On one level, the world’s response to the coronavirus pandemic over the past two and a half years has been a major triumph for modern medicine. We developed COVID vaccines faster than any vaccine in history, and started giving them just one year after the virus first infected humans. Vaccines turn out to work better than top public health officials dare hope. Combined with antiviral treatments, they have dramatically reduced the virus’ toll of severe illness and death, and helped hundreds of millions of Americans resume what looked like life before the pandemic.
However, on another level, the epidemic has demonstrated the inadequacy of such pharmaceutical interventions. In the time it took for vaccines to arrive, more than 300,000 people have died from COVID-19 in America alone. Even since then, declining immunity and the near-regular emergence of new variants have led to an uneasy breakthrough. And another 700,000 Americans died during that time, despite vaccinations and antiviral drugs.
For some epidemic prevention experts, the takeaway here is that pharmaceutical interventions alone will not eliminate them. Although injections and medication may be necessary to ease the blow of the virus once it arrives, they are inherently reactive rather than preventative. To prevent future epidemics, what we should focus on, some experts say, is attacking viruses where they are most vulnerable, before pharmaceutical interventions are necessary. Specifically, they argue, we should focus on the air we breathe. “We’ve dealt with a lot of variants, we’ve dealt with a lot of strains, and we’ve dealt with other respiratory pathogens in the past,” Abrar Karan, an infectious disease physician and global health expert at Stanford University, told me. “The only thing that has remained constant is the transmission path.” The most dreaded epidemics are transmitted through the air.
Several overlapping efforts are being made to stave off future disease outbreaks by improving air quality. Many scholars have long advocated reforming our method Ventilation of interior spaces, which has the potential to divert our air in the same way that the advent of sewage systems diverted our water. Some researchers are similarly excited about the promise germicidal lighting. Retrofitting state buildings with superior ventilation systems or germicidal lighting is likely to be a long-term task, although it requires extensive institutional involvement and possibly a significant amount of government funding. Meanwhile, a more specialized subgroup has focused on what is, at least in theory, a somewhat simpler task: designing the perfect mask.
Two and a half years into this pandemic, it’s hard to believe that the masks that are widely available to us today are pretty much the same ones that were available to us in January 2020. N95s, the gold standard in relation to the average person, be Very good: filtered at least 95 percent of .3 micron particles – hence N95—And they are generally the preferred masks in hospitals. However, anyone who’s worn one over the past two and a half years will know that, because we’re lucky to have them, they’re not the most comfortable. At a certain point, they start hurting your ears, nose, or entire face. When you finally unfold the mask after a long flight, you will likely look like a raccoon. Most current N95s are not reusable, and although each individual mask can be reused very cheapCosts can accrue over time. They impede communication, preventing people from seeing the wearer’s facial expressions or reading their lips. Because it requires adequate testing, the efficacy for the wearer is likely to be well below the advertised 95 percent. In 2009, the federal government published a file Report With 28 recommendations to improve masks for health care workers. Little seems to have been taken.
These shortcomings are part of the effort to get people to wear masks an uphill battle. What’s more, over the course of the pandemic, several new companies have submitted new mask designs to NIOSH, the federal agency tasked with certifying and regulating masks. Few, if any, have been adopted so far. Agency It seems Overstretched and underfunded. In addition, Joe and Kim Rosenberg, who in the early stages of the pandemic launched a mask company that unsuccessfully applied for NIOSH approval, tell me that the certification process is somewhat circular: Successful application requires huge amounts of capital, which in turn requires huge amounts of investment, but investors in general would like to see data showing that masks work as advertised in a hospital, for example, and that masks cannot be tested in a hospital without NIOSH’s prior approval. (NIOSH did not respond to a request for comment.)
Regardless of the new products, there are already masks that outperform the N95 standard in one way or another. Flexible respirators are reusable masks that provide them with replaceable filters. Depending on the filter you use, the mask can be just as effective as N95 or more so. When equipped with HEPA-quality filters, the flexible material filters out 99.97 percent of particles. It comes in both half-face (which covers the nose and mouth) and full-face versions (which also cover the eyes). Another option is PAPRs, or powered air purifying masks — battery-coated masks that cover the entire wearer’s head and continuously blow HEPA filtered air until the wearer breathes.
Given the challenges of convincing many Americans to wear flimsy surgical masks over the past two years, the problems with these superior masks – current models at least – are perhaps as underpowered as their widespread adoption in future outbreaks. Elastic materials are generally bulky, expensive, have limited range of motion, block the mouth, and require appropriate testing to ensure efficacy. PAPRs have a transparent interface and in many cases do not require proper testing, but they are also bulky, currently costing over $1,000 each, and because they are battery operated, they can be quite noisy. No, let me assure you that there is no kind of thing you would want to wear to the movies.
