Throughline - The Mask

Episode Date: May 14, 2020

The N95 respirator has become one of the most coveted items in the world, especially by medical professionals. But how did this seemingly simple mask become the lifesaving tool it is today? From bird beaks to wrapping paper to bras, we follow the curious history of one of the most important defenses in our fight against COVID-19.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Support for this podcast and the following message come from the NPR Wine Club, which has generated over $1.75 million to support NPR programming. Whether buying a few bottles or joining the club, you can learn more at nprwineclub.org slash podcast. Must be 21 or older to purchase. The fundamental question that existed in my life from the time I was this big was why? And in any explanation that I got,

I asked the question why. In 1958, a woman named Sarah Little Turnbull stood in the director's room at the 3M company. And in true Peggy Olsen, Mad Men style, she pitched a room full of men, a presentation called Why? The presentation centered around this question. Why should 3M go into the non-woven business? Non-woven. She was talking about the way many everyday products were manufactured. All sorts of things from ribbons to gloves to masks were made out of woven material, like cloth. Fibers woven together one over the other with tiny little gaps in between the threads. But a new, high-tech material had recently appeared on the market, which had polymers

that were melted together, hence the term nonwoven. Sarah had a lot of ideas about what to do with it. And after her presentation, 3M decided on one idea in particular. They asked Sarah to design a molded bra cup. That's right, a bra cup, using this non-woven material. Along with the design for the bra cup, Sarah came back to them with something else,

something revolutionary. It was a prototype for what would eventually become one of our most important defenses in the fight against COVID-19, the N95 mask. No, no, no, you'll sound good. You'll sound good. Oh, shoot. Okay.

So. Okay, so, yeah, so the N95 mask is this circular mask that's semi-rigid, and it's got two straps attached, and it's supposed to affix tightly to your face. There's usually a metal clip on the nose that helps seal the gap between your face and the mask. What does the shape remind you of? Does it remind you of anything? I was going to say a turtle shell. Okay.

This is Shahir Khan. Can you introduce yourself? Why are you so nervous? Why are you nervous? Yeah, you're nervous. My husband. I'm a hematology and oncology fellow at Columbia, New York Presbyterian. Normally, Shahir spends his days treating cancer patients.

But a couple of months ago... Things changed really quickly. He and most other doctors in the hospital were pulled onto COVID duty. The emergency room was packed. There were patients in the hallways. There were patients in the waiting rooms. All the rooms were full. They were intubating people in the hallways. There were patients in the waiting rooms. All the rooms were full. They were intubating people in the emergency room. And when things began to ramp up,

each doctor was handed a single N95 mask. And you had to protect it kind of at all costs. Before this, N95 masks were typically used once and thrown out. But as we know, there was a shortage. So a lot of health care providers were having to use their N95 masks over and over again. After that initial wave, there was an increase in the mask supply. But many providers are still closely guarding their masks. I still have that same N95 mask that I got the first day when I was admitting people. You've been using it for like three months? Not three months.

Whatever, however long it's been. It feels like it's been like six weeks or eight weeks. It's important to note that he puts a surgical mask on top of the N95 mask and keeps it in a paper bag between uses to protect it. Still, not ideal, considering how many patients he's coming into contact with who have the virus. People were sick. They were coughing. They were gasping. The only thing protecting us from inhaling those droplets was the mask. About a week ago, Shahir got a blood test, and after a few days, we found out he didn't have any antibodies for COVID-19, which meant he had never contracted the virus. So the mask worked? Yeah, it worked kind of to a surprising degree.

And given how many people with COVID it was exposed to, it worked really well. So how did we get to this point, where this mask can be so effective that it blocks out tiny microscopic particles, giving healthcare workers real protection? That's what we're going to dig into in this episode. The long, sometimes strange road that got us to the N95 mask. And remember Sarah Little Turnbull, the designer who walked into that boardroom at 3M? Well, when she did that, she was building on hundreds of years of trial and error that happened across multiple continents, cultures, and diseases.

