The shortage of essential materials is putting pressure on the production of medical masks (2023)



FRESNO, California -- Rachel Spray is still mourning the loss of her colleague, who died at Kaiser Permanente Fresno Medical Center in California after being exposed to the novel coronavirus. Now standing in front of the gleaming glass and concrete hospital, she says she's "scared to go in there" and dreads being next.

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That's because, like many US hospitals, the government is rationing supplies and keeping medical masks under lock and key.

White House officials say US hospitals have all the medical supplies they need to fight the deadly virus, but frontline health workers, hospital staff and even the Food and Drug Administration say shortages remain. Critical shortages of N95 medical respirators, commonly referred to as N95 masks, and other protective equipment began in March as the pandemic hit New York. The pressure on the medical supply chain continues today, and in many ways things have only gotten worse,” said Dr. Susan Bailey, in a recent press release.


"N95s are still in short supply," said Mike Schiller, senior director of supply chains at the American Hospital Association. "Certainly not even close to pre-COVID levels."

At the start of the pandemic, the White House ignored stern warnings from senior government officials, particularly about N95. The Associated Press noted that it took the government months to sign deals with companies that make the crucial component in these masks: plaster fabric. Meltblowing is the manufacturing process that transforms plastic into a dense mesh that drives N95 masks to effectively block extremely small particles, including viruses.

Even today, manufacturers say the Trump administration failed to make the long-term investments needed to reach full capacity. Meanwhile, the government allowed melted exports to leave the country as the pandemic and demand for masks skyrocketed.


(Video) The Importance of Mask Fit


EDITOR'S NOTE – This story is part of an ongoing investigation by the Associated Press, PBS series “FRONTLINE” and the Global Reporting Center into the deadly consequences of the world's fragmented medical supply chain.

Full Coverage: Deadly Shortage


Manufacturers say they risk significant losses if they invest millions in machinery, raw materials, new staff and factory space to produce a product designed to meet near-term demand, with no guarantees that the government will continue its meltblown textiles if necessary buys . for N95s post-pandemic withdrawals.

"I'm not going to sit here and say we're going to make the purchases in 2021 or any date you choose," said Rear Admiral John Polowczyk, who leads the Supply Chain Stabilization Task Force at the Federal Emergency Management Agency. He denies there is a shortage.


Meltblown fabrics are used in everything from diapers to air conditioners. Meltblown's electrostatic charge means it's able to capture particles too small to be filtered by traditional masks.

A study published this summer in the medical journal The Lancet found that frontline workers without N95 masks caring for patients with COVID-19 were at the highest risk of infection.

"The initial lack of personal protective equipment in nursing homes, and the lack of infection control practices in general, has contributed to widespread community across the country," said Dr. Andrew T. Chan of Harvard Medical School, one of the authors.

But at the start of the pandemic, such personal protective equipment simply wasn't available when demand for single-use masks and gowns exploded. It is not.

Before COVID-19, the disease caused by the new coronavirus, the government estimated that the US would need more than 5 billion N95 respirators a year in the event of a pandemic. In March, the Ministry of Health announced that the need would be around 3.5 billion.


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These estimates were based on the N95 manufacturer's recommendations and hospital best practices, which mandated that healthcare professionals wear one mask per patient visit, so a single nurse might wear a dozen a day. However, due to shortages, the Centers for Disease Control and Prevention has directed medical professionals to reuse them.

Because of this shift in use, it is difficult to accurately assess the extent of the shortage of medical-grade masks and gowns.

But today, hospital administrators — some of whom are facing new state stockpiling orders — say they can't get as many masks as they want, and the FDA has added N95s to its latest list of medical supply shortages.

In Fresno, Nurse Rachel Spray is typically assigned one N95 per shift.

Kaiser spokesman Marc Brown did not dispute that claim, but said the change in how masks are used allows clinic staff to continue to care for patients safely. The hospital is just being careful with the care, he said.


"We continue to prudently manage PPE stocks to ensure it is readily available to protect our healthcare workers during this pandemic," he said.

