In Pursuit of PPE
nejm.org
nejm.org
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.
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.
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.
- stuff gets ordered via Czech economic mission in China, communication goes by Chinese speaking Czech experts remotely, coordinating even the planes being loaded and other details
- plane lands in Pardubice/Prague/Ostrava airport
- supplies go to government stockpile in Opočník, designated as the centrail distribution point (from PRague and Ostrava I guess it might go directly to the destination sometimes, as that could be quicker that getting to Opočník & then back)
- army and firefigter transport it from the central stockpile to hispitals/care homes/minicipal offices/to army/firefighters/police who need it
For some English info:
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...
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.
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...
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.
> Even supplies for which there simply can't be a medical certification are stalling at customs.
I don't think there is way more ongoing. That's just how things work in China and CCP's distinct way of being incompetent. CCP is known for its intolerance of critics, especially when covered by international news firm. They try their best to avoid it, not considering anything else. When someone in country create buzz, they censor it, sometimes arrest the author. When someone they can't arrest does it, they suppress what they can to "avoid the problem". This is politic and weighted more than anything else. A lot of party members still don't recognize free market and a strong private side as being important, especially Xi. After all they are communist.
In this case, the problem was seen as "some shady businessmen exporting unreliable masks for their own profit and got caught, it harms our 'global image'". So they took them down, switched to assuming everything coming from private side are garbage unless you can prove otherwise.
OTOH, government-ran Red Cross have zero problems because they are "trusted and endorsed".
No, no, no, no. The point I make is very different. Don't think of them as that dumb.
While, yes, a giant amount of PPE is now being exported in contravention of the ban, the very few well connected companies are making 8 digit sums per day thanks to it.
Also, the Chinese red cross is now very happy with PPE makers having no way to sell their stuff to the West, because now they can buy piles of it on the cheap for export through their "special channel."
The same thing has happened during the ASF outbreak last year. Pork prices soared N-fold, state media were all screaming murder, the national pork reserve was unsealed, but... at the same time, pork importation was quietly banned using overzealous sanitary inspections, culls of otherwise healthy pigs were ordered, and somebody made billions.
I'm more on the other incentive behind the action. I agree it might not be primary, but to apply this top-down there had to be something more.
We've talked with multiple vendors who simply can't get non-woven material stock at all and are having to turn away orders.
You don't prevent a fire by taking the piles out of the smoke detector.
If you build a culture where reporting problems is dangerous, you'll only hear good news that can be shared and catastrophic news that can't be ignored.
These masks failed quality tests, but they were made by private manufacturers in China, that had no relation to the China government.
However, because they are stamped, “Made in China”, then they tarnished China’s international image.
And the European countries really didn’t help themselves here, when they did their media blitz, and claimed that the China-made masks were defective. Thereby insinuating that every single mask that is shipped out of China, is under the control and responsibility of the central China government.
Then, the entire Twitterverse lit up in laughter as: “Ha ha! See, we told you so! China only makes piece-of-shit crap! Now, they are selling us crappy medical products too!”
Venezuela has much bigger problems than price caps, it is not indicative of systemic ramifications either way here.
If you want someone to open up a factory churning out PPE, which might only be needed for a few months, you need to let them charge a huge premium.
And when production gets high enough prices will fall.
If you price control, you’ll just push them all to black markets.
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.
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.
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.
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.
And what, precisely, are the "essential social institutes" to which you refer?
Lack of institutional IQ/leadership manifests in myriad of ways, such as the dismantling of California's emergency medical supply reserve in 2011 [0], defunding of organizations that address the current risks [1], and so on.
Addressing potential systemic risks through domestic production is only one potential way that leadership can handle them. Creating reserves and funding preparedness are some of the other ways to handle such risks.
[0] https://revealnews.org/article/california-created-a-massive-... [1] https://www.washingtonpost.com/news/to-your-health/wp/2018/0...
During normal times, the US may use several million masks per week. During epidemics, we may need more than 2 billion masks per week (1 per citizen per day).
