17 ms·

In Pursuit of PPE

173 points by erwan 6y ago

sirsar 6y ago
Serious question: If the FBI and DHS are seizing PPE, where is it going? Why can't this hospital be a beneficiary of seized PPE, rather than an (almost) victim?
- cameldrv 6y ago
  Blue Flame Medical.
abinaya_remote 6y ago
Good approach!
sailfast 6y ago
This is insane. 5x markup and federal seizure of privately procured masks that will then get given to private companies to give to hospitals. Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go through while controlling part of the market. Absolutely crazy. Not to mention having to hope your governor praises the federal government to get their masks back. 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.
- m4rtink 6y ago
  >This is insane. 5x markup and federal seizure of privately procured masks that will then get given to private companies to give to hospitals. Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go through while controlling part of the market. Absolutely crazy. Not to mention having to hope your governor praises the federal government to get their masks back. 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.
  - hef19898 6y ago
    Firefighters played a crucial part in the distribution concept I came up with two weeks ago. Nice to see something like that being implemented! 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.
    - m4rtink 6y ago
      I'm not sure there is much coverage of that in English - from the local news, it looks like this: - 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://www.expats.cz/ https://www.expats.cz/ https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_Czech_Republic https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...
      - hef19898 6y ago
        Thanks a lot!
  - yread 6y ago
    Not everything is rosy though. Ministries buying 40m eur worth medical equipment from some company that had no revenues last year or year before that. One ministry paying double the price for the same thing as the other. And that's not even mentioning how many companies from prime minister's holding are benefitting disproportionately - subsidies, testing, hand sanitizer....
    - m4rtink 6y ago
      Yeah, it's definitely not perfect, but at the same time IMHO much better than the responce in other countries (or the lack thereof).
- blackrock 6y ago
  I saw an article saying the 5x markup is because of the air freight, which costs more. 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.
  - sailfast 6y ago
    The freight costs makes sense and that's a great counterpoint. Thanks! 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...
  - baybal2 6y ago
    > which forced the China central government to crack down on manufacturers, and only allow “medical grade” certified masks to be shipped. 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.
- voodooranger 6y ago
  Price ceilings cause shortages. Every time. Let’s not use Venezuelan-style economic illiteracy as a model for how to incentivize the flow of critical supplies to those who need it most during a crisis.
  - thelean12 6y ago
    What about price ceilings and purchase limits? You'd have to actually think about the purchase limits for different entities but it sounds doable.
    - deleted 6y ago
      [deleted]
  - BubRoss 6y ago
    Venezuela's problems come from international banking controls combined with hyperinflation and mandates to not increase prices. When you have a currency losing its value every week and the government mandating 10 cent gas with no way to transact with the outside world and escape your currency, things are going to get very distorted. Venezuela has much bigger problems than price caps, it is not indicative of systemic ramifications either way here.
  - qqssccfftt 6y ago
    I wonder how anyone can write a comment like this and think that our economic model is not completely broken for anything other than making one group richer.
    - astronautjones 6y ago
      leading a life insulated from the consequences of living in this economic model
    - rhino369 6y ago
      Whether or not you think our model is broken, price controls of goods you want more of is a terrible policy. 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.
- xster 6y ago
  And that's in the present. What's more frustrating too is that if we're still debating about the present, there will certainly not be any accountability for the lack of preparedness from all levels of government in the past to prepare for health crisis. Compare to these images https://upload.wikimedia.org/wikipedia/commons/thumb/a/a6/雁塔_曲江收费站的防疫检查_01.jpg/440px-雁塔_曲江收费站的防疫检查_01.jpg https://upload.wikimedia.org/wikipedia/commons/thumb/a/a6/雁塔... https://upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Check_for_2019-nCoV_in_Jishuitan_metro_station_%28Beijing%29.jpg/440px-Check_for_2019-nCoV_in_Jishuitan_metro_station_%28Beijing%29.jpg https://upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Ch... (source: https://en.wikipedia.org/wiki/2019–20_coronavirus_pandemic_in_mainland_China 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.
  - baybal2 6y ago
    This is the point I've tried to convey to my peers in the West over, and over, and over for years. 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.
    - makomk 6y ago