White House trade adviser Peter Navarro denies reports of shortages. In an interview in August, he said his office responds daily to news of under-resourced doctors and sends out supplies when needed.

"We have what it takes to give people what they need," he said.

In 2019, the US produced 15% of the world's meltblown, while China accounted for 45%. Navarro has long advocated moving production back to the United States, and during the Republican National Convention, President Donald Trump pledged to do just that with vital medical supplies.

“We are moving our business outside of China. We're taking it home," he said.

But the melted example shows that this government has failed to take the necessary steps to deliver on that promise.


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Meltblown is made from plastic pellets made from oil, typically polypropylene or polyethylene. Pellets are fed into a heated metal extruder and jets of hot air force the liquefied plastic through a series of extremely small holes, creating fine plastic fibers. As the fibers cool, they overlap and bind together, forming a dense web.

This year, American meltblown manufacturers are increasing their offerings. But some say they need more government support to meet demand.

Mike Clark, division manager at Hollingsworth and Vose, a meltblown manufacturer based in East Walpole, Massachusetts, said his company has tripled production of meltblown for masks by ramping up and exiting other markets. However, he and other manufacturers shy away from investing larger sums of their own money.

After the H1N1 epidemic in 2009, Hollingsworth and Vose bought a new fusion machine, but demand for N95 plummeted when the virus disappeared, Clark said.


"We're facing the same thing now," he said. “Nobody will guarantee volumes after 2021. And the problem is that the lead time for one of these machines is a year so that demand could go away once we have the machine configured and installed.”

The company has won a $1.9 million government contract to manufacture an additional 27.5 million N95 masks, but it doesn't come with any long-term purchase guarantees.

"That's half the problem solved," Clark said. "Still, if the government were to buy you a 100% paid machine, it wouldn't make sense to waste space in your factory just gathering dust."

Lydall Inc., based in Manchester, Connecticut, started the pandemic with a production line pumping out meltblown rolls. A second should be online by the end of this year and a third by May.

"We have one of the most in-demand products in the world," said Lydall CEO Sara Greenstein.


To increase production, Greenstein said the company has invested more than $25 million, which she expects to be offset by a $13.5 million government order for casting materials.

Dan Reese, president of Prestige Ameritech, the nation's largest maker of N95 medical respirators, said he used his own savings to expand operations and increase production during the H1N1 flu outbreak. In the end, however, he almost went bankrupt and laid off workers when demand fell. above.

These days he buys cast fabric everywhere and estimates that it would cost $15 million and take a year to start making his own fabric. One machine alone costs 5 million dollars.

"I have no money," he said. "If we continue to increase production as planned, we will run out of meltblown," Reese said. The meltblown shortage "limits our ability to do what we need to do for the country."

Some mask makers and casting manufacturers have received a boost under the Defense Production Act, a mechanism that allows the U.S. government to force companies to prioritize federal contracts and help manufacturers increase production capacity.

Between mid-April and early May, four N95 manufacturers -- O&M Halyard, Honeywell, 3M, and Hollingsworth and Vose -- received a total of $134.5 million to increase production, including expanding existing operations and creating new production lines. The federal government also approved smaller contracts with NPS Corp this summer. and Lydall to increase meltblown production.

But the government hasn't specifically restricted the export of molten material, a power it can use by law. Faced with shortages, US meltblown manufacturers continued to export their products abroad.

(Video) Volunteers craft reusable face masks, amid shortage

According to data analysis by Panjiva, S&P Global Market Intelligence's supply chain research unit, they shipped more than 40 containers of molten material and related supplies abroad, with around 40% going to Pakistan.

In comparison, there were only six containers in the same period in 2019.

The DPA gives the US government the power to block the export of essential products and materials.

The offshoring of manufacturing has left US medical supply chains vulnerable.

Lydall's Greenstein says if the U.S. is to have a steady supply of medical equipment, it must make all of the meltblown equipment itself.

"You can't rely on that long-distance supply chain to deliver the mission-critical, life-or-death items," Greenstein said. "If it affects everyone, countries that have domestic supplies will prioritize the deployment over others."

