UNMASKED

22
As the country heads into a dangerous new phase of the pandemic, the government’s management of the P.P.E. crisis
has left the private sector still straining to meet anticipated demand. By Doug Bock Clark / Photograph by Horacio Salinas
In his 30 years as a doctor, Andrew Artenstein had never equipment was getting to health care workers and not being hoarded by
worried about N95 respirators. The chief physician executive exploitative middlemen. Artenstein furnished proof that the respirators
of Baystate Health, he ran his four hospitals in western Mas- were destined for his hospitals. He was dismissed without a clear answer of
sachusetts exactingly, and an essential face covering being what was going on. Hours ground past as he paced in the vast warehouse,
out of stock was inconceivable. His doctors, nurses and other developing contingency plans and checking in with the agents until it
responders went through about 4,000 a month, usually for became clear they didn’t want to hear from him again. Finally, he was
treating patients with airborne diseases. There were always informed that the federal government was considering reallocating
more in the warehouse, just outside the city of Springfield, the shipment elsewhere.
where Baystate is based. But on April 6, as the novel coronavi- Artenstein had to wonder: How had the U.S. medical system
rus stampeded through the Northeast, Artenstein rose in pre- devolved to this? The Baystate Health team was just at the begin-
dawn darkness, on a mission to secure about a quarter-million ning of a monthslong battle to secure P.P.E. from an out-of-control
masks for his thousands of staff members. Baystate Health was market that the Trump administration would avoid closely man-
just days away from running out. aging — despite bipartisan calls to do so from mayors, gover-
For the next five hours, he was chauffeured down highways nors, congressional representatives and the leaders of some
drained of normal traffic, while overhead a private plane bearing of America’s largest health care workers’ unions and industry
four specialists, who would vet the authenticity of the deliv- associations. Indeed, during the initial outbreak, the federal
ery, headed toward the same destination: a warehouse in the government would sometimes be the most feared player in
Mid-Atlantic, where the masks were being stored by a third-party that market, acting not in an oversight capacity but as its
dealer. A driver had been hired separately for Artenstein, because most powerful buyer and disruptive agent. Though the
his frequent interactions with Covid patients meant he might Trump administration would subsequently take action
expose the rest of the team to the virus. Two semitrailers were to improve the P.P.E. supply, the result of its efforts was
also converging to convey the delivery back to Massachusetts. a characteristically American, ongoing experiment in
But it wasn’t actually clear yet how many N95 respirators there whether local governments and health care systems
would be to pick up — the night before, the dealer confessed can fend for themselves during a deadly pandem-
that he could only deliver a quarter of what had been promised, ic — an experiment that may have left the country
after canceling another pickup the previous week. (Because of an unprepared to deal with a record-shattering ‘‘third
agreement between Baystate Health and the dealer, The Times wave’’ of infections this winter.
has agreed not to identify him; he also declined to respond to
questions.) Baystate Health had been forced to turn to unproven The N95 respirator is emblematic of globalized
entrepreneurs like this after the corporate distributor it had once capitalism: It is made out of fossil fuels, manu-
depended on ran out of N95s, when national and international factured at enormous scale, often in develop-
supply chains collapsed at the beginning of the pandemic. Their ing nations by cheap labor, and distributed
predicament wasn’t unique. Many hospitals, states and even fed- on the shipping lanes that bind together the
eral agencies were also desperate, transforming the normally staid far-flung corners of the world; it is used
market for health care commodities into a Darwinian competition by urbanites to keep pollution expelled
of all against all. by their own factories from their lungs,
Artenstein and his team had no choice except to pursue this construction workers raising clouds of
tenuous lead. In the past two weeks, the number of Covid cases concrete dust as they build ever-grow-
nationwide had grown about sevenfold. Nurses complained of hav- ing cities and doctors treating patients
ing to improvise face coverings, even using modified ski goggles. coughing from the diseases multi-
Within a few weeks, the Centers for Disease Control and Prevention plying among increasingly urban-
would calculate that at least 9,282 health care workers had tested ized populations. It is meant to be
positive for the novel coronavirus, and 27 had died — a fatality count tossed after a single use.
that would pass 1,700 by mid-September. Artenstein knew that his These lightweight scoops of
own safety, and that of his doctors and other health care workers, breathable plastic — the shape
might depend on the success of his mission. of which was inspired by the
He finally pulled up to the warehouse a little after 10 a.m. The Bay- cup of a 1950s molded bra —
state Health equipment specialists picked several boxes at random, are simple to use. A person
and sliced them open to verify that the cargo was authentic. Arten- sets a respirator over the
stein was flooded with relief; the masks sealed to a person’s face. nose and mouth, and a
The respirators could be loaded into the semitrailers. The Baystate tensioned headband seals
team had hired trucks normally used by the food-service industry so it against the face. When
that their cargo would appear to be nothing more than refrigerated someone inhales, air
meats and vegetables. This precaution was taken to help keep the passes through tight-
respirators secure; stories were circulating of federal agencies, also ly woven, electro-
struggling to get respirators, appropriating shipments. statically charged

1.7 BILLION TO
Artenstein was about to direct Baystate headquarters to wire mesh, which snags
the payment when the dealer tapped him on the shoulder and said the vast majority
that the F.B.I. wanted to talk. Artenstein thought this was a joke. But of microscopic
then, he says, he was led to a glassed-in conference room deeper in
the warehouse, where a pair of agents stood up from their laptop
3.5 BILLION
The number of N95s the C.D.C.
airborne particu-
lates — 95 per-
computers and showed him their badges. They explained that they estimated U.S. health care workers would cent, hence
were part of a new nationwide effort to make sure that medical need in a ‘‘base scenario’’ pandemic. the name.

