In Pursuit of PPE

https://www.nejm.org/doi/full/10.1056/NEJMc2010025

by erwan • 6 years ago

173 194 6 years ago

sirsar2• 6 years ago

Serious question: If the FBI and DHS are seizing PPE, where is it going? Why can't this hospital be a beneficiary of seized PPE, rather than an (almost) victim?

cameldrv• 6 years ago

Blue Flame Medical.

abinaya_remote• 6 years ago

Good approach!

sailfast4• 6 years ago

This is insane. 5x markup and federal seizure of privately procured masks that will then get given to private companies to give to hospitals. Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go through while controlling part of the market. Absolutely crazy. Not to mention having to hope your governor praises the federal government to get their masks back.

You could not have invented a worse scheme for this, but somehow they have, AND they’re using federal manpower (in N95s, naturally) to intercept these shipments.

m4rtink4• 6 years ago

This is insane. 5x markup and federal seizure of privately procured masks that will then get given to private companies to give to hospitals. Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go through while controlling part of the market. Absolutely crazy. Not to mention having to hope your governor praises the federal government to get their masks back.

This is pretty much how it went here in Czech Republic - initially outright ban on sale on the PPE needed by medical personnel, that was only removed very recently. And the state (army & fire fighters to be precise) handling all the distribution of PPE. Mainly to hospitals, care homes and also to local municipality offices where local general practitioners could pick them up.

First state distributed the PPE from the (unfortunately rather small) existing emergency stockpile, later from a central warehouse located next to a suitable airport close to the middle of the country where most of the "aerial bridge" cargo aircraft with PPE ordered from China land.

hef198984• 6 years ago

Firefighters played a crucial part in the distribution concept I came up with two weeks ago. Nice to see something like that being implemented!

Do you have any details of how the logistics are run, especially the last mile? Really curious, because I never heard back from German authorities so far.

yread• 6 years ago

Not everything is rosy though. Ministries buying 40m eur worth medical equipment from some company that had no revenues last year or year before that. One ministry paying double the price for the same thing as the other. And that's not even mentioning how many companies from prime minister's holding are benefitting disproportionately - subsidies, testing, hand sanitizer....

blackrock2• 6 years ago

I saw an article saying the 5x markup is because of the air freight, which costs more.

Normally, the masks and other gear, are shipped via boat, and it takes over 30 days to transport it. But this is an emergency, so that lag in transport would have killed even more people and health care workers. Hence, the need to deliver it by air.

The problem is that the air freight companies are now resource constrained, that they are charging 3 to 4 times more than normal. These are the people that are causing the price gouging.

Then, to make matters worse, some European countries went on a media blitz to complain about shoddy Chinese made products. They bought non-medical masks, and were expecting it to be medical grade products!

So they complained about it on Twitter, which forced the China central government to crack down on manufacturers, and only allow “medical grade” certified masks to be shipped. This placed an even larger burden on the supply chain. (However, other masks not stamped with a “medical” label on it, were allowed to normally ship, as a consumer-grade item. So buy it at your own risk.)

So, this resulted in news that some expensive air freight flights, were only returning half-full. The other half was still sitting in the warehouse, awaiting customs export inspection approval, from the new Quality Control regulation.

Then, to make matters even worse, all countries all over the world, are now competing for the same products from China. And the Americans are buying the product outright, and in cash, and paying double or triple, what European countries are paying.

This all adds to the cost per product, which ends up justifying the 5x increase.

sailfast4• 6 years ago

The freight costs makes sense and that's a great counterpoint. Thanks!

That said, the government has the ability to cap mask costs per unit and then only charge for shipping or, you know, bring a bunch of C5s and do the freight themselves to get the cargo hours. Or charter planes to help with airline bailouts or...

Instead of hammering the hospitals we have all sorts of options to help here. The fact that the only thing that occurred was HARMFUL to the process says a lot. It must feel pretty weird to be told "you're on your own" and then also have that same crew confiscate your mask shipments. That's what the mafia would do. Would be a shame if something happened to your PPE...

baybal28• 6 years ago

which forced the China central government to crack down on manufacturers, and only allow “medical grade” certified masks to be shipped.

There is way more to it than that. That was a very convenient pretext for China to legitimise its unofficial exports ban. It reduced the number of exporters to single digits per provice, and even few ones with appropriate licenses are now being turn arond at customs without explanations.

China's official Red Cross, however, seems to have zero problem exporting just anything off the shelf.

Even supplies for which there simply can't be a medical certification are stalling at customs. I know a person who works in medical clothing industry, and they ran into that with... hospital bedsheets.

