The defense budget for the 2020 Fiscal Year is $738 billion. Funding the larger intelligence and national security ecosystem costs many billions of dollars in addition to this sum. This is money being spent in the name of protecting the American people. For a country that can spend that type of treasure on weapons and warfighting infrastructure, it is downright astonishing that it can't keep a stockpile of cheap respirators around, or at least guarantee the domestic production base to rapidly build more, in order to fight a pandemic that was not only far from unthinkable, it was inevitable. This simple fact alone should make you furious and question the priorities of the U.S. government and those who are tasked with presiding over it.
The N95 respirator is not a high-tech piece of equipment. Far from it. They are disposable masks that, when fitted and worn properly, offer a reliable barrier against a number of things, including viruses. They are considered as essential for healthcare workers who treat patients with infectious diseases that can be transmitted through droplets of bodily fluids, offering them some certainty that they themselves will not end up contracting the patient's illness. As such, they are absolutely critical to fighting a pandemic just like the one we are experiencing. In other words, they are just as important to keeping the American public safe as combat aircraft or a fighting ship.
It is a fairly straightforward problem to deal with. Just stock enough of the masks to meet the most likely cases that will be experienced during a pandemic health emergency. They have a shelf life of roughly five years—although they can be used after that if there is no other choice—so every year a fifth of the stockpile would have to be replenished to keep the entire supply fresh. This is standard logistics for big government.
A mix of a large on-hand supply in the Strategic National Stockpile and guaranteeing native production capability to rapidly make more is another option that invites some risk, while also alleviating the costs of stockpiling a portion of the shelf-life limited masks and could be more cost-effective over time.
That being said, here's the unimaginable reality courtesy of the New York Times:
"The federal government’s Strategic National Stockpile of medical supplies includes 12 million medical-grade N95 masks and 30 million surgical masks — only about one percent of the 3.5 billion that the Department of Health and Human Services estimates would be needed over the course of a year if the outbreak reaches pandemic levels. The department announced last week that the federal government had put in a guaranteed order for 500 million N95 masks over the next 18 months, a move it said would encourage manufacturers 'to immediately increase production of N95s for use by health care professionals.'"
You read that correctly. We have a minuscule fraction of the masks needed to deal with a pandemic. The Pentagon has announced it is contributing five million more N95s from its own reserves, but that clearly isn't enough even in the relatively near-term. But there it is, this is all that we have on the federal level.
While the production of 500 million N95 masks sounds like a lot over the next 18 months, it isn't even close to reaching the potential demand and those won't materialize anytime soon. What makes matters worse is that most of the production of these masks is based, you guessed it, in China. That country has its own incredible demand for respirators and is already running beyond production capacity. Additionally, although they are cheap to produce, they are not easy to make. So, it's not like the U.S. can just quickly spin up production to the level required domestically to meet the projected need.
At retail, small-batch prices, the average N95 mask costs between roughly $.75 and $1.50 under normal circumstances. Buying millions at a time direct would cut this cost down massively. Mike Bowen, vice president of Prestige Ameritech, which makes N95 masks, told the New York Times:
"You know what a mask costs?... Listen to this: A Class 2 medical device, you can buy two of them for the price of a gumball. They’re cheap. They’re automated. They’re not handmade."
So let's just use $0.50 per unit for government stockpile-sized contracted buys, which is likely high. In order for the U.S. Government to have a proper supply on-hand for a pandemic, we are talking about $1.75 billion worth of masks needed in the Strategic National Stockpile at any given time. Since the masks expire roughly every five years, that equates to $350 million a year. That is very roughly the cost of two KC-46 aerial tankers, a single Littoral Combat Ship, roughly one-thirty-eighth of a Ford class supercarrier, or about three F-35s and an F/A-18 Super Hornet. Once again, this is assuming an entire stockpile of 3.5 billion masks is on hand at all times instead of securing emergency production for a portion of that number if needed.
Of course, these are just comparative numbers. The country does need a strong military and you could plug in many other government spending initiatives here for fiscal comparisons, but how on earth do we spend the type of money we do on weaponry in the name of keeping the American people safe, yet we have only a fraction of the stockpile of cheap N95s masks in place necessary to fight a flu-like pandemic while having no way to make up for the difference in the short term? We can prepare for World War III in every way conceivable, but we can't stock some throw-away masks to ensure that our entire healthcare system doesn't implode during a pandemic that has been long considered as just a matter of time.
This is so astonishingly near-sighted it seems criminal.
In doing what I do for a living, I see so much government waste and financial abuse it can get very discouraging at times, but this may be the worst example of absolutely broken fiscal priorities I have ever seen, and it could cost you your life.
If we run out of N95 masks, our healthcare workers will be relegated to a potential death sentence in order to execute their jobs. Beyond their own risk, this would mean that a vast portion of all healthcare workers that are directly exposed to the virus will be knocked off active duty temporarily, and likely most around the time when the masks run out. Not only that, but those sick caregivers themselves will also end up taxing the healthcare system even more than it already is, and in a state with even less capacity to meet those demands than it had before.
