Hospitals did their best to come up with solutions to circumvent this shortage — including recommending repetitive use, performing ultraviolet light cleanings of used masks and simply rationing — but we still remember the stress of feeling physically under-protected.
Thankfully, as we enter year three of the pandemic, access to masks in the health care setting has improved. However, the Omicron variant has led to some of the highest daily case counts since the start of the pandemic and many states are utilizing greater than 70% of their inpatient and intensive care unit beds. The rapidly infectious nature of Omicron has made many public health leaders reconsider the approach to masking for the general public.
On Friday, the CDC updated its mask guidance for preventing the spread of Covid-19. The agency provided additional information about the various types of masks that are available and in which circumstances each type is appropriate. Overall, it is recommended that individuals wear masks that “fit well” and that they will “wear consistently,” with the understanding that higher quality masks like N95s and KN95s will offer more protection than a simple cloth mask if worn correctly.
While higher quality masks provide better protection, multiple barriers prevent widespread public use of them. The Occupational Safety and Health Administration (OSHA) specifies that, when masks are required in the workplace, those masks must be approved by the National Institute for Occupational Safety and Health (NIOSH). This has led to false marketing of non-NIOSH-approved masks and prompted the CDC to publish a guide on identifying counterfeits. On Project N95, a nonprofit organization which lists vetted masks and respirators, the prices for 20 N95s range from $27-$124. In addition to quality misrepresentation and financial limitations, proper size and fitting of these masks can vary from person to person.
President Joe Biden announced Thursday that his administration would make high-quality masks widely available and free or Americans. Also last week, Vermont Sen. Bernie Sanders introduced legislation to provide three N95 masks to every American using the United States Postal Service for distribution and additional pick-up sites at community locations. While these are promising steps for increasing mask access, we strongly urge officials to value local partnerships in their initiatives.
If vaccine rollout and the testing shortages have taught us anything, it is that we need to be proactive in ensuring equitable access to these masks. While the administration has noted that the masks will be available at some local pharmacies and community centers, it will be critical to ensure that sufficient supply is available to those who have high risk exposure to the virus.
For example, those who work outside of the home and interact with others may need more masks than those who work from home. In addition, if the method of signing up for free masks is similar to the current federal government’s free at-home Covid-19 test website that went up Tuesday, individuals with broadband access issues and limited English proficiency may be unable to navigate these services.
We, therefore, recommend the following three venues for mask distribution that will address both equitable access and effective use.
The first location is in established areas where people are already receiving medical care. These include the community centers and pharmacies that the administration has noted will be distribution spots, but the list should extend to primary care clinics, hospitals, medical and dental centers, Covid-19 vaccination sites and Covid-19 testing centers. By partnering with local places that the general public regularly uses and trusts with their health, effective education and prevention can be achieved. A state-based program in Maryland is already pursuing this method and will soon be distributing high-quality masks at state-run testing and vaccination sites.
The second location is the workplace. Individual companies could put in requests for masks based on their number of employees. Given that a “high-quality” mask is one that is not wet or soiled, organizations would have to assess the likelihood of mask reusability depending upon the task the employee is hired to do and request masks for more frequent changing if needed.
Especially after the recent Supreme Court ruling blocking the general workplace vaccine mandate, masks can be a line of protection for vulnerable populations while at work. In Los Angeles, employers are already required to provide well-fitting medical-grade masks to employees who work indoors in close contact with others.
The third location that would benefit from high-quality mask distribution is schools. We have argued in the past that school mask mandates play an important role in fighting the spread of this virus. For younger children who are not yet eligible for the vaccine or whose household members are immunocompromised or unvaccinated, high-quality masks may be their primary source of protection during the school day.
There are no N95 respirators designed for children and only certain KN95s and medical-grade surgical masks are made to fit children. Given the difficulties in purchasing these masks (including costs and supply availability), school partnerships would provide more equitable access. The number of masks needed could be identified through school rosters and then allocated appropriately. States like Colorado have been distributing free at-home Covid-19 testing kits through school-based programs. Similar processes to this can be used to plan for mask distribution.
Compared to the early days of limited personal protective equipment, we have made great strides. When the administration releases their plans for mask distribution this week, we hope they take into account the lessons learned thus far from the pandemic. By distributing high-quality masks directly to the public where they are at, we can maximize protection against the SARS-CoV-2 virus — balancing equitable access and effective use for all.
