I do China sourcing and have decent access to 3-ply surgical masks and limited access to N95 masks.
It's really hard to sell either of those to government bodies, even near cost. Already talked to the Red Cross, wholesale pharmacies and different ministries. They generally insist on payment on delivery, which we can't do for larger orders, as factories sell to whoever has the cash at the factory gate.
Some also want EU certifications (FFP2), while many factories in China only have the local Chinese standard (KN95). And some refuse to pay to a company outside Europa, while wanting to buy stuff from China.
So while I'd love to ship some of this stuff to Europe, currently people there are still blocking themselves. Hoping to work something out soon.
Why don't they just charge a higher price to buyers who don't pay cash now? I understand there is a lot of demand, but this does not compute with me. My spidey senses would be going off.
This works for private buyers, but these gov agencies have a regulation that doesn't allow them to pay in advance ever. The price isn't the issue. So they can only buy from really big firms, who don't have stock right now and aren't flexible.
Sure, but why do all of the smaller firms absolutely need cash right now? If they sell to a government or large entity, payment is all but assured. Even if they have a high discount rate, they can factor that into the price. There's no way they all need the money now to remain in operation.
We are way past discount rates here. Firms without enough cash won't survive. Even if you double or triple the price, it doesn't help if you're out of business when they pay weeks or months later. That's why some kind of financing is needed for larger orders that need like $ 1/4m to 1m in outlay first.
Can Chinese banks provide bridge financing? You'd think they would be happy to, since half of them are state-owned and China is in a position to help other countries afflicted by Coronavirus.
The bank can give the mask company money now. Once the American NGO receives the masks, it can directly pay the bank. That way the bank does not have to worry about the mask company stealing its collateral. The bank might even offer to pay for the provision of masks as a donation from China.
Can you email me? Can connect you to US hospitals in hotspots in California that are looking to buy. They’re currently not using PPE in all the situations they should be due to shortages.
You might not see this anymore, but in the hope: I'm saurik@saurik.com and am an elected government official in Southern California (in the United States) working with a nearby regional government, and have just learned that we are also interested in surgical masks (I had previously thought we were only interested in N95 masks). Are you also interested in shipping to the US?
What I'm getting at is that if you're talking tens of thousands of dollars for an order there's a far greater number of people who can put an advance towards that than if you're talking hundreds of thousands or millions per order.
Hospitals (public and private) in the Bay Area are publicly talking about sourcing PPE from non-medical vendors (e.g. construction companies) and nurses are protesting in front of hospitals. Seattle area hospitals are making their own. All of which is to say I think that procurement guidelines will be dramatically relaxed.
I’m working on a fundraiser to help with Corona. Initially our idea was to donate straight to e.g. the WHO. What is the most efficient way to spend money right now?
Last I heard, my employer (large hospital in New York) is looking to buy. If you could reach out by email, I will pass it along to the relevant people. Thanks!
Let this be a lesson to learn for western democracies to not put all of their eggs in one basket. Diversification, localization and strategic globalization of the supply chain should be at the forefront of the issues to be discussed, ratified and acted upon after this pandemic is over. When one country manufactures 90% of world's goods (not accurate, to make a point), while the top 1% gets their bonuses for increasing profit margins, this is what we have. We've lost skills, we've lost our stance to manufacture things in our own homeland. It is depressing, deeply worrying and feels like the entire world has been gutted out by one country. Just to make it clear - think about this scenario - what would happen if one country made the food for the rest of the world? (Thankfully, we don't, but it can happen). What about pharmaceuticals? (Unfortunately, 90% of the world's generic drugs are made in Asia, primarily in India who in turn depends on China) [1].
Edit: I just realized that some of the startup and entrepreneurs around the world are on this forum, if you'd like to get into manufacturing, want to learn about more abstract concepts of manufacturing, I implore you to checkout: Manufacturing Planning and Control for Supply Chain Management reference book - https://books.google.com/books/about/Manufacturing_Planning_...
This book is absolute gold. Manufacturing is like playing this game Factorio (google it) but in real life. It is an exciting field ripe for innovation, many very hard problems and unlimited potential (and a lot of risk as well).
It is not about autarky, but diversification and resiliency of the supply chain. Automakers are experts at this - BMW cars made in USA (South Carolina) have US made parts and ones made in Germany have locally sourced parts from Germany, yet the ones made in South Africa have diversified sources - both local and international. If you're in the US, you can see this % of locally made parts right on the window price sticker. It's not just for show - if there is a shortage of headliners in US, it can import it for a short term needs from Europe and vice-versa.
