need to talk about masks/PPE for hero medical staff at frontline of tsunami coming in, partic battling to save lives in critical care units...

Supplies earmarked for them, but what about A&E who in some hospitals don’t get top spec FFP3? Or maternity?

Msg from a Covid CCU:
bad news is that much of the supply of the FFP3 respirators came from China, and had a 3 month production haltage: China itself buying up all supply.
That is over now but prices have quadrupled one top importer told me.
Many of top spec protective overalls came from Hubei itself
Shortage means other frontline staff are using not v protective surgical masks, not respirators, and fear is, as in Italy, sheer weight of work means they will just end up having to be reused, which is a big risk for staff we need to stay healthy...
According to NYT - China as well as upping production of respirators from 10 million a day to 115 million a day in the month of February, imported 56 million in a week just after Wuhan shutdown but “require a special fabric in short supply” https://www.google.co.uk/amp/s/www.nytimes.com/2020/03/13/business/masks-china-coronavirus.amp.html">https://www.google.co.uk/amp/s/www...
The World Needs Masks. China Makes Them, but Has Been Hoarding Them.

As China grappled with the coronavirus, it kept the masks it made. Now that other nations need them, pressure is rising on Beijing to resume exports.

https://www.google.co.uk/amp/s/www.nytimes.com/2020/03/13/business/masks-china-coronavirus.amp.html
The better news here versus ICU ventilators is that there is some UK domestic production in County Durham at least for respirator masks... but the same efforts appear to be required here with enlisting manufacturers in fact more urgently than ventilators
Important interview here https://twitter.com/bbcnewsnight/status/1240053137903362055?s=21">https://twitter.com/bbcnewsni... https://twitter.com/BBCNewsnight/status/1240053137903362055">https://twitter.com/BBCNewsni...
From my BBC colleague in Essex: https://twitter.com/sidedman/status/1239922713482928133?s=21">https://twitter.com/sidedman/...
Apple CEO confirms it’s donating millions of masks for medics around the world.... https://abs.twimg.com/emoji/v2/... draggable="false" alt="👏🏾" title="Clapping hands sign (medium dark skin tone)" aria-label="Emoji: Clapping hands sign (medium dark skin tone)">

More of this needed from top manufacturers...

https://twitter.com/tim_cook/status/1241458458794188800?s=21">https://twitter.com/tim_cook/... https://twitter.com/tim_cook/status/1241458458794188800">https://twitter.com/tim_cook/...
This followed VP Pence changing US regulations so that tens of millions of industrial top spec N95/ FFP3 masks could be redeployed to health system...

Doctors saying that each individual patient effectively requiring dozens of masks for staff caring for them...
So the good news on this came from Simon Stevens saying there were 28 million masks including stockpiles at select committee last week, but they weren’t yet in right place and needed to be distributed partly with help of army...
BUT doctors report each patient requires each nurse/doc multiple PPE changes - so dozens of masks per critical patient per day, unless reused. Visors big issue too - much better protection than goggles.

28m masks burnt thru quickly if 30,000 patients in critical for 90 days...
Look at California alone, where Governor Newsom just said he is having to procure, for a population of 40 million...

500 million N95 masks
One BILLION gloves

200 million sets of PPE

Which he says will be exhausted for a 3 month hospital capacity surge to deal with Covid-19...
Chinese hospital donates masks, protective equipment to Birmingham University trust hospital - which says it has enough already... https://twitter.com/uhbtrust/status/1242847452589428738?s=21">https://twitter.com/uhbtrust/...
Brilliant. Medics seem to want improvised visors rather than goggles... who else has a spare 3D printer? https://twitter.com/stephen_thc/status/1242755870578159618?s=21">https://twitter.com/stephen_t... https://twitter.com/Stephen_THC/status/1242755870578159618">https://twitter.com/Stephen_T...
Confirmation from Number 10 that the UK Govt did not take part in the Joint European Procurement Initiative of millions of pieces of health protective equipment, masks, shields etc - making own efforts. Commission said UK was invited... https://twitter.com/vonderleyen/status/1242467406464684034?s=21">https://twitter.com/vonderley... https://twitter.com/vonderleyen/status/1242467406464684034">https://twitter.com/vonderley...
The issue here is that the Commission says it has procured everything - presumably buying up all the manufacturing capacity for what must be BILLIONS of items of PPE for two dozen countries - Govt says we have enough, but was only an issue of distribution, now settled by army
Given the decision not to go with this, the fact that EC has now bought up huge part of global capacity, some transparency on size of our PPE stockpile and the domestic UK surge manufacturing capacity, and whether that has been or when it will be activated, would be very helpful.
Latest numbers on army distribution given to lobby: https://twitter.com/chrismasonbbc/status/1243141809125154816?s=21">https://twitter.com/chrismaso... https://twitter.com/ChrisMasonBBC/status/1243141809125154816">https://twitter.com/ChrisMaso...
And now we have a clarification from Number 10 that we havent accepted the invitation to the Joint European Procurement of PPE and ventilators not because we’ve left the EU, but because Government did not get the email...

