COVID-19 Supply Chain Update
fda.gov
fda.gov
This is very weird: my understanding is that masks are sold out at standard suppliers and have been for a while (though available at extremely high prices from resellers). This seems like it is beyond "supply challenges" and into being a "specific widespread shortage"?
[1]: https://www.nytimes.com/2020/02/27/nyregion/new-york-coronav...
Where I live it's hit-and-miss, but not as bad as it used to be.
When this first started, masks were hard to come by because people were buying out stores to ship to relatives in China.
Today I've been to three places, and two of them had masks. The third was out of hand sanitizer.
I saw a shift in behavior following Trump's conference appointing Mike Pence as the effective coronavirus czar.
Every morning there was a small stash of N95 masks at my local Home Depot until yesterday. Similarly I started seeing specific sorts of non-perishables disappearing from the shelves of Trader Joe's and Safeways. Where it goes next, I don't know. But I think the crowd has spoken on the subject already.
Every morning there was a small stash of N95 masks at my local Home Depot until yesterday
Why do you go to Home Depot every morning?
One problem is that if masks cant be purchased, and here in Bangkok they are already almost entirely sold out, and someone runs out of masks, and the outbreak is bad, they arent going to leave their house. They wont risk it. I hope they also have enough food at home to last.
In any case, an N95 mask is insufficient if you don’t cover eyes as well and don’t use IPA70/Sporklenz or similar after touching any common surface. 10% bleach should also work but it’s nastier (to skin and materials).
OK, searching on that term brings up an impressive number of PDF data sheets.
IPA70 seems to mean Isopropyl Alcohol, 70%.
Sporklenz no idea but it conjured up images of a European Homer Simpson repping cleaning products as _Mr. Sporklenz._ (Herr Sporklenz?)
> cleanroom disinfectant, sterilant and sporicidal cleaner
Ah...got it. Thank you.
> Odor: Vinegar
Ewww. Hope it's not too bad. I wouldn't want a strong vinegar smell in my clean room.
Also interesting:
"Spor-Klenz RTU sterilant was found to be effective against mouse hepatitis virus, minute virus of mice, murine norovirus, murine para influenza virus type 1 (Sendai) and Human Immunodeficiency Virus (HIV-1) when tested according to EPA guidelines undiluted for 10 minutes at 20°C (68°F) exposure. Spor-Klenz RTU sterilant was found to be effective against mouse parvovirus when tested according to EPA guidelines undiluted for 25 minutes at 20°C (68°F). Treated surfaces must remain completely immersed for 25 minutes."
During a previous outbreak that led to hand sanitizer getting hard to find/expensive, I just dumped a bunch of 70% rubbing alcohol into my existing bottle once it gets half empty.
You mean concentrated (~5%) bleach that's been diluted 1:10, so it's ~0.5% bleach, right?
Something that was actually 10% strength would be way too strong for cleaning.
This is also a lot cheaper than buying liquid bleach.
Sometimes it's 100%, other times it's less, depending on actual availability.
Helps prevent stockpiling, but creates issues if your operation is bigger than it used to be.
HomeDepot will not get resupplied, Hospital down the street will get everything.
Joe can get sick, as long as the doctor treating him doesn’t?
We don't all consume naltrexone in case heroin accidentally falls in our mouth. Prophylactic use of antibiotics ruined antibiotics because of emerged resistance.
If you know you need a mask you can get one. If you want a mask at the cost of a health professional doing their job, shame on you.
Joe doesn't know he's sick. Joe won't avoid getting sick wearing a P2 mask. A health worker in P2 mask and gloves can avoid cross infection risks and help reduce transmission working in an environment of higher risk exposure. if Joe is infected and knows he is infected he will either be hospitalized or isolated. If Joe is prodromal the likelihood the knows and uses a mask to good effect is lower than the likelihood nobody knows and he isn't sick and the mask is wasted.
Do the maths.
Most Joes are wearing masks and wasting masks in a false belief they confer protection.
I've heard that harbor freight still has some in stock.. but there is a sense of irony buying facemasks from the country of covid19 epicenter... oh well
You can’t have a construction industry when the supply chain has choked
Article: With masks for coronavirus in demand, Fort Worth-area company selling only to hospitals | Fort Worth Star-Telegram
[1] https://www.nbcnews.com/health/health-news/main-focus-preven...
If you are carrying for a sick person in your home or in a hospital, you need a quality mask and eye protection.