As of now, the lion share of PPE coming from China is effectively being smuggled out.

makomk7• 6 years ago

I know the Chinese government has been pushing the narrative that it was those European countries fault for buying the wrong product, but it's just not true. Everyone is perfectly OK with using non-medical industrial filtration masks under the circumstances. The reason that European countries have had to recall a bunch of Chinese masks is that they didn't meet the filtration standard they claimed to be made to, full stop. They let through substantially more particles than the standard allowed when tested. They also failed fit testing, which would make them unusable anyway.

leemailll• 6 years ago

This week Poland used Antonov 225 to ship Ppe from China to Warsaw. That plane cost for 30k per hour which mean a single shipment might cost 1M.

ikeboy• 6 years ago

I can confirm this. I've brought in masks recently and some shipments have been stuck in Chinese customs for over two weeks now. It's crazy.

voodooranger2• 6 years ago

Price ceilings cause shortages. Every time. Let’s not use Venezuelan-style economic illiteracy as a model for how to incentivize the flow of critical supplies to those who need it most during a crisis.

BubRoss• 6 years ago

Venezuela's problems come from international banking controls combined with hyperinflation and mandates to not increase prices. When you have a currency losing its value every week and the government mandating 10 cent gas with no way to transact with the outside world and escape your currency, things are going to get very distorted.

Venezuela has much bigger problems than price caps, it is not indicative of systemic ramifications either way here.

qqssccfftt2• 6 years ago

I wonder how anyone can write a comment like this and think that our economic model is not completely broken for anything other than making one group richer.

thelean12• 6 years ago

What about price ceilings and purchase limits? You'd have to actually think about the purchase limits for different entities but it sounds doable.

ardy429• 6 years ago

Price ceilings cause shortages. Every time.

No, not in the situation. The shortage exists regardless of price.

We're not in econ 101 territory, so lets not analyze the situation with econ 101 tools.

anigbrowl• 6 years ago

Not this BS again. For the nth time, the model of supply and demand you are familiar with depends on perfect competition, which involves transparency, substitutability, and frictionless entry and exit. When those conditions don't exist your idealized economic model will not operate efficiently and may not clear at all.

this is in every economics textbook and students are cautioned about differences between idealized models and real markets, but economic ideologues never seem to read that part.

xster• 6 years ago

And that's in the present. What's more frustrating too is that if we're still debating about the present, there will certainly not be any accountability for the lack of preparedness from all levels of government in the past to prepare for health crisis.

Compare to these images

https://upload.wikimedia.org/wikipedia/commons/thumb/a/a6/雁塔... https://upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Ch... (source: https://en.wikipedia.org/wiki/2019–20_coronavirus_pandemic_i...)

where even the random person checking your temperature at subway entrances and toll stations are armed to the teeth in PPEs in China. And that's coming from a country that wasn't even able to genetically map SARS themselves <20 years ago.

baybal28• 6 years ago

This is the point I've tried to convey to my peers in the West over, and over, and over for years.

I hope this would finally be a rude awakening moment for countries in the West. The decay of essential social institutes in the West has reached the point when issues begin to snowball uncontrollably.

I don't like many points of that guy called Neil Fergusson makes, but he is 100% on the spot pointing that the West is loosing the "institutional IQ" after 20 to 30 years of "ultrapopulism" in government.

Just look at the level of organisation being exhibited now, and how emergency response was handled few decades ago. Quarantines were not so unheard of in the West even for things like bad flu outbreaks in the 20th century, but, nowadays, some countries can't quarantine even a single city.

pmorici6• 6 years ago

Whats even more nuts is that N95's have taken this level of importance in healthcare at all instead of reusable P100 masks. I read a post on medium the other day about a hospital in Texas that does that and it was being treated as some kind of amazing discovery as if this was some unknown miracle device.

[0] https://elemental.medium.com/a-tiny-hospital-in-texas-might-...

prostheticvamp2• 6 years ago

For most healthcare workers, it is unknown to them. N95 is the standard.

And P100s were sold out early into this adventure.

sailfast4• 6 years ago

Those are great but you still have to replace the filters quite often, right? Doesn’t solve the problem as the P100 filters are also sold out, and were in shortages back in January from what I saw.

danenania2• 6 years ago

I've found that the P100s tend to make me feel lightheaded pretty quickly. I tried to wear one on a very smoky drive from LA to SF during the fire season last year, but had to take it off after ~45 minutes because I felt my ability to concentrate on the road was being weakened too much. That would definitely be an issue for healthcare workers. I haven't experienced anything similar with an N95.

ardy429• 6 years ago

Whats even more nuts is that N95's have taken this level of importance in healthcare at all instead of reusable P100 masks.

The obvious drawback to using reusable respirators to manage a pandemic disease is that they're another item to become contaminated and spread infection.

toomim• 6 years ago

N95s are also reusable. Put them in an oven at 60°-100° for 20 minutes and all the virus will belong to death.

prostheticvamp2• 6 years ago

Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go throug

Every country in the world is hunting for N95s right now. For the US to institute price controls just means the supply will shift to another country that doesn’t.

praxulus• 6 years ago

If the top 10 bidders are all Americans (which is plausible, given America's wealth and inflated healthcare costs), the U.S. government could use price controls to drive the price down from the 2nd highest to the 10th highest bid without losing supply to other countries. There's still the possibility that driving prices down would push manufacturers out of the business (or more likely, fail to pull in manufacturers who otherwise would have started producing PPE).

m0zg2• 6 years ago

> distribute directly to those in need or allow

I'm not sure what you're complaining about then. This is exactly what those federal agents attempted to do (and chose not to do). Are you saying it'd be preferable if these masks were seized by the Feds and sent to e.g. New York?