24 11.22.20
The masks are made by melting huge quantities of specialized plastic pellets Before the pandemic, Pat Sheehy, a 61-year-old vice president at Baystate
and then blowing the molten liquid through perforated metal to produce Health, had been in charge of its supply chain for around 15 years without
a tangle of filaments that cools and fuses into a dense mat of fibers: the ever needing to consider how N95s arrived at his warehouse. He estimated
all-important filter. An electrostatic charge is added to help capture micro- that he only had to spend a few hours per week directly overseeing pro-
scopic particulates. Then the filter is sealed between curement. A computerized inventory-management
two protective layers, and a headband is welded or system monitored his warehouse’s supply of medical
stapled on. Tens of millions of masks can roll off a commodities like N95s, hand sanitizer, gloves and
factory’s conveyor belts in a month. isolation gowns and then automatically reordered
It was not preordained that the United States whenever they were running low. But in March, as
would have a shortage. In 1998, President Bill the pandemic exploded, he was shocked to find that
Clinton read a Richard Preston novel, ‘‘The Cobra the normal channels for getting respirators were, he
Event,’’ about a bioweapon wreaking havoc across says, ‘‘like a faucet without a stream of water.’’
the country. Horrified, he subsequently established In early 2020, many of the N95s used in the
what would become the Strategic National Stock- United States were produced in Chinese factories.
pile, which has since cached tremendous quanti- Medical-supply vendors bought massive quantities
ties of P.P.E., ventilators, vaccines and medicines. of these respirators, which were then loaded into
The S.N.S. eventually developed into a network of shipping containers and hauled by colossal ships on
warehouses strategically located near transportation a monthlong journey to the United States. The dis-
hubs, prestocked with 50-ton pallets of supplies that tributors knew from historical sales data how many
could be delivered anywhere in the nation within N95s hospitals would need during a given month,
12 hours. and strategically timed their orders to ensure that
The George W. Bush administration created a the new product arrived at their warehouses just
pandemic plan that called for the federal govern- as old product went out to customers. This balletic
ment to oversee the initial distribution of P.P.E. from relay delivered N95s so seamlessly that it was largely
the S.N.S., and later coordinate public and private invisible to hospital administrators. Each respirator
Andrew Artenstein, chief physician
efforts to provide America with more equipment. executive of Baystate Health, cost about 65 cents. It was a textbook example of
In 2009, the Obama administration disbursed 85 photographed at the company’s the win-win power of globalization.
million respirators from the S.N.S. while combating facility in Springfield, Mass., But as the coronavirus rapidly rode the channels
the H1N1 pandemic, and then failed to effectively had to use unproven suppliers of international commerce between continents, it
because of P.P.E. shortages.
replace them, despite being warned to do so. The turned the advantages of globalization into vulnera-
Trump administration also did not refill the stock- bilities. Right when the United States needed masks
pile, ignoring admonitions from public health officials and a pandemic-sim- most, there were severe shortages. Chinese production had ground to a halt
ulation test that showed America would run disastrously short of P.P.E. if as the country locked down to stop the virus’s spread — and just-in-time
the real thing occurred. supply chains dependent on their manufacturing quickly disintegrated.
In late 2019 and the first two months of 2020, the Trump administration Baystate Health was consuming about 15 times more respirators monthly
was inundated with red alerts about the incoming pandemic from internal than during pre-pandemic times, and had no easy way of finding new
entities like the National Security Council and external sources like the suppliers. It would take months for American companies to build out new
nation’s biggest medical-supply corporations. Some of those warnings production lines.
— including memos addressed directly to the president — highlighted The economy abhors a vacuum, however, and since N95s were soon
how America’s P.P.E. supply would be overwhelmed. As a whistle-blower selling for more than 10 times what Baystate Health had been paying, fly-
report would later reveal, in January, Department of Health and Human by-night speculators swiftly established a gray market for remaining stocks
Services officials effectively dismissed an offer from one of America’s of respirators. To navigate this treacherous bazaar, Sheehy expanded his
few remaining N95 manufacturers, Prestige Ameritech, to expand its team’s ranks from a dozen to 30 individuals, looking for supply-chain exper-
production lines. And when the head of an H.H.S. agency responsible tise and what he called a ‘‘runs toward accidents’’ personality. Days started
for preparing the nation for pandemics tried to expand his budget to with an early-morning conference call, during which the team discussed
increase domestic respirator production, he was overruled by a senior what was running low at the warehouse. Then everyone, most working from
H.H.S. official, Robert Kadlec. (H.H.S. says Kadlec was forced to make home, began plumbing personal networks for leads. An inbox was set up to
the decision because of appropriations rules.) consolidate the unsolicited sales pitches cascading in, many of which were
On March 3, Kadlec was pointedly questioned by the Senate’s commit- little more than a Gmail handle and a list of P.P.E. at grossly inflated prices.
tee on health about the nation’s supply of N95s. He referenced a C.D.C. Normally, Baystate Health vetted new suppliers and conducted cost-ef-
estimate that, in a pandemic, America would need as many as 3.5 billion fectiveness analyses in a process that could take weeks. But now it had to
N95s for its health care workers and emergency medical workers — but, decide within a few hours, lest another hospital or a government agency
he confessed, the government’s stockpiles held only 10 percent of that. claim the N95s first. The team members did their best to check out poten-
Shortly after, H.H.S. clarified that Kadlec had misspoken: The S.N.S. had tial sellers, splitting leads up among five teams of six, which would search
a tenth of the figure he’d cited, or one one-hundredth of what the country dealers’ backgrounds, check their tax forms and request ‘‘proof of life’’
would need. On March 12, about two months after warnings began about pictures of the product. Then Sheehy and the five team leads would debate
the pandemic, and one day before President Trump declared a national whatever information they had gleaned. Answers, they found, were usually
emergency, the federal government finally placed its first large-scale order not ‘‘black-and-white,’’ and came down to a gut feeling: ‘‘Does the broker’s
of N95 respirators. But by then it was too late, as global supply chains were story make sense?’’ In the first month of the pandemic, they would sift
breaking down. Domestic production of N95s was far too small to provide through some 2,000 leads, seriously investigate 368 of them and place 99
the nation with what it needed. Within weeks, numerous hospitals were orders — of those, only 25 resulted in goods being delivered by mid-April.
running short of N95s, just as Covid-19 cases were exploding, leading to This was because the marketplace was being bum-rushed by free-
Artenstein’s desperate mission — and his run-in with the federal agents. lancers whose previous experience in international logistics was, say,

