A FEMA FUMBLE?
Before Trump left office, agency OK’d exporting millions of N95 masks U.S. workers say they need
In the final moments of Donald Trump’s presidency, amid a national shortage of N95 masks, the U.S. government granted an exception to its export ban on protective gear, allowing as many as 5 million of the masks a month to be shipped overseas.
The Federal Emergency Management Agency issued the waiver, allowing a Texas company to export its products after it failed to secure U.S. customers, according to the FEMA letter obtained by KHN.
National Nurses United president Zenei Triunfo-Cortez called the export waiver “unconscionable” and said N95 masks remain under lock and key in many hospitals. She said she still has to “beg” for a new one if hers gets soiled during a shift caring for coronavirus patients.
Health care employers “and a federal agency that is supposed to be protecting the people of America are not doing their jobs,” Triunfo-Cortez said. “They have no regard for our safety.”
The disconnect between front-line workers going without better protection and federal officials suddenly exporting masks boils down to one thing, workplace-safety experts say: The government has not pivoted quickly enough to lift supply chain crisis-mode guidelines and force employers to take costly and sometimes cumbersome steps to better protect workers with top-quality gear.
The FEMA letter refers to the challenge that Fort Worth, Texasbased Prestige Ameritech faced in finding customers for its governmentapproved, high-end respirators: Hospitals did not want to “fit test” employees to its N-95s, a 15-minuteper-employee process to ensure that a new N95 model seals to the face, according to company president Mike Bowen.
Bowen said he ramped up N95 production during the pandemic from 75,000 to 9.6 million a month. Lately, he said, he can’t sell them to major buyers, does not have the infrastructure to sell them to small buyers and has so many in storage that he might need to lay off workers and wind down production.
The FEMA letter refers to those challenges and says the waiver was granted in the “national defense interest” to ensure that Bowen keeps production running at the same pace. The letter was transmitted to Border Patrol officials who oversee exports
103 minutes before Joe Biden was sworn into office.
Yet even with the waiver, Bowen said, he hasn’t been able to find an overseas buyer. He said he can’t understand the contradictory information he’s getting: Front-line workers say they need more N-95s, but hospitals say they don’t.
“There is a disconnect someplace, and I don’t know where it is,” Bowen said. “Why aren’t my phones ringing off the hook if there’s a shortage?”
A FEMA official said the waiver could be revoked at any time if U.S. demand increases and that the agency could require the company to “satisfy domestic demand” before exporting N-95s.
Though prices fall considerably when buying in bulk, prices for smaller lots of N-95s have reached $4 to $7 each, according to Get Us PPE, a notfor-profit organization meant to match front-line workers with needed gear.
The requirement for employers to perform fit tests annually was set aside amid the public health emergency, giving employers little incentive to veer from the industry-standard models like 3M that were used for years. And the federal Centers for Disease Control and Prevention has left guidelines in place that say a limited cadre of health care workers should get N-95s, which can be reused and rationed.
That adds up to an unusual situation in which U.S. mask supplies have surged, but employers’ motivation to buy the best protective gear has not, said Peg Seminario, a former union health and safety official who recently signed a letter urging the CDC to update its guidelines to reflect the risk of inhaling the virus.
“This is crazy,” Seminario said. “We could … crush this pandemic where the biggest risks of infection are, and we’re not doing it.”
Started by a group of emergency room doctors in March, Get Us PPE said it gets 89% of requests for gear — often N-95s — from health workers outside of hospitals, like community clinics, COVID-19 testing sites and psychiatric care facilities. Demand rose throughout January, with 28% of frontline workers seeking N-95s reporting that their workplace had none.
Yet the volunteer-run group has been able to fulfill only about 15% of the requests it receives. Dr. Ali Raja, a founder of the group and executive vice chair of the emergency department at Massachusetts General Hospital, said the need is vast outside of hospitals, but small facilities scrambling for gear are not connecting to bulk sellers like Bowen’s company.
“There was nothing out there — no centralized place for all facilities to report PPE needs,” Raja said. “We don’t want to be the website with the best data on this. We want that to be the federal government.”
On the last day of 2020, FEMA extended its rule prohibiting anyone from exporting PPE, including N95s, without getting express approval from the agency. The rule says the fall and winter surge in COVID cases meant “domestic supply of the allocated PPE has not kept pace with demand and is not anticipated to do so.”
The U.S. Strategic National Stockpile has not yet met its goal for N95 respirators, according to a U.S. Government Accountability Office report. The report said that, as of Dec. 18, there were 190 million N95 respirators in storage — well short of its goal of 300 million.
“GAO remains deeply troubled that agencies have not acted on recommendations to more fully address critical gaps in the medical supply chain,” the government watchdog report says.
Another twist to the saga is that millions of counterfeit N95s stamped “3M”— an industry standard that has long been used in previously required annual fit tests — have flooded hospital shelves even as federal agents rush to seize them at U.S. ports.
A prominent group of scientists wrote to the CDC on Monday to point out guidelines that urgently need to be changed to protect workers from inhaling tiny airborne virus particles. Their letter noted that the “CDC does not recommend the use of N95 respirators” outside of health care settings, even though outsize risks are documented for bus drivers, prison guards and meatpacking staffers.
CDC guidelines also allow hospitals to limit which workers get the N95s, leaving out those in community settings and lower-level workers, who typically spend the most time next to patients.