> institute price controls

That's a very good way to ensure those masks go to other buyers. I'm just not sure that's what you were aiming for.

m3nu• 6 years ago

I also help with buying PPE currently and it's not 5x markup by the seller only. Everything got more expensive. Input material, machines, shipping. This results in the final price being 5x (or more). It's not the greed of one sales person (mostly).

Most factories I work with are NOT looking to take advantage of the situation. It actually hurts them because they can't accept new orders when they don't know the future cost of raw material next week.

edge17• 6 years ago

The 5x markup is basically in line with the increase in material cost and increase in risk of importing. The melt blown fabric prices have been increasing dramatically since January when China ramped up production.

tosser0001• 6 years ago

I was certain by this point in the crisis we'd be seeing video akin to WWII/"Rosie the Riveter" stuff of PPE flowing out of factories around the country.

Is the U.S.A. simply not capable of this level of production any longer? What the heck is going on? It's sobering.

dfxm12• 6 years ago

The USA is capable, they just lack the leadership in Washington to do so.

altoidaltoid3• 6 years ago

The implementation of disaster federalism

rckoepke8• 6 years ago

It certainly sows doubt when I see things like this: https://www.youtube.com/watch?v=p9lchhBE7cE

Taiwan increased their production of N95 masks from 100,000/day earlier this year to over 20 million/day now.

Asia can build N95 plants, starting with concrete foundations, in <14 days and 3M hasn't managed to start up any new production lines in existing facilities since announcing them nearly a month ago.

I'd like to imagine this is primarily a leadership issue. I'd like to think that if money was given to the right highly motivated people that it wouldn't matter than "we don't have melt blown fabric machines" because we could design and manufacture them from scratch in our machine shops.

Sometimes though, I do worry about a potential domestic shortage of skilled machinists and manufacturers. And of our ability to allocate either public or private capital to the right entities during national emergencies. I'd imagine $10 million could go pretty far right now, but I haven't heard of any millionaires trying to work outside of the capitalist systems by building something philanthropically. I also haven't seen anyone try to crowdsource money for some plants here.

_ea1k• 6 years ago

We seem to have spent an amazing percentage of that energy on spooling up ventilator manufacturing instead. Most of that capacity will be ready once the crisis is well beyond its peak.

I also do not understand why we weren't able to scale basic PPE quickly.

dntrkv2• 6 years ago

Does anyone know why these shortages haven't been sorted out? I don't work in manufacturing but aren't these things relatively simple to manufacture? We have factories and employees that are sitting idle, why can't they be repurposed to manufacture these en masse? It would resolve our supply issues while providing employment. Am I missing something?

NikolaeVarius• 6 years ago

I don't really understand why the existence of a "factory" means it can produce arbitrary product in any meaningful fashion in a short period of time.

bluGill5• 6 years ago

You need the right machines. In the factory. A cnc lathe is no use. The large collection of jigs for whatever they made before don't help.

They can get the right machines and jigs but that means making them which takes time. They you need the right materials, you aluminum supply chain isn't helpful (unless they retool to make your raw materials...)

bolasanibk• 6 years ago

Because retooling is expensive and time consuming. And there is no guarantee how long this level of demand will sustain. And no guarantees on cheap chinese goods flooding the market and taking all your customers in a few months.

sirsar2• 6 years ago

This is an incredibly easy problem to solve, relative to the current crisis: it only requires the federal government allocate enough money.

There is some price per mask at which the N95 respirator manufacturers that currently exist in the US would be willing to hire more people, buy more supplies, etc and start running 24/7. The only reason they aren't already is because nobody has agreed to pay for it.

makomk7• 6 years ago

From what I've heard, the US federal government agreed contracts fairly early on in the crisis where they'd buy up any excess US production of N95 masks that goes unsold in order to guarantee a market for exactly this reason.

xienze• 6 years ago

And no guarantees on cheap chinese goods flooding the market and taking all your customers in a few months.

You might could fix that with strong tariffs. There was a guy recently, can’t remember his name, who was very much in favor of domestic manufacturing and tariffs against China. Seemed to catch a lot of flak for those policies! Wish I could remember who that was...

stainforth5• 6 years ago

We subsidize American agriculture because its important. We should do the same for other industries. I'm not sorry public services and concepts like this fly in the face of economic ideology that profit motive is the end-all be-all.

ls612• 6 years ago

It took a while for the US to get the war production really going during the war. Logistics and production was a mess in 1942 and it wasn’t really until 1944 that they were pumping out dozens of carriers and hundreds of liberty ships a year.

bb611• 6 years ago

The US completed 542 liberty ships in 1942, and 1943 was their peak production year: https://www.mathscinotes.com/2018/05/liberty-ship-production...

They reduced liberty ship production in 1944 to produce warships (which are more complex and were produced in much lower numbers)

MattGrommes• 6 years ago

I work at Nike and we've already retooled our major local factory to making PPE but it's all going to local hospitals at this point I believe so there hasn't been any big national news about it. I feel like this is probably happening elsewhere as well.