Open to future efforts. https://www.bbc.co.uk/news/uk-politics-52052694">https://www.bbc.co.uk/news/uk-p...
'Mix-up' over EU ventilator scheme

Labour demands an "urgent explanation" from ministers over why they did not join EU equipment plan.

https://www.bbc.co.uk/news/uk-politics-52052694
Royal Mint making visors - needs some specialist materials PET clear plastic to make thousands for the NHS workers neeeding protection: https://twitter.com/royalmintuk/status/1243558818262462469?s=21">https://twitter.com/royalmint... https://twitter.com/RoyalMintUK/status/1243558818262462469">https://twitter.com/RoyalMint...
*** NEW very interesting diplomatically worded press release from the fashion industry - it is offering to use idle factory capacity to make the protective equipment the NHS needs - but says “government is currently concentrating on importing these products”..which seems ..risky
What say you? @CocaCola_GB @PepsiMaxUK @innocent @RoyalMintUK https://twitter.com/hmofbray/status/1243854957545246726?s=21">https://twitter.com/hmofbray/... https://twitter.com/HMofBray/status/1243854957545246726">https://twitter.com/HMofBray/...
President Trump listing major US multinationals (Ford, Boeing 3M...) which have “converted factory floors to produce the respirators, masks, face shields and other protective equipment” required. Ie PPE.

Yet to see similar here re domestic production, more focused on ventilators
Again - look at this top German manufacturer’s info on masks, global demand, and what it is possible to manufacture.

HT @danbarker

http://spiegel.de/international/germany/german-ventilator-manufacturer-absolutely-mission-impossible-a-549d1e18-8c21-45f1-846f-cf5ca254b008-amp">https://spiegel.de/internati...
Gove tells Marr “we are increasing production” of PPE references “significant stocks” for pandemic flu and for No Deal Brexit and “we are seeking to get max amount from other countries”, but that more also needed for prisons etc...
So two Cabinet ministers in consecutive days acknowledging changes to system to get hold of more PPE, but approach is very different to national mobilisation of ventilator manufacturers.

Also general message from Government has been that we have enough PPE, but medics sceptical
It’s the numbers here that matter - on masks for example NHS chief said there were 28 million “of the most intense face masks available” in the two stockpiles...
And 15 million have been delivered acc to Number 10...

But eg Italy says it needs 90 million a month.
California 500m
As I’ve said before - is some domestic capacity - large factory in the north east making the FFP3 top spec respirators, which across the globe is doubling production. Unclear if that production is earmarked for UK.

But medics want those for use not just in critical care...
NEW -colleague @simbrowning has this on UK textile factories now going on record about their concern as to why their offers from a fortnight ago to immediately ramp up domestic PPE manufacture from sometimes idle factories not yet being taken up.
THREAD
https://twitter.com/simbrowning/status/1244240655301386241?s=21">https://twitter.com/simbrowni... https://twitter.com/simbrowning/status/1244240655301386241">https://twitter.com/simbrowni...
Empty factories ready to help ramp up for NHS protective gear - waiting for Government to give them the nod says @simbrowning
https://twitter.com/simbrowning/status/1244242037941075971?s=21">https://twitter.com/simbrowni... https://twitter.com/simbrowning/status/1244242037941075971">https://twitter.com/simbrowni...
And some local hospital trusts are going to local providers to try to get the kit... https://twitter.com/simbrowning/status/1244242477059637251?s=21">https://twitter.com/simbrowni... https://twitter.com/simbrowning/status/1244242477059637251">https://twitter.com/simbrowni...
Up thread, pointed out that the Government says it is trying to make it easier for private companies to make PPE, but without really asserting it is needed, in the same way as for example ventilators are needed. This was the announcement yesterday... https://www.gov.uk/government/news/regulations-temporarily-suspended-to-fast-track-supplies-of-ppe-to-nhs-staff-and-protect-companies-hit-by-covid-19">https://www.gov.uk/governmen...
Regulations temporarily suspended to fast-track supplies of PPE to NHS staff and protect companies...