We can't financially maintain 1000x production capacity for every potential emergency item. Businesses get screwed when they try to provide surplus capacity for our nation that it doesn't need the other 99% of the time: https://www.dallasnews.com/news/watchdog/2020/04/03/if-you-i... Even if we could it would be cost wasteful vs. stockpiles.
People talk about bringing all the production home, but that may be like getting rid of all your off-site backups and doing all backups onsite. It concentrates risk. What if there's a fire/pandemic/regional event that makes it so you need the emergency supplies, but also knocks out your plants that produce those emergency supplies? At least with some plants here, some plants there...if one country gets sick before the other, the currently-not-sick country can provide some supplies to the now-sick country, and vice versa when the pandemic ends in that place and moves to the other.
We probably need at least a 90 day supply of this stuff for the next pandemic. For n95 masks, I guess that's potentially 350 million * 90 days = 31 billion N95 masks. If they expire in 5 years, then we only need to manufacture 500 million per month to keep them up-to-date, and can pay maintainers to keep the supply rotating. We don't have to throw out soon-to-expire masks, we can sell them from the back of the stockpile at a small discount to end-users who need them regularly, like normal hospital or industrial use.
> building out the production capacity to actually be able to make PPE in sufficient quantities
as you put it, would require us to be able to make 10 billion masks per month (350 million * 30days), instead of just half a billion per month. Thats way more expensive. And those plants would sit idle for decades - who knows if they'd even turn on again? A rotating stockpile can be sold to hospitals for regular use, so we could constantly validate that the goods are good.
This is exactly the way the Czech Republic is going, with several companies now churning out such masks and the government being the bigger buyer. Stockpiling billions of expiration-sensitive disposable masks is more expensive, compared to pre-distributing one reusable mask to every citizen.
Also, if countries bring their production home with some surge capacity, then this actually gives really great redundancy compared to the status quo because all the countries which do this end up with production capacity that can be used to sell supplies to other countries in the case of some regional crisis there. It's much better than centralizing it in the lowest-cost country as often happens now.
Taiwan had a huge stockpile, and that let them increase their production from 100,000 N95 masks per day to 20 million per day while drawing down the stockpile. Asia has had success building these factories in ~14 days from pouring cement to startup, USA might need a bit more time of course.
It's not "decay". Call it like it is -- it's deliberate and directed erosion, backed by propaganda.
And this feeling that actions that were once unremarkable now seem impossible.
The breakdown of trust and the resulting inefficiency that exist in US systems aren't happening everywhere.
Again, it's true that the US has fallen farther (consider the federal coordination of industry in WWII and compare to the disaster today). But no one is doing "well" here.
[1] I despise that I have to euphemize that here on HN, but those seem to be the rules the community enforces.
Germany is apparently doing 500k tests a week, not that shabby especially if they keep increasing that number.
Here in Aotearoa things are not going too badly. The state institutions seem to have functioned well and people cooperating.
I fear it is a fluke, but whatever, I'd rather be good, but I will take lucky.
Are there other noteworthy measures taken by your government that explain the success?
The other thread of the creeping problems in the West - that it is growth of government rather than decay of government - has some evidence to show here.
Institutional IQ isn't the issue. The DHS was never clever and the FBI has been a corrupt mess for a long time. See also J. Edgar Hoover and imagine him as a current president.
[0] https://en.wikipedia.org/wiki/United_States_Department_of_Ho...
By the way Neil Ferguson is a mathematical biologist at Imperial College, London who was instrumental in getting the UK government to change directions.
Niall Ferguson (also from the UK though currently at Harvard) is a historian. He is an excellent and insightful observer (especially his earlier work) but like you I often find he ends up drawing the wrong conclusions.
I think the West's democratic model of loosely fitting parts (yes, even in a country like France) permits greater resilience against various threats....but permits is not the same as guarantees!
[0] https://elemental.medium.com/a-tiny-hospital-in-texas-might-...
And P100s were sold out early into this adventure.
https://www.ciirc.cvut.cz/covid-2/
And most rencently, after the 3D printed protoypes turned ot to work very well, an automated assembly line was put togehter in record time:
https://www.ciirc.cvut.cz/seriova-vyroba-ceske-masky-s-nejvy...
