PANDEMIC | How Nonprofits Are Helped by the CARES Act

In the Trenches against
the Coronavirus.

March 28, 2020–Two weeks ago the White House and the Centers for Disease Control and Prevention (CDC) seemed to be on the front line of the U.S. defense against the novel coronavirus, aka COVID-9.

But we in New York State are more focused at this point on the daily briefings of Governor Andrew Cuomo. What matters to us is our theater of the war and the specifics of the progress of the war. The Governor is the one matching hospital beds and PPE and ventilators and staff to where they are most needed to slow down the spread of the disease.

The trenches in this war are the hospitals, their emergency rooms (ERs) and intensive care units (ICUs). Many of these hospitals are nonprofit organizations, as are employers of home health care and visiting nurses groups, which are nonprofits. Often they get left out of laws, as they were in the case of the Tax Act of 2017.  Rep. Carolyn Maloney (D-NY12) wrote a bill last year to rectify the situation; it is H.R. 3323, the Nonprofit Relief Act, now with the House Ways and Means Committee.

So I was curious how the nonprofits fared with the new $2 trillion relief. The National Council of Nonprofits has prepared an excellent summary of the law as it applies to all nonprofits (i.e., charitable foundations with 501-c-3 status under IRS regulations), and I can do no better than to show their analysis below. I do so with their permission:

Coronavirus Aid, Relief, and Economic Security Act 

CARES Act (Pub. L. 116-132)

On Friday, March 27, the House unanimously passed and the President signed into law the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a $2 trillion economic stimulus law intended to provide immediate relief for individuals, nonprofits, businesses, and state and local governments. The CARES Act is the third law enacted in response to the COVID-19 pandemic.

What’s in the Act for Nonprofits

The CARES Act provides significant funding for governments, businesses, hospitals, schools, and social support programs. Below are key provisions of sector-wide interest to charitable nonprofit organizations.

Paycheck Protection Program Loans (emergency SBA 7(a) loans): Creates an emergency loan program providing loans of up to $10 million for eligible nonprofits and small businesses, permitting them to cover costs of payroll, operations, and debt service, and provides that the loans will be forgiven in whole or in part under certain circumstances. Section 1102.

• General Eligibility: Available to entities that existed on February 15, 2020 and had paid employees or paid independent contractors.
• Nonprofit Eligibility: Available for charitable nonprofits with 500 or fewer employees (counting each individual – full time or part time and not FTEs). The law does not disqualify nonprofits that are eligible for payments under Title XIX of the Social Security Act (Medicaid), but does require that employees of affiliated nonprofits may be counted toward the 500 employee cap, depending on the degree of control of the parent organization.
• No Personal Guarantee: No personal guarantee or collateral will be required in securing a loan.
• Loan Amount: The lesser of $10 million or 2.5 times the average total monthly payroll (including benefits) costs from the one-year period prior to the date of application.
• Loan Use: Loan funds can be used to make payroll and associated costs, including health and retirement benefits, facilities costs, and debt service.
• Loan Forgiveness: Employers that maintain employment for the eight weeks after the origination of the loan, or rehire employees by June 30, would be eligible to have their loans forgiven, essentially turning the loan into a grant. Section 1106.

Economic Injury Disaster Loans (EIDL): Creates emergency grants for eligible nonprofits and other applicants with 500 or fewer employees enabling them to receive checks for $10,000 within three days. Section 1110. (The National Council of Nonprofits has posted a side-by-side comparison of the loan programs.)

Self-Funded Nonprofits and Unemployment: Only reimburses self-funded nonprofits for half of the costs of benefits provided to their laid-off employees. This is explained in a recent blog article. Section 2103.

Charitable Giving Incentive: 

- Creates a new above-the-line deduction (universal or non-itemizer deduction that applies to all taxpayers) for total charitable contributions of up to $300. The incentive applies to cash contributions made in 2020 and can be claimed on tax forms next year. Section 2204. 

- The law also lifts the existing cap on annual contributions for those who itemize, raising it from 60 percent of adjusted gross income to 100 percent. For corporations, the law raises the annual limit from 10 percent to 25 percent. Food donations from corporations would be available to 25 percent, up from the current 15 percent cap. Section 2205.

                                         

Employee Retention Payroll Tax Credit: Creates a refundable payroll tax credit of up to $5,000 for each employee on the payroll when certain conditions are met. The entity had to be an ongoing concern at the beginning of 2020, experienced a whole or partial shutdown, and had seen a drop in revenue of at least 50 percent in the first quarter compared to the first quarter of 2019. The availability of the credit would continue each quarter until the organization’s revenue exceeds 80 percent of the same quarter in 2019. For tax-exempt organizations, the entity’s whole operations must be taken into account when determining eligibility. Notably, employers receiving Paycheck Protection Program loans would not be eligible for these credits. Section 2301.

Delayed Payment of Payroll Taxes: Allows employers to delay payment of the employer portion payroll taxes in 2020; payable in equal halves at the end of 2021 and 2022. Section 2301.

