Coronavirus Technology Solutions
November 10, 2020

CATE Masks Seven Times Better for Biden Mandate

PPE Demand Far Exceeds Supply but not if CATE Masks Can Be Used

Biden Will Mandate Masks

Biden Lays Out COVID Program

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CATE Masks Seven Times Better for Biden Mandate

The president elect in the U.S. is instituting a mask mandate. This will be more effective if the right masks are selected and worn.  CATE masks are seven times better than cloth masks. They can be quickly made available. The annual cost in the U.S. would be $30-60 billion/yr compared to $10-20 billion/yr for cloth masks. The cost is insignificant compared to the economic and social benefits. It is important that the new Administration and people around the world realize that the difference between masks is as great as the differences between pills.

CATE is an acronym for Comfortable, Attractive, Tight Fitting, Efficient. These masks have been available for many years to combat air pollution, wildfires and pollen. they are the ideal selection for the general public in the fight against COVID.  Here are the numbers.

In a room where people are social distancing at six feet and MERV 8 filters are used in an HVAC system with three air changes per hour unmasked individuals will be generating a cloud of virus particles similar to perfume or cigarette smoke. If masks are worn by transmitters as well as recipients, the net protection is a combination of the performance of both masks.

The net effectiveness is a function of the potential capability of the mask minus failure to achieve a tight fit and periods where the mask is discarded due to discomfort or social drivers. When all is considered the CATE mask combination is 93% effective compared to only 49% for the cloth mask.

Mask type: CATE masks are generally reusable and have various features to make them  attractive, tight fitting and comfortable as well as efficient. Surgical masks are efficient but not tight fitting. N95 masks  can be fitted for a tight seal but when worn by general public they are often not used properly.  Cloth masks can excel in comfort and attractiveness but are loose fitting and inefficient.

Direct Leakage: This is the amount of air which is exhaled around the mask directly.

Re-entrainment: Droplets initially captured on masks evaporate and split causing virus to escape.

Penetration:  This relates to the efficiency of the filter media.

Use Discount:  Masks should be worn as appropriate. Cloth and CAT masks are more comfortable than the others and are more likely to be used in borderline situations.

Recipient Load: This is the virus escaping the transmitter mask.

In Leakage: This is the amount inhaled around the mask seals.

There is no question that tight fitting efficient masks are the most effective weapon against COVID. These masks prevented any  U.S. medical staff fighting Ebola to become infected. The COVID incidence among medical personnel in high COVID environments is very low. In cases where these personnel had no choice but loose fitting surgical masks the infection rate was high. If a comfortable, attractive version is available to the general public the battle can be easily won.

PPE Demand Far Exceeds Supply but not if CATE Masks Can Be Used

This is the conclusion of many including CBS Money Watch.  But this is assuming that disposable melt blown surgical and N95 masks cannot be replaced by reusable CATE type masks for healthcare applications. In fact in any healthcare environment where the  virus load is not likely to be greater than the virus load in the community, the CATE masks are a better choice.  This would include nursing homes, hospital reception areas and most areas other than emergency rooms and areas of the hospital where infectious patients are being treated.

3M Company, the largest domestic manufacturer of N95 masks told CBS MoneyWatch that "U.S. and global demand for PPE continues to far exceed supply for the entire industry."

Some of 3M's health care clients are using 20 times the amount of PPE they needed before the pandemic, a company spokesperson said. 3M is also fielding requests for respirators from new clients that have never used them before. Some suppliers report a jump in sales in states where COVID-19 cases are rising. 

3M's monthly production of N95 respirators in the U.S. alone will have increased from 22 million in 2019 to 95 million by the end of 2020, a spokesperson said. Globally, by the end of 2020, the company will have produced 2 billion respirators. 

That's still not enough: Nine months into the pandemic, manufacturers are still limiting how many masks may be purchased, including for hospitals. 

In health care settings, as a rule of thumb, facilities should stock at least a 90-day supply of masks at all times, according to experts and some state health departments. But many cannot.

MidMichigan Health, a nonprofit health system in Michigan, only has about 30 days' worth of masks on hand. 