      Institutional IQ or leadership or anything else like that does you no good when your country no longer has the manufacturing infrastructure to make PPE anymore and the countries which can would rather use it to protect their own citizens, and it's mostly the anti-populists which seem to be doubling down on denying that simple fact.
- pmorici 6y ago
  Whats even more nuts is that N95's have taken this level of importance in healthcare at all instead of reusable P100 masks. I read a post on medium the other day about a hospital in Texas that does that and it was being treated as some kind of amazing discovery as if this was some unknown miracle device. [0] https://elemental.medium.com/a-tiny-hospital-in-texas-might-help-solve-the-mask-shortage-9ad3c0a7a861 https://elemental.medium.com/a-tiny-hospital-in-texas-might-...
  - prostheticvamp 6y ago
    For most healthcare workers, it is unknown to them. N95 is the standard. And P100s were sold out early into this adventure.
    - xg15 6y ago
      I wonder, could the plastic part of P100s be 3D printed? (Or otherwise manufactured in fablabs)?
      - mhb 6y ago
        Not unless you have a material that conforms nicely to a face. But you can still buy face pieces. The filters are what are hard to get.
      - vmh1928 6y ago
        Yes, search on Montana Mask. The 3D files are available and you could print them at home. Part of the mask is the filter holder which you can stuff with N1900 or greater furnace filters, vacuum cleaner HEPA bags or whatever. Edit- sorry, it's not quite like the P100, the filter holder is a rectangle in the center of the mask as opposed to the mask in the article that has two filter holders.
      - m4rtink 6y ago
        Yep, one by Czech Technical University: https://www.ciirc.cvut.cz/covid-2/ https://www.ciirc.cvut.cz/covid-2/ https://www.rp95.cz/en/ https://www.rp95.cz/en/ 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-nejvyssim-stupnem-ochrany-byla-zahajena-do-priprav-se-zapojilo-vice-nez-tricet-ceskych-spolecnosti/ 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/mask https://www.vutbr.cz/en/mask https://www.vutbr.cz/en/but/news-f19528/covid-19-protection-halfmask-but-h1-d197642 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.
- prostheticvamp 6y ago
  > Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go throug 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.
  - praxulus 6y ago
    If the top 10 bidders are all Americans (which is plausible, given America's wealth and inflated healthcare costs), the U.S. government could use price controls to drive the price down from the 2nd highest to the 10th highest bid without losing supply to other countries. There's still the possibility that driving prices down would push manufacturers out of the business (or more likely, fail to pull in manufacturers who otherwise would have started producing PPE).
- m0zg 6y ago
  >> distribute directly to those in need or allow 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.
- m3nu 6y ago
  I also help with buying PPE currently and it's not 5x markup by the seller only. Everything got more expensive. Input material, machines, shipping. This results in the final price being 5x (or more). It's not the greed of one sales person (mostly). 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.
- edge17 6y ago
  The 5x markup is basically in line with the increase in material cost and increase in risk of importing. The melt blown fabric prices have been increasing dramatically since January when China ramped up production.
tosser0001 6y ago
I was certain by this point in the crisis we'd be seeing video akin to WWII/"Rosie the Riveter" stuff of PPE flowing out of factories around the country. Is the U.S.A. simply not capable of this level of production any longer? What the heck is going on? It's sobering.
- dfxm12 6y ago
  The USA is capable, they just lack the leadership in Washington to do so.
  - altoidaltoid 6y ago
    The implementation of disaster federalism
  - rckoepke 6y ago
    It certainly sows doubt when I see things like this: https://www.youtube.com/watch?v=p9lchhBE7cE https://www.youtube.com/watch?v=p9lchhBE7cE 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.
- jsight 6y ago
  We seem to have spent an amazing percentage of that energy on spooling up ventilator manufacturing instead. Most of that capacity will be ready once the crisis is well beyond its peak. I also do not understand why we weren't able to scale basic PPE quickly.
nashashmi 6y ago
Where is the ppe going? And why is dhs stepping in when hospitals are ordering them? Why cannot health care workers order ppe directly? Hospitals are having a difficult time time giving them out to workers because it is low.
jhart99 6y ago
If this sort of seizure is being conducted under the Defense Production Act Section I, there should be greater transparency of what PPE materials are currently subjection to allocation control. Otherwise, we might as well have the National Guard protect shipments from seizure within the states.
ttul 6y ago
It's absolutely insane that PPE isn't something that's being procured on a national level. Why are hospitals and clinicians having to deal individually? If there were a monopsony buyer (i.e. the Feds), suppliers could be bullied into providing reasonable terms. Well, I suppose the real answer is: Because that's not how healthcare works in America...
