The metastasizing coronavirus outbreak in the United States has left health care providers and government officials facing a humbling reality as they scramble to procure medical gear key to containing the pandemic: On the global market for medical gear, America is just another buyer on a long list.
After weeks of dragging its feet, the Trump administration has deployed the Defense Production Act to plug gaps in the supply of the masks, gowns, and face shields supposed to protect healthcare workers and keep hospitals up and running. But a review of government pandemic preparedness documents, interviews with emergency medicine specialists, and supply chain experts reveals that the American government is ill-prepared to deploy the Cold War-era law to deliver gear to strapped US hospitals.
“We’re in new territory with the Defense Production act,” says Christopher Kirchhoff, a former Obama administration aide who authored a 2016 report on the lessons learned from the 2014 Ebola epidemic. “It’s never really been used in a broad mobilization to address the kind of situation we are in.”
With federal stockpiles nearly exhausted, public health officials are pleading with the Trump administration to use the Defense Production Act to lead a wartime mobilization of US industry to make the masks desperately needed by healthcare workers. The act allows the government to compel companies to prioritize its own orders, provide financial support for increasing production, and allocate supplies. But these powers are geared toward intervening in global supply chains, and it remains unlikely that domestic US production can be increased with sufficient speed to make a difference.
A key provision of the DPA allows the government to put so-called “priority rating” on contracts, which puts its orders at the front of the line, but that does nothing to increase supply. “What we are dealing with here is that there isn’t sufficient supply and that’s a situation where the priority rating system isn’t a sufficient answer,” says Dave Kaufman, a former senior official at the Federal Emergency Management Agency.
The Trump administration began using the DPA in earnest last week, in an effort that immediately descended into farce and recrimination. On Thursday, President Donald Trump denounced the manufacturing giant 3M on Twitter and issued a vague order granting FEMA the authority under the DPA to acquire from 3M any number of N95 masks, which are perhaps the most sought-after and difficult to obtain piece of medical gear for Covid-19 responders.
3M CEO Mike Roman went on CNBC to defend his company, warning that restricting exports from 3M’s US factories to Canada and Latin America could precipitate a public health emergency. In many countries, 3M is the only supplier of respirators, said Roman. By banning exports of medical gear, the US may incite other countries to do the same, which would further exacerbate supply shortages.
“The narrative that we aren’t doing everything we can as a company is just not true,” Roman said, adding that his company is rapidly increasing supply of N95 masks in the United States, to around 35 million a month, and is on track to double that by year’s end.
But that figure represents a small percentage of what’s needed. Ordinary N95 production in the United States is estimated at 1.5 billion annually. A 2015 study by government public health researchers estimated that a flu pandemic similar to what is currently playing out would require 1.7 to 3.5 billion respirators, a figure that would increase to between 2.6 to 4.3 billion as more Americans become sick. Under a “maximum demand scenario” during which “all eligible healthcare and emergency response workers would use respirators from the beginning of the pandemic until its end,” 7.3 billion would be required.
With the Centers for Disease Control recommending that all Americans start wearing masks—though not ones as sophisticated as N95s—demand for protective gear will only increase.
N95 masks, called that because they filter out 95 percent of particles smaller than .3 microns, represent a tricky production problem. They must sit snug enough to create a seal, and fit to the individual’s face. The masks consist of two pieces of cloth with a piece of meltblown polypropylene in between. The polypropylene is extruded at extremely small diameters, then settles and cools in a random pattern. The fibers are electrically charged, attracting particles while allowing air to pass through.
“That’s an extremely specialized manufacturing process,” says Doug Shultz, an entrepreneur who is working to source manufacturing facilities in the United States for medical PPE production. Shultz says he had reviewed an estimate from a manufacturer of the machines that make meltblown polypropylene that said the company expected a manufacturing facility begun in November to be online in July.