No one is suggesting complete in-house isolation aka Autarky, but to avoid SPOF (single point of failure) supply chains - probability of each link breaking adds up when your supply chain is 18 levels deep from an iPhone to the copper mine.
You can't stockpile everything you could need for every potential crisis. At an individual level, think of extreme preppers that have huge tanks full of water, years of storable food, an arsenal of guns, etc. This only covers a small set of scenarios, but the cost is unaffordable on a national scale.
What makes a country resilient is not stockpiles, although those help, but the ability to quickly switch production to whatever is needed in the moment. Flexible production capacity trumps stockpiles, because you don't have to decide in advance what the crisis will be.
Unfortunately all of the flexible production is now in a country that's accusing the U.S. of deploying SARS-CoV2 as a bioweapon over Wuhan.
I thought before that it was someone eating a bat, but the hard propaganda push is making me suspect something more sinister that the Chinese are afraid will come out eventually, and they want to muddy the waters before it does.
Purely economically, the west is at a disadvantage because they'd be fighting free-market pressure of everyone wanting the lowest price. Right now, for whatever reason, things are cheaper to make/buy-from China and other Asian countries. From my perspective, there are only 3 options as to how to fix this:
1. Accept and be willing to pay a higher price (for manufacturing that happened in friendly places)
2. Impose tariffs on Chinese-made goods so that the local higher-price is a non-issue and may even be cheaper due to lower shipping costs.
3. Impose whatever it is that makes things more expensive in the West to also happen in China. E.g. environmental laws, regulations, working conditions, etc.
My vote would be number 3. Get the damn UN to proclaim something, impose sanctions and embargoes if they don't comply, kick them out of the UN meetings, blockade their border and punish countries that don't comply with the sanctions/embargo, etc. Right now, we all keep complaining, treaties and stuff gets passed and blasted out on the news with feel-good promises of compliance X-years later, but when non-compliance happens blatantly, no one does anything but complain and half-ass it by proclaiming condemnation, imposing silly sanctions that do very little, etc.
Half the humanitarian and human-rights problems happening right now around the world can be fixed if strict rules were put in place, and non-compliance by various governments was punished severely. We need to stop treating countries as nebulous entities with no accountability. Hold the entire country accountable and watch the dominoes fall into place as everyone really at the end of the day wants to get along and just go about their daily lives. If democracy works for citizens, it should work for countries.
But can this be done without abandoning capitalism as a primary driving economic model? It would require a reversal in economic steering (tariffs, government intervention, etc) of enormous scale. The only thing that has come to matter is the hunt to squeeze every penny, we have forgotten to do anything else.
The government funds some percent of our food production by putting in place limited price and production controls for American-produced goods.
The hand of the market is not completely removed: producers still want to be as efficient as possible. The cost of food has gone down over time. And inefficient producers still go bankrupt.
Is this a good model? I have no idea. It certainly has drawbacks. (Ex: we subsidize too much corn and wheat.) But the US can feed itself without China or OPEC, so that's nice.
My grandmother born around 1900 said what happens when you don't have some government market coordination is damaging boom bust cycles in agriculture. Farmers chasing last years profits tend to over produce, prices crash and farmers go bankrupt. And if you don't keep your poor urban workers fed really bad things happen politically.
I think there can be a lot of debate about the mix of subsidies and price controls. But the need I think is there. Food is a critical need as we are about to note. And it's really not the end of the world if things aren't perfectly optimal.
While corporate farming gets trotted out as the Boogeyman anytime subsidies are discussed, and is indeed an issue, there's still a lot of non-corporate farming.
And it's a hard life.
You go into debt to buy machinery and raw materials (seed, fertilizer, pesticide) you need to generate competitive yields...
Then it doesn't rain. Or it rains too much. Or the weather is too good in Asia, depressing the global price.
And all it takes is a few years of the above, and the bank is foreclosing on property that may have been handed down to you through generations of family,
How does that make you feel as a person? And even if everything goes right, what does worrying about that constantly do to you?
Farm subsidies are a messy business, fraught with peril, but farmers can't just up and move like most of us. So I'm not unsympathetic to the underlying compassionate goal (even if the realization may be perverted).
