Coronavirus Technology Solutions
January 27, 2021

A Three-Step Strategy to Support the New U.S. Mask Mandate

Let’s Organize a Webinar Around This Three Step Mask Strategy

World Economy Could be Slowed by Lack of Vaccines in Emerging Countries

Expert Cites Challenges in Vaccinating Poorer Countries

Jiangsu Blue Sky is Supplying Three Layer FFP 2 Masks

Nanofiber Swabs are Better for Measuring COVID

CNN Perspective on the New ASTM Standards

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A Three-Step Strategy to Support the New U.S. Mask Mandate

This analysis just appeared in the Harvard Business Review and is by experts who we have quoted in the past (see authors at end of article).

Summary - The Biden administration’s efforts to promote the wearing of masks to combat the spread of Covid-19 are badly needed. Given the pace of the rollout of vaccines, the U.S. won’t achieve herd immunity until mid-or late 2021. In the meantime, mask wearing is essential.

We couldn’t agree more with the Biden administration’s plea for Americans to wear masks for 100 days and its mandates that people must wear masks on federal property and during interstate travel on airlines, trains, buses, and ships. These actions are crucial to address the surges in Covid-19 cases and hospitalizations that are occurring across the United States this winter.

Although two effective Covid-19 vaccines are being distributed in the United States and others hopefully will be available soon, it will probably take until sometime in mid to late 2021 for enough people to be vaccinated to reach herd immunity and for life to start returning to normal in the United States. Widespread vaccination is expected to take multiple years globally. In the meantime, with the growing concern about Covid-19 mutations, CEOs, mayors, and governors should immediately take three steps to promote the effective use of face masks.

1. Launch an awareness blitz. To increase the utilization of masks and dispel misinformation, an effective campaign is needed to raise awareness of the mask recommendations. With few exceptions, all people should wear masks consistently when sharing airspace with others from outside their bubble of family, friends, and coworkers. They are not currently doing so.

In a U.S. national survey we conducted in December, over 85% of the 466 respondents said they were using masks to protect themselves and those around them (consistent with a similar survey by Pew in August), and 80% said they were using their masks at the grocery store. But only 56% said they used one when with people outside their home, only 48% were doing so at work, and just 33% were wearing them when someone visited their homes.

The usage of masks and the way they are being worn also varies from city to city: Using publicly accessible street cameras, we recently counted how many people were correctly wearing masks in one location in San Francisco (Castro Street) and another in Los Angeles (Hermosa Beach); while 90% of people in the former were correctly wearing masks, only 60% in the latter were doing so.

2. Communicate which mask types people should wear. In our survey, the majority (71%) said they were using basic masks (cloth or surgical masks), which are a reasonable option for people at low risk of contracting a severe case of Covid-19 and have limited exposure to the virus or to people outside their bubble. Regions in Kansas and Germany that required basic (any) masks had much lower rates of infection than regions that did not.

But people at higher risk of contracting a severe case of Covid-19 or who have exposure to others outside their small bubble may require a higher-filtration mask. For example, wearing a basic mask did not stop infections altogether on a long-haul flight in Boeing 777 equipped with HEPA filtration and among workers at a seafood-processing plant and meat processing plants. Surgical masks distributed on an Argentine cruise ship during an outbreak and in a Danish randomized controlled study did not prevent transmission altogether, although these masks may have reduced the severity of symptoms. Germany, France, and other European countries are now requiring high-filtration (medical) masks in public.

New standards being developed by ASTM International, an international standards organization, for labels that display the filtration efficiency of face masks for consumers are coming in the near future. Several options for high-filtration masks are considerably more effective in limiting the spread of Covid-19 than basic cloth masks or consumer-grade “surgical” masks.

A few simple ways to improve masks’ fit and filtration for the general public that have been recently studied include putting a high-quality cloth mask on top of a surgical mask or sandwiching a surgical mask (or higher-quality filter) in-between two cloth masks. Consumer-grade surgical masks can be upgraded with “fitter” add-ons like Fix-the-mask to improve their fit, thereby enhancing the filtration of viral particles.

The N95 respirator is the best-known high-filtration mask in the United States. (Comparable models in other parts of the world include FFP2 in Europe, KF94 in South Korea, and KN95 in China). In our survey, 13% of respondents reported that they were wearing an N95 or the equivalent. In a Finnish study of health care workers, no infections occurred at work while wearing N95 type respirators, but 63% of workplace infections occurred while wearing surgical masks.

