For health care workers, the N95 mask is an invaluable line of defense against the novel coronavirus. These highly protective respirators can keep doctors and nurses from getting infected by patients, but the world is quickly running out of them. While countries around the world scramble to find stockpiles of N95s and manufacture more of the much-coveted masks, it’s unclear how this shortage will resolve itself.

The situation in the United States is increasingly dire. On April 2, President Trump invoked the Defense Production Act (DPA) to compel 3M, one of the only companies that manufacturers N95 masks in the US, to ramp up production. Many, including Democratic presidential primary candidates Joe Biden and Bernie Sanders, had pushed the White House to use the DPA more aggressively to deal with medical supplies shortages. The president later said in a tweet that 3M “will have a big price to pay” for exporting masks.

3M pushed back against Trump’s threats. In a Friday statement, the company emphasized that it had gained approval to import 10 million masks from its facilities in China. 3M also warned about the White House’s request to end its exports of N95 respirators, citing “humanitarian implications of ceasing respirator supplies to health care workers in Canada and Latin America.” If other countries retaliated by not sharing supplies, 3M argued, the US could soon end up with fewer masks than it had before the DPA order.

Despite global production ramping up, the US shortage of N95 masks is so great that companies, unions, and even average people have been scrambling to fill the need by searching for stockpiles of existing masks and seeking out alternative suppliers. Another problem is that many of these respirators, including those made by 3M, are ending up in a somewhat lawless gray market, where they’re subject to hoarding and price-gouging. Accordingly, federal authorities are hard at work tracking down stashes of this desperately needed personal protective equipment and redistributing what they find to health care worker.

In another move to increase the supply of respirators, the Food and Drug Administration has also lifted restrictions on importing KN95 masks, which are similar — though not identical — to N95 masks, and are certified by China, according to BuzzFeed.

In New York, now the epicenter of Covid-19 cases in the US, Gov. Andrew Cuomo has called for New York and American companies to transition to making N95 masks, among other medical supplies, if they're able.

“It is unbelievable to me that in New York State, in the United States of America, we can’t make these materials, and that we are all shopping China to try to get these materials, and we’re all competing against each other,” he said during a Friday press conference. Referring to an N95 mask, he said: “It can’t be that we can’t make these.”

So while discoveries of hundreds of thousands — and even millions — of masks might sound like good news, the everlasting shortage also draws attention to a supply chain that’s been riddled with mismanagement and misinformation. The situation also raises the question of why companies, unions, and average people have taken it upon themselves to find masks for health care workers, as well as why the federal government didn’t do more sooner to get masks into the hands of people who need them most.

What makes N95 masks so hard to find

Certified N95 respirators are special. Unlike a conventional surgical mask, N95 masks are built so that 95 percent of very small airborne particles can’t get through. These masks also need to be approved by the CDC’s National Institute for Occupational Safety and Health and, depending on the type, the Food and Drug Administration. In order to fulfill those requirements, N95 masks must be constructed so that they seal tightly around one’s mouth and nose, unlike surgical or cloth masks which are loose-fitting.

The CDC recommends several measures to help prevent the spread of Covid-19: Wash your hands often for at least 20 seconds.

Cover your cough or sneeze with a tissue, then throw it in the trash.

Clean and disinfect frequently touched objects.

Stay home as much as possible, and do not go out if you are sick.

Wear at least a cloth mask in certain public settings.

Contact a health worker if you have symptoms. Guidance may change. Stay informed, and stay safe, with Vox’s coronavirus coverage hub.

The United States is now confronted with a shortage of N95 masks for a number of reasons. The masks themselves are difficult to make, in part because they require specialized equipment to meet stringent regulatory standards. Many of the companies that can make the masks are also in China. That supply chain wasn’t prepared for a pandemic, especially one that originated in the same country where many of these masks are produced. And as the novel coronavirus spread throughout China, the country’s government bought its domestically produced masks, ensuring they weren’t exported. That’s made the gap between supply and demand in the US much larger.

In the absence of a pandemic, the US has typically not produced enough of these N95 masks to meet the needs of its own workers. 3M and Prestige Ameritech are the two primary companies that do end-to-end production of medical-grade N95 masks in the US, and both are both ramping up production. Another American company, Honeywell, recently started producing N95 masks at its Rhode Island and Phoenix facilities. Still, these three companies won’t solve our mask shortage.

Now that China appears to have slowed its own Covid-19 outbreak, overseas shipments of protective equipment are starting up again. Even if China exported the same number of masks that it did before the novel coronavirus outbreak, the US would still need a lot more since it’s now combating the highest number of confirmed cases of any country in the world. The US is also competing with many other countries eager to get hold of more N95 masks.

