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Amid a national shortage of N95 masks, the U.S. government tacitly granted an exemption from its protective equipment export ban that allowed up to 5 million masks to be shipped overseas per month.
The Federal Emergency Management Agency, in the final moments of Donald Trump’s presidency last month, enacted the waiver that would allow a Texan company to export its products after failing to secure U.S. customers, such as FEMA received from KHN – letter stating.
Zenei Triunfo-Cortez, President of National Nurses United, described the export cut as “irresponsible” and said that the N95 is still under lock and key in many hospitals. She said she still has to “beg” for a new N95 if her N95 gets dirty during a shift caring for Covid-19 patients.
Healthcare employers “and a federal agency protecting the people of America aren’t doing their jobs,” she said. “You have no regard for our security.”
The separation between frontline workers who don’t have better protection and federal officials suddenly exporting masks boils down to one thing, say occupational safety experts: The government hasn’t spun fast enough to repeal the supply chain crisis mode guidelines and Forcing employers to take costly measures and sometimes cumbersome steps to better protect workers with quality equipment.
The FEMA letter relates to the challenge that Fort Worth-based Prestige Ameritech faced in finding customers for its high-end government-approved respirators: hospitals didn’t want test workers to match their N95, a 15-minute process per employee According to company president Mike Bowen, a new N95 model has to seal the face.
Bowen said he increased N95 production from 75,000 to 9.6 million per month during the pandemic. Lately he can’t sell them to large buyers, doesn’t have the infrastructure to sell them to small buyers, and has so many in stock that he may have to lay off workers and stop production.
Addressing these challenges, the FEMA letter states that the waiver was granted in the “national defense interest” to ensure it kept production busy. The letter was forwarded to border guards who were monitoring exports 103 minutes before Joe Biden took office.
But even with the waiver, said Bowen, he had not found an overseas buyer. He said he couldn’t understand the conflicting information he was getting: frontline workers say they need more N95, but hospitals say they don’t.
“There’s a break somewhere and I don’t know where it is,” Bowen said. “Why don’t my phones ring when there is a shortage?”
A FEMA official said via email that the waiver could be revoked at any time if U.S. demand rises and that the agency could ask the company to meet domestic demand before N95s are exported.
Although prices for bulk buyers are falling significantly, prices for smaller quantities of N95 have hit $ 4 to $ 7 each, according to Get Us PPE, a nonprofit designed to provide frontline workers with the equipment they need.
The requirement on employers to conduct annual fit tests was lifted in the public health emergency, leaving employers with little incentive to deviate from the industry-standard models such as 3M that had been used for years. And the Centers for Disease Control and Prevention have guidelines in place that say a limited cadre of healthcare workers should be given N95s that can be reused and rationed.
This creates an unusual situation where U.S. mask shipments have skyrocketed, but employers’ motivation to buy the best protective gear has not, said Peg Seminario, a former health and safety union representative who recently signed a letter in which he asked the CDC to update their guidelines to reflect the risk of inhaling the virus.
“This is crazy,” she said. “We could … destroy this pandemic, which is the greatest risk of infection, and we are not.”
Launched by a group of emergency doctors in March, Get Us PPE said it received 89% of requests for equipment – often N95 – from health workers outside of hospitals such as community clinics, Covid testing sites and mental health facilities. Demand rose in January and 28% of frontline workers looking for N95 said their website didn’t have one.
However, the volunteer-led group was only able to meet around 15% of the requests it received. Dr. Ali Raja, founder of the group and vice chairman of the emergency department at Massachusetts General Hospital, said the need outside of hospitals is great, but small facilities looking for equipment fail to connect to mass sellers like Bowen’s company.
“There was nothing out there – no central place for all facilities to report PPE needs,” said Raja. “We don’t want to be the website with the best data. We want this to be the federal government. “
On the last day of 2020, FEMA expanded its rule banning the export of PPE, including N95, without first seeking express agency approval. The rule states that the fall and winter surge in Covid cases meant that “the domestic supply of assigned PPE has not and is not expected to keep pace with demand”.
According to a report from the US Government Accountability Office, the US Strategic National Stockpile has not yet reached its target for N95 respirators. According to the report, there were 190 million N95 respirators in storage as of December 18, well below the target of 300 million.
“GAO remains deeply concerned that the agencies have failed to respond to recommendations to better address critical gaps in the medical supply chain,” the government monitoring report said.
Another twist in the saga is that millions of counterfeit N95 stamped “3M,” an industry standard long used in pre-requisite annual fit tests, have flooded hospital shelves even when federal agents seize them in US ports.
A prominent group of scientists wrote to the CDC Monday to point out guidelines that urgently need to be changed to protect workers from inhaling tiny virus particles in the air. In their letter it was noted that “CDC does not recommend the use of N95 respirators outside of the healthcare sector,” although excessive risks have been documented for bus drivers, prison guards and meat packing workers.
The CDC guidelines also allow hospitals to limit which workers receive the N95, omitting those in the community and lower-level workers who usually spend most of their time alongside patients.
As part of the Lost on the Frontline project, KHN and The Guardian have documented the deaths of hundreds of more than 3,440 frontline health workers, of whom 2 out of 3 were color workers and 56% worked outside of hospitals. With more than 120 deceased, family members had concerns about PPE, including extensive reuse of N95 or the use of surgical masks to directly care for patients with Covid.
KHN senior correspondent JoNel Aleccia contributed to this report.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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