Fred Lybrand

I am not an expert in this space, but my credentials are reasonable. This is my personal outlook, not that of any employer.

There are heartbreaking stories of hospitals calling for PPE – especially facemasks – and courageous stories of people cobbling together devices to reduce the likelihood that a healthcare provider could get ill while treating a patient with COVID19. This post leans heavily on information from the Smart Air Filters website written by their CEO, Paddy Robertson. I summarize those documents here.

Step 1: Reduce the Danger of the Environment; Declare War on the Droplet

The virus dies as an aerosol. It lives in droplets. When there are enough coughing patients in the room, the likelihood of infection grows because the air is full of droplets.

Before being concerned with PPE, address this issue as much as possible:

• Increase air turn over.
• Filter the air.
• Change the filters often.
• Put out specific air treatment technologies – such as room-air cleaners, ionizers and UV-C light, that are known to kill the virus.
• Add room air cleaners (Dyson, Camfil, Austin Air, etc.)

Before Improvisation – How do Masks Work?

Masks involve several layers of technical fabrics (often nonwovens or other porous materials). The performance of the mask comes from the combined performance of the materials.

Types of Masks

N95 or NIOSH masks (also N99, N100) are designed to capture particulate. They fit snug to the face, but they are not necessarily droplet proof.

Surgical masks are droplet proof, but they are exposed on the sides, so that an aerosol could get around them.

Surgical N95 Masks, or S95, have the best of both worlds. They have high capacity of an N95, but have also been through the droplet testing of the surgical standards. (Nelson Labs is the dominant provider of testing to these standards, including ASTM-F2100.)

The Ideal Mask & PPE For Corona Virus

Given the dangers of COVID19, the ideal mask would appear to be an S95 mask, that is changed out on a regular basis. All of these masks are designed to be disposable. It would be reasonable to wear more extreme protective gear – protective shielding – and perhaps even have a powered air purifier attachment.

Performance

Masks work because they have the right amount of breathability (air flow), efficiency (what % of particles do they catch), and life. Life is the easiest – masks are designed to be disposable with short lives.

Efficiency is harder. Small particles – those below 0.3 micron – the formal cut off of HEPA measurement, are often captured with charge. In filtration particles can get caught primarily by making physically small holes (mechanical filtration, where there is a physical mechanism that stops the particle), and electrostatic filtration (where the filter media – the facemask) has a charge, that is used to attract the particle. For small particles, especially below 0.3 micron, that electrostatic force is powerful enough to have a big impact on filtration. Charged filter media is widely used in facemasks.

Filtration has a lot of bad jokes – this one is about breath-ability and air permeability. A table is 100% efficient at filtering your dinner from hitting the floor. Get it? However, the breath-ability is awful. Likewise, if you make a facemask that is too efficient, it is hard for the wearer to breath. When the air flow gets too low, or when the resistance is too high, this hurts the wearer’s compliance. Healthcare workers start to slide the mask over, which defeats the whole point of the mask in the first place.

The layers of a surgical and also S95 masks, are also going to have a hydrophobic treatment to prevent droplets from passing through, and therefore be able to slow down the passage of bacteria and viruses. They do not stop the water flow forever. If we run a water hose over a surgical mask, the mask becomes inundated, and its useful life is over.

Thoughts on Mask Cleaning

There are two characteristics of the mask that are important to preserve in cleaning:

1. DRY. If the mask is wet, it is likely easier for bacteria and viruses to get through the existing fluid. Make sure the mask is dry!
2. CHARGE. Charge is part of the efficiency. This improves also by drying the mask out, but also look to give it some static charge. Rub it on wool, run it over an incandescent lightbulb, etc.

My personal priority would be to focus on not getting the mask too wet. I’d rather have multiple masks that I’m swapping out often, making sure that no liquid ever gets through, than to have one ‘new’ mask that I wear all day.

Article 3: Is Washing Masks Effective After Virus Exposure?

Is Washing Masks Effective After Virus Exposure_ – Smart Air FiltersDownload

Masks work worse after washing. Don’t wear a wet mask! Masks depend on charge to work. Find ways to add back charge.

List of Improvisation

If I had to, I’d:

• Use a form fitting mask design.
• Use two pillow cases from the research above.
• I’d add in a pocket to put in a high air perm insert, and would use something like a swiffer dryer sheet. Modern masks work based on charge.
• I’d never wear a wet mask. A saturated mask gives disease a faster path to travel.
• I’d do everything possible to reduce the droplet danger in the room.