> A manufacturer has alerted us to a shortage of a human drug that was recently added to the drug shortages list. The manufacturer just notified us that this shortage is related to a site affected by coronavirus. The shortage is due to an issue with manufacturing of an active pharmaceutical ingredient used in the drug. It is important to note that there are other alternatives that can be used by patients. We are working with the manufacturer as well as other manufacturers to mitigate the shortage. We will do everything possible to mitigate the shortage.
They don't name the manufacturer, the drug, or really much of anything.
In an administration that frequently gets involved in cover-ups, you can't fault the FDA for trying to disclose as much as they can without causing new problems.
Plus the press release goes on to detail many other areas of FDA's regulatory domain that are also helpful.
Non mobile link: https://en.wikipedia.org/wiki/Special_English
Fortunately, there are different types of drugs that can help. We are making these other drugs available.
is WAY WORSE than
> there aren't enough ingredients for the drug
The phrase 'issue with manufacturing of' covers a much wider range of problems than a shortage. Maybe they have tonnes of materials and they just need a mechanic to fix the machine for example. No shortages of anything except people in the right place at the right time.
The websites of government agencies usually have a version in leichter Sprache, although it tends to be counterproductively hidden.
The NDR offers news using leichte Sprache: https://www.ndr.de/fernsehen/service/leichte_sprache/
Edit: or any of the other sites on this list: https://bpb.de/politik/grundfragen/politik-einfach-fuer-alle...
Further edit: there's a Wikipedia category for simplified languages, which in addition to English and German also has Latin and French: https://en.wikipedia.org/wiki/Category:Simplified_languages
But, you're right- the idea is to write as plainly and clearly as possible so the largest number of people can understand.
As for why the drug or manufacturer wasn't named, my guess is that it's so that there isn't a run on a particular medication causing unnecessary shortages.
Making things accessable to the common denominator has a generally negative effect on society IMO. This is one major reason why our U.S. schools have been falling behind for decades - they are too focused on not leaving the poor performers behind, at the cost of limiting the achievement of those above the average.
This is fascinating. I had trouble understanding the FDA's article until I slowed down and imagined a newscaster reading it. (It's still really hard to skim, though. Weird phrasing.)
You could probably figure it out from there. My guess is it would be irresponsible for them to name the Mfgr in the press release, particularly if it were a publicly traded company and people are going to jump to uninformed conclusions.
https://www.accessdata.fda.gov/scripts/drugshortages/
Supply chain security has also been a major focus at FDA over the last ~5 years, basically to ensure there are not "choke points" with respect to approved medicines:
https://www.fda.gov/drugs/drug-supply-chain-security-act-dsc...
So in general, I appreciate their transparency on this since they have been building up regs around this very type of issue for awhile.
Not only could it harm the company, it could be bad for patients. Naming it could cause a run (https://en.wikipedia.org/wiki/Market_run) on the drug, and if some people hoard it, there will be other people who are unable to get it.
I guess I'm grumpy today, after looking at the prices of respirators and antiseptics in Poland being already 10-20x the usual, and growing. And we don't even have a confirmed case just yet (doesn't stop the media from reporting a new "first case" every day for the past two weeks).
Also this morning I've seen an ad on our local equivalent of Craigslist; somebody is trying to sell a pre-packaged web store for selling face masks, complete with a bunch of legit-sounding domains (using phrases "medical respirators", "anti coronavirus respirators", etc.) and three contracts to wholesalers of surgical masks, for roughly $1k total. Note: surgical masks. The ones that are worn to prevent accidental exchange of bodily fluids between patient and the surgeon. The ones that are completely ineffective against airborne viruses.
I really feel that some people need to have cooperation and civil behavior beaten into them.
Not medical advice per se. I'm not a doctor. I'm just someone continuing to rudely fail to die instead of going along with politely dying according to schedule so other people can feel like they are smart and know things.
(This comment will self destruct in the near future.)
Still, what can I say about my concerns? I'm scared. For myself, my wife, our infant, our families. In this island of emptiness in the middle of red dots the Europe is on COVID-19 maps, we're all just nervously waiting for the first real case. Personal protection goods are already gone, people are slowly realizing that maybe it's about time to start stockpiling food. We've stocked ourselves up with ~two weeks worth of long-life consumables. Going to extend it over the weekend to a month's reserve. Our infant already has 2+ months supply. I try to be calm, but it's getting harder.
I don't know what I'm afraid more of at this point - of the virus, or of the quarantines and panic that will follow.
I'm not really comfortable talking about what I do rely on in public. There's a very long history of people being incredibly ugly to me, outright accusing me of being insane and of making up stories out of a sick need for attention. I've literally been accused of having Munchausen.