So before we get back to her, we're going to go to the beginning of this story in medieval Europe. I'm Randa Abdel-Fattah. I'm Ramtin Arab-Louis. And you're listening to ThruLine from NPR. Wise, the app for doing things in other currencies. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the Wise app today or visit wise.com. T's and C's apply.

...on a Friday evening, and it is nearly deserted here. There are some bars that we've seen, some pubs around this area where there are still people. What you're hearing is a report from the BBC on TV back in late March. The reporter is standing in front of an empty square in central London. That is shut. It has been shut for a while now. And right then, in the middle of her very earnest reporting, someone appears about 10 or 15 feet behind her. She's clearly not aware of their presence. The person is wearing a black mask with this long, pointy black beak thing protruding off the end of it. It's the kind of mask that doctors wore back in the time of the bubonic plague in Europe.

It's pretty bizarre and terrifying. Then, just a few weeks later, another person was spotted in another part of England, walking around neighborhoods in almost the exact same mask. At this point, residents were getting pretty freaked out and the police were actually trying to figure out who it was. But besides being the stuff of nightmares, what is this mask? Where did it come from? Well, for that answer, we have to go back to the 1600s, one of many times in history when plague is spreading and, you know, medical science as it is today doesn't really exist. This is Mark Wilson. He's a writer at Fast Company and wrote a piece on the N95 mask that inspired this episode. And so when people get sick, a lot of the time they're blaming this phenomenon called miasma. Okay, so miasma theory was this ubiquitous idea that disease came from and was spread by bad air, water, and...

Foul smells. This idea that breathing something, you know, foul made you sick. And to some extent, that's actually right, right? Like, to some extent, we are breathing in viruses or bacteria that can make us sick. But, you know, back then, they didn't really understand those mechanisms. I mean, they were clearly onto something with this theory, at least about diseases that pass through respiratory droplets like COVID-19. But they were very off when it came to what they were actually dealing with at the time. The bubonic plague, an illness spread by fleas. So they weren't totally right about the breathing in this case.

So the plague is spreading, people die, corpses smell. The bubonic plague was a horrible disease. People would get sick, become covered in awful boils, and sometimes die within days. And you have these plague doctors who start wearing these really long beaked masks that have two little nostril holes that they fill with incense. And the idea is that they smell the incense, they breathe the incense, so they're not sickened by the miasma. So it was almost like putting a Glade plug-in of the era, right, into a mask on your face. People suffered everywhere.

And you had these doctors walking around in the European countryside and cities treating people with plague. They carried a long wooden stick that allowed them to examine their patients from a distance. They used the latest in medical treatments like potions, bloodletting, and placing frogs and leeches on wounds. And just imagine what it would have been like for one of these guys to show up at your door wearing one of those bird beak masks with smoky incense pouring out to heal you. It would probably feel more like you were being visited by death. And really, that's kind of what was happening. I would see a strong parallel with being visited by the Grim Reaper, right? You have this person with these black robes with this kind of crazy face. You know, the plague doctor is not holding

a sickle, but they are holding the stick. I mean, I would certainly feel like I was dying if I was visited by this person. It's just a living nightmare to me. I don't know another way to put it. The plague hopped around Europe for almost 100 years, from the mid-1600s to the mid-1700s. To this day, no one knows exactly how many people died, but it's safe to say it was in the millions. Miasma as an idea is still around for several hundred years after that. It's not until, you know, around the 1870s that scientists begin learning about bacteria. That's when we have a sort of an understanding of illness start to form. So even though by that point doctors understood that

plague came from bacteria, they still didn't have antibiotics. Those were more than a century away. So when plagues or other disease outbreaks started, all they could really do was focus on preventing it from spreading. And that brings us to the early 20th century, to a place far from Europe, where an outbreak of plague would set the stage for the next phase in disease prevention. So in 1910, a plague broke out in Manchuria, which is what we now know as northern China. And this one was really, really bad. Some historians believe the death rate was as high as 100% in some areas.

It was really end of the world stuff. If you got this plague, you died within 24 to 48 hours, essentially. At the time, Manchuria was a highly coveted part of the world. It was rich in minerals useful for industrial production. China and Russia were vying to control it. And here's the other thing. The plague was spreading fast, facilitated by the vast networks of railroads in the region.