The other major technical university - Brno Uiversity of Technology - also developped a 3D printable face mask design:
https://www.vutbr.cz/en/but/news-f19528/covid-19-protection-...
In comparion to the mask above, this is a 100% DIY design that one can assemble with common hashold items and a 3D printer.
Part of the point, is that the flat, simple, small, replaceable pads for the elastomeric masks use less "melt-blown fabric" than the curved, complex, large N95 face masks. Right now lack of the melt-blown-fabric is preventing us from making enough masks. So being able to make more masks from the same fabric would help a lot.
Most doctors felt the elastomeric masks were inappropriate for healthcare workers. Articles like this are important for helping to challenge that perception. https://elemental.medium.com/a-tiny-hospital-in-texas-might-...
However, the filters do need to be swapped out from time to time. I don't think there's clear guidance on that yet, but there needs to be science backing up any kind of replacement cycle. Once per year would be atrocious, I feel. And of course the rubber itself should be constantly/consistently disinfected as you move between environments or take it off/put it back on.
Here they say to replace when "It becomes difficult to breathe comfortably (this will vary from individual to individual)." https://multimedia.3m.com/mws/media/565214O/3m-cartridge-fil...
This other brochure essentially implies the OV cartridges last up to 6 months, but those don't filter particulates. It does say however, that N95 masks become more effective as they get "dirtier", at the expense of being able to breathe easily. In this case, a tight seal would be extremely paramount, because eventually it would clog enough that you'd be breathing "around" the mask instead of through it. http://multimedia.3m.com/mws/media/447121O/filter-change-out...
They do have a web tool for calculating service life but it assumes you have at least one chemical contaminant, so the tool simply fails to calculate anything at all for hospital or home use.
The "documentation that come with the masks and filters from the manufacturer" are of no help to me: N95 pads - https://multimedia.3m.com/mws/media/528213O/userinstruction-... https://multimedia.3m.com/mws/media/994802O/userinstruction-...
These are verbatim PDF's of the documentation in the boxes that I have.
And even if you were, was the smoke so severe that the cartridge may have quickly collected so much particulate matter that it was rendered less capable of allowing a high flow of air at a low pressure difference?
The obvious drawback to using reusable respirators to manage a pandemic disease is that they're another item to become contaminated and spread infection.
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.
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.
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.
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?
I have to surprise you. A surprising amount of US defence hardware is double digit Chinese BOM.
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.
Of course it is unlikely someone would take the risk, but gouging laws make it impossible.
For every $10 of masks some wannabe gouger was motivated to buy and store in their closest for years, a professional gouger will buy $10,000 worth the day the crisis starts and help hasten the arrival of empty shelves and shortages. Then he'll turn around and ask those who truly need them for $100,000. If he can't sell all his inventory at his markup, he'll just dump the remainder after it's no longer needed for the crisis at the regular market price.
Nothing is exempt from market forces. Masks are more valuable now than they used to be, that's just a fact. If you try and hide that fact, you will prolong the shortage and cause more harm than good. If you don't like the idea of the government having to pay more to procure this essential commodity in this time of sudden shortage, the people you should be annoyed with are the ones who depleted the national PPE stockpile in time of plenty, when it existed for this very reason. Don't shoot the messenger.
You might also enjoy wikipedia. https://en.wikipedia.org/wiki/Economic_efficiency#Mainstream...
The "mainstream views" section suggests that market economies are believed to be closer to efficient than other known alternatives. The mainstream only recommends macroeconomic type interventions to counteract the economic cycle. Macroeconomic interventions are monetary policy, not price fixing, confiscation, etc.
Or how about the wikipedia on price gouging: https://en.wikipedia.org/wiki/Price_gouging#Opposition_to_la...
In a survey of economists, only 8% supported legislation against price gouging. 51% were against. The economists opposing the proposal argued that such legislation would lead to a misallocation of resources and lead to lower supply and greater scarcity of the resources, or argued that the proposal in question was vague.
Or how about the wikipedia on economic planning: https://en.wikipedia.org/wiki/Planned_economy#Advantages_of_...
