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| China Dominates Medical Supplies, in This Outbreak and the Next | China Dominates Medical Supplies, in This Outbreak and the Next |
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| BEIJING — Alarmed at China’s stranglehold over supplies of masks, gowns, test kits and other front-line weapons for battling the coronavirus, countries around the world have set up their own factories to cope with this pandemic and outbreaks of the future. | BEIJING — Alarmed at China’s stranglehold over supplies of masks, gowns, test kits and other front-line weapons for battling the coronavirus, countries around the world have set up their own factories to cope with this pandemic and outbreaks of the future. |
| When the outbreak subsides, those factories may struggle to survive. China has laid the groundwork to dominate the market for protective and medical supplies for years to come. | When the outbreak subsides, those factories may struggle to survive. China has laid the groundwork to dominate the market for protective and medical supplies for years to come. |
| Factory owners get cheap land, courtesy of the Chinese government. Loans and subsidies are plentiful. Chinese hospitals are often told to buy locally, giving China’s suppliers a vast and captive market. | Factory owners get cheap land, courtesy of the Chinese government. Loans and subsidies are plentiful. Chinese hospitals are often told to buy locally, giving China’s suppliers a vast and captive market. |
| Once vaccines emerge, demand will plummet. Factories will close. But Chinese companies are likely to have the lowest costs by far and be best positioned for the next global outbreak. | Once vaccines emerge, demand will plummet. Factories will close. But Chinese companies are likely to have the lowest costs by far and be best positioned for the next global outbreak. |
| “The Chinese have been successful weaving global personal protection equipment dominance with supply-chain command and control,” said Omar Allam, a former Canadian trade official trying to establish production of in-demand N95 medical respirators in his country. | “The Chinese have been successful weaving global personal protection equipment dominance with supply-chain command and control,” said Omar Allam, a former Canadian trade official trying to establish production of in-demand N95 medical respirators in his country. |
| China’s grip on the market is a testament to its drive to dominate important cogs in the global industrial machine. | China’s grip on the market is a testament to its drive to dominate important cogs in the global industrial machine. |
| For years, China’s leaders have worried that the country depended too much on foreign sources for everything from medical supplies to microchips to airliners. It has used subsidies, economic targets and other government inducements to emerge as a powerhouse in those important industries. | For years, China’s leaders have worried that the country depended too much on foreign sources for everything from medical supplies to microchips to airliners. It has used subsidies, economic targets and other government inducements to emerge as a powerhouse in those important industries. |
| When Chinese leaders grew concerned about pollution and dependence on foreign oil, for example, they helped local makers of solar panels, wind turbines and high-speed rail equipment clobber the competition. They have taken similar steps to dominate industries of the future, like the next generation of wireless data transmission, known as 5G. | When Chinese leaders grew concerned about pollution and dependence on foreign oil, for example, they helped local makers of solar panels, wind turbines and high-speed rail equipment clobber the competition. They have taken similar steps to dominate industries of the future, like the next generation of wireless data transmission, known as 5G. |
| The state’s heavy involvement in its economy has led to waste and graft that could slow China’s growth. But the policies have often proved effective in building industries that can withstand losses and tough foreign competition. Medical supplies may be similar. | The state’s heavy involvement in its economy has led to waste and graft that could slow China’s growth. But the policies have often proved effective in building industries that can withstand losses and tough foreign competition. Medical supplies may be similar. |
| “There will be massive consolidation after the epidemic,” said Howard Yu, a professor of management and innovation at the Institute for Management Development, a business school in Switzerland. “It will be exactly the same dynamics as in green energy, 5G and high-speed rail.” | “There will be massive consolidation after the epidemic,” said Howard Yu, a professor of management and innovation at the Institute for Management Development, a business school in Switzerland. “It will be exactly the same dynamics as in green energy, 5G and high-speed rail.” |