I guess the closest analogy for many would be being a web dev, if browsers decided to randomize their compatibility with all standards every year. And you needed to take out a loan for a laptop and tooling.
> It certainly has drawbacks. (Ex: we subsidize too much corn and wheat.)
Huge drawback right here, corn (high fructose corn syrup, corn itself) and wheat are both at the center of the obesity epidemic and health crisis. It's a point that's often brought up and isn't controversial at this point, but inertia makes it hard to correct, especially with said subsidies.
Corn and wheat are damn healthy when consumed raw. Individual trends and desires are the problem, not wheat or corn. Shredded wheat is one of the healthiest foods to eat. So is whole corn.
Let's go to the source of this problem - Corn/Wheat lobbyist paying off lawmakers in DC. This is the root cause of American sell out. It is an awful system that needs to be completely dismantled, criminilized and banned. Please don't tell me about how each special group has the right to lobby... this is an asymmetrical game. As the corn/wheat lobbyists lobby, who is opposing them? No one. And, as their interests are in billions of dollars, it is literally impossible of oppose.
I am willing to bet, large number of America's problems can be traced straight to the abhorrently corrupt process of lobbying.
That quote doesn't paint the full picture. E.g. We haven't tried direct-democracy. Still won't fix peoples' herd-like behavior of following skilled orators, but it should make a serious dent in lobbying.
This is what will happen to the 1000 bucks that they deposit in all accounts.
People don't get the number of systems that will automatically target the most vulnerable/easily exploitable as soon as a deposit shows up, is a much bigger issue than actually handing cash out to people.
The "squeeze every penny" mega machine has grown so complex and large its hard to see how it can be dismantled.
Tariffs result in domestic industries that can't compete. Germany has an export oriented manufacturing sector that employs lots of people and the US doesn't not because of Chins but because of US management.
I don't have a good answer. First and foremost, the shipping rates for consumer goods from China is outrageously low. People buying from Germany to Australia to USA - $2 shipped PCBs and $4 toys shipped - all have one thing in common: Shipping cost is highly subsized because of this treaty - https://www.vox.com/2018/10/19/17996378/trump-china-universa...
Locally made goods can benefit from some tax breaks and government subsidies as well, but the aforementioned problem needs to be resolved. Alas, it won't be because executives keep lobbying and paying off key decision makers.
The whole thing is corrupt. I don't agree with President Trump on majority of things, but I try to not let bias triumph over logic, pragmatism and rational ideas; no matter who is pushing them.
There is reason to believe that the hospital mask shortage is due in no small part to employee (and patient/family) theft of masks and not necessarily due to dramatically increased need at hospitals (at least not yet).
I say this as a resident physician at an urban hospital in the US. We're now severely low on N95 masks and moderately low on surgical masks but we have only had less than a dozen confirmed covid-19 cases (granted about 100 tested negative cases) so there's no way even 100 additional patients requiring masks suddenly plummeted our stockpiles of masks. Indeed, hospital administration noticed and sent out a mass email imploring employees to return unused masks in personal possession.
EMS provider in WA state - our current plan is "Assign N95 to provider. Use on calls as appropriate. If pt has flu-like symptoms/ upper respiratory/ etc, place mask in paper bag in warm space, write date. Re-use after two weeks (i.e. a safe time for virus to die)". Otherwise, re-use as needed. Disposal in case of blood/sputum/etc contamination, only.
Perhaps theft can explain the reduction, but isn't that equivalent to (for example) a leaky toilet destroying the room that the masks are in? In other words, perhaps it is still indicative a weakness in the hospital's supply chain that they can't make up for a sudden shortage of masks due to rare circumstances.
Oh there's definitely a supply chain issue now; we're not going to be able to re-stock anytime soon is my understanding. So there was absolutely a high degree of unpreparedness at many levels. However, we already nearly depleted our masks and we haven't even had a significant spike in need yet.
If people hadn't been stealing masks for their own personal use outside the hospital, we probably could have had our supplies last another few weeks, which is significant.
I'm honestly very conflicted now that you mention this. Yesterday some friends hit me up to donate to a gofundme page to support getting masks for a hospital a friend works at. It's a state university hospital with hundreds of millions in endowment in a red state.
It's easy to become jaded and cynical, but I'm beginning to believe this is the wake up call a lot of people need and anything less than an unmitigated disaster will be converted into a win to all these science denying, public health de-funding radicals running some governments.