The advantages show the Soviet Union industrializing... while starving to death because the central planners did not have infinite knowledge, which the central planning idea requires.
https://en.wikipedia.org/wiki/Planned_economy#Disadvantages_... This section of the same wikipedia article shows that markets are more efficient at allocating resources.
#############
It doesn't matter where you go, everywhere you will see markets are better at allocating resources. Politicians implement bad policy because voters demand action. Trump can use the Defense Production Act to command masks be confiscated and sent to a hospital, and he will act like he's a savior, and economically ignorant people will believe it because action looks better than inaction. But he's not doing that because all the economists have said that's the best way to get masks where they need to be. In the end, he's killing people with these kinds of actions, not saving them.
I wouldn't put too much stock in that survey. It was about a specific Connecticut law, it only included 40 economists, many chose not to answer, and many of the others took issue with some vagueness in the wording. Furthermore, I wouldn't blindly follow "economists" on any policy matter. Sure, their ideas have some merit, but their discipline has its biases, too.
> The advantages show the Soviet Union industrializing... while starving to death because the central planners did not have infinite knowledge, which the central planning idea requires.
Oh, please. Anti-price gauging legislation is not central planning. It's pretty weak to trot out the Soviet Union to refute anything but the purest capitalism.
> It doesn't matter where you go, everywhere you will see markets are better at allocating resources.
The first army to learn to allocate supplies to the front lines on free market principles will be unstoppable! /s
https://www.marketplace.org/2017/09/01/why-economists-dont-t... "Economists don't think price gouging is a problem"
https://www.forbes.com/sites/jeffreydorfman/2016/09/23/price... "Price gouging laws are good politics but bad economics"
https://hbr.org/2013/07/the-problem-with-price-gouging-laws "The problem with price gouging laws"
https://www.thoughtco.com/the-economics-of-price-gouging-114... supports price gouging
Can you provide ANY literature suggesting mainstream economists, on average, support price fixing, confiscation, or purchase limits as a means to allocate resources effectively in a crisis?
>The first army to learn to allocate supplies to the front lines on free market principles will be unstoppable! /s
The military primarily gets work done by allowing private contractors to bid on projects. In order to get troops near the front lines, most military personnel take commercial airline flights to get there because it's more efficient. Military operations are wildly inefficient, but they still use markets wherever possible because it gets things done as efficiently as possible.
If you think that, you must not have even read the links you gave me. The first one takes a turn halfway through with "but, as with so much of economics, there is disagreement," and has an economist outline a lot of the problems with price gouging that the other economists are missing.
> Can you provide ANY literature suggesting mainstream economists, on average, support price fixing, confiscation, or purchase limits as a means to allocate resources effectively in a crisis?
Frankly, I don't really care if "mainstream economists, on average" support anti-price gouging legislation or not. Like I alluded to before, they have their biases. For instance, they spend their careers focused on certain problems and not others. That doesn't mean those other problems are unimportant and can be ignored. Good policy will ignore economists in some cases, when factors economists de-prioritize need to be prioritized.
Your qualification of "mainstream" is also kinda interesting. I don't consider economics to be any kind of settled science. It's almost certain that there are serious problems caused by following "mainstream economics" due to its flaws, omissions, and biases. Its ideas should be given due weight, but they're not the gospel truth. That's especially clear on the question of price gouging, because even in the survey you cited there were economists that strongly supported efforts to curb it.
>>> It doesn't matter where you go, everywhere you will see markets are better at allocating resources.
>> The first army to learn to allocate supplies to the front lines on free market principles will be unstoppable! /s
> The military primarily gets work done by allowing private contractors to bid on projects.
That's clearly not what I was talking about. If, as you say, "markets are better at allocating resources" everywhere, don't you think a front line army unit should get supplies allocated to it based on market principles (e.g. the unit bids against other units in a market to get more ammunition)?
No, that's only true if you believe the simplistic myth that a price-driven market is always the best and fairest way to allocate scarce resources, in all circumstances. That myth is false, but it's a seductive myth because the market works very well in many situations.