A very deadly, contagious disease was spreading rapidly, and no one really knew what to do about it. It quickly became international news. So many doctors and scientists around the world actually traveled to the area and sort of consult on the project with the local governments. This led to a sort of scientific arms race between China and Russia. Because whoever could solve this crisis

would have sort of an intellectual power that would sort of reaffirm their power to rule. In other words, if your country is the one to stop the plague and save the world, then maybe you have a stronger claim to control the resources in the region. And the Chinese imperial court understood how high the stakes were.

They were desperate for answers. And they brought in a young, highly respected doctor named Wu Lintay. He was born in Penang. He does not speak good Mandarin. He was trained in Cambridge. He's kind of a young hotshot who comes in and analyzes the situation. He does some of his own autopsies. You know, he looks around and at this time, remember, we actually have an understanding of how the

plagues have spread traditionally. Like we now understand, oh, it's from fleas, right? Or it's, you know, it's from these flea bites. You get sick and you die. And so that's kind of what everybody was assuming at first. But Wu Linte had another idea. He didn't think this outbreak was being spread by fleas. And so he proposed a radical alternative diagnosis, one that would require an equally radical solution. tell history through stories, and it makes me think of how we all have our own narrative, whether we get a podcast episode written about it or not. Awesome stuff, guys. Thanks. independent hotels around the world, each exactly like nothing else. Autograph Collection is part of the Marriott Bonvoy portfolio of hotel brands. Find the unforgettable at AutographCollection.com.

The first thing Wu Linte did when he got to work was order the autopsy of someone who'd recently died of plague. In China, there was a taboo about autopsies at the time, but Dr. Wu pressed on anyway. What he found astonished him. The disease wasn't bubonic plague, the kind that spreads through blood. It was pneumonic plague, a version of the disease that impacts the lungs and is mainly spread through respiratory droplets, so by air. Now, just to be clear, this next part of the story comes directly from Wu's autobiography, and he casts himself as the clear hero. He made a huge discovery, but not everyone agreed. Enter Dr. Mesni. There's a really famous French doctor who calls out Wu in public. And he calls Wu a China man and essentially says,

what can we expect from you? You're wrong. And shames him. Mesni had arrived in Manchuria not long after Wu. He had experience in dealing with bubonic plague in India and was convinced that was the illness in Manchuria. Dr. Mesni is so confident, right? He is so confident in the existing prevalence about how plagues spread. And he wants to prove a point. So to prove his point,

Mesni went to a plague ward and just strolled through, examining patients, nothing covering his face. And just a few days later, he dies. After that, everybody agrees with Wu.

You know, it is worth mentioning that this account is told in Wu's autobiography he writes a few decades later. And so Wu goes from a young hotshot to later becoming a very smart, self-promoting person in his own right. So just know that Dr. Wu could have been creating a convenient villain out of Mezzany. But what he did next didn't require embellishment in his autobiography. He had figured out what the plague was, but now he had to figure out how to stop it. He came up with a plan to isolate patients, create quarantines. He even

convinced local governments to close railways to essentially socially isolate. And then he developed a mask. He was saying, you know, we're spreading this plague through our mouth, through the air. And so we need a type of mask that is made with simple cotton and linen. It wraps around your face really tightly and it essentially will stop this pathogen from spreading. You know, he creates this really kind of ingeniously simple design in that it can be made from materials everybody has on hand. The mask was different from surgical masks, which were more similar to the loose-fitting medical masks you might buy at the drugstore today.

Those were already around by the time of the plague in Manchuria. Dr. Wu's mask was white, made of cotton, and would tie around the ears, allowing it to fit tightly in order to prevent more particles from entering or exiting while still allowing the person to breathe. The masks started being used throughout Manchuria. All of the local health care institutions, the wards, they start producing these masks in numbers that we don't really know, but we know everybody started wearing them in the health care world. And then we also know that

some of the general public started wearing them as well. We don't know how many of the general public, but they became a main tool to anyone who was treating, you know, plague patients at the time. It was a long way from the scary plague doctor masks of the 17th century. And these simple white cotton masks of 20th century Manchuria worked. The last case of pneumonic plague was reported in March of 1911. Yeah, I mean, we're all alive today, right, in part because I think the mask worked. The other thing to note that while this is happening, this plague is international news. And this is the big newspaper era. And people are photographing doctors who happening, this plague is international news. And this is the big newspaper era. And people are photographing doctors who are fighting this plague.

