An interviewer asked a FEMA representative on CNN this evening a simple question: How many N95 masks will be delivered to hospitals, and when will they arrive? The representative managed to pivot and dodge the question, with a common response being heard a lot on the news: “It’s a fluid situation”. President Trump may yet use his authority under the Defense Protection Act to mobilize industry to manufacture scarce goods like N95 masks. And when President Trump went into his briefing today, he started rattling off numbers of masks being shipped…but what gives? Are these numbers real and will there be enough? No one seems to know..but the fact is that starting production can’t occur overnight.
The shortage of N95 masks seems to be a big mystery, but several recent articles in the New York Times and the Wall Street Journal explore the case of the missing masks. Not only masks, but hospitals are facing a dire shortage of surgical gowns, and eye gear, and this is creating massive anxiety on the part of our front-line providers. Despite President Trump’s statement that “millions of masks were in production..”, they are nowhere to be found. The masks can be used for eight hours of continuous or intermittent use, but must be discarded after treating an infected patient. Doctors are trying to spray it down with a disinfectant, hoping for the best, and are rationing as much as possible. Although there exists a national stockpile of 12 million N95 masks and 30 million surgical masks, the estimate is that the country will need 3.5 billion masks in the event of a pandemic lasting a year.
There are several reasons for the shortage. Before the coronavirus emerged, China produced about half of the world’s masks, although some of the factories were American brands like 3M that produced for the local market. The prolonged outbreak in China reduced the supply, and during the outbreak production expanded by nearly 12-fold (to 115 million per month). The global inventory of masks was also diminished by the wildfires in California and Australia, which used up many of the supplies held by humanitarian organizations. So why can’t the masks be distributed?
Evidence suggests that China is “hoarding” the mask supply, and is not exporting masks. China has claimed mask factory output for itself, and during the outbreak, they also purchased most of the global inventory of masks from other countries. According to official data, China imported 56 million respirators and masks in the first week after the January lockdown of the city of Wuhan, and on January 30, managed to import 20 million respirators and surgical masks in 24 hours. But China isn’t alone, as other governments are also restricting exports of protective gear. (For example, Germany, Italy, the Czech Republic, France, Belgium, the Netherlands, Austria, and other EU countries are putting in curbs to prevent supplies of masks from shipping to neighboring countries – a case of “every man for himself!”) In a statement, Minnesota-based 3M said most of the masks it made at its factory in Shanghai had been sold within China even before the outbreak. It declined to comment on when exports from China might resume. There are signs that China may be easing its grip and starting to resume exports, but others claim that exports have not yet been authorized. Ironically, Honeywell, 3M, and Bristol Myers Squibb donated millions of masks during the initial outbreak to China. A Chinese bureaucrat noted that manufacturers still needed to produce another 230 million surgical masks for the domestic market.
Okay, so what other options are there? The news is saying that companies like General Motors and Hanes can convert their factories into mask-production facilities. A General Motors joint venture in China built 20 of its own mask making machines and is focusing on bulk production. 3M has doubled production of N95 face masks and is now producing 1.1 billion a year, including 400 million in the U.S. Smaller companies also producing masks include the Nelson Laboratories, Medicom Group, and others. However, a major challenge is that a critical component for high-quality masks is nonwoven polypropylene, a dense network of fibers that serves as the primary filtering material, remain in short supply. For example, specialized textile producers of the non-woven polypropylene, Monadnock Non-Wovens LLC, in Mt Poconos PA, has been getting more than 100 calls and emails a day asking for huge quantities of non-woven polypropylene. (Some callers have offered luxury vacations and huge mark-ups to fulfill orders!) Other companies include Berry Global Group which has shifted its production entirely to nonwoven polypropylene fabric. However, there could be another supply chain shortage further up the chain: polypropylene resin, which ran short during the 2009 H1N1 influenz pandemic. Because of the shortage of raw materials, production lines are sometimes sitting idle.
Once production of masks occurs, than allocation of orders comes into play. No one has really identified a strong national policy for allocation of scarce masks to different regions of the country, and indeed, many people went out and bought masks and may be hoarding them at home. The Federal Government is seeking to prioritize distribution of masks to California, New York, and Washington, where the epidemic is rampant. Distribution becomes another important cog in the wheel to take the masks from production to hospitals. To that end, the Federal Motor Carrier Safety Administration has issued a 50-state waiver to the Hours of Service Rule for commercial vehicle drivers, to ramp up the capacity available to distribute equipment and supplies to hospitals. There are also instances of brokers who are exploiting the situation by marking up the prices of masks to profit from this sitaution.
There are real dangers present from these shortages of protective equipment to medical professionals. Some hospitals have even begun experimental procedures to decontaminate its masks using ultraviolet light and reuse them. The supply chain will hopefully ramp up to protect these medical professionals who are so critical during this epidemic, and who are the ones most likely to contract the virus.