- ttul 6y ago
  Anyhow, in Canada, the federal government has created its own global supply chain to produce and distribute PPE as needed within the country, hiring two international firms to store and verify equipment sourced from China. Meanwhile, national air carriers are re-fitting their unused jets to carry PPE and the feds are happily paying them to fly them. "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-ppe-supply-chain-in-china-amid-pandemic-1.4894402 https://www.ctvnews.ca/politics/canada-establishes-its-own-p...
- tejtm 6y ago
  Same reason we do not have (health) records in the same place in a common format that would allows us to intelligently coordinate moving what supplies we do have around in a proactive fashion. We do not have a national health care system.
  - Thriptic 6y ago
    We already have the ability to measure COVID status because diagnostic labs are required to report the presence of certain things to CDC in real time upon positive test result. COVID-19 is almost certainly one. Further, countries like Britain tried what you are describing and the process was a total shit show ultimately leading to failure. 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.
reggieband 6y ago
When I read this kind of thing I am happy we live in a society that allows the free discussion of information. It is no exaggeration to say this kind of honest description of events by a senior health official could have lead to imprisonment or worse in many historical and some modern contexts. 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?
- twblalock 6y ago
  > Who is organizing the effort to fill the gaps? 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.
  - reggieband 6y ago
    > The only way this will work on a nationwide scale is if the federal government coordinates it. 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?
    - ardy42 6y ago
      > 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.
hef19898 6y ago
While I can only speak for Europe, more particularly for Germany, I learned quite a lot about masks in the last couple if weeks when I tried to leverage my logistics contacts to get masks and stuff from China. 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.
- rfoo 6y ago
  Sounds duly familiar to what I read about Wuhan back in late January and February. Only donations work. Had massive trouble distributing things. Fortunately at least you don't have to deal with another distraction named "government redirected your donation shipment to Red Cross (ran by government in China) and they sat on their stockpile doing nothing or malicious".
  - hef19898 6y ago
    So far, no. I guess we have to be happy about the little things, don't we?
lucretian 6y ago
so many comments asking "how could this be?" and "what the heck is going on?" and so forth. the answer is obvious, but i guess it's too "political" for people to accept.
- krapp 6y ago
  Just repeat to yourself - all administrations are equally inept. All politicians are equally corrupt. All parties are equally to blame, and all governments are equally malicious and incompetent. No specific problem exists, therefore no specific solution exists. To suggest otherwise is to fall prey to partisanship and wrongthink. We can't have that.
  - altoidaltoid 6y ago
    Thoughts and prayers
  - astronautjones 6y ago
    I really hope (but doubt) that this crisis will finally annihilate this terrible line of thought we've been crippled by (it feels like especially in the last four years). It's not political to accurately describe the sheer ineptitude and corruption. It's not political to call the staggering, unacceptable lack of leadership, candor, and morality out for what it is. It's not apolitical to turn a blind eye to it in search of profit.
- qqssccfftt 6y ago
  Or it conflicts with their worldview that what we have now is the best thing possible and life cannot be better.
- notagamedev 6y ago
  In 2006, the US Congress funded the integration of protective equipment to a Strategic National Stockpile: 52 million surgical masks and 104 million N95 air-filtration masks were acquired and added. During the 2009 flu pandemic, tens of millions of masks were used, but during the Obama administration strategic stocks were not “significantly restored”, neither have they been during the Trump administration
altoidaltoid 6y ago
https://www.businessinsider.com/fema-paid-bankrupt-company-no-employees-55-million-n95-masks-2020-4 https://www.businessinsider.com/fema-paid-bankrupt-company-n... No corruption here...
- m0zg 6y ago
  Yeah, they should have spent a month or two vetting every single company out of tens of thousands involved in the effort. This armchair quarterbacking is tiresome.
  - altoidaltoid 6y ago
    doesn't take a month to pull a business license search and check employee records.
  - untog 6y ago
    Come on. There's a middle ground. Of course the government can't be expected to vet every company in absolute depth right now, but it can very easily check a few criteria: - 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.
    - m0zg 6y ago
