Facing a dire shortage of protective face masks for health care workers, administrators at the University of Nebraska Medical Center decided they had no choice.
Masks are certified for one-time use only. But on Thursday, the center began an experimental procedure to decontaminate its masks with ultraviolet light and reuse them. Administrators plan to use each mask for a week or longer.
To the knowledge of the program’s administrators, the medical center is the first to disinfect and reuse masks.
“We have talked with a lot of others around the country who are going after a similar approach,” said John Lowe, the medical center’s assistant vice chancellor for health security training and education, who designed the program.
When administrators made the decision, they knew the procedure violated regulations promulgated by the Centers for Disease Control and Prevention, which said that if masks were decontaminated they could no longer be certified for use.
But late Thursday night, the agency issued new guidance, saying that “as a last resort, it may be necessary” for hospitals to use masks that were not approved by the National Institute for Occupational Safety and Health.
That change would seem to mean it is now acceptable for hospitals to decontaminate and reuse masks during the coronavirus pandemic, said Shawn Gibbs, a professor of environmental health at Indiana University.
If that were not the case, he added, then many hospitals would find themselves in a tightening bind as gear shortages spread: “What is preferred — not using respirator protection equipment, or using a decontaminated respirator whose certification is voided?”
No one thinks reuse of face masks is ideal, and the practice may raise legal liability issues. But there seemed to be little choice.
Doctors and administrators at the University of Nebraska Medical Center calculated that if they continued to use masks only once, they would run out of masks in just weeks.
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“We are making the best of bad choices,” said Dr. Mark Rupp, the medical center’s chief of infectious diseases.
He feels confident that the masks will still protect health care workers. “The data is very clear that you can kill and inactivate viruses with UV germicidal irradiation,” he said. “It is also very clear that you will not damage the respirators.”
The alternative, Dr. Lowe said, would be to ask health care workers to carefully store their masks and reuse them without cleaning them. Handling a mask repeatedly also increases the chances that it will be contaminated.
“Health care workers are very apprehensive about that,” he said.
Decontamination and reuse of masks is not a new idea. Researchers have tested a variety of methods — ultraviolet light, bleach, ethylene oxide gas, moist heat — and have concluded in published papers that decontamination can work.
But the studies were small, and scientific interest in decontamination has been sporadic and fleeting.
“People get interested around the time of a SARS epidemic or an H1N1 flu epidemic, and then they forget,” said Dr. Lynn Goldman, dean of George Washington University’s Milken Institute School of Public Health.
“When you have an epidemic, it’s very cool,” she added. “When you don’t have an epidemic, it’s not cool.”
“If you are talking about cures, you can get very large grants” to study decontamination, Dr. Goldman added. “But if you are doing studies on prevention and protection, it’s very hard. It’s not clear whose job in the federal government it is to fund it.”
UV light was the Nebraska hospital’s choice because it is effective and convenient. Hospitals already use UV light to decontaminate rooms after patients with dangerous infections, like C. difficile, are moved.
The medical center also used UV light to disinfect rooms when it was treating Ebola patients a few years ago. Patients were sent there because the center has a sophisticated biocontainment area.
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated July 15, 2020
Is the coronavirus airborne?
- The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
- Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
What’s the best material for a mask?
- Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
Is it harder to exercise while wearing a mask?
- A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
I’ve heard about a treatment called dexamethasone. Does it work?
- The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
What is pandemic paid leave?
- The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
Does asymptomatic transmission of Covid-19 happen?
- So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
What’s the risk of catching coronavirus from a surface?
- Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
How does blood type influence coronavirus?
- A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How can I protect myself while flying?
- If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
What should I do if I feel sick?
- If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
“We bring in large UV lamps, hit ‘start’ and leave the room,” Dr. Lowe said. “We let it shine for three to five minutes. It disinfects anywhere it can shine.”
As for N95 masks, the kind used by health care workers, “there are really good data that it can decontaminate and that it doesn’t degrade the masks a significant amount,” Dr. Lowe said.
But, he added, “we inspect the masks before every use.” And the protocol Dr. Lowe designed uses three times the concentration of UV light needed to kill coronaviruses.
Masks conform somewhat to the health care worker’s face, and a tight seal is necessary. So each health care worker’s mask is returned to its user after decontamination.
Health care workers write their names on their masks before they first use them. After they remove the masks for decontamination, they are placed in brown bags labeled with their names.
The bags are transported to a special room covered in a beige paint that reflects UV light. After the masks are treated, each one goes into a white bag with the health care worker’s name on it.
The procedure is experimental, and there are uncertainties.
For instance: How many times can a mask be reused? For now, staff members will use each mask for a week before disposing of it. But the medical center may decide to keep using the masks for 10 days, or even two weeks, Dr. Rupp said.
“Hopefully, that will at least buy us enough time to offer protection through this epidemic,” he added.
He knows there may be risks, but he believes the medical center has made the right choice.
“I sleep very well,” he said. “If we get sued, I still think we are doing the right thing.”