Price gougers operate only in crises, inserting themselves as middlemen to extract a profit on emergency essentials. They can't do anything to increase supply, because there's no time for that. They don't direct resources to where they're most needed, rather they direct them wherever the most profit is. They perform no social good, and are actually a form of market failure.
> It might also spike demand earlier than it would have spiked, which sends a signal to ramp up production.
That's a fairy tale. The manufacturers aren't solely reliant on price to learn about demand, and they have clearer and more direct ways to communicate with their customers in situations like this. Do you think Purell and 3M needed guys like this [1] to tell them demand for their products was spiking due to an incipient pandemic? No. 3M was literally ramping up in late January [2], before the COVID-19 was even a blip on the price-gouger's radar.
> 1 person snapping up 10,000 masks with intent to sell is better than 100 people snapping up 100 masks each that they intend to stick in their closet "just in case", while people that really need them find empty shelves.
Firstly, there are better ways to manage the surge demand, which the actual businesses involved are implementing: prioritizing sales to customers based on need and implementing retail purchase quotas to prevent people (usually gougers) from buying everything up and creating artificial scarcity.
Secondly, it's likely that the 100 people in your example who bought from the gouger just put the masks in their closest anyway. Gougers take supply out of the normal channels and inflate prices so much that the people who bought from them are worried people with more money than sense, rather than those with real need like nurses and hospitals.
Thirdly, at the maximally inflated prices gougers often sell for, they may end up functionally becoming hoarders themselves and still make a profit. If a gouger buys 1000 masks at $1/per, sells 100 at $10/per, 200 at $5/per, 300 at $2.50/per, and unloads the rest at the original $1/per after it's all over, he's more than doubled his money while wasting half his inventory. He's not looking to speed resources to where they're needed, but milk every cent out of them that he can. The supplies do no more good in a profiteer's garage than in a prepper's closet.
[1] He Has 17,700 Bottles of Hand Sanitizer and Nowhere to Sell Them (https://www.nytimes.com/2020/03/14/technology/coronavirus-pu...)
[2] How 3M Plans to Make More Than a Billion Masks By End of Year (https://www.bloomberg.com/news/features/2020-03-25/3m-double...): "Andrew Rehder, manager of 3M Co.’s respirator mask factory in Aberdeen, S.D., got the call from headquarters on Tuesday, Jan. 21....Rehder told them that a new virus was spreading rapidly in China and that 3M was expecting demand for protective gear to jump....Now, Rehder told his charges, Aberdeen would shift to “surge capacity.” Idle machinery installed for precisely this purpose would be activated, and many of the plant’s 650 employees would immediately start working overtime."
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.
In short what the world needs is plans on how to make n95 mask making machines. There are plenty of manufacturers who can take those plans and build the machines in a few weeks (I'm guessing on time line but it seems reasonable) from there we can make as many masks as we have raw materials for.
But it's very much possible to expand NWF production at existing facilities many-times-fold.
But even that is not really needed. There are factories in China with piles of NWF that has nowhere to go because of the export ban.
So, it's really a non-issue... if global community could've functioned even on the level how it did 20 years ago.
The world community is no more... and the global cooperation went away along with it
The West had 20 years to do something about this, but it didn't.
https://www.youtube.com/watch?v=p9lchhBE7cE https://wfuv.org/content/covid-19-has-caused-shortage-face-m...
Where are you seeing reports on piles of NWF in China? I'd be very interested in this. Seems the masks/filters are pretty easy to make once you have the NWF
Chinese can probably make their own machinery eventually, but we still talk about months
Of course the traditional way to build these machines is more efficient.
If it was reasonable, why hasn’t it happened? Seems like it’s either not possible, or not worth it at whatever price points the masks would sell at, which is basically the same thing.
NPR wrote a good piece about this, if my memory serves me right. I apologise for the lack of sources.
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.
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?
Beyond volunteer sewing efforts that are already happening and do not produce medical-grade PPE, the answer is no.
Labor isn't the limiting factor. You need machines, raw materials, supply chains.
There isn't an AWS for N95 mask manufacturing.
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!