"We can't build to a 90-day supply at this point because the demand is going up across the country, which is basically what happened back in February right after all this started," said Jeff Wagner, the vice president of materials management at MidMichigan Health.

A three-month supply would be ideal given that case numbers are rising. "If we can get there, we could ride out the storm for a little bit. A 90-day supply of good-quality product would make me very happy," Wagner said.  

But rising case numbers in central Michigan will only make it harder to secure the goods. "It's just going to get tougher and tougher," he added.

MidMichigan, with hospitals, physician practices, urgent care and other centers serving 938,000 Michiganders, is coping with the shortfall by disinfecting the masks it has using UV light to prolong their usefulness. 

"There are safe ways to disinfect masks but it's very time-consuming. It's not the ideal solution by any means," said Awi Federgruen, a production and supply chain management expert and professor at Columbia University Business School in New York.

Part of the reason for the bottleneck in production stems from the complex process by which NIOSH-certified N95 masks are made. Though prices vary based on quantities purchased, buyers can expect to pay between 50 cents and one dollar per respirator, according to sellers.

"It's a pretty difficult item to manufacture, particularly the main filter. It requires specialized machinery that's very expensive," Federgruen said.

Brian Wolin, whose work as a chiropractor dried up when he was forced to stay home at the beginning of the pandemic, is trying to help meet hospitals' mask needs. Since August, his company, Protective Health Gear in Paterson, New Jersey, has been making and selling CDC-approved N95 masks. 

The company can now make up to 1.4 million masks per month, and it plans to increase production by year-end.

"We've started to feel the phone calls and emails escalating as the case numbers creep up," Wolin said. "We're not sold out yet, but we have to ramp up production."

Health officials in Montana, New Mexico and Wyoming also expect supplies to tighten in the coming weeks as cases rise and demand for masks increases, according to a Wall Street Journal report.  

In addition, thousands of nursing homes cite shortages of PPE, including masks, according to a recent report from the U.S. Public Interest Group. a consumer advocacy group.

In August, seven months into the pandemic, 20% of nursing homes had a less-than-one-week supply of one or more types of PPE, according to the report. which represents a critical shortage by industry standards.

"It's critical because an outbreak could wipe out their supply in a day or two," wrote U.S. PIRG's Teresa Murray and Jamie Friedman of Frontier Group, the report's co-authors.

Columbia's Federgruen says part of the problem is matching PPE supplies with demand around the U.S. "The level of organization is dismal in terms of knowing where people are holding and who can we make contracts with across the globe. It's still very much in its infancy."

Mike Bowen, vice president of Prestige Ameritech, which sells bulk quantities of N95 masks to hospital distributors, is among the suppliers that actually have a surplus on hand after more than tripling his employee headcount to boost mask production.

"We are looking for more hospitals that are in trouble. If there are hospitals that are in desperate need of respirators, we have them. We have excess capacity of N95s and of face shields," he said. 


Biden Will Mandate Masks

President-elect Joe Biden will personally call on governors around the country to enact mask mandates in their states once taking office next year, NBC News first reported on Sunday.

A Biden campaign official told the network that governors who resist the incoming president's requests will see Biden pressure mayors of cities in their respective states to enact mandates at the local level, potentially setting him up for confrontations with Republican governors around the U.S.

“If a governor declines, he’ll go to the mayors in the state and ask them to lead,” said the official, according to NBC. “In many states there is the capacity of mayors to institute mandates.”

More than 20 states currently require masks to be worn in private businesses and public places according to an NPR tally, and Biden has called for more governors to enact such mandates for months as case numbers have exploded around the U.S. with the fall.

Anthony Fauci, a top member of the White House coronavirus task force, has also expressed support for a national mask mandate. 

Biden Lays Out COVID Program

The U.S. can expect increased Covid-19 testing, a national mask policy and the possibility of nationwide lockdowns once President-elect Joe Biden takes office Jan. 20. Here is the plan he introduced previously.

The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak. That is why Joe Biden is outlining a plan to mount: 

·         A decisive public health response that ensures the wide availability of free testing; the elimination of all cost barriers to preventive care and treatment for COVID-19; the development of a vaccine; and the full deployment and operation of necessary supplies, personnel, and facilities.