| Before the pandemic, China already exported more respirators, surgical masks, medical goggles and protective garments than the rest of the world combined, the Peterson Institute for International Economics estimated. | Before the pandemic, China already exported more respirators, surgical masks, medical goggles and protective garments than the rest of the world combined, the Peterson Institute for International Economics estimated. |
| Beijing’s coronavirus response has only added to that dominance. It increased mask production nearly 12-fold in February alone. It can now make 150 tons per day of the specialized fabric used for masks, said Bob McIlvaine, who runs a namesake research and consulting firm in Northfield, Ill. That is five times what China could make before the outbreak, and 15 times the output of U.S. companies even after they ramped up production this spring. | Beijing’s coronavirus response has only added to that dominance. It increased mask production nearly 12-fold in February alone. It can now make 150 tons per day of the specialized fabric used for masks, said Bob McIlvaine, who runs a namesake research and consulting firm in Northfield, Ill. That is five times what China could make before the outbreak, and 15 times the output of U.S. companies even after they ramped up production this spring. |
| American companies have been reluctant to make big investments in fabric manufacturing because they worry that mask demand will be temporary. But Texas required on Thursday that most residents wear masks in public places, part of a broader embrace of face masks in recent days. | American companies have been reluctant to make big investments in fabric manufacturing because they worry that mask demand will be temporary. But Texas required on Thursday that most residents wear masks in public places, part of a broader embrace of face masks in recent days. |
| “It is a huge mistake to assume that the market will disappear,” Mr. McIlvaine said. | “It is a huge mistake to assume that the market will disappear,” Mr. McIlvaine said. |
| Ma Zhaoxu, vice minister of foreign affairs, said that from March through May, China exported 70.6 billion masks. The entire world produced about 20 billion all of last year, with China accounting for half. | Ma Zhaoxu, vice minister of foreign affairs, said that from March through May, China exported 70.6 billion masks. The entire world produced about 20 billion all of last year, with China accounting for half. |
| Other countries now want self-reliance. Earlier in the pandemic, China sometimes decided which countries received crucial supplies and demanded profuse and public thanks in exchange. | Other countries now want self-reliance. Earlier in the pandemic, China sometimes decided which countries received crucial supplies and demanded profuse and public thanks in exchange. |
| President Emmanuel Macron of France pledged in March to produce homegrown masks and respirators by the end of this year. Peter Navarro, President Trump’s industrial policy adviser, has begun a push for the federal government to buy American-made pharmaceuticals and medical supplies. | President Emmanuel Macron of France pledged in March to produce homegrown masks and respirators by the end of this year. Peter Navarro, President Trump’s industrial policy adviser, has begun a push for the federal government to buy American-made pharmaceuticals and medical supplies. |
| China, however, has a head start. | China, however, has a head start. |
| In 2005, after the outbreak of SARS, which killed 350 people in China, the Ministry of Science and Technology announced that it had developed respirators that better fit Chinese faces. In 2010, the government’s five-year economic plan ordered a “focus on developing basic equipment and medical materials that have high demand, wide application and are mainly imported.” | In 2005, after the outbreak of SARS, which killed 350 people in China, the Ministry of Science and Technology announced that it had developed respirators that better fit Chinese faces. In 2010, the government’s five-year economic plan ordered a “focus on developing basic equipment and medical materials that have high demand, wide application and are mainly imported.” |
| China also foresaw the importance of nucleic acid test kits, which can detect coronavirus infections. In 2017, the Ministry of Science and Technology identified the kits as a “targeted development” industry. | China also foresaw the importance of nucleic acid test kits, which can detect coronavirus infections. In 2017, the Ministry of Science and Technology identified the kits as a “targeted development” industry. |
| The ministry’s decision was part of the country’s $300 billion “Made in China 2025” industrial policy to replace imports in many key industries, including medical devices. The ministry called for raising China’s share of the local market by 30 to 40 percentage points in each category of medical supplies. | The ministry’s decision was part of the country’s $300 billion “Made in China 2025” industrial policy to replace imports in many key industries, including medical devices. The ministry called for raising China’s share of the local market by 30 to 40 percentage points in each category of medical supplies. |