WorldMaker• 6 years ago

It seems to be happening at the individual state level, but without smarter coordination between states there's a lot being left on the table.

WWII had the benefit of an extent Works Progress Administration [1] that had lot of power to swing jobs between and among states. It also had a lot of little powers that added up, like the Federal Arts Project (FAP) that pulled together the artists to create such works of art as "Rosie the Riveter" to motivate.

Maybe little things like a Federal Dank Memes Project could help in a time like this, maybe not. The "Rosie the Riveter" equivalent memes are out there, in some states, scattered and crowd sourced to social media. That more states don't even realize what their neighbors are up to in mobilizing PPE is itself a failure in coordination at the Federal level.

As we get through this we're probably going to need to talk a lot about renewing the New Deal.

[1] https://en.wikipedia.org/wiki/Works_Progress_Administration

nashashmi2• 6 years ago

Where is the ppe going? And why is dhs stepping in when hospitals are ordering them? Why cannot health care workers order ppe directly? Hospitals are having a difficult time time giving them out to workers because it is low.

jhart99• 6 years ago

If this sort of seizure is being conducted under the Defense Production Act Section I, there should be greater transparency of what PPE materials are currently subjection to allocation control. Otherwise, we might as well have the National Guard protect shipments from seizure within the states.

ttul2• 6 years ago

It's absolutely insane that PPE isn't something that's being procured on a national level. Why are hospitals and clinicians having to deal individually? If there were a monopsony buyer (i.e. the Feds), suppliers could be bullied into providing reasonable terms.

Well, I suppose the real answer is: Because that's not how healthcare works in America...

ttul2• 6 years ago

Anyhow, in Canada, the federal government has created its own global supply chain to produce and distribute PPE as needed within the country, hiring two international firms to store and verify equipment sourced from China. Meanwhile, national air carriers are re-fitting their unused jets to carry PPE and the feds are happily paying them to fly them.

"The ministry of procurement has signed a deal with two international firms to temporarily store and verify equipment in China – awaiting Canadian jetliners to safely retrieve the materials and return home.

Bollore Logistics – of France-based Bollore Group, a multi-national transport and logistics firm – is providing storage and transportation services within China, as well as preliminary testing capabilities."

This is the sort of war-time posture that every country needs to take. It's sad to see the lack of federal government leadership in the US leading to hospital staff becoming PPE supply chain experts. What a horrible waste of their talents.

https://www.ctvnews.ca/politics/canada-establishes-its-own-p...

tejtm• 6 years ago

Same reason we do not have (health) records in the same place in a common format that would allows us to intelligently coordinate moving what supplies we do have around in a proactive fashion.

We do not have a national health care system.

Thriptic2• 6 years ago

We already have the ability to measure COVID status because diagnostic labs are required to report the presence of certain things to CDC in real time upon positive test result. COVID-19 is almost certainly one. Further, countries like Britain tried what you are describing and the process was a total shit show ultimately leading to failure.

What makes flawless real-time communication hard is that you're talking about integrating thousands and thousands of groups of various sizes, with various technical capabilities and budgets, with various requirements, and with various legacy systems in place. You have multiple stakeholders who all want something different out of the project. You have very real security, availability, privacy, and fraud concerns. Oh and did I mention the government would really rather not pay for it?

Just creating a practical UUID for every citizen in the US is unprecedented, let alone associating all existing historical data for one person from all over the country / world with that handle, parsing that data into a standard format, and creating a system where that record could be updated in real time in a secure manner. Unsurprisingly, it's a monumental undertaking.

rhino3694• 6 years ago

That creates a single point of failure. You then have to trust that federal bureaucracy will do a better job than everyone scrambling.

In perfect conditions, it's likely true. But in actuality, I doubt it's better.

I doubt federal purchasing agents would be doing deals with local painting crews who have 2-3 boxes on N95 masks in the back of their truck.

nashashmi2• 6 years ago

I'm going to repeat your question: why isn't ppe being procured on a national level, and instead why is dhs seizing supplies, and why is not a war supplies act being declared when the national government is clearly needing them and not able to procure them.

It is insane on multiple levels.

notagamedev2• 6 years ago

Is a war supplies act different from the Defense Production Act that has been invoked?

Consultant324524• 6 years ago

The coronavirus task force has talked somewhat candidly about why the centralized monopsony buyer has been a problem. Because everyone is lying. A hospital might really need 100k masks, but they ask for 500k because they're afraid there won't be any more in the future. NYC demanded 40k ventilators, but it turns out they needed I think less than 10k. Multiply this by every hospital in every municipality across the country. There's no way a hand full of bureaucrats in Washington could make sense of that in reasonable time. I understand why pricing feels cruel, but it's a better system at more efficiently allocating resources. Anyone with some money can allocate some masks to a place with need that's in their line of sight. This provides much better coverage than the central planning models of: price controls, purchase limits, and confiscation/redistribution.

dashundchen• 6 years ago

Would you even trust the current administration to not interfere and distribute with partisanship in mind? On the remote chance they chose anyone competent to manage it.

