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Comment by jefftk | Hacker News Reader

"Regarding personal protective equipment—surgical gowns, gloves, masks, respirator protective devices, or other medical equipment designed to protect the wearer from injury or the spread of infection or illness—the FDA has heard reports of increased market demand and supply challenges for some of these products. However, the FDA is currently not aware of specific widespread shortages of medical devices, but we are aware of reports from CDC and other U.S. partners of increased ordering of a range of human medical products through distributors as some healthcare facilities in the U.S. are preparing for potential needs if the outbreak becomes severe."

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"?

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Manufacturers have stop shipping Masks and other protective gear to retail. Everything is going to the the Healthcare Industry.

HomeDepot will not get resupplied, Hospital down the street will get everything.

So we’re not containing the spread, we’re just fighting symptoms.

Joe can get sick, as long as the doctor treating him doesn’t?

Do you even understand risk planning and management? Triage? If the masks help people in direct contact maintain health and deliver health services more people survive, than if random people consume masks without contact or assessed risk. Masks are in short supply? What's the rationale to NOT direct masks to higher efficiency outcomes.

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.

Actually masks aren’t meant to help keep a person from getting sick. For that, wash your hands frequently and wear gloves. Masks are for people infected. Contain the contagion at the source with a mask. Doesn’t do anybody good for the paranoid to have all the masks.

Masks don't but respirators do. You can safely read "mask" as "respirator" in this thread.

‘Particulate Filtering Facepiece Respirator’ is the NIOSH term.

I repeat: Joe doesn't know he's sick. His mask is worth wearing if he knows he's sick. If he just suspects he's sick then a low grade hospital mask will contain sneezes and sniffles enough to reduce his fomite impact, although gloves might do more.

Most Joes are wearing masks and wasting masks in a false belief they confer protection.

This is really bad for the construction industry. Spraying oil based paints, environments with asbestos, dealing with lead paint, spraying insulation, and other really chemical heavy operations require protective gear.

can you say for certain that home depot supplies the construction industry to such an extreme degree that it will be really bad? maybe for small businesses, but the bigger ones have independent suppliers that aren't home depot for their shit.

Gearing up hospitals to protect before a possible full blown outbreak ranks higher than private industry specific needs. If those construction employers care, they can pay the premium supply vs demand price increase not their employees.

The problem is construction firms "encouraging" their employees to work without proper PPE. This is illegal, but...

That's been a VERY big problem in the construction industry.

Unions ftw

Or they won't do it. Which will degrade homes and infrastructure.

I'm relatively sure that homes and infrastructure can manage waiting a year.

Your permits will expire and the banks funding your construction are going to have a fit. If there is a market crash because of the virus that leads to a real estate slump, however, this could be a blessing in disguise. On the other hand, it could also be suppressed market activity that pushes the economy over the edge.

I ended up needing to paint something myself for a project due in a month and might just give up if I can't find any respirators.

I had to beg around my friends and asks for masks so I could do my hardie board install.

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

Maybe they were shipping over the used ones.

Oh nice, remodeling a bathroom with that hardie board or what? Is that the concrete sheet for wet environments?

Construction industry? I’ve had several people tell me this week, from plumbing to transport, saying people are starting to be let go because supply isn’t coming from China.

You can’t have a construction industry when the supply chain has choked

Where are you reading this? I have friends in the medical industry telling me that their surgical mask suppliers have started restricting orders.

The article was behind a paywall, I have posted an outline link in support of my previous post.

Article: With masks for coronavirus in demand, Fort Worth-area company selling only to hospitals | Fort Worth Star-Telegram

https://outline.com/XF3nwJ

I work in an outpatient medical office. Our office manager said that the major mask supplier that we use is rationing the number of boxes of masks that can be ordered, but still fulfilling orders. So while there may be a true shortage in medical facilities in the future, current shortages are in retail. Or at least that's my n=1 data point.

Usually one gets put on "allocation", where you can only order amounts based on your historical ordering history.

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.

I am guessing they are speaking specifically about supplies to medical facilities, not the general public. The NYTimes ran an article recently [1] that makes it sound like the New York area has a hefty stockpile ready in the case of an outbreak.

[1]: https://www.nytimes.com/2020/02/27/nyregion/new-york-coronav...

my understanding is that masks are sold out at standard suppliers and have been for a while

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.

Unavoidably slightly political but...

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.

Correlation, causation, etc.

Off topic from your post but:

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?

Likely to buy these masks :D

Buying them for my elderly Chinese inlaws, yeesh. As an asthmatic, I already had a bunch for fire season so I really don't need any more.

