Crystal Evans lives in constant fear that bacteria will grow inside the silicone tube that connects her windpipe to the ventilator that pumps air into her lungs.

Before the pandemic, the 40-year-old with a progressive neuromuscular disease followed a fastidious routine: She carefully changed the plastic circuits that carry air from the ventilator five times each month to keep them sterile. She also swapped out the silicone tracheotomy tube several times a month.