The necessity 

The COVID-19 coronavirus pandemic has resulted in a global supply chain problem for the availability of Personal Protective Equipment (PPE). Health experts, including the World Health Organizations (WHO) and the Center for Disease Control (CDC) in the United States have stated that in order to reduce the spread of this virus includes, along with social distancing measures, that people wear masks in public environments. 

This has created an enormous demand for PPE such as the surgical mask. Initially, there was a demand for N95 respirators, but this has transitioned to recommendations that surgical masks are a better protection for the general public. 

Evidence shows that wearing a surgical mask will reduce the spread of the virus considerably, to a fraction of the rate of transmission that would occur if people wore no masks at all. In this article we will briefly cover the differences between N95 masks, surgical masks, and cloth masks, and then will examine the supply chain. We will also discuss various recommendations for handling shortages of these devices, and what steps should be taken. 

Types of Masks 

N95 Masks 

N95 respirators are a form of disposable mask that are sometimes known as filtering facepiece respirators. These are masks which integrate a filter directly into the design using pressure particles. N95 respirators are designed to be tight-fitting around the face. As a result, these are considered to be the most effective masks at protecting the wearer against airborne particles. They have the ability to remove both large and small particles, as well as aerosols. 

These masks are specifically recommended to be used by medical professionals. They are not recommended to be used by the general public by the CDC, due to international shortages of these, and their necessity for use by doctors, nurses, and other medical staff who are required to wear these at all times.

Surgical Masks 

Sometimes referred to as a medical mask, a surgical mask is a relatively loose-fitting disposable mask which is designed to cover the user’s nose and mouth area. They are resistant to most liquids and are designed to protect those who wear them against large droplets, such as those commonly carried by sneezes, coughs, talking, or general breathing. In other words, a surgical mask protects the user against respiratory droplets. 

It is important to note that surgical masks are not considered to be respiratory protective devices. In other words, they do not provide much protection against the inhalation of smaller particles carried in the air. 

They are not particularly effective at protecting the wearer against small fluid droplets, such as those carried in a virus. They are, however, particularly effective at protecting others from exposure to fluid droplets expelled by the wearer. The primary use of these masks is for those to wear them to protect the general public against possible exposure to contamination from the individual who wears the mask. 

Cloth Masks 

Cloth masks are not considered to be Personal Protective Equipment (PPE). That said, they are recommended to be worn by those who do not have access to the other types of masks mentioned. Since COVID-19 can be spread by those who do not have a fever or any symptoms, the CDC has recommended that individuals wear at least a cloth mask in public. 

Like surgical masks, they are effective at protecting others against excreted fluid droplets, such as through a cough, sneezing, speaking, or regular breathing. Unlike surgical masks, cloth masks should be regularly cleaned, and can be reused. 

Unlike N95 respirators and surgical masks, which are considered to be critical supplies and are not as easily available, cloth masks can be made by people at home. For this reason, while they may not provide as much protection as a surgical mask, they are considered to be adequate for use by the general public. 

Supply chain stresses 

The Food and Drug administration (FDA) is aware of supply chain stresses that are happening as a result of scarcity of surgical masks and N95 respirators, which can occur if demand exceeds supply. 

Some distributors are placing various PPE devices on allocation, meaning that certain supplies are being withheld to make sure enough equipment is available to healthcare professionals. 

The Food and Drug Administration (FDA) has created a number of recommendations for managing supply of surgical masks and gowns. Currently the existing strategies suggest that there is an adequate supply of FDA-cleared surgical masks. 

That said, there are several strategies that have been recommended for periods of scarcity of these resources. In these cases, health care workers may be recommended to reuse single-use masks

Main Sources 

Prior to the beginning of the COVID-19 pandemic, China was the primary producer of masks. China manufactured up to half of the world production of PPE masks and other protective gear. However, the amount produced was determined to be seriously inadequate for the demands brought about by the introduction of this virus. 

At the start of the global reach of COVID-19, in January of 2020, China was only able to manufacture and distribute approximately 20 million masks per day, which was insufficient to meet the demands in their own country, which was estimated to be approximately 240 million daily. 

Due to collaboration of multiple sectors, China was able to ramp up its production of surgical masks to around 200 million in March of 2020, which was enough to equip health, manufacturing and transport workers. 

Complexity of Manufacturing 

Creating a surgical mask requires the use of oil and metal to be able to create non-woven materials, for the metal strips (designed to fit over the nose), and ear loops, which may be made of other materials such as cotton. 

A bottleneck exists within the supply chain, which exists combining these non-woven materials with the polypropylene fabric used in constructing the masks. 

