All ins and outs about face masks and ventilation -COVID19 affordable face mask program
James Post
LEV Technology Expert/Consultant - worldwide presentations earned him international renown - Digital (Technology) Marketing Specialist
The need for face masks and good ventilation is broadly missing. This article shows why this is needed and also offers an affordable collective purchase plan of face masks, targeted mainly at non-medical care groups.
In Asia, face masks are the norm since day one; the Western world now understands the need and this leads to massive demand. Many Chinese companies invested in face mask machines; most are offering at highly inflated prices. As I hate profiteering but also have extensive experience in negotiating with Chinese, I started this program.
But before sharing how we could collectively order face masks at reasonable prices, let me evaluate all the ins and outs of face masks. Most examples apply to my home country, the Netherlands, but are certainly relevant to many other countries in comparable situations:
To mask or not to mask
In the Corona crisis, there is almost no more controversial topic. China says the biggest mistake made by Western countries is not to use masks for the population; Dutch health authority RIVM trivializes the benefits and emphasizes the false security. And this is just one of many examples of blatantly opposed views. This article aims to clarify the confusion and the resulting indecision but also shows concrete solutions.
During the early days, the World Health Organization (WHO) recommended the general public not to use face masks. Was the reason to adjust the recommendation to the availability? We may never know… In most of Asia, with SARS in mind, people do wear face masks when going outside; often mandatory. More reading: https://www.scmp.com/news/hong-kong/health-environment/article/3078437/mask-or-not-mask-who-makes-u-turn-while-us
Whether the non-surgical masks (intended for the general public) have an efficacy of 50% or 80% may be relevant, but most important is to simply always wear them when entering public spaces such as trains, shops. The motivation needs not even be scientific evidence, but common sense: When an infected person coughs, talks, sings and has no mask, the chance of infection is clearly high. With masks, the chance is a lot less and that should be enough! It is true that social distance helps prevents infections caused by large droplets (coughing, sneezing), but sometimes (e.g. in the supermarket) closer contact is hard to avoid. Moreover, aerosols have a much longer active range and stay longer in the air (more on this below).
Types for professional use and certification
There is a general consensus that masks intended for the medical and health care sectors are necessary. There are many standards worldwide, of which 3M says 1: "It is reasonable to consider China's KN95, AS / NZ P2, Korea 1st Class and Japan's DS face masks as" equivalent "to the US NIOSH N95 and European FFP2 masks". Many countries, therefore, accept all masks (also called face masks or respirators -if there is a valve), which meet one of these standards, confirmed by a certified test report from a so-called “notified body”, an officially recognized test institute, which is this area is competent.
After Dutch opposition politician Thierry Baudet submitted a quotation to the responsible Minister, the Netherlands appears not to accept the apparently FDA-certified mouth masks. A memorandum of 23 March (12) shows that the equivalence of the standards is known. Does one hand not know what the other is doing, or have other considerations led to this policy, which is not shared by many neighboring countries? In any case, a bad situation, which put the Netherlands in a disadvantaged position.
RIVM follows the policy that due to shortages, the PPE regulations (mouth mask, closed glasses, an apron with long sleeves and gloves) have been relaxed. The RIVM states (5) that, outside hospitals, personal protective measures (the PPE regulations) are not necessary “when the distance to the patient is more than 1.5 meters. This also applies to quickly reporting something to a patient or coming to the aid of someone ”.
I personally consider this a policy which, just like triage (actually used in Dutch province North Brabant hospitals, where out of necessity 70+ patients were no longer admitted), is not acceptable outside wartime.
Whether or not to use mouth masks by the population
The Netherlands is increasingly alone in the policy that mouth masks are not necessary for the population (6): "We are at a distance (1.5 m) where drops (which spread the virus) do not come. And mouth masks do not offer any protection. That was the position and it still is ", states the RIVM. The RIVM also refers to the WHO, which (rightly) states that PPE should be reserved for care workers. However, the WHO is referring here to the professional mouth masks (N95, FFP2 etc.) and not to the non-certified versions, which are used by the public worldwide. This scientific article (14) provides an overview of this category of mouth masks.
The RIVM does not - as of April 2020 - acknowledge that aerosols are an important cause of transmission and do not recommend the use of non-professional face masks and does not recommend improving ventilation.
In Thailand, there are generally no shortages of masks and the consumer price is 8 Eurocents. If there are occasional shortages, the masks are often homemade. The effectiveness of this is of course usually less, but better than nothing (17). The typically good ventilation in Thailand works in its favor, but the strict and fast government response is the main reason why Thailand, although there were 1 million + tourists from China in Thailand last February, is much better in control of the virus.
The authoritative Journal of The American Medical Association (JAMA) has a less simplistic explanation for the safe distance in particular (7), which makes the need for mouth masks strikingly clear to the public:
Dr. Lydia Bourouiba, associate professor at MIT, has spent years researching the dynamics of exhalations (eg coughing and sneezing) in the Fluid Dynamics of Disease Transmission Laboratory and found that exhalations cause gas clouds that can travel up to 8 meters ”. The video included in the link (7) is truly an eye-opener.
