CATER Mask
Decisions
February 2, 2021
Step Three in the Three Step Mask Strategy
Webinar Friday, Feb 5 at 10:AM CST
Should the Mask Program
be Pursued Separately or as Part of Safe
Bubbles?
Everyone Should Wear Efficient Tight Fitting
Masks According to Allen and Others
HCA Healthcare and A Plus Partner to Manufacture
Masks in the U.S.
China Continues to be Major Supplier of Masks To
the U.S.
Combining SARS Testing with Droplet Analysis
PM Levels are Four Times Higher Than Guidelines
in the Largest Cities
_______________________________________________________________________________
Step Three in the Three Step Mask Strategy
Webinar Friday, Feb 5 at 10:AM CST
We need a program to insure that everyone is
fitted with tight fitting efficient masks as
quickly as possible. Distinguished researchers
have developed a three step plan which we will
be discussing on Friday.
On the 28th we covered the background
for Step 1 of the Friday webinar. Yesterday we
covered Step 2 and
today Step 3.
The three steps are (l) launching an awareness
blitz, (2) advise on which masks should be worn
and (3) prioritize masks for the vulnerable.
View the previous Alerts at
http://www.mcilvainecompany.com/CATER/subscriber/default.htm
The webinar will include a
display
and discussion of the three steps. We are
encouraging input from all the participants and
hope for a lively discussion and debate.
Click here to register for the February 5
webinar:
https://home.mcilvainecompany.com/index.php?option=com_rsform&view=rsform&formId=92
3.
Prioritize masks for the vulnerable
a.
who
Are the vulnerable those with health issues and
lack of funds or just health issues? One
argument is that many middle and upper income
families will prefer CATER masks to surgical
masks with braces. There is also the question of
mask life vs cost. Masks will be worn longer if
the cost is higher. Mask use should be a
function of human contact. People who have
little
contact with those not in their daily lives can
wear masks for fewer hours per day and for more
days.
There are debates about how infectious children
are and at what age they should start wearing
masks. This also relates to mask sizes and
whether the individual can find a mask that
fits.
There are cases where people who were recently
vaccinated become infectious. Also some vaccines
are rated at only 60% efficiency. So we cannot
automatically eliminate the vaccinated
populations.
b.
location – should this extend to other
countries?
Fareed Zakaria last Sunday predicted that until
everyone in the world is vaccinated the pandemic
will continue. New variants will arise in
developing countries. They will then travel back
to the developed countries and new infections
will occur. At best it will be 2024 before herd
immunity can be achieved through vaccinations
worldwide.
If masks are combined with vaccinations in the
developing countries, there is a good chance to
vanquish COVID.
c.
how
i.
vouchers
There is an effort underway for the U.S.
government to subsidize mask use.
One way used in other countries is to
distribute vouchers which would be used to
obtain a number of masks.
ii.
direct distribution
The Trump Administration and underwear
manufacturers were close to an agreement for
massive free mask distribution until it was
determined that the masks looked too much like
underwear let alone what efficiency level would
have been obtained.
If the cost per day for 300 million Americans is
$ 0.50 and the program extends for 180 days the
cost would be $27 billion. If the program were
just focused on the most vulnerable then the
cost would be considerably less.
This is a small amount compared to the $1.9
trillion package now being debated in the U.S.
Congress.
Should the Mask Program be Pursued Separately or
as Part of Safe Bubbles?
Mandating effective masks and making them
available at low cost is part of the push in the
push-pull initiative. The details such as which
type of masks will be supplied, insuring that
they are worn properly, and worn when in public
poses another set of challenges.
This is where the pull part of the initiative
can be effective. If each school, sports
stadium, fitness center, restaurant, church, or
office building becomes a safe bubble, there
will be major incentives to maximize the ability
of masks to reduce the risk. Schools are
desperately looking for ways to convince
teachers and parents that their classrooms are
safe. Hotels are already competing as to which
is the safest.
Life is about making choices. You may choose a
hotel, airline, or restaurant which is safer
than others. This relative safety or risk is
what is already being determined by many
consulting companies.
