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March 27 2020 12:22 AM
JOB HAZARD: A hazmat suit looming over you is not something you ever want to see, but it is better than no medical intervention at all.

The Guardian

They tread slowly, gracelessly, at a plodding pace. With their aspirators they could be astronauts, of this earth but detached from it, sucking clean air through umbilical tubes. They comfort and alarm in equal measure, these slow-moving harbingers of sickness and death. Intellectually, you know they are there to help, to protect. But the hazmat suit creates a divide. There is the person who wears it and the person they need protecting from. You never want to be on the wrong side of a hazmat suit, because if you are, you know something’s gone horribly wrong.
As the coronavirus pandemic spreads around the world, images of medical personnel in hazmat suits have become commonplace in newspapers and news bulletins. But it is not just medics who are donning protective wear. A fortnight ago, Naomi Campbell posted a video in which she explained her motivations for flying in a hazmat suit, accessorised with a Burberry cape. Last week, before the nationwide lockdown, activists in hazmat suits protested outside Downing Street about the government’s sluggish response to coronavirus. Personal protective equipment (PPE) in general has been high up the news agenda, as beleaguered NHS staff warn the government that an inadequate supply is putting frontline health workers at risk.
The hazmat suit is a familiar trope in pop culture, seen everywhere from the blockbuster HBO drama Chernobyl to the pandemic blockbusters of the 1990s and 2000s currently being revisited on streaming platforms. Some of us may encounter a person wearing a hazmat suit during the coronavirus pandemic for the first time. But where did the hazmat suit come from? And what does this symbol of man’s resistance to disease and destruction represent in these cringing, uncertain times?
As the government scrambles to supply hazmat suits to the hospitals that need them, these are busy times for PPE manufacturers. US firm Dupont, a major supplier of PPE, has ramped up production. Dupont’s David Dominish says that by the first week of the outbreak in Wuhan, the company was shipping more than 30 times the normal volume of hazmat suits to China. Weeks later, this had increased to over 100 times. “Whether it’s avian flu, Ebola, Sars or Covid-19, one thing we know is that whenever a terrible outbreak occurs, the demand becomes nearly infinite,” Dominish says.
Although it is loosely understood in popular culture to refer to a plastic outer layer covering the whole body, there is no uniform hazmat suit. “We have more than 15 different types of fabric, all with different levels of protection,” Dominish says. Two models in particular are proving popular: the Tyvek 800 J, featuring a hooded coverall, overtaped seams and self-adhesive zipper, and the Tyvek 600 Plus, which comes with attached socks and boot flaps. Hazmat suits may also feature built-in respirators and full masks.
Getting a licence to produce hazmat suits is a costly and laborious undertaking. “It can cost £63,000 to get the certificate to make one suit,” says Pam Parker of PPS, a British hazmat suit manufacturer. I ask how the company checks for potential tears. “It can’t have a tear in it,” says Parker vehemently. “There is no way there can be a tear.” Every suit is handmade; they are inflated to check for damage by machines and manually inspected before being shipped.
Before hazmat suits, there were leather oilskins and sweet-smelling pomanders; masks made out of muslin and perfumed rags. As early as the 1600s, paintings show grave-diggers approaching plague corpses with handkerchiefs over their mouths and noses. “These practices were not necessarily against contagion as we understand it,” says Dr Christos Lynteris of the University of St Andrews. “Illnesses were believed to emanate from the ground in gaseous form.”
The now-iconic Venetian beak-doctor costume was one of the earliest attempts by medical personnel to protect themselves during the bubonic plagues of the 17th century. Attributed to the French doctor Charles de Lorme, it featured a long leather coat with a beak mask containing garlic and rue. In effect, it was a permanent hazmat suit. Unfortunately, it probably made things worse. “A permanent hazmat suit without removal protocols and disinfectant would be a vector of disease,” Lynteris says, “rather than something that would stop it.”
Russian scientists designed a prototype hazmat suit to deal with a plague outbreak in the Volga in the 1870s. “The suits were never produced, but beautifully designed,” Lynteris says. “They were designed to prevent imaginary gases from reaching our nostrils. There is a long history of personal protection, but not from bacteria, as scientists didn’t have the understanding of it we do today.”
The origins of the modern hazmat suit lie in the Manchurian plague of 1910, where doctor Wu Lien-teh, says Lynteris, “had the theory that the plague was airborne and spread like the flu. He insisted that all doctors, nurses and burial staff wore a simple gauze mask he designed. It was the first time we had a mask devised for use during an epidemic.”
At first, Wu was ridiculed by his peers. But when a celebrated French doctor operated without a mask to prove Wu wrong and died days later, everything changed. He saved untold lives. By the Spanish flu pandemic of 1918, masks were commonplace. Through the 20th century, the chemical and nuclear sector developed the modern hazmat suit, with medical versions coming into widespread use during the Ebola outbreaks of the 1990s.
The public has always been fascinated by the sight of medical workers in protective gear. “The Manchurian plague was covered by the media across the globe,” Lynteris says. “Because newspapers could print photographs, people saw plague masks for the first time. It was a visually powerful image that worked well in black and white.”
