CDC mask guidance raises supply concerns

The latest face mask recommendations from the U.S. Centers for Disease Control and Prevention could further hinder frontline medical workers’ access to personal protective equipment, which has been an ongoing struggle since the start of the COVID-19 pandemic, experts say. 

The CDC in February released a series of guidelines that suggest the public may don certain medical-grade masks as protection from COVID-19. Regulators stated that N95 respirators — the gold standard for COVID-19 protection in the medical community and a requirement under the U.S. Occupational Safety and Health Administration’s respiratory standard — “should not be used outside of health care settings because they should be reserved for health care personnel.”

However, the same guidelines, which call for double-masking, include some details regarding the public’s use of KN95 masks, which are also used in health care settings and are approved, under some conditions as pandemic shortages continue, as a substitute when N95 masks are unavailable. 

The issue in health care is that as shortages of N95 masks — which filter out 95% of particles — continue to be a problem, some medical facilities have been relying on the less-protective KN95 masks for employees who are not working directly with COVID-19 patients, said Dr. Ernest Grant, president of the American Nurses Association in Silver Springs, Maryland.

“The new standard suggesting that the public wear the KN95 could interfere with the available supply that health care has,” he said. 

Bill Schwacke, Philadelphia-based health care practice leader for technology company Origami Risk LLC, said the push for more medical masks in the mainstream is “compounding” supply chain issues for hospital systems.

The new CDC guidelines have “a direct impact on their supply chain,” he said. “This is something that is front and center with the risk management people on a day-to-day basis.”

The CDC did not respond to a request for comment on the mask guidance.

On Oct. 2, 2020, months into well-documented shortages of N95 masks, OSHA issued notice that medical facilities, facing shortages of PPE, can use “discretion” in what to provide to workers. For many, that meant issuing KN95 masks, which are approved in other countries.

Adding to the confusion are media reports calling for everyone to wear the more-protective N95 masks, according to Get Us PPE, a Washington-based nonprofit organization advocating for more supplies for emergency medical workers amid the pandemic. 

“Recently … some writers and public health professionals have advised the public to buy N95s,” a spokeswoman with Get Us PPE wrote in an e-mail. “We disagree with this advice — as does the CDC — because there is a severe and worsening shortage of N95s, and we need to save them for health care workers.”

Mr. Schwacke of Origami said the demand for N95 masks has also created issues with counterfeit masks on the market.

Reusing masks is another dilemma. Under the OSHA standard, N95 masks should be worn once and disposed of. Since the pandemic began, most workers have been reusing them, Dr. Grant said. 

“They are asking health care personnel to reuse the mask for three, four or five days, and then re-sterilizing them,” he said. “We are in a crisis and there is a shortage, and this process is allowed, but the initial guidelines are that they are to be used once and thrown away. That’s still a concern we have,” Dr. Grant said.

Another problem, according to those who help health care facilities manage legal risks, concerns OSHA, which has cited hundreds of medical facilities over the past 12 months for violations of its respiratory standard. 

“Our clients have reported mask shortages and difficulties acquiring respiratory protection since the pandemic began,” said Adam Young, a Chicago-based partner in the workplace safety and environmental practice at Seyfarth Shaw LLP. He said the firm is aware of OSHA citing medical facilities for COVID-19 violations, often alleging violations of the respiratory protection regulations, despite the shortages. 

Andrew Brought, an attorney in the OSHA practice at Spencer Fane LLP in Kansas City, Missouri, said the problems with sourcing N95 masks will continue, and that any call for the public to wear such masks “presents a dilemma and challenge for health care professionals and their employers because they are the ones most directly at risk.” 

“All things being equal, given the variants (of COVID-19) that are now coming out, double masking and N95 make sense, but we are not at the point where all things are equal,” he said. “PPE should be directed to all those employers (with employees) who are in the high-risk categories.”

Mr. Brought said health care systems facing OSHA citations should “demonstrate that they have taken a variety of measures” to obtain adequate levels of PPE. “I think that those entities (that are cited) have a pretty strong basis to be able to push back against those citations issued.”