Economic Stabilization Fund: Creates a loan and loan guarantee program for industries like airlines to keep them solvent through the crisis. It sets aside $454 billion for “eligible business” which is defined as “a United States business that has not otherwise received economic relief in the form of loans or loan guarantees provided under” the legislation. It is expected, but unclear, whether charitable nonprofits qualify under that definition for stabilization loans. Mid-sized nonprofits and businesses that have between 500 and 10,000 employees are expressly eligible for loans under this provision. Although there is no loan forgiveness provision in this section, the mid-size business loans would be charged an interest rate of no higher than two percent and would not accrue interest or require repayments for the first six months. Nonprofits accepting the mid-size business loans must retain at least 90 percent of their staff at full compensation and benefits until September 30.  Section 4003.

Other Significant Provisions of the CARES Act

Direct Payments to adults of $1,200 or less and $500 per child ($3,400 for a family of four) to be sent out in weeks. The amount of the payments phases out based on earnings of between $75,000 and $99,000 ($150,000 / $198,000 for couples). Section 2201.

Expanded Unemployment Insurance: Includes coverage for workers who are furloughed, gig workers, and freelancers. Increases payments by $600 per week for four months on top of what state unemployment programs pay. Section 2104.

Amendments to the New Paid Leave Mandates: Lowers the amounts that employers must pay for paid sick and family leave under the Families First Coronavirus Response Act* (enacted March 19) to the amounts covered by the refundable payroll tax credit – i.e., $511 per day for employee sick leave or $200 per day for family leave. Sections 3601 and 3602.

Significant Spending: The law also calls for large infusions of cash to the following sectors:

• $150 billion for a state, tribal, and local Coronavirus Relief fund
• $130 billion for hospitals
• $30 billion for education
• $25 billion for transit systems

Legislative Resources

• Coronavirus Aid, Relief, and Economic Security (CARES) Act, H.R. 748 legislative text
• A section-by-section for unemployment insurance and tax policy
• A section-by-section for health policy
• A section-by-section for appropriations
• A section-by-section for banking policy

_________________

* See: Analysis of the Families First Coronavirus Response Act. Also, browse the National Council of Nonprofits collection of resources for nonprofits dealing with the impact of COVID-19.

NEW YORK STATE | County Deaths from COVID (1)

This table is updated on April 3, 2020.

March 27, 2020–As of yesterday, Bronx County (Borough of The Bronx) was the epicenter of coronavirus fatalities, within the New York City epicenter. 

It had suffered 5.8 deaths per 100,000 population, the highest rate of the large counties. 

The table shows all the New York counties with 300,000 population or more. NYS Governor Andrew Cuomo's observation that density is a key predictor of the spread of the virus is generally valid. However, within the five counties/boroughs of New York City, the fatalities may be affected by where people work, where they live and where they are hospitalized. 

The data in the table should be watched as an indicator of how the virus is spreading within the state and how hospitals are being challenged by lack of masks, testing kits and ventilators. New York State this week is where other states may be in three weeks.

VIEWS | 460K Top Ten Posts in March

Thanks for reading this blog! It has passed 460,000 Page Views. Google hosts this blog free, for which I am grateful.

Some blogs I write for have ads and Google pays the host when someone clicks on them. But there don't seem to be any ads on this blog.

Meanwhile, readers seem to appreciate it when I post a list of the links to the most popular posts on this blog. Here are the Top Ten in the last month. The most popular post was about Germany's low death rate from the coronavirus; it was boosted by a tweet from John Cassidy of the New Yorker, who thought it was a good question. Since then there have been several articles about how South Korea and Japan have shut down the spread of the virus by prompt action, and Italy has not done so. Younger generations (what are called Gen Z and the Millennials), who understand that the virus is usually not life-threatening for them, seem to have been eating out or even partying and brought home the virus to their families where older people are more vulnerable to severe illness. Research on this topic is still under way; I will be posting again here.

Entry

PANDEMIC | 1. Germany's Low Virus Death Rate Mar 19, 2020,

PANDEMIC | 3. German, Italian Death Rates Mar 21, 2020,

GERMAN ELECTIONS, 1933 | How a Democracy Was Destr... Mar 5, 2017,

WW2 | 9. Resistance Banker–Wally van Hall (Updated... Feb 19, 2015,

PANDEMIC | Breathing Equipment Mar 21, 2020,

ART BIZ | Fireplace Project–Meckseper and Troemel Aug 24, 2014,

WW2 | 6. Armed Resistance: Jan Canada and Sons (Up... Jan 29, 2015,

NAZIS ELECTED | Germany Votes in Führer, 85 Years ... Mar 7, 2018,

PANDEMIC | Homeschooling by Default Mar 24, 2020,

HEIDI FISKE | Is Trump Seeking War? Mar 26, 2018,

PANDEMIC | Involuntary Homeschoolers

The pandemic has closed schools, because the proximity of students in schools enables the coronavirus to spread rapidly. The virus is well tolerated by children but they become carriers and the illness is more likely to fell their grandparents. Some 400 million children worldwide are therefore being involuntarily homeschooled. Teachers and parents dealing with COVID-19 are facing, perhaps for the first time, the challenges of teaching from a distance, and children are ramping up their exposure to online learning. I have three points of reference to offer:

1. A report from a involuntarily homeschooling mother in Italy.  This an excerpt from the Baltimore Fishbowl, a lively newsletter. Cara Ober interviewed Irene Woodbury, an American living in Italy. I lightly edited, to save space, this paragraph from the long mid-March interview:

We have no experience in Italy with homeschooling. I’m supposed to be a remote worker, working 4 to 6 hours a day, but I have my kids home and I’m supposed to be homeschooling them in Italian, math, and geography. My 6-year-old is in first grade. Even so, the school assignments are building up and his math skills are getting rusty because we have not been diligent, and now his teachers are sending more stuff. I don’t know how many hours I am supposed to teach him, but Monday through Friday I’m aiming to devote three hours a day.