So front-line health care workers are sounding the alarm that there simply aren’t enough N95 face masks to keep themselves and their patients safe. A March survey conducted by the health care company Premier found that a shortage of N95 masks was hospitals’ top concern, and that many hospitals had less than 10 days’ worth of supplies. Facing limited supply, nurses have been forced to reuse masks and are turning to cloth and conventional surgical masks, which are not as protective.

The struggle to equip health care workers with proper protection has left some looking toward the US government for help. So far, many are frustrated by a lack of preparation in the face of the coronavirus crisis and the government’s failure at ensuring that masks and other essential medical equipment get routed to hospitals and other places where it’s most needed. The Department of Health and Human Services has estimated that the country will need 3.5 billion masks over the course of tackling the pandemic. Disparate sources in private industry are showing up to help.

Why companies keep discovering N95 masks in stockpiles

Many companies and organizations are purchasing masks for the specific purpose of donating them to fight the Covid-19 pandemic. However, others are offering up N95 masks that were being kept in storage. Reasons vary as to why so many companies have these high-end respirators stashed away in warehouses.

Mark Zuckerberg, for instance, recently said that Facebook was donating 720,000 N95 masks that were purchased following the wildfires in California last year. He added that the company was “also working on sourcing millions more to donate.”

Currently, California emergency regulations require that when air quality worsens by a significant amount, workplaces must take steps to ensure their workers have respiratory protection, like N95 masks, if other adjustments can’t be made. The change in regulation came following the catastrophic 2018 California wildfires. The same regulation suggests that a good number of other California employers also have N95 masks on hand.

But wildfires aren’t the only reason companies have N95 masks in storage. Goldman Sachs donated some 600,000 masks after buying them during past public health crises, like the H1N1 pandemic. The National Cathedral similarly kept a stockpile of more than 7,000 N95 masks because of concerns about the avian flu and recently donated 5,000 of them to Washington, DC-area hospitals. Meanwhile, a spokesperson for Intel told Recode that it is donating 1 million items of personal protective equipment, including N95 masks, from its “factory stock and emergency supplies.”

The list of sources for N95 masks keeps growing as officials keep seeking them out. A construction company in Columbus, Ohio, handed over its supply to local health officials, while some Habitat for Humanity workers in Atlanta gave nearly 1,500 N95 masks to their county health department. Both groups keep the masks for their everyday operations. Some masks have even come from the trash. A Maryland recycling company had saved 36,000 N95 masks that someone had previously tried to throw out. Now, those masks are being donated to health care workers.

There are also cases of discovered masks with more mysterious origins. For instance, the Service Employees International Union-United Healthcare Workers West (SEIU-UHW) announced in late March that it located a whopping 39 million respirators that could be sold to health care workers. But the union has thus far declined to name the distributor that had these masks, apparently out of concern that the company would be overwhelmed, and at least one hospital association appeared to walk away from the deal. Another intended recipient never received its order and said that the supplier never had the masks it promised, an allegation that has sparked a federal fraud investigation.

It’s also unclear exactly where several major N95 donations from corporations are coming from. Apple CEO Tim Cook tweeted in late March that his company had “sourced, procured, and is donating” 10 million masks, though it’s not immediately clear why the company had access to so many masks. The day before Cook’s tweet, Vice President Pence said in a press conference that Apple would be donating 9 million N95 masks from its “storehouses.” Still, Apple would not comment on why the company had these masks in supply.

When N95 expiration dates matter and when they don’t

Even though millions of N95 masks have reportedly surfaced in the past month, health care workers will need millions more in the coming months. And to some extent, all of these recently discovered masks are adding to feelings of confusion. One big question that keeps popping up: Which stockpiled N95 masks are still usable?

“You can find small pockets of available supplies as people realize, ‘Oh, yeah, we do have a warehouse.’ It is nearly impossible to find a large quantity,” Soumi Saha, senior director of advocacy at Premier, told Recode. She added that many of these products are now expired. “When you start seeing millions behind some of these finds, you really have to do so with a level of caution.”

These massive discoveries seem to be happening with some frequency. The most recently reported discovery happened in an Indiana warehouse, where government officials found nearly 1.5 million expired N95 masks. They had been part of the US Customs and Border Protection’s emergency supply, but according to the Washington Post, the Department of Homeland security is giving the masks to TSA workers instead of sending them to hospitals. It’s not clear whether the fact that the masks are expired played a role in how they’re being distributed.

While 1.5 million masks sounds like a lot, that load is just a fraction of the 21 million N95 respirators the state of California found in its emergency stockpile a few weeks ago. The state says that all of the masks “are expired but are usable” under updated CDC guidelines. Indeed, at the end of February, the CDC reported that “certain N95 models beyond their manufacturer-designated shelf life will be protective.” The San Francisco Chronicle explains that the issue with the expired masks isn’t the respirator itself; the elastic band that holds the mask on the wearer’s face can degrade over time, preventing a tight seal.

