As COVID-19 cases continue to climb, front-line health care workers are decrying unsafe working conditions 鈥 in particular, describing inadequate access to personal protective equipment, or PPE. Many hospitals and state lawmakers blame Washington, saying the Trump administration has not done enough to make this critical protective gear available.
But at a recent press conference, President Donald Trump suggested those claims are overblown, asserting instead that hospitals have the tools they need to sanitize and reuse protective facewear.
鈥淲e鈥檙e also using a sterilization process 鈥 some great equipment that will sterilize masks up to 20 times per mask. So that鈥檚 like ordering 20 times more masks. And it鈥檚 working very well,鈥 Trump said at the April 23 briefing.
In fact, the question of reusing masks 鈥 specifically, the highly effective N95 respirators that best protect wearers from COVID-19 鈥 has emerged as a major worker-safety concern. Traditionally, the masks have been designated only for single use.
But with hospitals running low on protective equipment, many seek to stretch their supplies.
With that context, we were curious 鈥 can N95s be sterilized and reused, as Trump suggested? And if so, are disinfected masks as protective as new ones?
We contacted the White House but never heard back. Our own research revealed the situation is more complex than Trump suggested. Hospitals are using new technology to sterilize masks. Some procedures do show promise. Still, according to experts we consulted, it鈥檚 an overstatement to suggest they are as effective as getting new equipment.
The Battelle Process
Trump appears to be referencing technology from the Battelle Memorial Institute, a nonprofit technology company in Ohio. Battelle, which has an in-house 鈥渃ritical care decontamination system,鈥 received from the Food and Drug Administration to sanitize N95s for reuse.
Hospitals send used N95s to , which has also in coronavirus hot spots, including New York, Boston, Seattle and Washington, D.C.
Workers wearing protective gear load the respirators into a sealed container. Masks are cleaned with vapor-phase hydrogen peroxide, aerated and then sent back to the originating hospitals. The decontamination process takes about 12 hours. A mask鈥檚 round-trip journey from a hospital to Battelle in Ohio and back again can take about
Battelle said masks can withstand the decontamination process without losing their ability to filter out viral particles.
So, the president is right that this technology exists. But is it fair to say the approach is the equivalent of buying new gear?
Put simply, no. Experts are clear that decontamination works in the current emergency. But 鈥 despite Trump鈥檚 enthusiasm 鈥 it is not a best practice.
鈥淚t鈥檚 not accurate to say that reprocessing respirators is as good as purchasing 20 of them,鈥 said Dr. Patrick Kenney, medical director of Yale-New Haven Health鈥檚 supply chain, who has also researched decontamination technology and processing. 鈥淭his is not a renewable resource. The respirators are intended for single use.鈥
In fact, in its letter designating emergency approval, the FDA specified that Battelle鈥檚 decontamination system 鈥渕ay be effective鈥 at protecting wearers but advised it specifically for 鈥渨hen there are insufficient supplies.鈥 The Centers for Disease Control and Prevention also recommends reuse 鈥渙nly be practiced as a crisis capacity strategy.鈥
The reasons are multiple. For one thing, research is limited on how effective this type of decontamination is. Also, masks vary in how they stand up to the procedure.
And it鈥檚 not as simple as doing a load of laundry. 鈥淒econtamination is a complicated process,鈥 said Hana El-Samad, a professor of biochemistry and biophysics at the University of California-San Francisco, who researches N95 sanitization. 鈥淎ssessing how well it works and which N95 makes and models remain unaffected is an area of active research,鈥 she said.
N95Decon, a research collaborative with which El-Samad works, has examined Battelle鈥檚 hydrogen peroxide approach and found the chemicals appear to eliminate COVID-19 spores without damaging the mask鈥檚 filtration.
Mask Integrity
Performance is only part of the equation. Another is mask structure: N95s work only when properly fitted to the face.
When workers reuse and re-wear the masks, they can lose their shape, which undermines the quality of fit and renders them less protective. For some masks, per an N95 report on hydrogen peroxide, fit quality declined substantially after just five uses. For others, it took 15 wearings to see a meaningful difference.
At Yale-New Haven, Kenney said, the hospital discards 20% to 30% of respirators that could have been refurbished before they hit the 20-reuse mark because they had sustained too much wear and tear. Battelle鈥檚 20-time reusability metric, he added, was calculated without factoring in the impact of regular hospital use.
In addition, decontamination can in some cases worsen the respirator鈥檚 fit.
鈥淚f [an N95] doesn鈥檛 fit well, then air will leak around the sides and it doesn鈥檛 matter how good a filter it is,鈥 Kenney said.
Plus, using this technology requires hospitals to have other protocols in place. Used masks must be safely collected 鈥 since they could be COVID-contaminated and pose a biohazard 鈥 and a plan must be in place to move them to and from the sanitization facility.
鈥淭hese are all complicated processes that need to be done right,鈥 El-Samad said.
She offered a key takeaway: Technology like Battelle鈥檚 can help. But nothing substitutes for new N95s.
Our Ruling
In describing ongoing efforts to reuse protective respirators, Trump said the United States is using 鈥渟ome great equipment that will sterilize masks up to 20 times per mask.鈥 That, he argued, 鈥渋s like ordering 20 times more masks.鈥
It is true that technology exists to sterilize N95s up to 20 times. But there are knowledge gaps and other shortcomings that limit how effective this process is. Government authorities and health care researchers are clear that this is a crisis measure and it is in no way as effective as 鈥渙rdering 20 times more masks.鈥
The statement is partially accurate but leaves out important details that undermine the president鈥檚 point. We rate it Half True.