As Coronavirus Looms, Mask Shortage Gives Rise to Promising Approach

Surgical masks are supposed to be used just once. But doctors in Nebraska are attempting a novel experiment as gear shortages arise.

Credit...Calla Kessler/The New York Times

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.

“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.

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Credit...Calla Kessler/The New York Times

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.

“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.”

  • Frequently Asked Questions and Advice

    Updated June 2, 2020

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

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      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

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      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

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      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.

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      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.

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      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • 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.


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.”