Elastomeric respirators are reusable respirators made by dozens of domestic manufacturers. The CDC and health care workers have been using these respirators using since 1996 to protect against deadly viruses. They can use different types of filters which are typically made of melt blown polypropylene and can filter 95% 99% or 100% (99.99997%) of airborne particles. Since they form a great seal around the individuals face and use special filters with electrostatic charges, they are the ultimate weapon in protecting individuals from droplet AND airborne spread of viruses.
Since elastomeric respirators protect against droplet and airborne transmission, it is like the equivalent of having an ABC type fire extinguisher. No matter the type of fire/virus transmission, having something offering universal protection ensures you can stop the fire/spread of the virus right away so that it can be contained and extinguished rather than allowed to quickly spread out of control.
This is the CDC page describing the main differences between surgical masks, N95s and elastomeric respirators. As you can see, the CDC doesn’t consider surgical masks to offer respiratory protection and instead should only be used to protect others from the wearer. N95s are also not made for reuse or extended use since they could lose their seal and filtration efficiency while elastomeric respirators offer the highest levels of protection and are made to be reused for years.
This is a popular YouTube video explaining the science behind how the electrostatic charges of N95s and elastomeric respirators help attract and trap virus particles and the physics behind it. Cloth masks and most surgical masks don’t offer protection from airborne transmission since they don’t seal to the face and are not able to attract and trap the smaller virus particles while N95s and elastomeric respirators will.
This is a presentation I did for the Occupational Health Clinics of Ontario Workers about elastomeric respirators in a health care setting and common misinformation surrounding their use for infection control.
Like N95, elastomeric respirators are commonly found in the mining, construction, agricultural and pharmaceutical industries. Millions of American households and businesses likely have them laying around because they are also commonly used during painting and home renovation projects. In the early 90s, drug resistant tuberculosis was starting to harm health care workers so the US government decided to start using N95s and elastomeric respirators to keep health care workers safe. Hospitals that would rarely have patients with deadly viruses would use N95s and hospitals like the Texas Center for Infectious Diseases that saw infectious patients on a daily basis decided to use elastomeric respirators as a sustainable PPE option that would also protect better than the N95.
This information and knowledge seems to have been lost by a lot of experts and the government itself. This OSHA document from 1994 shows you the government knew 27 years ago that “The wearing of a valveless fabric type disposable respirator has no advantage over a respirator equipped with an exhalation valve”.
In 2017, the CDC and Lew Radonovich made this presentation to explain that in a future pandemic, elastomeric respirators would be overlooked, that surgical masks would not be effective in protecting health care workers, that elastomeric respirator usage would prevent having to reuse N95s, would reduce costs for hospitals over N95s and that N95 shortages would likely occur.
This is a 2017 CDC blog post on elastomeric respirators, N95s and surgical masks.
This 2015 study by CDC scientists also showed elastomeric respirators would be the least costly form of PPE.
This is a great USA Today article from April 2020 where former CDC director Tom Frieden criticized the decision to not listen to recommendations to stockpile elastomeric respirators.
Federal recommendations on elastomeric respirators
These are the recommendations for the top US agencies to use elastomeric respirators. Due to a lack of communication and knowledge, some pages talk about how the exhalation valve can be covered while others don’t know it can be covered and just says to avoid using the respirators in certain areas and situations:
HHS and FEMA
OSHA even updated the PPE requirements for their workplace inspectors to use elastomeric respirators in high risk workplaces such as schools, hospitals, food plants, manufacturing facilities and more.
Here are studies on elastomeric respirators in a health care setting:
- This study from the American College of Surgeons and the Allegheny Health Network shows that during the first wave, after 2000 health care workers across several hospitals in New York and Pennsylvania were quickly fit tested and trained and given their own elastomeric respirator, none wanted to return to using N95s at the end of the 4 week study. It also showed a cost savings of over 90% by switching from N95s to elastomeric respirators.