So assessing the relative safety of a bubble is
much more straight forward than a quantitative
approach where there are other variables which
are important but not relevant in making the
choice. You may use quantitative risk to decide
whether to go to any school, restaurant, or
hotel.
But once the decision is made that the
quantitative risk is acceptable then the
relative risk becomes the determining factor in
the facility choice.
Everyone Should Wear Efficient Tight Fitting
Masks According to Allen and Others
Joseph Allen, an associate professor and the
director of the Healthy Buildings program at the
Harvard T.H. Chan School of Public Health,
penned an op-ed
for The
Washington Post on
Tuesday, laying out the case for why “everyone”
should be wearing an N95 mask at this point in
the COVID-19 pandemic.
Allen isn’t the only local public health expert
pushing for “better masks” as the pandemic
continues. His colleagues at Harvard Medical
School, Dr. Abraar Karan and Dr. Ranu Dhillon, are
pressing for a national initiative that
would distribute high-filtration masks, such as
N95s, to every household in the United States.
“I’m not alone in calling for better masks, and
certainly not the first,” Allen wrote. “But I am
joining the chorus calling for them. This could
be the key to slowing the pandemic and limiting
spread from the new more highly transmissible
variants until we all get vaccinated.”
While a typical cloth mask is expected to
capture about half of the respiratory aerosols
released when a person talks or just breathes,
high-filtration masks like N95s filter 95
percent, Allen wrote. Two people wearing N95s
results in a 99 percent reduction in potential
exposure.
“In the scrambling for information and tools in
early days of the pandemic, it was acceptable to
just say any cloth mask will do because it’s
true,” Allen wrote. “Any face covering is better
than none. But we’ve learned so much since then,
and we need to adjust our strategy.”
The professor said there’s no reason at this
point in the pandemic why any essential worker —
or anyone else — should be without better masks.
Before the pandemic, N95s cost about 50 cents
and were easy to manufacture, according to
Allen.
“We could reduce exposure by 99 percent for what
should be $1 a mask,” he wrote. “(Prices are
higher now because of the failure to produce an
adequate supply.) Throw in better ventilation
and some distance between people, and you have
hospital-grade protections.”
According to Dr. Nahid Bhadelia, an infectious
disease physician and the medical director of
the Special Pathogens Unit at Boston Medical
Center, not only does the United States need a
national effort to get hi-fi masks to the
public, but the government should also start
with releasing a standard for the masks that are
available.
“It’s unconscionable that we have the largest
use of PPE by American public in history and the
quality of these masks is not being moderated,
standardized or regulated,” she wrote on
Twitter. “It’s not just about N95s. Those may
not work in every situation but there are other
qualities to good masks aside from filtration
efficiency including fit and seal, ability to
withstand moisture (from sweat and saliva) etc.
These qualities could be improved in consumer
masks.”
What is needed is the equivalent of Operation
Warp Speed,
the government initiative started under the
Trump administration aimed at accelerating
development, production, and distribution of
COVID-19 vaccines, for “high quality cheap PPE
and improved ventilation in public places,” she
said.
“Do not get me wrong — a mask is better than no
mask,” she wrote. “Wear a mask. Using [the]
excuse of no high quality masks to not wear a
mask is like refusing a rescue raft because you
weren’t given a boat at the time.
Here are some relevant tweets on the subject
Agreed. And also we should start with releasing
a standard for masks available to consumers.
It’s unconscionable that we have the largest use
of PPE by American public in history & the
quality of these masks is not being moderated,
standardized or regulated.
Quote Tweet
Ranu Dhillon
@RanuDhillon
·
Jan 26
Instead of double-masking, governments in South
Korea & other countries got high-filtration
masks to their populations We need a federal
effort to do the same in the US
twitter.com/AbraarKaran/st…
It’s not just about N95s. Those may not work in
every situation but there are other qualities to
good masks aside from filtration efficiency
including fit & seal, ability to withstand
moisture (from sweat & saliva) etc. These
qualities could be improved in consumer masks.
I don’t think it’s enough to have guidance out
in media or public health agency pages for what
public should pick, although that’s helpful. I
think the private sector would love guidance on
how to get this right & welcome support to make
it low cost to public.