The German scientific Robert Koch Institute states (8): “The RKI recommends wearing a mouth and nose cover in certain situations in public areas as an additional part to protect at-risk groups and to reduce the infection pressure and thus the spread of COVID-19 in the population. Reduce. This recommendation is based on a reassessment due to the growing evidence that a large proportion of transmissions occur undetected, even before the onset of disease symptoms ”.
In Asia one did not have to wait for these studies; made wise by the SARS experience.
I live in Thailand, where the population absolutely does not question the wearing of mouth masks in public. The Thai government can impose a fine of ~ 600 Euro (10) on offenders, often Western tourists, inspired by more relaxed measures in their countries, who do not cooperate voluntarily. However, the fines are scarcely applied, primarily to hard-headed individuals.
Did we not know that face masks are crucial? Dutch newspaper Telegraaf had a news link (9) from the SARS period suggests that it was known... Moreover, countless warnings have come from China, among others, that the non-use of mouth masks by the public is a major mistake. Leading epidemiologist Dr. Fauci recognizes this but links it to availability (11).
Use by the population
Now that it is clear that the Dutch government, following RIVM recommendations, against having mouth masks worn by non-medical staff are debatable, the question arises “How?”. This simple question leads to a complex answer, as far as the Netherlands is concerned:
? According to my information, non-certified mouth masks are not on the approved RIVM list. If this is correct, the LCH (national center of purchasing aids) will routinely reject offers from suppliers. As a consequence, all who do not qualify for approved masks can get nothing via the official channels. This is especially painful in old-age homes.
? The Netherlands lags behind in the row of countries that are in competition to order (there seems to be no European Community plan) and get hold of the limited production. If they want to get this quickly, extortionate prices are asked, while air freight costs have risen to unprecedented levels. Charter flights are the best option. I should also state that state-appointed buyers may not be best positioned to negotiate.
? Last month I researched (13) – and am getting more and more support, including -indirectly- from Dr. Fauci that there is an inverse (but unknown magnitude) relationship between the spread of this virus and higher temperatures and humidity. Higher temperatures also mean more outside presence, where the infection danger by aerosols is obviously very low. Given the current precarious situation, we must hope that this turns out to be correct:
Then the spread of the virus could be lower during the summer months - and buy (delivery) time for protective materials, test capacity and upgrade ventilation systems. I am afraid though that the leadership may declare victory when the virus dies down in late Spring or early Summer and does not take measures strong enough.
? From chat consultations with specialists it appeared to me that there is consensus about the situations in which the population must wear masks: public transport, shops and insufficiently separated workplaces, as well as other busy indoor places. This position is also expressed by ECDC (17).
? Even with an impressive daily production of 226 million disposable masks per day (by market leader China at the end of March) (15), the production of masks is insufficient and re-use is inevitable. A better option (for the general public) is to use masks, which are designed for reuse - and can be washed (unanimous advice is 60?C).
Re-use of disposable face masks
The RIVM stated in an article (16) (which coincidentally also contains a link about the equivalence of international standards for face masks ..., showing that the organization was aware of this), that the reuse of face masks - in urgent cases - is justified and can be done by sterilization with hydrogen peroxide and possibly also with steam sterilization. In hospitals this can probably be easily achieved; impractical or impossible for use by others of course.
But as the general public does not need a high-grade face mask and can also use washable cotton (or polyurethane, which is a bit flexible), this is not a concern, provided they are ordered. The last part of this article shows the way how to do this cost-effective.
Precautions when reusing mouth masks
If a face mask has "done its job" and has collected virus particles on the outside, it must be handled with the utmost care (17). It is not for nothing that explanation for handling was commo practice during March in Thailand on TV; almost daily. It is important to be able to store the possibly infected mask safely (e.g. a disposable or washable bag) while traveling.
The following protocol can be used without too much effort for commuting using public transport (and when visiting shops or other locations where keeping distance is not possible) and is based on the use of reusable (washable) mouth masks and washable carrying bag :
? Before arrival at the station, bus or tram stop (or earlier when busy) or at shops and other busy places indoors, the washed mask is removed from the carrying bag and put on.
? As soon as the crowds (outside) permit, the face mask is removed and stored in the carrying case. Immediately afterward, the hands are washed or disinfected with a disinfectant gel or spray (most conveniently in a small bottle). In this way, the discomfort is minimal.
? This is repeated on the way home - if one visits a shop, it is important not to remove the mask until after the public transport or an extra mask plus carry bag. At home the masks need to be washed.
Implementation of masks and disinfectants for the population.
There are 3 possible scenarios:
1. Purchase by or on behalf of the government. This is the case, for example, in Thailand, where purchases are made centrally and sold through shops with maximum prices (about 8 eurocents for disposables- heavy fines in case of a violation - washable face masks are not regulated but also cheap). This is - by far - the most economical way if executed properly.