·         A decisive economic response that starts with emergency paid leave for all those affected by the outbreak and gives all necessary help to workers, families, and small businesses that are hit hard by this crisis. Make no mistake: this will require an immediate set of ambitious and progressive economic measures, and further decisive action to address the larger macro-economic shock from this outbreak. 

Biden believes we must spend whatever it takes, without delay, to meet public health needs and deal with the mounting economic consequences. The federal government must act swiftly and aggressively to help protect and support our families, small businesses, first responders and caregivers essential to help us face this challenge, those who are most vulnerable to health and economic impacts, and our broader communities – not to blame others or bail out corporations. 

Public health emergencies require disciplined, trustworthy leadership grounded in science. In a moment of crisis, leadership requires listening to experts and communicating credible information to the American public. We must move boldly, smartly, and swiftly. Biden knows how to mount an effective crisis response and elevate the voices of scientists, public health experts, and first responders. He helped lead the Obama-Biden Administration’s effective response to the 2009 H1N1 pandemic and the 2014 Ebola epidemic. Biden also helped lead the response to the greatest economic crisis since the Great Depression and ran point on implementation of the Recovery Act. He knows how to get relief out the door to families, as well as resources to state and local officials to deal with the challenges they are facing.

And, even as we respond to this crisis, we must prepare for the next one. As President, Biden will establish and manage a permanent, professional, sufficiently resourced public health and first responder system that protects the American people by scaling up biomedical research, deploying rapid testing capacity, ensuring robust nationwide disease surveillance, sustaining a first class public health and first responder workforce, establishing a flexible emergency budgeting authority, and mobilizing the world to ensure greater sustained preparedness for future pandemics. 

Congress has taken a step forward by passing an initial bipartisan emergency plan to combat COVID-19. The Trump Administration must now heed the calls of House Speaker Nancy Pelosi and Senate Democratic Leader Chuck Schumer to put the health and safety of the American people first. Much more needs to be done, now, to bring our country together, respond to this emergency, and set the groundwork for bold, long-term reforms, including ensuring quality, affordable health care and a comprehensive paid leave program for every American.

Biden will be ready on Day One of his Administration to protect this country’s health and well-being. But he is not waiting until then to communicate his views on what must be done now to properly serve the American people. Biden believes the following steps must immediately be taken.

The Biden Plan calls for:

·         Restoring trust, credibility, and common purpose.

·         Mounting an effective national emergency response that saves lives, protects frontline workers, and minimizes the spread of COVID-19.

·         Eliminating cost barriers for prevention of and care for COVID-19.

·         Pursuing decisive economic measures to help hard-hit workers, families, and small businesses and to stabilize the American economy.

·         Rallying the world to confront this crisis while laying the foundation for the future.

Biden understands that this is a dynamic situation. The steps proposed below are a start. As the crisis unfolds, Biden will build on this policy to address new challenges.

RESTORING TRUST, CREDIBILITY, AND COMMON PURPOSE 

Stop the political theater and willful misinformation that has heightened confusion and discrimination. Biden believes we must immediately put scientists and public health leaders front and center in communication with the American people in order to provide regular guidance and deliver timely public health updates, including by immediately establishing daily, expert-led press briefings. This communication is essential to combating the dangerous epidemic of fear, chaos, and stigmatization that can overtake communities faster than the virus. Acts of racism and xenophobia against the Asian American and Pacific Islander community must not be tolerated.

Ensure that public health decisions are made by public health professionals and not politicians, and officials engaged in the response do not fear retribution or public disparagement for performing their jobs. 
    

Immediately restore the White House National Security Council Directorate for Global Health Security and Biodefense, which was established by the Obama-Biden Administration and eliminated by the Trump Administration in 2018. 

MOUNTING AN EFFECTIVE NATIONAL EMERGENCY RESPONSE THAT SAVES LIVES, PROTECTS FRONTLINE WORKERS, AND MINIMIZES THE SPREAD OF COVID-19

Make Testing Widely Available and Free

Ensure that every person who needs a test can get one – and that testing for those who need it is free. Individuals should also not have to pay anything out of their own pockets for the visit at which the test is ordered, regardless of their immigration status. The Centers for Disease Control and Prevention (CDC) must draw on advice from outside scientists to clarify the criteria for testing, including consideration of prioritizing first responders and health care workers so they can return to addressing the crisis.

