
Doctors Say Shortage of Protective Gear Is Dire - Reedx
https://www.nytimes.com/2020/03/19/health/coronavirus-masks-shortage.html
======
m3nu
I do China sourcing and have decent access to 3-ply surgical masks and limited
access to N95 masks.

It's really hard to sell either of those to government bodies, even near cost.
Already talked to the Red Cross, wholesale pharmacies and different
ministries. They generally insist on payment on delivery, which we can't do
for larger orders, as factories sell to whoever has the cash at the factory
gate.

Some also want EU certifications (FFP2), while many factories in China only
have the local Chinese standard (KN95). And some refuse to pay to a company
outside Europa, while wanting to buy stuff from China.

So while I'd love to ship some of this stuff to Europe, currently people there
are still blocking themselves. Hoping to work something out soon.

~~~
immad
Can you email me (email in profile) and I can connect you to some people in
the US trying to solve this.

~~~
keenmaster
Why don't they just charge a higher price to buyers who don't pay cash now? I
understand there is a lot of demand, but this does not compute with me. My
spidey senses would be going off.

~~~
m3nu
This works for private buyers, but these gov agencies have a regulation that
doesn't allow them to pay in advance ever. The price isn't the issue. So they
can only buy from really big firms, who don't have stock right now and aren't
flexible.

~~~
fingerlocks
How do I learn more about this regulation?

~~~
m3nu
No idea. They told me by email. And it makes sense for normal times.

It's probably in a procurement regulation or guideline.

~~~
keenmaster
Sure, but why do all of the smaller firms absolutely need cash right now? If
they sell to a government or large entity, payment is all but assured. Even if
they have a high discount rate, they can factor that into the price. There's
no way they all need the money now to remain in operation.

~~~
m3nu
We are way past discount rates here. Firms without enough cash won't survive.
Even if you double or triple the price, it doesn't help if you're out of
business when they pay weeks or months later. That's why some kind of
financing is needed for larger orders that need like $ 1/4m to 1m in outlay
first.

~~~
keenmaster
Can Chinese banks provide bridge financing? You'd think they would be happy
to, since half of them are state-owned and China is in a position to help
other countries afflicted by Coronavirus.

The bank can give the mask company money now. Once the American NGO receives
the masks, it can directly pay the bank. That way the bank does not have to
worry about the mask company stealing its collateral. The bank might even
offer to pay for the provision of masks as a donation from China.

------
systemvoltage
Let this be a lesson to learn for western democracies to not put all of their
eggs in one basket. Diversification, localization and strategic globalization
of the supply chain should be at the forefront of the issues to be discussed,
ratified and acted upon after this pandemic is over. When one country
manufactures 90% of world's goods (not accurate, to make a point), while the
top 1% gets their bonuses for increasing profit margins, this is what we have.
We've lost skills, we've lost our stance to manufacture things in our own
homeland. It is depressing, deeply worrying and feels like the entire world
has been gutted out by one country. Just to make it clear - think about this
scenario - what would happen if one country made the food for the rest of the
world? (Thankfully, we don't, but it can happen). What about pharmaceuticals?
(Unfortunately, 90% of the world's generic drugs are made in Asia, primarily
in India who in turn depends on China) [1].

[1] China is the world's largest raw materials exporter for Drugs:
[https://www.wsj.com/articles/china-opens-door-to-foreign-
dru...](https://www.wsj.com/articles/china-opens-door-to-foreign-drugs-for-a-
discount-1543320003?mod=article_inline)

Edit: I just realized that some of the startup and entrepreneurs around the
world are on this forum, if you'd like to get into manufacturing, want to
learn about more abstract concepts of manufacturing, I implore you to
checkout: Manufacturing Planning and Control for Supply Chain Management
reference book -
[https://books.google.com/books/about/Manufacturing_Planning_...](https://books.google.com/books/about/Manufacturing_Planning_and_Control_for_S.html?id=TkGRswEACAAJ)
This book is absolute _gold_. Manufacturing is like playing this game Factorio
(google it) but in real life. It is an exciting field ripe for innovation,
many _very_ hard problems and unlimited potential (and a lot of risk as well).

~~~
cycrutchfield
Strategic stockpiles seem much more cost effective than autarky.