      Really? You're going to zero in on a _single_ contract, reported by Bezos Post from information provided by a bunch of Obama appointees? And just because they paid it doesn't mean at all that this money can't or won't be recovered. And just because a company is bankrupt and doesn't have any employees, doesn't mean it doesn't have a stock of masks. This is stage 4 TDS on full display. I've worked with USG in the past (through a prime contractor). I'd MUCH rather they pay some companies which can't deliver than run this shit through their usual procurement process that takes months and compares unfavorably to pulling teeth. And some companies won't be able to deliver even then. You can get the money back. You can't get lives back
  - 6y ago
learc83 6y ago
My fiancee is an ER doctor and her hospital is now getting considerably more N95s than they were a few weeks ago. It looks like the supply chain is finally ramping up.
fny 6y ago
I'm actively on the hunt for PPE on behalf of hospitals and I can tell you the mark up comes from several places: - 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.
- Cynddl 6y ago
  > I was out bid from someone from France. 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-regions-redoutent-le-vol-de-masques-par-les-americains-20200402 https://www.lefigaro.fr/actualite-france/coronavirus-les-reg... [2] https://www.liberation.fr/france/2020/04/01/une-commande-francaise-de-masques-detournee-vers-les-etats-unis-sur-un-tarmac-chinois_1783805 https://www.liberation.fr/france/2020/04/01/une-commande-fra...
  - nicbou 6y ago
    It doesn't help that the US tried to make some shady deals with a German company for exclusive access to the vaccine, and allegedly rerouted PPE paid for and headed to Germany.
- taylorhou 6y ago
  i've been sourcing kn95's from family friends who are higher ups at the handful of CDC NIOSH NPPTL certified manufacturers. they are reporting that their raw material costs have skyrocketed from what use to cost them 20k per ton to 400k per ton (RMB). 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.
gok 6y ago
We should give US doctors lots of PPE for no cost. 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.
- 0x00000000 6y ago
  Yeah it is rather ironic all this talk about price gouging in a state of emergency when hospitals do it all the time, especially for emergencies where the person has no choice. 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.
mhb 6y ago
It's easy to test the fit of the mask. I wonder what made him confident that the filter material actually worked.
somewhereoutth 6y ago
What I fail to understand - where was the emergency planning? A global pandemic is surely one thing that is a) foreseeable and b) possible to plan for. PPE could have been stockpiled, essential industry identified, testing infrastructure established, quarantine protocols put in place. We even had a dry run with SARS! 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?
- baybal2 6y ago
  Sure they were! 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
- casefields 6y ago
  George W. Bush in 2005: 'If we wait for a pandemic to appear, it will be too late to prepare' https://abcnews.go.com/Politics/george-bush-2005-wait-pandemic-late-prepare/story?id=69979013 https://abcnews.go.com/Politics/george-bush-2005-wait-pandem... Bush Administration planning here: https://www.cdc.gov/flu/pandemic-resources/planning-preparedness/national-strategy-planning.html 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.
pm_me_ur_fullzz 6y ago
> Having acquired the requisite funds — more than five times the amount we would normally pay for a similar shipment, but still less than what was being requested by other brokers 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.
anxman 6y ago
I wrote up instructions on how to buy KN95 Masks from China for $1.67 delivered. Please share it to anybody in need of KN95 masks. If you need samples of the masks, I can send them to you for free, just shoot me a message. https://docs.google.com/document/d/1BKUmZgwrvPG47VMR8SFvvSVh7lrUiMv0dvrnzmrs1Is/ https://docs.google.com/document/d/1BKUmZgwrvPG47VMR8SFvvSVh...
- pm_me_ur_fullzz 6y ago
  The price premium comes from shipping and the cost of time. 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.
- deleted 6y ago
  [deleted]
pm_me_ur_fullzz 6y ago
so they still buying or what
deleted 6y ago
[deleted]
syllable_studio 6y ago
Fixing our PPE supply chain was/is a solvable problem that our governments have utterly failed to address properly. It is shameful that our federal and state governments haven't better organized and incentivized solutions to fix this. I understand that it's hard. I understand that they're working hard to address this problem. But it's unacceptable that we haven't just gotten this done -- that we've instead put the burden on our medical workers to solve this life-or-death problem. As if they didn't already have enough to worry about. 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 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.
rckoepke 6y ago
> As a chief physician executive, I rarely get involved in my health system’s supply-chain activities. 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.
Jemm 6y ago
Time to start manufacturing in country which now means that, in North America, we need to provide financial incentives to all manufacturing because you can’t start building one product without the local supply chain to accomplish that. The time of cheap Chinese made goods must come to an end.