It's probably the stress, anxiety and anger at the impotence caused by all this, but I can't help but feel a desire to lash out those people who have made things worse.
This. There are barely any covid 19 patients yet hospitals are low on masks due to panic. Beds are still open and ventilators contrary to media claims are not currently on a shortage.
There are also not nearly as many tests being run as there are patients with suspect symptoms. Yes, the number of confirmed COVID-19 patients may be low, but that doesn't mean that the number of people with the disease is low.
According to the CDC[1], you can contact your healthcare provider for the possibility of a test if (and only if) you are in close contact with someone with the disease or if you're in a community where there's ongoing spread. That's still a very limited subset of people who might have the disease.
There's very limited insight into who does or does not have the disease in the US.
And these criteria become a catch-22. How does a community become identified as having community spread if you won't test anyone in a community that isn't so identified? My understanding is someone has to be admitted to the hospital and then tested to get the ball rolling.
True but maybe 1% of those need respirators and those that do need them regardless of testing are currently getting them. Due to current measures no one is dying due to a shortage of medical equipment in the US.
That said, we must manufacture medical equipment for pandemics locally or have a reserve like oil.
My family (and myself) work as various healthcare providers.
One of them said a few days ago masks and other supplies were stolen from a delivery truck that was broken into as the driver went in to start the delivery to the hospital.
My sense is there's a lot of leakiness in supply of various forms.
My experience is similar to those of others here: it's not really clear there's a substantial increased patient count at the hospitals here, test or not, but supplies are getting scarcer. Maybe other areas of the country or world are creating shortages.
Testing is a mess, but that's a different issue, one maybe more relevant to public health and policies in some ways.
Well, and now we have at least 4 GOP Senators who, after receiving non-public briefings, made in the order of $35M in trades, and/or told private lunches for large donors about projections that were extremely different from what they were standing in front of a TV camera saying.
I mean say what you will, but that kind of is the American way since the founding of the republic. Don't trust the sovereign to take care of you, because just sometimes that ends with the cops welding people into apartment buildings
Does that mean people should hoard and price gouge their fellow man during a pandemic, of course not.
I'd call myself a libertarian. I've gone through phases of many different flavors, but ultimately all united by a general belief that people should be free to make choices for themselves, and ultimately know themselves better than a centralized government.
Having said that, there is a huge blindspot of this philosophy with regards to public health. So much so, that when public health officials do their job, we can comfortably take them for granted. Wasn't it great when the CDC was simply a "waste of taxpayer money" ?
In general we shouldn't blindly trust the government to take care of us. But we all implicitly did anyway, by not already having stockpiled all of these goods far ahead of time. As this has now become acutely apparent, everyone is looking to stock up for themselves aka hoard.
We're about to see what happens to Freedom when this centralized response is not performed early enough to nip the problem in the bud. In a month, the national guard is likely to be patrolling to keep order, as the supply of hospital beds severely lags demand.
I personally don't think that Libertarianism (and anarcho-capitalism by extension) have a blindspot when it comes to public health. Right now we're seeing huge efforts in the private sector to mitigate this disaster, that can not be discounted. As simple examples, private entities are giving out sanitizers, increasing hygiene and cleaning policies, putting up posters for awareness, coming up with contact-less procedures for public interaction, hiring people to fix online shopping demand, etc. When people are scared, they act. When a business's continuation is threatened, it will act.
My private health-care provider and insurance provider have already extended (without government mandate, direction or legislation or extra-cost) my cover for any corona-related treatment/illness/death. In-case I lose my income due to this, they've also extended my unemployment to cover that so I won't be losing my income if it comes to that. And I can get a private test at my-cost (or healthcare provider will reimburse me) for less than $70.
So that just leaves what...Mass coordination of "public" spaces? Again, tragically those spots are both everybody's and nobody's at the same time, essentially paralyzing them from doing anything too drastic without government approval.
Not to mention the government is now stepping in and stopping some of these efforts because "human rights". They're planning on commandeering private hospitals and facilities to provide healthcare for free for those that don't pay and to deal with the fact that they were inadequately prepared for this crisis. They've also started with curfews, sent military police to private premises to "count" heads in case they go above some magical government number, prohibited public-dissemination of information by epidemiologists without government-approval.
