How the World’s Richest Country Ran Out of a 75-Cent Face Mask全世界最富有的國家為何沒有足夠的口罩？
Why is the United States running out of face masks for medical workers? How does the world’s wealthiest country find itself in such a tragic and avoidable mess? And how long will it take to get enough protective gear, if that’s even possible now?為什麼美國醫護人員的口罩快耗盡了？這個世界上最富有的國家怎麼會看到自己陷入如此不幸且可以避免的境地？得到足夠的防護器材將需要多長時間，如果現在還有這種可能的話？
I’ve spent the last few days digging into these questions, because the shortages of protective gear, particularly face masks, has struck me as one of the more disturbing absurdities in America’s response to this pandemic.過去幾天裡，我一直在探究這些問題，因為防護器材的短缺，尤其是口罩的短缺，讓我覺得這是美國應對新型冠狀病毒疫情的眾多荒謬之處當中最令人不安的一個。
Yes, it would have been nice to have had early, widespread testing for the coronavirus, the strategy South Korea used to contain its outbreak. It would be amazing if we can avoid running out of ventilators and hospital space, the catastrophe that has befallen parts of Italy. But neither matters much — in fact, no significant intervention is possible — if health care workers cannot even come into contact with coronavirus patients without getting sick themselves.是的，如果儘早對新冠病毒做廣泛檢測的話，本來可以更好，韓國將疫情遏制住用的就是這個策略。如果我們能避免呼吸機和醫院床位不夠用的狀況，本會令人欣慰，醫院爆滿是意大利部分地區正在發生的災難。但是，如果醫護人員根本不能在保護自己不生病的情況下接觸新冠病毒感染者，上述問題就都不重要了，確切地說，在這種情況下，不可能對患者採取多少干預措施。
That’s where cheap, disposable face masks, eye protection, gloves and gowns come in. That we failed to procure enough safety gear for medical workers — not to mention for sick people and for the public, as some health experts might have recommended if masks were not in such low supply — seems astoundingly negligent.這就是便宜的一次性口罩、護目鏡、手套和防護服起作用的地方。我們沒有為醫護人員採購足夠多的安全裝備似乎是個驚人的疏忽，更不用說像一些衛生專家可能會建議的那樣，如果口罩供應不是這麼少的話，本應讓患者和公眾都戴上口罩。
What a small, shameful way for a strong nation to falter: For want of a 75-cent face mask, the kingdom was lost.這麼小的事情搞垮一個強大的國家讓人多丟臉呀：因為缺少75美分一個的口罩，一個國家完蛋了。
I am sorry to say that digging into the mask shortage does little to assuage one’s sense of outrage. The answer to why we’re running out of protective gear involves a very American set of capitalist pathologies — the rise and inevitable lure of low-cost overseas manufacturing, and a strategic failure, at the national level and in the health care industry, to consider seriously the cascading vulnerabilities that flowed from the incentives to reduce costs.我很遺憾地說，探究口罩短缺的問題絲毫不能平息人們的憤怒。我們為什麼缺少防護器材這個問題，答案涉及一組非常美國的資本主義病態——海外低成本製造的興起及其不可避免的吸引力，以及沒有從國家層面和醫療衛生行業的角度認真考慮降低成本的動機所帶來的一連串脆弱性的戰略失敗。
Perhaps the only way to address the shortfall now is to recognize that the market is broken, and to have the government step in to immediately spur global and domestic production. President Trump, bizarrely, has so far resisted ordering companies to produce more supplies and equipment. In the case of masks, manufacturers say they are moving mountains to ramp up production, and some large companies are donating millions of masks from their own reserves.也許現在解決這種短缺的唯一方法是認識到市場已經崩潰，需要政府介入，立刻鼓勵全球和國內生產這些東西。奇怪的是，特朗普總統迄今一直拒絕下令企業生產更多的器材和設備。就口罩而言，製造商們說，他們正在竭盡全力提高產量，一些大公司從自己的儲備中捐獻出來數百萬個口罩。
But given the vast global need for masks — in the United States alone, fighting the coronavirus will consume 3.5 billion face masks, according to an estimate by the Department of Health and Human Services — corporate generosity will fall short. People in the mask business say it will take a few months, at a minimum, to significantly expand production.但考慮到全球對口罩的巨大需求——據美國衛生與公眾服務部(Department of Health and Human Services)估計，僅美國一個國家，在抗擊新冠病毒的戰鬥中將消耗35億個口罩——企業的慷慨不足以滿足需求。口罩行業的人士說，至少需要幾個月的時間才能顯著擴大生產規模。
“We are at full capacity today, and increased production by building another factory or extending further will take anywhere between three to four months,” said Guillaume Laverdure, the chief operating officer of Medicom, a Canadian company that makes masks and other protective equipment in factories around the world.“我們現在已經滿負荷運轉，通過再建一座工廠或進一步擴大產能來提高產量，將需要三到四個月的時間，”加拿大麥迪康(Medicom)的首席運營官紀堯姆·拉弗杜爾(Guillaume Laverdure)說，麥迪康在世界各地有生產口罩和其他防護器材的工廠。
And though some nontraditional manufacturers like T-shirt factories and other apparel makers have announced plans to rush-produce masks, it’s unclear that they will be able to meet required safety standards or shift over production in time to answer demand.雖然一些非傳統生產商，比如T恤衫工廠和其他服裝生產商等，已經宣佈了加急生產口罩的計劃，但目前還不清楚它們能否達到所要求的安全標準，或能否及時轉移生產以滿足需求。
