Doctors Say Shortage of Protective Gear Is Dire
nytimes.com
nytimes.com
It's really hard to sell either of those to government bodies, even near cost. Already talked to the Red Cross, wholesale pharmacies and different ministries. They generally insist on payment on delivery, which we can't do for larger orders, as factories sell to whoever has the cash at the factory gate.
Some also want EU certifications (FFP2), while many factories in China only have the local Chinese standard (KN95). And some refuse to pay to a company outside Europa, while wanting to buy stuff from China.
So while I'd love to ship some of this stuff to Europe, currently people there are still blocking themselves. Hoping to work something out soon.
It's probably in a procurement regulation or guideline.
The bank can give the mask company money now. Once the American NGO receives the masks, it can directly pay the bank. That way the bank does not have to worry about the mask company stealing its collateral. The bank might even offer to pay for the provision of masks as a donation from China.
Hospitals (public and private) in the Bay Area are publicly talking about sourcing PPE from non-medical vendors (e.g. construction companies) and nurses are protesting in front of hospitals. Seattle area hospitals are making their own. All of which is to say I think that procurement guidelines will be dramatically relaxed.
If you can ballpark it I'll ask around.
About $0.5 to 0.6 for surgical masks ex factory. My email is in the profile if you got a hospital or similar. Not selling to consumers for now.
Can you contact me? (Email in my profile)
[1] China is the world's largest raw materials exporter for Drugs: https://www.wsj.com/articles/china-opens-door-to-foreign-dru...
Edit: I just realized that some of the startup and entrepreneurs around the world are on this forum, if you'd like to get into manufacturing, want to learn about more abstract concepts of manufacturing, I implore you to checkout: Manufacturing Planning and Control for Supply Chain Management reference book - https://books.google.com/books/about/Manufacturing_Planning_... This book is absolute gold. Manufacturing is like playing this game Factorio (google it) but in real life. It is an exciting field ripe for innovation, many very hard problems and unlimited potential (and a lot of risk as well).
No one is suggesting complete in-house isolation aka Autarky, but to avoid SPOF (single point of failure) supply chains - probability of each link breaking adds up when your supply chain is 18 levels deep from an iPhone to the copper mine.
If a BMW contains 99% local American parts, it's quite likely that much of the 1% are the hardest things to produce locally.
What makes a country resilient is not stockpiles, although those help, but the ability to quickly switch production to whatever is needed in the moment. Flexible production capacity trumps stockpiles, because you don't have to decide in advance what the crisis will be.
Unfortunately all of the flexible production is now in a country that's accusing the U.S. of deploying SARS-CoV2 as a bioweapon over Wuhan.
I thought before that it was someone eating a bat, but the hard propaganda push is making me suspect something more sinister that the Chinese are afraid will come out eventually, and they want to muddy the waters before it does.
1. Accept and be willing to pay a higher price (for manufacturing that happened in friendly places)
2. Impose tariffs on Chinese-made goods so that the local higher-price is a non-issue and may even be cheaper due to lower shipping costs.
3. Impose whatever it is that makes things more expensive in the West to also happen in China. E.g. environmental laws, regulations, working conditions, etc.
My vote would be number 3. Get the damn UN to proclaim something, impose sanctions and embargoes if they don't comply, kick them out of the UN meetings, blockade their border and punish countries that don't comply with the sanctions/embargo, etc. Right now, we all keep complaining, treaties and stuff gets passed and blasted out on the news with feel-good promises of compliance X-years later, but when non-compliance happens blatantly, no one does anything but complain and half-ass it by proclaiming condemnation, imposing silly sanctions that do very little, etc.
Half the humanitarian and human-rights problems happening right now around the world can be fixed if strict rules were put in place, and non-compliance by various governments was punished severely. We need to stop treating countries as nebulous entities with no accountability. Hold the entire country accountable and watch the dominoes fall into place as everyone really at the end of the day wants to get along and just go about their daily lives. If democracy works for citizens, it should work for countries.
Sum({Some percentage of total use / year} * {Storage costs}) over {All strategic materials}
And remember, all strategic materials would have to extend to things like non-woven fabric to be useful here.