2. Leave it to the market, but impose maximum prices. Many Western countries, such as the Netherlands have maximum prices for house rental and medications. A potential danger of this approach is that there is not enough availability on the regular market and the black market comes in.
3. Leave it entirely to the market. This may suit Western society best, but has the disadvantage that the costs for the consumer are much higher.
Scroll down for information on the collective face mask program.
About the author.
James Post is an out-of-the-box thinker and doer with 45+ years of experience in high-tech electronics, a lithium battery specialist, speaker and author. He is CEO of startup ECOpro Technology BV, which will introduce a new, sustainable prefab construction system later this year, which is cheaper than traditional construction due to efficient CNC production techniques, automation and smart electronics and despite free green energy. Depending on the developments now or later, he decided to give his start-up an extra dimension by offering air treatment systems as a separate product line.
Update May 30: We are currently working on a low-cost HEPA air purifier, which offers a solution, especially in poorly ventilated areas, by filtering the (virus) aerosols from the air. Available: September 2020
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Update 1 September: The low-cost HEPA air purifier has gone into production with a limited number (400 units) due to lack of response. This is largely insufficient, but we cannot order large numbers without publicity. A collective price of approx. 90 Euro is possible. Our website https://ecopro.technology will go live around mid September and press releases follow shortly thereafter.
Email: [email protected] Available for (where necessary/appropriate pro bono) advice and assistance.Profile: www.dhirubhai.net/in/james-post/
Sources:
3 https://www.honeywell.com/en-us/newsroom/news/2020/03/n95-masks-explained
5 https://lci.rivm.nl/covid-19/PBMbuitenziekenhuis
7 https://jamanetwork.com/journals/jama/fullarticle/2763852 (tip: disable eventual VPN)
8 https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/19/Art_01.html
9 https://krant.telegraaf.nl/nieuwslink/teksten/nws.venster.nieuwsl.mondkapjes.html
11 https://www.youtube.com/watch?v=rnP7v0SsVq8
13 https://www.dhirubhai.net/pulse/holistic-scenarios-how-manage-end-covid-19-coronavirus-james-post/
14 https://academic.oup.com/annweh/article/54/7/789/202744
16 https://www.rivm.nl/documenten/hergebruik-mondmaskers-isolatiekleding
17 https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-use-face-masks-community.pdf
18 https://iuvanews.com/stories/pdf/archives/110101KostyuchenkoEtAl_Article.pdf
A huge demand for face masks – inflated prices
By the end of February, 2,500 Chinese companies produced 116 million face masks daily. I am confident that by now (April 8) it will be a lot more. As long as demand is higher than production, there will always be a higher price, but selling at factors higher is appalling. This is why I am starting this program, where I will be negotiating with many Chinese vendors, with the simple rule that only moderately above normal prices will be considered. As I will publish these prices, this forces others to follow suit, at least on the middle-long term.
Affordable face mask program (for non-certified washable masks)
Although “without profiteering” captures the intent perfectly, this more neutral name makes more sense to attract more suppliers. This is my plan:
- I invite manufacturers to quote prices for various categories masks (see below) and will indicate maximum prices (that float as time goes by). The manufacturer’s quotes will be evaluated based on price and quality.
- For the consumer (non-medical) 3-ply washable face mask I will start the program at a maximum wholesale-price -for a good quality in this category- of $ 0,23 (including distribution, shipping- and finance margins as specified below). Full 40 ft HighCube containers contain about 2 million pieces.
- The above CIF price included the (regular) distribution margin of 15% for wholesale volumes (8% at full containers), plus 5% finance and escrow (reduces risks) service cost, as well as transport, logistic and storage costs at both sides, ocean freight and import/export costs (total 6%). These margins are by far lower than individual purchasing and only work collectively.
- The MRRP (manufacturer’s recommended retail price) will be 2 times the CIF-price This allows the retail industry a (normal with a small amount) 50% margin on the selling price. Note that retailers may sell lower or higher than the MRRP.
- At a wholesale price of $ 0,23 the MRRP is $ 0,46 + sales tax or € 0.423 + VAT. Each pack will likely contain 10 pcs, which is OK, considering that washing may not be done daily.
I am doing this program as I wish to put an end to the scandalously high prices. By setting maximum prices, I present large Chinese manufacturers with a take it or leave it, yet reasonable deal, rather than let them limitlessly increase prices. The success of this program will depend on enough participants for collective purchases.
The main target group for this program is those who do not qualify to get certified masks and cannot find face masks themselves (at a reasonable price), such as old-age homes, home care, companies (for their staff).
Update May 30: The Affordable Mask Program was sent to most Dutch politicians; without any response -what I cannot understand-. The press was not interested in this "milked out" subject, which I can understand. Hence the program has never been implemented. Shortages are still a huge issue, but nobody seems to care... I deleted the operational instructions for participants, included in the earlier article.
Restarting the Affordable Mask is possible - but not likely.