~~~
systemvoltage
It is not about autarky, but diversification and resiliency of the supply
chain. Automakers are experts at this - BMW cars made in USA (South Carolina)
have US made parts and ones made in Germany have locally sourced parts from
Germany, yet the ones made in South Africa have diversified sources - both
local and international. If you're in the US, you can see this % of locally
made parts right on the window price sticker. It's not just for show - if
there is a shortage of headliners in US, it can import it for a short term
needs from Europe and vice-versa.

No one is suggesting complete in-house isolation aka Autarky, but to avoid
SPOF (single point of failure) supply chains - probability of each link
breaking adds up when your supply chain is 18 levels deep from an iPhone to
the copper mine.

~~~
bryanlarsen
I imagine that unless it's 100%, the "% of locally made parts" is very poorly
correlated with supply chain robustness.

If a BMW contains 99% local American parts, it's quite likely that much of the
1% are the hardest things to produce locally.

------
outlace
There is reason to believe that the hospital mask shortage is due in no small
part to employee (and patient/family) theft of masks and not necessarily due
to dramatically increased need at hospitals (at least not yet).

I say this as a resident physician at an urban hospital in the US. We're now
severely low on N95 masks and moderately low on surgical masks but we have
only had less than a dozen confirmed covid-19 cases (granted about 100 tested
negative cases) so there's no way even 100 additional patients requiring masks
suddenly plummeted our stockpiles of masks. Indeed, hospital administration
noticed and sent out a mass email imploring employees to return unused masks
in personal possession.

~~~
rhegart
This. There are barely any covid 19 patients yet hospitals are low on masks
due to panic. Beds are still open and ventilators contrary to media claims are
not currently on a shortage.

~~~
diabeetusman
There are also not nearly as many tests being run as there are patients with
suspect symptoms. Yes, the number of confirmed COVID-19 patients may be low,
but that doesn't mean that the number of people with the disease is low.

According to the CDC[1], you can contact your healthcare provider for the
possibility of a test if (and only if) you are in close contact with someone
with the disease or if you're in a community where there's ongoing spread.
That's still a very limited subset of people who might have the disease.

There's very limited insight into who does or does not have the disease in the
US.

[1][https://www.cdc.gov/coronavirus/2019-ncov/symptoms-
testing/t...](https://www.cdc.gov/coronavirus/2019-ncov/symptoms-
testing/testing.html)

~~~
cameldrv
And these criteria become a catch-22. How does a community become identified
as having community spread if you won't test anyone in a community that isn't
so identified? My understanding is someone has to be admitted to the hospital
and then tested to get the ball rolling.

------
quietthrow
Again severe failure on the govt’s part. Their inaction in when it was needed
the most led to all these circumstances that makes it ripe for situations like
these. As the number of infections spread and economic situation get worse
these kind of things will get really really bad. Once the second and third
order effects kick in it’s going to be a catastrophe. And our leaders answer
to all of this is to give $1200 checks to people. All they care is about the
economy as it gives them higher odds for their reelection. I don’t understand
how such incompetence can be tolerated and why they are not fired and instead
have to wait till next election.

~~~
DoofusOfDeath
> Again severe failure on the govt’s part.

If you live in a democracy, then you _are_ part of the government. You can't
just blame other people for this.

~~~
baddox
That’s ridiculous. An average citizen cannot vote more medical supplies into
existence no matter how hard they vote.

------
jeremydw
I keep seeing articles like this pop up. During one of the first coronavirus
press conferences, the White House invited CEOs from Walmart, Target, CVS,
etc. – presumably to show strength of the private sector.

On the flip side, why can't we enlist money and resources from the private
sector to quickly fix some of these supply issues? For example:

\- Convert car factories to produce masks and ventilators.

\- Convert construction companies to build makeshift hospitals. (Or use
hotels.)

\- Use tech companies to improve national information access with regards to
CV19 testing and track and help patients using their software on their phones
to help with contact tracing.

I realize that it's not as simple as pressing a button and instantly
converting a factory that makes Teslas into one that makes masks. I also
realize there are potential privacy concerns with nationalized information
tracking.

But, we're about to enter an unprecedented public health crisis. We have
resources that can lessen the impact if we just align and get behind this
direction.

I can't help but think we could do more and not just wait for the shortage to
happen, and for the curve to spike.

