From New York Times. I'm likeable borrow this is, today, states and cities across the. U S pudding you're shortages of vital supplies needed to contain the pandemic. Sarah cliff on! What's behind those shortages, it's Tuesday March, thirty, first! Well, it's Friday! What feels like there's been an endless weak. I know so many new Yorkers.

I really felt this week has been very, very difficult. Last Friday in New York City mayor, build a bio given news conference and he essentially came out and said that the city is running out of medical supplies were getting through this week. It's tough! We have what we need for next week, but it will definitely be a very hard weak, but after next Sunday April. Fifth, is when I get very, very worried about everything. We're gonna need the p power, we're gonna need the equipment that supplies. I was due to vent leaders that they only have about a week laughter the things they really need I want to put down that marker right now. I've put down that market to the White House that that is a decisive moment for the city of New York. We need to make sure that we can get to that day, ready to face the week after that and the week after that, as well and right now we're not there.

And this is what we are hearing from: mayors from governors all across the country: everybody's looking prevent legs, everybody's lookin for PV or by looking for medical staff and irrational, confer beds, and so that's what makes this particularly hard. There aren't enough supplies to treat the krona virus outbreak, there's not enough family We need thousands of ventilators in Michigan. There is not enough and ninety five masks. We ve got nurses who are wearing the same mask from the minute they show up for their long shift to the end of that shift. There aren't enough masks there aren't enough hospital bed large enough mentally, where's. The list is long and hospitals are getting worried about running out, sir. How can that be? How is it that the? U S is running so low and in many cases actually running out of so many essential components of a response to this pandemic. Well for each compose

there is actually a unique back story, there's a clear reason why we don't have enough and why it is hard to get more. Let's go through each one of the three that you mention, starting with what would seem to me like the easiest problem to solve, which is So what explains the shortage there? The masks or one of the first things to come into short edge with one the first places where we started realizing. We might not have enough supplies for our health care workers and to understand the shortage of masks. You probably want to go back twenty or thirty years

back then, a lot of the masks are being used in hospitals were made in the United States that really shifted about fifteen years ago, or so you saw mask manufacturers, like other manufacturers, moving their operations offshore, where they could manufacture, masks cheaper. A lot of them went to China and if you think about it, you can manufacture in a bride. You didn't you know a ton of specialised equipment than you could ship it right back to the United States. Orders are generally pretty predictable. At that time it seemed like a prudent

business decision for mask manufacturers to move their business to places where labour was cheaper, and so why is there now a shortage if this was a rational outsourcing decision with predictable deliveries from China to the? U S? That would allow us to create stockpile this system made sense when you understood the health care needs. When you knew a certain number of people tended to get the flues here's, how many surgical masks you would need a country. It really falls apart when you have a pandemic like corona virus, which has spiked the amount of healthcare supplies we need and all of a sudden we're in this situation, where the surgical masks, we want our half whirled away. A lot of the transport that we rely on has been shut down and other countries where the masks are being made or thing we need these masks too. This is

regularly true in China, which had a krona virus outbreak before us and in certain cases has been holding on to its masks, not allowing manufacturers to export them abroad. So it made sense at the time, but it was not a supply chain built for the pandemic, we're in right now So how solvable is this problem, given what you ve laid out is sovereign,

but it takes time and it takes some kind of unusual measures. So one of the things you do see happening is factories being turned over to mask manufacturing and companies are trying to do that. If you look at Honeywell, for example, David Factory that makes glasses and goggles usually they're, going to turn that over two making masks, but they say it's gonna take about a month to make the transition they're going to have to hire five hundred workers. You can't just slip a switch and these factories that have been used from something else, and I think that's why you see everyone trying anything possible. It's why individuals are sowing masks at home and giving them to their local hospitals. You know that's how Dyer the need as that

really looking at any possible way to make a mask, even if it's not in the traditional factories that typically manufacture them. Ok, so that is masks. Where should we turn next, I think we should talk about hospital beds were facing a pre dire shortage there, but for entirely different reasons. So the United States has significantly fewer hospital beds per capita than a lot of our poor countries and a lot of other countries that are fighting krona virus, and you can really trace that back to a law that past and nineteen seventy four. This was about a decade after Medicare medicated, come into existence and all of a sudden, the government had become a huge pair of health care bells right, so they had a significant reason to be concerned about rising healthcare costs and one of the things they started noticing with that, when you had more hospital beds, they just seem to get filled. It's like

When you add a lane onto a highway, you think it's going to make the traffic better. It just turns out more cards, show up and start using that route, the theory they're kind of being that, however many beds you have hospitals which our businesses they will find a way to fill them. So policymakers identified that having all these hospital beds was probably driving a car, because hospitals had strong financial incentives to keep those hospital beds fall. So in nineteen, seventy four. They pass this law that essentially required hospitals to apply for permission to build beds. So if I wanted to build a five hundred, bat but all in New York. I'd have to go to the state and say here's my! I think there aren't enough rules in this area, and why I should be allowed to build this new hospital in water.

