In our battle against COVID-19, one of our unique challenges is the use of face-coverings. Despite evidence that supports wearing face coverings, this has become a polarizing issue in a highly politically-divided climate. After shifting mask guidance in the early days of the pandemic, the WHO and the CDC issued formal guidelines on wearing face coverings in indoor and outdoor public spaces. Public health officials followed-up by emphasizing that N-95 respirators should only be used by healthcare workers at highest risk of transmission. They suggested people purchase or make their own cloth face coverings so as to not deplete healthcare workers’ supply. Yet they missed delivering a sustainability message – the opportunity for us to think about our environment during a challenging time.
With face coverings being required, COVID-19 raises concerns about PPE waste that need to be addressed head on.
Single-Use Masks Are Littering Our Streets
Dr. Evelyn Alvarez (Cal State LA) collects single-use masks littered on LA County beaches.
The pandemic has challenged our sustainability conventions. Single-use masks and gloves are littering the streets of Los Angeles, where I live. They are washing up on our beaches and local islands. Cloth-based or DIY up-cycled face coverings, ethically sourced and washed daily, are a more sustainable option. [Erin Dobbins, here at The Medical Care Blog, has some advice on making your own.] We should remind our non-healthcare sector communities of this.
A crucial educational mission emerges to educate essential workers in non-health sectors on sustainable mask usage. Reusable cloth-based coverings are better for our environment, and therefore better for us. This may seem like a tough mission. Some people may be struggling to simply get a hold of any mask, let alone learn about sustainable mask usage. It is, nonetheless, a mission on which our Earth depends.
Back in June, LA County promised to give away 3 million masks over the course of 90 days. With this, a unique opportunity emerges to raise awareness about using more sustainable masks.
PPE sustainability educational efforts should address at least three things:
1. The Protection of Our Environment
Posters in popular community settings like parks, beaches, and hiking trails can convey the environmental benefits of reusable face coverings. Recently, LA mayor Eric Garcetti announced a grassroots poster campaign–the L.A. Mask Print Project–to remind Angelenos to wear masks through open-source art produced by local artists and businesses (see photo below). A similar campaign can leverage local artists’ talent while showcasing the environmental benefits of wearing reusable face coverings.
One of those benefits includes the protection of our bodies of water, by preventing the littering of potentially contaminated single-use masks into our waterways. Another is the conservation of resources (avoiding the use of materials that are energy-intensive to produce and potentially include toxic materials that can leach into our waterways). And lastly, reusable masks may ensure that our streets are clean and devoid of waste that reduces the aesthetic value of our beaches and parks, and that is ultimately correlated with our mental health. Similarly, stock photos used in online advertisements or websites should reflect reusable face coverings when used outside a healthcare setting.
2. The Cost Savings
Poster campaigns can also highlight the cost savings of using reusable face coverings. Although reusable face coverings may be more expensive per unit, they are washable and reusable. Making masks from existing clothing material can lead to savings for those who use them over time. It’s particularly important that these poster campaigns elucidate the cost savings given the pandemic’s economic toll.
There is some public apprehension in using reusable face coverings as opposed to single-use masks due to misconceptions on sterility. The CDC has guidance for safely using and cleaning reusable masks. Television news, newspaper and magazine editors can disseminate information on the environmental benefits and cost savings of reusable face coverings. They can air specific segments that showcase these benefits and help to debunk misconceptions. Incorporating Q&A sessions, with real viewers chiming in via social media, may be particularly helpful at reaching skeptical viewers.
3. Assuring Proper Translation of Materials
Currently, the Latinx community has the highest COVID-19 death rate in LA county. Since many of our non-health sector essential workers are Latinx, it is imperative that messaging is available in Spanish. The burden of translating COVID-19 information, including information about masks, should not fall on our Latino children, who are already dealing with the struggles of remote learning at home in addition to other disproportionate impacts of the pandemic. Proper communication in Spanish can convey the environmental and economic savings of wearing reusable cloth face coverings. Some interventions have addressed this issue, but it’s important to create a nationwide initiative.
Minorities disproportionately impacted by COVID-19 need to have access to free reusable face coverings. Essential businesses like supermarkets can be providers of free masks. Latinx supermarkets in under-served areas are easily accessible to the Latinx community. The same may be the case for other ethnic groups that frequent ethnic markets. Other communities may need similar translation, so each locality needs to consider making materials available in other commonly-spoken languages.
A Unique Opportunity to Examine Sustainable Ways to Deal with PPE Waste
In a hospital setting, reusable masks and other PPE may not be viable options. In the early days of the pandemic, PPE shortages and lack of emergency preparedness forced healthcare workers to reuse PPE. As the U.S. catches up with N-95 mask reserves, hospitals and skilled nursing facilities need to receive them without delay. It is medically ideal to ensure masks in healthcare settings are single-use for maximum patient and worker protection.
Therefore, how we examine PPE sustainability educational efforts in healthcare settings is different than in non-healthcare settings. But since PPE usage in hospital settings is skyrocketing and contributing to the increasing amount of waste during the pandemic, we must consider ways to reduce.
Promising Approaches to Reducing PPE Waste in Hospital Settings
Future research on UV radiation decontamination devices may shed light on how they can be used to help in dire times when hospital PPE is in short supply and re-usage of masks may be the only option. Copper antimicrobial surfaces have also shown some promise in passively combatting pathogens that cause hospital-associated infections. This approach has demonstrated some initial effectiveness in tackling 2019-NCoV, the virus that causes COVID-19. Perhaps copper-coated surfaces will help to reduce the spread of COVID-19 in healthcare settings, and therefore reduce the need for such high PPE turnover. More research on UV light and copper surfaces will ultimately shed light on how they can prevent the spread of COVID-19 in healthcare settings.
Without more research, it is unclear how single-use mask usage in healthcare settings can be reduced in times of a pandemic. For everyone else, there is an urgent need to use reusable face coverings as an alternative to single-use masks. While there are many societal lessons about sustainability to be drawn from COVID-19, we must do our individual part to protect the environment and reduce pandemic-related PPE waste.
Evelyn Alvarez