"Regarding personal protective equipment—surgical gowns, gloves, masks, respirator protective devices, or other medical equipment designed to protect the wearer from injury or the spread of infection or illness—the FDA has heard reports of increased market demand and supply challenges for some of these products. However, the FDA is currently not aware of specific widespread shortages of medical devices, but we are aware of reports from CDC and other U.S. partners of increased ordering of a range of human medical products through distributors as some healthcare facilities in the U.S. are preparing for potential needs if the outbreak becomes severe."
This is very weird: my understanding is that masks are sold out at standard suppliers and have been for a while (though available at extremely high prices from resellers). This seems like it is beyond "supply challenges" and into being a "specific widespread shortage"?
This is really bad for the construction industry. Spraying oil based paints, environments with asbestos, dealing with lead paint, spraying insulation, and other really chemical heavy operations require protective gear.
Gearing up hospitals to protect before a possible full blown outbreak ranks higher than private industry specific needs. If those construction employers care, they can pay the premium supply vs demand price increase not their employees.
Your permits will expire and the banks funding your construction are going to have a fit. If there is a market crash because of the virus that leads to a real estate slump, however, this could be a blessing in disguise. On the other hand, it could also be suppressed market activity that pushes the economy over the edge.
Construction industry? I’ve had several people tell me this week, from plumbing to transport, saying people are starting to be let go because supply isn’t coming from China.
You can’t have a construction industry when the supply chain has choked
I had to beg around my friends and asks for masks so I could do my hardie board install.
I've heard that harbor freight still has some in stock.. but there is a sense of irony buying facemasks from the country of covid19 epicenter... oh well
can you say for certain that home depot supplies the construction industry to such an extreme degree that it will be really bad? maybe for small businesses, but the bigger ones have independent suppliers that aren't home depot for their shit.
Do you even understand risk planning and management? Triage? If the masks help people in direct contact maintain health and deliver health services more people survive, than if random people consume masks without contact or assessed risk. Masks are in short supply? What's the rationale to NOT direct masks to higher efficiency outcomes.
We don't all consume naltrexone in case heroin accidentally falls in our mouth. Prophylactic use of antibiotics ruined antibiotics because of emerged resistance.
If you know you need a mask you can get one. If you want a mask at the cost of a health professional doing their job, shame on you.
Joe doesn't know he's sick. Joe won't avoid getting sick wearing a P2 mask. A health worker in P2 mask and gloves can avoid cross infection risks and help reduce transmission working in an environment of higher risk exposure. if Joe is infected and knows he is infected he will either be hospitalized or isolated. If Joe is prodromal the likelihood the knows and uses a mask to good effect is lower than the likelihood nobody knows and he isn't sick and the mask is wasted.
Actually masks aren’t meant to help keep a person from getting sick. For that, wash your hands frequently and wear gloves. Masks are for people infected. Contain the contagion at the source with a mask. Doesn’t do anybody good for the paranoid to have all the masks.
I repeat: Joe doesn't know he's sick. His mask is worth wearing if he knows he's sick. If he just suspects he's sick then a low grade hospital mask will contain sneezes and sniffles enough to reduce his fomite impact, although gloves might do more.
Most Joes are wearing masks and wasting masks in a false belief they confer protection.
I work in an outpatient medical office. Our office manager said that the major mask supplier that we use is rationing the number of boxes of masks that can be ordered, but still fulfilling orders. So while there may be a true shortage in medical facilities in the future, current shortages are in retail. Or at least that's my n=1 data point.
I am guessing they are speaking specifically about supplies to medical facilities, not the general public. The NYTimes ran an article recently [1] that makes it sound like the New York area has a hefty stockpile ready in the case of an outbreak.
I assume you live in America or Europe. In countries hardest hit masks are almost entirely sold out from retail. I'm HK I hear some people are having trouble buying toilet paper or canned goods locally as people are stocking up.
One problem is that if masks cant be purchased, and here in Bangkok they are already almost entirely sold out, and someone runs out of masks, and the outbreak is bad, they arent going to leave their house. They wont risk it. I hope they also have enough food at home to last.
I saw a shift in behavior following Trump's conference appointing Mike Pence as the effective coronavirus czar.
Every morning there was a small stash of N95 masks at my local Home Depot until yesterday. Similarly I started seeing specific sorts of non-perishables disappearing from the shelves of Trader Joe's and Safeways. Where it goes next, I don't know. But I think the crowd has spoken on the subject already.
