Respirators Return to Hawai‘i Conversation

During the 2018 eruption, many Hawai‘i Island residents received a crash course in using respirators. N95 particulate masks and other reusable respirators were commonly worn to protect against small shards of tephra. To deal with massive volcanic gas emissions, we used “half facepiece respirators” with pink filters designed for SO2. When exposed to emissions, we kept our masks close, needing them frequently throughout the eruption to continue to help our community. The Big Island now faces another crisis where proper protective gear plays an important role for those on the frontlines, and respirators are back in the conversation. Medical professionals and essential workers need adequate protection that is more effective than what many nurses and doctors have resorted to due the lack of proper protective equipment. Shortages are so severe the Centers for Disease Control have resorted to recommending the use of bandanas, scarfs, and homemade cloth masks [1]. While it is true that the coronavirus is smaller than the pores on many varieties of filters and masks, the WHO has stated that the SARS-CoV-2 “virus is primarily transmitted between people through respiratory droplets and contact routes”, with droplets at least 10 times larger than the pores (5-10 vs 0.3 microns) [2]. An N95 mask filters out at least 95% of 0.3 micron particles, and thus is recommended for individuals with high risk of exposure such as medical professionals testing for and treating these cases [3]. According to the manufacturer 3M™, “respirators capture viable H1N1 influenza and other virus aerosols as well as or better than their respective N95 or P100 rating” [4]. The performance of cloth masks is significantly lower when compared with medical grade masks in dealing with viruses, yet all forms of respiratory protection have a place in a pandemic [5]. As of March 27th, The Queen's Medical Center on O‘ahu began accepting donations of cloth face masks [6]. The local medical community of Hawai‘i Island has put out the call for donations of adequate Personal Protective Equipment (PPE), including N95 respirators [7]. Thankfully, many in our community have heard that call. Beginning on March 23rd, Ikaika Marzo, with the support of Pu’uhonua O Puna, began donating reserves of personal protective equipment from the 2018 eruption to various medical centers and volunteer organizations around Hawai‘i Island. Last week, he donated roughly 285 half facepiece reusable respirators island-wide, including 75 units to nurse practitioner Anne Broderson on behalf of the Ali‘i Health Center in Kona: “These PPEs are going to be used for a popup COVID-19 testing site here in Kona. Dr. Miscovich and the Premier Medical Group have done an awesome job of showing me the way of how they have been able to organize this operation.” “I have been working with local County Council to gain connections, like to Ikaika, to try and get another site up and running. We anticipate that we’re going to have another date announced hopefully within the next week, sponsored by Ali‘i Health Center, and then also working with all the other primary care providers here in West Hawai‘i.” - March 23, 2020 [8] The same respirators that were warmly accepted by local medical professionals in Hilo, Kona and Kohala were also donated to the Boys And Girls Club of the Big Island to protect volunteers helping provide support for at-risk people during the COVID-19 pandemic. The Boys and Girls Club of the Big Island have established a program to provide meals to low-income children and homeless kupuna. Despite the unsourced reports which question the effectiveness of P100 masks donated by Ikaika Marzo to the Boys and Girls Club of the Big Island, these respirators exceed all applicable regulatory requirements for medical workers on the front lines fighting COVID-19. The Occupational Safety and Health Administration recommends: “Workers, including those who work within 6 feet of patients known to be, or suspected of being, infected with SARS-CoV-2 and those performing aerosol-generating procedures, need to use respirators… N95 filtering facepiece respirators or better must be used in the context of a comprehensive, written respiratory protection program.” [9] N95 masks have a 95% efficiency. N95 masks were not designed to be reusable for long, yet are being reused widely. There is a limit of the amount of times a disposable N95 mask can be reused before it degrades. Yet, nationwide reports of the wide reuse of protective equipment and supply shortages of surgical masks and other PPE worldwide make the situation more complex [10]. Half facepiece reusable respirators are designed to be reused, and have interchangeable filters for differing purposes. The filters that Marzo donated with the respirators were particulate Combination Cartridges (60923) filters, rated for particulate matter at P100. The donated masks operate at 99.97% efficiency according to the CDC [11]. P100 is the highest grade for personal respiratory protection, making them comparable to N95 respirators. NOTE: Face masks and respirators do NOT alone prevent the spread of COVID-19, but are a useful tool for those most at risk when used and fit properly. The importance of proper hand washing and physical distancing stand on their own. Details from Ikaika Marzo: Type of respirators donated: 3M™ Half Facepiece Reusable Respirator 6200/07025 3M™ Half Facepiece Reusable Respirator 6100/07024 Filters donated: 3M™ Organic Vapor/Acid Gas Cartridge/Filter 60923, P100 REFERENCES: [1] - CDC, Strategies for Optimizing the Supply of FacemasksStrategies for Optimizing the Supply of Facemasks, https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html [2] - WHO, Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations, https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations [3] - CDC, FAQ About Personal Protective Equipment, https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html [4] - 3M™, Respiratory Protection for Airborne Exposures to Biohazards, https://multimedia.3m.com/mws/media/409903O/respiratory-protection-against-biohazards.pdf [5] - C Raina MacIntyre, et. al., A cluster randomised trial of cloth masks compared with medical masks in healthcare workers, https://bmjopen.bmj.com/content/5/4/e006577 [6] - The Queen's Medical Center, UPDATE ON DONATIONS FOR PERSONAL PROTECTIVE EQUIPMENT (PPE): https://www.facebook.com/TheQueensMedicalCenter/posts/10157256551777934 [7] - Hilo Medical Center, HILO MEDICAL CENTER IS DOING A COMMUNITY DRIVE FOR MEDICAL-GRADE MASKS: https://www.facebook.com/HiloMedicalCenter/posts/2626344170930081 [8] - Ikaika Marzo Livestream, https://www.facebook.com/ikaika.marzo/videos/2928670327185484 [9] - OSHA, Guidance on Preparing Workplaces for COVID-19, https://www.osha.gov/Publications/OSHA3990.pdf [10] - NBC News, In California, protective equipment shortage pushes nurses to consider drastic action, https://www.nbcnews.com/health/health-news/california-protective-equipment-shortage-pushes-nurses-consider-drastic-action-n1168976 [11] - CDC, NIOSH Guide to the Selection and Use of Particulate Respirators, https://www.cdc.gov/niosh/docs/96-101/default.html