| Chinese makers of medical gear enjoyed generous government subsidies. Shenzhen Mindray, a maker of ventilators and other intensive care equipment, received up to $16.6 million a year over the past three years, according to company documents. Winner Medical, a mask manufacturer, received $3 million to $4 million a year. Guangzhou Improve, a producer of masks and test kits, received $2.5 million to $5 million a year. | Chinese makers of medical gear enjoyed generous government subsidies. Shenzhen Mindray, a maker of ventilators and other intensive care equipment, received up to $16.6 million a year over the past three years, according to company documents. Winner Medical, a mask manufacturer, received $3 million to $4 million a year. Guangzhou Improve, a producer of masks and test kits, received $2.5 million to $5 million a year. |
| Shenzhen Mindray and Winner Medical declined to comment, while Guangzhou Improve did not respond to numerous requests. | Shenzhen Mindray and Winner Medical declined to comment, while Guangzhou Improve did not respond to numerous requests. |
| Hospitals began to buy locally. Three years ago, the central government required purchasers to buy from domestic producers that could meet requirements. Local governments followed. Sichuan Province, for example, cut in half the number of categories for which medical equipment and supplies could be imported. Only the top hospitals could import anything, the provincial government said, while lower-ranked hospitals had to buy everything in China. | Hospitals began to buy locally. Three years ago, the central government required purchasers to buy from domestic producers that could meet requirements. Local governments followed. Sichuan Province, for example, cut in half the number of categories for which medical equipment and supplies could be imported. Only the top hospitals could import anything, the provincial government said, while lower-ranked hospitals had to buy everything in China. |
| At least three other large, populous provinces — Liaoning, Hubei and Shandong — made similar announcements. | At least three other large, populous provinces — Liaoning, Hubei and Shandong — made similar announcements. |
| Such efforts helped put China firmly at the front of the industry, as Rakesh Tammabattula discovered. An entrepreneur in the Los Angeles suburbs, he shifted his business making nutrition supplements and moisturizer to the production of medical masks and hand sanitizer in response to the epidemic. To do that, he needed a machine that could compress and cut fabric to make masks. | Such efforts helped put China firmly at the front of the industry, as Rakesh Tammabattula discovered. An entrepreneur in the Los Angeles suburbs, he shifted his business making nutrition supplements and moisturizer to the production of medical masks and hand sanitizer in response to the epidemic. To do that, he needed a machine that could compress and cut fabric to make masks. |
| Updated July 7, 2020 | |
| The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization. | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| He discovered that the machines were made only in China. He had to charter a jet to fly the huge device — 36 feet long, six feet high and five feet wide — from southern China to Los Angeles. | He discovered that the machines were made only in China. He had to charter a jet to fly the huge device — 36 feet long, six feet high and five feet wide — from southern China to Los Angeles. |
| “It’s not that we can’t make this,” said Mr. Tammabattula, the chief executive of QYK Brands. “It’s just that we haven’t focused on it.” | “It’s not that we can’t make this,” said Mr. Tammabattula, the chief executive of QYK Brands. “It’s just that we haven’t focused on it.” |
| The Chinese government played a major role in this year’s medical-equipment build-out. | The Chinese government played a major role in this year’s medical-equipment build-out. |
| Sinopec, a state-owned Chinese oil company, said it had worked closely with the Chinese Communist Party as it set out to build a factory to make the particle-trapping fabric needed for surgical masks and respirators. | Sinopec, a state-owned Chinese oil company, said it had worked closely with the Chinese Communist Party as it set out to build a factory to make the particle-trapping fabric needed for surgical masks and respirators. |
| At one site, 600 engineers and workers labored in shifts day and night for 35 consecutive days to build a factory that would normally take a year to construct. A “party member assault team” worked 20 hours straight on Feb. 26 to prepare a warehouse for the project, according to the company. | At one site, 600 engineers and workers labored in shifts day and night for 35 consecutive days to build a factory that would normally take a year to construct. A “party member assault team” worked 20 hours straight on Feb. 26 to prepare a warehouse for the project, according to the company. |