This cultural obsession never abated. In movies and TV shows, hazmat suits evolved into an evocative signifier of peril and death. Part of the reason that the hazmat suit is so useful to film-makers is because it makes visible what cannot be seen to the naked eye: the threat to life posed by disease. The act of donning a hazmat suit and venturing into a stricken area is a visual representation of extreme heroism in films such as Outbreak, Contagion, and Flu. “They are a great prop to visualise danger,” Lynteris says.
The 1995 pandemic blockbuster Outbreak begins with the reflection of a dying man in the mask of epidemiologist Dustin Hoffman’s hazmat suit and the actors wear little else throughout. “Dustin was more miserable than he has ever been in his life, wearing that suit — they were boiling,” says Outbreak costume designer Erica Edell Phillips. The distinctive blue and yellow suits were modelled on those used in the field. Phillips used airflow packs to prevent the helmets from fogging up and remodelled the helmets so the actors’ faces could be seen. “We wanted the suits to look real, but to have some style,” she says. Warner Bros later rented out her suits to films and TV shows: “They became the definitive biohazard suit for decades.”
The wearing of hazmat suits is central to the plot of Outbreak, underscoring the danger medical personnel confront for the greater good. A scientist who breaches his hazmat suit dies a bloody death. Another character accidentally sticks herself with a needle through the suit: the hazmat suit is imperfect, the boundary between life and death only a scalpel nick away.
“The epidemiologist is an interesting cultural hero,” Lynteris says. “They are part-detective, trying to find patient zero or the animal the disease came from. But they are also someone who promises to restore society.” The hazmat suit signals a looming catastrophe: in these films, a pandemic is usually accompanied by the collapse of society. (In Contagion, Matt Damon watches as home raiders murder his neighbours; in Flu, screaming shoppers descend locust-like on a supermarket.) “The epidemiologist is the rational person who brings society back from catastrophe,” Lynteris says. “They are Noah, the person who will save humanity and restore social order.”
The hazmat suit creates a barrier between humanity and nature. Nature is conceived as hostile, full of threat. The opening scene of I Am Legend shows Times Square overgrown by vegetation following a global pandemic. “The virus is a revenge of nature,” Lynteris says. “It decimates humanity, and then nature flourishes.” The hazmat suit represents humanity’s resistance to this existential crisis. Like a knight going into battle in a jangling suit of armour, the epidemiologist dons the hazmat suit to wage war on nature.
Outside of Hollywood, this militaristic tone permeates our thinking about pandemics. “In epidemiological language, the opposite of a pandemic is called peacetime,” Lynteris says. Meaning that, right now, we are at war with coronavirus — and the medical personnel you see wearing hazmat suits are soldiers. But as any soldier knows, in war there are casualties. “It’s still difficult for me to talk about,” says virologist Dr Joseph Fair of his friend Dr Sheik Umar Khan, his voice thick with emotion.
In 2014, they worked side by side in Sierra Leone. A staff of around 17 medics had to cope with hundreds of Ebola patients. “The walls of the hospital were covered in blood, vomit, and stools,” says Fair. “There was no-one to clean them because all the cleaners had died.” When Khan contracted Ebola, Fair desperately tried to arrange a medevac. Two days later, Fair received word that Khan had died. “I completely broke down,” he says. Khan was buried in Kenema, alongside the people he died trying to save.
Fair believes Khan contracted Ebola when taking off his PPE. “The protective equipment is solid, but it’s when taking it off that people get infected. You are exhausted, you have worked for 23 hours with no sleep; inside the suits, it’s like wearing a garbage bag in sub-Saharan Africa, so you’re sweating non-stop, dehydrated and hungry. Your first inclination when you walk outside is to get the damn thing off as quickly as possible.”
“Safely removing a PPE requires meticulous concentration,” says Dr JaHyun Kang of Seoul National University and Harvard’s TH Chan school of public health, who has conducted research showing how medical workers can contaminate themselves during the removal of hazmat suits. “We need to develop better PPE out of more breathable material, so medical workers don’t get so hot and aren’t in such a rush to get them off,” she says. “We also need to standardise the PPE protocols and train healthcare personnel so they become confident about how to remove PPE without contamination.”
A hazmat suit looming over you is not something you ever want to see, but it is better than a lonely room, with no medical intervention. 
Researchers are working on improvements. In 2015, a team at Johns Hopkins University redesigned the hazmat suit to make removal safer. In addition to simplifying the zips and improving the cooling system, they created more transparency around the face. “We tried to make the face very visible … [That is] really important for someone on their deathbed,” one of the researchers told Wired. But these suits are not yet in widespread use.
Making hazmat suits less alienating can save lives. During the 2014 Ebola outbreak in west Africa, infected people avoided medical personnel because their hazmats were frightening. This is an age-old problem: just as in those Ebola-stricken villages, 17th-century plague victims cowered from doctors in their beak suits, Lynteris says.
On a fundamental level, being treated by a medical worker whose face is obscured has a dehumanising effect. The patient realises they are no longer just a person, but a vector of disease. A hazmat suit looming over you — well, it’s not something you ever want to see. But it is better than the alternative: a lonely room, with no medical intervention at all. Because, although the person in a hazmat suit may seem far away, or even uncaring, they are doing the most humane thing imaginable: putting themselves in harm’s way, to save a stranger’s life. — The Guardian

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