Photograph by Christopher Payne for The New York Times The New York Times Magazine 25
importing bat guano as organic fertilizer for cannabis. Some were expat Federal officials have denied appropriating legal shipments of N95s
hustlers who conjured ideas over drinks in a Shanghai bar, drawn by the and other P.P.E. headed to American hospitals. But in the spring, the
potential for huge paydays. Some were just inept, making promises they stories of them doing so were widespread enough that the Baystate
couldn’t keep: One man who had received a $34.5 million order from the Health team figured that’s what was happening to them. They even had
Department of Veterans Affairs, despite having no a similar experience the week before, when a ship-
relevant expertise, allowed a ProPublica reporter ment was withdrawn because the V.A. had exer-
to ride along with him on a hired private jet to pick cised its precedence over Baystate Health — or so
up his shipment — only to have it fail to material- the dealer claimed. (The V.A. declined to respond
ize. But others were accused of outright criminal to questions.)
behavior, such as two Californians charged with Similar incidents made news all over the coun-
conspiracy to commit wire fraud for trying to sell try. The mayor of Los Angeles described cutting a
millions of dollars in masks that didn’t exist. By check for a shipment of masks, only to have FEMA
early May, the Department of Homeland Securi- swoop in at the last moment. The governor of Mon-
ty would open 370 cases and arrest 11 people for tana complained on a conference call to President
mask-related fraud. Steve Francis, a special agent in Trump that his state lost four or five orders in the
an investigatory division of the D.H.S., told me that previous week to federal agencies. After Massachu-
the illicit P.P.E. market was so profitable that some setts officials came to suspect that the federal gov-
transnational criminal organizations turned from ernment had snatched supplies already in transit,
smuggling humans and narcotics to moving masks. the state’s Republican governor arranged for over a
Even the government struggled in these condi- million N95s to be flown in from Shenzhen on the
tions. The Miami Herald reported in April that of New England Patriots’ private jet. Illinois officials
the 10 largest mask contracts signed by Florida, five similarly spent nearly $1.8 million chartering flights
of them, worth $170 million, were canceled, inclu- from China to airlift P.P.E. in secret, afraid that the
ding one inked with a consulting firm owned by Trump administration might otherwise comman-
one of the stars of ‘‘Shark Tank.’’ That same month, deer it. And when the federal government was not
Sofia Nadolski (left) and Kelly
a review of federal contracting data by The Wall Salls, photographed at Baystate reportedly seizing shipments, it was outbidding its
Street Journal would find that federal agencies had Health’s warehouse in Holyoke, less resourced competitors and compelling domes-
ordered more than $110 million in masks from ven- Mass., helped lead efforts to tic N95 manufacturers and importers to prioritize
dors with scant experience, who then had trouble procure KN95 respirators and its orders, making it extremely hard for anyone
medical gowns.
delivering. else to get P.P.E.
For several weeks, Baystate Health’s efforts yield- The Federal Emergency Management Agency
ed little more than dead ends. But then, on the morning of March 30, denied ever commandeering P.P.E., and referred me to a media briefing
as yet another important deal had just collapsed for Baystate, an email in which these events were described as misunderstandings and a result
arrived in the inbox of Kelly Salls, one of Sheehy’s team leads, who was of unscrupulous dealers’ blaming FEMA to cover up for their own inability
trying to help her four children with remote-schooling while also scour- to deliver promised supplies. It also emailed the following statement in
ing the globe for P.P.E. In the email, a friend of a friend claimed to have May: ‘‘This is a global pandemic — demand continues to outweigh supply
KN95 respirators, a technical equivalent to N95s, certified to a Chinese across the globe, not just in the U.S. Considering that, FEMA and H.H.S.
standard. Web searches showed that this company had long manufactured are both working hard to ensure federal contracting efforts don’t compete
specialized medical products in China. When Salls spoke on the phone with states’ abilities to acquire P.P.E. and other supplies.’’ (The F.B.I. declined
to the dealer, he agreed to rush-deliver samples to her — something no to comment on Baystate Health’s claims.)
one else had done. After the samples were authenticated, Salls placed an The widespread belief, in the face of its protestations to the contrary,
order for about half a million KN95s and half a million three-ply medical that the Trump administration was appropriating P.P.E. shows the extent
masks, to be picked up the next day. to which the federal government came to be seen as part of the problem
Soon, however, the dealer called back, saying that wouldn’t be possible. rather than the solution. Public-health experts generally agree that the
Two days passed. Finally, on the night of April 5, the dealer announced that federal government alone has the power to coordinate a comprehensive
Baystate could pick up a quarter of the original shipment the following response to a nationwide pandemic, and throughout the last century it
morning — the rest he had divvied up among equally desperate health has usually taken the lead during national disasters. Indeed, according
care systems. Salls and Sheehy monitored the mission from Springfield, to a detailed internal plan the administration produced in March, just
while Artenstein went down in person. When the F.B.I. held up the release as the virus was gaining a foothold in the United States, it identified one
of the respirators, Artenstein telephoned Mark Keroack, the C.E.O. of of the ‘‘Key Federal Responsibilities’’ as buttressing ‘‘medical supportive
Baystate Health. It was clear to Keroack that he needed to call in ‘‘the equipment, supplies and P.P.E. needs’’ across the nation.
biggest favor I’ve ever asked.’’ The Trump administration, however, appeared to do the opposite.
On March 19, President Trump declared at a press briefing: ‘‘The federal
Across the street from Baystate Health’s flagship hospital, a phone rang. government is not supposed to be out there buying vast amounts of
Representative Richard Neal, chairman of the powerful House Ways and items and then shipping. You know, we’re not a shipping clerk.’’ This was
Means Committee, picked up at his house, where he had been self-iso- what resulted in the chaotic P.P.E. marketplace, described by Andrew M.
lating. During his three decades representing the district, Neal had been Cuomo, the Democratic governor of New York, as ‘‘50 states competing
a patron of its hospitals, which were vital to the region’s economy, and against the states, and the federal government competing against the
he immediately agreed to help Keroack. At first, thinking it was a routine states,’’ which he said drove up the cost of masks for New York from
intramural conflict, he dispatched his chief of staff, William Tranghese, 85 cents to around $7 apiece. To solve this ‘‘madness,’’ he asked for the
to unstick things. Tranghese, however, reported back that not only were federal government to step in and take control of all buying to suppress
the F.B.I. and H.H.S. involved, but the Department of Homeland Security bidding wars and to direct P.P.E. more efficiently toward hot spots — as
was, too. This made Neal even more concerned. the Bush administration’s previous guidelines, the administration’s own