But homeschooling for various reasons is already well-entrenched in some 2 percent or more of the population of the United States and Canada. Homeschooling families have been tackling the problem of keeping up with a government curriculum for decades.

2. A report from my homeschooling niece in Canada. An Oxford alumna (doctorate in English), she homeschools her three children, and has seven years of experience homeschooling.

One thing that's important with homeschooling is to take the long view. It's not a matter of cramming masses of information into a child's brain within a short space of time. Rather, figure out what basic skills you are trying to impart to your child over a given period of time (say, for at least the next three months, preferably longer), and decide which of those skills you will try to impart each week. Follow a schedule but don't feel you need to cover every subject every day. Observe your children to see how much repetition they need before they have grasped a skill. Don't force them to do unnecessary repetition. Schools give students a lot of busy work because they have to keep everybody busy until all the students are ready to move on. But your child can just move on to the next thing when he/she is ready.

If you're not sure what skills are appropriate for your child's age, check your state's curriculum guidelines, which should be easy to find online. Another option is to follow a recognized homeschooling curriculum, such as Seton [Seton Home Study School]. It's not necessary to follow their system slavishly – just take what's useful and leave the rest. We combine resources from a few homeschooling programs (Catholic Heritage Curricula is one of our favourites), and add our own too.

At the end of the day, try to enjoy the process. This is a unique opportunity to bond with your child – to learn how your child thinks. What really interests each child – that is a great discovery. Have fun, and don't stress too much! Your child will learn lots, as learning from parents is a very natural way to learn.

3. Some recommendations from Bethlehem Books. I asked Jack Sharpe of Bethlehem Books for some recommendations for homeschooling aids, based on his long exposure to the field. Bethlehem Books is a big supplier of books to homeschoolers. He gave three recommendations:

• Homeschool.com, a blog founded by Rebecca Kochenderfer 19 years ago and now edited by Jamie Graddy. 
• Sonlight.com, a 30-year-old shopping site and homeschool curriculum.
• Time4learning.com, a curriculum that appears to offer the parent a great deal of flexibility. They promote the idea that their resources can be used for after-school of summer programs.

If you don't like any of these suggestions, visit a site that lists the 25 top homeschooling blog sites. Two of the 25 are on Sharpe's list.

PANDEMIC | 3. German, Italian Death Rates

This is the third of a series of posts on comparative coronavirus death rates. See also posts of March 19 (#1, on Germany's low death rate), March 20 (#2, on infection rates). Virus Deaths Tracker (FT).

	Cases	Deaths	Rate, %
World	307,278	13,049	4.25
USA	26,747	340	1.27
Germany	22,364	84	0.38
Italy	53,578	4,825	9.01

March 22, 2020–As of Sunday morning in the Eastern United States, the novel coronavirus (SARS-CoV2) had 307,278 confirmed infection cases in 171 countries in the world, according to the Johns Hopkins interactive COVID-19 map. Of these cases, 13,049 patients died, for a global death rate or case-fatality rate of 4.25 percent, as shown in the top line of the data in the table above.

The United States had a lower death rate than the world total, as one might expect because we are at the tail end of the westward spread of the disease, so our peak will come later. Surprisingly, Germany's death rate is less than one-third of that of the United States, and Italy's is about seven times that of the United States. Italy's death rate is nearly 24 times that of Germany's–why? I speculated on Friday in Post #2 that countries that test early flatten the curve.

What Explains Germany's Low Death Rate?

Why is Germany's death rate so low? I asked this question three days ago in Post #1, and I suggested that rapid early testing was an explanation. Here is a more comprehensive answer from a German retired corporate executive to whom I sent an email asking for his views:

I am not an expert on the virus, but I have some explanations for the low death rate: Germany has benefitted from:  1. A well-distributed nationwide lab system.  2. A "best practice" testing approach. 3. Most important, an immediate start to testing. 4. Germany has health care that is well established nationwide, health insurance for all citizens, cost coverage by insurance companies starting from the test to hospital treatment and hospitals with ICUs even in smaller communities.  5. Currently, Germany's legislative leadership, an alliance between Christian Democrats (CDU) and Social Democrats (SPD), was able to make quick decisions about expanding the number of ICUs and taking emergency measures. 6. Strong leadership from Angela Merkel and Jens Spahn (Federal Minister of Heath), both from the CDU. Plus Olaf Scholz (Federal Minister of Finance) from the SPD. They agree that money is less important than human lives, and they have the strong support of the European Commission and even their political opposition in the German Bundestag. However: 1. Germans expect a rapid increase of confirmed infections and higher death rates in the next two to four weeks. The biggest problem is to stop social interaction among citizens beyond core families, to break the chain of infections and "flatten the curve." 2. Rules about curfews and isolation have been left to decision-makers at the state level. Angela Merkel and her Government will decide on Sunday whether additional 

A CNN analysis puts its money on nurses per 1,000 population as an indicator of the quality of health care, and reports that Germany's 13.2 per thousand nursing staff is an indicator of high-quality medical care. https://www.cnn.com/2020/03/24/opinions/germany-low-death-rate-for-coronavirus-sepkowitz/index.html.

