wearing gloves, gowns, eye gear and masks. But for weeks, hospitals have been running dangerously low on essential supplies.
Many doctors said they were being given just one mask, to use indefinitely. Between patients, they spray it down with a disinfectant or wipe it off, hoping for the best. But they feared that being forced to reuse a mask might infect patients who did not yet have the virus.Many doctors said they were being given just one mask, to use indefinitely. Between patients, they spray it down with a disinfectant or wipe it off, hoping for the best. But they feared that being forced to reuse a mask might infect patients who did not yet have the virus.
In part, a widespread buying of masks by anxious citizens limited commercial supply. Experts say masks and respirators are not effective for protecting the general public, but are crucial for health care workers.In part, a widespread buying of masks by anxious citizens limited commercial supply. Experts say masks and respirators are not effective for protecting the general public, but are crucial for health care workers.
Also, the prolonged outbreak in China dwindled supply. Even before the coronavirus emerged, China produced about half of the world’s masks. During the outbreak, it expanded its mask production by nearly 12-fold.Also, the prolonged outbreak in China dwindled supply. Even before the coronavirus emerged, China produced about half of the world’s masks. During the outbreak, it expanded its mask production by nearly 12-fold.
(The outbreak also comes after a particularly mask-intensive few months. Wildfires in California and in Australia had already diminished the supply of some humanitarian organizations.)(The outbreak also comes after a particularly mask-intensive few months. Wildfires in California and in Australia had already diminished the supply of some humanitarian organizations.)
Even though no new local infections have been reported in China in recent days, the country continues to hoard its supply. The Trump administration appeared to be conflicted about whether to recommend that all Americans wear cloth masks if they go out in public, even as federal health officials were revising guidance to reflect new concerns that the coronavirus is being spread by infected people who have no symptoms.
Guidelines by the CDC on mask-wearing for the public are currently under review. This week, Dr. Robert Redfield, the director of the CDC, cited new data in an interview with National Public Radio that indicated high rates of transmission from people who are infected without showing symptoms. In light of the new information, he said the guidance on mask wearing was “being critically re-reviewed, to see if there’s potential additional value for individuals that are infected or individuals that may be asymptomatically infected.” Until now, the federal Centers for Disease Control and Prevention, like the World Health Organization, has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. (The New York Times and other news outlets had been reporting the C.D.C.’s previous guidance.)
Widespread adoption of nonmedical masks may reduce community transmission, and a federal official confirmed on Tuesday that the CDC’s review of mask-wearing came from a request by the White House coronavirus task force, which is leaning toward recommending the practice. According to a federal official, the C.D.C. has been preparing to recommend that everyone wear face coverings in public settings, like pharmacies and grocery stores, to avoid unwittingly spreading the virus. Public health officials have continued to stress, however, that N95 masks and surgical masks should be saved for front-line doctors and nurses, who have been in dire need of protective gear.
Experts are divided on how much protection a regular surgical mask, or even a scarf, can provide for people who aren’t yet sick. The W.H.O. and C.D.C. say that unless you’re already sick, or caring for someone who is, wearing a face mask while you go about your daily life isn’t necessary. Masks don’t replace hand-washing and social distancing.
And stockpiling high-grade N95 masks can do more harm than good, making it harder for nurses and other workers to access the resources they need to help on the front lines.
But researchers are also finding that there are more cases of asymptomatic transmission than were known early on in the pandemic, especially through younger people who have mild cases and don’t know they are sick but are still infectious. And a few experts say that masks could offer some protection in crowded places, like subways, buses or other public gatherings where it is not possible to stay 6 feet away from other people.
As of March 31, guidelines by the C.D.C. on mask-wearing for the public are under review. Widespread use of nonmedical masks may reduce community transmission, and the C.D.C.’s review of mask-wearing came from a request by the White House coronavirus task force, which is leaning toward recommending the practice, a federal official confirmed on Tuesday.
Ideally, clinicians would be using a new, tightly-sealed respirator, like the N95, with each patient. These are thicker than standard surgical masks, and are designed to fit more tightly around the mouth and nose to block out much smaller particles. The Food and Drug Administration said that neither surgical masks nor N95s should be shared or be reused.Ideally, clinicians would be using a new, tightly-sealed respirator, like the N95, with each patient. These are thicker than standard surgical masks, and are designed to fit more tightly around the mouth and nose to block out much smaller particles. The Food and Drug Administration said that neither surgical masks nor N95s should be shared or be reused.