New measures announced today will give vital support to frontline NHS staff battling COVID-19 and support businesses under pressure as a result of the coronavirus outbreak.

https://www.gov.uk/government/news/regulations-temporarily-suspended-to-fast-track-supplies-of-ppe-to-nhs-staff-and-protect-companies-hit-by-covid-19
On closer inspection one main Covid announcement - that non “CE”-marked gloves, visors, masks, overalls for NHS use, can be imported as long as adheres to WHO standards - is in fact European Commission announcement from 2 weeks ago, which already applied to UK - ie its EU rules
On closer inspection one main Covid announcement - that non “CE”-marked gloves, visors, masks, overalls for NHS use, can be imported as long as adheres to WHO standards - is in fact European Commission announcement from 2 weeks ago, which already applied to UK - ie its EU rules
On closer inspection one main Covid announcement - that non “CE”-marked gloves, visors, masks, overalls for NHS use, can be imported as long as adheres to WHO standards - is in fact European Commission announcement from 2 weeks ago, which already applied to UK - ie its EU rules
Here is it entering EU law more than two weeks ago: https://op.europa.eu/en/publication-detail/-/publication/a247dab0-6794-11ea-b735-01aa75ed71a1/language-en">https://op.europa.eu/en/public...
C/2020/1712, Commission Recommendation (EU) 2020/403 of 13 March 2020 on conformity assessment and...

https://op.europa.eu/en/publication-detail/-/publication/a247dab0-6794-11ea-b735-01aa75ed71a1/language-en
Well this sounds promising... new numbers from Health Secretary on PPE being delivered - considerably higher than previously communicated numbers:

https://twitter.com/matthancock/status/1244366191210176512?s=21">https://twitter.com/matthanco...
But no fewer individual stories coming our way about protective equipment shortages, esp for non critical care work... GPs going into “hot hubs” having to borrow respirators... private sector making visors.. even on here, procurement told “no gowns”...

https://twitter.com/alsprocurement/status/1244338769056223232?s=21">https://twitter.com/alsprocur...
This from NI, Belfast consultant: https://twitter.com/tjbrown55/status/1242837492665061376?s=21">https://twitter.com/tjbrown55... https://twitter.com/tjbrown55/status/1242837492665061376">https://twitter.com/tjbrown55...
But this has been the local response - a NI blinds manufacturer making visors, still needs some supplies: https://twitter.com/investni/status/1244540236773953536?s=21">https://twitter.com/investni/... https://twitter.com/investni/status/1244540236773953536">https://twitter.com/investni/...
Respected Health Service Journal on the “no gowns” situation/ PPE supply chain... https://www.hsj.co.uk/im-losing-the-will-to-live-god-help-us-all-despair-of-nhs-procurement-chief/7027266.article">https://www.hsj.co.uk/im-losing...
‘I’m losing the will to live, god help us all’: despair of NHS procurement chief

Gowns for front-line staff were not included in the national pandemic stockpile of personal protective equipment, procurement chiefs have been told.

https://www.hsj.co.uk/im-losing-the-will-to-live-god-help-us-all-despair-of-nhs-procurement-chief/7027266.article
More international comparisons -

France is “airlifting” 600 million masks, mainly from China, of which 74m are second top spec FFP2 masks, using a special air bridge, according to @lemondefr - vast bulk would appear to be the simple surgical masks https://www.lemonde.fr/international/article/2020/03/27/600-millions-de-masques-l-objectif-du-pont-aerien-en-preparation-entre-la-chine-et-la-france_6034705_3210.html">https://www.lemonde.fr/internati...
600 millions de masques : l’objectif du « pont aérien » en préparation entre la Chine et la France