Few in the protective equipment industry are surprised by the shortages, because they’ve been predicted for years. In 2005, the George W. Bush administration called for the coordination of domestic production and stockpiling of protective gear in preparation for pandemic influenza. In 2006, Congress approved funds to add protective gear to a national strategic stockpile — among other things, the stockpile collected 52 million surgical face masks and 104 million N95 respirator masks.在防護裝備行業，很少有人對這種短缺感到驚訝，因為相關預測已經存在數年時間了。2005年，喬治·W·布什(George W. Bush)政府曾呼籲協調防護裝備的國內生產和儲備能力，以應對大流行性流感。2006年，美國國會批准了國家戰略儲備增購防護裝備的資金，增加的庫存中除其他裝備外，還有5200萬個醫用口罩和1.04億個N95口罩。
But about 100 million masks in the stockpile were deployed in 2009 in the fight against the H1N1 flu pandemic, and the government never bothered to replace them. This month, Alex Azar, secretary of health and human services, testified that there are only about 40 million masks in the stockpile — around 1 percent of the projected national need.但2009年抗擊H1N1流感大流行用掉了大約一億個口罩的庫存，而政府從未考慮過補充它們。本月，美國衛生與公眾服務部部長亞歷克斯·阿扎爾(Alex Azar)在國會作證說，庫存中只有大約4000萬個口罩，約為全國預計需求的1%。
As the coronavirus began to spread in China early this year, a global shortage of protective equipment began to look inevitable. But by then it was too late for the American government to do much about the problem. Two decades ago, most hospital protective gear was made domestically. But like much of the rest of the apparel and consumer products business, face mask manufacturing has since shifted nearly entirely overseas. “China is a producer of 80 percent of masks worldwide,” Laverdure said.隨著今年早些時候新型冠狀病毒開始在中國傳播，防護裝備的全球短缺問題看來不可避免。但美國政府在這個時候為解決短缺問題採取行動為時已晚。20年前，大多數醫院用的防護裝備都是美國國內生產的。但與服裝和消費者產品等許多其他行業一樣，口罩的生產已幾乎全部轉移到了海外。“中國生產全球80%的口罩，”拉弗杜爾說。
Hospitals began to run out of masks for the same reason that supermarkets ran out of toilet paper — because their “just-in-time” supply chains, which call for holding as little inventory as possible to meet demand, are built to optimize efficiency, not resiliency.醫院裡口罩開始缺貨的原因與超市裡衛生紙缺貨的原因一樣，都是因為它們的“準時制”(just-in-time)供應鏈優化的是效率，而非韌性。這種做法要求用盡可能少的庫存來滿足需求。
“You’re talking about a commodity item,” said Michael J. Alkire, president of Premier, a company that purchases medical supplies for hospitals and health systems. In the supply chain, he said, “by definition, there’s not going to be a lot of redundancy, because everyone wants the low cost.”“你說的是一種大宗商品，”為醫院和衛生系統採購醫療用品的公司Premier的總裁邁克爾·J·阿爾凱爾(Michael J. Alkire)說。他說，這種商品的供應鏈“按照定義，不會有多少冗餘，因為人們要的是低成本”。
In January, the brittle supply chain began to crack under pressure. To deal with its own outbreak, China began to restrict exports of protective equipment. Then other countries did as well — Taiwan, Germany, France and India took steps to stop exports of medical equipment. That left American hospitals to seek more and more masks from fewer and fewer producers.今年1月，這個脆弱的供應鏈在壓力下開始斷裂。為了應對本國的疫情，中國開始限制防護裝備出口。隨後，其他國家也跟著這樣做——臺灣、德國、法國和印度都採取了停止醫療設備出口的措施。這使得美國的醫院不得不從越來越少的生產商那裡尋找越來越多的口罩。
People in the industry assured me they would prepare better next time. “We are laserlike focused to ensure that our health care systems are never in this scenario again,” Alkire told me. “There will be a lot more domestic manufacturing of these products going forward.”業內人士向我保證，他們下次會準備得更好。“我們正在專心致志地確保我們的衛生保健系統不再出現這種情況，”阿爾凱爾對我說。“未來將有更多的此類產品在國內生產。”
I don’t doubt it — but that we did not plan, as a nation, for this entirely predictable shortage makes me wonder what other inevitable pothole is lurking out there for all to trip over. Getting enough protective gear was among the cheapest, most effective things we could have done to slow down the pandemic. That we failed on such an obvious thing reveals an alarming national incapacity to imagine and prepare for the worst.我並不懷疑這點，但作為一個國家，我們沒有計劃應對這種完全可以預見的短缺，這讓我想知道，前面的路上還有什麼其他不可避免的坑窪會把所有的人絆倒。儲備足夠的防護裝備是我們減緩新冠病毒大流行本來可以採取的最便宜、最有效的措施之一。我們在如此顯而易見的事情上的失敗，暴露了這個國家在做最壞的打算方面的駭人的無能。
We will get enough masks in time for the next disaster. But wouldn’t it be nice, for once, if we prepared for trouble before it hit us in the face?我們會弄到足夠多的口罩來應對下一次災難。但如果我們能在危機出現之前就做好準備的話，那不是更好嗎？
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