We stockpile enough nukes to basically destroy the whole Earth (exaggeration
but you get the idea), but we can't stockpile some ventilators and face masks
in case of a pandemic? You can't fight a pandemic with diplomacy. At least you
can fight a foreign enemy with that.

~~~
atomic_rabbit
Turns out N95 masks are quite high-tech, and even China is having trouble
scaling up its production. They're made of a material, meltblown fabric, which
only a limited number of factories are capable of producing.

[https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...](https://www.npr.org/sections/goatsandsoda/2020/03/16/814929294/covid-19-has-
caused-a-shortage-of-face-masks-but-theyre-surprisingly-hard-to-mak)

~~~
fma
They aren't having trouble scaling up... They already have. 200 million masks
a day, 20x in February.

If we (America) can't scale up we are in deep doodoo. Trump has been pissing
off China by calling the Corona virus the "China Virus".

~~~
generatorguy
200 million surgical masks but only 600k n95 masks, per the npr article gp
linked to.

The machines to make the n95 masks take both the Germans and Chinese about 6
months to make.

------
jdkee
The ER docs at my wife’s hospital this morning were wearing pediatric masks
with Disney characters emblazoned on them. And this is in a major suburban
hospital.

------
joe_the_user
The inability to just requisition, demand resource, mobilize people and so-
forth, is breathtaking here. The start of WWII saw the quick re-purposing of
industries for the war effort.

Today, it seems an inability to see what's necessary and get it to people is
disturbing. The situation is effectively a war and one that's being fought
very quickly.

I could brainstorm and mention the "fast fashion" is renown for creating
conventional clothing to a variety of specifications, _quickly_. It seems like
that talent could be harnessed for various kinds of safety equipment. Just an
example, I'm sure there are a hundred similar things conceivable but despite
the looming collapse of conventional procedures, somehow all bureaucratic
hurdles remain in place.

~~~
patrec
I still can't believe that no western country is even capable of creating
freaking face masks at scale (and no, doesn't need to be N95).

------
neonate
[https://archive.md/8EcPa](https://archive.md/8EcPa)

~~~
mjevans
Thank you

------
diabeetusman
My sister's an ER doc in Baltimore and they're getting one mask per 12-hour
shift. That quantity doesn't protect them from anything or their patients

~~~
fma
My understanding is they are good for 4 hours. When the masks are saturated
they are not effective. Maybe it's better to have 2 and rotate them out.

I saw someone else post this on HN... Worth a look.
[http://www.imcclinics.com/english/index.php/news/view?id=83](http://www.imcclinics.com/english/index.php/news/view?id=83)

~~~
diabeetusman
That's a valid idea, but it's unfortunately not something she's in control of.
All the PPE protocols are coming from people higher than her.

They're also not getting eye protection at all so she's taken to wearing her
glasses instead of contacts. Not as good as actual eye protection, but it's
better than absolutely nothing.

In short, they don't have what they need.

------
lettergram
The crazy thing to me is the government or hospitals haven’t issued a massive
n95 drive to obtain more.

I have a few left over from a house project I did a while back. Kept one for
myself, but happy to donate the other 4 I have. I’m sure if the request was
actually made people would donate. Is it enough? No idea, but construction
workers, painters, etc don’t need them right now.

People want to do something, let them.

~~~
viraptor
Just curious why are you waiting for a request? Why not call the nearest
hospital and say "I've got 4 n95 masks, do you want them?"

There is a problem with issuing a request - not everyone will know about it.
As you mentioned, you think there was no request. But there were multiple:
here's one example [https://www.poynter.org/reporting-editing/2020/hospitals-
are...](https://www.poynter.org/reporting-editing/2020/hospitals-are-running-
out-of-masks-industrial-masks-have-been-okd-for-use-are-local-construction-
sites-donating-them/)

------
elihu
I wonder what if there's a straightforward way to make facemasks by hand, or
with tools that are generally available?

I'm imagining cutting apart a furnace filter and wrapping the fabric around a
wire frame, or something like that. If someone were to develop a process that
was simple and reliably repeatable and produced good quality effective masks,
that could be a way for otherwise un-busy people to keep hospital staff
supplied.