Moving production back to the US is a key goal for Navarro, which has warned for years that the US is reliant on China for production. This year's pandemic shortage, he said, "is the kind of scenario that has me worried about steroids."

But Navarro's dream of "restructuring" is thorny, partly because end-product costs often rise.

U.S. healthcare providers are calling for significantly more government investment in manufacturing home health care, even if it means increasing costs.

“For years there has been a huge effort to reduce healthcare costs and one way to do that is to lower the cost of the products, and one of the ways to do that is to make them in one place that labor and materials are cheaper,” said Teresa Dail, director of supply chain at Vanderbilt University Medical Center, which includes four hospitals and more than 200 clinics.

"I'm willing to bear the costs," she said, "to make sure we have access to product and our pipeline is more stable than we've seen with a global failure like this."

Before the pandemic, five US manufacturers were producing around 42 million N95 masks a month. According to the Nonwovens Industry Association's analysis of the impact of COVID-19 on the merged markets, the company is expected to have grown to 11 US manufacturers by October, producing 168 million per month, which could reach 2 billion per year.

According to the association's Brad Kalil, 24 North American companies were also making meltblown prior to the pandemic, with 79 machine lines in operation. But only a fraction of that went to medical ventilators, Kalil said. By the end of 2021, he said, there will be 28 new lines in the US, an increase of 35%, with almost all of the new textiles produced going to medical supplies.

The Trump administration helped fund seven of those lines, Kalil said. Most often, however, they are built through private investment, which, in his opinion, may not pay off.

"If all countries and regions decide to do their own thing to be self-sufficient, we're likely to see a lot of meltdown late next year," Kalil said.

Still, some US companies are throwing the dice.

As Seattle has emerged as a major coronavirus hotbed this spring, apparel and athletic wear company Outdoor Research has also charted a new course. The company had money, two factories in the US and highly skilled employees and started making masks, said Jason Duncan, the company's vice president.

The company manufactures cloth masks for the general public and continues to manufacture medical masks. To do this, it invested millions to convert an entire floor of its downtown headquarters to an FDA-approved facility.

Outdoor Research used its strong industry ties to protect the molten material, and this summer the National Institute for Occupational Safety and Health approved its N95 masks.

where does it melt

"It's a closely guarded secret," Duncan said.


Linderman reported from Washington, Peipert from Denver and Hwang from Atlanta.


This story has been corrected to clarify that Outdoor Research's N95 masks are approved by the National Institute for Occupational Safety and Health and not the Food and Drug Administration.

Copyright 2020 by Associated Press. All rights reserved. This material may not be published, broadcast, transcribed, or redistributed without permission.

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Is there a shortage of PPE during the pandemic? ›

Many nursing homes have reported shortages of PPE, which has led to the use of lower-grade equipment or the reuse of equipment across patients with and without COVID-19. In response to this shortage, the federal government promised to provide two weeks' supply of PPE to all US nursing homes back in May.

How can we prevent PPE shortage? ›

  1. Implement just-in-time fit testing.
  2. Limit respirators during training.
  3. Implement qualitative fit testing.
  4. Use alternatives to N95 respirators such as other filtering facepiece respirators, elastomeric respirators, and powered air purifying respirators.
  5. Additional guidance.

What are medical reasons for not wearing a mask? ›

This includes persons with a medical condition for whom wearing a mask could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a mask without assistance.

Why are so many people opposed to wearing masks? ›

The qualitative content analysis of a sample of opposing tweets revealed 6 major categories of concerns or justifications for opposing facial masks: (1) physical discomfort or negative effects (30.6%), (2) lack of effectiveness (27.4%), (3) unnecessary or inappropriate for certain people or under certain circumstances ...

Is there a PPE shortage in the United States? ›

Even with millions of Americans vaccinated against COVID-19, many physicians continue to report problems accessing personal protective equipment (PPE). In addition, supply chain issues may further impact the ripple effect in the shortage of PPE for healthcare workers.