> private entities are giving out sanitizers, increasing hygiene and cleaning policies, putting up posters for awareness, coming up with contact-less procedures for public interaction, hiring people to fix online shopping demand
You're helping to prove my point. These are all reactive actions that simply attempt to mitigate the problem. I've personally upped my hygiene, policies, and mask / hand sanitizer use as well. This isn't going to actually solve the epidemic, but it will reduce my own exposure now that it's a major problem.
Where was the private company temperature-checking international travelers in February, testing, and quarantining or contact tracing as necessary?
Proactive prevention requires focus and coordination. A team that is paid to sit around looking for specific threats will take them seriously, while businesses (really all entities, including individuals and the non-specialized parts of government) only respond to the current conditions. Large companies could certainly employ similar risk teams, but don't seem to have done so for the current problem.
> deal with the fact that they were inadequately prepared for this crisis
The entire medical system, public and "private", is unprepared for the crisis. One could make the argument that if healthcare had been a freer market there would be much increased hospital capacity, but I don't see how this makes sense given businesses tendency to be reactive. Supplies like masks could have been easily stockpiled by companies and sold at a decent profit when needed, but weren't.
> They've also started with curfews, sent military police to private premises to "count" heads in case they go above some magical government number, prohibited public-dissemination of information by epidemiologists without government-approval.
You'll get no argument from me about these being injustices. But I think the real anti-freedom jackboots are going to come out when people start dying in significant numbers from hospital crowding. Which is kind of my entire larger point - when situations are allowed to get out of hand, restoring forces step in and none of them are conducive to lofty ideals of freedom.
I'm of the libertarian persuasion too, but I'm really more of what I might refer to as a competitivist, that the government ideally increases competitive exchange of goods services and ideas. Sometimes this means more government services, sometimes less. Regulation is also different from service or resource provision.
In a lot of ways, this crisis was worsened by overregulation. The FDA and CDC to some extent contributed to testing shortages by emphasizing centralized micromanaging of test protocol over test availability. It was entirely preventable.
Many of the crunches we're seeing are due to rent seeking monopolies restricting provider pools and other red tape, that are entirety self inflicted. You're starting to see glimpses of this problem with things like lifting interstate licensing practice constraints, but it's the tip of the iceberg.
US healthcare needs a lot more public support in the form of single payer, etc, but also needs a lot of deregulation.
Libertarianism isn't anarchism either. Healthcare is one of those areas where I think public services makes a lot of sense.
It's true that the government was a net negative here. But in an alternative timeline with the same agencies, international travelers were examined, possibly quarantined, tested, and contact traced when it mattered. The red tape took just as long to get through, but started earlier, such that mass tests were available when community spread was a concern. And there wasn't an official narrative telling everyone to just ignore the problem.
I hate to say it, but getting a government that is worse than nothing is the outcome of the "drown it in the bathtub" philosophy. It's a direct result of a lack of belief in institutions. I'm all for cutting government bloat, but it has to be targeted at middle management, corporate welfare and outright citizen-hostile programs (NSA, DEA, TSA, CIA, ATF) rather than kneecapping public services. Yet when politicians get elected on a promise of downsizing, they go after the soft targets rather than actually disrupting the status quo.
As for healthcare itself, tomes have been written about that. I think regulating providers to have to charge uniform prices to all payers, at time of service, would go a long way. You don't go to the grocery store and pay at the checkout, only to receive a bill for the cashier's time three months later. Not that this would have solved our current shortage, but it certainly would have made people less scared to seek medical help for possible covid.
Again severe failure on the govt’s part. Their inaction in when it was needed the most led to all these circumstances that makes it ripe for situations like these. As the number of infections spread and economic situation get worse these kind of things will get really really bad. Once the second and third order effects kick in it’s going to be a catastrophe. And our leaders answer to all of this is to give $1200 checks to people. All they care is about the economy as it gives them higher odds for their reelection. I don’t understand how such incompetence can be tolerated and why they are not fired and instead have to wait till next election.
Agree. Active citizenry is the cornerstone of democracy. That’s why we have elected officials. But when they are unfit for the job and it doesn’t mean you blindly follow them to the abyss. There is something to be said for course correction and not waiting for the next cycle to make changes while millions of people get impacted. There is no doubt that people will needlessly die due to our abject failure to provide these test kits in a timely manner. Maintaining status quo / Dealing with things just for sake of tradition dosnt make sense in 2020. By that logic we should still not have women’s rights and continue on slavery because that’s the way it had been for so long? The leaders can do whatever they want and we have to wait for the next cycle beastie that’s the way things have always been?