173 points by erwan 6y ago

Serious question: If the FBI and DHS are seizing PPE, where is it going? Why can't this hospital be a beneficiary of seized PPE, rather than an (almost) victim?

cameldrv 6y ago
Blue Flame Medical.

abinaya_remote 6y ago

Good approach!

sailfast 6y ago

This is insane. 5x markup and federal seizure of privately procured masks that will then get given to private companies to give to hospitals. Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go through while controlling part of the market. Absolutely crazy. Not to mention having to hope your governor praises the federal government to get their masks back. 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.

m4rtink 6y ago
>This is insane. 5x markup and federal seizure of privately procured masks that will then get given to private companies to give to hospitals. Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go through while controlling part of the market. Absolutely crazy. Not to mention having to hope your governor praises the federal government to get their masks back. 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.
- hef19898 6y ago
  Firefighters played a crucial part in the distribution concept I came up with two weeks ago. Nice to see something like that being implemented! 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.
  - m4rtink 6y ago
    I'm not sure there is much coverage of that in English - from the local news, it looks like this: - 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://www.expats.cz/ https://www.expats.cz/ https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_Czech_Republic https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...
    - hef19898 6y ago
      Thanks a lot!
- yread 6y ago
  Not everything is rosy though. Ministries buying 40m eur worth medical equipment from some company that had no revenues last year or year before that. One ministry paying double the price for the same thing as the other. And that's not even mentioning how many companies from prime minister's holding are benefitting disproportionately - subsidies, testing, hand sanitizer....
  - m4rtink 6y ago
    Yeah, it's definitely not perfect, but at the same time IMHO much better than the responce in other countries (or the lack thereof).
blackrock 6y ago
I saw an article saying the 5x markup is because of the air freight, which costs more. 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.
- sailfast 6y ago
  The freight costs makes sense and that's a great counterpoint. Thanks! 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...
- baybal2 6y ago
  > which forced the China central government to crack down on manufacturers, and only allow “medical grade” certified masks to be shipped. 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.
voodooranger 6y ago
Price ceilings cause shortages. Every time. Let’s not use Venezuelan-style economic illiteracy as a model for how to incentivize the flow of critical supplies to those who need it most during a crisis.
- thelean12 6y ago
  What about price ceilings and purchase limits? You'd have to actually think about the purchase limits for different entities but it sounds doable.
  - deleted 6y ago
    [deleted]
- BubRoss 6y ago
  Venezuela's problems come from international banking controls combined with hyperinflation and mandates to not increase prices. When you have a currency losing its value every week and the government mandating 10 cent gas with no way to transact with the outside world and escape your currency, things are going to get very distorted. Venezuela has much bigger problems than price caps, it is not indicative of systemic ramifications either way here.
- qqssccfftt 6y ago
  I wonder how anyone can write a comment like this and think that our economic model is not completely broken for anything other than making one group richer.
  - astronautjones 6y ago
    leading a life insulated from the consequences of living in this economic model
  - rhino369 6y ago
    Whether or not you think our model is broken, price controls of goods you want more of is a terrible policy. 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.
xster 6y ago
And that's in the present. What's more frustrating too is that if we're still debating about the present, there will certainly not be any accountability for the lack of preparedness from all levels of government in the past to prepare for health crisis. Compare to these images https://upload.wikimedia.org/wikipedia/commons/thumb/a/a6/雁塔_曲江收费站的防疫检查_01.jpg/440px-雁塔_曲江收费站的防疫检查_01.jpg https://upload.wikimedia.org/wikipedia/commons/thumb/a/a6/雁塔... https://upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Check_for_2019-nCoV_in_Jishuitan_metro_station_%28Beijing%29.jpg/440px-Check_for_2019-nCoV_in_Jishuitan_metro_station_%28Beijing%29.jpg https://upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Ch... (source: https://en.wikipedia.org/wiki/2019–20_coronavirus_pandemic_in_mainland_China 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.
- baybal2 6y ago
  This is the point I've tried to convey to my peers in the West over, and over, and over for years. 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.
  - makomk 6y ago
    Institutional IQ or leadership or anything else like that does you no good when your country no longer has the manufacturing infrastructure to make PPE anymore and the countries which can would rather use it to protect their own citizens, and it's mostly the anti-populists which seem to be doubling down on denying that simple fact.
pmorici 6y ago
Whats even more nuts is that N95's have taken this level of importance in healthcare at all instead of reusable P100 masks. I read a post on medium the other day about a hospital in Texas that does that and it was being treated as some kind of amazing discovery as if this was some unknown miracle device. [0] https://elemental.medium.com/a-tiny-hospital-in-texas-might-help-solve-the-mask-shortage-9ad3c0a7a861 https://elemental.medium.com/a-tiny-hospital-in-texas-might-...
- prostheticvamp 6y ago
  For most healthcare workers, it is unknown to them. N95 is the standard. And P100s were sold out early into this adventure.
  - xg15 6y ago
    I wonder, could the plastic part of P100s be 3D printed? (Or otherwise manufactured in fablabs)?
    - mhb 6y ago
      Not unless you have a material that conforms nicely to a face. But you can still buy face pieces. The filters are what are hard to get.
    - vmh1928 6y ago
      Yes, search on Montana Mask. The 3D files are available and you could print them at home. Part of the mask is the filter holder which you can stuff with N1900 or greater furnace filters, vacuum cleaner HEPA bags or whatever. Edit- sorry, it's not quite like the P100, the filter holder is a rectangle in the center of the mask as opposed to the mask in the article that has two filter holders.
    - m4rtink 6y ago
      Yep, one by Czech Technical University: https://www.ciirc.cvut.cz/covid-2/ https://www.ciirc.cvut.cz/covid-2/ https://www.rp95.cz/en/ https://www.rp95.cz/en/ 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-nejvyssim-stupnem-ochrany-byla-zahajena-do-priprav-se-zapojilo-vice-nez-tricet-ceskych-spolecnosti/ 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/mask https://www.vutbr.cz/en/mask https://www.vutbr.cz/en/but/news-f19528/covid-19-protection-halfmask-but-h1-d197642 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.
prostheticvamp 6y ago
> Instead, the government could institute price controls and distribute directly to those in need or allow all private purchases to go throug 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.
- praxulus 6y ago
  If the top 10 bidders are all Americans (which is plausible, given America's wealth and inflated healthcare costs), the U.S. government could use price controls to drive the price down from the 2nd highest to the 10th highest bid without losing supply to other countries. There's still the possibility that driving prices down would push manufacturers out of the business (or more likely, fail to pull in manufacturers who otherwise would have started producing PPE).
m0zg 6y ago
>> distribute directly to those in need or allow 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.
m3nu 6y ago
I also help with buying PPE currently and it's not 5x markup by the seller only. Everything got more expensive. Input material, machines, shipping. This results in the final price being 5x (or more). It's not the greed of one sales person (mostly). 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.
edge17 6y ago
The 5x markup is basically in line with the increase in material cost and increase in risk of importing. The melt blown fabric prices have been increasing dramatically since January when China ramped up production.