Another role model for responding to the COVID-19 disease is South Korea. That story is told here: https://thebulletin.org/2020/03/south-korea-learned-its-successful-covid-19-strategy-from-a-previous-coronavirus-outbreak-mers/. Rep. Caroline Maloney (NY-12) asked at a hearing how South Korea was able to test 15,000 people per day. http://english.hani.co.kr/arti/english_edition/e_national/933773.html.

What Explains Italy's High Death Rate?

Looking at the other end of the spectrum, what explains Italy's high death rate? That might provide some guidance for what NOT to do. I looked for answers and one came in via email from the Baltimore Fishbowl, a lively newsletter. Cara Ober interviewed Irene Woodbury, an American living in Italy. I have excerpted, and lightly edited to save space, portions of the long mid-March interview that bear on the question.

Italy was slow to respond to warnings. Italy is a few weeks ahead of the United States in spread of the virus. Italy's peak is expected in the first week of April. The Italian government closed schools and universities on March 4. But life in Italian cities and towns continued much as usual, with people eating, drinking and socializing in public. Not till cases kept surging did the government lock down the country. By the time they locked down Italy, we were at 300 deaths. The lockdown was incremental, because people resisted a complete quarantine. The 20-year-olds were thinking, “I’ll just be fine, it’s just a flu.” Statistically, they will probably will be, but they pass the virus to other people that it kills.  Now 20-year-olds are on ventilators in the hospital, and they can no longer assume they will be fine. Italians are very social and have had a hard time isolating. When the government issued a new lockdown in places like Milan, everyone ran to the train station and went home to towns in the south they’re from. The idea of two weeks isolated in their apartments was unthinkable. What made a difference was seeing people dying every day. Now people are taking it seriously. It’s weird, because you have this invisible enemy. Everyone is wearing masks and you feel you’re in a war zone. Socially, it’s so strange – no shaking hands, keeping a distance, trying to be nice to people without interacting with them. 
Supplies and equipment were lacking. People are wearing masks, but the stores all ran out of them, especially the good ones with the filters. At the beginning, they tested everyone, and healthcare workers often. When they started running out of tests, they rationed them. Now you get the test only if you have symptoms or have travelled to certain places. It has been taking up to three days to get results, because of the overload. But Italy's availability of tests has been better than in the United States. So 10 to 15 percent end up in the hospital in need of ventilators and the hospitals are running out of beds. It’s like a war zone. They’re opening up 30 new beds a day, using shipping containers to make beds and ICU units. The lack of ventilators is a national crisis. One company in Italy makes them, a small, family-run company, and they have accepted a government request to make five times the number a month; they have stopped making everything else and sell directly and only to Italy. They have brought in soldiers to help. If some people don’t get a ventilator, their lungs collapse and they die. With a normal flu, people might need a ventilator for seven days, but with this coronavirus it can require 20 days. Hospitals in the south are not as well equipped and prepared. Health professionals are scared. Nurses on TV are saying it really is a war for them, with thirty new ICU patients a day and hardly anyone leaving. Regular operations at the hospital have been shut down. If you have tonsillitis and need surgery, you have to  wait a month. "Sorry—we have to dedicate all of our resources to this virus." Italy has an enormous elderly population.  New cases include so many older people. One reason is that the elderly are used to grocery shopping every day. In public spaces,  the only thing you can do is go to the grocery store. Everyone is there. This is probably why the death rate is higher in Italy than other places.

Postscript, April 9— Here's an article that attempts to summarize the factors that affect reports of COVID cases n different countries.

MASKS AND BREATHING AIDS | Updated June 2, 2021

June 2, 2021—The Centers for Disease Control has issued mask guidelines that supersede suggestions I posted here a year ago. Here are the latest guidelines: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html.

A Mechanical Ventilator. But we learned that
ventilators are a last resort, because 
intubation has serious risks of its own.

March 21, 2020–New York State Governor Andrew Cuomo today gave an enlightening speech about the COVID-19 challenges stressing the need for masks in the millions, and ventilators, of which the Governor says there are 6,000 in the State and 35,000 are needed. 

(Update October 21, 2020: A survey of more than 200 U.S. mayors earlier in 2020 indicated a shortage of 139,000 ventilators. 

But ventilators are no longer such a priority. Preferred treatment avoids using full-scale ventilators except as a last resort. Ventilators require intubation that is risky. Intermediate equipment such as use of oxygen or sleep apnea machines is less invasive and sometimes works. 

Masks are ranked here according to quality: https://bit.ly/2HmrnUu.)

