Imagine a world in which restaurants could produce meals so cheaply that people didn’t bother to cook at home anymore. That people no longer owned refrigerators. Or ovens or stoves or even pots and pans. Where people no longer even knew how to cook. That’s a bit like the state of American manufacturing. We get everything from overseas.
And then imagine something occurred to force all the restaurants to close. How would we eat?
We used to make stuff here. We don’t anymore, and some day (if that day is not already upon us) it’s going to bite us in the butt.
I’ve learned a whole lot in the last, oh, month or so, since New York Gov. Andrew Cuomo requested that domestic manufacturers step up to the plate to manufacture necessary medical equipment. I don’t even know just how long it’s been since the world turned upside down. But in that time I’ve been buried in the world of Personal Protective Equipment (PPE), an expression I had never even heard before.
Over the last month I have been working with nurses and doctors and surgeons and microbiologists and epidemiologists and hospital procurement agencies. I have been working with county and state and provincial and federal governments in two countries. I have been working with three testing facilities and three universities. And in that time, everything I have learned has led me to one inescapable conclusion: it is absolutely imperative that we do things very differently from now on.
Medical masks are single-usage only. The entire world is currently in the middle of a great shortage of these masks, and to understand why, it helps to understand how they are constructed, and how they function.
Let’s start with something called “meltblown.” Meltblown is a nonwoven material, usually made of polypropylene, created basically by melting the polymer and using high velocity air to create extremely fine fibers (thus, Melt Blown). Think cotton candy, only much, much finer. These fibers are then squashed together to form a very fine, nonwoven filter. The machines to make meltblown cost in the millions of dollars, and apparently take nine to twelve months to make. Meltblown is the filtration material used in N95 respirators, but also in surgical masks; it is the element that provides between 95% and 99% of bacterial and particle filtration. Though it is a good filtration element, it is not physically stable so it needs to be housed in between layers of something stronger.
“Spunbond” is another nonwoven material, though, not nearly as fine as meltblown, it is much stronger. So N95 and surgical masks are a sandwich of a layer of Meltblown between two layers of Spunbond. Remember that as it becomes important later. In surgical masks, the spunbond layers are treated to make them hydrophobic, or water-resistant; during medical procedures we want to protect the patient from infection but also prevent splashes of fluid (think blood and other bodily fluids) from infecting the health care providers.
One hospital in Rochester, NY told me they go through between 10,000 and 20,000 surgical masks A DAY. Hospitals are facing such a critical shortage of these masks, and now that the general public has been advised to wear the masks, they are even harder to find, so people have started to ask the question- can I sterilize a mask and reuse it? The most common sterilization technique in hospitals is to steam sterilize in an autoclave. When masks come out of the autoclave they seem intact. But are they?
I mentioned meltblown could filter very fine particles. And it can. But the very finest, sub-micron particles are not actually filtered, as they are finer than the mesh created by the meltblown. Instead, the meltblown has been given an electrostatic charge during production which attracts and holds these very small particles. Humidity, among other factors, will reduce or eliminate the electrostatic charge, making the filtration media less efficient.
The humidity in the autoclave reduces the filtration efficiency of the meltblown to as low as 80%, far below the FDA recommended minimum of 95% for a Level 1 mask. (ASTM Standards are available here.) Which also gives a clue to why the N95 should only be worn for a limited amount of time- the humidity in your breath will also reduce its effectiveness over time. So even though the FDA has given emergency authorization to a different sterilization technique which, in and of itself, does not degrade the filtration of the mask, the very fact of it being worn can do it.
I mentioned that sandwich of three layers of Spunbond, Meltblown, and Spunbond in surgical masks. The blue and yellow disposable isolation gowns, surgical gowns, surgical drapes, and sterilization wraps are made of a material known as “SMS.” And can you guess what that is? The three layers of nonwoven are fused into one single layer; sometimes more than three are used to make SMMS, SSMMS, SMMMS, etc. They provide an excellent fluid barrier and great viral and bacterial filtration during procedures.
