Are these right masks?

The authorities were only able to provide an insignificant number of American N95 masks to healthcare professionals fighting Covid-19 in the country. Now they have supplies of imported masks "equivalent" to N95 respirators, mostly from China.

Besides, counterfeit and low-quality masks are also entering Bangladesh, creating potential health risks for those using it, especially healthcare professionals.

The N95 mask is considered a protective equipment of the gold standard, filtering out airborne particles of 0.3 micron by up to 95 percent.

Across the globe, this is one of the key personal protective equipment (PPE) for healthcare professionals treating Covid-19 patients in hospitals and collecting or testing samples.

On the other hand, health experts and professionals question the quality of other masks available in the market. In March, the Dutch government sent back a shipment of KN95 masks from a Chinese manufacturer after determining that those did not meet quality standards.

"We got some N95 masks [made in US] from the WHO but after that we did not get any N95 masks. We are now providing health professionals with masks equivalent to the N95," Abul Kalam Azad, director general of the Directorate General of Health Services (DGHS), told The Daily Star.

The government has been importing respiratory masks equivalent to the N95, through listed vendors, mostly from China, he added. 

Brig Gen Md Shahidullah, director of Central Medical Store Depot (CMSD), "We have around 1.4 lakh masks -- KN95, FFP-2 and others. As America stopped selling the N95, we could not collect those masks anymore."

Earlier this month, major US mask manufacturer 3M said the government has asked it to stop exporting US-made N95 masks to Canada and Latin America.

In a statement, 3M said the government had invoked the act "to require 3M to prioritise orders from the Federal Emergency Management Agency (Fema) for our N95 respirators", and had also requested that 3M import more respirators made in its overseas factories into the US, the BBC reported on April 3.

Currently, 17 hospitals in Bangladesh are dedicated for Covid-19 treatment, and Brig Gen Md Shahidullah said around 300 to 400 masks are required every day for health professionals in these hospitals.

He, however, did not provide details on the current stock of masks of various brands.

Contacted, a CMSD source said around 4,470 N95, 6,195 FFP2 and 60,210 KN95 masks have been deposited at the CMSD. The FFP2 masks are European and KN95 are Chinese standard for respirators. 

The CMSD director said they were distributing face masks among five groups of professionals -- doctors and nurses dealing directly with coronavirus patients, technologists of PCR test, sample collectors, and doctors and nurses engaged in coronavirus screening and in ICU management.

A mask costs between Tk 450 to Tk 1,200 depending on the quality and price in the international market, he added.

WHAT IS N95, ACTUALLY?

Experts say N95 a particulate-filtering face-piece respirator that meets the US National Institute for Occupational Safety and Health (NIOSH) N95 classification of air filtration.

N95 means a respirator that blocks at least 95 percent of very small -- 0.3 micron -- airborne particles. A micron is one-millionth of a metre, and viruses are in the range of 0.3 microns.

However, types of N95 mask vary from one manufacturer to another.

Since Covid-19 was first detected in the Chinese city of Wuhan in December last year, and subsequently spread across the world including to the United States and Europe, N95 masks have become scarcer and pricier.

The price of an N95 face mask shot to $12 from $1.75, according to a Washington Post report published on April 18. The report also said hospitals in the US were complaining of a shortage of face masks.

The skyrocketing demand across the world made it difficult for developing countries like Bangladesh to source face masks from China, which meets more than half of the global demand for face masks.

According to various media reports, prices of Chinese face masks have "quadrupled". There are also reports of China companies not being able to comply with the influx of orders.

Then, there is the question of quality.

Be-Nazir Ahmed, former director (disease control) of the DGHS, said the Directorate General of Drug Administration or the CMSD should properly check the masks as the quality of the Chinese masks is questionable.

"I personally saw some masks labelled as N95 but basically those were not. So, if we fail to provide the right masks to health officials, it will be a disaster."

Prof Muzaherul Huq, former adviser (Southeast Asia Region) at the World Health Organisation, said, "As we failed to collect N95 masks, we have to accept the KN95 and FFP2 masks."

"But we have to ensure that the quality is checked as there is a question about Chinese masks."

MISTAKE?

The supply of fake N95 masks came to the fore when doctors, nurses and other health workers in different hospitals bemoaned the scarcity of N95 masks, with some resorting to social media to vent their frustration about the shortage of masks and supply of fake ones.

JMI Group, a Bangladeshi company producing medical equipment certified by the DGHS, has been supplying masks, gloves, and sanitisers to the CMSD.

 CMSD, the government body that sources medical supplies, collected a total of 20,600 face masks from JMI Hospitals Requisite Manufacturing Limited, and later disbursed these to hospitals. 

But when it surfaced that the supplied masks were far from N95 quality, the CMSD started withdrawing the masks.

Talking about this blunder, CMSD Director Shahidullah said JMI was not supposed to supply N95 masks.

He added JMI had long been supplying surgical masks. The company was asked to supply regular surgical masks and they delivered accordingly, but wrongly labelled those as N95.

Asked whether there was any negligence from CMSD in examining the product, he said, "We try our best but sometimes it is not possible because it is an emergency.

"We show-caused them over the matter. They replied to us saying it was a mistake and we have withdrawn all their masks after the matter came to light."

In an official statement, JMI explained that ordinary masks were wrongly put in N95 packets and it was a packaging mistake.

The CMSD recalled 7,000 masks distributed at government hospitals first in the wake of the growing outrage over the fake N95 masks.

When the CMSD has been struggling to collect N95 masks, Gazipur City Corporation Mayor Mohammad Jahangir Alam claimed to have brought about 28,000 N95 masks from China using his own resources and distributed those.

He also claimed a consignment of 20,000 N95 masks were under the process of shipment.

Asked whether those are real N95 respirators, Jahangir said, "It is Chinese N95. China manufactured those by copying the American N95 mask."

The mayor, however, said he did not crosscheck it with the DGDA regarding the authenticity and quality of the product.

He added that each piece of those cost RMB 30 to 40 or TK 400-450.

Recently, Grameen telecom has also imported 50,000 N95 masks from China and given samples to the DGDA for approval along with necessary test reports.

"We brought N95 GB19083-2010 medical protective masks from China. They meet the NIOSH standard of N95," said Ashraful Hasan, managing director of Grameen Telecom.

N95 masks are tested and certified by the National Institute for Occupational Safety and Health (NIOSH), a research agency that is part of the Centres for Disease Control and Prevention (CDA) in the US.

In its current guidance, the FDA says  when pre-approved respirators are not available, the agency "generally would not object" to the use of unauthorised masks if they are on the CDC list of alternatives, which includes the KN95.

The Grameen Telecom MD also said the mask they brought is registered with China National Medical Product Administration.

He added that buying authentic face mask from different sources in China is a big challenge and warned that lower-quality or ill-fitting masks are more likely to let airborne pathogens through, putting healthcare workers in a vulnerable situation.

Prof Dr Iqbal Arsalan, president of Swadhinota Chikitshak Parishad, said in the beginning, there was some chaos over masks but now things are getting better.