One solution that could avoid the risk of using expired equipment might just be to keep reusing the disposable N95 respirators. The Food and Drug Administration recently approved an Ohio company’s disinfection system. This new machine can disinfect up to 80,000 N95 masks a day, though regulators are capping each device’s capacity at 10,000 masks.

Why the gray market for N95 is complicating things

At this point, it seems obvious that the question of how health care workers can get access to large numbers of functional N95 masks is complicated. It’s not always clear where the masks are coming from or whether they’re any good.

“As the world scrambled to acquire [N95 masks] — for different reasons — it created a weird market dynamic between those who are looking to buy and those who are looking to provide,” Andrew Stroup, a co-founder of the medical equipment clearinghouse Project N95, told Recode. “That imbalance in the market happened, and then you saw a rise in secondary or open market individuals showing up saying they could supply it.”

In other words, a gray market for N95 masks has emerged. As Vox recently reported, a growing number of individuals and organizations are raising money through websites like GoFundMe and working with suppliers in China to fill the gap in supply that the US government can’t or won’t properly address. These importers have to worry about not only expired N95 masks but also counterfeits and substandard products, which are increasingly being offered to US health care workers.

The number and breadth of sellers has grown drastically in recent weeks, adding to the general state of confusion in this crisis. Now, a troublesome class of middlemen is in the N95 mask business, and hospitals might find themselves dealing with anyone from legitimate distributors to criminal counterfeit rings. Meanwhile, prices for masks have spiked from just around $1 per mask to as high as $7, $8, or even $9 a mask. Michael Einhorn, president of the medical supplier Dealmed, says that despite 3M’s promise not to raise prices during the pandemic, these so-called diverters still find a way to intervene and profit from the pandemic.

Amazon has now effectively banned the sale of N95 masks to the public, and platforms like Facebook and Google have prohibited ads for Covid-19-related medical products (though that hasn’t necessarily stopped these ad from popping up).

Meanwhile, through suspicious accounts on platforms like Instagram and Twitter, there appear to be unauthorized people advertising N95 masks, which may or may not be legitimate. Facebook, which owns Instagram, told Recode that it will remove “posts and accounts selling masks, hand sanitizer, surface disinfecting wipes, and Covid-19 test kits.”

A Twitter spokesperson told Recode that several accounts that appeared to be selling N95 masks have been removed for violating the company’s rules regarding platform manipulation and spam.

“Diverters are people who are able to get ahold of a 3M product, either from another distributor or somehow they were able to siphon off the supply chain, and they hold onto it and flip it,” Einhorn told Recode. “3M has a major problem. We’re an authorized 3M dealer, and we haven’t gotten masks in months.”

Einhorn added that philanthropists and companies looking to donate masks could end up buying from diverters on the gray market, and they might be “a little surprised to learn how expensive it is.”

So what’s the federal government doing about this?

The government’s Strategic National Stockpile, which has emergency supplies stored in secret locations around the country, contains millions of masks. Nevertheless, the Trump administration seems to be distributing medical supplies unevenly during this public health crisis. Michigan, whose governor has recently drawn the president’s ire, says that the 112,000 masks supplied by the federal government will still leave the state “in dire straits.” The governor of Florida, on the other hand, says his state has received everything it’s asked for. Not all states are getting what they’ve asked for.

To address the shortage, the president has turned to the DPA, which enables him to force private companies to produce needed medical supplies during an emergency. He’d previously used the law to manufacture much-needed ventilators. Denying health care workers access to essential equipment inevitably raises questions about the Trump administration’s ability to manage a supply chain that’s been consumed by disruption, misinformation, and profiteering.

“I think the bigger and more important story around this,” Steve Trossman, the SEIU-UHW director of public affairs, told Recode, “is where in God’s name is FEMA and the federal government, which has the ability to pull all of the strands of a chaotic and fractured supply system together and aggregate the large supply of PPE that seems to be out there, stabilize prices, figure out distribution, etc.?”

Inevitably, the entire world needs many, many more N95 masks not only to keep health care workers safe but also to stop the spread of the coronavirus. As the search continues, US health workers might be forced to take whatever they can get. For some, that might mean the insufficient, loose-fitting cloth masks, even some that people are sewing at home. Some may just have to settle for face shields, which are now also being manufactured by volunteers.

If the CDC does end up changing its policy and recommending that every American wear a mask in public, the shortage of N95 masks could very well worsen. So if you’re not a health care worker or someone with Covid-19, consider an alternative like a surgical or cloth mask. And if you happen to have any unused N95 masks, consider donating them to health care workers immediately. You could save someone’s life.

Update, April 3, 12:45 pm ET: This post has been updated with new information about the N95 mask shortage, including that President Donald Trump has invoked the Defense Production Act to push 3M to make more masks, as well as the company’s response.

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