Elsayed Mohammed Mohsenawi, a nurse at El-Nujaila Hospital in Marsa Matrouh (west of Egypt), would go to work with an N95 mask fitted tightly to his face, thinking he was immune to the deadly virus. Little did he know, his main source of protection was in fact a counterfeit. It didn’t take long for him to contract the virus, shortly after which he sadly passed away.
After news of his death, the words “Rest in Peace” flooded his pictures online, as people mourned the nurse who had fallen victim to the virus as announced by Mohamed Allam, Vice President of the First Hospital allocated for COVID-19 isolation in Egypt on April 27, 2020.
But Al-Mohsenawi was not the first El-Nujaila hospital staff member to succumb to the deadly virus. In fact, he was one of many. Preceding his tragic death, was that of the hospital’s warehouse keeper, Naji Saleh al-Jarari, who passed away shortly before the hospital announced that three of its staff physicians were infected.
Dr. Mohamed Allam, another infected physician, attributes his injuries to direct contact between patients and health sector workers. He also affirmed that the hospital supplied them with all the preventive tools stipulated in the infection control protocol, including the US-made mask model “N95”.
Dr. Musab Al Badrawy had a similar experience after he was infected while working in the emergency department of Cairo’s Dar Al-Shifa Hospital and seemingly despite all odds, considering that he was fully protected with the gear provided to him before he tended to possible COVID-19 victims.
A common factor between these four COVID-afflicted hospital staff is that they all relied on the same kind of face mask - the “N95 NIOSH” type “TY 0424” - as a protective measure against the virus.
The N95 mask tops the list of the seven protective measures advised by the Egyptian Protocol for Infection Control. The World Health Organisation (WHO) also recommends using it when dealing with an infected person. The implication is that not using the mask, or any malfunctions in its performance, significantly increases the risk of infection.
This investigation documents how the TY 0424 masks used in Egyptian hospitals are not on the list of approved masks issued since the outbreak of the COVID-19 by the specialised US institute NIOSH. Instead, scattered across Egyptian hospitals are the product of an unauthorised Chinese factory: counterfeit N95 face masks.
Elsayed Mohammed Mohsenawi wearing the mask
Dr. Musab Al Badrawy wearing the mask
The use of these masks within Egyptian health care institutions is in violation of the Egyptian protocol for COVID-19 prevention at hospitals which specifically obliges medical staff to wear N95 masks or a mask that matches its efficiency when directly handling patients suspected or infected with COVID-19, and to prevent infection through saliva and mucous droplets.
Furthermore, their use contradicts recommendations by the WHO to supply healthcare workers with N95 masks, especially those who are in direct contact with patients suspected to be infected with the virus.
Tracking the masks’ production and shipping routes reveals that their arrival in Egypt dates back to 2007 — almost 13 years before the pandemic. Further investigation revealed an intermediary company, HIGH TECH FOR PROJECTS AND TRADING S.A.E., that won a call for a bid to supply masks to the Egyptian Ministry of Health within the framework of a project funded by the World Bank to prevent seasonal and avian flu (H5N1); a project that ceased all operations in 2011.
Thus, the so-called N95 masks that have appeared at Egyptian hospitals during the pandemic have in fact been stored in warehouses for 13 years.
Inside 10 Egyptian medical edifices we took samples for our research. We reported the masks’ distinctive-shape with a rectangular label embossed with its type and production number, and at the bottom an indication that the TY 0424 muzzle belongs to the US brand N95 approved by the National Institute for Occupational Safety and Health.
Al-Nakhilah Central Hospital in Matrouh
Abu Khalifa in Ismailia (eastern Egypt)
Qiha in Qalyoubia Governorate (northern Egypt),
the Agami isolation hospital in Alexandria (Northern Egypt)
the Isolation Hospital in Aswan (the far south of Egypt)
Luxor International Hospital
the isolation department at Assiut University
the Health affairs laboratories in Assiut (southern Egypt) which are specialised in analysing PCR samples
Dar Al-Shefa Hospital in Cairo.
We took it upon ourselves to search the NIOSH institute and the US Food and Drug Administration’s website for lists of the approved medical N95 face masks, but the TY 0424 was nowhere to be seen.
A search for the source of the counterfeit mask revealed that it is a product of “TE Yin” located in Jiangsu, China. On its website it lists masks that claim to carry the NIOSH N95 trademark. The company has a factory that specialises in the production of protective clothing and accessories. However, a cross-reference with the US NIOSH Institute website, revealed that the factory itself was not among the list of approved suppliers.
Upon comparing the Chinese mask with the masks approved by NIOSH as listed on their website in order to distinguish between original and counterfeit products, we found, firstly, that information placed on the mask is ordered differently, and secondly, that the Chinese version lacks a TC code of product approval. The NIOSH institute warned that any product without the approved TC number indicates counterfeits.
