Comment by crazygringo | Hacker News Reader

Comment by crazygringo | Hacker News Reader

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There are a lot of things about this pandemic that have left me depressed.

But the fact that as the world's richest country, we don't even have the administrative ability to keep a national emergency stockpile of essential medical supplies like face masks to get to hospitals immediately is just... I can't even.

By sheer coincidence, I happened to spend a week in Mexico City the day swine flu hit it, a decade ago. For the next several days, there were policemen everywhere distributing masks to the public. Instant response, zero shortage.

I am genuinely curious what the root cause is here, if you did a "five whys" analysis. Not a knee-jerk thing, but the real answer.

Is it that political squabbling has left things unfunded? Unappointed administrators have left things undone, unmaintained, or backlogged? Was it a conscious decision to decentralize and expect each hospital to be responsible for maintaining its own emergency supply? A belief that supply chains would handle it and stockpiling not needed? Is there a stockpile somewhere that isn't being released?

I'm really looking forward to a newspaper exposé on this one, because it's a true scandal.

From what I read, it seems there was a cache of N95 respirators in the Strategic National Stockpile.

However, it was depleted during the 2009 H1N1 outbreak and never replenished. Instead, their budget was used for what they thought were more pressing concerns at the time — stockpiling drugs/equipment for other emerging diseases.

Source: https://www.washingtonpost.com/investigations/face-masks-in-...

With a larger budget, they could have done both. And why was their budget so limited?

How much of a budget would you need to stockpile like 10 million masks? I don't think it is a cost problem.

No, it's not a cost issue. But I suspect that it was a consequence of meeting fixed cost reduction targets, and being something where cutting had no immediate impact.

Probably in part due to the 2012 sequester

More generally, the Budget Control Act of 2011.

Privatization means surplus gets extracted to investors, rather than saved for good times.

Pervasive managerial culture causes oversight to become opaque, phrasing it in terms of vague financials instead of specific structure by domain experts.

Economic annealing makes margins thinner and thinner ("cost cutting"), leaving no slack for any change in conditions.

These trends are happening to individual private institutions, as well as at the government level. Stockpiling masks is impossible if it's no longer in your vocabulary.

As soon as a metric becomes a target, it ceases to be a good metric. The market is a large part of our national religion, appointing metrics supreme in a circular fashion.

Isn't it stunning that even three months ago, no one in the federal disaster preparation programs thought about supply chains for masks?

I simply don't know how to process the news that we both waste $1 trillion dollars per year on our military, and we haven't built a $5m (or hell, $50m) machine that can allow us to totally source N95 masks from the raw materials up. Does Walmart seriously think more deeply about supply chains than our disaster prep and military?

Commerce sees results at the end of the quarter. Disaster prep sees results years later or maybe never.

So this is the main problem if all is driven by optimizing to a single value.

In the news it was said that normal procedures require about 30 masks per IC patient per day. That’s a lot of masks to stockpile and even then it wouldn’t last too long.

Still difficult to understand how in Japan everyone wears these masks every day and in the West they can’t be produced.

> But the fact that as the world's richest country...

It's at times like these you should question whether it really is the "world's richest country". I'm sure you can find certain metrics where it is, but that's irrelevant if the country is unable to respond to disasters like a hurricane or an epidemic.

The strategic stockpile shouldn't just be masks. It should also be an assembly line to make more masks should the stockpile run out.

The US had a stockpile, but it was for bioterrorism scale and not pandemic scale.

Ontario (Canada) stockpiled a lot after the whole SARS thing. Unfortunately they never planned rotating the supply or budgeted for it. So out of the 55 million masks we stocked, 80% have expired.

https://www.reuters.com/article/us-health-coronavirus-canada...

I'm certain the people unnecessarily infected with Covid-19 will be glad, as they pass away, that the cough that killed them wasn't suppressed by an out-of-date mask.

"Expired" might mean that the mask material has disintegrated and could itself be sucked into the lungs. Or perhaps it means that fungal infections could have grown in the masks. Or maybe the government really made a decision based on short term thinking and tossed the masks to make room for piles of salt or something. Or maybe the cost of storing masks really isn't worth it because there's lots of things that can decimate society (nuclear war?) and we needed to more urgently spend money there. Who knows, right?

"Expired" mostly seems to mean that no-one has tested that they still meet specs beyond that date, because there's no commercial incentive to do so. Similar thing with expiry dates on many medicines.

Along those lines, Meltblown fabric used in N95 respirators is made from plastic by some incredibly high tech machines. Each costing $5m per machine (line): https://www.reicofil.com/en/pages/meltblown_lines

You’re absolutely right. When a mask is expired, it should not be used. There is a reason for the expiration date and it’s not just for profiteering or some malicious motive.

