Outsourced manufacturing exacerbates crisis
Wildfires in Australia consumed millions upon millions of face masks. Wildfires in California, ditto. That was the pre-pandemic planet.
Since then, the wildfire outbreak of coronavirus in China of course; at the height of contamination, the country was cranking out 116 million masks a day, and it wasn’t enough.
Taiwan, which has done an extraordinary job of containing COVID-19 — just two deaths despite proximity to the China epicentre — ratcheted up daily production to 10 million, rationing them to citizens at a cost of 17 cents each. But naturally they put Taiwanese first, the government banning export of surgical masks and the upgraded N95 version on Jan. 27, although provision for nationals abroad was permitted this month.
Countless countries import the cheap masks from Taiwan and China. Hence, the international shortage at a time in history of unprecedented need, with the supply chain cut off as the coronavirus tsunami struck.
“We should never have outsourced production,” says Dr. Kashif Pirzada, an emergency department physician at a Toronto hospital.
“We’re seeing the consequences now — the urge to save a nickel or a dime on each mask. All those Italians shouldn’t have died. Their health-care workers should have had all the protections available to them at the front lines. Local factories should have been able to scale this up. Basically, all the countries that export them got hit with the epidemic. This is why we have a short supply now.”
Around the globe, if belatedly, assembly line factories are being rapidly retrofitted to produce masks and other medical protective gear — gloves, gowns, face shields, goggles and ventilators, though the ventilators, with multiple moving parts, require more sophisticated manufacture and expertise.
So, nurses in the United States are reduced to posting urgent call-outs for gear on social media and one Toronto hospital has launched an appeal for public donations to ward off an impending crunch.
“I’ve heard of fist fights happening in the U.S. over getting the last mask with a face shield,” says Pirzada, who is on a vast medical networking site.
Because some hospitals in Canada and the U.S. have been churlish about letting their own employees know how dire the situation is becoming.
“I was provided with one mask, they said that’s all I’m getting,’’ a nurse in Ohio told CNN.
The call to arms — the warning — was triggered particularly after the New Yorker published an article a few days ago by Dr. Atul Gawande, a highly respected surgeon and public health researcher in Massachusetts, who addressed how to keep health-care workers from becoming patients. The public health system will utterly convulse if doctors and nurses and lab technicians fall ill by the hundreds.
Italy, for its sins, is the cautionary tale. As of Tuesday, 4,824 health-care workers had been infected. Nineteen doctors and nurses had died.
“We haven’t seen the crush yet,” Pirzada says of his hospital, which he asked not to be named.
“The models show rolling cases, the peak, will arrive in about a week. Then we’ll see. If you start hearing about hospitals collapsing, you’ll know that what we did to prepare wasn’t enough.”
Until only a few days ago, Pirzada’s hospital administrators were telling medical staff they didn’t need to don protective masks unless they were dealing directly with patients and further protective equipment wasn’t required unless there was intimate contact, such as intubation.
But that may have been illadvised.
“Recommendations keep changing from day to day, from Public Heath,” Pirzada says, noting that his hospital has been losing one or two doctors a day merely because they present with the sniffles.
“They’re asked to isolate and get tested. Health-care workers are moving to the top of the list for testing. Then they try to get you back in the field within a few days of testing (negative).”
Doctors and nurses, for all their dedication to humanity, have no desire to become martyrs. Some are questioning the wisdom of both overprotecting — doctors removed from the quota who may have nothing more than a light cold — and under-protecting, assuring staff that social distancing is adequate when encountering one another.
“It’s actually a controversial area right now,” Pirzada continues.
“There is a huge shortage of all kinds of masks, especially N95s and also the paper masks, the surgical ones. We’ve all heard about how countries like
Taiwan and South Korea and Singapore have managed to control the outbreaks. But what nobody mentions is that nearly every single person is wearing masks all the time, in hospitals, in public.
