Federal health officials issued guidelines for how medical workers should protect themselves from Tuberculosis in the early 1990s, long before P.P.E. became a household term.
In the decades that followed, the gold standard for infection-control specialists focused on the dangers of airborne pathogens would be the elastomeric respirators.
During the swine flu epidemic of 2009, the Centers for Disease Control and Prevention promoted them. A few studies have suggested that disposable N95 masks should be used for frontline medical workers during a respiratory epidemic, which experts predicted would quickly deplete supplies of N95s, which are mostly made in China.
When the coronaviruses swept the globe and China cut off exports of N95s, elastomeric respirators were nowhere to be found in most hospitals and health clinics in the US. More than 3,600 health workers died from infections caused by the dire mask shortage early on.
There are a lot of lessons to be learned from the Pandemic. The federal government has been criticized for its handling of the health crisis caused by the C.D.C.'s bungled coronaviruses testing.
Health care facilities in the US still don't use elastomeric respirators three years after the swine flu outbreak. The C.D.C. has done little to promote the masks, and all but a handful of the dozen or so domestic companies that rushed to manufacture them over the past two years have ceased making them.
The filters cost $5 each and should be replaced at least once a year. Health care worker surveys show that the masks are comfortable to wear and have a shelf life of at least a decade.
A mask like this can make the difference between life and death, but no one knows about it.
Even though American mask producers and health policy experts have been pressing federal officials to promote them more aggressively, the government has largely escaped scrutiny. They say that the masks are an alternative to N95s. They offer better protection than N95s because they are worn properly. The majority of elastomerics exceed 100 percent.
Most of the masks are made in the US.
Experts warn of the dangers of the nation's dependency on foreign-made protective equipment now that hospitals have resumed buying cheap, Chinese-made face coverings. Many of the U.S. companies that call it quits are start-ups.
Lloyd Armbrust is the president of the American Mask Manufacturers Association. The number of companies that are still making masks has gone down. 17 of the companies have closed.
The C.D.C.'s hands-off approach to respirators is unintentionally encouraging a return to disposable masks made overseas, according to some experts. The head of the Covid-19 task force at the World Health Network criticized federal officials for not doing more to protect against aerosolized viruses. He said that failure to act on the existing science is a betrayal of duty.
To be clear, federal health experts are in favor of the use of elastomerics, but are waiting for more study results before giving full-throated support for their widespread adoption by medical personnel. Researchers at the C.D.C.'s National Institute for Occupational Safety and Health, or NIOSH, are still grappling with the need to regularly disinfect them and complaints about muffled communication, though some newer models make it easier for wearers to be heard.
She says the biggest challenge is convincing hospitals and group purchasing organizations to embrace the masks given the abundance of N95s, which can be thrown away after each use.
The issue right now is cultural, because there has been so much research in the last 10 years. It can be difficult to introduce a new system of respiratory protection.
Federal leadership could be used to overcome these obstacles. The advantages of giving them to frontline medical workers were clear, especially given the nation's ruinous overreliance on single-use. He said health authorities could promote elastomerics by showing their cost savings for hospitals and the environmental benefits of a mask that is reuseable. It's a puzzle why they haven't become more widespread
Nicolas Smit is the executive director of the American Mask Manufacturers Association and is an expert on elastomerics. He pointed out that the federal government spent $413 million on a failed attempt to decontaminate N95 masks.
James C. Chang has always been a fan of rubber. He persuaded his employer to purchase 1,500 masks after helping to produce a report on them for the National Academies of Sciences, Engineering and Medicine. The decision was based on research that said a respiratory epidemic lasting more than a few weeks would cause supply chain shortages.
He said that when they ran the numbers, it was clear they would burn through a six- or seven-digit cache of disposables. It is not possible for any hospital to stock that many masks.
He was concerned that their look would frighten patients or that it would be difficult to clean them. Hospitals across the country scrambled to find N95s, and the C.D.C. issued guidelines stating that N95s can be used up to five times.
He set up a system that allowed workers to drop off masks after each shift so they could be cleaned before being given to others.
Mr. Chang said that the staff felt more reassured wearing elastomerics than they did wearing N95s.
The Allegheny Health Network of Western Pennsylvania was one of the only hospital systems in the country to distribute more than 8000 masks. The decision to do so was made due to the fact that the manufacturing plant of the company that got its start producing coal miner protective gear was close to the headquarters of Allegheny.
Prompted by an appeal from hospital administrators, MSA began sending over masks but they ran into a problem. According to Dr. Zane Frund, executive director for materials and chemicals research at MSA Safety, the protruding filters only screened the air in the lungs and not the air exhaled by the wearer.
The solution was not rocket science, and the new models were approved by NIOSH in late 2020. A mechanical voice amplifier was added to make communication easier.
Dr. Sricharan Chalikonda, Allegheny's chief medical operations officer, said he was surprised by how popular they became among the medical personnel who had been equipped to wear them.
None of the employees went back to wearing N95s according to a paper he published. Outfitting the workers was one tenth as expensive as providing them with disposable N95s. The filters were still effective after a year.
Elastomerics were a game-changing factor for us. When I think of the millions of dollars wasted on N95s and then trying to reuse them, I realize how much elastomerics are a missed chance.
Federal health officials say they are moving quickly to produce better guidance. Maryann D'Alessandro is the director of the National Personal Protective Technology Laboratory. She hopes that a tool kit will help move the needle and serve as a guide for organizations and educate users.
Entrepreneurs who wear masks are unlikely to last that long. Max Bock-Aronson, the co-founder of Breathe99, which makes an elastomeric respirator that Time magazine included on its 2020 list of best inventions, has been winding down operations.
He blamed the decline in sales on Covid fatigue. The company's fortunes were doomed early on by the C.D.C.'s mask guidance, which prompted Amazon, Google and Facebook to limit or bar the sale of medical-grade masks to consumers.
The entire industry has been destroyed. Every time there is a new variant, we get a small boost in sales, but I haven't taken a nickel out of the company since May.
He is trying to find a buyer for his company while henywayanyday his online inventory sale. The masks cost $59 and can be sheathed in eight different colors.
The website says that all sales are final.
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