26 11.22.20 Photograph by Christopher Payne for The New York Times

planning and numerous public-health experts, mayors, governors and Many in the health care industry encouraged tting the market
congressional representatives suggested. the president to make use of the Defense Pro- work out the rest.
It wasn’t just the political opposition, as well as a small number of duction Act, which allows him to exert con- A key reason
conservatives, asking the administration to provide more leadership trol over domestic manufacturing during for the adminis-
— the private sector was also pleading for direction. Starting in late Jan- national emergencies. But for weeks tration’s hands-
uary, representatives from six of the largest medical-supply companies during the initial phase of the pandemic, off approach was
and members of the Health Industry Distributors Association, a trade the administration resisted invoking the ideological. ‘‘Our
group, had raised concerns about supply-chain problems. They requested D.P.A. Eventually, at the end of March, role is to be able to
guidance from senior administration officials on what became daily calls, it began to make limited use of the deploy assets and
according to documents released by the House oversight committee. act, ordering companies like 3M, resources into areas
Bafflingly to some high-level industry leaders, however, after nearly two the largest remaining American that have an unusual
months, they were still trying to get the administration to take straight- producer of N95s, to increase surge in demand, based
forward actions — all while the supply chain was visibly fracturing. respirator production in the on things like Covid or
An industry leader, who met with the president and the vice president, United States. (The company hurricanes,’’ and not to
and requested anonymity to avoid retaliation, described widespread frus- had already taken many of meet ‘‘daily needs,’’ said
tration among private-sector health care leaders at the administration. He the steps to expand pro- a senior administration
recalled a ‘‘shocking’’ and ‘‘galling’’ White House sit-down in March, in duction at the outset of official who helped lead
which the vice president, Mike Pence, started by discomfiting the health the pandemic that the the P.P.E. response, and
care professionals with handshakes, and then tried to smooth over an hour administration would requested anonymity so
of criticism they had unloaded on a senior H.H.S. official by simply asserting later mandate.) It he could speak candidly.
they’d get the problems solved. ‘‘It was like we were in two different real- would never take Rear Adm. John Polowczyk,
ities,’’ the individual said. ‘‘I could see the vice president was in a bubble.’’ a primary role who eventually took over the
The administration’s attempts to deal with the P.P.E. crisis reportedly in distributing P.P.E. supply-chain response,
emanated from a team of unpaid consultants, many in their 20s with little P.P.E. nation- described it as ‘‘locally execut-
to no experience in health care, assembled by Jared Kushner, the pres- wide, instead ed, state managed, federally
ident’s son-in-law. After distributing the dregs of the Strategic National directing supported’’ — which effectively
Stockpile, the federal government focused on procuring whatever sup- supply meant that health care systems
plies it could from corporate medical distributors and the gray market, mostly would largely be responsible for
distributing them through FEMA. An analysis by The Associated Press to hot securing their own provisions on
suggested that rural states with less serious outbreaks were awarded more spots the market, with states being the
P.P.E. per confirmed case than states with significantly more dangerous and first to step in during emergencies
outbreaks. This raised accusations of political favoritism in a life-or-death le- and the federal government last.
situation — though the administration has strongly denied this. That this decision was influenced
Kushner’s team, meanwhile, was also starting Project Airbridge, a by political philosophy is unsurpris-
program that expedited the delivery of P.P.E. from Asia to America by ing. (By contrast, the Biden campaign
paying for it to be flown rather than shipped. During the first four months was promising that, if elected, it would
of the outbreak, Project Airbridge would help bring in 5.3 million res- essentially nationalize the P.P.E. supply
pirators and 122 million medical masks. These figures, though large, chain and appoint a ‘‘supply command-
represent just a tiny fraction of the 3.5 billion respirators that Kadlec er’’ to oversee distribution.) But the
said were needed. In June, Project Airbridge would be wound down Trump administration’s decision to duck
without fanfare. the responsibility may have had strate-
At the outset of the pandemic, at least from Baystate Health’s gic elements as well; as an administration
point of view, what the administration’s response succeeded in official explained to Politico, ‘‘No matter
creating was a feeding frenzy. In this kind of chaos, everyday how well you did, we also knew it was never
citizens had little chance, and so Keroack reached out to going to be considered good enough.’’
Representative Neal. At first, this seemed to accomplish The oddity of this seemingly laissez-faire
nothing, and Artenstein left the federal agents and the approach is that the P.P.E. shortages pro-
masks, and drove home. But that evening, when he was vided the administration a perfect chance to
back at the hospital, he got word that the shipment had fulfill its ‘‘America First’’ campaign promise,
been loaded onto the trucks. Representative Neal had to return manufacturing jobs to the Unit-
managed to get on the phone with the Department of ed States. In the spring and summer, Peter
Homeland Security, and delivered a strongly word- Navarro, assistant to the president, director of
ed message to release the respirators. Still, as Salls his Office of Trade and Manufacturing Policy
monitored the trucks on their long drive north, and a longtime advocate of returning manufac-
she was nervous each time they stopped for gas. turing jobs from China, helped shape the P.P.E.
The masks finally hit the guarded warehouse response. ‘‘This was an opportunity to make sure
well after midnight, and pictures of them production was on-shored and to break our dan-
were giddily shared. Over the next few days, gerous dependence on foreign P.P.E. sources,’’ he
the remaining three-fourths of the order said in an October interview. It was an important
arrived in chunks, with Representative
Neal’s chief of staff, Tranghese, usher- 724%
The percentage by which the price of N95
shift in strategy, but also one that had come too
late to help Baystate and others through the initial
ing each portion through customs. But respirators increased at the outset of the chaos. By this point, agreement on the importance
Baystate’s ordeal was far from over. pandemic, according to Gov. Cuomo. of onshoring the P.P.E. supply (Continued on Page 51)