While polypropylene is a very commonly produced plastic (it is already used in a wide variety of consumer cloth products, such as diapers), however the specific type used for these masks is only produced by a limited number of companies due to high up front investment costs involved in the construction of these materials. Access to this fabric has created a bottleneck in the construction of a surgical mask. 

As a result of this crisis, there has been a wide range of cooperation between various industries to be able to increase the supply, including ventures between BYD (a carmaker) and a joint venture between General Motors, SAIC, and manufacturer of baby goods DaddyBaby. China Petroleum and Chemical also ramped up its scale for the manufacture of surgical masks to 1 million per day. 

China was particularly responsive in increasing the supply of non-woven fabrics, as they pushed industries to increase the amount of production of polypropylene. 

Distribution 

Transportation and logistics have also created some bottlenecks. Due to limited availability of supplies, many countries have imposed some severe restrictions on export of PPE equipment such as the surgical mask. This has made it difficult for many regions to be able to gain access to these masks in a timely fashion. In some cases, there have been regulations placed to require that governments compulsorily purchase all available stocks of PPE to ensure domestic access to materials. 

These export restrictions create a number of unfortunate consequences. For countries that do not have an adequate manufacturing base to be able to construct their own masks, this has resulted in extreme shortages. Another political effect of this is that when countries are being prevented from exporting

materials, they are unable to do so in exchange for other necessary medical equipment that may be unavailable domestically. These restrictions also create the situation of scarcity, and can push prices up, which can also lead to a growing black market for surgical masks and other PPE equipment. 

Distribution, including domestically within the United States, has also been disrupted by the impact of the virus itself on workforces. The lack of preparedness of the health infrastructure in the US (there have been extreme shortages in hospitals and medical facilities) has made it difficult to bring the surgical mask into the hands of the general public. 

Shortages have also led to some corruption in some countries, and disagreements between states and the federal government in the United States have impacted the availability of equipment to some regions. 

Demand is higher than Supply 

Typically, the length of time that a surgical mask is considered to be effective is approximately four hours. After this period, they need to be changed. While for the general public, the amount of time spent in an environment where these need to be worn may be less than this amount daily, for those people who work in general contact with the public, such as healthcare workers, supermarket employees, or anyone who works for a significant amount of time facing the public, a person will be expected to use at least two masks per day. While not all healthcare workers will be in direct contact with those infected by COVID-19, at least a third will likely need this many masks. For emergency workers, this would require approximately 28 million masks a day alone. If we add in other caregivers who are responsible for working with infected populations, this could increase the demand to another 12 million per day. 

Solutions 

To address weaknesses in the supply chain, there are a number of successful approaches that can be taken to be able to provide enough surgical masks to both medical professionals and the general public to reduce the spread of COVID-19 

Trade and Global Production 

There needs to be a relaxation of export restrictions placed on access to PPE supplies such as surgical masks. It is impossible for every nation to be able to “go it alone” and meet the demand by themselves. There needs to be considerably greater international cooperation. For those countries that have the ability to increase production of masks, they need to be able to make up for those countries which do not have the infrastructure or machinery in place to create these masks. 

Transportation and Logistics 

While many countries prefer to do most distribution by sea, this can slow availability and access to certain parts of the world. Using air traffic may be more efficient, but it is more expensive and may drive up costs. 

Free trade by itself is not enough 

We need to increase supply immediately. This will require government intervention into markets to ensure that enough equipment is manufactured. For more advanced mask types, these can be reserved for most critical workers; we can emphasize creation of lower level masks for workers in the general population to at least decrease the spread somewhat.

Open Markets are necessary 

Governments need to be able to cooperate freely and not place trade restrictions during this global pandemic. Cooperation and free flow of capital is essential to be able to bring resources to all parts if the globe. This is also something that needs to be addressed domestically. Within the US, government stockpiles need to be shared freely throughout different states. Distribution should not be held up for political reasons. 

Robust Supply Chains 

Cooperation between different providers and distributors within countries is necessary, however this needs to be expanded internationally to make sure that resources are able to be accessed where they are needed 

Conclusion 

We are currently in what could be considered unprecedented times when it comes to dealing with the global COVID-19 pandemic. Access to PPE, particularly surgical masks, is of tantamount importance for a wide range of people in a wide variety of professions. Access to these materials is causally related to 

limitations in manufacturing and distribution. Political pressures and disagreements have also gotten in the way of access to necessary supplies for various parts of the globe. 

Increase in production of surgical masks is absolutely necessary. However, this will require the cooperation of countries with sufficient infrastructure to be able to produce the necessary raw materials, and to those with the ability to construct the face masks. Only through cooperation can these goals be achieved.