Establish at least ten mobile testing sites and drive-through facilities per state to speed testing and protect health care workers. Starting in large cities and rapidly expanding beyond, the CDC must work with private labs and manufacturers to ensure adequate production capacity, quality control, training, and technical assistance. The number of tests must be in the millions, not the thousands.

Provide a daily public White House report on how many tests have been done by the CDC, state and local health authorities, and private laboratories.

Expand CDC sentinel surveillance programs and other surveillance programs so that we can offer tests not only to those who ask but also to those who may not know to ask, especially vulnerable populations like nursing home patients and people with underlying medical conditions. This must be done in collaboration with private sector health care entities. 

Task the Centers for Medicare and Medicaid Services to help establish a diagnosis code for COVID-19 on an emergency basis so that surveillance can be done using claims data.

Surge Capacity for Prevention, Response, and Treatment
Task all relevant federal agencies to take immediate action to

ensure that America’s hospital capacity can meet the growing need, including by:

·         Preparing to stand up multi-hundred-bed temporary hospitals in any city on short notice by deploying existing Federal Medical Stations in the strategic national stockpile and preemptively defining potential locations for their use as needed.

·         Directing the U.S. Department of Defense (DOD) to prepare for potential deployment of military resources, both the active and reserve components, and work with governors to prepare for potential deployment of National Guard resources, to provide medical facility capacity, logistical support, and additional medical personnel if necessary. This includes activating the Medical Reserve Corps, which consists of nearly 200,000 volunteer health care professionals who stand ready to serve across America; training and deploying additional surge capacity, including U.S. Department of Veterans Affairs/DOD medical equipment and U.S. Department of Health and Human Services (HHS) Disaster Assistance Medical Teams; and directing and assisting existing hospitals to surge care for 20% more patients than current capacity through flexible staffing, use of telemedicine support, and delaying elective procedures.

·         Instructing the CDC to establish real-time dashboards tracking (1) hospital admissions related to COVID-19, especially for ICUs and emergency departments, in concert with the American Hospital Association and large hospital chains, for which the HHS must ensure data is able to be shared, as needed; and (2) supply chain information – including availability, allocation, and shipping – for essential equipment and personal protective equipment, including in the various places where there may be federal reserves. The strategic national stockpile must be used to supplement any shortages that exist, especially for essential medical supplies, like oxygen, ventilators, and personal protective equipment. 

·         Ensuring that training, materials, and resources reach federally qualified health centers, rural health clinics, and safety-net hospitals, which are typically resource-poor and care disproportionately for vulnerable populations that will bear the brunt of COVID-19. This effort will lay the foundation for a deeper and more lasting public health infrastructure for accessible national health care for all.

Surge tele-emergency room, tele-ICU care, and telemedicine through a concerted, coordinated effort by health care providers to enable staff to manage additional patients and save beds for the very sick. Leverage existing efforts like Project ECHO to ensure health professionals have tele-mentoring and other training resources they need to make informed decisions.

Support older adults, vulnerable individuals, and people with disabilities. Ensure essential home- and community-based services continue and Centers for Medicare and Medicaid works to provide the waivers necessary for those who rely on medication to have a sufficient supply. 

Protect health care workers, first responders, assisted living staff, and other frontline workers. 

·         Give all frontline workers high-quality and appropriate personal protective equipment – and enough of it and appropriate training to use it – so they don’t become infected. If our health care workers, first responders, and essential workers like transportation and food workers cannot function, we cannot protect and care for the public. The Biden Plan calls for issuing guidance to states and localities to ensure first responders and public health officials are prioritized to receive protective personal equipment and launching an education campaign to inform the general public about equipment that should be reserved for professionals. 

·         Direct the Occupational Safety and Health Administration (OSHA) to keep frontline workers safe by issuing an Emergency Temporary Standard that requires health care facilities to implement comprehensive infectious disease exposure control plans; increasing the number of OSHA investigators to improve oversight; and working closely with state occupational safety and health agencies and state and local governments, and the unions that represent their employees, to ensure comprehensive protections for frontline workers. 