The government funds some percent of our food production by putting in place limited price and production controls for American-produced goods.
The hand of the market is not completely removed: producers still want to be as efficient as possible. The cost of food has gone down over time. And inefficient producers still go bankrupt.
Is this a good model? I have no idea. It certainly has drawbacks. (Ex: we subsidize too much corn and wheat.) But the US can feed itself without China or OPEC, so that's nice.
I think there can be a lot of debate about the mix of subsidies and price controls. But the need I think is there. Food is a critical need as we are about to note. And it's really not the end of the world if things aren't perfectly optimal.
And it's a hard life.
You go into debt to buy machinery and raw materials (seed, fertilizer, pesticide) you need to generate competitive yields...
Then it doesn't rain. Or it rains too much. Or the weather is too good in Asia, depressing the global price.
And all it takes is a few years of the above, and the bank is foreclosing on property that may have been handed down to you through generations of family,
How does that make you feel as a person? And even if everything goes right, what does worrying about that constantly do to you?
Farm subsidies are a messy business, fraught with peril, but farmers can't just up and move like most of us. So I'm not unsympathetic to the underlying compassionate goal (even if the realization may be perverted).
I guess the closest analogy for many would be being a web dev, if browsers decided to randomize their compatibility with all standards every year. And you needed to take out a loan for a laptop and tooling.
Huge drawback right here, corn (high fructose corn syrup, corn itself) and wheat are both at the center of the obesity epidemic and health crisis. It's a point that's often brought up and isn't controversial at this point, but inertia makes it hard to correct, especially with said subsidies.
I am willing to bet, large number of America's problems can be traced straight to the abhorrently corrupt process of lobbying.
What's your proposal for how to ban lobbying?
You could vote for him if you're in the US.
People don't get the number of systems that will automatically target the most vulnerable/easily exploitable as soon as a deposit shows up, is a much bigger issue than actually handing cash out to people.
The "squeeze every penny" mega machine has grown so complex and large its hard to see how it can be dismantled.
Specifcally, the problem is the Universal Postal Union: https://en.wikipedia.org/wiki/Universal_Postal_Union
Locally made goods can benefit from some tax breaks and government subsidies as well, but the aforementioned problem needs to be resolved. Alas, it won't be because executives keep lobbying and paying off key decision makers.
The whole thing is corrupt. I don't agree with President Trump on majority of things, but I try to not let bias triumph over logic, pragmatism and rational ideas; no matter who is pushing them.
I say this as a resident physician at an urban hospital in the US. We're now severely low on N95 masks and moderately low on surgical masks but we have only had less than a dozen confirmed covid-19 cases (granted about 100 tested negative cases) so there's no way even 100 additional patients requiring masks suddenly plummeted our stockpiles of masks. Indeed, hospital administration noticed and sent out a mass email imploring employees to return unused masks in personal possession.
Perhaps theft can explain the reduction, but isn't that equivalent to (for example) a leaky toilet destroying the room that the masks are in? In other words, perhaps it is still indicative a weakness in the hospital's supply chain that they can't make up for a sudden shortage of masks due to rare circumstances.
If people hadn't been stealing masks for their own personal use outside the hospital, we probably could have had our supplies last another few weeks, which is significant.
It's easy to become jaded and cynical, but I'm beginning to believe this is the wake up call a lot of people need and anything less than an unmitigated disaster will be converted into a win to all these science denying, public health de-funding radicals running some governments.
It's probably the stress, anxiety and anger at the impotence caused by all this, but I can't help but feel a desire to lash out those people who have made things worse.
According to the CDC[1], you can contact your healthcare provider for the possibility of a test if (and only if) you are in close contact with someone with the disease or if you're in a community where there's ongoing spread. That's still a very limited subset of people who might have the disease.
There's very limited insight into who does or does not have the disease in the US.
[1]https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/t...
That said, we must manufacture medical equipment for pandemics locally or have a reserve like oil.
One of them said a few days ago masks and other supplies were stolen from a delivery truck that was broken into as the driver went in to start the delivery to the hospital.
My sense is there's a lot of leakiness in supply of various forms.