I think it’s largely to soon to judge countries on this issue. In my mind the outliers are:
South Korea, as they had much better testing than China and new infections have been increasing at ~1% per day for the last week. It’s still early, but it’s a very promising sign.
Finland on the other hand had it’s first diagnosis on February 26th and closed all schools etc on March 16. That’s an unusually rapid response, though it’s to soon to say how effective it is.
PS: At least in the US it’s rare for the the people in power to actually get even 50% of the vote. But, I think we can safely blame non voters just fine.
I elected people to govern. If I have to govern for them, what exactly are they being paid to do again? Besides, what we need during a crisis is expedient, logical decision making, not incredibly slow and decentralized power.
That seems like a complete non sequitur, but it reminds me of an old joke.
1. Elect people who don’t believe in government 2. Get shocked when they do a poor job. 3. ??? 4. Profit
More seriously, I don’t think this is the kind of situation where people are ever going to be happy with how it’s handled. But, governments can do a better or worse job.
Every western country has used some central economic control continuously for the last 100+ years. Tariffs are ancient, but more modern tools like the FED or child labor laws are far from recent.
Saying they never work is clearly disingenuous.
PS: Unless you’re thinking of central planning aka communism and just using the wrong word.
> Every western country has used some central economic control continuously for the last 100+ years. Tariffs are ancient, but more modern tools like the FED or child labor laws are far from recent.
Tariffs and child labor laws are not remotely "turning industry over to government to run."
Would private industry have won WW2 on its own, or put humans on the moon? That’s the level of commitment and organization that is now required. Private industry is great at many things, but sacrificing profit for a shared goal is not one of them.
The US in WW2 was not a planned economy. The government put out contracts, and private capitalist companies delivered the goods. The government did not run industry. Capitalism worked so well the US was able to fight the war in two theaters while also supplying the other Allied nations. The Axis powers got simply overwhelmed by what American capitalism produced.
> or put humans on the moon?
In the 1960s, nope. The Apollo shots cost $288 billion in today's dollars. That kind of money simply wasn't available to any particular corporation back then. It wasn't sustainable by the government, either, as we went to the moon, landed, came back, and then ... oh well. Nobody has been able to justify the cost since.
But today we are seeing capitalism make enormous cost reductions in rockets, and that will change the game completely.
Nobody is claiming that the government should run the factories directly. They should have showed up in early February at the ventilator and PPE factory doors with blank checks to ensure that output is ramped up to 11 immediately.
I would say I want more tests kits, more protective gear for health professionals, more unified and clear communication. What use are said laws and elections if they are not able to provide security for the citizens. They sound great in theory and that about it. Because of these clowns so many people are going to pay with their lives or their daily livelihoods or both. If the only option to removing incompetent people from gov is a military coup then we have a bigger fundamental problem. It can’t be binary. World can and does operate in shades or gray. So no military coup is not what I want.
> If literally the only thing they do is force a sensible election system, it’ll be worth it.
If global history (even just the past 70 years) is any indication of the results, there's a very high chance a coup won't force a sensible election system. Let's not dream up this situation
I keep seeing articles like this pop up. During one of the first coronavirus press conferences, the White House invited CEOs from Walmart, Target, CVS, etc. – presumably to show strength of the private sector.
On the flip side, why can't we enlist money and resources from the private sector to quickly fix some of these supply issues? For example:
- Convert car factories to produce masks and ventilators.
- Convert construction companies to build makeshift hospitals. (Or use hotels.)
- Use tech companies to improve national information access with regards to CV19 testing and track and help patients using their software on their phones to help with contact tracing.
I realize that it's not as simple as pressing a button and instantly converting a factory that makes Teslas into one that makes masks. I also realize there are potential privacy concerns with nationalized information tracking.
But, we're about to enter an unprecedented public health crisis. We have resources that can lessen the impact if we just align and get behind this direction.
I can't help but think we could do more and not just wait for the shortage to happen, and for the curve to spike.
We stockpile enough nukes to basically destroy the whole Earth (exaggeration but you get the idea), but we can't stockpile some ventilators and face masks in case of a pandemic? You can't fight a pandemic with diplomacy. At least you can fight a foreign enemy with that.
