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Nurses and doctors: ‘We are forced to reuse masks’

Is it time to start mining … for masks? Why some doctors are getting creative to meet the growing demand for this medical equipment.

Healthcare workers are reporting shortages of medical masks in three provinces and say they are being asked to reuse masks meant to protect them from the new coronavirus, as COVID-19 cases continue to rise in South Africa. 

Workers in the Western Cape, Mpumalanga and the North West have complained they’re running low on the gear. Doctors and emergency medical services (EMS) workers in the provinces warn reusing the masks, meant to protect them from contracting the new virus, put them at an increased risk of infection. 

The virus, named SARS-CoV-2, gives rise to the illness COVID-19. But some health professionals and small businesses are getting creative about how to solve what they say is a larger looming scarcity of the masks standing between our healthcare workers and the new virus. 

So far about eight out of every 10 cases of COVID-19 are mild, according to a February analysis of more than 70 000 cases by the Chinese Centers for Disease Control and Prevention. However, local and international experts are unsure whether this will hold true in South Africa because of the country’s large proportion of people with weakened immune systems because of conditions such as TB, diabetes and HIV.

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In the Western Cape, district and regional hospitals are preparing to receive serious cases, caring for patients in isolation wards. But with more specialist services, Tygerberg Hospital is likely to see the sickest of the sick. 

On Wednesday, medical students at the hospital were frantically circulating WhatsApp messages and emails. 

“We are in crisis,” read one email. “The hospital staff exposed to COVID-19 patients will soon run out of N95 masks.”

The message continued: “Can I please ask all 2nd [year] students to bring their unused masks?”

N95 masks, also known as respirator masks, are special masks that protect the wearer from airborne particles — SARS-CoV-2 is spread through respiratory droplets produced when an infected person coughs or sneezes. Respirator masks are different from surgical masks that you can buy at a chemist. 

Hospital workers, who asked to remain anonymous, say they are being asked to reuse the critical medical respirator masks that are used exclusively by healthcare workers in healthcare settings to prevent infections such as TB.

But Western Cape health department deputy director of communications, Mark van der Heever, refuted the allegation. He says that although respirator masks can be reused for some illnesses in some settings, this was not true for SARS-CoV-2. 

“Should staff be able to prove the allegation,” Van der Heever says, “they can approach the department’s quality division, which oversees infection control across the province.”

Meanwhile, some emergency medical services (EMS) workers in Mpumalanga have also complained of shortage of masks to the South African Emergency Personnel’s Union, according to the union’s president, Mpho Mpogeng.

“[In] Mpumalanga, they were given one mask for a month. How is that possible?” Mpogeng told Bhekisisa.

“And it’s not only the masks,” he explains. “Some [EMS workers] in the North West, they literally don’t have any equipment to deal with the virus.”

The Mpumalanga health department has denied any shortages of protective gear for staff. 

The national health department and the North West provincial department of health had not responded to requests for comment by the time of publication.

As of Thursday, South Africa has 150 reported cases of the new coronavirus. Although initial cases were confined to those who had recently arrived from countries hard-hit by the virus, Health Minister Zweli Mkhize confirmed this week that cases are now spreading on South African soil. 

Crowdsourcing in the time of the coronavirus gets creative

The hospital group Netcare has already donated some protective gear for emergency medical workers, says Netcare’s group medical director, Anchen Laubscher.  

The South African Society of Anaesthesiologists (SASA) is also trying to collect protective gear for healthcare workers, even appealing to the mining sector — which also uses respirator masks.

“It’s not just about masks,” explains Anthony Reed, senior lecturer at the University of Cape Town’s department of anaesthesia and perioperative medicine. Reed is also part of SASA’s COVID-19 task team. 

“Everything has to be disposable in this situation — so it’s the hat, it’s the masks, you need to have some kind of visor because [the virus] can pass through any of the [tissue lining the eyes, nose and mouth]. 

Reed explains that a typical kit for any healthcare worker dealing with COVID-19 patients includes a visor, mask and apron. And all of this needs to be put on, taken off and thrown away each time someone checks on an individual patient to prevent catching or spreading the virus.  Because of this, Reed estimates workers might go through 14 to 28 sets of this gear each day.

“We just don’t have those kinds of numbers around,” Reed says. “Nobody, no country has them, it’s an international problem now that we’re going to need much more of them than we’ve ever had.”

SASA is already thinking about possible solutions. Mines often use respirator masks to protect workers’ lungs from small particles released into the air as a result of mining. The only problem? Unlike masks meant for medical use, those bought by mines aren’t made in specialised factories with conditions that assure the gear is sterile. 

But, said SASA Wednesday night, you could sterilise masks meant for the mines at health facilities when the gear arrives. This would also make masks easier to produce. 

Reed explains: “In this outbreak, a lot of the stuff that we need is just to protect the healthcare worker and it doesn’t actually have to be sterile.”

If masks don’t have to leave the production line germ-free, he explains, then they could be made in any type of factory. Facilities now producing items such as t-shirts could be re-jigged to help increase production, he argues. He says the society has already been approached by the Small Enterprise Development Agency and private businesses keen on testing the idea. 

Medicines regulator, the South African Health Products Regulatory Authority, doesn’t require equipment to be sterile unless it’s coming into contact with patients

“There’s sterilising mechanisms across the healthcare sector and other industrial sectors, which can be harnessed for this,” Reed continues. “So really, it’s an opportunity for us to create the local employment and to generate the essential things that we need.”

Shortages were projected even before South Africa’s first case of COVID-19

Fears of a global shortage of medical masks because of the new coronavirus outbreak surfaced in February — even before South Africa had seen its first case of COVID-19

National department of health spokesperson Popo Maja told Bhekisisa in February that while South Africa did have local manufacturers, they weren’t able to supply the large numbers needed by healthcare workers.

In the same month, international and local manufacturers said they were already ramping up production.

For instance, German mask manufacturer Dräger produced at most 50 000 masks at its East London factory for the southern African market. But even before the COVID-19 outbreak hit South Africa, order requests had soared to one-million. In essence, more than local production at the plant was designed to handle, product manager Quinton Taylor told Bhekisisa. 

“Everyone is trying to order more material [for the masks],” he said. “The guys that manufacture the material are eventually going to run out with the numbers that are coming through. It’s inevitable.” — additional reporting by Joan van Dyk

Sethu Mbuli was a junior health reporter at Bhekisisa in 2020.