My experience is similar to those of others here: it's not really clear there's a substantial increased patient count at the hospitals here, test or not, but supplies are getting scarcer. Maybe other areas of the country or world are creating shortages.
Testing is a mess, but that's a different issue, one maybe more relevant to public health and policies in some ways.
If you live in a democracy, then you are part of the government. You can't just blame other people for this.
Not that I think it would have really mattered. All the western countries were struck by surprise it seems, even though they had months to prepare.
South Korea, as they had much better testing than China and new infections have been increasing at ~1% per day for the last week. It’s still early, but it’s a very promising sign.
Finland on the other hand had it’s first diagnosis on February 26th and closed all schools etc on March 16. That’s an unusually rapid response, though it’s to soon to say how effective it is.
PS: At least in the US it’s rare for the the people in power to actually get even 50% of the vote. But, I think we can safely blame non voters just fine.
Just imagine how bad it would be if we turned industry over to the government to run, too.
1. Elect people who don’t believe in government 2. Get shocked when they do a poor job. 3. ??? 4. Profit
More seriously, I don’t think this is the kind of situation where people are ever going to be happy with how it’s handled. But, governments can do a better or worse job.
Saying they never work is clearly disingenuous.
PS: Unless you’re thinking of central planning aka communism and just using the wrong word.
Tariffs and child labor laws are not remotely "turning industry over to government to run."
> or put humans on the moon?
In the 1960s, nope. The Apollo shots cost $288 billion in today's dollars. That kind of money simply wasn't available to any particular corporation back then. It wasn't sustainable by the government, either, as we went to the moon, landed, came back, and then ... oh well. Nobody has been able to justify the cost since.
But today we are seeing capitalism make enormous cost reductions in rockets, and that will change the game completely.
Writing a check to the company is very different.
Because we still have laws, and elections. What do you want a military coup?
If global history (even just the past 70 years) is any indication of the results, there's a very high chance a coup won't force a sensible election system. Let's not dream up this situation
On the flip side, why can't we enlist money and resources from the private sector to quickly fix some of these supply issues? For example:
- Convert car factories to produce masks and ventilators.
- Convert construction companies to build makeshift hospitals. (Or use hotels.)
- Use tech companies to improve national information access with regards to CV19 testing and track and help patients using their software on their phones to help with contact tracing.
I realize that it's not as simple as pressing a button and instantly converting a factory that makes Teslas into one that makes masks. I also realize there are potential privacy concerns with nationalized information tracking.
But, we're about to enter an unprecedented public health crisis. We have resources that can lessen the impact if we just align and get behind this direction.
I can't help but think we could do more and not just wait for the shortage to happen, and for the curve to spike.
We stockpile enough nukes to basically destroy the whole Earth (exaggeration but you get the idea), but we can't stockpile some ventilators and face masks in case of a pandemic? You can't fight a pandemic with diplomacy. At least you can fight a foreign enemy with that.
https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...
It's just like nukes. We have a stockpile of them that are maintained... nukes are very hard to produce... etc. etc.
Filters with greater air flow resistance can be used if we add a blower. Remember that the virus can enter via eyes. Eyes need protection. Eyes also need air, and it can't be humid or the protection will fog up. For this too, a blower would help.
If we (America) can't scale up we are in deep doodoo. Trump has been pissing off China by calling the Corona virus the "China Virus".
The machines to make the n95 masks take both the Germans and Chinese about 6 months to make.
this is where you lose me... it’s not unprecedented, quite the opposite. Throughout all human history this has been common. Recently (since WWII), we’ve been able to limit the lethality of most diseases and/or reduce transmissions.
But this should have been prepared for. They (the government) even had a playbook for it, they had evidence it could even be from this family of viruses.
This is a massive mistake by hundreds of our leaders.
In theory, a free-market democracy would solve the misallocations caused by these blunders more efficiently than the other systems. But the US doesn't have a free-market healthcare system -- or even a free-market mask manufacturing system. As this thread indicates, we're about to see a lot of people die from red tape in Western countries.