The people who seem to be focusing more on improving masks are a mix of biologists, biosecurity experts and others whose main interest is not another coronavirus-like pandemic, but something more terrifying: a deliberate act of bioterrorism. In the apocalyptic scenarios that worry them the most — which, to be clear, is conjectural — bioterrorists release at least one highly infectious pathogen with a lethal potential in a range of, say, 40 to 70 percent. (COVID’s on the verge 1 percent.) Because this is going to be a new virus, we won’t have vaccines or antivirals yet. The only way to avoid complete societal collapse is to provide essential workers with personal protective equipment that they can be confident will provide infallible protection against infection – the so-called ideal PPE. In such a scenario, N95s wouldn’t be enough, Kevin Esvelt, an evolutionary biologist at MIT told me: “A virus that’s 70 percent lethal, 95 percent protective—it just wouldn’t fill me with confidence.”
Esvelt tells me that current masks that use HEPA filters may be protective enough in this worst-case scenario, but that’s not a given. Vaishnav Sunil, who directs the PPE project at Esvelt Lab, believes PAPRs show the most promise, because they do not require proper testing. Currently, the MIT team is scanning existing products to determine how to proceed. Their goal, ultimately, is to ensure that the state can distribute protective masks completely to every essential worker, which is first a design problem and secondly a logistical one. The mask the Esvelt team is looking for may already be there, just selling for a very high price, in which case they will focus on lowering that price. Or they may need to design something from scratch, in which case, at least initially, their work will consist mainly of new research. Most likely, Sunil tells me, they will identify the best products available and make modest adjustments to improve comfort, ventilation, ease of use, and efficacy.
The Esvelt team isn’t the only group exploring the future of the mask. Last year, the federal government began soliciting requests to design a mask Competition Aiming to stimulate technological development. The results were nothing if not creative: among the ten winning models selected in the first stage of the competition, there was a translucent mask, an origami mask, and a mask for babies with a pacifier inside.
Ultimately, questions about how much we should invest in improving masks and how we should actually improve them boil down to a deeper question about which potential future pandemic worries you the most. If your answer is a biologically designed attack, you would naturally dedicate significant resources to perfecting efficacy and improving masks in general, given that in such an epidemic, masks may be the only thing that can save us. If your answer is SARS-CoV-3, you may worry less about efficacy and spend relatively more on vaccines and antiviral drugs. This is not a cheerful option. But it is important as we move out of our current epidemic and into all that lies ahead.
For the elderly and the immunocompromised, super effective masks can be beneficial even outside of a worst-case scenario. But traditional public health experts, who do not place as much importance on the potential for a highly lethal and deliberate pandemic, are less concerned with improving efficacy for the general public. And they say the biggest gains will not come from marginal improvement in the effectiveness of existing high-potency masks but from getting more people to wear high-potency masks in the first place. “It’s important that we make masks easier, more convenient, and more effective to use,” Linsey Marr, an environmental engineer at Virginia Tech told me. She said it wouldn’t hurt to make it a little more fashionable. Reuse is also important, Jassi Bano, a fellow at the Johns Hopkins Center for Health Security, tells me, because stocks of single-use products will almost always run out in a pandemic.
Karan of Stanford University envisions a world in which everyone in the country has a flexible ventilator — not, in most cases, for everyday use, but available when necessary. Instead of constantly replenishing your stock of reusable masks, you can simply swap out the filters in flex (or maybe PAPR) every now and then. The mask will be transparent, so a friend can see your smile, and relatively comfortable, so you can wear it all day without cutting your nose or pulling at your ears. When you come home at night, you spend a few minutes cleansing it.
Karan’s vision may be far away. American tensions over concealment of the pandemic throughout the pandemic give no reason to hope for any unified or global assimilation into future disasters. And even if it did, everyone I spoke to would agree that masks alone are not a solution. It is almost certainly the smallest part of the effort to ensure the air we breathe is clean, to change the physical world to stop the transmission of the virus before it happens. However, making and distributing millions of masks is almost certainly easier than installing super-ventilating systems or germicidal lighting in buildings across the country. The masks, if nothing else, are the dangling fruit. “We can handle the dirty water, we can handle cleaning the surfaces,” Karan told me. “But when it comes to cleaning the air, we’re way too far behind.”
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