We Need Simple, Effective Ways to Decontaminate Potentially COVID-Infected PPE—Now

The global statistics are stark—more than 52 million cases of COVID-19 and 1.2 million deaths—and those numbers continue to climb as we head into the cold and flu season.

This pandemic has unmasked blind spots and inequities in every society, industry, and economy around the world. Schools and businesses are shuttered; unemployment is soaring; numbers of malnourished people are on the rise; PPE (personal protective equipment) shortages are putting health and frontline workers at risk; and death tolls are spiking. While we wait for a vaccine and hope for life to return to normal, our global community is struggling, particularly in low-resource areas.

But here’s the thing: We’re waiting in vain. Vaccines take time to broadly distribute, and even then, they aren’t a silver bullet.

We need more solutions.

We need a simple, effective, and readily available defense against COVID-19 and whatever pathogen comes along next.

PPE removal & reuse create infection risk

The World Health Organization estimates that health workers account for one in seven COVID-19 infections, resulting in more than 7,000 deaths worldwide as of September 2020. Roughly a third of those deaths involve concerns of “inadequate PPE.” As a surgeon, I’m deeply troubled by those rates. I think about them each time I remove my mask and other PPE at the end of a long day and store them for reuse during my next shift.

The shortage of PPE is well documented. You likely recall that the CDC initially discouraged the general public from wearing masks at the outset of the pandemic to help mitigate the global shortage’s impact on health workers. There aren’t enough N95 respirator masks—the kind that trap virus and pathogen particles—to go around. So, we improvise.

At Children’s Hospital where I work in Seattle, Washington, staff wear a combination of medical-grade surgical masks and face shields. Before the pandemic, we’d use 20 to 30 surgical masks each day, carefully disposing of them between patient visits. Now, we use the same mask for days or even weeks, and its chances for exposure to infectious virus particles multiply by the 20 to 30 patients we see daily.

You might be surprised to learn that the simple act of removing our PPE is the thing that puts us health workers at the most risk.

The tiny airborne droplets of COVID-19 remain in the air for hours, so when they land on a mask or other PPE, they’re still actively infectious. When we remove our masks after knowing or unknowingly being exposed to COVID-19, any infectious particles can transfer to our hands, face, and exposed skin—putting us at high risk for infection.

In the absence of definitively knowing our patients’ COVID status, we treat all PPE as if it’s infected. My removal routine has become second nature. I’m methodical and thorough. When I take off my mask, I imagine that it’s radioactive. I avoid touching any part of it with my bare hands, and I handle the straps as little as necessary. Once safely removed, I carefully place the mask in a paper bag to store in a place where it won’t be exposed to, or expose, anything else. I wash my hands immediately and watch as the water washes the invisible virus particles down the drain.

Though health workers like me are the most at risk of coming into contact with a COVID-positive individual, the risks of mask and PPE removal aren’t unique to our field. Outside of medical facilities, nearly anything goes.

Most people wear masks in public, and many of them reuse those masks without washing or decontaminating them between uses. And each time they remove their masks, whether to throw them directly into the trash or hang them from the car’s rear view mirror for later use, they risk coming into contact with virus particles.

That reuse is literally killing us.

In the health community, we collectively mourn the loss of Adeline Fagan. The 28-year-old Texas doctor lost her fight against COVID-19 in September, after being hospitalized for more than two months. Young and otherwise healthy, Fagan’s death was avoidable. She, like many health workers, reused her PPE for days on end due to the aforementioned global shortages.

We need a decontamination method for PPE that’s inexpensive, accessible, and simple to allow for safe reuse and better protection against COVID-19, especially for health and frontline workers and vulnerable populations.

Current decontamination methods aren’t scalable or efficient, nor do they solve the root issue

The go-to methods for decontaminating PPE, vaporized hydrogen peroxide (VHP) and UV light, are resource intensive and aren’t realistic for wide-scale adoption beyond well-funded medical facilities. What’s more, they don’t solve the underlying issue: how to safely remove PPE that’s contaminated with virus particles.

Vaporized hydrogen peroxide requires an enormous financial, electrical, and physical footprint and the user experience is subpar. Thousands of masks are decontaminated at once in a retrofitted shipping container, so workers must label their PPE to later locate in a sea of gear. Though effective, VHP isn’t a viable decontamination option for much of the world, including rural, remote, and low-resource settings or those without reliable access to electricity.

UV light is another decontamination method, but it’s not universally approved due to lack of research on its effectiveness and it, too, requires technology and machinery that’s inaccessible to many communities.

Vaccine is not a silver bullet

A vaccine alone isn’t going to return us to life as we knew it. Broadly distributing a vaccine takes time. As its rolled out in stages, those underserved and rural communities whose residents are most at risk may be last in line.

And as with the seasonal flu vaccine, a COVID-19 inoculation won’t work for everyone. For example, recent research from the University of Chicago shows that an individual’s immune history with the flu impacts how their immune system will or won’t respond to the flu vaccine.

We need innovative new ways to defend against this wily airborne pathogen.

This isn’t the first pathogen to come along and it certainly won’t be the last. Our global community needs better protection against this and future pandemics so life doesn’t grind to a halt. Without new defenses, we will continue to struggle.