When to Donate Masks?

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As peo­ple start com­ing into hos­pi­tals with the coro­n­avirus, the num­ber of masks we go through with stan­dard pro­to­cols goes up enor­mously. Th­ese masks are nor­mally sin­gle-use, and you put on a new mask ev­ery time one is needed. Roughly, a hos­pi­tal could in­crease its daily us­age of masks 100x as they get their first few covid-19 pa­tients, and then even more as the full force of the epi­demic hits. This is a ton of stress on the sup­ply chain, and not sur­pris­ingly sup­pli­ers haven’t been able to ramp up. Run­ning your fac­tory around the clock and bring­ing on ex­tra work­ers can help some, but when even dou­bling out­put would be im­pres­sive this is nowhere near enough.

There are many types of mask, but the two main ones in health care are sur­gi­cal masks and N95 res­pi­ra­tor masks:

  • A sur­gi­cal mask is pri­mar­ily in­tended to pro­tect oth­ers from the wearer by catch­ing droplets, but pro­vides limited pro­tec­tion to the wearer.

  • A vented N95 mask pro­tects the wearer against not just droplets but also air­borne trans­mis­sion.

  • An un­vented N95 mask pro­tects both the wearer and oth­ers.

When I say “mask” be­low, I’m talk­ing about N95 masks. We can get some­thing to re­place sur­gi­cal masks, even if it’s peo­ple sewing reusable cloth ones, but N95 pro­duc­tion is bot­tle­necked on ma­chines that can make good enough melt-blown fabric.

Luck­ily, health care is not the only field where peo­ple need res­pi­ra­tory pro­tec­tion. In­dus­trial N95 masks are very widely used in con­struc­tion, de­mo­li­tion, and other situ­a­tions where there’s mod­er­ately haz­ardous dust. Th­ese masks aren’t rated as sur­gi­cal N95 masks, and they’re more likely to be vented, but their re­quire­ments are very similar and the gov­ern­ment is now al­low­ing them to be used.

As hos­pi­tals are un­able to get re­sup­plied with their reg­u­lar masks, they’re ask­ing for dona­tions from the com­mu­nity and in­dus­try. This makes a lot of sense: peo­ple and or­ga­ni­za­tions that use masks gen­er­ally keep ex­tras, and med­i­cal use is now much more ur­gent.

On the other hand, dona­tions of masks will not get us through this epi­demic on their own: hos­pi­tals also need to make mas­sive ad­just­ments in how quickly they go through masks, and this is a hard ad­just­ment. Reusing masks is mod­er­ately dan­ger­ous, but it’s much less dan­ger­ous than the very likely prospect of later not hav­ing them at all. It looks like hos­pi­tals used masks at nearly their reg­u­lar rate through­out Fe­bru­ary and in early March, even though the short­age goes back to late Jan­uary. Re­ports of mask ra­tioning are hap­haz­ard, and in the last cou­ple days I’ve seen posts from health care work­ers say­ing they’re us­ing N95 masks:

  • At their reg­u­lar rate, but they’re wor­ried about run­ning out.

  • For aerosol-gen­er­at­ing pro­ce­dures on sus­pected pa­tients only.

  • One per day, only as needed.

  • One in­definitely.

  • Not at all, be­cause there are no more.

Hospi­tals are not the kind of places that change policy quickly, and it seems they’re mostly ad­just­ing in re­sponse to their re­sup­ply or­ders not be­ing filled. The CDC should be tel­ling hos­pi­tals across the coun­try that we’re very short on masks and that we should be go­ing through them as slowly as pos­si­ble, but in­stead it’s offer­ing much weaker guidance that would be more ap­pro­pri­ate to lo­cal short­ages.

Since most of this change in be­hav­ior is hap­pen­ing in re­sponse to masks be­ing un­available or in very short sup­ply, mask pro­duc­tion is hard to ramp up, and we don’t ex­pect this to peak for at least a month, if you donate masks to­day I ex­pect them to be used much more quickly than if you wait and donate them when things are worse. You don’t want to wait too long, be­cause at some point the short­age re­ally will be over and the need will de­crease, but I ex­pect the need for masks to be much higher in two weeks than it is to­day.