Turns out N95 masks are quite high-tech, and even China is having trouble scaling up its production. They're made of a material, meltblown fabric, which only a limited number of factories are capable of producing.
IDK. I get that it's a hard problem, but it's a solvable one. It's not like it's some equation or law of science that needs to be discovered. It can be solved with money and effort. :\ I get the economics don't work out in normal times for a reserve like this, but that's exactly what an insurance policy (i.e. a federal reserve of medical supplies) is for.
It's just like nukes. We have a stockpile of them that are maintained... nukes are very hard to produce... etc. etc.
The only real facility for high volume production in the US is 3M in Minnesota, I believe. Current estimates place supply chain matching demand in 80-90 days (though I don't know if that's domestic or worldwide).
The problem is harder if we demand flexible fabric. That isn't how gas masks are done. With a canister filter, all sorts of options become possible. We could use sintered glass, ceramic, or metal. We might be able to use aerogel, diatomaceous earth, or metal foam. We could even go electronic, with a UV light.
Filters with greater air flow resistance can be used if we add a blower. Remember that the virus can enter via eyes. Eyes need protection. Eyes also need air, and it can't be humid or the protection will fog up. For this too, a blower would help.
You need the tools, but you don't have them. So you need the tools that make the tools. But you don't have those either. So you have two layers of tools you need to make from basic tools. Then you need supply chains for all the inputs. It's not as easy as waving a magic wand. But I do suspect that if we had started in January something could have been done.
> we're about to enter an unprecedented public health crisis.
this is where you lose me... it’s not unprecedented, quite the opposite. Throughout all human history this has been common. Recently (since WWII), we’ve been able to limit the lethality of most diseases and/or reduce transmissions.
But this should have been prepared for. They (the government) even had a playbook for it, they had evidence it could even be from this family of viruses.
This is a massive mistake by hundreds of our leaders.
While it's obviously not unpredictable, it was a widespread failure, across a range of political systems - EU, China, and US. We've seen success at scale in SK, which is a smaller, homogenous, high-conformity democracy.
In theory, a free-market democracy would solve the misallocations caused by these blunders more efficiently than the other systems. But the US doesn't have a free-market healthcare system -- or even a free-market mask manufacturing system. As this thread indicates, we're about to see a lot of people die from red tape in Western countries.
I understand. But, it's about keeping a reserve. On one hand, it's wasteful. On the other hand, a maintained reserve can save lives. This is a problem that can be solved with money.
Planet Money did a great episode recently on how the US government is currently paying for a year-round supply of chicken eggs to produce vaccine for a pandemic flu. (https://www.npr.org/transcripts/812943907).
I understand this situation is different from eggs, as an egg not used for a vaccine can be converted to feed, but in the end it's all about money. It's like an insurance policy. I pay for auto insurance but don't use it until I really need it.
> But in a subsequent tweet on Wednesday evening, Trump indicated that even though he invoked the act, he is in no rush to use it.
> "I only signed the Defense Production Act to combat the Chinese Virus should we need to invoke it in a worst- case scenario in the future," he said. "Hopefully there will be no need, but we are all in this TOGETHER!"
The ER docs at my wife’s hospital this morning were wearing pediatric masks with Disney characters emblazoned on them. And this is in a major suburban hospital.
The inability to just requisition, demand resource, mobilize people and so-forth, is breathtaking here. The start of WWII saw the quick re-purposing of industries for the war effort.
Today, it seems an inability to see what's necessary and get it to people is disturbing. The situation is effectively a war and one that's being fought very quickly.
I could brainstorm and mention the "fast fashion" is renown for creating conventional clothing to a variety of specifications, quickly. It seems like that talent could be harnessed for various kinds of safety equipment. Just an example, I'm sure there are a hundred similar things conceivable but despite the looming collapse of conventional procedures, somehow all bureaucratic hurdles remain in place.
That's a valid idea, but it's unfortunately not something she's in control of. All the PPE protocols are coming from people higher than her.
They're also not getting eye protection at all so she's taken to wearing her glasses instead of contacts. Not as good as actual eye protection, but it's better than absolutely nothing.
The crazy thing to me is the government or hospitals haven’t issued a massive n95 drive to obtain more.