I am not the author of these posts – they are from the Smart Air Filters website by their CEO, Paddy Robertson. With the COVID-19 and Corona Virus emergency, many are struggling to download these articles to make use of their information. I’m only providing them here until his website is back up or the current quarantines in the US and Europe are over. (Thank you, Mr. Robertson.)

These articles cite a primary source as their inspiration: (2013) “Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?”

Article 1: What are the Best Materials for DIY Masks?

Use two pillow cases, that works well enough. From a personal standpoint, I’d add a swiffer dry sheet to get some electrical charge.

Article 2: Can DIY Masks Protect from Corona Virus?

They are about 50% as efficient as a surgical or N95 mask.

Article 3: Is Washing Masks Effective After Virus Exposure?

Masks work worse after washing. Don’t wear a wet mask! Masks depend on charge to work. Find ways to add back charge.

Article 4: N95 vs Surgical Masks – Which is Best for Corona Virus?

It depends. In a room with lots of droplets, N95 has a better seal. Surgical protects against droplets.

Article 5: How Long do Pollution Masks Last?

Get 3 hours out of your mask!

Best Illustrations

[I’m not an expert, but based on the degree of panic and activity and Corona Virus, I’m writing this in an attempt to be helpful.]

Assumptions:

• The virus does not survive as an aerosol like measles, but it does appear to survive longer as a droplet than rhinovirus. I believe the reports of Dr. Ian Mackay (Flight of the Virus), that the virus does not survive outside of a droplet.
• Physicians who have treated this disease have died from exposure to the virus. (Dr. Marcello Natali in Italy, and Dr. Li Wenliang in China.)
• PPE shortages – facemasks, etc. – are putting physicians at risk.
• However, before addressing the PPE shortage, how can we reduce the risk of the ICU?

Airborne Droplet Dangers of the ICU with Corona Virus

Patients are coughing.

The patient is putting droplets – laden with corona virus – into the air.

If inhaled in sufficient volume, that virus is a danger to infect anyone in the environment.

All of the previous dangers of the ICU still exist – the extreme nature of this airborne droplet danger changes how safety should be approached.

Safety Approaches to Air Quality Danger

If a production site works with particulates that can explode, there are clear OSHA guidelines for how to work with that material. In a similar fashion, from working with industrial mix stations – if there is explosion risks, there are basic guidelines from Europe as well in how to manage that risk. For certain flammables under low concentration, the air in a room must turn over 6 times per hour. As those concentrations increase, the air turnover per hour increases – as high as 10 or more times per hour.

If there are enough cough droplets in the air from corona, there is risk for anyone in the room. To reduce that risk, follow established standards:

• Turn the air over. Keep the air moving.
• Reduce the life of droplets by reducing the humidity.
• Filter the air to capture droplets on filter media.
• Change out air filters as often as possible.
• Put out specific air treatment technologies – such as room-air cleaners, ionizers and UV-C light, that are known to kill the virus.

If I was running an ICU and was Concerned About Corona Virus Exposure

I would do everything possible to reduce the indoor air quality risk, which would include:

• Making sure there was lots of air turnover.
• Make sure that air turnover is filtered.[1]
• I would change the filters often for the ICU area. Daily would not be too much.
• I would add room air cleaners (Dyson, Camfil, Austin Air, etc.)
• I would add UV-C lights (and appropriate eye protection when using them)
• I’d do everything I can to make a hostile environment for droplets.
• I’d open windows and try to let in as much sunshine as possible (UV, new make-up air that is uninfected, air flow, and improved evaporation).

1: Question – Do Cruder, Non-HEPA Filters Work?

Yes, they are better than nothing. Fibers in filters have capacity. They catch dirt. Many types of filters only work when they are loaded with dirt – this dust-cake is what creates the actual filter layer.

The virus is also traveling in droplets which can be as large as 100 micron. A MERV 5 filter is 20% efficient, and at MERV 7 is 80% efficient, and it only gets better as it gets higher. If the air is being turned over multiple times per hour, then the there is a high probability that droplet – and the related virus get trapped.

I’ve spent nearly 15 years working with porous materials – helping companies develop improved porous material products, designing the production systems that deliver membranes and nonwovens, and overseeing these supply chains. I am not a facemask expert – but I’ve worked all around this space and led several facemask product development efforts. I am not an infectious disease expert. I am not an expert in the design of hospital ICUs.