La rotation des avions pourrait durer plusieurs mois, en fonction des aléas de la production, afin de combler la pénurie de matériels dont souffrent les hôpitaux français.

https://www.lemonde.fr/international/article/2020/03/27/600-millions-de-masques-l-objectif-du-pont-aerien-en-preparation-entre-la-chine-et-la-france_6034705_3210.html
Interestingly, doesnt appear in this case that France has operated mainly through the EU procurement scheme for these masks, but the more greatly in demand super protective FFP3 masks may be where this is at
On that - this story from @LaraMarlowe on how France seized the stock at the Lyon warehouse of a Swedish mask distributor - is incredible.... https://www.irishtimes.com/news/world/europe/coronavirus-european-solidarity-sidelined-as-french-interests-take-priority-1.4216184">https://www.irishtimes.com/news/worl...
Coronavirus: European solidarity sidelined as French interests take priority

Row over face masks exposes threat to EU principles of free trade and collaboration

https://www.irishtimes.com/news/world/europe/coronavirus-european-solidarity-sidelined-as-french-interests-take-priority-1.4216184
DHSC publishes detailed PPE spec for manufacturers trying to help create visors, lend equipment etc - helpful on what each piece of kit is supposed to do, eg single use respirator masks...

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/876892/Gowns_Masks_Eye_protection_Spec_V4.pdf">https://assets.publishing.service.gov.uk/governmen...
So I’m pretty confused now - Cabinet ministers are now totally understandably sourcing local PPE for “NHS locally” but the official Government line is that there is no shortage ... https://twitter.com/brandonlewis/status/1244960102580453377?s=21">https://twitter.com/brandonle... https://twitter.com/BrandonLewis/status/1244960102580453377">https://twitter.com/BrandonLe...
*** NEW:

Government has now dropped repeated claim it has delivered “170 million masks”, eg Health Sec deleted this tweet from Sunday as number was not correct...

Corrected numbers coming - but seems to be reference to all items of PPE, not masks alone, eg includes 43m gloves
In past two weeks NHS Supply Chain has delivered 170m pieces of PPE in total (ie not just masks).

In last 4 days:
42.8m gloves
23 million surgical face masks
1 million FFP3 masks
13.7 million aprons
182k aprons.

“working round clock to give social care sector support they need”
This “170m masks” appears to be error/ mix up rather than a conscious attempt to exaggerate - but it was big error - wasn’t just the tweet - it was conveyed in Downing St by the CLG Secretary at one of the central Coronavirus press conferences, and quoted in most press...
More ordinary citizens organising PPE to be manufactured for medics dealing with Covid patients - trying to get access to 3D printers to make visors to prevent infections coming in to contact in this case through face: https://twitter.com/psychicpsych/status/1245111975182557186?s=21">https://twitter.com/psychicps... https://twitter.com/psychicpsych/status/1245111975182557186">https://twitter.com/psychicps...
again rather intrigued by 397 million pieces of PPE in past fortnight that have been distributed.

Day before it was 170 million in past fortnight (at weekend press conference it was 170 million masks alone, but that was incorrect).. definition changed? https://twitter.com/dhscgovuk/status/1245383728370778119?s=21">https://twitter.com/dhscgovuk...
Alternatively 227m pieces were delivered in one day - which would be impressive, but seems implausible. Seeking clarity on this now, or whether definition of PPE widened to include other materials in past day
Trying to get to bottom of impressive 742 million PPE units delivered...Not being provided with breakdown.

does matter - FFP3 respirator not same as alcohol rub

Last breakdown gaps:
461m units

194m gloves
107m surgical masks
87m aprons
7m FFP3s
5m eye protectors = 400m

+61m??
Now there is a partial breakdown from DHSC:

“Since 25 February 2020, over 761 million pieces of #PPE have been distributed to NHS trusts and providers across the UK

This includes:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">158 million masks
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">1 million gowns
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">135 million aprons
https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶️" title="Right-pointing triangle" aria-label="Emoji: Right-pointing triangle">360 million pairs of gloves”

...
changed the date range from previous NHS England counts (starts Feb 25 rather than Mar 11)

But gloves confirmed as counting as “pairs of” not singly - half of all units are gloves though.

No longer breaking down masks by hi protection, short global supply FFP3s... still 105m ??
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