Short on masks as they faced a surge in COVID-19 patients, Seattle hospital workers once resorted to rigging their own face shields out of vinyl and tape acquired at Home Depot. Now, less than four years later, Washington has trashed millions of masks, gowns, gloves and other personal protective equipment it stockpiled during the contagion’s early days.
The state’s Department of Health confirmed it junked more than 14 million gowns, 5 million surgical masks and 140,000 face shields as of July 2023 — supplies the agency paid about $1.5 million to acquire. Washington is not alone in tossing its painstakingly acquired surplus – at least 15 states have dumped pandemic stockpiles, The Associated Press reported last December.
A DOH official said the agency disposed of expired supplies with no market value and little demand among hospitals that otherwise would have continued to cost money and space for storage. They also kept some expired N95 respirators for emergency use and put out notices to community groups offering items before junking them.
“Folks are not seeking those supplies out anymore,” said Cory Portner, director of the DOH’s Office of Emergency Medical Logistics. “If they need them, they can get them in the quantities that they need.”
A state health spokesperson also emphasized that the agency donated hundreds of thousands of masks and gloves to the Marshall Islands in September 2022 following a hurricane.
But some public health professionals say the offloading highlights continued shortcomings in national disaster preparedness, and said states could work harder to find alternative uses for stockpiled gear before tossing it in the trash.
Dr. Georges Benjamin, executive director of the American Public Health Association, said expired surgical masks could still be utilized by janitors, garbage collectors or other non-medical settings where the mask does not need to be sterile, it just needs to block particulate matter.
“The problem is we went from famine to feast, and I suspect we will go back to famine again,” Benjamin said. “An expired mask is better than no mask.”
Pandemic panic-buying
Washington purchased some $364 million of protective equipment during the first year of the pandemic, according to a spokesperson for the Department of Enterprise Services, which led PPE procurement for the state during that time.
The department suspended competitive bidding requirements, ordering tens of millions of masks with no-bid contracts, The Seattle Times reported in December 2020. Most of the state’s current stockpile of N95 masks came from a single Chinese car manufacturer to which Washington paid nearly $100 million.
Public health professionals say the recent junking illustrates a national public health system that remains ill-prepared for disasters due to reliance on a limited pool of mostly overseas manufacturers. A disorganized national response to the virus and inadequate stockpiles left state health departments scrambling to source masks anywhere they could.
The executive director of the Washington State Public Health Association wrote in an email that agencies trashing pandemic gear was “a shame,” but declined to comment for this story.
Expired masks can largely continue to meet protection standards if properly stored, according to research by the CDC and French universities, which found the biggest issue was the breaking strength of the elastic ties. When COVID-19 first hit, Washington health officials actually distributed 10-year-old masks left over from the swine flu pandemic. And the federal government also sent tens of thousands of expired N95 masks to Oregon and New York City in March 2020, The New York Times has reported.
Dr. John Balmes, a professor of environmental health science at UC Berkeley, told Business Insider in March 2020 that “N95 masks really don’t expire in terms of their functionality. The only part that is subject to damage over time are the elastic bands that attach the mask to the user’s face, which can be damaged by sunlight.”
“N95” refers to a mask that filters at least 95 percent of airborne particles, according to the CDC.
Culling the stockpile
While expired items could prove useful in another emergency, it costs the state money to store them. When deciding what stockpiled items to keep, the state looks at the level of demand for the item, its market value and whether it can be tested to ensure performance past its expiration date, said Portner of the Department of Health.
Once the department determines an item is worth zero dollars and is no longer in demand, the agency seeks to offload it. Hospitals can now source their own supplies thanks to an improved supply chain, Portner said, and some stockpiled N95 masks were made to fit larger face shapes than hospitals need. The state decided that any possible future use for the surgical masks, gowns and gloves was not worth the cost to store them.
“They are expired, there’s no demand, and ultimately they then incur a cost to the state because storage is not free,” Portner said. “At this point, with the market’s ability to support that demand, … expired versions which don’t have that manufacturer endorsement just aren’t sought after.”
The department held on to some items that could be tested and validated for use past their expiration dates, such as N95 masks approved by the National Institute for Occupational Safety and Health. This process previously allowed masks left over from the swine flu/H1N1 outbreak in the 2000s to be used during the COVID-19 pandemic, Portner said. But there is not a similar process to verify the efficacy of expired surgical masks, he added.
The discarded items also included more than 70,000 expired N95 masks that were not approved by NIOSH. Scrambling to find whatever protection they could, states obtained these at the federal government’s suggestion in 2020, but the FDA no longer endorses their use.
The agency first reached out to medical schools and community groups to gauge interest in the expired supplies, Portner noted.
The DOH maintains a warehouse of medical supplies in Thurston County. That stockpile currently includes pandemic supplies equivalent to 20 percent of peak demand during the worst COVID-19 spikes, Portner said. The state currently has more than 13 million N95 masks, about 2 million Antigen and PCR test kits, and more than 50 million gloves, according to an inventory report provided on Feb. 15.
Fixing the supply chain
Benjamin, of the American Public Health Association, traced the fundamental challenge back to supply chains. Governments rely on a small pool of companies to produce supplies, he said, rendering them unable to handle sudden surges in demand. After decades of outsourcing, nearly all protective supplies used in the U.S. in 2020 were made in other countries, The Associated Press reported. Those foreign manufacturers prioritized supplying their own countries, and the resulting shortages in U.S. hospitals cost lives.
For years before COVID-19 hit, medical experts and even some federal officials warned the country would be unprepared for a pandemic, according to the AP. They called on lawmakers to enhance stockpiles and make long-term purchasing commitments to the few remaining American mask producers. The pandemic renewed some interest in kick-starting U.S. mask production, but many of those efforts quickly ran aground.
Being prepared for the next disaster may require maintaining some level of overcapacity that could seem inefficient or wasteful, Benjamin said, but that surplus could help us avoid devastating consequences.
“We will have shortages of gowns and gloves and masks again,” he said, if not from another pandemic then perhaps due to wildfires or some other unforeseen disaster. “We’re going to wish we hadn’t thrown some of that stuff out.”