And when you think about those photos going to even small towns in America where you have a black and white photo, this big white mask on someone's face that just would pop on the page. The mask itself starts to sort of, I think, permeate the cultural consciousness worldwide as this tool to fight, you know, a pandemic. And according to Mark, this design that Wu came up with, a design that successfully restricted some particles from entering and exiting while still allowing you to breathe and that was easy to replicate and distribute, it was a game changer. And the design was even used around the world

to fight the 1918 flu pandemic. If you look at his mask design, it's very similar to what would become the N95 respirator later. You know, it fits very tight to your face. There's not gaps in the side like you see with surgical masks. And that seal means that you should be breathing

through the front. He used layers and layers of cotton, but that's really why I see him as foundational in this history. Dr. Wu's design helped save Manchuria and maybe even the world, from pneumonic plague. But the reality is, a lot of particles could still penetrate the cotton material of his mask. When we come back, how a product designer unknowingly took the baton from Dr. Wu

and designed the prototype for the modern medical respirator, the N95 mask. Hi, this is Thule from Helsinki, Finland, and you've been listening to ThruLine from NPR. She said she was somewhere between being a peeping Tom and the neighborhood gossip. I want to know everything. I want to know why this and why that and what's in that drawer and what's behind that door and things like that. And she was nonjudgmental. She said, I don't care if somebody has purple carpet. I'm just interested in why they have purple carpet. This is Paula Reese. She's an urban space designer. And I'm the founder of a firm called Forseer, which Seer is my name spelled backwards, Reese. Paula was part of a group of friends

who took care of Sarah in the last years of her life. They called themselves The Little League. The recordings you're hearing of Sarah are from an interview Paula did with her before she passed away in 2015. I first heard Sarah speak at a women in design lecture in Seattle in 1984. And I had never heard of her before.

She was so dynamic and so powerful. I just couldn't believe that there was a woman who had been in the business of creating so many products that we use every day and had been working since the 1940s and was here in front of me as an example of what was possible. Paula spent the next three decades getting to know this person, Sarah Little Turnbull, both as a friend and a historian. Along the way, she pieced together how Sarah ended up in that boardroom at 3M, pitching an idea that would pave the way for the N95 mask. I didn't have any money. Very often, I had a choice of either buying a pencil or an eraser, or being able to have some lunch, or have something to drink with my lunch. Sarah grew up in Brooklyn, New York, in the 1920s, the roaring 20s to some. But for Sarah and her family, it was a struggle. My mother came from Europe and spoke fractured English, but she read with great facility and was educated in Europe as a literary scholar.

Poor and in a new country, Sarah's mom did what she could to build a better life for her kids. You can just imagine a mother who was very intelligent, but suffering from having three children and not knowing quite how to feed them. Despite that, her mom still managed to find the silver linings in everyday life.

Her mother would lecture about the beauty of the form of the egg or the transparency of the onion skin that was going into something that she's trying to make to feed her children. And Sarah followed her mother's lead. The struggles of her background, I think, helped inform her taking delight in simple things. Like spending time at the park or going to museums. She was sort of adopted by the security guards. They knew that she was just this kid that was looking to kill time,

but she was actually in there studying and becoming quite, you know, informed about various cultures. It was curiosity shaped by survival. She was an extremely bright and very precocious child. And she always led with an amazing sense of humor. And she was always having this big, gigantic smile and a great laugh. And she probably was never bashful about being who she was from a very early age. As a teenager, Sarah's love for art and nature and the simple things morphed into an interest in design. So she decided to apply to one of the best design schools in the country, the Parsons School of Design.