The media department at NIOSH, via e-mail correspondence, asserted that if the TC code number and the Lot number are not printed onto the front of the TY mask, then “we cannot say it is NIOSH-approved.”
Furthermore, NIOSH’s website lists dozens of fake and/or counterfeit N95 respirators being sold as ‘NIOSH Approved’, complete with bogus NIOSH certification numbers. It sure is an eye-opening list (with scores of photos) of even more fake N95s flooding the market.
Counterfeit respirators are also being falsely marketed and sold as “NIOSH-approved”. The danger here lies in that they may not be capable of providing appropriate respiratory protection to healthcare workers.
Supplying medical teams with counterfeit Chinese versions of the US-made N95 masks is a grave violation of the Egyptian protocol to combat the transmission of infection, issued by the Central Administration for Preventive Affairs. The protocol emphasises the necessity of wearing a respiratory N95 mask or FFP2 (EU approved mask) when performing a procedure that may result in exposure to bodily fluids and virus droplets, such as installing a trach tube, aspiration of respiratory secretions, or collecting a throat swab sample.
The Egyptian protocol is to a large extent in line with the provisional manual issued by the WHO on April 6, which recommends that N95 or FFP2,3 masks should be made available to all medical personnel directly interacting with COVID-19 patients as a precautionary measure.
This investigation reveals a huge gap between the announced protocol and what actually happens at hospitals.
“N95” stands for the mask’s ability to filter the air by at least 95% compared to the filtering percentage of other surgical masks of between 10-90%, according to a study conducted by the NIOSH Institute in 2009, which recommended that doctors use the N95 mask for protection when treating H1N1 patients.
According to a summary of scientific experiments on N95 masks published by a professor in environmental engineering at the University of New Hampshire and an expert in epidemic control, professor Jim Malley PhD, the N95 mask has three layers: the first to repel droplets; the second to trap virus particles through electrostatic materials; and the third layer is biocompatible with the face.
The Chinese mask does not provide such protection.
An image of two masked workers wearing protective clothing and carrying paint tools bearing the caption “filtering face mask industry leader” is how the Chinese company chose to brand its website.
The company further promotes the TY 0424 mask with the trademark N95 printed on it on several Chinese commercial advertising platforms stating the uses of the mask while neglecting any medical use for the so-called N95 mask. The ad limits the mask uses to protection from the following: “sanding, sweeping, grinding medicine, disintegration projects, cement, agriculture and animal husbandry, cutting dust, and pollutes from heavy metal."
Professor Jim Malley explains that the size of particulate matter ranges from 10 to 2.5 microns and has a negative impact on the lungs. The N95 mask has three layers to purify the air from particles that exceed 0.3 microns, which in turn is effective for dust prevention.
Comparatively, COVID-19 virus particles are much smaller at approximately 0.12 micron in size, hence the N95 mask repels 25% of the aerosolized virus. The first layer of the original N95 mask filters dust or droplets, while the second electrostatic layer contains the cation charged polypropylene fibres, by attracting the anion charged virus, and preventing it from seeping through to the N95 mask wearer. All of which the counterfeit Chinese mask cannot do.
Discovering the source of the TY mask prompted us to search for answers as to why it is being used in hospitals at such a critical time.
We have since contacted the Chinese company (TE YIN)’s office via e-mail and inquired about the available quantities of TY 0424 masks. Although the company did not deny the mass production of the mask, it claimed that N95 masks were completely out of stock and turned a blind eye to our inquiry regarding the counterfeit N95 brand, and to our request for it to disclose the parties that received shipments of the counterfeit masks.
However, according to our search, the geographical proliferation of commercial advertisements of the counterfeit product is limited to China and Egypt. Moreover, the counterfeit mask’s first advertisement in Egypt dates back to February 17, 2020. Since, advertisements of the mask have taken over social media, yet all have been posted by individual advertisers.
We also contacted one of the advertisers to inquire about the documents that should accompany the Chinese TY mask, particularly the declaration of origin and the NIOSH certification.
The advertiser responded via a recorded voice message stating that this mask is Chinese-made, therefore they do not have product eligibility documents, which explains its cheap price of E£65 (approximately $4.5) per mask, compared to the price of the original American made masks sold at E£135 (approximately $9) per mask because it includes product eligibility documents
Upon receiving close-up pictures of the product, we examined the packaging information and it became evident that the TY 0424 mask is counterfeit. The product package has a red label, to supposedly certify that the product is approved by the NIOSH Institute. It also does not mention the type of mask nor does it print a clear picture of it on the package. Instead it has the exporter’s information listed as Xiantao Fushi Protective Products Co. Ltd. which is not the manufacturer we located. Furthermore, the alleged exporting company’s website does not display that its factory produces this type of masks, nor is it among NIOSH’s list of approved suppliers.