We need equivalent of Operation Warp Speed but
for high quality cheap PPE & improved
ventilation in public places. Such innovations
would help not just during this pandemic but
future threats from emerging respiratory viral
threats.
And make these new innovations (cheap,
comfortable, efficient) free. Make such high
quality masks available to everyone. Pennies on
the dollar, a preventing transmission is still
cheaper & better for individual & public health
than treatment.
HCA Healthcare and A Plus Partner to Manufacture
Masks in the U.S.
HCA Healthcare Inc. entered into a joint venture
business with Chino, Calif.-based healthcare
supplies company A Plus International Inc. to
manufacture personal protective equipment such
as surgical and procedure masks in the U.S.
Under the collaboration, an Asheville,
N.C.-based manufacturing facility is expected to
soon begin producing masks according to safety
and quality standards set by the American
Society for Testing and Materials.
The increased demand for personal protective
equipment, or PPE, due to the pandemic has
"underscored how dependent we have been on
supplies from overseas," said Jonathan Perlin,
president, clinical operations group and chief
medical officer of HCA Healthcare. The
collaboration focuses on the domestic production
of PPE to support medical staff on the
frontline, he added.
Initially, both the companies will equally
invest in the new business, which aims to cater
to the increasing global demand of PPE courtesy
of the COVID-19 pandemic. HCA noted that in 2020
it spent more than $196 million on PPE compared
to 2019.
The joint venture will be co-managed by A Plus
and HealthTrust — a global leader in purchasing
aggregation and performance improvement for
healthcare. HealthTrust's unit Resource
Optimization & Innovation is the distribution
partner and will provide PPE to HealthTrust
member organizations throughout the U.S.
A Plus is a leading manufacturer of disposable
medical and surgical supplies. It has
the following infrastructure in place in
China:
-
Kier bleaching
system
-
Gauze folding
machine
-
PE extrusion
system
-
Blown film
system
-
Non-woven
printing
capabilities
-
Ultra-sonic
bonding system
-
Thermo bonding
system
-
Form-fill and
seal
capabilities
-
High speed
on-winding
system
-
Class 10/100
clean room with
laundry
-
Steam
sterilization
China Continues to be Major Supplier of Masks To
the U.S.
In the last few months U.S. suppliers have
greatly increased production of masks but they
have a long way to go if the vision is to match
Chinese output.
In September 2020 China accounted for more than
85% of all U.S. imports in the category
dominated by N-95 respirators, disposable and
non-disposable face masks, surgical drapes and
surgical towels, and, oddly enough, including
U.S. flags.
The textile category for these personal
protection equipment items is growing more
rapidly than any of China’s other top 15 imports
into the United States this year, according to
the latest Census Bureau data, which runs
through July. Those top 15 imports accounted for
almost 46% of U.S. imports from China.
While overall U.S. imports from China are down
14.71%, which is more than overall U.S. imports,
which are off 12.04%,
While dominated by masks and other PPE, it is a
broad category that includes furniture movers’
pads, pillowcases and wall banners — as long as
they are made of textiles — and U.S. flags.
Through there are a number of U.S. manufacturers
of U.S. flags, imports from China in the first
seven months of the year accounted for 98.91% of
the total. The $4.28 million in U.S. flags, a
trifling compared to $1.4 billion in N95
respirators, was the lowest total since 2015.
The percentage, however, has been consistent for
years.
Though the category is broad, it does not, of
course, necessarily capture all personal
protection equipment.
Looking more broadly at the leading U.S. imports
from China through the first seven months of the
year, 12 of the 15 fell in value.
In addition to the textile category, a category
of miscellaneous plastic articles — which also
includes products that could be related to the
pandemic, such as pneumatic mattresses, plastic
facemasks and other laboratory ware — also
increased 13.22% but accounted for a record
53.72% of all U.S. imports.
Combining SARS Testing with Droplet Analysis
SGS has the capability to combine the aerosol
ventilation testing with its SARS testing. One
use of the viral RNA test is to see how well a
surface has been cleaned. It would seem that an
equally important function is to see how
efficient or inefficient the filter system is in
actually reducing virus spread.