Disposable N95s, which have been in short supply during the pandemic, have been largely reserved for health care workers. But N95s are now available at Costco, Amazon, Office Depot, and some manufacturers point out that demand for N95s from the general public will help even out the ebbs and flows of demand from hospitals, allowing them to maintain consistent production. To be effective, N95s also need to be properly fitted, and users need to be trained to wear them correctly. While in a setting like a hospital, a respiratory protection program can ensure that this happens, that’s not feasible for the general public.

As we wrote in October, a U.S.-manufactured, federally-approved option that is not in short supply and is reusable is an elastomeric N95 (eN95) respirator. Since that article was published, a number of organizations — most notably the Fire Department of New York — have begun to use them. In our survey, 9% of respondents reported that they were wearing eN95 masks.

According to the CDC, eN95s have sealing surfaces and adjustable straps that can help achieve a better fit (or lower leakage), and the replaceable filters in some models can be used for one year as long as the filter cartridges remain in good condition. To protect others, many eN95 models also require a workaround to cover their exhalation valve, although the CDC recently reported the maximum particle emissions through the valve are similar to or better than surgical masks or unregulated face coverings. Some manufacturers (e.g., Envomask and MSA) now address this by completely plugging the valve. In addition, valveless, bidirectional, and transparent high-filtration masks designed for public use are also becoming available. As with disposable N95s, fitting and training are essential to ensure that workers get the best protection possible.

Some people with asthma, chronic lung diseases, or heart diseases may not be able to tolerate N95 or eN95 respirators and should consult their medical provider before using one. But for the general public, we expect that wide availability of respirators and low-leakage, high-filtration face masks combined with education on how to use them will significantly reduce exposure to the coronavirus that causes Covid-19.

People might want to keep eN95s on hand even after the pandemic ends for new outbreaks of diseases that spread through the air, intentional bio attacks, and wildfire emergencies.

3. Prioritize the distribution of high-filtration masks to the vulnerable. In addition to upgrading indoor ventilation and air filtration at places where essential workers, older adults, and people with comorbidities live or work, organizations should make providing these populations with high-filtration, low-leakage masks a top priority. They need to be equitably subsidized or provided for free to people who cannot afford them.

In October we proposed providing federal credits to consumers to buy high-filtration masks, and Germany is now sending “vouchers” to all its senior citizens over 60 years old and vulnerable populations that can be redeemed for 12 FFP2 masks (N95-equivalents) at pharmacies and grocery stores. That’s 34 million people. Austria implemented a similar policy.

President Biden has requested Congress to appropriate $30 billion for personal protective equipment and signed the Defense Production Act to boost production of masks. However, until those resources become available, it is up to CEOs, mayors, and governors to implement these three steps to ensure consistent use of the best possible masks for vulnerable groups. These steps will dramatically reduce the spread of Covid-19 and save lives.

Authors of this article are

• Devabhaktuni Srikrishna is the founder of Patient Knowhow, which curates patient educational content on YouTube. In 2014, he worked on the response to the Ebola outbreak in Guinea. Follow him on Twitter at @sri_srikrishna.
• Joseph Buccina is a director at In-Q-Tel’s B.Next, a strategic initiative focused on biotechnology and national security.
• Dan Hanfling, MD, is a clinical professor of emergency medicine at George Washington University, co-chair of the National Academy of Medicine Forum on Medical and Public Health Preparedness, and a vice president on the technical staff at In-Q-Tel.
• Monica Gandhi, MD, is an infectious disease specialist, professor of medicine, medical director of the Ward 86 HIV Clinic, and director of the Center for AIDS Research at the University of California, San Francisco. Follow her on Twitter at @MonicaGandhi9.
• Donald Milton, MD, is a professor of environmental and occupational health at the University of Maryland School of Public Health. Follow him on Twitter at @Don_Milton.

Let’s Organize a Webinar Around This Three Step Mask Strategy

As Sri and the other authors point out the three step plan needs to be quickly implemented and “it is up to CEOs, mayors, and governors to implement these three steps to ensure consistent use of the best possible masks for vulnerable groups.  Let’s arrange a webinar to discuss the three step plan. Here is a proposed agenda of subjects to be addressed.