Ensure first responders, including local fire departments and Emergency Medical Services, can meet the staffing requirements needed to respond and are trained to recognize the symptoms of COVID-19.
 

Accelerate the Development of Treatment and Vaccines

Ensure the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority are swiftly accelerating the development of rapid diagnostic tests, therapeutics and medicines, and vaccines. NIH must be responsible for the clinical trial networks and work closely with the U.S. Food and Drug Administration (FDA) on trial approvals.

Ensure the FDA is working with the NIH to prioritize review and authorization for use of COVID-19 countermeasures and strengthen regulatory science at the FDA to make certain it has the needed resources to evaluate the safety and efficacy of new tools.

Provide Timely Information and Medical Advice and Guidance

Work with the CDC and HHS to ensure that health departments and health providers across the country give every person access to an advice line or interactive online advice so they can make an informed decision about whether to seek care or to stay at home. This will preserve the health care system for those who are sick and prevent people who may not need to see a provider from becoming needlessly exposed. Ensure all information provided to the public is accessible to people with disabilities, including through plain language materials and American sign language interpreters.

Instruct the CDC to provide clear, stepwise guidance and resources about both containment and mitigation for local school districts, health care facilities, higher education and school administrators, and the general public. Right now, there is little clarity for these groups about when to move toward social distancing measures, like cancelling school, mass gatherings, and travel and when to move to tele-work and distance learning models.

Ensure firefighters and other emergency responders are notified if they have been exposed to individuals infected with COVID-19.

Launching Urgent Public Health System Improvements for Now and the Future

Work with businesses to expand production of personal protective equipment, including masks and gloves, and additional products such as bleach and alcohol-based hand sanitizer. Incentivize greater supplier production of these critically important medically supplies, including committing, if necessary, to large scale volume purchasing and removing all relevant trade barriers to their acquisition.

Task the U.S. Department of Justice with combating price gouging for critical supplies.

Take steps in the aftermath of the crisis to produce American-sourced and manufactured pharmaceutical and medical supply products in order to reduce our dependence on foreign sources that are unreliable in times of crisis. The U.S. government should immediately work with the private sector to map critical health care supplies; identify their points of origin; examine the supply chain process; and create a strategic plan to build redundancies and domestic capacity. The goal is to develop the next generation of biomedical research and manufacturing excellence, bring back U.S. manufacturing of medical products we depend on, and ensure we are not vulnerable to supply chain disruptions, whether from another pandemic, or because of political or trade disputes. 

Establish and fund a U.S. Public Health Service Reserve Corps to activate former Public Health Service Commissioned Corps officers to expand medical and public health capacity. By creating the Reserve Corps, we will have a larger team of health professionals to deploy across the nation to help train health care systems in detection and response, educate the public, provide direct patient care as needed, and support the public health infrastructure in communities that are often under-resourced and struggling.

Expand the Staffing for the Adequate Fire and Emergency Response (SAFER) Grant program so that fire departments – critical first responders in health emergencies—can increase staffing. As Vice President, Biden secured an expansion of the SAFER Act to keep more firefighters on the job during the Great Recession. He will expand the grants to build well-staffed, well-trained fire departments across the country.

Providing the Resources Necessary to Achieve These Outcomes

To implement this national emergency response, the Biden Plan calls for an immediate increase of federal resources to cover all necessary federal costs, as well as the creation of a State and Local Emergency Fund that gives state and local leaders the power to meet critical health and economic needs to combat this crisis. This Fund will be designed as follows:

Resources will be allocated according to a formula: 45% to state governments; 45% to local governments; and 10% reserved for special assistance for “hot-spots” of community spread.

Menus of Permissible Usages: Governors and mayors will be given significant flexibility to ensure that they can target their health and economic spending where it is most needed in their respective states and cities. Such usages include:

·         Paying for medical supplies and expanding critical health infrastructure, including building new or renovating existing facilities, if necessary; 

·         Expanding hiring where needed including health care and emergency services workers, caregivers in nursing homes, drivers, childcare workers, substitute teachers, and others;

·         Providing overtime reimbursements for health workers, first responders, and other essential workers.