I think they’re still in stock at _some_ Home Depots. At least last I checked.
In any case, an N95 mask is insufficient if you don’t cover eyes as well and don’t use IPA70/Sporklenz or similar after touching any common surface. 10% bleach should also work but it’s nastier (to skin and materials).
0 inventory at Home Depot, Lowes, Harbor Freight, etc. Hand sanitizer sold out at almost all retailers in the major city I live in too, I managed to snag some from a store people wouldn't think of (office depot). I have a few N95 masks, but I bought them ages ago and I'd be using them for painting or grinding metal, not the virus.
Not sure about Sporklenz but yes IPA70 is referring to an Isopropyl Alcohol solution of 70% isopropyl alcohol. Higher concentrations are also effective but above 75% you risk burn or excessive drying upon direct skin contact. FWIW, a 99% concentration will very quickly pick up atmospheric moisture and stabilize closer to 96% in all but the most dry of environments.
> Not sure about Sporklenz but yes IPA70 is referring to an Isopropyl Alcohol solution of 70% isopropyl alcohol. Higher concentrations are also effective but above 75% you risk burn or excessive drying upon direct skin contact. FWIW, a 99% concentration will very quickly pick up atmospheric moisture and stabilize closer to 96% in all but the most dry of environments.
During a previous outbreak that led to hand sanitizer getting hard to find/expensive, I just dumped a bunch of 70% rubbing alcohol into my existing bottle once it gets half empty.
The chemistry is kind of interesting. If you distill isopropyl alcohol, you can't get more concentrated than 91% because it forms an azeotrope. That is, if you try to distill 91% isopropyl alcohol, the vapors are also 91% concentration, so distillation doesn't get you any further. Thus, 91% isopropyl alcohol is a common product. Similarly, ethanol forms an azeotrope at 95% concentration, so you can't distill higher than that. This is why, for instance, Everclear has a 95% alcohol concentration. (You can produce higher concentrations, of course, but it requires a more expensive process than distillation.)
The water slows down the evaporation letting it linger long enough to be useful (at least that's what I think I read). Either way, 70% is gentler on skin. 90%+ is great for cleaning oily stains and whatnot.
> cleanroom disinfectant, sterilant and sporicidal cleaner
Ah...got it. Thank you.
> Odor: Vinegar
Ewww. Hope it's not too bad. I wouldn't want a strong vinegar smell in my clean room.
Also interesting:
"Spor-Klenz RTU sterilant was found to be effective against mouse hepatitis virus, minute virus of mice, murine norovirus, murine
para influenza virus type 1 (Sendai) and Human Immunodeficiency Virus (HIV-1) when tested according to EPA guidelines
undiluted for 10 minutes at 20°C (68°F) exposure. Spor-Klenz RTU sterilant was found to be effective against mouse parvovirus
when tested according to EPA guidelines undiluted for 25 minutes at 20°C (68°F). Treated surfaces must remain completely
immersed for 25 minutes."
If bleach gets hard to find, some varieties of Pool Shock are basically highly concentrated (around 70%) dry bleach. The one you need for that is calcium hypochlorite. Just add water to get the desired proportion.
This is also a lot cheaper than buying liquid bleach.
Is there a higher level than N95 that filters more airborne particulates or is that entering HEPA filter territory and impossible to breath through such dense material.
I think they're referring to availability for medicine. My facility has zero issue ordering PPE at the moment; we order many thousands of boxes of gloves and masks and have no issue with that.
FYI on the extremely high prices: while the prices from online resellers are dramatically higher than before all this, they're still probably affordable for most people on this forum, in the range of $5-$20 per disposable N95 mask. (CDC says you can reuse disposables)
I'm guessing they mean "specific widespread shortage (at medical facilities)." Which is categorically different from a retail shortage at your local pharmacy or retail store.
The masks do absolutely nothing for the general public. The purpose of a mask in a hospital setting is to stop what's in you from going into anyone else. That's true of both the doctors in the OR and patients. They do nothing to stop what comes out of someone else getting into you. Unless you're wearing a full-on bio suit like in a research facility or an N95, save yourself the trouble. [1] Just wash your hands before you touch your face.
> A manufacturer has alerted us to a shortage of a human drug that was recently added to the drug shortages list. The manufacturer just notified us that this shortage is related to a site affected by coronavirus. The shortage is due to an issue with manufacturing of an active pharmaceutical ingredient used in the drug. It is important to note that there are other alternatives that can be used by patients. We are working with the manufacturer as well as other manufacturers to mitigate the shortage. We will do everything possible to mitigate the shortage.
