On March 25, Philadelphia closed a deal on an order of 500,000 highly coveted N95 masks to protect police, firefighters, and other first responders from the coronavirus. At $2.8 million, or $5.60 per mask, the price was inflated by about five times normal, but officials were glad to get them.
Adam Thiel, head of the city’s Office of Emergency Management, knew better than to celebrate.
“It is not done," Thiel, also the city’s fire commissioner, said in a March 30 interview. "It will be done when I actually see them on our loading dock.”
His skepticism proved to be prophetic. The next day BJ’s Wholesale Club, the supplier, reported the order had been canceled, for reasons unclear. The only bright spot was that the check had not been sent.
That kind of failure is a window into what has become a national scandal, the inability of governments and health-care systems to protect those on the front line of the pandemic. Hospitals were “reporting delays of 3-6 months in being able to replenish key supplies, including surgical and N95 masks,” according to a report released Monday by the U.S. Department of Health and Human Services’ Office of the Inspector General.
Disrupted supply chains, hyper-competitive purchasing, and novice suppliers seeking quick profits are all complicating life-or-death transactions.
Meanwhile, Philadelphia officials have ordered more masks, but can’t say when — or if — they might arrive.
Last month’s mask deal was not the first to fall through, said Brian Abernathy, the city’s managing director. “It’s one option of many options that we have pursued that haven’t come to fruition,” he said.
The mask problem is particularly vexing because unlike simple surgical or homemade masks, the N95s block at least 95% of very small airborne particles, including those too tiny to be blocked by surgical or cloth masks. Airborne viral particles are considered one way the virus transmits, and are a particular risk in hospitals where ventilators and other respiratory treatments can lead to aerosolized particles. These masks are also fitted specifically for the wearer, forming a tight seal against the face. Because health care workers and emergency responders encounter the virus repeatedly, they need high-quality protection.
“The thing about the N95 is, it’s not something we can make at home,” Thiel said. “The N95 is a little bit of a specialized thing and that’s why we’re being aggressive about that.”
The masks were scheduled to arrive, BJ’s informed the city, by April 3. The supplier told the city the order was canceled because it “did not clear the testing facility in the country of origin,” said Jeff Kolakowski, a spokesperson for the Office of Emergency Management.
There was no more explanation, he said. City officials aren’t even sure who manufactured the masks or where they originated.
“You can place an order with vendors,” Kolakowski said, “but that does not necessarily mean you will get the product.” BJ’s did not reply to several calls for comment.
Philadelphia’s experience isn’t unusual, said Devika Daga, a volunteer in New York City with ProjectN95, an organization vetting the reliability of suppliers and manufacturers of personal protective equipment. Before this year, the U.S. Food and Drug Administration had 38 companies registered as suppliers of N95 masks, she said. An additional 1,367 registered with the FDA in 2020, according to agency data. Untested newcomers to the field, many of them in China, are suddenly producing equipment, and distributors are seeking new sources as established ones run out of stock.
“You have factories trying to seize the opportunities of this moment,” Daga said. “Do they go through the entire product development process? You have a lot of sort of cutting corners, and that coupled with suppliers not having established relationships.”
The FDA did not reply to a request for comment.
Philadelphia’s efforts to obtain more masks have been stymied by intense competition with, in some cases, other municipalities or states, and even the federal government, Kolakowski said.
“We see competition for items between city procurement and federal purchases,” he said, “as both look to obtain PPE from the same vendors and manufacturers in the United States and other countries.”
The city, along with making its own purchases, is relying on donations, state and federal sources, and local manufacturers, Kolakowski said.
The result, the HHS report stated, is a disrupted supply chain.
“The prices are changing not only just daily, the prices are changing sometimes by the minute,” Thiel said. “I’ve heard of commodities being purchased and either don’t show up or the price is originally quoted and delivery time is originally quoted and then there’s a backlog.”
The competition results in a bidding war that has pushed the price of N95 masks from a dollar or less to $5 to $6 a mask. In that bidding battle, wealthier states have an advantage. The fierceness of competition led California Gov. Gavin Newsom to call for collaboration among states to purchase PPE.
With COVID-19 cases expected to peak soon in Philadelphia, the city anticipates needing 10,000 to 30,000 masks per day for law enforcement and emergency responders, who normally would dispose of a mask after aiding one person. The city has about 10,000 police and firefighters alone, Thiel said. In the HHS study, one hospital reported that by late March, it was using 2,000 masks daily — 10 times the pre-coronavirus volume.
Area hospitals are adapting by directing employees only to use N95 masks in the most high-risk situations. Yet often health-care workers have no way to know which patients have COVID-19. They do know that other types of face coverings offer significantly less protection.
So medical workers and their families are getting creative, with the help of local networks and donations. Anna Goodwin began a drive about two weeks ago to gather masks for her father, Christopher Goodwin, a doctor at Temple University Hospital. She has obtained 1,500 N95 and surgical masks, she said, with an additional 1,000 expected. She hasn’t had time to think about why she is in the position of having to find essential safety equipment for a hospital.
“I’m very worried — I’d say, like, 9 on a scale of 1 to 10," the 26-year-old said. "It’s pretty scary.”
Robert Kushner, whose brother-in-law is a doctor at Einstein Hospital, is among the American importers who recently entered the mask business. His company, UT Brands of Orange County, Calif., had since 1995 imported home goods for stores like Bed Bath & Beyond and Kohl’s.
His first order of 100,000 masks is en route, Kushner said, but he had to cancel an order for 500,000 masks after learning they were counterfeits. His connections in China are doing quality checks where possible. But, Kushner said, they’re liable to hear, “I’ve got a line out the door of people with cash who aren’t asking questions of me.”
A dizzying array of FDA regulatory codes and a lack of cargo flights into the United States are also frustrating, he said. On Tuesday, he managed to scrounge up one small order — 15 Chinese N95 masks to his brother-in-law, who has been wearing the same one for a week.