Is there a shortage of PPE in US? ›

Since early 2020 the US has experienced a severe shortage of personal protective equipment (PPE) needed by healthcare workers fighting the COVID-19 pandemic (Emanuel et al., 2020; Livingston et al., 2020).

What is PPE shortage? ›

Hospitals are still having trouble getting enough personal protective equipment four months into the pandemic. ( Advocate Aurora Health) More than four months into the COVID-19 crisis, hospitals are continuing to struggle to find enough personal protective equipment (PPE) for front-line healthcare workers.

What is the main factor affecting of PPE usage? ›

State of Mind. State of mind is perhaps the most important factor in influencing PPE compliance.

What is the best argument for not wearing a mask? ›

The top 3 reasons for opposing public mask wearing were physical discomfort and negative effects, lack of effectiveness, and being unnecessary or inappropriate for certain people or under certain circumstances.

Who should not wear a respirator? ›

Breathing through a respirator is more difficult than breathing in open air. People with lung diseases, such as asthma or emphysema, elderly people, and others may have trouble breathing. People with claustrophobia may not be able to wear a full facepiece or hooded respirator.

What is the mask exemption in Canada? ›

Individuals who are unable to put on or remove their mask without assistance. Individuals with medical conditions that could be exacerbated by wearing a mask, such as certain respiratory conditions. Employees who require an accommodation based on the provincial or territorial Human Rights Code.

Is it still a good idea to wear a mask? ›

Evidence shows that face masks help protect against viruses other than COVID-19, particularly influenza A and B, the viruses responsible for most cases of the flu. So if you want extra protection from the flu, RSV and other respiratory illness, it's a good idea to go ahead and put on a face mask.

Is it still safe to not wear a mask? ›

You probably don't need to wear a mask, but you may continue to do so if it makes you feel more comfortable. Areas with medium transmission. If you have a higher chance of getting severe COVID-19, wear a mask in indoor public spaces.

What is the argument for masks? ›

There are five main types of arguments for mask requirements: Masks reduce airborne spread of coronavirus. Mask requirements are good for the economy. Mask laws are justified to promote public health.

Why is there a shortage? ›

A shortage is a condition where the quantity demanded is greater than the quantity supplied at the market price. There are three main causes of shortage—increase in demand, decrease in supply, and government intervention. Shortage, as it is used in economics, should not be confused with "scarcity."

Why do workers refuse to use PPE? ›

Lack Of Awareness

Lack of awareness can contribute to workers not wearing Personal Protective Equipment (PPE). Workers may be unfamiliar with the hazards they face in their work environment or the equipment designed to protect them from those hazards.

Does PPE really protect you from COVID? ›

The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks.

Is COVID still causing supply chain issues? ›

The pandemic continues to offer significant challenges for supply chains globally. Even in 2022, national lockdowns slow or even temporarily stop the flow of raw materials and finished goods, disrupting manufacturing as a result.

Who pays for most PPE? ›

Employers Must Pay for Personal Protective Equipment (PPE)

completely voluntary. Even when a worker provides his or her own PPE, the employer must ensure that the equipment is adequate to protect the worker from hazards at the workplace.

Why is PPE less effective? ›

PPE is not the most effective safety measure because it places only a barrier between the worker and the hazard. The hazard still exists; so if the right PPE is not worn properly or when it is needed, or the PPE fails (for example, gloves leak), the worker is not protected.

Why PPE is very much needed? ›

Personal protective equipment, commonly referred to as "PPE", is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards.

Do you have to supply PPE? ›

Employers should, therefore, provide appropriate personal protective equipment (PPE) and training in its usage to their employees wherever there is a risk to health and safety that cannot be adequately controlled by other means.

Why do we need PPE in industry? ›

Personal protective equipment, or PPE, protects its user against any physical harm or hazards that the workplace environment may present. It is important because it exists as a preventative measure for industries that are known to be more hazardous, like manufacturing and mining.

What are 2 main reasons for PPE? ›

Personal protective equipment is special equipment you wear to create a barrier between you and germs. This barrier reduces the chance of touching, being exposed to, and spreading germs. Personal protective equipment (PPE) helps prevent the spread of germs in the hospital.

