On March 20 2020, KOMO anchor Mary Nam shared a photograph of a person wearing a surgical mask (a form of personal protective equipment, or PPE, known to be in short supply due the coronavirus pandemic), and put out a call for anyone who knows how to sew and has access to a sewing machine to participate in an effort to fortify COVID-19 medical supplies with homemade surgical masks:
Know how to sew? Got a sewing machine?
WE NEED YOU!
Please click on link for details.
**All provided material is…
In her original post, Nam wrote:
Know how to sew? Got a sewing machine?
WE NEED YOU!
The post was later updated to include the following text:
Please click on link for details.
**All provided material is surgical grade and products will be UV sterilized and inspected before use. The mask design was lab tested to ensure safety and effectiveness.**
The Food and Drug Administration (FDA) maintained a page, “N95 Respirators and Surgical Masks (Face Masks),” defining the terms used during discussions of PPE shortages; linked on that page was a March 11 2020 letter from the FDA about coping with PPE shortages in a clinical environment:
N95 respirators and surgical masks (face masks) are examples of personal protective equipment that are used to protect the wearer from airborne particles and from liquid contaminating the face. Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) and Occupational Safety and Health Administration (OSHA) also regulate N95 respirators.
The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95 percent of very small (0.3 micron) test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However, even a properly fitted N95 respirator does not completely eliminate the risk of illness or death.
Comments on Nam’s Facebook post were often left by people who met the stated requirements of knowing how to sew and having access to a sewing machine. However, a self-identified nurse from a Seattle hospital (a city where many of the United States’ earliest cases occurred) politely expressed some concerns about the 100 million masks initiative:
As a RN at Swedish, I am extremely skeptical of the efficacy of masks that are sewn. Are these CDC approved?! Seems to me that the CDC keeps downgrading the necessary PPE based on availability and not science. We healthcare workers put our health (and our family’s health) at risk every day now. We deserve the best equipment.
Jeffries explained that it was her experience that standards for protective equipment were relaxed due to a dearth of supplies — not the parameters of SARS-nCoV-2 safety protocols in a clinical setting.
A second commenter did not claim to be a medical professional, but questioned the safety of the program in general, citing concerns about sterility and donations from volunteers possibly exposed to SARS-nCoV-2 themselves:
Do all the masks go thru a sterile process before their used??
I’m so confused …cross contamination from many homes going into medical and health facilities…
I’m a Teacher and when parents offered to drop off work at the school every week I about flipped out inside…if your kids cant be here in person, your willing to pack up their germs in a bag and send them back to the school…
Can someone please explain to me how everything is not being cross contaminated? Including the school lunches they are delivering?? Doesnt the virus live on things for a period of time?
Be nice…I’m just looking for information not a lashing
That commenter noted that as described, the program would entail raw materials distributed to “many homes,” then collected and distributed to health facilities without any sterilizing measures described. Two comments down, the exact concern the commenter raised seemed to be illustrated:
I’m in Wenatchee WA, I believe I’ve been exposed but not exhibiting symptoms. A family member in this household is suspected of having the virus. I would welcome the chance to help if it is safe.
We clicked on the link shared by Nam, and it led to a page with the same graphic seen in the Facebook post:
Under “100 Million Mask Challenge” and “the journey begins with us … learn how to get involved,” the page explained global demand for PPE led to a shortage of “masks”:
Let’s come together to keep our health care workers safe, so they can safely care for our patients.
The global demand for personal protective equipment (PPE) has created a severe shortage of PPE across the world. While regular distribution channels ramp up, we need to act now to ensure caregivers have the isolation masks they need to do their jobs safely.
So, we’re calling on you! Anyone with a willing heart and the ability to sew can help us protect our caregivers by sewing masks they can wear on the front lines of the fight against COVID-19.
We are starting with Western Washington, which is one of the hardest hit areas in the nation. The effort will grow from there over the coming days and weeks so eventually everyone can participate.
Please note: Volunteers must have the ability to sew and a sewing machine at home.
A subsequent portion explained that all willing participants were asked to commit to sewing 100 masks. An initial date of March 23 2020 was provided for volunteers to collect the materials being distributed:
Here’s how it will work.
Since materials are precious and large quantities are required to make a difference, we’re seeking volunteers willing to make at least 100 masks. If you know how to sew, have a sewing machine, and are up for that challenge, here’s how you can help:
Pick up a kit that will include all the materials you need to make 100 masks. We’ll offer various pick-up and drop-off times and locations. The first date and location for picking up a kit is [listed.]
Be sure to check back for future kit distribution dates and locations as we will be updating regularly.
A contact form providing the organizers of the 100 Million Mask Challenge with information for volunteers followed; filling out the form did not lead to any additional information on the kits’ contents or parameters.
