Drs. Jackie Boehme and Alex Stone, anesthesiology residents at Brigham and Women’s Hospital in Boston, co-founded MasksOn.org. Credit: Dr. James Rathmell

Sanjay Vakil has launched multiple for-profit startups, but it was COVID-19 that gave him a crash course in social entrepreneurship as a founder of MasksOn.org, which converts full-face snorkel masks into emergency personal protective equipment for medical providers.

“This is so removed from my own self-image of what I do,” said Vakil, MasksOn.org’s executive director, whose day job is at Google as a senior product manager. “On the other hand, it’s a weird confluence of skills that I gained over the years in terms of being a little entrepreneurial, a little maker-y.”

MasksOn.org has shipped 18,000 free masks to more than 2,500 institutions in 47 states, including hospitals, doctor groups and hospices. The masks are to be used only in emergencies, when N95 masks and other PPE are not available.

Robin Khan, who leads a dental group of six chair-side providers in Omaha, Neb., said her team was nervous to restart the clinic during the uncertainty of COVID-19, given dentistry is a highly aerosolized industry. Khan’s staff found N95 masks uncomfortable and other face shields fogged, before receiving a MasksOn.org donation.

“These masks are so comfortable, and breathing is far easier than with N95 masks,” said Khan, head of Dentistry for Health. “The availability and cost of PPE coupled with the guilt of PPE landfill pollution are added concerns. Needless to say, these masks have minimized those issues.”

The idea of adapting full-face snorkel masks into PPE started with Vakil’s co-founders, Drs. Jacqueline Boehme and Alexander Stone, anesthesiology residents at Brigham and Women’s Hospital in Boston — Stone snorkels, but Boehme and Vakil do not. They connected with Eugene Mann, a Google product manager, who sent a note on March 18 to an internal list of “makers” at the company’’s Cambridge office.

Would Launching A Nonprofit Be Too Slow?

Robin Khan, dentist in Omaha, Neb.

“It went out to the office and kind of snowballed from there,” said Vakil, who began brainstorming what type of device could connect a full-face snorkel mask and anesthesiology circuit. The team 3D printed the device before switching to injection mold technology using Protolabs in Maple Plain, Minn., which specializes in quick production.

In the fight against COVID-19, old-school invention that stops virus spread is taking center stage. For instance, Western Massachusetts-based VentureWell spotlighted five maker-y launches for infection prevention and control. New York City-based Kinnos developed a powder to add to disinfectants, turning them blue and allowing users to spot any coverage gaps.

As COVID-19 spread, getting masks to clinicians quickly was critical. Vakil, whose first four startups were software businesses, worried that launching a nonprofit would be a slower process, but Boston-based MasksOn.org surprised him.

“This moved faster than any other company I’ve been involved with,” said Vakil, noting they went from concept to doctors testing masks in the field within 11 days. “This is the fastest, by probably a factor of four. In terms of actually shipping product, probably by a factor of 10.”

Other differences between software and a physical product were timescale and the cost of mistakes, he said. “Bugs in software are pretty easy these days to both fix and deploy, but a bad injection mold can lose you weeks, tens of thousands of dollars, and results in a heap of material getting thrown out,” Vakil said.

The Fundamental Difference Is How You Measure Scale

Launching a maker-y business with a societal impact influenced Vakil, whose most recent experience in software was in consumer-facing products. “At some level I derive satisfaction from them by multiplying the relatively small benefits they provide over a large set of users: the benefit to each individual user is pretty small,” he said. “I had a profound conversation with one of our senior advisors who pointed out that healthcare workers are motivated and derive their satisfaction from saving one patient – just one patient – but the value of saving a life is so critical that there is no multiplication needed. She pointed out that the work of MasksOn was similar: if we only kept one clinician safe, we could rest easier.”

The organization has raised $2.3 million, which is used to purchase, convert and ship masks;  no one draws a salary. MasksOn.org is a program under its fiscal sponsor, the Fab Foundation based in Boston.

The team obtained 30,000 snorkel masks at or near cost from HEAD, Ocean Reef and Wildhorn Outfitters. The masks’ adaptors are installed by Lightspeed Manufacturing, in Haverhill, Mass., which had capacity because one segment of its business is building in-flight entertainment systems. Vakil works on the travel team at Google, and his managers gave him clearance to devote time to the masks project. “They gave me room to run, which is phenomenal,” said Vakil.

Leveraging his engineering training, Vakil knew the masks could be adapted with a relatively small modification, making it a tractable project. But deciding when the masks could be shipped was a more complicated calculus. Caution permeated every step as MasksOn.org carefully balanced how much testing to do against the goal of getting masks distributed quickly. A “mask approval committee” of engineers, clinicians, testers and a medical ethicist weighed in. “Waiting a day was always the easiest thing to do, and also the hardest thing to do,” Vakil said.

MasksOn.org is a family affair for Vakil. His wife, Naoka Carey, 46, helps with public relations and fundraising, and provides prospective on nonprofits from her work at a juvenile justice organization. Han, 18, is the courier manager, running a Slack channel of 35 volunteers who make local deliveries after picking up boxes of masks from the Vakils’ porch. Even the youngest children are involved: Saoirse, 11, makes mask-wearing emojis, and Kieran, 9, donated $3 he received from the tooth fairy.

“We had a long discussion before I got deeply involved, which was can we do this as a family, is this something we can take on,” said Vakil, 49. “We couldn’t not do this.”

Sanjay Vakil and his son, Han. 18. Vakil needs to decide whether to continue MaskOn.org as a full-fledged venture, or wind it down.

A Sprint Becomes A Marathon

MasksOn.org is evaluating its long-term plans.

“We originally conceived of MasksOn.org as a very short-term effort,” said Vakil. “We hoped that N95s would be showing up in huge quantities by the end of April, and we could all shut the organization down and go home. In practice, we’ve seen that the supply chains have taken much longer to fulfill the needs.”

The group has a goal of adapting 100,000 masks if it can raise enough funding, which is becoming more difficult as some of the 20 core team members return to day jobs. Otherwise, the team will finish the masks on hand and wind down the organization, or turn the keys over to an organization better able to work at an international scale to supply masks overseas. Any leftover funds would be donated to a charity, perhaps one established to look after the families of healthcare workers who lost their lives to COVID-19, Vakil said.

“We haven’t had enough conversations yet to know which way we want to go, but figuring this out changes how we retool the organization for a longer run,” Vakil said. “We need to change to a marathon rather than a sprint.”

This story and others on New Builders Dispatch are made possible by a sponsorship from the Ewing Marion Kauffman Foundation. The Ewing Marion Kauffman Foundation is a private, nonpartisan foundation that provides access to opportunities that help people achieve financial stability, upward mobility, and economic prosperity – regardless of race, gender, or geography. The Kansas City, Mo.-based foundation uses its grantmaking, research, programs, and initiatives to support the start and growth of new businesses, a more prepared workforce, and stronger communities. For more information, visit www.kauffman.org and connect with www.twitter.com/kauffmanfdn and www.facebook.com/kauffmanfdn.