I sure as hell don't, we have our head of state literally saying governors need to be nice to him to get their states federal help and stirring up in-person quarantine protests against governors from the opposite party. Unfortunately in this vacuum of leadership states are all we have. I am glad the north east and west coast seem to be starting to coordinate on a larger level.

reggieband5• 6 years ago

When I read this kind of thing I am happy we live in a society that allows the free discussion of information. It is no exaggeration to say this kind of honest description of events by a senior health official could have lead to imprisonment or worse in many historical and some modern contexts.

Given how many people are currently unemployed - how is it that we can fail to ramp up our own ability to produce this needed equipment? There is no shortage of labor. Forget about the failures to prepare in January, February and March - what are we doing right now to prepare for the next 6 months?

I'm looking around for a leader who has that vision. Governors are blaming the federal government. The federal government is blaming China and the WHO. Who is organizing the effort to fill the gaps?

voodooranger2• 6 years ago

Excellent point. What is 3M for example — an American company — doing? Are they attempting to ramp up production in the US or have they determined that it’s not feasible because PPE prices are are not permitted to rise because of anti gouging laws?

tinalumfoil• 6 years ago

The issue is a lot of the factories that make these products are in China. The US has foresight to ensure military supply lines aren't dependent on China, but that foresight didnt extend to medical equipment. There simply isnt the capacity enough masks in the US.

ardy429• 6 years ago

The problem isn't anti-gouging laws, it's that medical customers aren't willing to commit to long-term contracts to justify the investment to increase production.

https://www.dallasnews.com/news/watchdog/2020/04/03/if-you-i...

...during an outbreak like this, everybody wants to be [an American mask/respirator maker's] customer. But as soon as an outbreak subsides, his customers dump him and run back to China. The reason? His masks may cost a dime each, but a made-in-China mask might go for two cents.
“Last time he geared up and went three shifts a day working his tail off,” the mayor recalled. “As soon as the issue died, he didn’t have any sales. He had to pay unemployment for all these people, and he had to gear down.”

Also, why would you think anti-gouging laws would be the problem? The only thing raising prices would do is send PPE towards people with money who may or may not have actual need. No one sensible is going to ramp up extra capacity or create stockpiles of perishable goods with the idea that they'd be able to gouge during infrequent, unpredictable crises. The only people that price gouging helps are the parasitic middlemen who make a profit engaging in it, and the fools with money to burn who can't demonstrate priority need.

Thriptic2• 6 years ago

According to anecdata from a friend of mine at 3M, they are running manufacturing 24 hours / day and are expanding. Apparently one of the problems was that when China was infected, 3M depleted a lot of their existing mask stock selling to the Chinese. When the virus came to the US, existing stocks were already somewhat depleted.

dboreham• 6 years ago

The governor I watched talk about this (NY) said something completely different: he said if you know how to make PPE, call me. If need funding to spin up manufacturing, I'll get it for you. And so on. This was a week or two ago.

baybal28• 6 years ago

This is a level above doing blame game, for sure, but a governor of a state should always be the No.1 emergency responder.

They should not be just asking for help, they should lead, and command the emergency respone.

With the state of emergency declared, they have full authority to order businesses to make supplies, or requisition manufacturing facilities for that.

twblalock• 6 years ago

Who is organizing the effort to fill the gaps?

Who is left, between the federal and state governments, except private companies? Some of them are doing things to acquire or manufacture PPE but it's a piecemeal effort. Apple and Tesla come to mind as companies not traditionally in the medical space who are trying to help.

The only way this will work on a nationwide scale is if the federal government coordinates it. Leaving it to the states is problematic because some states won't try to do it, and some can't afford to do it without federal money even if they wanted to. That's only going to get worse as unemployment claims use up all the money the states have left.

reggieband5• 6 years ago

The only way this will work on a nationwide scale is if the federal government coordinates it.

Your comment made me think of a wild and impractical idea. Airbnb, Uber, Lyft, Etsy and others unlocked a gig economy in specific industries. Is there any possibility to do the same with PPE?

rhino3694• 6 years ago

Given how many people are currently unemployed - how is it that we can fail to ramp up our own ability to produce this needed equipment? There is no shortage of labor.

Labor isn't the limiting factor. You need machines, raw materials, supply chains.

There isn't an AWS for N95 mask manufacturing.

giggles_giggles• 6 years ago

Hol' up, are you saying that there's a reason besides economics that the government might introduce protectionist trade measures to keep some critical manufacturing domestic for use during an emergency when you cannot trust your supply chains which come from hostile -- or even friendly -- nations?