They don't name the manufacturer, the drug, or really much of anything.
This is called “Special English” aka “Simple English” or “Voice of America English”. It is meant to be very clear and straightforward to understand to minimize the possibility of miscommunication and make it so that non-experts of all backgrounds can take away the important messages. Given how important the medicine supply chain is to lots of people’s daily lives, I’m sure they didn’t want this page to seem understandable only by the educated.
There is not enough of a drug, according to a drug maker. There aren’t enough ingredients to make the drug. The missing ingredients are made at a place affected by the coronavirus.
Fortunately, there are different types of drugs that can help. We are making these other drugs available.
If they are trying to say there aren't enough ingredients to make the drug then the second way is better. But that isn't the same as what the original sentence said.
The phrase 'issue with manufacturing of' covers a much wider range of problems than a shortage. Maybe they have tonnes of materials and they just need a mechanic to fix the machine for example. No shortages of anything except people in the right place at the right time.
> Special English is a controlled version of the English language first used on 19 October 1959... World news and other programs are read one-third slower than regular English. (paraphrased from Wikipedia)
This is fascinating. I had trouble understanding the FDA's article until I slowed down and imagined a newscaster reading it. (It's still really hard to skim, though. Weird phrasing.)
I work for a health-related company, and to us it's called "Health literate."
But, you're right- the idea is to write as plainly and clearly as possible so the largest number of people can understand.
As for why the drug or manufacturer wasn't named, my guess is that it's so that there isn't a run on a particular medication causing unnecessary shortages.
I'm also interested in this question of "Special $LANG" for other languages. For German learners, DW has a daily podcast Langsam gesprochene Nachrichten ("News read slowly"), which I have found invaluable.
I'm glad to see this posted. When you dumb down the vast majority of media that your population consumes and make all of it essentially predigested, the average person becomes substantially less able to parse technical literature or think critically, because in the majority of the media they consume there is little required in the way of thinking.
Making things accessable to the common denominator has a generally negative effect on society IMO. This is one major reason why our U.S. schools have been falling behind for decades - they are too focused on not leaving the poor performers behind, at the cost of limiting the achievement of those above the average.
I had a lot of trouble understanding it until I read it 5 times. All the words just turn to soup in my brain as I read them... It's like the information density of the text isn't high enough to keep my attention or something.
The first sentence in particular has a very "the department of redundancy department" structure. Also took me a few tries to realize what it was actually saying.
FDA has an entire drug shortage database that is updated daily and publicly accessible. There are tons of drug shortages at any given time, and most of them go back to API (Active Pharm Ingredients) - the raw active chemicals produced in bulk, that are then put into pills, injection solutions etc.
You could probably figure it out from there. My guess is it would be irresponsible for them to name the Mfgr in the press release, particularly if it were a publicly traded company and people are going to jump to uninformed conclusions.
Supply chain security has also been a major focus at FDA over the last ~5 years, basically to ensure there are not "choke points" with respect to approved medicines:
> My guess is it would be irresponsible for them to name the Mfgr in the press release, particularly if it were a publicly traded company and people are going to jump to uninformed conclusions.
Not only could it harm the company, it could be bad for patients. Naming it could cause a run (https://en.wikipedia.org/wiki/Market_run) on the drug, and if some people hoard it, there will be other people who are unable to get it.
I guess I'm grumpy today, after looking at the prices of respirators and antiseptics in Poland being already 10-20x the usual, and growing. And we don't even have a confirmed case just yet (doesn't stop the media from reporting a new "first case" every day for the past two weeks).
Also this morning I've seen an ad on our local equivalent of Craigslist; somebody is trying to sell a pre-packaged web store for selling face masks, complete with a bunch of legit-sounding domains (using phrases "medical respirators", "anti coronavirus respirators", etc.) and three contracts to wholesalers of surgical masks, for roughly $1k total. Note: surgical masks. The ones that are worn to prevent accidental exchange of bodily fluids between patient and the surgeon. The ones that are completely ineffective against airborne viruses.
I really feel that some people need to have cooperation and civil behavior beaten into them.
I deal with protecting myself medically daily. If you want to chat about your concerns, you are welcome to email me.
Not medical advice per se. I'm not a doctor. I'm just someone continuing to rudely fail to die instead of going along with politely dying according to schedule so other people can feel like they are smart and know things.