I assume you live in America or Europe. In countries hardest hit masks are almost entirely sold out from retail. I'm HK I hear some people are having trouble buying toilet paper or canned goods locally as people are stocking up.

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.

I think they’re still in stock at _some_ Home Depots. At least last I checked.

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).

> IPA70/Sporklenz

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?)

https://www.sterislifesciences.com/products/surface-disinfec...

> Spor-Klenz® Ready-to-Use Sterilant

> 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."

That hyphenation makes a lot more sense, I was parsing it as 'spork-lenz'

Yup, me too. Something sounding like "spore cleanse" makes a lot more sense in this context than "spork lens".

Fork, spoon, and magnifier all in one! Sporklenz!

Not sure about Sporklenz but yes IPA70 is referring to an Isopropyl Alcohol solution of 70% isopropyl alcohol. Higher concentrations are also effective but above 75% you risk burn or excessive drying upon direct skin contact. FWIW, a 99% concentration will very quickly pick up atmospheric moisture and stabilize closer to 96% in all but the most dry of environments.

> Not sure about Sporklenz but yes IPA70 is referring to an Isopropyl Alcohol solution of 70% isopropyl alcohol. Higher concentrations are also effective but above 75% you risk burn or excessive drying upon direct skin contact. FWIW, a 99% concentration will very quickly pick up atmospheric moisture and stabilize closer to 96% in all but the most dry of environments.

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.

50-70% IPA is actually a more effective disinfectant than 99%; the water helps it penetrate cell walls, I'm told.

The water slows down the evaporation letting it linger long enough to be useful (at least that's what I think I read). Either way, 70% is gentler on skin. 90%+ is great for cleaning oily stains and whatnot.

The chemistry is kind of interesting. If you distill isopropyl alcohol, you can't get more concentrated than 91% because it forms an azeotrope. That is, if you try to distill 91% isopropyl alcohol, the vapors are also 91% concentration, so distillation doesn't get you any further. Thus, 91% isopropyl alcohol is a common product. Similarly, ethanol forms an azeotrope at 95% concentration, so you can't distill higher than that. This is why, for instance, Everclear has a 95% alcohol concentration. (You can produce higher concentrations, of course, but it requires a more expensive process than distillation.)

https://en.wikipedia.org/wiki/Azeotrope

0 inventory at Home Depot, Lowes, Harbor Freight, etc. Hand sanitizer sold out at almost all retailers in the major city I live in too, I managed to snag some from a store people wouldn't think of (office depot). I have a few N95 masks, but I bought them ages ago and I'd be using them for painting or grinding metal, not the virus.

>10% bleach should also work but it’s nastier

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.

Yes, true. The stuff you get for the laundry load at home should be about 1:9 water. But it loses potency over a few days.

Right: mix your diluted bleach solutions at least daily

What about the 60% alcohol content hand sanitizer I'm seeing?

Is there a higher level than N95 that filters more airborne particulates or is that entering HEPA filter territory and impossible to breath through such dense material.

I've heard N100 would be the next best thing, but I'm not sure.

If bleach gets hard to find, some varieties of Pool Shock are basically highly concentrated (around 70%) dry bleach. The one you need for that is calcium hypochlorite. Just add water to get the desired proportion.

This is also a lot cheaper than buying liquid bleach.

I think they're referring to availability for medicine. My facility has zero issue ordering PPE at the moment; we order many thousands of boxes of gloves and masks and have no issue with that.

I wonder how many boxes of masks "go missing" in a given month and if this will spike now that the resale price is so high.

We're starting to keep a more careful eye on inventory for that reason.

FYI on the extremely high prices: while the prices from online resellers are dramatically higher than before all this, they're still probably affordable for most people on this forum, in the range of $5-$20 per disposable N95 mask. (CDC says you can reuse disposables)

I'm guessing they mean "specific widespread shortage (at medical facilities)." Which is categorically different from a retail shortage at your local pharmacy or retail store.

One would hope that the government has a stockpile of a lot of this sort of thing. The question will be whether they stockpiled enough.

The masks do absolutely nothing for the general public. The purpose of a mask in a hospital setting is to stop what's in you from going into anyone else. That's true of both the doctors in the OR and patients. They do nothing to stop what comes out of someone else getting into you. Unless you're wearing a full-on bio suit like in a research facility or an N95, save yourself the trouble. [1] Just wash your hands before you touch your face.

[1] https://www.nbcnews.com/health/health-news/main-focus-preven...

True for cheap surgical masks, definitely not true for N95 or P100 masks with HEPA filters.

If you are carrying for a sick person in your home or in a hospital, you need a quality mask and eye protection.

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