The New York Times Magazine 27

Masks Like the Trump administration, the Bay- administration’s labors to expand domestic pro-
(Continued from Page 27) state Health team came to consider domestic duction, Sheehy and his team were still partly
production as the answer to the shortages. reliant on foreign P.P.E.
chain had become bipartisan, and the Biden Springfield had been one of America’s original Because China had quickly brought the pan-
campaign was calling for similar measures. industrial centers and its economy had been demic to heel, its factories reopened relatively
Starting in April, the Trump administration rebuilt around the health care services indus- quickly, and businesses were converting facilities
made a series of high-profile onshoring announce- try. Baystate already had a business initiative, into new P.P.E. production lines, with govern-
ments, such as awarding a billion-dollar contract TechSpring, that sought to revitalize the area’s ment support. Throughout the summer, Ameri-
to 3M to manufacture medical supplies domes- once-proud manufacturing base by developing can health care systems and states increasingly
tically. The company began rapidly building out specialized medical equipment and software. tapped back into this booming Chinese pro-
production lines. In 2019, it produced about 22 In May, TechSpring decided to establish a Mas- duction. Miranda Tan, a broker whom Baystate
million N95s monthly in America; by June 2020, sachusetts-based N95 factory and furnished a Health had come to rely on, had transformed a
this leapt to around 50 million monthly; by the long-term contract to Marc Etchells, a medi- business that had placed Western products with
end of the year, it expected to be producing cal-equipment entrepreneur, which would guar- Chinese social media influencers into one procur-
about 95 million a month. Six other large Amer- antee him steady demand — if he could get a ing P.P.E. from all over Asia for American custom-
ican manufacturers, such as Honeywell, also production line running. ers. She estimated that ‘‘hundreds’’ of Americans
received substantial respirator orders from late Etchells had overseen a factory that made had gotten into the market, and saw no signs of
March through July. According to data provided similar products in the past, but he found domestic production replacing her line of work.
by H.H.S., domestic production would more than himself stymied: The materials were impossi- By the end of October, Etchells had finally
double over the summer, hitting around 160 mil- ble to get because of overwhelming demand managed to secure raw materials for Baystate
lion respirators monthly in November. In total, worldwide. Other business owners were also Health’s N95 factory, and he had ordered two
the administration would invoke the D.P.A. at least trying to pivot to N95 production, and they, respirator-production machines, as well as one
30 times to expand the domestic medical man- too, were finding the terrain unnavigable; the for medical masks, which would arrive by the
ufacturing base, for respirators as well as other Trump administration was mostly interested in end of the year. Each factory line would cost him
items. And after operating with limited visibility at providing direct support to a small number of in excess of a million dollars to buy and install,
the beginning of the pandemic, H.H.S. developed corporate giants like 3M. The administration meaning he would be deep in the red long before
tools that integrated data from manufacturers and had used the D.P.A. to compel experienced the machines started churning out masks in the
health care systems so it could better track where ventilator producers to share their production first quarter of 2021. And meanwhile, the influx
supplies were and who needed them. techniques with neophytes, leading to one of of supply from overseas had depressed prices
These actions would both increase the total its signature supply-chain successes in rapidly to a still-inflated but more reasonable $2 apiece.
supply and somewhat improve the distribution expanding ventilator production. But it declined Though it increasingly seemed possible that
of it. As the catastrophic outbreak waned in the to do the same with N95 masks, forcing new Baystate Health might one day again spend just