Does this sound like a looming disaster on top of a disaster? It is.
The writing is already on the wall. The Vice President of the United States and the head of the Pandemic task force on coronavirus, Mike Pence, is now asking any industries that use N95 masks to protect their own workers to donate them to Hospitals. All new production had been diverted to the healthcare system and the federal government.
Doctors I have talked to say that rationing medical supplies, in particular N95 respirators, has already begun and there is grave uncertainty around the state of the supply as the pandemic picks up steam. Some hospitals have already requested additional supplies from the Strategic National Stockpile. What some have received, even at this early stage in the crisis, are fewer masks than requested, many of which are actually expired.
This is happening in the richest country on earth, one with supposedly the best medical system in the world, and before the pandemic balloons in scope.
So, how did this happen? Well, what's clear is that the federal government released 85 million N95 respirators out of its strategic stash along with other staple medical items, like gloves and gowns, to deal with the H1N1 outbreak in the late 2000s. The N95 reserve in the National Strategic Stockpile was not replenished. This lack of action occurred even as alarms were sounding that a horrific pandemic could hit at any time. Only so many could be bought a year with the stockpile's roughly $600 million annual budget, which many have decried as chronically underfunded to an absurd degree. In all, the reserve is worth just around $7 billion.
Although not as egregious, a similar situation is happening with ventilators, critical life-saving breathing equipment used to save patients' lives with this type of lower respiratory infection. There are about 200,000 of these machines active, in reserve, or retired and in mothballs in the United States. Realistically, the number is far lower due to issues with older units that may not be able to be reconstituted. At the same time, the demand for these units could reach nearly a million units as the pandemic peaks.
These are not cheap N95 masks, they are expensive machines costing thousands of dollars each. Still, hasn't there been a massive push by the government to produce and purchase as many as possible in as short a time as possible and train more staff on how to use them? Without these machines, doctors and nurses could be faced with similar horrific circumstances as what is being experienced in Italy, where patients with the best chance at living are given critical resources and the others are left to die.
Considering we will go into the jaws of hell to rescue a single American being held overseas against their will, it is odd that we are not doing everything possible, and have not been doing everything possible for weeks, to bring as many of these units and technicians to work them online as fast as possible. Why is an American life far more pressing of an issue where a dramatic military operation or negotiation is required than when one is dying on a medical bed without a piece of technology that can save their life?
Of course, more resources can be focused on one person when many others are also not in need of help and it may be impossible to be able to satiate the demand for that many respirators in the near or even not so near term, but that doesn't mean we shouldn't try? Every minute has been critical for weeks, yet movement on this issue remains abysmally slow. Meanwhile, other countries are putting in huge orders that will make it harder for the U.S. to receive additional units and parts to sustain them.
Although they are costly, each ventilator costs roughly the price of a single Joint Direct Attack Munition (JDAM) guided bomb kit, they can be used repeatedly as the pandemic progresses. How is it that when U.S. bomb stocks get low we move to replenish them, but we take many weeks to spool of ventilator procurement during a crisis the likes of which we have never seen? How can we prepare and arm ourselves so completely for wars that may never come, but we are so ill-prepared for one that we knew was more likely around the corner than not?
Maybe it's the nature of the enemy. It's easier to wrap your mind around a foe that has a body, a following, political aims, and threatening capabilities than something you cannot see that can't be killed with bullet or bomb and can't be tracked from 20,000 feet in the sky in some dangerous land. But that is no excuse for government and elected officials to have literally blown off the most basic and obvious necessity that will allow healthcare workers to even attempt to combat the enemy. It is a horrific mistake of historic proportions that could have the direst consequences in the weeks and months to come.
We had every warning: H1N1, MERS, Swine Flu, and Ebola, and that was just in roughly the last decade or so. It wasn't debated if a pandemic was coming, it was just the question of when. Yet the American people will be potentially subject to a 'respirator gap' that could kill far more Americans than the events of 9/11 or even an attack far more deadly by an enemy actor.
We need to understand how this horrible oversight occurred and those who are responsible for it, on all levels, must be held accountable for their decisions or their inaction.
If nothing else, this is the most glaring reminder of just how screwed up the American government's priorities are when it comes to "protecting the folks." How we could have gotten to a point where the Pentagon loses far more money than it would cost to have these medical necessities on hand? It screams of a government and a society that has lost its sense of reality. It also points to a military-industrial complex that has brainwashed or bought those in power to such a degree that the protection the American people are given for their tax dollar is almost entirely against threats that go boom, regardless of the massive scale of harm that could be done by far less glamorous enemies of microscopic nature.
Just ask yourself, which would you rather have right now as an American citizen: $1.75 billion worth of weapons or some non-essential pork or an ample supply of N95 respirators for the soldiers on the front line of a medical war that could be deadlier and more economically damaging than any conflict we have seen in the better part of a century?
Sadly, the powers that be in Washington D.C. never asked themselves that question or just didn't care. Now it's too late.
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