It's funny because this was a U.S. conservative talking point going back as long as I can remember (for me that's the mid/late 90s). There's even an episode of The Office (U.S.) where this point of view is lampooned (Oscar to Michael: "Wouldn't you say that the services sector is much more relevant than manufacturing?"). Never thought I'd see it expressed openly on HN, and with upvotes!

reggieband5• 6 years ago

I think you are underestimating the productive potential of 4 million people. Machines can be built, raw materials can be gathered and supply chains can be organized. The alternative is to sit at home doing nothing until the equipment we need comes from China, which is more-or-less what our current leaders are recommending.

elihu• 6 years ago

There are some surprisingly resourceful groups doing local manufacturing in incredibly inefficient, seemingly-unscalable ways and actually producing masks and eye-shields by the thousands.

https://www.facebook.com/groups/pdx3dplab/ https://team2471.org/ https://pdxhackerspace.org/

This is just in the Portland area. I assume there are similar efforts around the country and around the world.

Ideally this stuff should be made in factories rather than hundreds of bespoke 3d printers operated by volunteers, but if the need and motivation is there, a lot can be accomplished. Maybe it's not enough, but it's a lot more than nothing. And the longer this goes on, the more efficient the organization and manufacturing gets.

Normally the regular supply chain would handle all this, but if the supply chain is broken by hoarding behavior or the wrong kinds of active government intervention, the alternative is to bypass the usual market and use whatever local workforce volunteers or can be hired to make what's needed directly for the institutions in need.

ardy429• 6 years ago

Given how many people are currently unemployed - how is it that we can fail to ramp up our own ability to produce this needed equipment? There is no shortage of labor.

Labor isn't the only limiting factor:

https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...:

COVID-19 Has Caused A Shortage Of Face Masks. But They're Surprisingly Hard To Make
...
Both the masks made for medical personnel and for consumer purchase require a once-obscure material called melt-blown fabric. It's an extremely fine mesh of synthetic polymer fibers that forms the critical inner filtration layer of a mask, allowing the wearer to breath while reducing the inflow of possible infectious particles...
And there's now a global shortage of melt-blown fabric due to the increased demand for masks — and the difficulty in producing this material.

reggieband5• 6 years ago

I think one of the hallmarks of great leadership is to inspire people to see beyond barriers. Melt-blown fabric is not likely to be the only or even the biggest hurdle.

Maybe it will take months/years to go from zero to production quantity/quality no matter how hard we try or how well we organize. And maybe by the time that production capacity is active the market will be flooded by PPE from China (let's hope). Yet I would still rather be over-prepared and with people actively productive compared to behind the ball with people sat at home.

Maybe I'm just tired of the government telling us to be patient while we continue to hear reports like this. I want someone to tell us how to be proactive.

hef198984• 6 years ago

While I can only speak for Europe, more particularly for Germany, I learned quite a lot about masks in the last couple if weeks when I tried to leverage my logistics contacts to get masks and stuff from China.

IMHO we see what a complete brake down of an established supply chain looks like. As end users in Germany are unable to source directly from Chinese suppliers, and these suppliers are unable to import, the high demand, combined with production shutdowns, resulted in a near global stock out.

While this is bad enough, the multi-tiered distribution chain (producer, importer, wholeseller, local distributor) is by definition not capable or fast enough to recover in any reasonable amount of time. And that is under ideal conditions, and not during a global shortage and run on the product in question.

One would be tempted to assume some central entity would be able to step in. But in Germany, that fell to the armed forces and other government entities. And those have not the slightest clue about international trade. So the insisted on suppliers to import. Remember why the supply chain is the way it is? So the only thing working is donations, because there logistics pros are running things.

It is not a question of availability of masks nor transportation capacity or lead times, just price.

Now it seems the import part is solved. I give the government 2 weeks tops to realize distribution is not that easy neither. Just having masks in some warehouse is only the first step of supplying the front line people.

rfoo3• 6 years ago

Sounds duly familiar to what I read about Wuhan back in late January and February. Only donations work. Had massive trouble distributing things. Fortunately at least you don't have to deal with another distraction named "government redirected your donation shipment to Red Cross (ran by government in China) and they sat on their stockpile doing nothing or malicious".

hef198984• 6 years ago

So far, no. I guess we have to be happy about the little things, don't we?

lucretian• 6 years ago

so many comments asking "how could this be?" and "what the heck is going on?" and so forth.

the answer is obvious, but i guess it's too "political" for people to accept.

qqssccfftt2• 6 years ago

Or it conflicts with their worldview that what we have now is the best thing possible and life cannot be better.

notagamedev2• 6 years ago

In 2006, the US Congress funded the integration of protective equipment to a Strategic National Stockpile: 52 million surgical masks and 104 million N95 air-filtration masks were acquired and added. During the 2009 flu pandemic, tens of millions of masks were used, but during the Obama administration strategic stocks were not “significantly restored”, neither have they been during the Trump administration

altoidaltoid3• 6 years ago

https://www.businessinsider.com/fema-paid-bankrupt-company-n...

No corruption here...

m0zg2• 6 years ago

Yeah, they should have spent a month or two vetting every single company out of tens of thousands involved in the effort. This armchair quarterbacking is tiresome.

altoidaltoid3• 6 years ago

doesn't take a month to pull a business license search and check employee records.

untog• 6 years ago

Come on. There's a middle ground. Of course the government can't be expected to vet every company in absolute depth right now, but it can very easily check a few criteria:

- does this company have any experience making the product in question?

- what size workforce does this company have to deploy once they receive funds?