“What’s been difficult for us is that hospitals have been telling us masks aren’t necessary, you guys can just stay two metres apart from each other, good luck to you. And what we’re seeing, first in Europe and now in New York City, is that a lot of them are getting sick.”
California, so severely hit by COVID-19, is trying to procure a billion gloves and hundreds of millions of gowns. The state says it also needs 50,000 more hospital beds to cope with the burgeoning pandemic.
Medical associations of doctors and nurses issued a statement imploring President Donald Trump to activate the Defense Production Act, which dates to 1950 — the Korean War — to convert factories, take all actions possible to increase domestic production of equipment “so that hospitals, health systems, physicians, nurses and all front-line providers” get the equipment they “so desperately need.”
The Trump administration has so far declined to compellingly mobilize the private sector to deal with the nationwide medical supply shortage, as state authorities have been furiously trying to outbid each other to secure what’s needed, whether by importing orders or from quite limited domestic producers.
Ontario — 588 confirmed cases — is no different. Take a number.
Premier Doug Ford said on Tuesday that a United Kingdom mask provider has refused to fill orders from Europe and North America.
“We’re doing everything we can to make sure we have a supply on hand, putting competitive orders for a million masks, a blanket order for two million. We’re making sure our name is on the list.”
Dr. Theresa Tam, Canada’s chief public health officer, reminded reporters that there’s also been a concerted effort to increase domestic capacity. Auto parts suppliers and pulp and paper companies are converting to make ventilators and masks. “I’m really optimistic — of course we’re in a difficult situation — but we are actually pulling out all stops.”
Across the globe, knitters and sewers have taken up the challenge where governments have failed. Crafty people who are nimble with a thimble. The unexperienced who’ve downloaded mask patterns off the internet, if only to feel like they’re doing something to help.
St. Luke’s University Health Network in Bethlehem, Penn., on the weekend posted a notice on its website asking not only for donations of personal protective equipment and other supplies — thermometers in dreadfully short supply — but fabric and elastic to make their own.
A swimsuit company has donated 3,600 yards of elasticized fabric, enough to make 10,000 masks. A national crafts chain in the U.S. has opened depots where home-sewers can drop of masks and gowns. In Baltimore, 160 volunteers with 414 3D printers are making plastic face shields for Johns Hopkins University and other area hospitals.
At the Paratroop School in Murchia, Spain, members of the national Air Force are turning out 500 masks a day.
In Belgium, a broad network of home-sewing mask makers has swollen from what was at first just one little old lady. Nuns in Italy sew. Fashion houses in France have morphed into mask assembly lines.
Of course cloth masks are far from ideal, certainly not as effective as triple-ply professional masks or isolation gowns made from “melt blown fabric” with glued seams; certainly a poor cousin to N95 respirators that filter out 95 per cent of airborne particles. But still a damn sight better than the scarves and bandanas that have been urged upon health-care providers as a last resort.
The Centers for Disease Control and Prevention in the United States actually recently changed its recommendations for optimizing the supply of face masks amidst a need surge. Now, except in case of intubations (inserting a breathing tube) the agency says standard surgical masks are acceptable when examining or treating a patient. Indeed, nurses can resort to scarves and bandanas as makeshift masks when caring for COVID-19 patients.
The American Nurses Association didn’t like the sound of that at all, stating in a released public letter: “We are concerned that the CDC recommendations are based solely on supply chain and manufacturing challenges.”
Clearly so. But Dr. Pirzada, for one, would be grateful for anything he can get if the situation becomes dire.
“They’re useful,” he says of homemade masks, speaking as a physician who goes home after every shift to a newborn and a two-year-old. “They won’t protect you, they won’t save you. But they will protect everyone around you.”
Won’t filter out microbes in the air or flung across a room when intubating a patient but could prevent a health-care worker, who’s contracted the virus, from spreading it to co-workers in cough droplets.
A flimsy shield. Sometimes, in these worst of times, that’s as good as it gets.