New York State suffers from a shortage of both
I. Protective Devices (masks and face coverings) and
II. Mechanical Aids, i.e., devices for putting oxygen into the lungs.

This post details these two types of equipment.  This is a lay summary to fill an information vacuum that existed, when first posted, in a field replete with changing and contradictory instructions for hospital staff. If you have a better explanation of any of the equipment that follows, balancing simplicity with precision, or something else to add, please comment or send me a note – john @ cityeconomist.com.

I. PROTECTIVE DEVICES: (A) THE N95 MASK, (B) HIGHER-STANDARD MASKS AND (C) THE CLOTH FACE COVERING. 

A fabric mask is worn by three groups of people: (1) health-care workers and anyone with COVID symptoms, who are expected to wear an N95 mask if they can get them, (2) higher-standard masks for special situations, and (3) lower-standard masks of "cloth face coverings" for people with no symptoms who are in public places.

A. The N95 Mask. The top-quality commonly used working mask in the United States is the N95 mask. The "N" comes from the National Institute for Occupational Health and Safety (NIOSH), which sets standards for protective equipment in the workplace. The 95 references the fact that the mask filters out 95 percent of particulates. 3M makes a lot of them. The higher standard is N99. Availability: The shortage of masks is acute, but this shortage may ease in two weeks and be over (at least in New York State) in three weeks, because the call has gone out to collect and make these masks, and many groups and people are responding. Governor Cuomo of New York has been working on putting millions of masks in hospitals in New York City and the rest of the state. The masks are simple in concept, but the N95 standard requires (1) a tight fit, and (2) a very fine screen, because the coronavirus is microscopically tiny and can get past a casually handled mask. They are easy to put on and are used by both medical staff and patients, mostly to contain any viral infection they have as well as provide a defense against a virus from someone else. Governor Cuomo said that new masks are a priority for hospitals to meet the first waves of patients from their expanded testing.  There is already a shortage of masks in New York City. The N95 masks I have seen are supposed to be used only once (although they can be set aside for a month and then reused safely after the SARS-CoV2 virus has died), but doctors at Brooklyn's Kings County Hospital Center report that because of a lack of masks they have been reusing masks for up to a week, disinfecting them with hand sanitizer between shifts. The masks are relatively cheap to buy (prices have been as low as 80 cents each but, with the pandemic, Governor Cuomo says that he has had to pay as much as  $7 for an emergency order, as state governments have been bidding against one another for them. The Congress should pass a waiver of these masks from President Trump's new China tariffs – perhaps all medical supplies should be exempt from tariffs during a pandemic.

Other related masks are:

• The "N45" Mask. The "N45" mask, referred to in a tweet by Mia Farrow, is fictional. It does not exist.

It would mean a mask that filters out only 45 percent of particulates, which is not very effective. The origin of the "N45" mask reference appears to have been facetious, referencing that our current president is the 45th. Probably a lot of homemade masks for the public (see below) are as low as the N45 standard would be, but no manufacturer would advertise it.

• Masks Comparable to the N95. The equivalents of the N95 masks in Europe are the FFP2 and FFP3 face masks (see Postscript below for a test of the equivalence of the two standards). An Asian standard has been reported, KN95, which also screens out 95 percent of particulates; such masks are widely sold in the United States and have recently been accepted by the FDA as equivalent to N95 masks. (P.S. June 2021: The Centers for Disease Control says that perhaps 60 percent of KN95 masks currently sold in the United States are counterfeit and do not meet NIOSH N95 standards. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html .)

B. Higher-Standard Masks and Respirators.  The NIOSH N99 standard is higher but less commonly used, probably because such a fine screen might be hard to breathe through and might interfere with work. Respirators with Intake Filters: A respirator with a protective intake filter is used to protect a medical staff member working in an area with chemicals or germs.  It looks like a World War gas mask. It typically has a replaceable or cleanable filter. It is not something one sees on COVID patients, but people on the staff of an ICU might prefer to have a respirator with a mechanical filter than a mask. However, it is NOT recommended for the general public, because it may protect the user, but allowing exhalation means that other people are not protected.  Availability: There is no reported shortage of such respirators for a wide variety of uses. They are more expensive than surgical masks. They are bulky and require maintenance and training in use. Many are available online at a wide range of prices. They are not recommended for public use by the Centers for Disease Control: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html.

C. Cloth Face Coverings: Masks for the Public. In Asian countries, 80 percent of the public wear face masks in public. People are convinced that the masks make them safer, and indeed infection rates are much lower than in the West. A mask debate has been raging in the United States. Those who argue that containing the virus means everyone should wear a mask in public have been gaining adherents. One conclusion from the little research that has been done on mask-wearing is that if only 20 percent of the public wears a mask, it won't make much difference, but if 50 percent does, it will make a substantial difference. Masks for the public do not have to fit as tightly or have such a fine screen as the N95 mask. Their purpose is in part to remind people not to keep touching their face. These masks are simpler in design and can be made more cheaply, even homemade. The quality can be high if several layers of filtration are used. It is a good craft project for families. The CDC is now calling them "Cloth Face Coverings" to distinguish them from NIOSH-rated and similar quality masks. Availability. Simple versions of masks can be made by hand. YouTube videos show how; here's a link from the office of Rep. Carolyn Maloney, D-NY12 with ideas.