What is the main weakness of PPE? ›

PPE has its limitations because: PPE only protects the wearer. It is ineffective if not working or fitted properly. Theoretical levels of protection are seldom reached in practice.

What are some challenges of wearing PPE? ›

Difficulties and challenges associated with PPE use among healthcare providers were previously reported, including -but not limited to- early fatigue, thermal discomfort, ill-fitted PPE, lack of proper training on fitting them, and uncertainty of the effectiveness of the used PPE.

What are the risks of not wearing PPE? ›

Without PPE, employees are at risk of:

Cuts and punctures. Chemical burns. Electric shocks. Exposure to excessive noise or vibration.

What is PPE how it can help to reduce risks and hazards at the workplace? ›

PPE is anything used or worn by a person (including clothing) to minimise risks to the person's health and safety. This may include respiratory protective equipment, hearing protection, eye protection, protective clothing, and safety harness systems.

How does PPE provide protection? ›

When used properly, PPE acts as a barrier between infectious materials such as viral and bacterial contaminants and your skin, mouth, nose, or eyes (mucous membranes). The barrier has the potential to block transmission of contaminants from blood, body fluids, or respiratory secretions.

What to say if you don t want to wear a mask? ›

If it's someone you know or feel comfortable with:

Talk about how covering our noses and mouths protects our most at-risk friends and family, like the elderly and those with other health conditions. Remind them: "Wearing a mask does seem to give me some protection.

Why is wearing a mask important during COVID-19? ›

Masks and face-coverings are one of the most effective tools we have to slow or stop the spread of COVID-19. By acting as a barrier over the nose and mouth, the number of respiratory droplets that may be expelled from an infected person drops dramatically.

How many times can you wear a KN95 mask? ›

Rotate and use a different KN95 mask every day so you do not wear the same mask more than once every 72 hours. Note: If following this rotation, KN95 masks may be reused as long as they do not become wet, visibly soiled or deformed, causing them to not fit well anymore.

Can a person with COPD wear a N95 mask? ›

If you have severe lung disease, such as COPD or asthma, we still recommend you wear a face covering. There has been information reported that masks do not allow you take in enough oxygen, or that they increase CO2 levels, but there is no medical evidence to support these claims.

Why do surgeons wear masks? ›

Face masks are worn by all operating room personnel when treating patients susceptible to infections as in neurosurgery, vascular, and orthopedic procedures involving implants and regional anesthesia procedures (e.g. , spinal or epidural). Face masks are also used to protect staff from contamination.

Who is exempt from wearing a mask in America? ›

A child under the age of 2 years; A person with a disability who cannot wear a mask, or cannot safely wear a mask, because of the disability as defined by the Americans with Disabilities Act (42 U.S.C.

Should you wear a mask in Canada? ›

We recommend that you wear a mask in public indoor settings. You should feel free to wear a mask even if it's not required in your community or setting. It's especially important to wear a mask if you're: at risk of more severe disease or outcomes.

What is a N95 face mask? ›

An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. Note that the edges of the respirator are designed to form a seal around the nose and mouth.

Should you wear a mask on an airplane? ›

Wearing a high-quality mask or respirator is most beneficial when: You are in crowded or tight spaces with poor ventilation like airport jetways, airplanes when the ventilation system is off, seaports, or when in close-contact situations like on a train or bus.

What is the difference between KN95 and N95 masks? ›

The difference between the two types of masks is the certi cation. N95 is the United States (U.S.) standard and the KN95 is the China standard. Only N95 masks are approved for healthcare use in the U.S. KN95 masks have many of the same protective properties.

Is it safe to wear N95 mask for 8 hours? ›

A nonfit-tested N95 will protect the wearer from an infected individual who is also wearing an N95, for 25 hours of exposure,” said Dr. Edje. “This is in contrast to two unmasked individuals—one infected and one not infected—who can only be together for 15 minutes without the uninfected becoming infected.”