Not only did Sarah get in, she got a number of scholarships, too. And while still a student, she landed a job designing products and packaging for Marshall Fields, which later became Macy's. After that, she was hired as the decor editor of House Beautiful, the popular interior decorating magazine. And all the while, she lived in a 400-square-foot hotel room in Midtown Manhattan. And this was sort of her living experiment. And she's very clever with her design ideas and had super organized storage so that you go into the space and everything was contained in the cabinetry

and then it would unveil. Sort of like the Marie Kondo before Marie Kondo. Yeah. In 1958, Sarah decided to start her own company. She incorporated the world into her work, looking for connections between seemingly different things. She would look at a flower and tell you how the pieces of it would inspire a toweling for one of her clients. If I sit down to analyze a project, I start looking at the material

as though I had never seen it before. She would look at a pot with boiling bubbles and it would make her think about a glass process and chemistry that could help create new dishware. What is glass? What does it do? What are the good features of it? What are the dangerous features of it? What are the dangerous features of it?

What else do you have to know about it? And it's a willingness to face one's own naivete. From Rocket Research, a great new cook and serve ware made of an amazing new material. Looking around at all the big corporations and manufacturers of 1950s America, Sarah was struck by something. Say, this looks like fun. An afternoon at the amusement park and a very pretty girl. They seemed to be designing and marketing their products without accounting for the most important part of the equation, housewives. And she decided to go public with that criticism. She wrote an article called Forgetting the Little Woman. And what she did is she sort of called out America's major manufacturers by saying, why do you create products for the buyers? Why aren't you considering the real needs of the end

user, which at the time was the housewife? This was a bold move, a designer calling out the heads of American capitalism, telling them how to design and market their products. But some companies took notice of her approach and really liked it. Among them. 3M. They're very curious about who she is and what she's doing. And so they decide to hire her, and they put her into the gift wrap, ribbons, and tape division, which seems like a pretty obvious placement for a woman at the time. Now remember, around this time, manufacturers were experimenting with moldable, non-woven material that could retain all kinds of shapes. It was a brand new material. It was a brand new way of melding the fibers together so that they could be strong enough to make something else. Sarah saw a lot of potential in this new material, which led to her iconic presentation with that unforgettable title. Why?

And her many ideas. A hundred ideas. At the end of which, 3M chose the molded bra cup. Women were wearing some pretty bizarre lingerie at the time. So having something that was out of a different material and was molded was sort of the beginning of new bra forms of the time. Sarah went back to her office and got to work. She was on her way to making a groundbreaking bra. And at the very same time, she was taking care of three of her immediate family members that were all in the process of dying from different

ailments. And so she spent a considerable amount of time in the medical situation with, you know, doctors and nurses and watching them fiddling around with these flat masks that they had to tie on. And she just was thinking, oh, man, I wonder if there isn't some way we could do a better mask. That's when it hit her. Maybe, just maybe, that molded bra cup design could be turned into a mask. Sarah probably didn't know about Dr. Wu or the centuries of masks that had come before. But that didn't stop her from brainstorming

how to use the new non-woven technology for medical purposes. Since the non-woven material had fewer gaps, that meant, in theory, fewer particles, germs, viruses, bacteria would be able to get past it. So she went back to the 3M execs and told them, let's think bigger. Let's make a real difference. Let's design better medical masks. And she must have been pretty convincing because they agreed. They started to experiment with trying to do the medical mask, and the bra project seems to have just dissolved.

3M moved fast, and by 1961, they patented their first lightweight medical mask based on Sarah's design. It had the same shape as the bra cup, was molded and disposable, and had an elastic band instead of ties that went around your ears and a nose clip. Sarah's vision had come to life. The only problem was it didn't really work. Pathogens were still getting past the non-woven material. So the first mask may have been seen as a failure, but I know Sarah, she always said that 90% of her career was made up of failure. And she didn't see that as something that was defeating for anybody who was

looking to innovate or to create new horizons. Sarah had designed the medical mask of the future, but the technology hadn't quite caught up yet. The non-woven material still couldn't effectively block bacteria and viruses. I have a favorite quotation. If you don't stretch. If you don't stretch. You don't know where the edge is. You don't know where the edge is.