Though we don't interact often, you've been uncommonly kind and respectful to me in a sea of what often feels like outright abusive and sadistic behavior.
So if you are interested in talking with me privately about what I do in hopes of expanding your options and trying to protect you and yours, I'm willing to chat and leave it completely up to you whether or not you use any of that information.
Consider it to be an offer of a personal favor. If you don't think I can possibly help you, it's okay. Maybe you honestly don't recall my diagnosis or understand what that's supposed to mean.
I'm sorry you are under so much stress.
So if they fail to contain it, you'll be more likely to get it than to get the flu, but not especially more likely to die if you do get it. And even less likely in either case if you're currently healthy.
There isn't much reason to be concerned about quarantines either. The point of a quarantine is to limit the spread of the virus. When there are only a small number of cases, using extraordinary quarantine measures is justified because there is the potential to stamp it out entirely. If too many people get infected, there is no longer any hope of that and continuing the extraordinary measures is impractical. You shut down an airport when a city is infected, you don't shut down every airport when every city is infected. So if it spreads, you fall back to the ordinary measures. Wash your hands, if you get sick go to the doctor and not to work, get vaccinated once they have a vaccine etc. It's not good but the world doesn't shut down.
Around 10% of people get the flu every year. If this is equally severe but more contagious, maybe it's twice as bad, or five times as bad. It seems pretty implausible that it could be much more than ten times as bad.
An advantage we have here is that February is over. Flu season is ending rather than beginning in the northern hemisphere (and it's still several months off in the southern hemisphere). So if they can keep it somewhat contained as things warm up, it shouldn't spread as fast in the spring.
Don't panic.
Particularly with reference to "a human drug"
Veterinary drugs are a thing, and it appears the FDA regulates them, too:
https://www.fda.gov/animal-veterinary/resources-you/fda-regu...
If you're the person who writes press releases for an organization which regulates both human and animal drugs, then you have a reason to be specific.
The Governor of California stated yesterday that California has only around 200 test kits for the entire state. To this very day, there is virtually zero testing of anyone happening in the entire United States — a fact that many people still are unable to believe (they remain in total denial). The SF Chronicle also confirms this story.
According to a highly disturbing Wall Street Journal story (https://www.wsj.com/articles/whistleblower-says-federal-empl...) federal employees who ran the quarantine sites in California and elsewhere failed to wear proper protective equipment (PPE) and also weren’t trained in how to handle people exposed to the virus. Most disturbingly, as the WSJ subhead says, “Employees weren’t tested for virus before leaving California quarantine sites on commercial flights.”
I am astounded by the frequency of idiots in key decision making positions globally.
That kind of short sightedness drives me nuts.
It is absolutely insane to be in the position where essential medical equipment is not going to be available in the US because of COVID19 quarantine in China.
What the absolute F are we paying US Pharma 1000% premiums for, if not in part to maintain control over supply chain.
Shameful.
https://www.reddit.com/r/gout/comments/faym30/pharmaceutical...
There are quite a few people in this thread assuming the press release is all the FDA has to say, and who appear to have made little effort to test that assumption.
I guess this proves the point that the use of Special English as per this comment https://news.ycombinator.com/item?id=22445952 is well warranted.
Given the number of illnesses that can be transmitted by indirect contact, including cases of sick food workers contaminating a supply, I feel like they should indicate a little more caution in this section.
China Rx is a very good book about this.
(Oblique reference to the movie Contagion)
https://www.ncbi.nlm.nih.gov/pubmed/12814717 https://www.nature.com/articles/news030609-16 https://en.wikipedia.org/wiki/Glycyrrhizin
https://www.mercurynews.com/2020/02/28/santa-clara-county-an...
Pressure Swing Absorption oxygen generators have been getting cheaper, and will separate oxygen from air as long as they have electrical power and maintenance every few months. PSA is not suitable for all medical uses though as it typically produces 90-95% oxygen and is not directly capable of producing pure oxygen.
They have various answers, but my experience now working on H1N1, SARS, Ebola and COVID-19 is that hospitals weirdly take the flow of oxygen as a given.
"Implementing critical infrastructure monitoring" is giving out an email address? Hmmm.
So when I see this:
> It is important to note that no law exists requiring medical device manufacturers to notify the FDA when they become aware of a circumstance, including discontinuation of a product, that could lead to a potential shortage, and manufacturers are not required to respond when the FDA requests information about potential supply chain disruption.
...in my head, I translate it to this:
> We welcome a law requiring medical device manufacturers to notify the FDA when they become aware of a potential shortage or discontinuation, and requiring manufacturers to respond when the FDA requests information about potential supply chain disruption.