May 2022 | John Strong, ASPI
During the initial spread of COVID-19, there were understandable shortages of Personal Protective Equipment (PPE) including N95 masks and respirators. It would have been impossible, even for the most conservative healthcare providers, to foresee and have enough inventory for such an unprecedented event. As a nation, are we still overreliant on disposable products with long geographical supply chains?
“The Government Should do Something”
In fact, the federal government began looking at the desirability of innovative respiratory protective devices in healthcare settings in 2009. A working group of representatives from federal agencies convened and reached a consensus on many key related topics. It was sponsored and chaired by the Office of Public Health and Environmental Hazards in the U.S. Department of Veterans Affairs (VA). Representatives were drawn from the Centers for Disease Control (CDC), National Aeronautics and Space Administration (NASA), the U.S. Department of Labor, and others.
While the report noted that employers often sought the “least expensive respirator model”1 and some healthcare workers do not like to wear them, there was strong consensus that there was clear employer and employee desirability for better respirators.
The government had massive stockpiles of respirators at the federal and state level. Unfortunately, many of the principles of stockpile management were ignored, resulting in N95 respirators that were only marginally effective or completely unusable due to age.
Healthcare Workers Protest
Perhaps one of the clearest signals that healthcare workers do not feel safe is made with their feet. Since the onset of the global pandemic, one in five healthcare workers have left their jobs, and by 2030 the world faces a shortage of 18 million healthcare workers2. According to Cornell University, there were at least 30 strikes involving healthcare workers between January and October 2021. According to The Advisory Board Company, the leading “pain point” driving strikes in healthcare is “Workplace Safety Concerns”3.
During the pandemic many experts have suggested that the healthcare supply chain, and practices in it, be thoroughly re-examined. They should be.
The Centers for Disease Control and Prevention (CDC) reported 389,380 infections and 1,332 deaths among healthcare workers as of February 1, 2021. These figures may be understated. ProPublica reported in the same period that based on past pandemics an infection rate of 5% to 15% would be expected. This would imply at least one million COVID-19 cases among healthcare workers with thousands of deaths, just here in the U.S.4 This type of under-reporting is unfortunate because it downplays the need for and the push toward better solutions for protecting healthcare workers.
The Irony
Many observers, including the federal government, have recognized that there is not only better personal protection value coming from reusable respirators, but environmental and economic ones, as well. A study published in the British Medical Journal in 2021 concluded “decontamination and reusable respirator-based strategies decreased the number of respirators used, costs, and waste generated compared with single-use or daily extended-use of disposable respirators.”5
The Numbers are Huge—Just in America
In the U.S., a new N95 (disposable) respirator used for each patient encounter requires approximately 14.8 billion respirators, at a cost of approximately $12.8 billion annually.6 Reducing our reliance on disposable N95 respirators can dramatically decrease the amount of medical waste incrementally generated by the COVID-19 pandemic. That increase is estimated at over 7,200 tons per day, much of it from disposable respirators.
Reusable N95 respirators are far more cost effective than disposable N95s. Reusable respirators with disposable filters could offer annualized savings in the U.S. market alone of more than $11 billion.
Conclusion
The benefit of using reusable N95 respirators is enormous, in terms of improving staff protection, decreasing lost work time and reducing costs of treatment incurred when clinicians become infected. On top of that, there are the direct cost savings of almost $11 billion in unpurchased disposables and a sharp reduction in landfill waste and the related disposal costs of transportation.
In addition, shortening the supply chain reduces the shipping carbon footprint of air and ocean transportation. Reusables can be made available without the need for massive stockpiles—both at the federal and state level as well as for individual healthcare providers.
Is our healthcare supply chain going to revert to the old way of doing everything or is it time to take a fresh look at alternative methods, such as the use of reusable N95 respirators in American healthcare facilities?
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References
1”Better Respiratory Equipment Using Advanced Technologies for Healthcare Employees (Project B.R.E.A.T.H.E.) (2009) by Office of Public Health and Environmental Hazards in the Veterans Health Administration of the U. S. Department of Veterans Affairs.
2Schwartz, Emma, “The Global Health Care Worker Shortage: 10 Numbers to Note”, April 6, 2022, at HTTPS;//www.projecthope.org.
3Advisory Board Company “Daily Briefing”, October 22, 2021, “Why healthcare workers are going on strike” © 2022 by Advisory Board Company
4American Journal of Nursing”, “The Toll of COVID-19 on Healthcare Workers Remain Unknown”, Vol. 121. No. 3, March 2021.
5Chu, Jacqueline, Ghernand, O, et. al., “Thinking green: modelling respirator reuse strategies to reduce cost and waste”, Vol. 11, Issue 7, p.1.
6Ibid., p.3.