- This study from last month shows that health care workers performing occupational CPR with N95s lost their seal and breathed in contaminated air 28% while those wearing elastomeric respirators never lost their seal. This can also be extrapolated to other scenarios for the military like trying to treat a critical wound or performing more strenuous duties requiring rapid movement. If soldiers and especially medics are given elastomeric respirators vs N95s, they can focus all their attention on the downed patient or task at hand and not worry about getting exposed to the virus if the patient is infectious or if there are environmental dangers such as chemical or biological dangers.
- This is a great study from Finland on how high risk health care workers were given N95s and elastomeric respirator and none became infected while those is lower risk areas of the hospital were given surgical masks and had a 63% of infection.
- This is a great 2018 study on elastomeric respirators in a health care setting.
- This CDC/NIOSH page on elastomeric respirators includes current studies and a large pilot project currently taking place across the US looking to put elastomeric respirators into widespread use.
- This is a study on how elastomeric respirators are safe and more sustainable than N95s during the Covid 19 pandemic.
- 2014 Study on common health care disinfectants on elastomeric respirators and H1N1.
- Hospital use of elastomeric respirators pre and post covid.
- Training and fit testing of elastomeric respirators vs N95s.
- CDC Webinar and studies on elastomeric respirators.
- TSI Webinar with top elastomeric respirator experts. This webinar and studies also touch on the common myth surrounding the assumed dangers of exhalation valves at the 19:15 and 40:00 mark of the video.
- These studies show the theories behind exhalation valves being dangerous were wrong and that even uncovered, exhalation valves are safe while surgical masks allow for more contaminated air to escape into the environment. Second study here.
In the news
Here are some news articles about elastomeric respirators for infection control:
- "They Evoke Darth Vader, but These Masks May Save Your Doctor’s Life" - New York Times, 2020-5-27.
- "Reusable respirators protect doctors and nurses against coronavirus, they aren't in the national stockpile" - USA Today, 2020-4-3
- "A Tiny Hospital in Texas Might Help Solve the Mask Shortage" - Elemental, 2020-4-16
- "COMMENTARY: Healthcare Workers Should Wear Reusable Elastomeric Masks" - WedMD, 2020-5-1
- "Healthcare Workers Should Wear Reusable Elastomeric Masks" - Medscape, 2020-5-1
Elastomeric Respirator Manufacturers
Current list of NIOSH approved elastomeric respirators.
Here are manufacturers listed by country. There is likely much more than these manufacturers around but these are ones I am more familiar with.
US: 3M, Dentec, MSA Safety, North, Enny, Breathe 99, Canopy One, Maskforce, Castle Grade, GVS, Envomask. There is also a large American PPE association called AMMA which is lead by Lloyd Armbrust, CEO of Armbrust America. AMMA is credited for the FDA and US government officially announcing the PPE shortage as being over, for hospitals to stop reusing N95s and switch to elastomeric respirators and for high risk workplaces like food plants to start using elastomeric respirators.
This is the open letter AMMA sent to President Biden and others about US PPE manufacturing capacity.
Canada: Mi Integration (Dorma), Trebor Rx, Precision ADM, Prescientx, Eclipse. Canada also has a newly formed association of PPE manufacturers called CAPPEM lead by Barry Hunt. https://cappem.ca/about-us
UK: Full Support (Design Reality)
Besides these manufacturers, some hospitals have learned how to 3D print their own and have offered the designs for free online.
The DOD is also tinkering with their own version.
Problems/Common Misperceptions with elastomeric respirators
Since the government failed to ensure the public would know about elastomeric respirators, common misinformation has been allowed to spread and sometimes the source of that misinformation is the government and CDC itself due to the lack of communication between agencies.
These are common misinformation about elastomeric respirators. A lot of the assumptions are due to thinking all elastomeric respirators are the same and that only industrial versions exist.
Communication issues: it is assumed all elastomeric respirators are like the 3M industrial ones and are impossible to communicate through making them hard to use in loud work environments or in places where instant communication is important. Not only are there versions of elastomeric respirators with speech diaphragms to improve communication but the new health care worker versions created during the pandemic have built improved communication into the design and some elastomeric respirators not only offer clear communication but also a clear window for people that are hard of hearing to be able to read lips and facial expressions. This Tweet of mine is but one example of a HCW version of an elastomeric respirator without communication issues.