The impact of the law on the number of beds in our system. It really limited the number of beds. You know we ve shed about a half million hospital bed since nineteen. Seventy four, I think, that's pretty dying, there's other things driving this certain procedures that used to acquire a few nights in a hospital have got and faster and safer. You don't really need that medicines have gotten better, so certain things that used to be treated with surgery. You can treat with prescriptions, but at the core of this we really have made this decision that we want to limit the number of hospital beds in the United States and in that way, pulled down costs in a normal time, but then we get to a pandemic and all of a sudden, it becomes a real constraint on our ability to treat a wave of sick patients rights a week hated this shortage on purpose and

with a reasonable motive that just wasn't anticipating what it would mean in a crisis. Exactly- and you know when you think about hospitals, you have to remember their business- is that if you have an empty bad in a hospital, that's a bed, that's not generating revenue, so hospitals try to operate pretty fall allowed the ones I've been talking to tend to operate. You know, particularly now, in the middle flew season like a ninety five percent capacity. That means there isn't a lot of slack in the system to surge up when you have a lot of patients who need care at once because off, but are already generally so fall. They just don't have these empty beds sitting around for patients to use, but now we're seeing that not having slack and our health care system not having empty beds that could be used when the need for healthcare. Third,

is that leaves us really vulnerable in a situation like corona virus, where you actually really want some slack in the system to treat those extra patients. So that brings us to what I think is probably one of the scariest and most urgent problems of this pandemic, which is ventilators rights. Ventilators are a crew. I'll tour and fighting crown of arrests and the story of why we don't have enough of them, it highlights probably better credible anything else, this incredible tension between the business of american ability to and the ability to respond to a crisis will be right back.

The daily is supported by tedium irritated, there's, no oral. Why aren t am I that's? Why tedium Eritrea, aided a learning experience. I will actually learn with you curated from their vast library of exclusive content. It customized affect your investing goals, interests and needs, so you get exactly the Formation, you need, and none of the information you don't get started at tedium era: trade, dot, com, slash, education, that's tv, a merry trade dot com, hush education, I'm Wendy Door and I'm an editor on the daily. For most my adult life, I thought of the New York Times as edge I ain't news machine that spit out news stories all day, long kind of like a vending machine. And I'm embarrassed to say that it wasn't really until I came to work here at the times that I started to think about the reporters behind those news stories and what it takes to get the story in the first place.

Sometimes these reporters risked their lives. Sometimes they talk to us. Two in the morning. Sometimes they call us from a war zone and nodded Do they tell us what's happening on the ground wherever they are, but they also give us the context that we need to understand it if you like hearing These reporters every day, which I know I do the one thing that you can do to support them and the daily is to subscribe to the New York Times if you'd like to do that, go to and why times dot com slash subscribe. Caesar what is the story behind our shortage in ventilators, so intelligent sex? The federal government creates an entire new division just to prepare medical responses to whatever sort of disaster, as you can imagine, and in its first year operation. They started thinking about how to expand the number of ventilators. They thought that we would need about. Seventy thousand

for machines in a moderate flu pandemic, and one of the things they noticed is that we did have some ventilators international stockpile but they were really ideal. They were big, they were expensive. You can order a lot more of them. Their acquired alive training, so they come up with this idea that the federal government should develop. A ventilator that is the opposite of all that, so the U S is gonna, get into the business of making its kind of its own ventilators. Exactly what they're going to outsource So they're gonna find a private partner who already makes ventilators and ask them to design something to their specifications, and what they want is a machine that is cheap. That is wings. You can move around that doesn't require a lot of training to use and they set out to find a private company that is willing to build such ventilator and a small medical device company in California called Newport Medical raises their hand, and they are really excited about it. They think it be really prestigious to work with the government. They want to build this device.