The three steps are (l) launching an awareness blitz, (2) advise on which masks should be worn and (3) prioritize masks for the vulnerable

1.      Launch an awareness blitz

a.       roles

                                                              i.      mainstream media including local news outlets

                                                            ii.      role of association and occupational media including business  and medical

                                                          iii.      suppliers from the large validators such as SGS and Eurofin to media suppliers to mask manufacturers

                                                           iv.      CATER Mask Decisions

b.      message

                                                              i.      push - the need to mandate use of efficient masks

                                                            ii.      pull - the advantage of using pull or incentives

1.      the safe bubble with the promise of full occupancy within  the bubble

                                                          iii.      criteria

1.      general and absolute

2.      relative risk reduction as proposed by Mcilvaine

                                                          iv.      product availability

1.      media

2.      masks

3.      timing

4.      geographies

2.      Communicate which type of masks people should wear

a.       N95

b.      CATER

c.       surgical mask with brace

d.      eN95

e.       other

3.      Prioritize masks for the vulnerable

a.       who

b.      location – should this extend to other countries?

c.       how

                                                              i.      vouchers

                                                            ii.      direct distribution

We will be arranging a meeting time. If you would like to participate please communicate with us and also add your thoughts on additional aspects to address.

World Economy Could be Slowed by Lack of Vaccines in Emerging Countries

With several Covid-19 vaccine candidates showing promising trial outcomes, investors and analysts have turned increasingly optimistic that the pandemic could soon come to an end.

But a new report by Citi Research showed that the economic benefits of vaccination may not kick in until late 2021, when “herd immunity” is expected to start forming. Herd immunity occurs when enough people in a population develop protection against a disease that it can no longer spread easily among them.

The report, written by Citi economists, drew on a paper in the American Journal of Preventive Medicine that simulated the percentage drop in daily Covid-19 cases under various scenarios of vaccine efficacy and coverage.

The paper, Vaccine Efficacy Needed for a COVID-19 Coronavirus Vaccine to Prevent or Stop an Epidemic as the Sole Intervention, concluded that vaccines must have an efficacy of at least 70% to prevent an epidemic and at least 80% to “largely extinguish” an epidemic without any other measures.

Among the current vaccine frontrunners, Pfizer-BioNTech and Moderna reported preliminary results showing that their respective candidates were around 95% effective. Meanwhile, Oxford-AstraZeneca said an interim analysis showed their vaccine having an average efficacy of 70% in protecting against the virus.

The Citi analysis assumes those three vaccine candidates would receive emergency approvals between next month and January 2021 — which would allow the pharmaceutical companies to produce and distribute their vaccines.

The economists said that developed economies, many of which have secured vaccine pre-orders, will first experience the economic benefits of herd immunity.

Overall, the bank has forecast that Covid-19 vaccination could raise global economic growth by 0.7 percentage points in 2021, and 3 percentage points in 2022 as activity returns to normal.  

According to Citi, developed markets have collectively secured 85% of total bilateral pre-orders of Covid-19 vaccines. Countries such as the U.S., U.K., Japan, Canada, Australia and those in the European Union have ordered supplies that exceed their populations, the analysts added.

That means major developed economies could start wider distribution of the vaccines in the second or third quarter next year, and form herd immunity by the final three months of 2021, they explained.

“Most people, who seek vaccination, may be vaccinated at least by the end of 2021,” said the analysts.

Normalizing economic activity is projected to raise growth in developed markets by 1.2 percentage points in 2021 and 3.9 percentage points in 2022, said Citi.

In comparison, emerging markets could see growth increase by 0.1 percentage points in 2021 and by 2 percentage points in 2022, projected the bank.   

The smaller economic benefits in emerging markets are partly because some countries, especially those in Asia such as China, have contained the virus and allowed most activity to resume, Citi explained. In addition, vaccine distribution may take a longer time to reach emerging economies, with lower-income countries potentially having to wait until end-2022 or even later, the bank added.

Emerging markets may have to rely on the Covax facility for vaccine supply, Citi analysts said, referring to  the United Nations’ program that will subsidize rollouts of Covid-19 vaccines to low-income countries.

Citi said there are uncertainties that could alter the timing of its forecasts for when herd immunity will be reached.

Those factors include:

• Efficacy of vaccines and Covid-19 reproduction rate, which refers to the number of people that an infected individual goes on to infect.
• The speed at which mass production of vaccines can be ramped up.
• People’s acceptance to a vaccine.

The bank, citing a survey by Ipsos and the World Economic Forum, pointed out that vaccine acceptance appeared to have fallen in recent months. The survey conducted in October found that 73% of respondents across 15 economies intend to get vaccinated — 4 percentage points fewer than the same survey done three months earlier.

“In general, vaccine coverage should reach at least 70% to form some herd immunity,” said Citi.

“However, vaccine acceptance rates of 54%-59% in France, Hungary, Poland and Russia suggest potential delays in the timing of herd immunity by vaccination in some countries.”

