N95?

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Author: Julie B., an undergraduate at Columbia University

Fieldsite: New York City area

This post is the first in a short series about PPE and masks in the New York City area. This series is continued on DearMsRona.com, an undergraduate ethnography blog about the lived experience of the coronavirus. 

One evening in early March, my teenage sister walked to the end of the driveway to check the mailbox. Stuffed inside it was a box of N95 masks. There was no note on the box and no sign of who had left it, and the top of the box was folded together as though it had been opened before. She tucked it under her arm, brought it back in with the rest of the mail, and laid it on the countertop in the kitchen. A few hours later, my mother asked her where these masks had come from. The anonymity of the drop-off felt threatening, echoing the invisibility of the coronavirus that has exposed a world of imperceptible threat. At first glance, there was no way to know the “realness” of the mysterious mailbox masks or their effectiveness at preventing the spread of the covert virus.

There are many types of masks and other face coverings being used these days as Personal Protective Equipment (PPE) against the virus, all of varying degrees of “realness.” Different kinds of PPE have been arriving at our house in various capacities over the last month. These include homemade 3D-printed visors for face shields dropped off on the front porch by our local high school physics teacher; FedEx packages of masks shipped from my dad’s contacts in China; or little baggies of cloth masks given to my mother by her concerned patients. The mailbox masks could be seen as simply another version of these deliveries of PPE, different only because we don’t know who brought them, but they raise the same issue as the others. Even though they are sitting right in front of us, we can not tell if they were “real.”

The issue of “realness” cropped up the other day when my friend’s mother sent a package of masks from China. She separated the masks she sent into two Ziploc bags. One was for surgical masks to be used to go to the supermarket and around the neighborhood. The other bag she labeled “N95?” because although she had ordered N95s, they came in a box that she thought was not labeled properly. They don’t look like the white and yellow ones I have seen around. I cannot tell just from looking at them whether the masks are “real” or not, and at this point, I’m not even sure what “real” means. My mother says that she can bring the masks to the hospital to be checked for a certain serial number that will confirm whether or not the mask is real, but she doesn’t know the number herself.

We have been receiving this PPE because our neighbors and friends are trying to donate it directly to healthcare workers and hospitals through my parents, physicians at major hospitals in NYC. Elective procedures at these hospitals have all been cancelled, but emergency and obstetric patients are still being seen. Healthcare workers need to wear PPE when they treat these patients to make sure that they do not contract the disease from those patients whose COVID-19 status is often unknown or may even be positive. At the very beginning of the crisis in NYC, hospitals were dangerously understocked on N95s and other PPE, and the lack of equipment has led to rationing to preserve the safety of healthcare workers and patients alike.

Although she has accepted other PPE without question, my mother is very suspicious of these mailbox masks because she doesn’t know who gave them to us and they are not labelled in a recognizable package, so she cannot verify their “realness” or safety. She says that maybe someone coughed on them and then put them in the mailbox. My initial reaction is that this sounds paranoid, but there have been recent scandals in my county in which people lick supermarket shopping carts to inspire fear or perform in some sort of Internet challenge. There is such a shortage of N95s at the hospital, however, that she decides to let the masks sit for a week to let any virus potentially remaining on them die, and then she will bring them into the hospital.

She cannot just bring them to the hospital and distribute them to nurses and doctors, however; first, they have to be examined to determine if they are “real.” The printing on the box says that they are “Disposable N95 Particulate Respirator and Surgical Masks.” These mailbox masks are not from 3M, the most recognizable brand, but they are NIOSH-Approved, 1730 Respirators from Flu Armour. Ordinarily, I would be content with these labels and ratings, even if I don’t really know what they mean, but there has been news that many masks are not actually of good quality, even if they are labeled as such. (For more about the developing parallel grey market for PPE and other virus-related products, see Adam R.’s piece on DearMsRona.com.)

The coronavirus pandemic has generated a collective awareness of the invisible dangers present in our world. The virus itself is particularly threatening because it remains a threat for an unknown amount of time on surfaces, emanating from the bodies of our loved ones and neighbors, and even within our own bodies. Any and every interaction with another person could be a moment of contagion and we would never know. Covid-19 contagion is an epistemological problem, and there is no way to ascertain an understanding or full knowledge of the virus. The mask is a sign of that unknowingness, a visible barrier on our faces to protect us from the invisible threat and to protect others from us, as well. In addition to the fear, invisibility, and knowledge related to the virus itself, we also cannot know how “real” or effective is the protection we wear.

It is interesting to consider the issue of the “realness” of these N95 masks. Since the beginning of the pandemic, N95 masks have been a valuable commodity as they were understood to be the only ones that could filter out the small particles of the virus. People were told to save N95 masks for healthcare workers, while surgical masks and homemade cloth masks were recommended for general use. The justification for this, as I understood it, was that healthcare and other essential workers–who need to remain healthy so that they can continue to work and who are more likely to be vectors of disease to high numbers of other people–need to wear an N95, which has better viral protection. Those who are sheltering in place, however, wear masks to prevent spreading the infection to others, especially because they may be part of the “silent spread.” The CDC says that cloth masks and bandanas are sufficient in this case. Different masks are assigned different purposes, creating a hierarchy with N95s at the top.

From the beginning, we have easily accepted that N95 masks are the best, but what does this number actually mean? N means “not resistant to oil,” which is important because industrial oils can damage filter performance. 95 means that under careful testing, the mask blocks at least 95% of very small (0.3 micron) test particles. These standards compose the rating given only to certain masks, but the rating alone does not guarantee protection. An N95 mask with an improper fit (gapping on the sides, not tight enough on the nose) does not actually provide adequate personal protection. While N95s may block 95% of particles, if those particles can reach the nose and mouth through gaps, the material of the mask doesn’t really matter at all.

The mailbox N95s still remain in the house. Any contagion that may have been on them is now long dead, but we have not yet ascertained their “realness.”  The NIOSH-Approval seems legitimate, but the masks will still have to be checked and tested before they can be used in a hospital. My father says it’s not even worth it to bring them in because a few of them will be used up during testing for quality. My mother, however, has piled up an assortment of masks from many sources in a bag on the kitchen floor, which she says she’s going to bring to the hospital when supplies get very low again. If there is a second wave, it will be interesting to see if there is as much concern about the “realness” of the masks.