SGS offers lab-based testing for the presence of
SARS-CoV-2, the virus responsible for COVID-19
on environmental surfaces and air samples.
Testing for the presence of SARS-CoV-2 viral RNA
is the most direct and definitive test for
ensuring completeness of disinfection
procedures. The COVID-19 virus analysis is based
on the Centers for Disease Control and
Prevention, adapted and validated for
environmental samples in consideration of test
equipment and consumables. Especially in
critical high-risk scenarios, and for targeted
testing of areas of known contamination,
appropriately validated RT-qPCR methods can
provide the highest level of confidence.
WHAT IS RT-QPCR? RT-qPCR, or Reverse
Transcription, quantitative-Polymerase Chain
Reaction measurement is a technique used to
measure RNA. It works by converting the RNA into
its complementary DNA using a transcriptase
enzyme, and then amplifying the DNA using the
polymerase chain reaction. A fluorophore (or
fluorescent chemical compound) is added to the
mixture to be able to read the fluorescence of
the amplified cDNA. In the Covid-19 RT-qPCR
test, the specific primers and probes used
ensure that only RNA from the Covid-19 virus is
detected.
WHAT
DOES THE RT-QPCR TEST REPORT? The test reports
the presence/absence of RNA characteristic of
the SARS-COV2 virus that causes COVID-19. The
test is based on CDC RT-qPCR panel(1) and
measures the same gene targets as the clinical
tests used for Covid-19 testing in humans. As
this RT-qPCR assay tests for the presence of RNA
fragments that are unique to the Covid-19 virus,
and no other virus, it is the most direct,
specific and sensitive test for the presence of
Covid-19 RNA on a surface.
WHY USE RT-QPCR? While coronaviruses are easily
destroyed by the application of soap and
multiple other cleaning and disinfection agents,
their presence on a surface is the most
definitive measure of incomplete cleaning. For
critical areas, RT-qPCR testing provides the
greatest confidence on the efficacy of a
cleaning and disinfection protocol.
WHAT MATRICES ARE THE TEST OFFERED IN? The RT-qPCR
test for the SARS-CoV-2 virus is currently
offered in: • Surface swabs, typically 5 cm x 5
cm surface wiped per swab • Air samples from
endotoxin-free polycarbonate cassettes and PTFE
cassettes. The polycarbonate cassettes can be
sampled at up to 15L/ min, at least 2 hrs is
recommended. The PTFE cassettes, SKC PTFE
Filter, 0.3 µm, 37 mm. For example require a
lower flow rate and longer sampling time (~
2-4L/min, and 10 hr sampling time
PM Levels are
Four Times Higher Than Guidelines in the Largest
Cities
The average level of particulate matter (PM2.5)
pollution in the largest cities in the world is
39 ug/m3, nearly four times higher than the
World Health Organization guideline of 10 ug/m3,
according to analysis conducted by NGO OpenAQ.
According to the
research, the worst affected cities in the world
are all in Asia, with Pakistan, India and China
all having the highest measured levels.
OpenAQ has
highlighted that this data illustrates the stark
global inequalities when it comes to air
pollution, with over half of the world’s
population having no access to official
government data on air quality.
In order to address
the problem, a coalition of NGOs have come
together to create a new open-source data
platform that uses low-cost air pollution
sensors to provide the general public with
access to air quality data from across the
world.
The platform brings
together low-cost sensor air quality data from
the Environmental Defense Fund (EDF), as well as
from Purple Air, HabitatMap and Carnegie Mellon
University.
While prices of the
sensors con vary, the sensors can be installed
by individual users, communities or governments
to increase coverage and access to air quality
data.
Jeremy Taub,
executive director of OpenAQ, said: ‘We want to
encourage new, affordable solutions to monitor
air quality, and bring that data to OpenAQ to
increase funding and action for those
communities who are most affected by air
pollution. It will fill important data gaps
allowing communities to develop solutions to air
pollution.’
Millie Chu Baird,
associate vice president at Environmental
Defense Fund, added: ‘One of the keys to
fighting air pollution inequity is data
transparency – ensuring that as wide a range of
people as possible have access to as much of it
as possible. It’s foundational to the ability to
take acti0n.