·         The Fund will also be deployed to cushion the wider economic impact of the crisis, helping hard-hit families and communities, as described later in the fact sheet.

Bringing Our Country Together

·         Now is the time for empathy, decency, and unity. In times of crisis, Americans come together, and everyone steps up to meet our shared civic duty.  We need that spirit now: volunteers standing ready to fill essential gaps, neighbors looking out for neighbors, business taking care of their workers, people contributing to frontline non-profit organizations, social media companies combating the spread of misinformation, universities and the private sector driving innovation in the search for new treatments and vaccines, and all of us following the guidance of health officials to take steps that reduce the spread of the virus. Biden believes this can’t just be a government response — it has to be a whole-of-society response.

ELIMINATING COST BARRIERS FOR PREVENTION OF AND CARE FOR COVID-19

·         The cost of preventive care, treatment, and a potential vaccine could be an insurmountable economic barrier for many Americans. If we fail to remove this barrier, we will be turning our backs on these Americans in a time of crisis, and putting all Americans at risk by discouraging people from getting necessary testing and treatment.

The Biden Plan:

·         Ensures that every person, whether insured or uninsured, will not have to pay a dollar out-of-pocket for visits related to COVID-19 testing, treatment, preventative services, and any eventual vaccine.  No co-payments, no deductibles, and no surprise medical billing. This will be achieved by: 

·         Amending the Public Health Service Act to immediately cover all testing, treatment, and preventive services that are necessary to address a Public Health Emergency for an infectious disease. Once triggered by the HHS Secretary in consultation with the CDC, all commercial plans in all markets will be immediately required to cover such services as COVID-19 testing and any eventual vaccine with no copayments and deductibles, including for the visits themselves. 

·         Amending the Social Security Act and other authorizing statutes to extend the same requirement to all public health programs.  As such, there will be no co-pays for programs including but not limited to Medicare, Medicaid and CHIP, the Indian Health Service, the Dept. of Veterans Affairs, DoD’s TriCare program and the Federal Employees Health Benefit Plan.

·         Fully funding and expanding authority for the National Disaster Medical System (NDMS) to reimburse health care providers for COVID-19-related treatment costs not directly covered by health insurance; this includes all copayments and deductibles for the insured as well as uncompensated care burdens incurred by uninsured and underinsured populations. Direct the HHS Secretary to direct NDMS, in collaboration with the Centers for Medicare and Medicaid Services for administrative and enforcement support, to directly reimburse health care providers for: 

o    All uncompensated care associated with the testing, treatment, and vaccines that are associated with COVID-19 for uninsured. This includes Americans in so-called “junk” health plans that are not regulated as compliant with the standards for individual market coverage under the Affordable Care Act. 

o    All copayments, deductibles and any cost-sharing for treatment for COVID-19 for insured. Providers will submit cost-sharing claims to NDMS that document private insurance contractual arrangement for co-payments. To ensure maximum provider participation and minimum billing abuses to consumers, current Medicare law’s “conditions of participation” and system-wide prohibitions against balance billing and surprise medical bills will apply. To guard against fraud and abuse by bad-apple health care providers, harsh civil and monetary penalties under the False Claims Act will apply.

Secures maximum Medicaid enrollment for currently eligible populations by explicitly authorizing federal matching dollars for presumptive eligibility, simplified application processes, and eligibility criteria. In past public health crises, such as Hurricane Katrina and 9/11, the federal government provided matching dollars for states to expedite enrollment for individuals who are eligible for Medicaid but not yet enrolled. This option must be specifically made available to states for the COVID-19 public health crisis. These policies are consistent with and complementary to the FMAP policy included in the federal economic assistance package below. 

Reverses the Trump Administration public charge rule, which places new, burdensome restrictions on documented immigrants who receive public benefits and discourages all immigrants from seeking health care services for COVID-19.

Supports bipartisan efforts to delay the Medicaid Fiscal Accountability Regulation, which forces states to change how they finance their Medicaid programs and leads to major reductions in funding for critically important health care.

Additional details are found at  https://joebiden.com/covid-plan/