Lot of expiration dates you see in medicines is FDA regulated and should be taken seriously.

Some expiration dates are important. Many, perhaps most, are arbitrary, fake, or ultra-conservative – optimized to minimize liability & maximize repurchases in non-emergency situations.

An expired mask will almost certainly be better than no mask. And especially so stored well with no visible degradation – it's heat & contamination by elements that could jeopardize their essential properties.

(Some N95 masks I bought during last year's northern California fires are individually sealed in cellophane with no expiration date. Stored in a cool, dry place they'd likely be fine decades from now. If some governments bought flakier masks in more-fragile packaging with early expiration dates, that's on them.)

As a consumer, how do you know which ones are to trust and which ones to not?

How do you know that your N95 mask is “fine”? Ultra fine submicron particles in your lungs can lead to a lot of problems. These fibers are essentially plastic.

How does one know anything's "fine"? Your senses & accumulated evidence.

Let's say it's the Zombie Uprising of 2040, and I open a well-stored, individually-wrapped N95 mask from 20 years ago.

It's got no expiration date on it (as per the ones I bought last year), & it looks good, & doesn't give off any dust, & it smells the same as I recall new masks smelling. I'll figure that's "fine" – unless & until someone has specifically shared some study demonstrating their dangerous-yet-imperceptible degradation.

Is there such a study, or is this just "there be dragons" fear-of-the-unknown?

> Lot of expiration dates you see in medicines is FDA regulated and should be taken seriously.

This is not true. The FDA dates are ultra-conservative for liability reasons. The military has done a lot of research (well, asked other people to do research) on this, and found that the vast majority of "expired" medicine is perfectly fine:

> To save money on regularly replacing its drug stockpile, in 1985 the US Air Force asked the FDA to test some products. Since then, the FDA has found that 90% of over 100 prescription and over-the-counter drugs tested could be used safely past their expiration date, a Pentagon spokesman told the Associated Press, adding that the dates tended to be very conservative. Products were tested by either the manufacturer or the FDA, but always with agency supervision.

Source: https://www.thepharmaletter.com/article/fda-tests-let-milita...

The CDC has literally outlined which expired masks are acceptable and which are not:

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/FAQ-N95.aspx

Take that for what you will.

I speak from experience. Most expiration dates for this kind of thing are absolutely meaningless. I see expiration dates for sealed glass containers of water, methanol, dry chemicals stored at -80C, etc. It is all complete bull.

That's probably because there's a legal obligation to put an expiration date on it. Where I live all consumables have to have an expiration date so there is a best before date on table salt. Salt. Most likely this is because it's cheaper and easier to put an expiration date on everything rather than discussing the exceptions on a case by case basis.

The only food I can think off that literally says "last forever if stored properly" is sugar.

Eg. soda stream bottles (the water container) have an bogus expiration date, honey have expiration dates ...

When decades-old drugs were tested, nearly all were found to be just as effective as when they were new.

All an expiration date really means is they never bothered to test the efficacy beyond a couple years, but the compounds are remarkably stable.

https://www.npr.org/sections/health-shots/2017/07/18/5372578...

Expired masks are better than no masks. I hope they didn't get tossed.

At the very least, give them to service workers.

Why would "bioterrorism scale" & "pandemic scale" be different, especially if a bioterror agent was crafted to be contagious (& thus create pandemic conditions)?

A bioterrorist cell would not have the resources to craft a perfectly engineered biological weapon. They'd be more likely to have access to limited quantities of some pre-existing biological agent (like anthrax, say). So what you'd see in that scenario is attacks that cause a bunch of casualties in a few locations in one big splash, and then quickly peter out after that.

It's like, what's the difference between a terrorist nuclear attack and a full-scale nuclear war? In the former scenario, you're talking a small number of low-yield devices triggered in one country; the rest of the world still stands able to provide assistance. In the latter scenario, there's nobody left to help who hasn't also been blown to ashes.

I think you would re-evaluate this reasoning after watching the show ‘Jericho’.

https://en.m.wikipedia.org/wiki/Jericho_(2006_TV_series)

Just to add, but why would a bioterror agent not be crafted to be contagious?

Spread is the big differential on bioterror, and most other forms of terrorism do not require a team with members that have 2 PHDs each.

Unfortunately putting incompetent people in charge of the Federal government has had predictable results -- We don't have enough masks (they're sending 1/10th the number that states are requesting) and the majority of the stockpiled gear is expired:

https://twitter.com/hshaban/status/1240114213009358852

In case you're suggesting the current administration is entirely at fault, the mask stockpile was depleted in 2009 and never replenished https://www.washingtonpost.com/investigations/face-masks-in-...