| Officials also accelerated efforts to make land available for new factories. The city of Hangzhou in Zhejiang Province transferred 1.6 acres to the Jiande Chaomei Daily Chemical Company on Feb. 15 for an emergency expansion of respirator production. Lanxi, a county in Zhejiang, transferred land to the Baihao New Materials Company by the end of February for respirator production. Officials in Guangdong Province and the city of Jinan in Shandong Province approved more lenient land policies for medical supply businesses as well. | Officials also accelerated efforts to make land available for new factories. The city of Hangzhou in Zhejiang Province transferred 1.6 acres to the Jiande Chaomei Daily Chemical Company on Feb. 15 for an emergency expansion of respirator production. Lanxi, a county in Zhejiang, transferred land to the Baihao New Materials Company by the end of February for respirator production. Officials in Guangdong Province and the city of Jinan in Shandong Province approved more lenient land policies for medical supply businesses as well. |
| Government support for the medical supply industry is continuing. Guangzhou Aoyuan Biotech Company decided this year to expand from its usual business of making disinfectant into the manufacture of N95 masks. A top local official immediately visited the company, arranged land for it in an industrial park and approved all of the necessary forms. | Government support for the medical supply industry is continuing. Guangzhou Aoyuan Biotech Company decided this year to expand from its usual business of making disinfectant into the manufacture of N95 masks. A top local official immediately visited the company, arranged land for it in an industrial park and approved all of the necessary forms. |
| A few economic policy experts in China contend that their country may be going too far. According to Tianyancha, a Chinese data service, more than 67,000 companies have registered in China this year to make or trade masks. Many start-ups with poor quality control have already run into trouble. The Chinese government has imposed increasingly stringent customs inspections on exports. | A few economic policy experts in China contend that their country may be going too far. According to Tianyancha, a Chinese data service, more than 67,000 companies have registered in China this year to make or trade masks. Many start-ups with poor quality control have already run into trouble. The Chinese government has imposed increasingly stringent customs inspections on exports. |
| “Many mask-manufacturing enterprises — especially the small and medium enterprises that came into the picture much later and do not possess strong foundations — would have to face closure when they have a surplus of masks and profits begin to plunge,” wrote Cai Enze, a retired deputy mayor and economic planner in central China, in an essay in April. “That marks the start of a crisis.” | “Many mask-manufacturing enterprises — especially the small and medium enterprises that came into the picture much later and do not possess strong foundations — would have to face closure when they have a surplus of masks and profits begin to plunge,” wrote Cai Enze, a retired deputy mayor and economic planner in central China, in an essay in April. “That marks the start of a crisis.” |
| Still, the broader industry in China appears to be better prepared for the future. | Still, the broader industry in China appears to be better prepared for the future. |
| In Los Angeles, Mr. Tammabattula has found that even producing hand sanitizer is hard. He has been unable to find any company in the United States that still makes plastic bottles with pump handles. He imports them, on expensive chartered aircraft, from China. | In Los Angeles, Mr. Tammabattula has found that even producing hand sanitizer is hard. He has been unable to find any company in the United States that still makes plastic bottles with pump handles. He imports them, on expensive chartered aircraft, from China. |
| Mr. Tammabattula has applied for a federal loan for small businesses trying to produce medical supplies, but the paperwork has proved extensive, daunting and slow, he said. | Mr. Tammabattula has applied for a federal loan for small businesses trying to produce medical supplies, but the paperwork has proved extensive, daunting and slow, he said. |
| “If we were to compare to the Chinese government,” Mr. Tammabattula said, “there’s just no support for domestic manufacturing.” | “If we were to compare to the Chinese government,” Mr. Tammabattula said, “there’s just no support for domestic manufacturing.” |
| Coral Yang contributed research from Shanghai. | Coral Yang contributed research from Shanghai. |