Expert Cites Challenges in Vaccinating Poorer Countries

The global vaccine rollout is full of glitches, shortages, and problems, but not every country faces the same challenges. Evening out those inequalities to make sure poorer countries are included in the vaccination race isn’t just the ethical thing to do it’s good for rich countries, too. A new study from the National Bureau of Economic Research shows that the entire global economy depends on poorer countries’ getting residents vaccinated: advanced economies will still bear 49% of the costs of the pandemic, even if they get their own populations entirely inoculated. 

With a new leader in the White House, we’re seeing signs that the US will do its part. The Biden administration says it will join Covax, a global vaccination effort led by the World Health Organization that aims to get the first batches of vaccines to poorer countries in February. To learn more about global vaccine inequality, MIT Review spoke with Anita Ho, associate professor in bioethics and health services research at University of British Columbia and the University of California, San Francisco. 

This interview has been condensed and edited for clarity.

Q: What’s the upshot of the US joining Covax? Do you expect that to be any sort of game-changer for global vaccine inequity?

A:  Even from a symbolic perspective it’s really important to have the US rejoining the WHO efforts and Covax. It’s also important for financial reasons, because Covax needs money to get supplies. It’s not just vaccines ... we need money for personnel, we need money for protective equipment. We need money for glass, for syringes, for needles—everything. So the US being there can provide leadership and provide more financial security as well.

Q: So it really goes beyond just needing the doses. What are some of the biggest disparities in global vaccine distribution right now? It sounds like supplies might play into that.

A: It’s not just Are we willing to donate the vaccines? It’s Do we have the infrastructure to even store and transport the vaccines? The main ones approved in the US, for example—the Pfizer and Moderna vaccines—really require very cold refrigeration. That is not even very feasible in some areas of the world that have limited electricity supply. 

Despite early gains, Israel’s vaccine rollout is still leaving far too many people out, says one expert.

One of the greatest contributors to the disparity is when wealthier nations pre-order vaccines from manufacturers. They’re buying up most of the supply—the potential supply, even. So even when companies are ramping up the supply, they’re not going to be able to go to these poorer countries unless Covax can buy them.

Q: You’ve spoken before about vaccine disparities even within high-income countries. Why do those happen? What should we be watching out for?

A: Think about how people get notifications that it’s their turn to get vaccinated. In the US, for example, the ones who’d get those notifications would have smartphones, have email addresses, would already have a primary care provider. If you are undocumented, if you are homeless, you may not have access to that information and you wouldn’t even know. 

The Pfizer, Moderna, and AstraZeneca vaccines all require two doses with variable time between them. This means we need careful tracking of individuals twice: to get their first dose, and then to get them to return at the right time frame to get their second dose. For people in remote areas, or places that don’t have convenient access to pharmacies—often poorer neighborhoods—it’s difficult for them to travel twice. And for people who may be homeless or without cell phones, it would be challenging to reach them twice in a designated time frame. So one way to promote vaccination equity is to have reserve vaccines that would only need one dose for these populations. Johnson & Johnson is developing a one-dose vaccine right now.

There may also be another disparity. There are many people who, even if you offer them the vaccine, will not take it. And that’s partly because of the distrust. There is a much higher level of distrust among Latino and Black Americans, partly because of historical mistreatment. 

Q: How are you seeing mistrust affect global vaccination disparities more globally?

A: When we think about mistrust on a global scale, that may be partly because of how the pharmaceutical industry prices things and how they have patents. Some countries may be thinking, “These companies from the US or Europe are really trying to sell us their expensive vaccines. But we can’t really afford them for our population in the first place because they are patented, and we are not allowed to just make a generic version of it.” They may be thinking, “These companies are just trying to take advantage of us.” And there certainly have been examples of lower-income countries that have been exploited by the pharmaceutical industry. 

Inequitable vaccine allocation definitely will disrupt the supply chain for all, including the wealthiest nations that have come to depend on cheap sources of labor.

In Indonesia, for example, this happened with H5N1. Whenever there’s an outbreak, if you’re a WHO member, you send samples to a WHO lab and they try to find out about this particular virus or disease. Based on genetic material sent from Indonesia, scientists developed therapeutics for H5N1 and tried to sell them back to Indonesia. Then Indonesia thought, “Okay, these were our samples. Should there not have been collaboration? You’re using them to sell drugs back to us.”

Q: Does the US have a moral obligation to send people to other countries to help with vaccinations?