tosser0001 6y ago

I was certain by this point in the crisis we'd be seeing video akin to WWII/"Rosie the Riveter" stuff of PPE flowing out of factories around the country. Is the U.S.A. simply not capable of this level of production any longer? What the heck is going on? It's sobering.

dfxm12 6y ago
The USA is capable, they just lack the leadership in Washington to do so.
- altoidaltoid 6y ago
  The implementation of disaster federalism
- rckoepke 6y ago
  It certainly sows doubt when I see things like this: https://www.youtube.com/watch?v=p9lchhBE7cE https://www.youtube.com/watch?v=p9lchhBE7cE 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.
jsight 6y ago
We seem to have spent an amazing percentage of that energy on spooling up ventilator manufacturing instead. Most of that capacity will be ready once the crisis is well beyond its peak. I also do not understand why we weren't able to scale basic PPE quickly.

nashashmi 6y ago

Where is the ppe going? And why is dhs stepping in when hospitals are ordering them? Why cannot health care workers order ppe directly? Hospitals are having a difficult time time giving them out to workers because it is low.

jhart99 6y ago

If this sort of seizure is being conducted under the Defense Production Act Section I, there should be greater transparency of what PPE materials are currently subjection to allocation control. Otherwise, we might as well have the National Guard protect shipments from seizure within the states.

ttul 6y ago

It's absolutely insane that PPE isn't something that's being procured on a national level. Why are hospitals and clinicians having to deal individually? If there were a monopsony buyer (i.e. the Feds), suppliers could be bullied into providing reasonable terms. Well, I suppose the real answer is: Because that's not how healthcare works in America...