Organizing the 100 Million Mask Challenge appeared to be Providence.org, described on the site’s “about” page as “the largest health care provider in Washington state”:
Providence Health & Services is the largest health care provider in Washington state. Our not-for-profit network includes hospitals, physicians, clinics, care centers, hospice and home health programs and diverse community services across Washington. It also features a unique affiliation with Swedish Health Services in Western Washington.
With more than 35 hospitals and various health and living facilities and 20,000 employees statewide, our health and services organizations work together to provide quality care to those in need. We continue to honor and live by a commitment to compassionate service that the Sisters of Providence began more than 155 years ago. Washington is part of our five-state network, which also serves Alaska, Oregon, Montana and California.
On March 18 2020, a very brief post to Providence.org’s blog (“100 Million Mask Challenge: Volunteers Making Masks to Combat Shortage”) announced the initiation of the homemade mask effort. The post said Providence was “taking matters into its own hands” due to a “massive national shortage” of PPE during the COVID-19 pandemic.
In that post, the organization said that Providence’s infection control was creating “face shields” with materials they already had on hand — “marine-grade vinyl, industrial tape, foam and elastic,” not sewing masks from fabric:
Facing a massive national shortage of personal protective equipment (PPE) to fight COVID-19, Providence is taking matters into its own hands by making their own protective gear out of what they have on hand.
To buy time as cases grow, Providence infection control is creating face shields with materials from their shelves – marine-grade vinyl, industrial tape, foam and elastic. Earlier this week they visited hardware stores to get materials, and volunteers came together to start making the masks.
“We are very close to being out of face shields,” said Becca Bartles, executive director of infection prevention at Providence. “Masks, we’re probably a couple of days away.”
On the same day Providence.org published their blog post, the Evansville Courier & Press reported that similar efforts were being organized by Deaconess Health System in Illinois:
Citing shortages, Deaconess Health System, including Henderson’s Methodist Health, has asked the public to sew face masks for staff fighting coronavirus.
“This does follow CDC protocols that you can find on their website that if all other supplies are not available, that handmade masks that meet certain criteria are acceptable,” Deaconess spokeswoman Becca Scott said.
The release with the video, pattern and instructions was posted to the Deaconess Facebook page [on March 19 2020] and is available at www.deaconess.com/masks. A PDF of the pattern is available here and embedded at the bottom of this article.
Deaconess has “a sample video” about how to make the masks, which Scott said will be sterilized when they come in.
“This is not outside CDC guidelines if other supplies are exhausted. And so we want to have these coming in,” Scott said.
Shortages of specialized masks moved federal health officials this month to liberalize their recommendations about which face protection front line health-care workers should use to ward off the highly contagious disease stemming from coronavirus.
In that reporting, Deaconess Health System spokeswoman Becca Scott provided some additional context for that project:
- That handmade or homemade masks “follow CDC protocols if all other supplies are not available,” — in other words, handmade masks are better than nothing;
- Detailed instructions (including video) were shared to that organization’s Facebook page on March 19 2020;
- Deaconess Health System planned to sterilize handmade masks as they came in;
- Due to PPE shortages, federal guidelines were relaxed.
Scott reiterated that handmade masks for healthcare workers were acceptable under said guidelines if all “other supplies are exhausted,” a stipulation which echoed the concerns in the Seattle nurse’s Facebook comment. As she observed, it appeared a massive shortage of masks and N95 respiratiors did indeed cause the CDC to loosen regulations on acceptable forms of PPE.
That article also included instructions provided by Deaconess Health Systems for handmade masks, as well as information about any surplus of donated homemade masks:
• Use tightly-woven cotton fabric.
• Please remember that both women and men in a variety of roles may wear these masks.
• When your masks are complete, please call 812-450-8673 to arrange delivery. (You will be met in a facility parking lot at a pre-arranged time.)
• Collected masks will be immediately sent to laundry/processing to be prepared for use.
• Any surplus masks will be distributed to other organizations in need.
In contrast to Providence’s organized pick-up date and time, Deaconess Health Systems arranged individual deliveries, likely to reduce contact between mask-makers. Instructions in the article were published to deaconess.com/How-to-make-a-Face-Mask.
At the top of the original page in big red text was a message indicating that Deaconess Health Systems no longer required volunteers thanks to a broad and enthusiastic response to their original request:
Update: We have been overwhelmed by the outpouring of support and kindness from our community, the country and the world. We now have plenty of masks coming our way. Please consider reaching out to a hospital, nursing home, cancer-related organization, etc. near you, as many other health care facilities are also experiencing shortages in masks.
On Facebook, a post published to the Deaconess Health Systems’ page at 9:39 AM on March 19 2020 originally read:
We are welcoming fabric masks from our community as we prepare for COVID-19. Learn more at www.deaconess.com/masks.