A: One of the problems is that we’re not able to train enough people in the local places. For Covax or other kinds of international collaboration, it’s not about sending people so much as it’s about how do we help them build up their own infrastructure? Even financial resources for training courses or other kinds of ways to beef up their own human resources. Because you can imagine we’d go, and then we’d leave, and they’re not any better in terms of infrastructure.

Q: How would it affect higher-income countries if other, lower-income countries don’t receive their vaccines until later? Recent research says, for example, that if poor countries don’t get vaccines, it will disrupt the economy for everyone. 

A: While it’s still likely that at the human level, people in the most vulnerable countries will suffer more, inequitable vaccine allocation definitely will disrupt the supply chain for all, including—perhaps even especially—the wealthiest nations that have come to depend on cheap sources of labor. If supplying nations have lots of people being sick, or they have to shut down, [there are] no workers to process or transport the raw materials, or to manufacture and deliver the products. People in these countries also can’t travel or spend money, which can greatly affect international hotel chains, airlines, and hospitality industries as well.

This would apply within a high-income country too. If undocumented workers, farm workers, homeless people, and others in low-wage jobs can’t get vaccinated, they can’t work to keep the supply chain going. So restaurants, entertainment industries, etc. would suffer. If they can’t pay the rent or mortgage or have extra money, that also affects the rest of the economy.

Jiangsu Blue Sky is Supplying Three Layer FFP 2 Masks

This Chinese company is a major international exporter of dust collector media and bags. They now are supplying disposable masks.  Edward Wu wrote us with the following, 

“This year we are also to produce the FPP2, FFPP1, KN95, paper diaper, etc. use ES hot air cotton, SS, SMS, etc. fabric, the ES hot air cotton machine is imported from Taiwan, could do the weight from 20-50 gsm, width below 3m such fabric for you, each day could do about 8-12 Ton. 

Nanofiber Swabs are Better for Measuring COVID

Following the COVID-19 outbreak, swabs for biological specimen collection were thrust to the forefront of healthcare materials. Swab sample collection and recovery are vital for reducing false negative diagnostic tests, early detection of pathogens, and harvesting DNA from limited biological samples.

In this study (linked below), we report a new class of nanofiber swabs tipped with hierarchical 3D nanofiber objects produced by expanding electrospun membranes with a solids-of-revolution-inspired gas foaming technique. Nanofiber swabs significantly improve absorption and release of proteins, cells, bacteria, DNA, and viruses from solutions and surfaces.

Implementation of nanofiber swabs in SARS-CoV-2 detection reduces the false negative rates at two viral concentrations and identifies SARS-CoV-2 at a 10× lower viral concentration compared to flocked and cotton swabs. The nanofiber swabs show great promise in improving test sensitivity, potentially leading to timely and accurate diagnosis of many diseases.

https://pubs.acs.org/doi/full/10.1021/acs.nanolett.0c04956#

CNN Perspective on the New ASTM Standards

The three step plan discussed earlier includes activities to inform the main stream media about mask options.  Here is the CNN reporting this week.

A draft of the first national mask evaluation standard for consumer masks obtained by CNN shows proposed guidance would call for two tiers of certification.

• A level one mask would require the product to filter 20% of particles -- something that would make the mask easy to breathe through, but that would provide minimal protection.
• A level two mask would require "high performance" filtration of at least 50% of particles but would provide less breathability.

The standards are currently in development with ASTM International and the National Personal Protective Technology Laboratory, which is an arm of the US Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health.

The current standards: Currently, only medical-grade masks and respirators must meet standards. These include N95 masks, which are regulated for fit, filtration efficiency, flammability and other qualities.

The new standards: The proposed standards will outline specific fit, design, performance and testing requirements for face masks and coverings, according to a draft of the standards provided to CNN by ASTM International. 

The draft evaluates both single use and reusable masks and outlines specific requirements. For instance, the standards would prohibit the use of vents, valves or any feature that allows air flow to bypass filtration -- though there are exceptions to this that reflect current CDC guidance.

The review process is ongoing, and these guidelines are subject to further review and change. The drafted guidelines will be further reviewed next week.

The ASTM draft standard currently is far different from standards required for masks in several European countries. Germany, Austria and France are now requiring people wear masks with a minimum filtration efficacy of 80-90% while on public transport, shopping or in public areas. 

The overall takeaway from reading this article is that the U.S. will be falling behind  European countries even with the ASTM standard.

The article also does not emphasize that the ASTM  standard is not a regulation whereas the European standards are required to be met. It also implies that these standards have the same weight as the current standards which are enforceable in medical applications.  So there is no real distinction between creating a standard and writing regulations to enforce it .