And they get the contract for the first two years. Things go pretty well. Newport medical actually creates three working prototypes and a ship them out to Washington DC. Officials are excited. You know they. They see this thing. They wanted to build the neck and start envisioning it as part of the national stockpile. So everything really seems to be going as planned until May. Twenty two That's when its announced that Newport Medical is being purchased by a much larger medical device. Company called committee in Newport Medical was about a hundred million dollars. Canadian was worth twenty six billion dollars while the magnitude larger company that makes all sorts of devices, whereas Newport Medical, the only thing they did was make ventilators the government officials who worked on the contract. Say, they saw kind of an immediate change and how things were going. The larger company didn't seem quite as interested. They requested more money to finish the contract.

And at the end of the day, late, twenty thirteen early twenty fourteen, the contract just falls apart. And the ventilator is never built So what's your sense of why this larger company Canadian didn't want to make this ventilator, even if it was prestigious enough for this little company, why wasn't it prestigious enough for this bigger company? Yet when I talk to former government officials, they kind of had a son That committee in didn't want to manufacture a lower cost that a later that will compete against their higher costs than the leaders that ninety in the market. You know it doesn't make a lot of sense for them as a business to introduce a product, that's going to earn less money into the marketplace, so, basically, it wasn't economically advantageous. That is becoming

exactly even more than that, it is economically disadvantageous. Now there's other product on the market. You could video executives, they tell a different story. They felt, like the government, had unrealistic expectations that when they came in purchased a small company, they realise this tat, was just not feasible and ultimately had to negotiate their way out of it. With the government, in any case, once this company was purchased, the contract was never vanished, and the ventilator that was supposed to be designed was not designed so all of a sudden this ahead, time. Pre planned programmes to make sure that Europe has an offender leaders is not producing ventilators that the? U S may eventually need rate and the gun when does keep trying, they read the contract after this one falls apart and they wanted to fill up another very large company. The thing is: it was too late for the crisis that were in right now so were in a situation where the government spent thirteen

There's about twenty million dollars. Try to build a device that could respond to a pandemic outbreak, and we don't currently any ventilators to show for it and so weird, that Lee, if the United States stockpile- ventilators how made we have persist. How many we expect to be needed in this moment? Thereabout sixteen thousand ventilators in the national stockpile that have been serviced recently are ready to go out to american hospitals if needed, but back into doesn't seven. When this whole effort started the government estimated we'd need about seventy thousand ventilators. There were obviously still quite short of that number and what is the federal government doing in the face of this ventilator shortage so our figuring out how to best use the stockpile that effort is alive. I'll bet mysterious to the public. We don't exactly know which states are going. Which ventilators when they will be released and how

that will roll out what is happening a little more publicly and would like they produce more ventilators. Is companies wrapping up their production of new units? Thank you very much. I gave you You really say that in two ways, one is trying to get other manufacturers, particularly car manufacturers, to start making ventilators deserve to know to invoke the defence production act, to compel general motors to accept performance, prioritize federal contracts for ventilators. This is something president, is put some pressure on the industry on general motors. To start doing this invocation of Gpa, should demonstrate clearly too all that we will not hesitate to use the full authority of the federal government to combat this crisis? and while it is one tension, it's an effort, that's gonna be pretty challenged. Why

Well, the thing to know my ventilators as they are complex machines that really cannot malfunction we're talking about machines with hundreds of parts that, if they stop working A patient stops breathing rights. You need them, do you put together correctly and you need all those hundreds of parts to be an exact right spot. That's not something a technician learns do overnight. So when I have talked to some of these ventilator manufacturers, asking them to think and automobile company could make these there a little skeptical. They worry that the expertise isn't there and some tree is really going to have to happen before you can turn a car assembly line into event later assembly line, the other thing we see happening ventilator manufacturers themselves, ramping up their adding second shift. They are bringing in more workers bed, that's really limited by labour supply. One of the things that really hard right now is you're trying to breathe.