I’ve served on the board of INDA, the US nonwovens trade association. Nonwovens are the primary materials used in facemask production. They are also the dominant material used in filters for indoor air quality (“IAQ”) worldwide. Through that, I’ve joined multiple ASHRAE committee meetings and been a featured speaker at filtration, fiber, aerosol particulates, and membrane trade shows.

The nonwovens and engineered materials industry plays a major role in producing materials essential to reduce the spread of COVID-19.  From disinfecting wipes to face mask material to Personal Protective Apparel and more, INDA member companies are providing products to help people be safer in difficult environments.

From the INDA website on Corona Virus

There are many standards relevant to how IAQ is measured, how filters work, and how to measure the capture of particulates – especially when those particles (or aerosols) may involve bacteria or viruses. Most of my time now is spent with the standards around liquid filtration – B. diminuta and S. marescens.

These are my personal opinions – not those of my employer. I currently work at H&V, where I am responsible for the liquid filtration portfolio at one of the world’s largest makers of porous materials, I was CEO of Elmarco, the leading global technology provider for nanofibers and electrospinning – in total I spent nearly 9 years pioneering the most advanced fibrous products globally.

My undergraduate degree is in biology. Prior to my time in porous materials, I’d worked in finance with private equity groups that invested in the healthcare, life science, drug development, biopharma and other supply chains.

Goldratt teaches that to improve a system, we must identify the constraints, and then systematically work to relieve them. There are several constrains in the global pandemic:

1. Is the information about the Coronavirus accurate?
   • How does it spread? (It does *not* aerosolize.)
   • When do symptoms become evident?
   • How many people who get the disease require medical assistance?
   • How many die?
2. Can we test and identify people that have the virus?
   • Everlywell, an Austin, TX start up that was on Sharktank, has announced a future personal test kit.
3. If someone comes down with COVID19, is the right equipment available?
   • PPE for the physicians (facemasks, etc.)
   • Respirators and ventilators for treatment
4. Are there medicines and therapies that can treat or prevent the spread of the infection?
   • Is there a vaccine?
   • Are there medicines which help those who are infected?

A third medicine has been identified – another anti-malarial drug, Chloroquine. It is sold by Aventis (formerly Rhone Poulenc) under the trade name Nivaquine. A less aggressive version, hydroxychloroquine is also shown to work.

It also appears as if blood transfusions from those who have had the disease may also help immunize and activate the immune systems of others.

Goldratt teaches that systems should be judged by their output, addressed at the highest level, and constraints should be removed. For a patient that has the disease, some treatment options are emerging.

Remdesivir: Nucleotide analog

Produced by Gilead, this class of drug has existed for some time and has been shown to perform well against RNA virsues.

Camostat: Serine protease inhibitor

A German research team found that a cell line was susceptible to Sars-2, and then showed that Camostat was capable of slowing and perhaps stopping the damage created by the virus.

As SARS-2 containment and COVID19 treatment increase in importance – many global, regional and national systems are activating, cooperating and working towards solutions. The complexity begs for an application of Goldratt’s principles:

1. Pick a Goal.
2. Identify constraints between the current setting and your goal.
3. Remove the biggest known constraints.
4. Achieve Goal.

The Life Science’s tradition of “First, do no harm” is a noble and well established goal. Do not diminish the public’s health. The virus does diminish health, so stopping its spread (while doing “no harm”), becomes important, as does treating those who have contracted COVID19.

Developing Data

In The Goal, Alex notably never has to deal with an absence of data or a resistance to data development and usage. Alex also exists in a world where there is a strong sense of community and teamwork.

Neither exist clearly in the global response to the new Coronavirus. In the US now, testing capacity is limited. Globally, nations are releasing ‘test’ data that has come under question and faces skepticism.

Testing for Corona

If testing and data are crucial to developing a response to the disease, then that is the current constraint. Goldratt teaches to remove the constraint; testing must be addressed.

Testing is currently performed with the polymerase chain reaction (“PCR”) a method widely taught in high school and college biology classes that breaks, copies and then measures DNA for comparison. Specifically, a reverse transcriptase PCR is used, and there has even been success in using a chest CT scan as a diagnostic tool.

Conclusions

Testing for Corona is the first step in creating an appropriate response. There is a lack of testing equipment;

1. Create more testing equipment – reduce the constraint directly.
2. Identify bypasses to the constraint – such as using Chest CT scans, as has been shown to be predictive of positive diagnosis of Corona.