Reusable respirator masks could be a lifeline for health careworkerstrying toprotect themselveswhiletreatingcoronavirus patients.

Theyprovidethesamelevel ofprotection as disposableN95 respirators,which arein short supply around theworld.Theycan beeasily disinfected between patients and shifts. And theylast for months.

But thenationsemergency supply of medicalequipment never stocked them,despiteyears of research predicting direshortfalls of disposablerespirators during a pandemic andrecommendations to stockpilereusableones.

Thedecision not to buy them for the Strategic National Stockpileis inexplicabletoTomFrieden,who led theU.S.Centers forDiseaseControland Preventionuntil 2017.

You can get oneto a health careworker and say,Here's how you clean it and it's yours for theduration of thepandemic, Friedentold USA TODAY. And thoseareon themarket."

Hesaid theCDC predicted as many as 4 billion disposablemasks would beneededin anemergency liketheonethecountry faces now.

An official at theDepartment of Health and Human Services, which oversees thestockpile,said not buying thereusablerespirators was a matter of balancing funding and priorities.

The stockpile hasan alternativeto disposable masks,the official said: battery-powered, air-purifyingmasks.Butthe official,who declined to be identified without authorization,declined to say how many of those are in stock.

Thosedevices, which blow air into the users faces, can becomplicated, noisy and costly.Theyrun$500to $800apiecemany timesmore thana reusable respirator,according to astudyby researchers at the U.S. Department of Veterans Affairspublished in 2015.

Reusablerespirators costbetween$25 and $50;the disposable ones are 25to65 centseach.

In addition to disposable masks, that study recommended stockpiling reusablerespiratorsover air-purifying devices because they cost less and are easier touse.

Officials running thenational stockpileshould havebought reusablerespirators,said Lisa Pompeii, a researcherat Baylor Collegeof Medicine.

Pompeiiis theleadauthor of a study published last week that concluded health careworkers could bequickly fittedfor reusablerespirators and trained on how to usethem.

Theneed is moreurgent thanever.Almost 20% of health careproviders surveyed a weekagohadnorespirators.Another 28% said they werealmost out, according totheAssociation for Professionals in Infection Control andEpidemiology.

Its so discouraging,thesituation wefind ourselves in,said Ann MariePettis, theassociations president-elect.Wereout theretrying to help thosewho aretruly on thefront lines to help them besafeand keep their families safe.

But "so much of what wenormally teach is having to bethrown out thewindow becauseof thelack of supplies, shesaid. Theres all theseweird things weretelling peoplethey can do, suchasreusing disposablemasks.

TheJoint Commission, which accredits hospitals nationwide,altereditspolicyon protectiveequipmentTuesday to allowtheuseof homemademasksan extrememeasureto betaken onlywhenstandardequipmentis unavailable.

Thedeath toll from coronavirus topped 9,600 in the United States on Saturday,with thenumber of confirmed cases rising to337,000, according to Johns Hopkins University.Worldwide, thevirus haskilled more than 70,000 peopleand sickenedmorethan 1.2 million.

Reusable respirators vs. disposable face masks

Reusablerespiratorsarewidely used in manufacturing andotherindustriesto prevent users from inhaling harmful particles, such as thosefromasbestos.Millions of Americans havethemin their garages and on their workbenches.

Researchers specializing in respiratory protection have foundreusablerespirators,known as elastomerics,arealsoeffectivein health care settingsbecause theyofferthe same protectionas a disposable N95 respirator mask.

Thelogistics aremorecomplicated with thereusable, but thebenefits arethat wevegot protection, and you dont haveto worry about it running out, Pompeii, theBaylor researcher, said.

Themasksarefitted for size, just likethedisposablemasks,toensurea properseal.Theycan bewiped down with hospital-gradedisinfectant wipes between patientsand fully sanitized between shifts. They havecartridges thattrapparticles in theair, includingnano-sized ones, saidStella Hines,a professor and researcher at theUniversity of Maryland School of Medicine.

Thevirus at somepoint will dieon thefilterwerenotexactly surehow long, but within days, saidHines, whohas co-authoredseveralstudies on theuseofelastomeric respiratory masks in health care.

"And then as long as that filter doesnt get damaged by being wet,you should beableto usethat filter for a prolongedperiod of time, shesaid.Oneguidelinesays filters can bechangedevery threemonths, shesaid.

Hines is familiar with the respiratorsnot just through herresearch, but becauseemployees at theUniversity of Maryland Medical Centerusethem.

At thebeginningoftheirshifts,workers sign out masks in their size. Theycleanthemwith hospital-gradedisinfectant wipes between patients. At theend of their shifts, therespiratorsaresanitized, saidJim Chang, director of safety andenvironmental health at themedical center.

Theyrewashed, basically, hesaid.Theyredisinfected, dried, packaged, brought back up to thepoint of distribution and theyregood to go for thenext go-around.

The medical center used reusable masks during the 2009 H1N1 pandemic, Chang said, and learned a lot about how to makethem work. Now, weveput all thoselessons back in use.

Health care industry hasn't adopted reusable respirators

Butelastomericshavenot been widely adopted in thehealth careindustry.According to somestudies,workers saytheyrenot as comfortableas disposablemasks andpatients find themscary-looking. In somecases, workers found itmoredifficultto communicatewith patients.

Pompeiinoted that manufacturers havemodified therespirators to makeiteasier tospeak when wearing them.The masks aremadein colors likepurplish pink.

But thelack of widespread usemay havehampered their inclusion in theStrategic National Stockpile.

KerriWizner, anepidemiologistwithMDGuidelinesand lead author of a 2016 studyexaminingrespiratory protectivedevices andemergency preparedness, said themakeup of any medical stockpileshould reflect whats in use.

They want to stock thethings peopleareusing in hospitals, sotheyrenotgoing, 'Usethis thing thats great, but nobodysever used it,Wiznersaid.Inanemergency situationlikewerehaving rightnow, youdont havetheluxury of setting up this fancy program.

Shortages of masks, ventilators needed to treat coronavirus patients

Officialsacross thecountryareventing aboutshortagesof disposablemasks, ventilators and otherequipmentand spiraling pricesas theycompeteagainst oneanother to buy them.

Its thewild, wild west of personal protectiveequipment, Jared Moskowitz, Floridasemergency management director,said Thursday.

Thestateplaced ordersfordisposablerespiratorsmorethan a monthago, hesaid,buthasntbeen told whenthey will arrive.He's now pleadingwith3M,oneof themanufacturers,to selldirectlyto thestaterather than through a distributor.

Nobody really understands who has product, wheretheproduct is or who represents who, hesaid. Frustration is not theword I would use, but theword I would use,you cant print.

Butat theUniversity of MarylandMedical Center, they facenosuchshortage of respirators.

Themedical centerstockpiledelastomericrespiratorsbefore the H1N1 pandemic in 2009.They wereused regularly fora number ofyears beforethey wereput back in storagefor anemergency,Changsaid. Heserved on a National Academies of Sciences,Engineering, and Medicinepanelin 2017 studying theuseofelastomeric respirators in health care, includingsurgesituations.

Themedical centerordered morewhen COVID-19started to spread across China.When the virus struck the United States, workers were fitted and they were passed out toemployees,Chang said.

Chang saidleadership is key when making decisions about how to preparefor a pandemic likethis.

It becomes incumbent upon peoplelikemyself, otheremergency managers, other safety officers,to then sell it to theinstitutions leadership team, that hey, this is a real problem, weneed to beprepared, and this is what you need to do to beprepared.

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Reusable respirators protect doctors and nurses against coronavirus, they aren't in the national stockpile - MetroWest Daily News