How long does COVID last? ›

Most people who test positive with any variant of COVID-19 typically experience some symptoms for a couple weeks. People who have long COVID-19 symptoms can experience health problems for four or more weeks after first being infected, according to the CDC.

How long are you contagious with COVID? ›

People with moderate or severe COVID-19 should isolate through at least day 10. Those with severe COVID-19 may remain infectious beyond 10 days and may need to extend isolation for up to 20 days.

Do you have to wear a mask at Disneyland? ›

Guests must properly wear approved face coverings as required, refrain from using offensive/abusive language towards Cast Members or other Guests, and follow all other Park rules. Disney reserves the right to require a Guest to leave if they fail to comply.

What are masks and what do they represent? ›

Masks usually represent supernatural beings, ancestors, and fanciful or imagined figures, and they can also be portraits. The localization of a particular spirit in a specific mask must be considered a highly significant reason for its existence.

Why was there a supply shortage during COVID-19? ›

Early in the COVID‐19 pandemic, a global shortage of hospital gowns, gloves, surgical masks, and respirators caused policymakers globally to panic. China increased imports and decreased exports of this personal protective equipment, removing supplies from world markets.

Has the COVID-19 pandemic had a significant impact on the clothing industry? ›

“COVID-19 brought financial uncertainty and insecurity, and spending on fashion apparel quickly decreased,” said Marian Zengel, assistant teaching professor and coordinator of Bowling Green State University's top ranked apparel merchandising and product development program.

What is the recommended PPE for COVID patients? ›

Wearing Face Masks and Shields covers public use. Standard recommended PPE for care of suspected, probable, and confirmed COVID-19 patients or infectious material includes gown, gloves, eye protection, and N95 respirator or medical mask.

What is causing all the shortages? ›

While the supply chain shortages started with COVID, they're also due to increased consumer demand, which was fueled by the federal stimulus checks that we probably didn't need to keep the economy recovering. We just didn't understand how consumer demand was going to shift, once the pandemic began to ease.

Why are there medical supply shortages? ›

Shortages of medical devices can occur for many reasons, including manufacturing and quality problems, geopolitical issues, natural disasters, delays, public health emergencies, and discontinuations.

Why are shortages getting worse? ›

Fox Business explains that California's devastating drought has led to empty rice fields and a 10% loss of viable farmland. Simply put, lost agricultural revenues from lost crops means less money and land to produce the foods we place on our dinner tables.

How is COVID-19 affecting the world today? ›

The COVID-19 pandemic has overwhelmed healthcare systems around the world, having a knock-on effect on the diagnosis and treatment of other diseases. Social distancing and lockdowns have reduced diagnosis rates of infectious diseases such as seasonal influenza, as would be expected with reduced social contact.

Has the COVID-19 pandemic made us more materialistic? ›

Abstract. The COVID-19 pandemic has led to an increase in the factors that typically facilitate the endorsement of materialistic values (e.g., higher media consumption, stress and anxiety, loneliness, death anxiety, and lower moods).

How did COVID-19 impact the world? ›

The COVID-19 Pandemic has altered human existence's political, environmental, and economic elements, which affect psychological growth and sustainability. This impacts people's living standards and quality of life. The COVID-19 era resulted in social problems and international crises in the early 2020's (30).

How long is COVID contagious for? ›

By the 10th day after COVID symptoms begin, most people will no longer be contagious, as long as their symptoms have continued to improve and their fever has resolved. People who test positive for the virus but never develop symptoms over the following 10 days after testing are also probably no longer contagious.

Am I still contagious after 7 days of Covid? ›

You are most infectious (or contagious) in the first 5 days after your symptoms start. You can also spread COVID-19 in the 48 hours before your symptoms start. If you never have symptoms, consider yourself most infectious in the 5 days after you test positive.

What PPE should be removed last? ›

The sequence for removing PPE is intended to limit opportunities for self-contamination. Sequence of removal: (1) Gloves, (2) Gown, (3) Face shield or goggles, (4) Mask or respirator*. Perform hand hygiene after PPE removal, preferably after each step.


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