Isn't the reason obvious? Healthcare in the US is an insanely profitable and powerful business. If everybody gets infected, tens of millions will need expensive treatment the rest of their lives. Healthcare will make tens of trillions dollars. Remember the anecdote that there are no laws that big capital wouldn't break for the 3x profit? Here we are talking about profits comparable with the entire world's wealth. We have an opportunity to witness this sociopathic system in its nature state: the virus needs 1-2 months to spread everywhere and during this short period, the healthcare system is going to openly block any attempts to prevent its spread. After that it's going to open the gates and let the tests, masks and vaccines flood the market.

There aren't "tens of trillions of dollars" people can spend on healthcare. Making everyone sick collapses the economy, and these companies would be negatively impacted by it.

Face masks are running out in many countries, not just the US. This isn't really a product of the atrocious healthcare system the US has, it's just a product of not being well-prepared for disaster scenarios.

Think about how most companies don't check whether their backups work. Now, replace "working backups" with "stocked-up pandemic supplies".

I'm not going to argue. We only need to wait for 2 months to see who's right.

You don't need to wait to do some basic logic checking on your post.

You said it yourself: "Here we are talking about profits comparable with the entire world's wealth". What do you exactly think is going to happen if americans try to spend "the entire world's wealth" on health care?

I don't believe your implications but even I could make a more convincing case for them than that.

I suspect that federal stockpiles of medical supplies were sacrificed to give money to the wealthy. Likely because there was no constituency for them.

Edit: So how are stockpiles of masks somehow not part of downsizing the federal government?

Stockpiles weren’t replenished under the Obama admin. Unless he passed a tax cut I missed, you can blame him for the de-prioritization of mask stockpiles. Let’s not forget the CDC has been working on “diseases” such as gun violence and climate change. They should have stuck to their core competency of infectious diseases.

Obama was forced into broad brush cost reductions.

We’re almost 80% into Trump’s term. Why blame Obama for it? What stopped Trump from doing the right thing? His poor tweeting habit? Let’s face it, this administration is ill prepared for such an event. This will cost them dearly in November.

> Let’s face it, this administration is ill prepared for such an event. This will cost them dearly in November.

That still remains to be seen. Right now the states with the most cases (CA, WA, NY, see [0]) are firmly Democrat, with much fewer cases in Republican and swing states.

It's possible that the number of cases in those states won't rise to critical numbers, and thus have limited effect on his reelection odds.

[0] https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/case...

Most urban counties are blue. Cannot blame Dems for infectious disease based on density of cases.

I'm not blaming anyone. I'm merely pointing out that at the moment, Republican areas don't have as many cases, and thus don't really have a reason to have doubts about the current Republican leadership.

This can be seen in polls of how the current administration is handling the Coronavirus [0], with an extremely sharp divide between Republicans and Democrats. The vast majority of Republicans approve of the current administration and their handling of it, whereas very few Democrats do.

This, of course, may change significantly between now and election time. The polls quoted by fivethirtyeight are also from early in March, and the public opinion may have shifted since then.

[0] https://fivethirtyeight.com/features/how-concerned-are-ameri...

You're "merely" ignoring the confounding reason why Republican-leaning areas have fewer cases, as pointed out by the parent post.

From your own reference:

> This party-line split isn’t that surprising, though: According to experts, many public health issues — which are seemingly nonpartisan — have become increasingly polarizing.

So no surprise that Republicans think their guy's doing good, and Democrats think he's doing badly.

It's surprising (and a little disappointing really) that 538 didn't seem to consider where independents split on it.

> You're "merely" ignoring the confounding reason why Republican-leaning areas have fewer cases, as pointed out by the parent post.

Can you explain to me how that's relevant here? The grandparent post said that "This will cost them dearly in November," which is not borne by evidence at this point in time.

If you have evidence that points to the fact that Republicans or independents are considering voting Democrat based on this issue, I'd love to hear it.

> Can you explain to me how that's relevant here?

>> Most urban counties are blue. Cannot blame Dems for infectious disease based on density of cases.

GP asserted that incidence of SARS-CoV-2 didn't correlate with majority voting inclination.

> If you have evidence that points to the fact that Republicans or independents are considering voting Democrat based on this issue, I'd love to hear it.

If you have any proof that Republicans or independents are more inclined to vote, or to vote Republican, as a direct consequence of the Republicans' handling of this pandemic, I'd love to hear it.

On the basis that the pandemic is likely to be the causal factor in a global recession, there's plenty of evidence that would factor negatively in the US election [1]

1: https://fivethirtyeight.com/features/americans-views-of-the-...

> the fact that independents appear persuadable on the economy is a point in favor of the theory that a recession would indeed damage his reelection chances.

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