Uncomfortable and not wanted by health care workers: it is often assumed these respirators would be to uncomfortable to wear for long periods of time and that health care workers would not like to use them. For comfort, quite a few new manufacturers have entered the market during the pandemic and a lot of manufacturers have created lightweight versions that are comfortable to use even for 12 hour days. This American College of Surgeons study with the Allegheny Health Network had a 100% satisfaction among all 2000 health care workers who used them. Not a single health care worker wanted to stop using elastomeric respirators and go back to using N95s.
Too expensive: Elastomeric respirators can be used for years and start at $20 for the respirator and $2 for the filters. Since these respirators are reusable and cost effective, they will significantly reduce costs for anyone using them. MSA Safety created a webpage where anyone who would like to determine cost savings from switching to elastomeric respirators. If all 18 million health care workers in the US where given their own elastomeric respirator, it would cost between $200-$500 million but would mean hospitals and ltc homes would no longer be major sources of infection. This would help hospitals go back to offering elective surgeries, procedures and tests. Since a lot of tests are not going on, things like cancers are going undetected and spreading to other parts of the body and will be much harder to treat once diagnosed.
Too scary looking: some people say these respirators look too scary looking to use or are not fashionable enough to want to use. This is due to the majority of people and experts not realizing health care worker versions exist and that some manufacturers have created fashion into the design of their respirator. These are only a few examples of fashion friendly respirators:
Availability: it is assumed there is not enough elastomeric respirators for health care workers and for the public/businesses to also use them. This is due to the lack of knowledge of all the new manufacturers that exist and where to find them due to things like the ban preventing PPE manufactures from advertising what they have available. Some manufacturers like Mi Integration (Dorma 99) can manufacturer over 1 million elastomeric respirators per month per mold. It would take weeks to make enough for every health care worker in Canada to each have their own. There are so many elastomeric respirators available that cities like New York have stopped buying N95s and have switched to only buying elastomeric respirators for first responders.
Exhalation valves dangers: it is often assumed elastomeric respirators would be dangerous to use because they could allow unfiltered contaminated air into the environment and infect those around the person wearing the respirator. The CDC came out with studies showing exhalation valves do not release dangerous levels of contaminated air into the environment and that even uncovered exhalation valves are safer than surgical masks. A common recommendation is for health care workers to cover the exhalation valve with a cloth or surgical mask if source control is needed. If working on covid patients, the patient is already infected so source control is not an issue. Another alternative if source control is needed is to give the patient a surgical mask while the health care worker uses elastomeric respirators. It is not well known but there are quite a few manufacturers with elastomeric respirators that don’t have exhalation valves at all and filter the air in and out through the same filter. The CDC also published studies showing the assumption around exhalation valves being dangerous was wrong and surgical mask continue to be the greater risk of infecting patients if the health care worker wearing them is infected.
Benefits to using elastomeric respirators in high risk workplaces such as schools and food plants schools.
Since there are now kid sizes of elastomeric respirators, children can use them to go to school in person and not become infected and in turn, would not bring the infection home to their parents which could then introduce it to their workplaces. By breaking the cycle of transmission in workplaces like food plants, manufacturing facilities, airports, border crossings, correctional institutions and other high workplaces, we can prevent a large amount of community spread, chances of new mutations and help stabilize supply chains and the economy. By reducing the spread and preventing workplace outbreaks, this would in turn greatly reduce the future need to shut down businesses or cities which would save jobs and continue to help stabilize the economy and supply chain.
Long term effects of the virus
While the focus is on the amount of people that die, an even greater focus should be on the long term and common effects of the virus which are found in more than 1/3 survivors. Since so many people are suffering brain, heart, lung and kidney damage, there is a large potential for a significant loss to the American workforce and more people will end up needing social assistance since they may no longer be able to work. A military service member, paramedic, fire fighter or police officer would no longer be able to be on active duty if their lungs or heart cannot keep up for the job at hand. Common issues like brain fog would also create a devastating effects on these individuals since they often have to make instant life and death decisions or actions.
Disinfection resources and implementation guides
Here are resources on disinfection:
Here are implementation guides: