There’s no question: social-distancing, teleworking, and staying at home to the extent possible, especially if you are elderly or otherwise vulnerable are reasonable and necessary precautions. Yet the United States also need a functioning economy—individuals need to be able to provide for themselves and their families, and America needs a workforce to produce critical medical and other supplies during the current crisis.
Last week, hospitals around the country began running out of protective gear like masks, face shields, and gowns—equipment they need safely to provide crucial care to patients at risk for Covid-19.
The situation is “dire,” according to health officials. In particular, medical masks are in short supply. Healthcare workers treating patients with coronavirus symptoms can go through as many as fifty masks in one day. One hospital system, for instance, currently is using 14,000 masks a week. Before COVID-19, it averaged 2,000. And while the federal government has a stock pile of masks, HHS has acknowledged that the reserves cannot hope to meet the coronavirus demand. New York, for example, requested 2.2 million masks from the federal stockpile. They received 78,600 expired masks.
China, a top producer of masks (as well as pharmaceuticals and other medical equipment), has been hoarding them. China’s State Council directed at least one manufacturer to sell its entire supply of surgical masks and protective clothing to the government. Local officials have taken similar actions: Shanghai officials ordered Mediacom Group to sell its medical masks to the local government, and Dongguan officials requisitioned Makrite Industries’ entire production.
In addition to banning exports, China imported 56 million masks the week after the Wuhan quarantine. Companies and charities also flooded China with masks during the height of the pandemic. 3M donated a million, Honeywell, 500,000, and the Bristol Myers Squibb Foundation, 220,000.
The risk to our healthcare workers from insufficient protective gear is obvious. Across the United States, healthcare workers are testing positive for COVID-19 and hundreds are in quarantine. Over 3,300 healthcare workers in China were infected with COVID-19 by late February. In Italy, some 1,700 healthcare workers have COVID-19, an astounding 8% of total infections.
In America, doctors and nurses struggling with equipment shortages have been resorting to extreme measures. Brigham and Women has been collecting racquetball goggles from the community. Masks intended for one use are being reused, two, three, or even five times. Emergency room doctors have resorted to spraying masks with bleach and then letting them dry overnight. On Monday evening, hospital administrators from Providence, a 51-hospital system across seven states, even went to arts and crafts stores to purchase supplies for homemade masks and face shields. Hospital managers created an assembly line to produce the face shields—again from supplies bought at the local craft stores.
There are varying types of medical masks. The N95 respirator is most often used in hospitals because it blocks 95% of small (0.3 micron) particulates. Made of a special type of material, the mask fits snugly, leading to more efficient particulate filtration. It is in particularly short supply.
In response to the N95 shortage, the CDC issued new guidelines stating that “the supply chain of respirators cannot meet demand” and that looser fitting surgical face masks “are an acceptable alternative.” The CDC further advised that N95 respirators should be reserved for “protecting workers in the most dangerous situations, where fine aerosol is likely to be generated, such as during intubations.”
Similarly, as part of the first wave of coronavirus legislation, the Health Care Workforce Protection Act of 2020 helps get respirators quickly to healthcare workers during health crises, like the current pandemic.
The legislation amends the PREP Act which permits HHS to grant limited liability protection to manufacturers and distributors of respirators in the event of an epidemic (the federal government assumes that liability). With the goal of allowing healthcare workers to “quickly access CDC-approved equipment,” the new legislation ensures all NIOSH-certified respirators are eligible for the same liability protections as other medical products, vaccines, and drugs.
But of course the CDC’s relaxed guidelines and the Health Care Workforce Protection Act only help if a supply chain for medical supplies exists. As COVID-19 illustrates, we cannot rely on a supply chain outside the United States, and we need to take steps to ensure that the the supply chain inside the United States survives COVID-19.