Resources. Below are some sources of information on creating or collecting masks and other equipment for coronavirus medical personnel, who are the priority at the moment:

• Governments and companies race to make masks for the coronavirus fight (NY Times): https://www.nytimes.com/2020/03/21/business/coronavirus-masks-hanes-trump.html.
• What coronavirus doctors and nurses fighting the pandemic wear (HuffPost): https://www.huffpost.com/entry/nurses-doctors-wear-coronavirus-pandemic_l_5e73bd19c5b6eab779447292. 
• Are homemade masks better than no protection? (Medscape): https://www.medscape.com/viewarticle/927259.
• The Netherlands recalled defective masks made in China, about 600,000 of which had been distributed to local hospitals, the health ministry said. Earlier, Spain and Turkey complained of faulty rapid-testing kits from China. (Medscape): https://www.medscape.com/viewarticle/927259.
• Austria makes masks compulsory as protection debate shifts.
• Four European countries make masks mandatory.
• The crucial missing Coronavirus Protection Guideline https://www.youtube.com/watch?v=hVEVve-3QeM
• How Czech Republic Maintains Low Contagion https://www.youtube.com/watch?v=T2dOs-LhJaQ
• How to make your own mask https://www.youtube.com/watch?v=4FB--BOyTiU

II. MECHANICAL BREATHING AIDS: (A) The Ventilator, (B) Oxygen Tank and mask, (C) CPAP machine, (D) BIPAP and Vapotherm machine.

A. The Ventilator (also called a "medical ventilator" or a "mechanical ventilator") provides breathing assistance to patients for whom providing oxygen is not enough. It's what is required for COVID-19 patients who have a serious case. Unlike previous flu infections, which did not require a ventilator for as long or as many people, the COVID virus can require use of a ventilator for many weeks and for a significant portion of those who are sick. A “ventilator” (mechanical ventilator) is a machine that takes over the work of breathing for a patient with primary respiratory failure due to lung disease or secondary respiratory failure due to central nervous system disease, anesthesia or drug overdose. Ventilators are connected to the patient via an endotracheal tube (“breathing tube”) that is placed in the patient's trachea (“wind pipe”). Ventilators remove carbon dioxide and deliver oxygen to maintain physiologic homeostasis (normal blood pH). Clearly, such a machine requires expertise to operate. New York startups are working hard to develop a simpler ventilator that will be cheaper and easier to use. Availability: Scarce. The cost for a ventilator is about $7,000, but prices vary widely based on location of manufacturer and demand. They are cheaper in China. In New York State some hospitals are already doubling up on ventilators because they are not just expensive but are hard to buy. Governor Cuomo suggested on March 21 that they might be adapted so that two patients can be on one machine, and some innovators are experimenting with more than two. They are also not easy to use and training staff takes time that no one has during the pandemic. If the hospitals are not ready, difficult triage decisions will have to be made. Governor Cuomo has put out a call for all medical ventilators not in use as he seeks to buy more and create more emergency beds. He has also noted that the competitive bidding among the states could be ended by invocation of the Defense Production Act by the President. He has said that the New York hospitals will run out of ventilators in the second week of April, right before Easter. Most recently he has been saying that only 20 (sometimes he says 20-30)  percent of ventilator patients survive. The National Health Service in Britain says that one-third survive. However, of those who survive, a large portion, perhaps one-third, suffer from trauma or scarred lungs or trachea.

B. The oxygen tank doesn't reliably get oxygen to a COVID patient. It is the first mechanical resource for a person who has trouble breathing. But a COVID patient's problems are all the way in the lung, and the oxygen from a tank is is fed through the nose or mouth with plastic tubing, a regulator and a face mask or nasal prongs. The good news is that it is relatively inexpensive ($1,000-$2,500 range) and is relatively easy to learn to use. One of my late uncles had his own oxygen tank for years.  Availability: There seems to be no shortage of oxygen tanks in the United States, or of people who know how to use them, but they are not ideal for treating a COVID patient because the virus finds its way to the lungs. If and when ventilators are scarce, oxygen tanks might have some role.

C. A sleep apnea or CPAP machine blows ambient air into the lung like an oxygen machine. (CPAP stands for "continuous positive airway pressure.") It can be a lifesaver for someone who has breathing problems at night in bed. It has a computer-chip-controlled air flow regulator, a tube and a mask; many models include a humidifier. It is not a substitute for an oxygen tank, which in turn is not a substitute for a ventilator. However, conceivably innovators will be at work adapting equipment where there are shortages of ventilators. (A problem with CPAP machines, as David notes below in a comment, is that the exhale part of the cycle would spew viruses into the air; this would have to be modified.) Some new models might replace an oxygen tank regulator, for example. Meanwhile, it is not an alternative to a ventilator for someone hospitalized with COVID-19. Availability: Too bad the CPAP machine isn't ready yet to replace oxygen tanks or ventilators, because these machines are much less expensive, about $1,000, and are widely available. Reportedly some innovators are working on bridging the gap between the CPAP machine and the oxygen tank, and the CPAP machine and ventilator.