I was constantly stretching into areas that I didn't know very much about. She would say, designers don't just look, but they see. They don't just hear, but they listen. And they don't just touch, but they feel. She said design is to attempt to make a world a better place. Sarah went on to advise on and design all sorts of other products, not just for 3M, but also for major companies like Procter & Gamble, Coca-Cola, General Mills, Ford, even NASA. Things like dishes that go straight from freezer to oven,

the first glass cooktop, the iconic bugle snack, and lightweight insulation for spacesuits. And her mask design didn't go to waste. It was used by 3M to address another problem. Since the start of industrialization, workers were constantly being exposed to airborne toxins. And they needed protection. The respirators that we saw industrial workers wearing were evolved from gas masks used in wars.

And they were hot, they were big, they were bulky. And workers didn't like wearing them. This is Nikki MikAuliffe. She leads a team of occupational safety and health specialists at 3M. So these new dust masks really were a more lightweight solution. They didn't have to clean them every night. They were much easier to breathe through and much lighter on their faces. In 1972, 3M released the mask. It looked much like Sarah's original design, though few knew of her contribution.

And over the next couple of decades, with each new version of the mask, the technology got better and better. And by the early 1990s, things came full circle, and people began to use these masks in the medical field. We were seeing outbreaks of multi-drug resistant tuberculosis and health care workers getting sick and dying. This was during the height of the HIV AIDS epidemic. People suffering with the disease often had very weak immune systems and were susceptible to tuberculosis. It's a highly contagious airborne disease, so the stakes were

very high. And in 1995, U.S. officials certified a new class of masks, the N95, which were capable of filtering at least 95 percent of airborne particles, including tuberculosis. Some doctors and nurses were still a little skeptical that these N95 masks would actually keep them safe. But with few alternatives, they tried them out. Since then, they've become a crucial part of our crisis response, whether we're dealing with an outbreak or a natural disaster. When we started to see the cases of coronavirus in China, we were actually busy responding to the wildfires in Australia to help get them, their N95 equivalent in Australia, to help protect against airborne smoke. And also there was a volcano

eruption in the Philippines. So we were already meeting as an emergency response team trying to get filtering face pieces to Australia for smoke, to the Philippines for ash, and then starting to send them then into China for a disease outbreak. Which helps explain why supply just can't keep up with demand. The hospitals went from using very few every month to now using some of them millions every month. And we're fortunate that we were able to ramp up our production so quickly, but even that, we still see the demand outpacing supply significantly. It is beyond what I could have imagined. The N95 mask is the culmination of centuries of innovation, a technological feat that took years and years of work across multiple continents. These respirators appear to be really simple devices. You know, they look just like most of them, like a simple cup with a couple of straps. And I can tell you these devices have years and years of research and development that go into them to ensure that not only that that filter media works really well and is easy to breathe through, but those respir they keep us safe is if we use them correctly.

So we'll leave you with this quick PSA from my husband, Shaheer. So, I mean, you basically put the mask over your face, your mouth and your nose. And then you pull the two straps over your head. You pull one kind of to the crown of your head. So that's over your ears. And then the other one goes below your ears, around your neck. And, you know, you adjust it so that it's in the right place.

And then you pinch down the bridge of your nose area so that it's tightly fit. I'm going to cross-reference with an actual PSA online. All right. That's it for this week's show. I'm Randab DeFatta. I'm Ramtin Adab-Louis, and you've been listening to ThruLine from NPR. This episode was produced by me.

And me and... Jamie York. Lawrence Wu. Lane Kaplan-Levinson. Julie Kane. Nigeri Eaton. Fact-checking for this episode was done by Kevin Vocal. Thanks also to Anya Grunman and Kia Miyaka-Natisse.

Our music was composed by Ramteen and his band, Drop Electric, which includes... If you have an idea or like something on this show, please write us at... Or find us on Twitter at... Thanks for listening. numbers would drop, customer satisfaction scores would rise, and everyone would be more productive. That's what happens when you give Grammarly to your entire team. Grammarly is a secure AI writing partner that understands your business and can transform it through better communication. Join 70,000 teams who trust Grammarly with their words and their data. Learn more at Grammarly.com. Grammarly. Easier said, done.