Northeast and cases throughout the rest of the producers to reinvent the wheel. In the end, quarters for N95s manufactured great distanc-
nation saw only modest gains, hospitals were the Trump administration invested a relative- es away, Keroack, the Baystate Health C.E.O.,
soon reporting going from having a few days’ ly small amount in improving the N95 supply remained committed to paying a premium for
supply on hand to one or two weeks’ worth. In chain: $280.6 million, according to figures it some P.P.E. to support a modest local industry,
June, Admiral Polowczyk appeared to declare provided. An analysis by The Washington Post as a hedge against future pandemics or other
victory in a presentation to the Senate Home- found that the Department of Defense, which supply-chain-snapping disasters.
land Security committee, claiming that expand- administers the D.P.A., has spent more money
ed domestic industry would largely address annually on musical instruments, outfits and As October turned to November, the United
the nation’s acute N95 shortages by July. And travel for military bands. States entered a ‘‘third wave’’ of the pandemic.
come October, the administration predicted, After making its initial investments in the Soon, it would break numerous daily records for
the problem would largely be resolved, with the N95 supply chain, the Trump administration the number of Covid infections, adding in excess
six American companies producing about 140 turned its attention elsewhere. It made a few of 100,000 cases a day. Around 10 months after the
million respirators monthly, and the remain- investments in the manufacturing of other cru- Trump administration was first warned that P.P.E.
ing 40 million N95s that were needed being cial P.P.E., such as isolation gowns and nitrile shortfalls could hinder its ability to corral the
provided through imports and a novel decon- gloves, which are also produced largely overseas virus, the lack of basic equipment was still endan-
tamination system. and subject to similar shortfalls. Baystate Health gering Americans. Baystate Health was receiving
But by the end of June, tens of thousands of would come within days of running out of med- just enough domestically made N95s to get by,
new Covid cases were being registered daily and ical gowns, and had to enlist the help of a local but not enough to store many away. Sheehy was
hospitalization rates were rising significantly furniture factory and a prison manufacturing still hunting for supplies on the gray market.
throughout the South and the West, again strain- line to engineer backups. Other hospitals were Shortages persisted. Get Us P.P.E., a nonprofit
ing the nation’s P.P.E. supply. In July, smaller dressing nurses in rain ponchos, a fate Baystate that gives away protective gear nationwide, had
doctor’s offices and private health care providers Health ultimately avoided by finding domes- analyzed nearly 17,000 requests in October and
complained about lacking enough P.P.E. to safe- tically made gowns produced from materials found that the United States was still in a crisis,
ly reopen, as they couldn’t compete with bigger like airbag fabric, by American businesses that especially among long-term-care facilities, like
purchasers, who were snapping up the increased had pivoted into P.P.E. manufacturing. Sheehy nursing homes. For the first time since April, the
domestic P.P.E. output. In August, a nationwide and his team also landed several huge orders organization said, P.P.E. requests were once more
survey of nurses reported that 68 percent of them of Chinese-made surgical-isolation gowns on rising nationwide. Not long before, the Govern-
were reusing N95s for days or weeks at a time, the gray market, which were cheaper and better ment Accountability Office published a report
often in violation of C.D.C. guidelines. Supply than some of their American counterparts. All warning of ongoing constraints in the market.
and demand for respirators were locked in a life- of which meant that despite Baystate Health’s Admiral Polowczyk said the G.A.O. report
or-death race. efforts to create its own supply, and the Trump was ‘‘absolutely wrong.’’ (Continued on Page 53)

