This was much more than a feel-good story. This was about being able to do something at a time when there is precious little we can do. Washing hands, staying home, physical-distancing, yes, but none of that feeds our deep, human need to help others. Sewing face masks speaks to mission: These could save lives!
Yet in the rush to do good, we could be setting ourselves up for yet another in a series of public health blunders during this still-expanding crisis. Face masks can turn into fomites—physical objects that spread disease—if they are not used properly.
In the raging debate about whether or not the American public should start wearing masks en masse—as they do in China, South Korea, Singapore and other countries that have managed to “flatten the curve”—the focus has been on efficacy: Does wearing a mask stop the spread of the virus?
Ed Yong at The Atlantic explores the pros and cons in great detail, but in a nutshell, wearing a mask helps, at least it can help some people, at least sometimes. Maybe. A home-made mask can keep someone who may not be showing any symptoms but is still shedding virus (asymptomatic or pre-symptomatic) from shedding virus on other people, or the things they might touch. Likewise, a mask can act as a barrier that keeps out viral particles propelled through the air in droplets or aerosolized.
A DIY mask, however, is not a medical-grade N95 mask, so the protection is limited. More to the point, according to WHO guidelines, once a mask—any type of mask—becomes moist, it should be thrown out.
Consider the pre-symptomatic mask-wearer: With each exhale the mask become more saturated with virus. With each inhale the wearer breathes in virus, potentially setting up a nasty feedback loop. Recent research shows a correlation between viral load (how much virus is in a patient) and severity of symptoms.
Either way, whether a wearer is breathing virus into the mask, or the mask is filtering virus from the air, the mask itself becomes a fomite. We have become a nation obsessed with Clorox wipes, hand-washing and the finer points of sanitary grocery-shopping. And yet almost nothing is said about the importance of throwing out used masks. While it is possible to wash a DIY cloth mask with detergent (and possibly bleach), each washing will break down fibers, reducing its effectiveness.
It matters. In one of the first examples of modern biowarfare, there is evidence suggesting that British soldiers in the mid-18th century gave Native Americans “presents” of blankets that had been used by smallpox patients. The soldiers didn’t have a clue what a microbe was, but understood perfectly the deadly potential of fomite disease transmission.
Smallpox was a novel pathogen for Native Americans, just as Covid-19 is a novel pathogen for us. They had no natural defense against it, nor was there a vaccine. Indeed, it would be several decades before a smallpox vaccine—the very first vaccine of any kind—was developed.
PUBLIC HEALTH DONE RIGHT
In February, when the Covid-19 outbreak ramped up in South Korea, public demand for face masks when through the roof, leading to shortages, price-gouging and protests. The government stepped up, buying half the inventory from the nation’s 130 mask manufacturers to guarantee civilian supply. These were good masks, too—the equivalent of N95s. A system for equitable distribution was put in place and costs subsidized so that consumers paid about $1.23 per mask. The recommendation was to use a new mask each day. When manufacturers strained to meet demand, the government increased the buy to 70% of supply and Koreans were asked extend the the use of a single mask to a couple of days.
To follow the Korean example of best practices—one mask per person per day—we would need more than billion masks every three days.
But in the US, there aren’t enough N95s for our doctors, nurses, EMTs, caregivers—the people on the frontlines of this crisis—much less for the rest of us. It isn’t only masks that are in short supply. With the peak of the pandemic still weeks away, the Federal stockpile of personal protective equipment (PPEs) is already nearly depleted.
So the sewists sew. And we are lucky they do. But they cannot fill the need: One mask per day for every American would top one billion masks every three days. Nor is the product nearly as good as an N95. Still, hospitals are glad to have them, though used as mask-protectors strapped over N95s to extend how long they can be used.
As for the rest of us, we need to understand the limitations of DIY masks and that they must either be discarded (sealed in a plastic bag), or washed with detergent immediately after each use.
It is profoundly moving to witness the ingenuity, determination and generosity of all those making masks and also 3D-printing face guards, and redesigning, building and sourcing ventilators. In so many critical ways have come to the rescue.
But it is important to understand that what brought us to this point is also evidence of rot. We should not be needing this kind of save-the-day heroism. For many it will be far too little, far too late.
It did not have to play out this way. For decades government agencies—at all levels of government—have used scenario training exercises to prepare for every imaginable disaster. Last year’s massive “Crimson Contagion” exercise, which modeled a national pandemic response, revealed system-wide weaknesses, amplified by chronic underfunding and poor inter-agency communication. Yet few considered the possibility that expert advice in a crisis would not only be ignored but aggressively refuted.
In a searing interview with NPR’s Terry Gross, author Max Brooks (World War Z), who is also a nonresident fellow at West Point’s Modern War Institute, spoke at length and in detail about the spectacular failure of the federal government to the Covid-19 crisis:
“I can tell you that the federal government has multiple layers of disaster preparedness—who are always training, always planning, always preparing, regardless of how much their budgets get cut. I have toured the CDC and I have seen all their plans. I have witnessed what was called ‘Vibrant Response.’ This is the homeland nuclear attack scenario, which was a coordination of FEMA, the Army, the National Guard, state and local officials, all working together in a massive war game to prepare us for a nuke. I have also witnessed what was called a hurricane Rehearsal of Concept drill, where not only did the same players come in, but also bringing our allies from Canada and Mexico. So I have seen that we have countless dedicated professionals who think about this constantly. And they’re ready to go, and they have not been activated.”
Instead, as New York Governor Andrew Cuomo and others have pointed out repeatedly, we have a medical supply system designed to benefit profiteers: States are competing against one another—and against FEMA—to secure essential supplies, driving up prices. “It’s like being on eBay with 50 other states bidding on a ventilator...That’s literally what we’re doing,” explained Cuomo. States already facing massive budget deficits will be hard-pressed to recover after the pandemic has passed.
The good news in the bad is that several countries with far fewer resources than the United States have managed to mount an effective response to Covid-19 and we can learn from their examples. With any luck, we can also learn from our past mistakes and stop making new ones. This means not rolling back Clean Air Act and fuel efficiency standards, a particularly cruel move in the midst of a lung-shredding pandemic. This means not closing down the healthcare exchanges for poor people desperate to buy medical insurance.
The list seems to grow by the day.
We deserve better. We can do better. Others are doing better. There is no reason not to do better. And there is everything to lose if we don’t.