It wasn’t hard to predict, back in the early days of the Covid-19 pandemic, that a shortage of masks would eventually lead to a shortage of surgical gowns, etc. Because if you’re one of the few companies making meltblown, and the whole world is simultaneously scrambling for N95 respirators, are you more likely to divert your meltblown production toward respirators, or toward disposable gowns that retail in the range of $0.50 to $1.00 apiece? I heard that the Quebec health system goes through 200,000 surgical gowns A DAY so you can imagine what New York or California must burn through (and imagine all that plastic ending up in landfills, and, increasingly, oceans).
Can the gowns themselves be reused? If you try to wash them, the special treatment making them water-repellent is lost rendering them useless.
So here we are: the hospital systems can’t get enough masks or gowns, the police departments are now scrambling for masks, and the world can’t keep up with the demand, because they were designed to be used only once. Nurses are wearing trash bags in emergency rooms and doctors are reusing masks that are no longer as effective as they were designed to be.
Surgical gowns used to be reusable; since that went out of fashion years ago, it is now very difficult to find the kind of technical fabric to make them today. I have been in contact with weavers of this fabric and supplies have been fluctuating by the hour, and now the yarns themselves which are used to weave it have become scarce, just as the meltblown has become scarce.
I have never been one to beat the sustainability drum too loudly, but in this case we have a very jarring example of the need to change our habits where single-use items are concerned. A study of reusable versus disposable isolation and surgical gowns showed that reusable gowns resulted in a 28% lower energy consumption, 30% lower greenhouse gas emissions, 41% lower water consumption, and a 93%-99% lower solid waste generation at health care facilities.
We have recently witnessed the disappearance of the single-use grocery bag and the plastic straw without even considering the environmental impact of this medical waste, but more importantly the practical impact of its scarcity when demand increases.
COSTS AND THE VANISHING SUPPLY CHAIN
We have relied for far too long on a cheap and seemingly inexhaustible supply of components which are far too critical to our health and safety. Though a $0.50 disposable gown may seem a bargain compared to a $15.00 reusable one, if that reusable gown is used for the full expected life cycle of 75 washes, it works out to $0.20 per usage and far less waste.
We are also far too reliant on cheap foreign labor to produce critical health care items. Our supply chains have moved so far offshore that in moments of crisis, like this one, we find it next to impossible to even create the things we need for ourselves when procuring them through normal supply channels becomes impossible. We can’t even source the raw materials to make them ourselves when we need to.
The media has been complaining about price gouging, forgetting the laws of supply and demand, decrying items selling for as much as ten times the normal price; I can tell you first hand that the cost to cut and sew an individual surgical mask by an American laborer in a clothing factory is going to be astronomical compared to the cost of banging them out on an automated machine that cranks out 300 of them a minute. So yes, that mask costs ten times what it normally does. And yes, that gown costs many times more to produce in America than it did to make in Myanmar, but if they’re all sold out because the whole world is scrambling to buy them all at the same time, what other choice is there?
Hospitals, whose budgets have been decimated by the shutdown and prohibition of elective surgeries which normally provide most of their operating capital, are squeezed as it is even before having to cough up inflated prices for their PPE.
And to make bad go to worse, our own governments have made it even more difficult and expensive to produce domestically the items they are so desperate for us to make. The governments of both the United States and Canada have offered supplements and cash payouts for people who are out of work. What happened when manufacturers across both countries tried to recall their employees back to work to start manufacturing this badly-needed PPE? We have been told our employees could get as much, or MORE money to stay at home than they would if they were working so they choose not to come in, and the new legislation empowers them to do so. Many employers are now paying sizable bonuses to get employees to come in, thus further driving up the cost of these critical medical items.
WHAT’S MY POINT?
- Stockpiles are great, but as we have recently seen, they can run out.
- Disposable things are convenient, but when they become unavailable and we have no other options readily available, we end up making some very bad choices.
- Cheap stuff from China seems great, but when China can’t, or won’t, supply us, we are incapable of keeping up with our own needs and requirements.
- American manufacturing may be expensive, but we must not be dependent upon other countries to keep us supplied with critical supplies.
- This virus has exposed huge flaws in our supply chains and our ability to be self-sustaining. Our health care system is vulnerable because we were unable to get the stuff we needed from China due to a virus.
- What if this were a war?
More Coronavirus Response…