Workers into a factory and exact moment when the government is asking people to stay home, so increasing work in a factory means providing protective equipment to those employees. It means doing temperature tax when they come into the factory to make sure nobody gets sick. When I talk to ventilator manufacturers, the key constraint their faces Isn't enough assembly lines, it's enough people to work on those assembly lines and who have the knowledge to work on those lines? That's really what stands between us. And having a larger number of ventilators. So, despite always, activity were hearing about despite the invocation of the defence production act despite company saying they're gonna start making ventilators I'm hearing, you say that there is not going to be tens of thousands of ventilators, suddenly whirling off some assembly line in solving this shortage in the next couple of weeks. Exactly, and I think that's why you see hospitals experimenting with how to expand the work of the

two letters. They have some of those experiments are using one ventilator to support multiple patients. Another one is taking the Caesar machines that would be used in surgery and with elective surgery being cancelled, reed those as ventilators. You know these are not things that would be happening if it were business as normal, but it's obviously not business as normal and because hospitals, particularly those in New York, are waiting for ventilators. There are starting to see how they can expand. Pass city of the ventilators that they already have certain three examples that you have taken us through the masks hospital beds ventilators each of them seem to share the common theme that our preparedness, or something like this pandemic, which people been warning about for so long was on her mind by the simple fact that our healthcare system is driven by profits rate.

Things you know about american hospitals about device makers. Is there just like any other business? They have to turn a profit and bring in revenue to stay open, but there is also something that makes them really different. We absolutely need them in a pandemic situation like the one we are now in a way. We don't quite as much need restaurants and carmakers and other manufacturer Is there playing a crucial role in our safety nets, but, at the end of the day, we don't have a tool where using to prevent them from being what they are, which is businesses. So, sir, there is a corner of our economy, work everything you have just described is true, and yet The federal government oh finds a way to make sure it gets what it needs, and that is the military there is a principle in United States that the Eu military has to be able to fight multiple wars at the same time and the United States government and our

Spare dollars make sure that that always happens. So we know this is possible it's just that the government hasn't tried that it seems when it comes to stockpile for healthcare. I think a lot of public health officials would agree with that the ones I have talked to say that if we wanted to, of course, we could build a giant national stockpile. It's a question of priorities and the question of funding the kind of sea this cycle that happens, the United States when there's a bad pandemic disease. It reveals flaws in our system and suddenly lawmakers are talking about wanting to commit a lot of money, but the money never quite seems to come through. You know a year or two later there are other things they want to spend government money on a kind of feeds into the background until the next pandemic cats. Right now we seem treat military threats as real as something we need to be prepared against. We don't really tree public health threats the same way, but I think what model

Thousands of kroner virus may be is that the public health threats are just as real as the military ones, and it takes a out of planning and a lot of money to be prepared for them. Thank you, sir. Thank cycle the times reports that, in response to the shortages, the Trump Administration has begun: air lifting supplies of protective gear, including masks and gas from China to the United States. The White House said it would make twenty two. Such flights by early April will be right back What would you do if you had to figure out how to photograph something in deep space that nobody knows is really there? This question

WAR, get answered, Don T mystery. The new podcast from Atlantean hosted by filmmaker Gabrielle a cupboard, wait, t mystery, looks pass the front page headlines and into the untold stories of teams behind groundwork, moments. Each episode examines how the extraordinary chemistry of these teams may be impossible possible, Download T mystery for Freeware Realist, Nepal, guests, and learn more at lassie and dot com, Slash t mystery. What else you need ten ordained as death from the corona virus, climbed in ITALY and Spain boost trees, tightened restrictions on the movement of their citizens. Spain called for a period of quote Hibernation saying that only essential workers could leave their homes, while it'll said that its national lockdown would be extended until the middle of April. They said no machine ass. You mind me stand that he broke out. It was to me sore at committee level

They rode on multiple, a brooch area. More could be a girl and Tajikistan. Rwanda persuaded during an inner ITALY's health minister They are two Speranza warned that loosening the restrictions to soon would quote, burn everything we ve hand. Until now, in the U S, the virus, is now spreading to mid western cities like Detroit, where there have been at least thirty five deaths and five hundred police officers are now under point. There is no question that we have more density. We're more risk. You also seeing the Chicago area, and the New Orleans here are also hotspots in you. Gonna see that on Monday, Detroit Mayor, MIKE Doug. Predicted that many mid size american cities would be next major.

It is in America that our destinations, that plaza people come into are likely to develop. But I think, as a matter of time before you see Philadelphia, Houston and some other cities develop the same way. That's it for the deal. I Michael by sea tomorrow. This episode of the railway is supported by the new Showtime original series: penny dreadful city of angels when a gruesome. Are shocks: nineteen thirty, eight LOS Angeles detected Tioga Vega, his partner Louis mentioned, or find themselves grappling with nazi spies, crooked politicians and powerful supernatural forces Natalie D.

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