(This comment will self destruct in the near future.)
Still, what can I say about my concerns? I'm scared. For myself, my wife, our infant, our families. In this island of emptiness in the middle of red dots the Europe is on COVID-19 maps, we're all just nervously waiting for the first real case. Personal protection goods are already gone, people are slowly realizing that maybe it's about time to start stockpiling food. We've stocked ourselves up with ~two weeks worth of long-life consumables. Going to extend it over the weekend to a month's reserve. Our infant already has 2+ months supply. I try to be calm, but it's getting harder.
I don't know what I'm afraid more of at this point - of the virus, or of the quarantines and panic that will follow.
I don't rely on standard personal protection goods.
I'm not really comfortable talking about what I do rely on in public. There's a very long history of people being incredibly ugly to me, outright accusing me of being insane and of making up stories out of a sick need for attention. I've literally been accused of having Munchausen.
Though we don't interact often, you've been uncommonly kind and respectful to me in a sea of what often feels like outright abusive and sadistic behavior.
So if you are interested in talking with me privately about what I do in hopes of expanding your options and trying to protect you and yours, I'm willing to chat and leave it completely up to you whether or not you use any of that information.
Consider it to be an offer of a personal favor. If you don't think I can possibly help you, it's okay. Maybe you honestly don't recall my diagnosis or understand what that's supposed to mean.
I'm writing you an e-mail parallel to this comment. I've been reading your comments on this site for years now - they often stand out as particularly insightful - so I do remember some of the context.
It's important to remember that the big concern with the coronavirus isn't that it's unusually severe, it's that it's unusually transmissible. In particular it becomes contagious before it becomes symptomatic.
So if they fail to contain it, you'll be more likely to get it than to get the flu, but not especially more likely to die if you do get it. And even less likely in either case if you're currently healthy.
There isn't much reason to be concerned about quarantines either. The point of a quarantine is to limit the spread of the virus. When there are only a small number of cases, using extraordinary quarantine measures is justified because there is the potential to stamp it out entirely. If too many people get infected, there is no longer any hope of that and continuing the extraordinary measures is impractical. You shut down an airport when a city is infected, you don't shut down every airport when every city is infected. So if it spreads, you fall back to the ordinary measures. Wash your hands, if you get sick go to the doctor and not to work, get vaccinated once they have a vaccine etc. It's not good but the world doesn't shut down.
Around 10% of people get the flu every year. If this is equally severe but more contagious, maybe it's twice as bad, or five times as bad. It seems pretty implausible that it could be much more than ten times as bad.
An advantage we have here is that February is over. Flu season is ending rather than beginning in the northern hemisphere (and it's still several months off in the southern hemisphere). So if they can keep it somewhat contained as things warm up, it shouldn't spread as fast in the spring.
They also have to tread a very fine line where these companies are "required" to self report important details that would damage a "brand". By not naming names they maintain the trust which increases the prospect of getting the important information we all need. (and that is not X.inc's next quarters earnings)
California looks set to explode into another Italy scenario as local, human-to-human transmission now appears to be taking place in Solano County, where a woman now critically ill with the coronavirus previously exposed dozens of hospital workers in two hospitals. She was not tested for 11 days because the CDC’s testing flow chart excludes the testing of people who contract the virus in America and who didn’t visit China.
The Governor of California stated yesterday that California has only around 200 test kits for the entire state. To this very day, there is virtually zero testing of anyone happening in the entire United States — a fact that many people still are unable to believe (they remain in total denial). The SF Chronicle also confirms this story.
According to a highly disturbing Wall Street Journal story (https://www.wsj.com/articles/whistleblower-says-federal-empl...) federal employees who ran the quarantine sites in California and elsewhere failed to wear proper protective equipment (PPE) and also weren’t trained in how to handle people exposed to the virus. Most disturbingly, as the WSJ subhead says, “Employees weren’t tested for virus before leaving California quarantine sites on commercial flights.”
I am astounded by the frequency of idiots in key decision making positions globally.
A lot of the US problems around covid handling seem to be coordination related. There used to be coordinating personnel specifically for that at the NSC. But that has been slashed over the last few years.
This is what I'd expect having worked for ~10 years in pharma. These companies are very sensitive to announcements like these because they can be misinterpreted by the public/media. They'll be trying to find some alternative options and the details of the shortage will become evident from other sources eventually.
Well, we know that there is a disruption and that as far as the FDA knows it's just the one report so far.
