Efforts to prepare Marin for a pandemic go back years, but that forethought did not prevent planners from a key oversight: Anti-virus masks degrade over time.
As a result, the county’s stockpile of N95 masks — part of an emergency cache created in 2009 during the H1N1 swine flu pandemic — were past their expiration date when the coronavirus outbreak struck.
Dr. Matt Willis, the county’s public health officer, said 10,000 to 15,000 N95 masks were packed 10 to a plastic bag, placed in boxes and kept at a storage site near the Civic Center in San Rafael.
“We were in the process of thinking about how we were going to dispose of them when COVID-19 hit and there were massive shortages of N95 masks,” Willis said. “All the masks were expired in terms of the official use date.”
California’s emergency stockpile of 21 million N95 masks was also expired when the pandemic arrived in March.
However, the nationwide shortage of N95 masks caused the Centers for Disease Control and Prevention (CDC) to revise its guidelines for their use. So the old masks could still serve a purpose.
“It was an active topic of conversation whether or not these were usable,” Willis said, “and the answer was yes, after testing by the Occupational Safety and Health Administration. It turns out they have been an important part of our response.”
Willis said most of the expired masks statewide were usable under the relaxed CDC guidelines that allow N95 masks to be reused under some circumstances.
“The alternative in some cases would have been either no mask or a surgical mask that wouldn’t have offered the same level of protection,” he said.
Willis said Marin’s expired masks were not issued to front-line health workers who were likely to be directly exposed to patients infected with COVID-19. Those health workers were issued new N95 masks.
Troy Peterson, a Marin County emergency medical services specialist, said that due to an ongoing shortage of N95 masks some Marin hospitals are continuing to follow the CDC’s revised guidelines to reuse the masks. He said one recommended strategy is for nurses to store their mask in a paper bag between shifts.
David Ebright, a spokesman for Kaiser Permanente Medical Center in San Rafael, wrote in an email, “Many incoming shipments of new supplies and equipment we have had on order are now being delayed or cancelled, due to manufacturers’ supply chain challenges and a surge of demand across the global health care industry.”
Kaiser uses a combination of new N95 masks and extended use of these masks with decontamination procedures aligned with CDC protocols, he said. For example, Kaiser uses a device that employs hydrogen peroxide vapor and low-temperature gas plasma to sterilize N95 masks so they can be reused.
Andrew Apolinarski, executive director of nursing at MarinHealth Medical Center, said the hospital is not reusing N95 masks.
“We use N-95 masks around all patients that require airborne precautions,” Apolinarksi wrote in a email. “N-95 masks are also used by staff performing COVID-19 testing or interacting with patients of unknown status, called persons under investigation, and COVID-19 positive patients undergoing various procedures.”
Marin’s concern about a possible viral pandemic predates the swine flu. In December 2006, health officials sent 40,000 flyers home with Marin school children in an effort to spur family preparation for a potential bird flu pandemic.
The public information campaign was developed by a Marin County task force that was formed to create an influenza pandemic preparation and response plan. Today, public health officials say they have no record of such a plan, but a pandemic influenza response plan created for Marin County schools in 2007 can be found online.
In 2009, much of the county’s homeland security money went to prepare for a flu pandemic. Funding included $69,000 for a flu project coordinator, $150,000 for equipment and supplies to outfit a site where patients could be cared for if hospitals were overwhelmed, and $13,000 to pay for storage of extra medical supplies. The project coordinator, who was on staff for about a year, helped arrange large-scale flu vaccinations and did public outreach.
Former Marin County supervisor Cynthia Murray, who served as Marin’s director of emergency services, advocated for the creation of the task force. Murray said the paradox of prevention is that when efforts succeed, they are often invisible.
“You’re seeing this play out in areas that haven’t had a lot of the coronavirus,” Murray said. “They think it’s not going to happen so they don’t have to do anything. That was always such a frustration as the director of emergency services to get people to take prevention seriously.”