One issue I suppose is whether there are upstream bottlenecks, like not being
able to get a reliable supply of the right kinds of filter material.

~~~
j-c-hewitt
There are a lot of hospitals directing employees to sew them by hand.

There is a simple and reliably repeatable method: having a factory. Not sure
what is needed but there are lots of suppliers on Alibaba for this type of
item. There are lots of rumors about export controls in China, denials of the
same from Chinese officials, and rumors of seizure by US customs.

Never imported medical stuff but anecdotally many US sellers are being
solicited by Chinese factories looking to sell masks and other PPE into the
US.

------
eigenvalue
Chinese n95 masks are available very cheaply on Ali-Express from a variety of
sellers who can ship by airmail. I don’t see why doctors/nurses shouldn’t
order them personally if they can’t get them from work. For example: US $10.09
20％ Off | 10PCS Disposable KN95 Mask FFP2 Protective Mask Safety Masks 99％
Filtration for Dust Particulate Pollution N95 Protection

[https://a.aliexpress.com/_dSIOgZ3](https://a.aliexpress.com/_dSIOgZ3)

------
zachguo
Car factories can be converted to produce masks. An electric car manufacturer
in China, BYD, became the biggest mask maker in 3 weeks.

[https://www.bloomberg.com/news/articles/2020-03-13/buffett-b...](https://www.bloomberg.com/news/articles/2020-03-13/buffett-
backed-byd-says-it-s-now-the-biggest-maker-of-face-masks?srnd=technology-vp)

------
toohotatopic
What does it take to build those masks from scratch?

We are at roughly 1 out of 100.000 being infected. Until 60% have developed
immunity, there is still a long way to go where almost everybody on earth will
want to own masks. The need of the hospitals is just the tip of the iceberg.

Is it possible to source the machines and materials now to be ready for
production when the wave hits really hard?

------
innagadadavida
Are there any reusable masks that are effective? It seems like throwing away
these masks after a few hours of usage is partly to blame for the shortage.
Generally damp materials are good at blocking particles better than dry ones.
So is there any possibility of reusing the mask after washing in soap water?

------
uxcolumbo
Maybe this DIY approach to masks can help in the interim - better than no mask
at all?

[http://www.cidrap.umn.edu/practice/homemade-personal-
protect...](http://www.cidrap.umn.edu/practice/homemade-personal-protective-
equipment)

------
ackbar03
>“The federal government’s not supposed to be out there buying vast amounts of
items and then shipping,” Mr. Trump said. “You know, we’re not a shipping
clerk.”

Hey, the guys not wrong, he's not a shipping clerk

~~~
mirimir
They do that for weapons, ammunition, food, clothing, etc, etc, etc.

~~~
arcticbull
The interstates, rail networks, oh and THE USPS, which makes the federal
government, literally a shipping clerk.

------
aaron695
If this article was dated January I might care.

Everyone in the hospitals from nurses to management knew exactly what is
coming but did nothing.

And nothing has even happened yet, wait till the virus actually arrives in a
few weeks.

Did any hospital plan or ask for help properly? Did any nurses union raise the
issue?

Anyway they have numerous studies from Africa where they can't afford
equipment, rather than the lack of planning by people on half a million a
year, to look at.

~~~
viraptor
Nurses and other staff are not there to make decisions based on firsthand
geopolitical and epidemiology research. They have enough day-to-day work to
do. This information should be provided to hospitals and other healthcare
workers from higher up. This level of resource use / need may be even above
what the local management should analyse, because ideally there would be
regional stock available to shift to the clinics/hospitals affected by most
cases.

~~~
skat20phys
I agree with you regarding client-facing staff, and think the parent post has
misplaced lack of concern. However, I also think the post makes an important
underlying point about hospital administration generally and "where their
heads were at."

Increasingly a lot of hospital administration is very profit-focused. Not all
but maybe most; where it's not, it's increasing, and where it's not supposed
to be it often is, but hidden.

What this means is that the focus of hospital administration is often not on
epidemiology and public health, even though it should be. It _should_ include
that more. It's focused more on squeezing out the maximum from each provider
in terms of billable hours and patient contacts. When you're focused on stuff
like that, you're not thinking about public health.

And so we have the consequence of that now. I don't think this is the only
problem -- there's also government overregulation, rent-seeking provider
monopolies that artificially restrict supply of services, and lack of coverage
for patients -- but it's part of it. In general, at an abstract level,
healthcare in the US has become very focused on protecting the interests of
the established system, and less so on the interests of citizens and patients.
It's a house of cards with several problems at once, getting hit by the
perfect storm.

