Speaking of wood dust, just before this all happened I had purchased an RZ mask setup from Amazon for woodworking based upon online feedback. It claimed to be N95, but awaiting certification. It was deep in winter when I bought it, so no chance to use it yet.

Now if I search Amazon for the RZ mask nothing is found. That makes me think that this respirator "shortage" will be very long term for non healthcare folks, otherwise Amazon would just say it's out of stock.

Amazon, Home Depot... they’re all out.

One of the reasons that retailers are out is the federal government has declared eminent domain over protective clothing in order to make sure the supplies are going to healthcare, first responders and other critical sectors.

Another major issues is the Strategic National Stockpile was severely depleted over the last decade and not replenished. So there weren't enough supplies that healthcare and first responders were told they could rely on in a disaster or crisis.

The problem is getting solved, it just isn't something that is going to be fixed overnight. Reputable manufacturers are revamping their production to make the needed masks and other PPE, once they get going the supplies will become available.

Aren't most (all?) of the 3M factories in China? You know, the place that has banned export of the very same masks that 3M is supposedly ramping up on?

Hopefully this little detail won't be lost on corporate management who choose where they manufacture their products. If China's poor quality, poor working conditions, and mandated turn over of intellectual property weren't enough reason to return to US manufacturing, maybe this will be. I'm not sure I'd want a N95 mask that was manufactured by an employee who just returned from their lunch of bat sandwich.

You both bring up excellent points that should not be forgotten in the wake of this.

As early as March 4th, reports were coming in from overseas experience that the median serial interval of Coronavirus was shorter than the median incubation period. This means that someone who is infected can spread the virus (for potentially on the order of a week) before they even feel sick, or show signs and symptoms. This pre-symptomatic spread frustrated early efforts of isolation and containment.

https://pubmed.ncbi.nlm.nih.gov/32145466/

https://www.cidrap.umn.edu/news-perspect...der-containment

For this reason, it was worrisome that our updated EMS guidelines still relied on "flu like symptoms" to judge whether or not to practice source control on our patients or don PPE ourselves. The safest course of action would have been for everyone to consider themselves a potential source even if they don't feel sick, and cover their face along with social distancing, hand hygiene and so on. Masks are of course no panacea, but as part of a comprehensive strategy to mitigate risks can help (with caveats).

With the working theory at the time of aerosolized spread being the primary means of transmission, masks were known to be effective at mitigating risk when used in conjunction with other best practices, however, the decision was made to definitively proclaim that masks are not effective for the general public in order to reduce panic buying (which unfortunately happened anyway) as Dr Fauci implicitly admitted in an article shortly before the announcement on April 3rd that everyone should wear them.


https://www.politico.com/news/2020/03/31/fauci-mask-recommendation-coronavirus-157476

I understand the need to try and avoid panic, but there are two things wrong with that.

Firstly, there should never be a reason that we lack mission critical items (especially PPE, given the universal nature of its importance) necessary to do the job, and that unfortunately represents a failure of leadership. Our stockpile consisted of somewhere around 112 million N95 masks, reduced after the H1N1 epidemic in 2009-2010 to just 12 million and never replenished at any time during the subsequent decade.

Even if it had been, 112 million masks would have lasted around a week during a fully developed nationwide pandemic... it should have been on the order of 3.5 billion according to one testimony by HHS Secretary Alex Azar, which at $2.50 / kg represents less than $200 million in material costs.

That's stupid cheap, in the grand scheme of things, even accounting for having to replace them due to expiration dates. Sometimes distribution can understandably be a problem (such as immediately following a natural disaster) but supply should not be -- panic buying is a known variable that can be accounted for in emergency management planning, and whether or not the public panic buys should therefore be irrelevant to mission readiness on the healthcare end if things are running as they should. Unfortunately, we are where we are, you fight with the army you have, and that will hopefully be addressed in the after action report.

Secondly, it's disingenuous to deliberately mislead people about the efficacy of an intervention at mitigating potential risk in order to manipulate their actions (in other words, saying "masks do not help the general public" driven not by actual evidence that they're ineffective, but because we're short and want to avoid panic buying) and is extraordinarily unethical and would likely be career ending if anyone else was caught doing it. The layperson may not be subject matter experts but they know when something doesn't add up, and it understandably sounded suspect when officials implied that coughing into your arm helps, as do masks for medical professionals, but nothing else is effective. People aren't stupid, and they really don't like being misled. Public threads on social media indicated that a non trivial number of people immediately referenced the Surgeon General and parroted the claims that masks don't help, which indicates that this unfortunately disseminated misinformation.