As the outbreak worsened and there were shortages in medical supplies across the country, the C.D.C. updated its recommendations for optimizing the supply of protective gear.As the outbreak worsened and there were shortages in medical supplies across the country, the C.D.C. updated its recommendations for optimizing the supply of protective gear.
Now, except in the case of intubations, which involve inserting a breathing tube, the agency says standard surgical masks are acceptable when examining or treating a coronavirus patient. (This aligns more closely with the W.H.O., which advises that surgical masks can be used in some situations, but warns that they are not sufficient on their own.)Now, except in the case of intubations, which involve inserting a breathing tube, the agency says standard surgical masks are acceptable when examining or treating a coronavirus patient. (This aligns more closely with the W.H.O., which advises that surgical masks can be used in some situations, but warns that they are not sufficient on their own.)
Some medical professionals suggested that the C.D.C.’s new recommendations are borne of political expediency instead of science.Some medical professionals suggested that the C.D.C.’s new recommendations are borne of political expediency instead of science.
“We are concerned that C.D.C. recommendations are based solely on supply chain and manufacturing challenges,” the American Nurses Association said in a public letter.“We are concerned that C.D.C. recommendations are based solely on supply chain and manufacturing challenges,” the American Nurses Association said in a public letter.
Now, the C.D.C. also outlines a crisis strategy for wearing the same mask for repeated encounters with different patients. It suggests medical professionals may need to use masks beyond the manufacturer-designated shelf life date, and to prioritize the use of masks for activities in which there may be sprays, splashes or prolonged exposure.Now, the C.D.C. also outlines a crisis strategy for wearing the same mask for repeated encounters with different patients. It suggests medical professionals may need to use masks beyond the manufacturer-designated shelf life date, and to prioritize the use of masks for activities in which there may be sprays, splashes or prolonged exposure.
“As a last resort,” the C.D.C. says “homemade masks” like a bandanna or a scarf can be used, although their protective ability is unknown.“As a last resort,” the C.D.C. says “homemade masks” like a bandanna or a scarf can be used, although their protective ability is unknown.
At a news conference on Saturday at the White House, Vice President Mike Pence said the federal government had ordered “hundreds of millions” of N95s for health care centers across the country, but he did not say precisely when they would be delivered to workers. At a news conference in March at the White House, Vice President Mike Pence said the federal government had ordered “hundreds of millions” of N95s for health care centers across the country, but he did not say precisely when they would be delivered to workers.
The White House also signaled that American companies have been increasing efforts to restock hospitals, citing that Hanes and General Motors will make masks. But it again stopped short of discussing in detail any sort of fulfillment of the more assertive demands coming from some state and local leaders.The White House also signaled that American companies have been increasing efforts to restock hospitals, citing that Hanes and General Motors will make masks. But it again stopped short of discussing in detail any sort of fulfillment of the more assertive demands coming from some state and local leaders.
Some doctors in Oregon and in Washington have recently received gear from the Strategic National Stockpile, a federal repository of critical medical supplies for public health emergencies. But officials in both states said it was far less than what they had requested.Some doctors in Oregon and in Washington have recently received gear from the Strategic National Stockpile, a federal repository of critical medical supplies for public health emergencies. But officials in both states said it was far less than what they had requested.
There have been other efforts to donate masks. In New York, the Federal District Court in Manhattan donated and delivered 1,000 N95s that were in storage to the Hospital for Special Surgery. On Wednesday, some N95s reserved for construction work were temporarily approved for medical use by the F.D.A.There have been other efforts to donate masks. In New York, the Federal District Court in Manhattan donated and delivered 1,000 N95s that were in storage to the Hospital for Special Surgery. On Wednesday, some N95s reserved for construction work were temporarily approved for medical use by the F.D.A.
Individual doctors are looking out for one another, too. Some are shipping supplies to colleagues across the country. Others are just grateful for people leaving donations outside their doors.Individual doctors are looking out for one another, too. Some are shipping supplies to colleagues across the country. Others are just grateful for people leaving donations outside their doors.
Benjamin Weiser and Sanam Yar contributed reporting. Abby Goodnough, Margot Sanger-Katz, Benjamin Weiser and Sanam Yar contributed reporting.