D. BiPAP and Vapotherm machines. When patients with respiratory illness need assistance to breathe, multiple respiratory care options are available before physicians resort to intubation and use of a ventilator—including nebulizers, high flow nasal cannulas and bi-level positive airway pressure (BiPAP) machines. The risk from them again is airborne transmissions to healthcare workers. Vapotherm's high velocity therapy provides mask-free non-invasive ventilatory support," says  the product's website. High velocity/high flow therapy, properly fitted and applied, is associated with a low risk of airborne transmissions. A North Fork, L.I. hospital worker has laid out $10,000 to purchase such a machine for her hospital's ICU. (I have no idea whether the Vapotherm machine does the job and is appropriately priced; I am still trying to find out.)

Three general comments:

• Experimentation with several breathing aids will surely generate gradations that could reduce the excess demand for ventilators.
• For the moment, the challenge is to get something basic to hospitals. Some day maybe engineers who design these products so they are easier to use and designers will make them look better. Maybe they could help make ventilators look less like a gas pump and more friendlier both for the patient and the person who operates it. 
• Meanwhile, the pandemic will provide lots of time for families to experiment with interesting fabrics for their homemade masks and for medical-device people and apparel designers to work together on Zoom to make the look of the business of defeating illness more imaginative.

Postscript 1: The big brands have been stepping up to make the N95 and other masks that are in short supply. LVMH is using a Chinese distributor to order 40 million FFP2 (European standard) for France. https://www.businessoffashion.com/articles/news-analysis/lvmh-to-supply-france-with-40-million-surgical-masks-to-tackle-shortage. 

Postscript 2: Here is a 2009 study comparing the filtration effectiveness of NIOSH N95 and the European-standard FFP2 and FFP3 masks. https://www.ncbi.nlm.nih.gov/pubmed/19261695

Ann Occup Hyg. 2009 Mar;53(2):117-28. doi: 10.1093/annhyg/men086.

Comparison of nanoparticle filtration performance of NIOSH-approved and CE-marked particulate filtering facepiece respirators.

Rengasamy S1, Eimer BC, Shaffer RE.

Abstract

The National Institute for Occupational Safety and Health (NIOSH) and European Norms (ENs) employ different test protocols for evaluation of air-purifying particulate respirators commonly referred to as filtering facepiece respirators (FFR). The relative performance of the NIOSH-approved and EN-certified 'Conformité Européen' (CE)-marked FFR is not well studied. NIOSH requires a minimum of 95 and 99.97% efficiencies for N95 and P100 FFR, respectively; meanwhile, the EN requires 94 and 99% efficiencies for FFRs, class P2 (FFP2) and class P3 (FFP3), respectively. To better understand the filtration performance of NIOSH- and CE-marked FFRs, initial penetration levels of N95, P100, FFP2 and FFP3 respirators were measured using a series of polydisperse and monodisperse aerosol test methods and compared. Initial penetration levels of polydisperse NaCl aerosols [mass median diameter (MMD) of 238 nm] were measured using a method similar to the NIOSH respirator certification test method. Monodisperse aerosol penetrations were measured using silver particles for 4-30 nm and NaCl particles for 20-400 nm ranges. Two models for each FFR type were selected and five samples from each model were tested against charge neutralized aerosol particles at 85 l min(-1) flow rate.

PANDEMIC | Online Free Resources, Alphabetized!

March 30, 2020–Zoom (see below) was an eye-opener for me. It's so easy to use, I wonder why I haven't used it before. Maybe this period of self-enforced physical isolation in the pandemic can open us all up to underused software resources. I will add more resources to this list as I get information. (P.S. Everything posted on CityEconomist.com is free to read. To update, contact john @ cityeconomist.com)

Adobe Creative Suite is offering free access to its Creative Cloud programs for college students through May 31. To qualify, your school or college must be a current customer with an active Adobe plan.

Amazon’s Kindle Unlimited has a library with more than a million free titles, is offering a two-month free subscription.

Berliner Philharmoniker, the German orchestra based in Berlin, has brought its performances to the digital concert hall for the next 30 days, offering its library of more than 600 performances for free when you use the code BERLINPHIL.

Bookhampton and other local bookstores can be supported remotely, by buying books from them online (bookstores use Libro.fm or Bookshop.org).

Boy Scouts activities.

Brit+Co, a media company focused on DIY crafts, offers access to all online classes for free through March 31 when you use code SELFCARE at checkout.

Cambridge University Press is opening its library of college textbooks, book chapters, journal articles, and key reference works to students for free until the end of May (although it has had to pause free access to textbooks while it handles the unprecedented demand for resources).

Coursera, an online learning hub used by college professors, is opening its catalog of 3,800 courses to college students for free. Also: Courses on line. Free!

Downward Dog Yoga, a fitness app that offers guided yoga, HIIT, and barre classes, is opening its library of videos for free until April 1.

Evite has invitations online to 4,000 virtual events.

Headspace, a mediation app that we recommend, is offering free subscriptions to US health-care workers through the end of 2020. To qualify, you’ll need to provide your National Provider Identifier.

Hertz and Enterprise are waiving the surcharges for college kids ages 18 to 24 through May 31; Avis is nixing its fees for drivers ages 21 to 24 through April 30.