The New York Times Magazine 51

Masks managed, federally supported’’ response. ‘‘I Answers to puzzles of 11.15.20
(Continued from Page 51) beg to differ about putting the full weight of THEME SHMEME
all that responsibility for every office worker
B A R T A B D R A W B B A L L
Pointing to increased domestic production, he and grocery store clerk who thinks they need I V O R I E S C R A S H C O U R S E
blamed health care systems for asking work- an N95 mask on my shoulders,’’ Polowczyk N A T U R A L S T R I C K O R T R E A T

ers to reuse P.P.E. when there actually was said. ‘‘There’s a lot of people who should be A L O E T E A L E A V E S A T B A T
C O U R T R E P O R T E R A W L S
enough supply nationwide — an incongruity he accountable for their own preparedness for the A N T R I P W R E N J U D E W W E
explained by suggesting that management was pandemic.’’ M A X W E I R S U G A R C O A T
stockpiling unnecessarily because they were For those on the front lines, the Trump F O R A Y G A R B T U N E D H U R T
A V E R M O I L I E N O R S A L M A
traumatized by running short of P.P.E. earlier administration’s decision to be the last line D E L E T E D S C E N E S S P E N D S
in the pandemic. At the beginning of November, of response felt a lot like abandonment. The E R A S E R T H I N N E D R E C I P E
FEMA and the S.N.S. had on hand about 136 nation’s largest health care and labor organi- S Y N C E D A D E S T E F I D E L E S
R I T E S A R T E R Y T I M S I L T
million N95s and 45 million KN95s — a signifi- zations, such as the American Hospital Asso-
A G E S G R E T A W H E N W I E L D
cant buffer that Polowczyk hoped would sustain ciation, the American Medical Association and T H A T S O K A Y S E A R P I T
the country through a potentially nightmarish the A.F.L.-C.I.O. have continued to plead for A T M H U E D S P E D A R M D U A

winter, but also less than half of what officials the administration to more forcefully invoke D E R N S K I N N Y D I P P I N G
A L A R M S H O E S T O R E R E B A
projected to have earlier this year. the D.P.A. S L U M B E R P A R T Y W E B S I T E S
In total, H.H.S. said that over the course of Artenstein, the chief physician executive at P L A N E T E A R T H P U M M E L S
the pandemic, federal agencies and the private Baystate Health, emailed me in October. ‘‘There F A U S T D Y E S S H O R T I

sector delivered about 318.5 million N95s — a still does not appear to be a coherent, organized
substantial number, and one made possible by and effective (or even potentially effective) plan KENKEN
the administration’s success at expanding the by this administration to address ongoing P.P.E.
domestic production. But it’s a number that shortages,’’ he wrote. ‘‘Trust me, these are ongo-
still fell far short of the 3.5 billion that Kadlec ing and will only worsen.’’ Indeed, the shortages
had estimated were needed — a figure that was have already returned as the virus runs rampant
actually the ‘‘base’’ scenario the C.D.C. study laid through the country once again. And though
out; it had calculated that a ‘‘maximum demand’’ President-elect Biden has promised to federal-
situation could require more than twice as many ize the P.P.E. response, he won’t take office until
respirators. Like much of the rest of the admin- January 20 — and the current administration’s
istration’s response to the virus, its P.P.E. suc- obstruction of the transfer of power may further
cesses relied partly on redefining reality: Per- delay his ability to act quickly.
JELLY ROLL
haps the most consequential decision it made The primary wisdom that Artenstein was
in expanding respirator supply was loosening providing to other health care systems asking
safety guidelines, over the protests of health care for his advice was to not expect substantial
worker advocates, so that a respirator designed help from the federal government. In a sense,
for seeing a single patient could be worn for the Trump administration had achieved one of
days or even weeks. its goals: It had trained Americans not to rely
Ultimately, Admiral Polowczyk felt that the on it. Everyone was on his or her own in this
Trump administration had done what it had pandemic, Artenstein warned. That was the
set out to do — lead a ‘‘locally executed, state American way.

KENKEN
Fill the grid with digits so as not to repeat a digit in any row or column, and so that the digits within each heavily outlined
box will produce the target number shown, by using addition, subtraction, multiplication or division, as indicated in the box.
A 5x5 grid will use the digits 1–5. A 7x7 grid will use 1–7.
NINE TO FIVE YIN-YANG
1. Thankless 2. Ayatollah
3. Orchestra 4. Sequester
5. Fireproof 6. Reservoir
7. Dishonest 8. Wasteland
9. Gastropod 10. Bathrobes
11. Antitheft 12. Extrovert

Answers to puzzle on Page 52

the beehive, feel free to include them in your score.
veneer. If you found other legitimate dictionary words in
neocon, nerve, never, nonce, recon, reconvene, reverence,
crooner, encore, hence, heron, honcho, honor, honoree,
conch, convene, corner, coroner, coven, crone, croon,
Chevron (3 points). Also: Cocoon, coherence, concern,
SPELLING BEE