There are also discrepancies between the label and the actual product. Furthermore, it does not meet the labelling requirements and is in direct violation of the import regulations issued by Resolution No. 770 of 2005 which stipulates that imported shipments must be subjected to laboratory examination in accordance with Article 90 of the resolution. Further, the Egyptian Customs Authority must adhere to the results of the examinations carried out by the laboratories of the Ministry of Health, and accordingly withhold or release the shipment, in accordance with Article 108.
The discrepancies we found between the product data attached to the packages and the reality of the product violates what is stipulated in the import regulations issued by resolution No. 770 of 2005 which states, in accordance with Article 90, that all incoming shipments should undergo laboratory examination. Additionally, the resolution states that the Egyptian Customs Authority should adhere to the results of the examination carried out by the laboratories of the Ministry of Health before the final release of the shipment, in accordance with Article 108.
The TY mask package attributes the import of the product to a company called HIGH TECH FOR PROJECTS AND TRADING S.A.E., under registration number EGS50591C014. According to the company's website it provides contracting and supply services. It also provides medical equipment and maintenance services to various segments of the Egyptian Ministry of Health, including the Contracts and Procurement Department.
We found an image from one of the warehouses that showed the TY masks in the same package that we obtained at the black market. We then received a close-up of the box containing the packages only to find that these masks were procured by the Ministry of Health itself, which contracted HIGH TECH FOR PROJECTS AND TRADING S.A.E. to import the product on its behalf.
By cross-referencing the World Bank procurement data, we found that it funded the TY mask procurement as part of the seasonal and avian influenza prevention program via a supply bid awarded to HIGH TECH FOR PROJECTS AND TRADING S.A.E. in July 2007, for the amount of $1,185,000.
According to data obtained by ARIJ Data Desk, the program ceased operation in June 2011. In 2013 the World Bank conducted an evaluation of the project and deemed it “unsatisfactory”.
The mask does not have an expiration date or any information about its shelf life, whereas the shelf life of 3M N95 "original" products is a maximum of 3 to 5 years.
We confronted the Ministry of Health with the obtained and documented information regarding the masks used at Egyptian hospitals and did so through its official mail after ongoing failed attempts to communicate with the ministry’s spokesman, Dr. Khaled Mujahid. Yet, to date, the Ministry has not responded to our questions.
Last March, the General Administration of Infection Control disseminated to hospitals a list of all medical supplies that should be used when dealing with patients affected by COVID-19, including the use of a "highly efficient respiratory mask" to prevent possible exposure to aerosol or droplets of suspected or infected patients.
In early April, the Preventive Medicine Department issued regulations to forbid any medical service provider to interact with patients except after ensuring that they were wearing the "appropriate" personal protective equipment as stipulated in the infection control protocol.
The Minister of Health, Dr. Hala Zayed, announced in a statement issued on May 25 that the infection control teams have provided a total of 274,840 N95 masks, and 37,500 "highly efficient" medical masks.
High-efficiency masks are those that are used in hospitals, but with cases that do not require direct contact with COVID-19 patients. N95 masks are manufactured in both the US and China according to Chief of the General Division for Medical Supplies at the Chambers of Commerce, Muhammad Ismail Abdo, indicating that Egypt imports its medical supplies mainly from China.
He further added that last February, and at the beginning of the pandemic’s outbreak, the Ministry of Health met with Egyptian manufacturers of medical supplies and requested that they mass produce masks. To that end, the manufacturers supplied the ministry with 20 million masks produced at 15 local factories.
An inside source at an Egyptian hospital reported his experience, stating that he used to work at two hospitals as COVID-19 began to spread. One of the hospitals distributed N95 masks to its staff, while the other hospital distributed TY masks, which led him to resign from that hospital.
Our source’s statements have been confirmed by official records indicating that nine health agencies requested the supply of N95 masks in mid-February, but according to the public contracting portal of governmental TENDER database, no supply authorisation was made until the end of May.
This information has been further confirmed by Assiut University hospital which ordered 20,000 N95 masks on February 13 and had to submit a renewal of its order on April 27. On May 8, we observed the use of TY masks at the isolation hospital in the university’s campus. Ironically, just one day later, Assiut University’s President announced that 14 of the medical staff working at the university are to receive treatment at Al-Rajhi University Hospital after being infected with COVID-19.
Tanta University Hospitals
February 13 and April 27
Assiut University Hospitals
Al-Mataria Residential Hospital
Directorate of Health Affairs in Alexandria
Menoufia University Hospitals
Qalioub Specialized Hospital
Zarqa Central Hospital
Luxor International Hospital
Allam and Al Badrawy have since recovered from the virus, and have returned to work alongside their colleagues at hospitals fighting the unrelenting coronavirus with nothing but a Chinese made TY mask which is unsuitable for protection let alone prevention, and especially not after outliving its expected lifetime.
As the WHO warned the world of a deadly pandemic spreading across the globe, Egypt’s Ministry of Health equipped its staff with insufficient, counterfeit and expired 13-year old masks to confront the deadly virus.