ttul 6y ago
Anyhow, in Canada, the federal government has created its own global supply chain to produce and distribute PPE as needed within the country, hiring two international firms to store and verify equipment sourced from China. Meanwhile, national air carriers are re-fitting their unused jets to carry PPE and the feds are happily paying them to fly them. "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-ppe-supply-chain-in-china-amid-pandemic-1.4894402 https://www.ctvnews.ca/politics/canada-establishes-its-own-p...
tejtm 6y ago
Same reason we do not have (health) records in the same place in a common format that would allows us to intelligently coordinate moving what supplies we do have around in a proactive fashion. We do not have a national health care system.
- Thriptic 6y ago
  We already have the ability to measure COVID status because diagnostic labs are required to report the presence of certain things to CDC in real time upon positive test result. COVID-19 is almost certainly one. Further, countries like Britain tried what you are describing and the process was a total shit show ultimately leading to failure. 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.

reggieband 6y ago

When I read this kind of thing I am happy we live in a society that allows the free discussion of information. It is no exaggeration to say this kind of honest description of events by a senior health official could have lead to imprisonment or worse in many historical and some modern contexts. 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?

twblalock 6y ago
> Who is organizing the effort to fill the gaps? 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.
- reggieband 6y ago
  > The only way this will work on a nationwide scale is if the federal government coordinates it. 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?
  - ardy42 6y ago
    > 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.

hef19898 6y ago

While I can only speak for Europe, more particularly for Germany, I learned quite a lot about masks in the last couple if weeks when I tried to leverage my logistics contacts to get masks and stuff from China. 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.

rfoo 6y ago
Sounds duly familiar to what I read about Wuhan back in late January and February. Only donations work. Had massive trouble distributing things. Fortunately at least you don't have to deal with another distraction named "government redirected your donation shipment to Red Cross (ran by government in China) and they sat on their stockpile doing nothing or malicious".
- hef19898 6y ago
  So far, no. I guess we have to be happy about the little things, don't we?

lucretian 6y ago

so many comments asking "how could this be?" and "what the heck is going on?" and so forth. the answer is obvious, but i guess it's too "political" for people to accept.

krapp 6y ago
Just repeat to yourself - all administrations are equally inept. All politicians are equally corrupt. All parties are equally to blame, and all governments are equally malicious and incompetent. No specific problem exists, therefore no specific solution exists. To suggest otherwise is to fall prey to partisanship and wrongthink. We can't have that.
- altoidaltoid 6y ago
  Thoughts and prayers
- astronautjones 6y ago
  I really hope (but doubt) that this crisis will finally annihilate this terrible line of thought we've been crippled by (it feels like especially in the last four years). It's not political to accurately describe the sheer ineptitude and corruption. It's not political to call the staggering, unacceptable lack of leadership, candor, and morality out for what it is. It's not apolitical to turn a blind eye to it in search of profit.
qqssccfftt 6y ago
Or it conflicts with their worldview that what we have now is the best thing possible and life cannot be better.
notagamedev 6y ago
In 2006, the US Congress funded the integration of protective equipment to a Strategic National Stockpile: 52 million surgical masks and 104 million N95 air-filtration masks were acquired and added. During the 2009 flu pandemic, tens of millions of masks were used, but during the Obama administration strategic stocks were not “significantly restored”, neither have they been during the Trump administration

altoidaltoid 6y ago

https://www.businessinsider.com/fema-paid-bankrupt-company-no-employees-55-million-n95-masks-2020-4 https://www.businessinsider.com/fema-paid-bankrupt-company-n... No corruption here...

m0zg 6y ago
Yeah, they should have spent a month or two vetting every single company out of tens of thousands involved in the effort. This armchair quarterbacking is tiresome.
- altoidaltoid 6y ago
  doesn't take a month to pull a business license search and check employee records.
- untog 6y ago
  Come on. There's a middle ground. Of course the government can't be expected to vet every company in absolute depth right now, but it can very easily check a few criteria: - 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.
  - m0zg 6y ago
    Really? You're going to zero in on a _single_ contract, reported by Bezos Post from information provided by a bunch of Obama appointees? And just because they paid it doesn't mean at all that this money can't or won't be recovered. And just because a company is bankrupt and doesn't have any employees, doesn't mean it doesn't have a stock of masks. This is stage 4 TDS on full display. I've worked with USG in the past (through a prime contractor). I'd MUCH rather they pay some companies which can't deliver than run this shit through their usual procurement process that takes months and compares unfavorably to pulling teeth. And some companies won't be able to deliver even then. You can get the money back. You can't get lives back
- 6y ago

learc83 6y ago

My fiancee is an ER doctor and her hospital is now getting considerably more N95s than they were a few weeks ago. It looks like the supply chain is finally ramping up.