Their contention was likely that if you're practicing social distancing like you should be doing, the general public doesn't need masks, and combined with the severe shortage of PPE they were hoping it would trick the populace into not panic buying. Not only did it not prevent panic buying, but downplaying the seriousness and significant potential for pre-symptomatic transmission (relative to things like Flu, SARS and MERS) which were known, caused everyone down the line to drag their feet in their response, and it illustrated a fundamental disconnect between ostensible guidelines and the realities on the ground, as evidenced by the pictures in mid-March of standing room only crowds at the airport and essential businesses being slow to implement social distancing measures. Those people really thought masks didn't help.

So I get their contention, but this isn't China or HBO's Chernobyl, this is the United States and it's unethical IMO to not be fully truthful to the public for fear of them not being responsible enough to do what is necessary. We can't make informed decisions if the information we're being given is deliberately misleading, and unfortunately the result is that it hurt the public trust, potentially irrevocably. During the April 3rd press conference they tried to play this information off as if they didn't have it the whole time and were keeping us up to date with the latest developments. Their approach was conduct unbecoming and this should not be forgotten in the wake of this, because without a doubt their actions cost lives that didn't have to be lost.


Here were further studies showing masks + hand hygiene and social distancing was most effective:

https://ncbi.nlm.nih.gov/pubmed/20088690
https://ncbi.nlm.nih.gov/pubmed/19652172
https://ncbi.nlm.nih.gov/pubmed/22280120

We are where we are though, and hopefully in the end will be a stronger, more resilient populace with a robust ability to absorb hardship whether it be through natural disaster, terrorism, scarcity, or otherwise. I bet april of next year most people will have a box of N95 masks and plenty of TP, just in case

Yes, Americans love conspiracy theories to begin with an trust in public officials is at an all time low. This didn't help. When the public is flat-out lied to, that just hurts credibility next time around. We really need a reboot. I'd like to say maybe from here on out things will be done more effectively but I don't see much evidence of that.

Unfortunately that is the case around here too. The reported usefullness of masks increased with the perceived probability of obtaining some.
While there are a few instructions for sewing masks, there are none for proper donning and doffing. Consequently most people I see use gloves and masks in way that makes contamination of hands face more likely.

Excellent post. Particularly appreciate the pubmed footnotes.

That said, the epistemology of public health practitioners is fundamentally different from that of front line clinicians. Public health folk focus on the course of illness in populations; clinicians focus on the course of illness in an individual patient. And there are overtones of the epistemic difference between lawyers and scientists: lawyers believe that truth comes from the process of argument by skilled advocates before a disinterested judge or jury; scientists believe that truth comes from rigorous, reproducible experimentation reported to and evaluated by the scientific community.

Which explains the antipathy between physicians and lawyers, and the truly odd behavior that ensues when lawyers and physicians interact in trials.


So, the public health crowd sees that health care workers (HCW) fail often to correctly use ppe. Fail to choose to use it all, choose a type unsuited to the pathogen or procedure, or fail to follow donning and doffing procedures, All this despite aggressive training, retraining, policy and procedure, and some very threatening pathogens.
Dealing with untrained users, they fall back on two very reliable infection control practices: distance and hand washing. Cheap, effective, and the foundation of all infection control. Because nothing works without program compliance, and the program needs to be as simple as possible.

So, if my friend wants to obtain a firearm for personal protection, I might suggest a medium caliber revolver, or a single barrel shotgun. Not maximally efficient, but effective and with a pretty brief manual of arms. Shorter training period, shallower learning curve, better choice. And there are friends t whom I have recommended a baseball bat. Depends on the friend.

I am a hcw, so the public-facing position of the CDC regarding civilian use of masks seems manipulative and counterfactual to me, too. But it makes perfect sense to the politicians and public health types. Which is reassuring, because much of the stuff done by pols and political docs seems manipulative and counterfactual. But their intentions are good.

The road to Hell is paved with good intentions.








HCW compliance with ppe usage standards

HCW respiratory protection practices

Good analysis, nursemike! I suppose things are rarely as simple as we like to think.