This is basic stuff. Very basic stuff. And the government is failing at it.

adrr• 6 years ago

To be distributer of FDA regulated medical gear you need a FDA license, they could have easily verified that. They couldn't even legally take possession of the masks for distribution.

learc83• 6 years ago

My fiancee is an ER doctor and her hospital is now getting considerably more N95s than they were a few weeks ago. It looks like the supply chain is finally ramping up.

fny2• 6 years ago

I'm actively on the hunt for PPE on behalf of hospitals and I can tell you the mark up comes from several places:

- First, manufacturers have marked up prices. What used to cost 5c from a Chinese manufacturer now costs 30c or more. - Aside from supply being keen on the shortage, demanders are also willing to push prices even higher. I have even had people /outbid/ my place in line for product. - Airfreight costs $14.50 a kilo. It's typically around $2-3 a kilo. - Financing is hard. In many cases, no one wants to pay up front at all or make deposits because of all the scams and counterfeit products. Suppliers similarly want money up front, often 100%. The transaction itself becomes a more risky proposition. I can't find anyone willing to finance part of a 30 day transaction for 5% returns.

The Federal seizures have made everything even more risky. Price controls will not fix this. A manufacturer in China has enough demand from the rest of the world to charge. (I was out bid from someone from France.)

The only thing we can do is ramp up supply.

Cynddl• 6 years ago

I was out bid from someone from France.

This is quite interesting to read. Most of the media coverage in France has been very hostile against the US with little evidence to back it. We've seen claims of Americans waiting on the tarmac to buy our masks and redirect planes, cash in hand ready to be given. And in major newspapers [1, 2].

[1] https://www.lefigaro.fr/actualite-france/coronavirus-les-reg... [2] https://www.liberation.fr/france/2020/04/01/une-commande-fra...

nicbou3• 6 years ago

It doesn't help that the US tried to make some shady deals with a German company for exclusive access to the vaccine, and allegedly rerouted PPE paid for and headed to Germany.

taylorhou• 6 years ago

i've been sourcing kn95's from family friends who are higher ups at the handful of CDC NIOSH NPPTL certified manufacturers. they are reporting that their raw material costs have skyrocketed from what use to cost them 20k per ton to 400k per ton (RMB).

another problem is due to the limited number of actual manufacturers that got the CDC/CE certifications long ago, they have established brands (ie: Maskin) that now, has knockoffs/counterfeits of which is sowing mistrust even for the certified manufacturers.

lastly, especially in America... we keep biting the hand that is feeding us in the sense that we are dependent on China's ability to mass produce KN95 masks but inevitably, when there are counterfeits as people cash in on the craze, "China" as a whole gets a bad rep.

this week, China issued an entire ban on mask exports. if you had problems getting masks already, it's about to get almost impossible to get them as there are plenty of other countries that would gladly receive shipments.

even so, i'm flabbergasted at the price the US government is reportedly reselling masks to states for between $5.50-7.50 per KN95/N95 mask... my current cost to the states is around $3.50/mask (after accounting for lost shipments) and i'm not getting any sort of big volume.

fny2• 6 years ago

Do you have supplies for N95 masks or just KNs?

gok• 6 years ago

We should give US doctors lots of PPE for no cost.

Then a few months later, mail the hospitals bills for every person involved in making those masks. Also separate bills for the "specialists" who packed them into cardboard boxes. Then a month later we should send them another bill explaining that we decided the original mask shipment actually wasn't covered under their donation plan.

If they have trouble paying we should let them know we have payment plans available.

0x00000000• 6 years ago

Yeah it is rather ironic all this talk about price gouging in a state of emergency when hospitals do it all the time, especially for emergencies where the person has no choice.

Oh masks cost 5x as much now? What a tragedy, they are charging 1-3 orders of magnitude markup on everything, all the time. But now people want to talk about “ethics”?

I hope when this is all over that is sparks a serious conversation about the healthcare mafia. A lot more needs to change before throwing tens of trillions of dollars at them for Medicare for all.

mhb2• 6 years ago

It's easy to test the fit of the mask. I wonder what made him confident that the filter material actually worked.

somewhereoutth• 6 years ago

What I fail to understand - where was the emergency planning? A global pandemic is surely one thing that is a) foreseeable and b) possible to plan for. PPE could have been stockpiled, essential industry identified, testing infrastructure established, quarantine protocols put in place. We even had a dry run with SARS!

I'm sure there are (or were) civil defence / continuity of government plans in case of nuclear war, this must have been number 2 on the list of possible national emergencies?

baybal28• 6 years ago

Sure they were!

Some titles to Google:

National Security Council: National Biodefense Strategy 2018

H.R. 269 (116th): Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019

H.R. 6378 (115th): Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018

United States Government Accountability Office — Report on national bio defence strategy

Bipartisan Commission on Biodefense Report 2019

casefields• 6 years ago

George W. Bush in 2005: 'If we wait for a pandemic to appear, it will be too late to prepare'

https://abcnews.go.com/Politics/george-bush-2005-wait-pandem...