A follow-up article by Evansville Courier & Press reported an overwhelming response to the Facebook post and plea:
In an unusual time, Deaconess Health Systems made an unusual plea.
Like every hospital in the world right now, Deaconess is worried it could run out of supplies if a rush of COVID-19 patients overwhelms its facilities.
So it asked for the public’s help: grab your sewing machine, make some masks at home and deliver them to the hospital.
There’s no way they could have imagined the response they received.
“I can’t even begin to tell you what the outpouring has been on that,” spokeswoman Pam Hight said Friday morning. “It’s unbelievable. From all over the world. All over the whole wide world.”
That article was published at 12:36 PM on March 20 2020, and at that time, masks were still being collected and sought:
Despite all the attention, they’ll need as many people as possible to step forward.
Just before 2PM on March 20 2020, the text on the Facebook post was replaced with the above update, but the instructional video remained. So while the mid-afternoon article indicated that Deaconess still needed mask-making volunteers, the health system advised volunteers immediately thereafter to consider donating excess masks to other organizations.
A concurrently circulating Wired interview with pandemic expert and epidemiologist Larry Brilliant included a brief exchange about masks and N95 respirators. The author asked if everyone ought to be wearing masks (the public has been repeatedly advised to refrain from further taxing supplies needed by hospitals), and Brilliant explained why that particular piece of equipment was vital in clinical settings during the coronavirus pandemic:
The N95 mask itself is extremely wonderful. The pores in the mask are three microns wide. The virus is one micron wide. So you get people who say, well, it’s not going to work. But you try having three big, huge football players who are rushing for lunch through a door at lunchtime—they’re not going to get through. In the latest data I saw, the mask provided 5x protection. That’s really good. But we have to keep the hospitals going and we have to keep the health professionals able to come to work and be safe. So masks should go where they’re needed the most: in taking care of patients.
As noted by Scott, CDC guidelines did allow for alternatives to N95s in the absence of PPE — but only as a port of last resort. On a page (“Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings”) last updated on March 19 2020, the CDC acknowledged a gap in available N95s and added:
In times of shortages, alternatives to N95s should be considered, including other classes of FFRs, elastomeric half-mask and full facepiece air purifying respirators, and powered air purifying respirators (PAPRs) where feasible. Special care should be taken to ensure that respirators are reserved for situations where respiratory protection is most important, such as performance of aerosol-generating procedures on suspected or confirmed COVID-19 patients or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella).
The anticipated timeline for return to routine levels of PPE is not yet known. Information about strategies to optimize the current supply of N95 respirators, including the use of devices that provide higher levels of respiratory protection (e.g., powered air purifying respirators [PAPRs]) when N95s are in limited supply and a companion checklist to help healthcare facilities prioritize the implementation of the strategies, is available.
In a final section titled “Summary of Changes to the Guidance,” CDC guidelines included reports about a lack of PPE in clinical settings:
Updated information in the background is based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns.
The CDC also maintained COVID-19 specific guidance on “Strategies for Optimizing the Supply of PPE,” with a subsection headlined, “Strategies for Optimizing the Supply of Facemasks.” A final section was titled “When No Facemasks Are Available, Options Include,” and it explained:
[Health Care Professional] use of homemade masks:
In settings where facemasks are not available, [health care professionals, or] HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.
That excerpt explained:
- Handmade or homemade masks might be used in clinical settings “as a last resort” in treatment of patients with COVID-19;
- Handmade or homemade masks might include bandanas or scarves as well as sewn masks;
- Handmade or homemade masks are not considered PPE;
- Potential for handmade or homemade masks to protect health care professionals “is unknown”;
- Handmade or homemade masks should be used in conjunction with approved PPE where available.
Additional guidance explained:
This document offers a series of strategies or options to optimize supplies of disposable N95 filtering facepiece respirators (commonly called “N95 respirators”) in healthcare settings when there is limited supply. It does not address other aspects of pandemic planning; for those, healthcare settings can refer to existing influenza preparedness plans to address other aspects of preparing to respond to novel coronavirus disease 2019 (COVID-19). The strategies are also listed in order of priority and preference in the Checklist for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during the COVID-19 Response in an easy-to-use format for healthcare facilities.
During the week ending March 20 2020, Providence.org and Deaconess Health Systems put out a call for volunteers to make homemade masks due to national shortages of surgical masks and N95s. Discourse included some concern from health care professionals about CDC guidelines based on availability rather science. The appeals for homemade masks were legitimate, as were the concerns.
CDC guidelines maintained that when all PPE courses of action were exhausted, handmade or homemade masks could be used to protect doctors and nurses for whom no N95 masks were available. However, the CDC also emphasized that such an approach was acceptable only when absolutely necessary.