Planet Money did a great episode recently on how the US government is currently paying for a year-round supply of chicken eggs to produce vaccine for a pandemic flu. (https://www.npr.org/transcripts/812943907).
I understand this situation is different from eggs, as an egg not used for a vaccine can be converted to feed, but in the end it's all about money. It's like an insurance policy. I pay for auto insurance but don't use it until I really need it.
> But in a subsequent tweet on Wednesday evening, Trump indicated that even though he invoked the act, he is in no rush to use it.
> "I only signed the Defense Production Act to combat the Chinese Virus should we need to invoke it in a worst- case scenario in the future," he said. "Hopefully there will be no need, but we are all in this TOGETHER!"
Today, it seems an inability to see what's necessary and get it to people is disturbing. The situation is effectively a war and one that's being fought very quickly.
I could brainstorm and mention the "fast fashion" is renown for creating conventional clothing to a variety of specifications, quickly. It seems like that talent could be harnessed for various kinds of safety equipment. Just an example, I'm sure there are a hundred similar things conceivable but despite the looming collapse of conventional procedures, somehow all bureaucratic hurdles remain in place.
I saw someone else post this on HN... Worth a look. http://www.imcclinics.com/english/index.php/news/view?id=83
They're also not getting eye protection at all so she's taken to wearing her glasses instead of contacts. Not as good as actual eye protection, but it's better than absolutely nothing.
In short, they don't have what they need.
I have a few left over from a house project I did a while back. Kept one for myself, but happy to donate the other 4 I have. I’m sure if the request was actually made people would donate. Is it enough? No idea, but construction workers, painters, etc don’t need them right now.
People want to do something, let them.
There is a problem with issuing a request - not everyone will know about it. As you mentioned, you think there was no request. But there were multiple: here's one example https://www.poynter.org/reporting-editing/2020/hospitals-are...
I'm imagining cutting apart a furnace filter and wrapping the fabric around a wire frame, or something like that. If someone were to develop a process that was simple and reliably repeatable and produced good quality effective masks, that could be a way for otherwise un-busy people to keep hospital staff supplied.
One issue I suppose is whether there are upstream bottlenecks, like not being able to get a reliable supply of the right kinds of filter material.
There is a simple and reliably repeatable method: having a factory. Not sure what is needed but there are lots of suppliers on Alibaba for this type of item. There are lots of rumors about export controls in China, denials of the same from Chinese officials, and rumors of seizure by US customs.
Never imported medical stuff but anecdotally many US sellers are being solicited by Chinese factories looking to sell masks and other PPE into the US.
https://www.bloomberg.com/news/articles/2020-03-13/buffett-b...
We are at roughly 1 out of 100.000 being infected. Until 60% have developed immunity, there is still a long way to go where almost everybody on earth will want to own masks. The need of the hospitals is just the tip of the iceberg.
Is it possible to source the machines and materials now to be ready for production when the wave hits really hard?
http://www.cidrap.umn.edu/practice/homemade-personal-protect...
Hey, the guys not wrong, he's not a shipping clerk
Everyone in the hospitals from nurses to management knew exactly what is coming but did nothing.
And nothing has even happened yet, wait till the virus actually arrives in a few weeks.
Did any hospital plan or ask for help properly? Did any nurses union raise the issue?
Anyway they have numerous studies from Africa where they can't afford equipment, rather than the lack of planning by people on half a million a year, to look at.
Increasingly a lot of hospital administration is very profit-focused. Not all but maybe most; where it's not, it's increasing, and where it's not supposed to be it often is, but hidden.
What this means is that the focus of hospital administration is often not on epidemiology and public health, even though it should be. It should include that more. It's focused more on squeezing out the maximum from each provider in terms of billable hours and patient contacts. When you're focused on stuff like that, you're not thinking about public health.
And so we have the consequence of that now. I don't think this is the only problem -- there's also government overregulation, rent-seeking provider monopolies that artificially restrict supply of services, and lack of coverage for patients -- but it's part of it. In general, at an abstract level, healthcare in the US has become very focused on protecting the interests of the established system, and less so on the interests of citizens and patients. It's a house of cards with several problems at once, getting hit by the perfect storm.