COVID-19 Elastomeric Respirator Masks for Healthcare Workers

MAY 2, 2020 – As the COVID-19 pandemic unfolds, the guidelines have begun to adapt. Just a few weeks ago, the Centers for Disease Control and Prevention (CDC) and other public health luminaries pleaded with the public not to wear masks. Now, many supermarkets across the country will not allow you to enter unless your face is covered.

As a staff cardiologist at a hospital in upstate New York, I followed guidelines for preserving and reusing single-use masks amid a shortage of personal protective equipment (PPE). We hoped that the shortage of face masks would be resolved by federal, state and private initiatives at this time. The reality, however, is grim: global demand has strained the supply chain, leaving many unprotected.

But there is a solution, and it is one that is often not considered: reusable, like elastomeric respirators.

The overlooked elastomer

You have probably seen industrial workers wearing the reusable elastomeric mask. These respirators have snug facepieces supported by straps. According to the CDC, they provide equal or superior protection to N95 disposable respirators, last years, and can withstand repeated cleaning. The filter in these masks is an interchangeable cartridge that can be used for an extended period.

The CDC refers to them as “the overlooked elastomer” because many healthcare workers have never heard of them and are rarely used in healthcare. The supply of disposable respirators, while convenient for routine use, cannot be maintained during an outbreak.

According to the Department of Health and Human Services (HHS), the need for masks during a pandemic can reach a staggering 3.5 billion N95 masks per year. In early March, the United States had just over 1% of that required amount in the National Strategic Reserve. To make matters worse, the supply chain for disposable masks, which are primarily manufactured in Asia, was severely disrupted during the pandemic. Extreme need has created a global frenzy filled with wars of supply and price increases.

Concerned about shortages of supplies during the H1N1 pandemic, the National Institute for Occupational Safety and Health (NIOSH) reviewed the use of reusable respirators in medical care for both routine and emergency use. In 2017, Dr. Lewis Radonovich, head of research at NIOSH, concluded that these respirators are a practical option for respiratory protection within healthcare institutions. In 2018, the National Academies of Science, Engineering, and Medicine further evaluated reusable elastomeric respirators and published a book, which describes evidence-based considerations for use in the healthcare environment.

That publication noted that “the durability and reuse of elastomeric respirators make them desirable for emergency storage.” However, HHS, citing budget constraints and priorities, did not include them in the national reserve, a decision that has been criticized by former CDC director Tom Frieden, MD.

Amid the current demand for guidance, the CDC published “Strategies to Optimize the Supply of PPE and Equipment,” which focuses primarily on how to conserve and reuse disposable respirators and masks. On April 20, a section on elastomeric respirators was added.

The medical community has been slow to take note of reusable ones. A recent review of the protective equipment, published in the New England Journal of Medicine, He did not mention reusable ones.

Reusable respirators are not without flaws. They are cumbersome, interfere with speech and vision, and require disinfection and storage between shifts. On the positive side, they protect against respiratory virus transmission and are cost effective.

The few institutions that have adopted reusable products provide an encouraging example. The University of Maryland Medical Center (UMMC) has weathered the national shortage through a reusable supply that began in response to the 2009 H1N1 pandemic. When the coronavirus outbreak began in China, UMMC ordered more and was able to protect your workers.

So why did more institutions not do the same? Despite the knowledge that reusables are a viable option, “cognitive myopia” or status quo bias may cloud our decision-making process. As in general society, “disposable” became the convenient standard in healthcare.

The dangerously short supply of disposable respirators and masks during COVID-19 requires that we overcome these biases and begin to implement the use of reusable respirators in accordance with recent CDC guidelines. Even if it’s too late for the current wave of infection, it can help in subsequent waves or the next outbreak, which is believed to be only a matter of time.

Eldad Einav, MD, is a cardiologist in New York City. He also likes to cook Mediterranean food and go out with his son. You can follow him on Twitter: @eeinav

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