We marvel sometimes at how quickly China raises cities from the dust seemingly out of nowhere in short time frames. In this very thread are reports of Chinese companies building entire factories to manufacture N95 masks in weeks, including brand new factories for the difficult melt-blown fabric material.
The US doesn't lack the ability, it lacks the will and the vision. The alternative sentiment to what I'm saying is "It's too hard, it will take too long and China can do it better so let's all wait it out at home doing nothing until they catch up enough to get us what we need". Why do people believe this? Where are the leaders saying anything else?
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.
You need a lot of capital for a melt-blown fabric facility, and some specialized engineers. China and Taiwan managed to build new facilities of huge size very quickly - it can be done, but apparently much harder for the large American conglomerates to get off the ground as quickly. https://www.wfuv.org/content/covid-19-has-caused-shortage-fa...
If you can get >$10 million together, and a very dedicated and specialized team of engineers, plant operators, machinists, and businesspeople - you might be able to finish your factory before 3M's Rhode Island and Arizona plants, if you start right now. But you won't do it in a distributed way with a bunch of people with 3D printers.
However, it seems there's evidence that non N95 masks have some efficacy. Just regular old cotton clothing cloth. You could start an MLM/Amway/Mary-Kay/Avon/Vemma/Younique style thing to get out-of-work people to make these at home and sell them to friends and family.
Sinopec decided on Feb 24 to built a melt-blown fabric plant https://www.youtube.com/watch?v=p9lchhBE7cE. It was operating on March 6. It took them 10-12 days to build, from scratch, a facility to produce 1.2 million N95 masks per day. One of my links above shows another facility built in 11+ days making 200,000 N95 masks per day.
At the start of the outbreak, Taiwan could product 100,000 N95 masks per day, but have built over 60 production lines, and now make enough melt blown fabric to product over 20 million N95 masks per day. Notably, Taiwan had a HUGE stockpile of masks, so even though making 100,000 masks per day wasn't enough for their population, they had enough in storage to last them while they built up their capacity. Now they make enough to send tons of masks the the USA every week.
USA (3M) decided to build melt-blown fabric facilities around March 23: https://www.powderbulksolids.com/news/Honeywell-Expands-N95-... and to a much smaller capacity. And none of the new lines in the USA are up and running yet. "Before the onset of the COVID-19 pandemic, 3M was manufacturing about 50 million masks per month" ... "In its continuing effort to help meet demand, 3M says it is working to double its global N95 mask production numbers once again to 200 million units monthly." But they think that will take another YEAR to accomplish. Only 35 million N95 masks are currently made in the USA, by 3M or others. https://www.nasdaq.com/articles/n95-mask-production-wont-mee...
Ideally, each citizen would have a new N95 mask for every day. We'll get to 1 mask per citizen per month, sometime around a year from now.
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.
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.
There are many other tutorials online from various sources which use different machines (sewing machine, 3d printers, etc), so people can improvise based on what they have.
The PDF shows detailed price breakdown for materials of ~$5/mask and estimates 10 minutes per mask, since of course it's diy, there's a lot of warning labels, but it's better than nothing. If people can produce ~40 masks per day using basic tools, this can scale based on the availability of raw materials and tools.
- 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.
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...
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.
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.
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.
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.
Well, I suppose the real answer is: Because that's not how healthcare works in America...
"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...
We do not have a national health care system.
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.
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.
It is insane on multiple levels.
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.
Is the U.S.A. simply not capable of this level of production any longer? What the heck is going on? It's sobering.
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.
I also do not understand why we weren't able to scale basic PPE quickly.
[0]: https://news.nike.com/news/nike-ppe-face-shields-covid-19-su... [1]: https://support.apple.com/en-us/HT211028 [2]: https://www.theverge.com/2020/4/15/21222219/general-motors-v...
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...)
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.
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...
They reduced liberty ship production in 1944 to produce warships (which are more complex and were produced in much lower numbers)
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
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?
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
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.
No corruption here...
- 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.
https://docs.google.com/document/d/1BKUmZgwrvPG47VMR8SFvvSVh...
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.
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.
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.
The time of cheap Chinese made goods must come to an end.
the answer is obvious, but i guess it's too "political" for people to accept.
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.