Photograph: Lynne Sladky/AP
With crucial protective gear in short supply, federal authorities are saying health workers can wear lower-grade surgical masks while treating Covid-19 patients – but growing evidence suggests the practice is putting workers in jeopardy.
The Centers for Disease Control and Prevention (CDC) recently said surgical masks are “an acceptable alternative” to highly protective N95 respirators unless workers are performing intubations or other procedures on patients with Covid-19 that could unleash high volumes of virus particles.
But scholars, not-for-profit leaders and former regulators in the specialized field of occupational safety say relying on surgical masks – which are considerably less protective than N95 respirators – is almost certainly fueling illness among frontline health workers, who probably make up about 11% of all known Covid-19 cases.
“There’s no doubt in my mind that that’s one of the reasons that so many healthcare workers are getting sick and many are dying,” said Jonathan Rosen, a health and safety expert who advises unions, states and the federal government. As of 23 April, more than 21,800 healthcare workers had contracted the coronavirus and 71 have died, according to a House education and labor committee staffer briefed by the CDC.
The allowance for surgical masks made more sense when scientists initially thought the virus was spread by large droplets. But a growing body of research shows that it is spread by minuscule viral particles that can linger in the air as long as 16 hours.
A properly fitted N95 respirator will block 95% of tiny air particles – down to 0.3 micron in diameter, which are the hardest to catch – from reaching the wearer’s face. But surgical masks, designed to protect patients from a surgeon’s respiratory droplets, aren’t effective at blocking particles smaller than 100 microns, according to the mask maker 3M. A Covid-19 particle is smaller than 0.1 micron, according to South Korean researchers, and can pass through a surgical mask.
The CDC’s recent advice on surgical masks contrasts with another CDC web page that says surgical masks do “NOT provide the wearer with a reliable level of protection from inhaling smaller airborne particles and is not considered respiratory protection”.
Research from other nations hit hard by the virus confirms the concern. A report published earlier this month examined data from two hospitals in South Korea, and found that surgical masks “seem to be ineffective in preventing the dissemination” of coronavirus particles. A 2013 Chinese study found that twice as many health workers, 17%, contracted a respiratory illness if they wore only a surgical mask while treating sick patients, compared with 7% who continuously used an N95, per a study in the American Journal of Respiratory and Critical Care Medicine.
Yet many health facilities, citing the CDC guidelines and scarce supply, are providing N95s in only limited medical settings.
Earlier this month, the national Teamsters Union reported that 64% of its healthcare worker membership – which includes people working in nursing homes, hospitals and other medical facilities – could not get N95 masks.
At Michigan Medicine, one of the largest hospitals in the state, employees don’t get N95s except for performing specific procedures on Covid-positive patients – such as intubating – or treating them in the ICU, said Katie Scott, an RN at the hospital and vice-president of the Michigan Nurses Association. Employees who otherwise treat Covid-19 patients receive surgical masks.
We are at a risk of getting this virus and we are at a risk of bringing it home to our families
That matches CDC protocol, but leaves nurses like Scott – who has read the research on surgical masks versus N95s – feeling exposed.
“We are at a risk of getting this virus and we are at a risk of bringing it home to our families,” Scott said.
At Michigan Medicine, employees are not allowed to bring in their own protective equipment, according to a complaint the nurses’ union filed with the Michigan Occupational Safety and Health Administration. Scott said friends and family have mailed her personal protective equipment (PPE), including N95 masks. It sits at home while she cares for patients.
“To think I’m going to work and am leaving this mask at home on my kitchen table, because the employer won’t let me wear it,” Scott said. “You feel sacrificial in a way.”
News reports from Kentucky to Florida to California have documented nurses facing retaliation or pressure to step down when they have brought their own N95 respirators.
A spokesperson for Michigan Medicine declined to answer questions about the hospital’s protective equipment protocols.
In New York, the center of the US’s outbreak, nurses across the state report receiving surgical masks, not N95s, to wear when treating Covid-19 patients, according to a court affidavit submitted by Lisa Baum, the lead occupational health and safety representative for the New York State Nurses Association (NYSNA).
So far, at least 16 NYSNA members have died from the coronavirus, and more than 1,000 have tested positive, according to union estimates.
National Nurses United has pushed Washington lawmakers to pass legislation that would ramp up production of N95s by compelling the White House to invoke the Defense Production Act, a Korean war-era law that allows the federal government, in an emergency, to direct private business in the production and distribution of goods.
It is also calling on Congress to require that Occupational Safety and Health Administration (Osha) put forth an emergency temporary standard to mandate that employers provide healthcare workers with protective equipment, including N95s masks, when they interact with patients suspected to have Covid-19.
“Nurses are not afraid to care for our patients if we have the right protections,” said Bonnie Castillo, the executive director of National Nurses United, “but we’re not martyrs sacrificing our lives because our government and our employers didn’t do their job.”