Bush Administration planning here: https://www.cdc.gov/flu/pandemic-resources/planning-prepared...

It was all ignored. It's why Obama got heat during the 2009 H1N1 outbreak, and Trump now.

pm_me_ur_fullzz3• 6 years ago

Having acquired the requisite funds — more than five times the amount we would normally pay for a similar shipment, but still less than what was being requested by other brokers

Pay attention people, this IS the market price. Even most state's "price gouging" laws are limited to 30 days after the State of Emergency because if the emergency has lasted that long, it is probably external forces outside of the state. Just like is happening here.

This equipment has to be provided to the whole population, eventually, and each person needs a whole pack. So since this does not exist, the prices go up as every state and organization has its needs and tries to prioritize health care workers.

To those noticing you can wash N95 masks in certain procedures:

It is also possible to boil water from a stream to remove some impurities. Or you could just have more clean water, maybe even bottled. I wonder what people will choose?

We are still at the healthcare workers first, phase. The inventory does.not.exist, the inventory is not re-usable, there is a market that has no relation to what prices were before the state of emergency. Insatiable quantity and people just catching on can't effectively be in this market quickly. China limits factories and more.

anxman• 6 years ago

I wrote up instructions on how to buy KN95 Masks from China for $1.67 delivered. Please share it to anybody in need of KN95 masks. If you need samples of the masks, I can send them to you for free, just shoot me a message.

https://docs.google.com/document/d/1BKUmZgwrvPG47VMR8SFvvSVh...

pm_me_ur_fullzz3• 6 years ago

The price premium comes from shipping and the cost of time.

MOST suppliers and even stateside vendors are trying to use Fedex, UPS, DHL. Many profiteers/altruists have already seen the possibilities here, and it is crowded but has irreconcilable limitations. You need your own cargo planes, shutting out most of the market. Plenty of other pitfalls too. With the risk involved, the "public health" ethical debate around pricing now falls flat, there is fortune involved in overcoming these hurdles.

People IN THE US want supplies IN THE US, not 10-15 days later with threat of seizure by CCP, by Customs in China, by Customs in US, by Federal Government and questionable product validity. So there is still actual, irreconcilable scarcity, because even the fastest trendiest entreprenuers just really cannot tell and operate on assurances, whereas the people that can have a limited supply that is bought instantly in a constant bidding war.

pm_me_ur_fullzz3• 6 years ago

so they still buying or what

syllable_studio• 6 years ago

Fixing our PPE supply chain was/is a solvable problem that our governments have utterly failed to address properly. It is shameful that our federal and state governments haven't better organized and incentivized solutions to fix this. I understand that it's hard. I understand that they're working hard to address this problem. But it's unacceptable that we haven't just gotten this done -- that we've instead put the burden on our medical workers to solve this life-or-death problem. As if they didn't already have enough to worry about.

I feel much closer to this issue than I expected to be. Because I worked for weeks with a volunteer group called helpfulengineering.org to help figure out how to make face shields through local partnerships. I was helping organize efforts for the city of Chicago. Our group made dozens of 3D printed face shields, then hundreds. Each face shield was given to a medical worker who sent back stories about how desperately important each one was to them.

https://twitter.com/syllablehq/status/1247891099324051462

In an effort to scale up faster, we got price quotes from local manufacturers who could manufacture NIH vetted face shields in bulk using injection molding or die cutting. These local manufacturers were very eager to help and work with us. We were prepared to get our own investment to kick-start the manufacturing as long as we had some confidence that we could get the products to market and not lose tens of thousands of dollars. We were prepared to sell them AT COST - not even for a profit. Next step: we just needed help to connect these manufacturers with an organized supply chain.

We talked to government offices and offered to help them get this plan in motion. But no one could do anything except direct us to generic websites and phone numbers. We filled out forms and called numbers. Never heard back. One government office told us they were working as hard as they could, and there were numerous projects in the works... but they couldn't give us any more information. No transparency.

Weeks later, the hospitals are still in desperate need. There is still no plan to solve this problem. Corporations have stepped up to donate a million here and a million there. This is great. But it's not a replacement for the war-time effort we need to save thousands of lives.

Thank you to so many leaders who are working hard -- including those from Chicago. But we've got to do better than this. If our medical workers were soldiers, we would not send them to war expecting them to find their own community donated helmets.

rckoepke8• 6 years ago

As a chief physician executive, I rarely get involved in my health system’s supply-chain activities.

This seems crazy to me. Maybe it's because I came from manufacturing, where even front-line managers are heavily involved in supply-chain activities. We constantly have discussions about how this-or-that global/regional/local event might affect x or y commodity and the tortuous potential paths that may have to affecting our business niches. However, high functioning bars and restaurants also generally seem to have an excellent grasp of their extended supply chain and market forces.

It blows my mind that hospital executives didn't understand much at all about where their necessary supplies came from.

Jemm• 6 years ago

Time to start manufacturing in country which now means that, in North America, we need to provide financial incentives to all manufacturing because you can’t start building one product without the local supply chain to accomplish that.

The time of cheap Chinese made goods must come to an end.

In Pursuit of PPE

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