KenKen® is a registered trademark of Nextoy, LLC. © 2020 www.KENKEN.com. All rights reserved. 53
Contributors

Jonathan Mahler ‘‘Individual-1,’’ Jonathan Mahler is a staff writer for the Editor in Chief JAKE SILVERSTEIN
Page 34 magazine. He recently won the 2020 Loeb Deputy Editors JESSICA LUSTIG,
BILL WASIK
Award for feature writing with Jim Rutenberg for Managing Editor ERIKA SOMMER
their article about the Murdoch media empire. Creative Director GAIL BICHLER
Director of Photography KATHY RYAN
For this issue, he looks back on Donald Trump’s Art Director BEN GRANDGENETT
presidency in the context of a very specific Features Editor ILENA SILVERMAN
question: Will the Biden administration prosecute Politics Editor CHARLES HOMANS
Culture Editor SASHA WEISS
Trump for any of the potential crimes he may Digital Director BLAKE WILSON
have committed while in office? ‘‘There was Story Editors NITSUH ABEBE,
SHEILA GLASER,
a sense among a lot of the legal experts and
CLAIRE GUTIERREZ,
former government officials whom I spoke with LUKE MITCHELL,
that Trump’s moment of accountability would DEAN ROBINSON,
WILLY STALEY
take place at the ballot box,’’ Mahler says. ‘‘But Assistant Managing Editor JEANNIE CHOI
political accountability is not legal accountability, Associate Editors IVA DIXIT,

and it’s not clear that America will really be able KYLE LIGMAN
Poetry Editor NAOMI SHIHAB NYE
to move on from Trump without fully reckoning Staff Writers SAM ANDERSON,
with his subversion of the rule of law.’’ EMILY BAZELON,
RONEN BERGMAN,
TAFFY BRODESSER-AKNER,
C. J. CHIVERS,
Doug Bock Clark ‘‘Unmasked,’’ Doug Bock Clark is a writer whose book, ‘‘The PAMELA COLLOFF,

Page 22 NICHOLAS CONFESSORE,

Last Whalers,’’ about a hunter-gatherer tribe SUSAN DOMINUS,
grappling with globalization, won the Lowell MAUREEN DOWD,
NIKOLE HANNAH-JONES,
Thomas Travel Book Silver Award in 2019.
JAZMINE HUGHES,
JENEEN INTERLANDI,
MARK LEIBOVICH,
JONATHAN MAHLER,
Susan Dominus Screenland, Susan Dominus is a staff writer for The New York
DAVID MARCHESE,
Page 7 Times Magazine. She last wrote about frontline WESLEY MORRIS,
clinicians treating patients with unproven drugs JENNA WORTHAM
Digital Art Director KATE L A RUE
for Covid-19. Deputy Art Director ANNIE JEN
Designers CLAUDIA RUBÍN,
RACHEL WILLEY
Deputy Director of Photography JESSICA DIMSON
Theodore R. Johnson ‘‘The Challenge of Theodore R. Johnson is a senior fellow at the Senior Photo Editor AMY KELLNER
Black Patriotism,’’ Brennan Center for Justice and the author of the Photo Editor KRISTEN GEISLER
Page 30 Contributing Photo Editor DAVID CARTHAS
forthcoming ‘‘When the Stars Begin to Fall: Copy Chief ROB HOERBURGER
Overcoming Racism and Renewing the Promise of Copy Editors HARVEY DICKSON,
America.’’ He is a retired U.S. Navy commander. DANIEL FROMSON,
MARGARET PREBULA,
ANDREW WILLETT
Jonah Weiner ‘‘The Impossible Eye,’’ Jonah Weiner is a contributing writer for the Head of Research NANDI RODRIGO
Page 42 magazine. He last wrote about watching nest Research Editors RILEY BLANTON,
ALEX CARP,
cams during the pandemic. CYNTHIA COTTS,
JAMIE FISHER,
LU FONG,
TIM HODLER,
ROBERT LIGUORI,
LIA MILLER,

Dear Reader: For the rest of STEVEN STERN,

MARK VAN DE WALLE,

your life, you can only listen to 2000s Production Chief

BILL VOURVOULIAS
ANICK PLEVEN

music recorded during one of 12% Production Editors PATTY RUSH,

HILARY SHANAHAN

the following decades. Which 1990s

12%
Managing Director,
Specialty Printing
MARILYN McCAULEY

do you pick? 1970s

Manager, Magazine Layout
Editorial Assistant
THOMAS GILLESPIE
ALEXANDER SAMAHA
55%
NYT FOR KIDS
Every week the magazine publishes the results 1980s
18% Editorial Director CAITLIN ROPER
of a study conducted online in June by The Art Director DEB BISHOP
New York Times’s research-and-analytics Editor AMBER WILLIAMS
department, reflecting the opinions of 2,250 Staff Editor MOLLY BENNET
Associate Editor LOVIA GYARKYE
subscribers who chose to participate. See how Designer NAJEEBAH AL-GHADBAN
they responded to this week’s question. Did not answer 3% Social Editor ALEXA DÍAZ

4 11.22.20
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without permission.