History Remote-Learning Aids, free from the Gilder Lehrman Institute. 

Humu, a company that specializes in encouraging productivity within remote workforces, is providing free nudges (short, scientifically backed email suggestions to help you work from home) during the coronavirus outbreak.

iKaossilator for iOS and Kaossilator for Android, apps that let you create music with a single finger, are free to download from Korg through March 31 and March 20, respectively.

Instagram is live-streaming mini concerts by musicians like John Legend and Keith Urban.

International Tennis Hall of Fame Digital Exhibits

Jamm, a video call platform, is allowing free access to its program for four months.

Khan Academy, a free online learning platform, has released daily schedules for students in pre-K through grade 12.

Kickstarters is offering a resource list for artists during the pandemic.

Kindle Deal! Get two months free at Kindle Unlimited.  Payments (small!) are nonetheless  made to authors and publishers. (Shameless self promotion: My book Oxford College Arms is one of the books you can read free on Kindle.)

Krisp is an app that removes background noise from calls. It has introduced a free tier that gives all users 120 minutes of free noise cancellation per week. The company is also granting free unlimited use of the app to all students, teachers, and hospital and government workers worldwide for the next six months.

LinkedIn is offering free business development courses through LinkedIn Learning that are centered on remote working.

Loom Pro, a screen recording platform, is removing the recording limit on its free plan through July 1.

Lunch Doodles are daily projects offered free by Kennedy Center Education artist-in-residence and children’s book author Mo Willems.

MeeroDrop, a visual content sharing site, is offering large file transfers for free. It’s also increasing the storage capacity to 10 GB and the length of time that files can be accessed to three months.

Melbourne Symphony Orchestra is live-streaming its performances on YouTube while closed to the Australian public through April 13.

Metropolitan Opera of NYC's Nightly Met Opera Streams offers a nightly series of free, live opera performances.

Minimoog Model D, an iOS app that allows you to turn your device into a synthesizer, is free to download from Moog Music until further notice.

Mint Mobile is giving customers free unlimited data until April 14.

Movies Anywhere has added Screen Pass, a new feature that will allow members to lend digital movies to their friends and family. Members can share up to three movies a month, and recipients will have two weeks to watch (and re-watch) a movie.

Netflix Party, a Google Chrome extension, is available free to watch movies with friends from different locations. Thanks to Wirecutter for spreading this news.

NFL Game Pass, free access to a library full of football game replays and other programs, is extended by the NFL through the end of May.

NPR's List of New Free Things during the Pandemic.

Outschool is offering free live, online classes for public school students through the end of the school year.

PBS Kids is sending out a daily newsletter to subscribers that’s filled with activities and educational games for kids ages 2 through 8.

Planet Fitness is streaming live, at-home workouts for free on its Facebook page daily at 7 p.m. Eastern Standard Time.

Publishers Weekly. Temporarily free Digital Edition.

Pure Barre studio is offering Pure Barre On Demand free for 30 days with code EXTENDEDTRIAL.

Scholastic is offering free, daily online courses for involuntarily homeschooling families on its new “Learn at Home” website targeted at students from pre-K to grade 6. All school children are now Home Schoolers! Advice from NYC Comptroller on home schooling.

Scribd is offering free access to all of its ebooks, audiobooks, and other digital content for 30 days. Thanks to Wirecutter.

Shudder, a streaming site dedicated to thriller, suspense, and horror movies, is offering 30 days of free access to its titles with the promo code SHUTIN.

Sling TV is offering free access to select on-demand movies, television shows, and ABC News Live.

Talkspace, an online therapy company, plans to provide 1,000 free months of therapy for impacted health-care workers. The company is also offering $100 off all plans with the code 1004U.

The Know-How Series, a mix of creative writing and Instagram branding classes released by the media company Frolic, is now free for the duration of the outbreak.

Tone It Up, a workout streaming app, is offering free access to its programs for new members through April.

U-Haul is offering 30 days of free self-storage for new customers with college IDs.

Uber Eats is waiving delivery fees for all orders from independently owned restaurants through the duration of the COVID-19 pandemic.

Vimeo, great video on protecting your family,  from a doctor at Cornell Weill in Manhattan, where the 1200 beds are mostly assigned to Covid-19 patients. 

YouTube on how to shop and handle food (a doctor explains how to do it safely) 
... and YouTube on making surgical masks. A good project for a homebound family that wants to be useful. Ideas for designers. Why can't surgical masks look more individual and interesting, like individual or college coats of arms? (See above under Kindle.)

• 3D printed masks; instruction by an MD https://www.youtube.com/watch?v=ySOCNycv-aA
• DIY How to make a super-easy surgical mask (3 minutes) https://www.youtube.com/watch?v=PhDFaulAgoA Uses copyright-free patterns S-M-L at www.//freesewing.org/designs/fu/
• Make your own face mask (10 minutes) How to sew your own DIY mask, not N95 but used in some hospitals short of masks or by the public.
• Making a mask (or two) out of a bra https://www.youtube.com/watch?v=Dy59oQArwXI

Zoom.us. The most-used videoconferencing app.