fny 6y ago

I'm actively on the hunt for PPE on behalf of hospitals and I can tell you the mark up comes from several places: - 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.

Cynddl 6y ago
> I was out bid from someone from France. 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-regions-redoutent-le-vol-de-masques-par-les-americains-20200402 https://www.lefigaro.fr/actualite-france/coronavirus-les-reg... [2] https://www.liberation.fr/france/2020/04/01/une-commande-francaise-de-masques-detournee-vers-les-etats-unis-sur-un-tarmac-chinois_1783805 https://www.liberation.fr/france/2020/04/01/une-commande-fra...
- nicbou 6y ago
  It doesn't help that the US tried to make some shady deals with a German company for exclusive access to the vaccine, and allegedly rerouted PPE paid for and headed to Germany.
taylorhou 6y ago
i've been sourcing kn95's from family friends who are higher ups at the handful of CDC NIOSH NPPTL certified manufacturers. they are reporting that their raw material costs have skyrocketed from what use to cost them 20k per ton to 400k per ton (RMB). 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.

gok 6y ago

We should give US doctors lots of PPE for no cost. 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.

0x00000000 6y ago
Yeah it is rather ironic all this talk about price gouging in a state of emergency when hospitals do it all the time, especially for emergencies where the person has no choice. 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.

mhb 6y ago

It's easy to test the fit of the mask. I wonder what made him confident that the filter material actually worked.

somewhereoutth 6y ago

What I fail to understand - where was the emergency planning? A global pandemic is surely one thing that is a) foreseeable and b) possible to plan for. PPE could have been stockpiled, essential industry identified, testing infrastructure established, quarantine protocols put in place. We even had a dry run with SARS! 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?

baybal2 6y ago
Sure they were! 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
casefields 6y ago
George W. Bush in 2005: 'If we wait for a pandemic to appear, it will be too late to prepare' https://abcnews.go.com/Politics/george-bush-2005-wait-pandemic-late-prepare/story?id=69979013 https://abcnews.go.com/Politics/george-bush-2005-wait-pandem... Bush Administration planning here: https://www.cdc.gov/flu/pandemic-resources/planning-preparedness/national-strategy-planning.html 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.

pm_me_ur_fullzz 6y ago

> Having acquired the requisite funds — more than five times the amount we would normally pay for a similar shipment, but still less than what was being requested by other brokers 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.

anxman 6y ago

I wrote up instructions on how to buy KN95 Masks from China for $1.67 delivered. Please share it to anybody in need of KN95 masks. If you need samples of the masks, I can send them to you for free, just shoot me a message. https://docs.google.com/document/d/1BKUmZgwrvPG47VMR8SFvvSVh7lrUiMv0dvrnzmrs1Is/ https://docs.google.com/document/d/1BKUmZgwrvPG47VMR8SFvvSVh...

pm_me_ur_fullzz 6y ago
The price premium comes from shipping and the cost of time. 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.
deleted 6y ago
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pm_me_ur_fullzz 6y ago

so they still buying or what

deleted 6y ago

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syllable_studio 6y ago

Fixing our PPE supply chain was/is a solvable problem that our governments have utterly failed to address properly. It is shameful that our federal and state governments haven't better organized and incentivized solutions to fix this. I understand that it's hard. I understand that they're working hard to address this problem. But it's unacceptable that we haven't just gotten this done -- that we've instead put the burden on our medical workers to solve this life-or-death problem. As if they didn't already have enough to worry about. 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 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.

rckoepke 6y ago

> As a chief physician executive, I rarely get involved in my health system’s supply-chain activities. 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.

Jemm 6y ago

Time to start manufacturing in country which now means that, in North America, we need to provide financial incentives to all manufacturing because you can’t start building one product without the local supply chain to accomplish that. The time of cheap Chinese made goods must come to an end.