In an administration that frequently gets involved in cover-ups, you can't fault the FDA for trying to disclose as much as they can without causing new problems.
Plus the press release goes on to detail many other areas of FDA's regulatory domain that are also helpful.
I stumbled on a daily supply chain sub over at reddit. r/supplychain which gets a daily update from a user who pulls his data from across manufacturing, shipping, and other sources. I recommend anyone interested in supply chain detailed analysis, that’s where to go.
I've been reading the updates there and have been making specific purchases as a result. For example, I read about disruption to clothing manufacturing and bought some summer shorts, pairs of boxers, and packages of socks - stuff I was expecting to buy soon anyway.
It is absolutely insane to be in the position where essential medical equipment is not going to be available in the US because of COVID19 quarantine in China.
What the absolute F are we paying US Pharma 1000% premiums for, if not in part to maintain control over supply chain.
There is a good general daily thread in https://www.reddit.com/r/supplychain/ that's a decent starting point each day for what's going on in the world of supply chain/logistics.
This is a little different. The FDA has an entire infrastructure setup around Supply Chain security - basically to ensure critical medicines are always available from SOMEONE. Not to spam on my comments, but see here:
You’re message here and in your other comment is quite important.
There are quite a few people in this thread assuming the press release is all the FDA has to say, and who appear to have made little effort to test that assumption.
« We are not aware of any reports at this time of human illnesses that suggest COVID-19 can be transmitted by food or food packaging. »
Given the number of illnesses that can be transmitted by indirect contact, including cases of sick food workers contaminating a supply, I feel like they should indicate a little more caution in this section.
I was reminded of that when reading about a compound in licorice (glycyrrhizin) that seem to be effective in reducing the replication of SARS, (another coronavirus):
Making a basic mask to protect for “USA nuclear attack” was mandatory lesson in all Soviet region schools. It takes less time and skills than whining about supplies here. China has has won us by creation of total learned helplessness?
N95 masks are a pretty fine filter material and they seal pretty well while minimally obstructing breathing; I think it would be hard to equal their performance out of improvised materials, and perhaps more important, it would be impossible to know whether you had succeeded. Would you like to share the instructions you learned? Even if the result was less effective than an N95 mask, it might be useful.
The main difference between industrial and medical oxygen is that for medical oxygen the providence of the tank is tracked to make sure that it has only been used to store oxygen, and hasn't been left unused for a long period of time. With the massive need for various gasses and the cost in transporting them long distances, most large metro areas have at least one air distillation plant that produces them.
Pressure Swing Absorption oxygen generators have been getting cheaper, and will separate oxygen from air as long as they have electrical power and maintenance every few months. PSA is not suitable for all medical uses though as it typically produces 90-95% oxygen and is not directly capable of producing pure oxygen.
Yeah - but doing some work for one such distributor, "Are we delivering to hospitals?", "Are we unloading at hospitals?", "Do we have surge inventory?" and "Do we want the cylinders back if they've been used for coronavirus patients, or do you need to decontaminate them first?" are all questions being asked.
They have various answers, but my experience now working on H1N1, SARS, Ebola and COVID-19 is that hospitals weirdly take the flow of oxygen as a given.
A quick search suggests that we produce 99% oxygen just by running it through two stages of pressure swing absorption. Is that also not good enough for hospitals? If so, what do we use for even purer oxygen.
So they aren't predicting anything, are relying on manufacturers to self report, already have surprise shortages, and are monitoring and mitigating? These statutory authorities and responsibilities to assure blah blah blah, that doesn't give permission to prepare or ramp up requirements?
"Implementing critical infrastructure monitoring" is giving out an email address? Hmmm.
They're doing their job. My view is that bureaucracy has its own doublespeak for everything.
So when I see this:
> It is important to note that no law exists requiring medical device manufacturers to notify the FDA when they become aware of a circumstance, including discontinuation of a product, that could lead to a potential shortage, and manufacturers are not required to respond when the FDA requests information about potential supply chain disruption.
...in my head, I translate it to this:
> We welcome a law requiring medical device manufacturers to notify the FDA when they become aware of a potential shortage or discontinuation, and requiring manufacturers to respond when the FDA requests information about potential supply chain disruption.
This is very weird: my understanding is that masks are sold out at standard suppliers and have been for a while (though available at extremely high prices from resellers). This seems like it is beyond "supply challenges" and into being a "specific widespread shortage"?