I have a few left over from a house project I did a while back. Kept one for myself, but happy to donate the other 4 I have. I’m sure if the request was actually made people would donate. Is it enough? No idea, but construction workers, painters, etc don’t need them right now.
I wonder what if there's a straightforward way to make facemasks by hand, or with tools that are generally available?
I'm imagining cutting apart a furnace filter and wrapping the fabric around a wire frame, or something like that. If someone were to develop a process that was simple and reliably repeatable and produced good quality effective masks, that could be a way for otherwise un-busy people to keep hospital staff supplied.
One issue I suppose is whether there are upstream bottlenecks, like not being able to get a reliable supply of the right kinds of filter material.
There are a lot of hospitals directing employees to sew them by hand.
There is a simple and reliably repeatable method: having a factory. Not sure what is needed but there are lots of suppliers on Alibaba for this type of item. There are lots of rumors about export controls in China, denials of the same from Chinese officials, and rumors of seizure by US customs.
Never imported medical stuff but anecdotally many US sellers are being solicited by Chinese factories looking to sell masks and other PPE into the US.
It's not that easy to make N95 masks. Other kinds of masks are better than nothing but if you're in close proximity for hours a day, probably not good enough.
Chinese n95 masks are available very cheaply on Ali-Express from a variety of sellers who can ship by airmail. I don’t see why doctors/nurses shouldn’t order them personally if they can’t get them from work. For example: US $10.09 20％ Off | 10PCS Disposable KN95 Mask FFP2 Protective Mask Safety Masks 99％ Filtration for Dust Particulate Pollution N95 Protection
What does it take to build those masks from scratch?
We are at roughly 1 out of 100.000 being infected. Until 60% have developed immunity, there is still a long way to go where almost everybody on earth will want to own masks. The need of the hospitals is just the tip of the iceberg.
Is it possible to source the machines and materials now to be ready for production when the wave hits really hard?
Are there any reusable masks that are effective? It seems like throwing away these masks after a few hours of usage is partly to blame for the shortage. Generally damp materials are good at blocking particles better than dry ones. So is there any possibility of reusing the mask after washing in soap water?
>“The federal government’s not supposed to be out there buying vast amounts of items and then shipping,” Mr. Trump said. “You know, we’re not a shipping clerk.”
Hey, the guys not wrong, he's not a shipping clerk
Everyone in the hospitals from nurses to management knew exactly what is coming but did nothing.
And nothing has even happened yet, wait till the virus actually arrives in a few weeks.
Did any hospital plan or ask for help properly? Did any nurses union raise the issue?
Anyway they have numerous studies from Africa where they can't afford equipment, rather than the lack of planning by people on half a million a year, to look at.
Nurses and other staff are not there to make decisions based on firsthand geopolitical and epidemiology research. They have enough day-to-day work to do. This information should be provided to hospitals and other healthcare workers from higher up. This level of resource use / need may be even above what the local management should analyse, because ideally there would be regional stock available to shift to the clinics/hospitals affected by most cases.
I agree with you regarding client-facing staff, and think the parent post has misplaced lack of concern. However, I also think the post makes an important underlying point about hospital administration generally and "where their heads were at."
Increasingly a lot of hospital administration is very profit-focused. Not all but maybe most; where it's not, it's increasing, and where it's not supposed to be it often is, but hidden.
What this means is that the focus of hospital administration is often not on epidemiology and public health, even though it should be. It should include that more. It's focused more on squeezing out the maximum from each provider in terms of billable hours and patient contacts. When you're focused on stuff like that, you're not thinking about public health.
And so we have the consequence of that now. I don't think this is the only problem -- there's also government overregulation, rent-seeking provider monopolies that artificially restrict supply of services, and lack of coverage for patients -- but it's part of it. In general, at an abstract level, healthcare in the US has become very focused on protecting the interests of the established system, and less so on the interests of citizens and patients. It's a house of cards with several problems at once, getting hit by the perfect storm.
It's really hard to sell either of those to government bodies, even near cost. Already talked to the Red Cross, wholesale pharmacies and different ministries. They generally insist on payment on delivery, which we can't do for larger orders, as factories sell to whoever has the cash at the factory gate.
Some also want EU certifications (FFP2), while many factories in China only have the local Chinese standard (KN95). And some refuse to pay to a company outside Europa, while wanting to buy stuff from China.
So while I'd love to ship some of this stuff to Europe, currently people there are still blocking themselves. Hoping to work something out soon.