Printed on the front of certain legitimate N95 masks is a logo of sorts: a figure surrounded by a cloud of air particles, represented by tiny, pointillistic dots. The dots float around the figure’s head, and then travel through its mouth and into its lungs, where they hang in a state of suspended animation. It’s an image that Amy Aminlari, a forty-two-year-old emergency-room doctor at a San Diego hospital, has scrutinized many times, sometimes in the middle of the night, after her shift ends and before her three daughters wake up in the morning.
At Aminlari’s hospital, as the coronavirus pandemic took hold, patients with no symptoms of COVID-19—rushed through the door for appendicitis or a heart attack—were testing positive for the virus, before those attending to them could find the right gear. Prior to the crisis, Aminlari would pick up N95 masks—the gold standard, which filter out the small droplets that carry the virus—from a supply closet on her unit’s floor, and throw them away after one use. Now there were shortages, and she was having to reuse masks, or go without one entirely. Her colleagues were attempting to buy medical-grade masks off eBay for fifteen dollars a pop without knowing if they were real. Aminlari and a friend started looking for suppliers too, comparing the masks on offer to guidelines issued by the National Institute for Occupational Safety and Health. Through friends of friends of friends, they gathered and investigated around twenty proposed mask suppliers. They spent hours examining the markings on the front of the masks, and the fine print on the boxes in which they were packed. “We came up with this huge, expensive, rigorous vetting process,” Aminlari told me. “At the end of the day, everything was counterfeit.”
It was around this time that Aminlari got sick. She felt winded walking up a flight of stairs; her blood-oxygen levels fell to eighty-eight per cent. Her husband, who is also an E.R. doctor, gave her an ultrasound at home on a device connected to his phone: her lungs were full of the veiny pattern that indicates the presence of the virus. She continued to look for masks, this time asking for small donations from her community in California—surfboard shapers, construction workers, homeowners with earthquake emergency kits. “We got maybe a hundred or two hundred N95 masks in a week and a half,” she told me. She began trying to get some of the masks to other nearby hospitals, where she had heard E.R. doctors were each being given one N95 mask and told to use it for a month or two. “Just one,” she said. “I don’t think it’s right for people to be trying to help others and not have the protection they need.”
In doctor’s offices, hospitals, and nursing homes all over, health-care practitioners have struggled to get the personal protective equipment, or P.P.E., that they need to safely do their jobs. The outbreak of COVID-19 has triggered a global race for gowns, face shields, and, in particular, N95 masks. In the U.S., Jared Kushner put together a task force of inexperienced volunteers, many of them twenty-somethings recruited from the tech industry, to source equipment for the government, which only created more confusion. (In one instance, a sixty-nine-million-dollar contract to produce more than a thousand ventilators, awarded to an unvetted Silicon Valley engineer, produced no ventilators). Without a coördinated federal response, states have been forced to bid against one another for supplies. Last month, Maryland’s governor, Larry Hogan, sealed a deal for five thousand testing kits from South Korea, with the help of his wife, who is Korean-American. Illinois’s governor, J. B. Pritzker, has reportedly arranged secret flights bearing masks from China, for fear of them being seized by the federal government. “The supply chain has been likened to the wild West,” Prizker’s press secretary told the Chicago Sun-Times recently, “and once you have purchased supplies, ensuring they get to the state is another herculean feat.”
Individual hospitals have not fared any better. Recently, in The New England Journal of Medicine, Andrew W. Artenstein, the chief physician executive of Baystate Health, a hospital system in Massachusetts, wrote of a team working “around the clock” to secure P.P.E. “Deals, some bizarre and convoluted, and many involving large sums of money, have dissolved at the last minute when we were outbid or outmuscled, sometimes by the federal government,” he wrote. Artenstein described being present for a shadowy pickup of a shipment of masks from China (which were transported in food-service trucks, to avoid detection), which was interrupted by agents from the F.B.I.; later, a congressperson had to make a call to prevent their seizure. “I remained nervous and worried on the long drive back,” Artenstein wrote, “feelings that did not abate until midnight, when I received the call that the PPE shipment was secured at our warehouse.”
With supply chains gone haywire and limited help forthcoming from the government, ordinary citizens have started volunteer networks around the country, forming what one enlistee referred to as “a last-minute bucket brigade.” Get Us PPE, one of the largest groups, estimates that it facilitated the delivery of some one and a half million masks in April alone. Smaller groups—amorphous, and nimble on their feet—have been built from webs of real-life connections made manifest in Slack channels, WhatsApp groups, and endless 2 A.M. Zoom calls. Often, there’s no formal hierarchy, just a rotating crew of bleary-eyed volunteers: teachers, coders, lawyers, artists, historians, and the recently unemployed. “There are dozens of these groups working across the country,” Megan Ranney, an E.R. doctor and a founder of Get Us PPE, told me recently. “We need every one we can get.”
As Aminlari recovered from the virus over the course of a month, a friend put her in touch with one such volunteer effort, known as Last Mile PPE. Founded in New York, Last Mile groups have sprung up around the country, including in Los Angeles, where Aminlari first made contact. She began coördinating her mask-sourcing efforts with the L.A. branch and soon founded her own, in San Diego. She sees it as a temporary but necessary solution to the problem of P.P.E. shortages. She doesn’t like to speculate on why the gear isn’t getting to doctors on the front lines. “I just know what the end result is,” she said. “We don’t have it.”
Last Mile, like many things born in the time of the coronavirus, grew out of a mixture of alarm and neighborly affection. When the virus hit New York City, Tricia Wang, a thirty-nine-year-old sociologist and tech ethnographer living in Bedford-Stuyvesant, Brooklyn, had already been following its progress for months. Years earlier, Wang had lived in Wuhan, where she studied the use of technology among vulnerable populations. In January, when Wuhan began shutting down, she worked with two former colleagues there to study how residents were coping, conducting interviews over the messaging app WeChat.
Wang’s biggest takeaway was the importance, during the quarantine in Wuhan, of the xiao qu, or the hyper-local groups that exist all over the city. Once the virus hit, these groups, run by volunteers, were transformed into networks that could help isolated residents secure food, medicine, and other supplies. They also provided emotional support, with members trading memes, recipes, and virtual workouts. In New York, Wang set up her own xiao qu in Bed-Stuy. In Wuhan, she told me, “it wasn’t just top-down measures that reduced infection or made the quarantine a success, it was also bottom-up measures of grassroots community members coming together.”
Unrelated to her local work, Wang was invited to join a WhatsApp group started by Harper Reed, whom she had known through the tech world for years. Reed was the chief technology officer in Barack Obama’s 2012 reëlection campaign, and wanted to bring people of different backgrounds together for discussions on the virus—a kind of virtual think tank. “I knew that my power was the network and getting people together,” he told me. Reed’s group grew quickly as members added friends and even posted an open invite link to Facebook, ballooning at one point to some hundred and eighty people. It soon splintered into smaller, more focussed groups, one of which was concerned with sourcing P.P.E. Wang eventually created a sub-subgroup that would have a more local focus and called it #NYCPPE.
In its first iteration, #NYCPPE included about thirty people. Its first deliveries were small. One of its early members was a woman named Xin Liu, a twenty-nine-year-old Chinese artist, who lived a few blocks from Wang. In early March, Liu’s father, a doctor in China, grew so concerned about her that he sent her a box of a hundred N95 masks. (“There’s a joke in China,” Liu told me, “that if this is a football game, China plays the first half, the U.S. plays the second half, and Chinese people who are living abroad play the whole game.”) Many of Liu’s Chinese friends living in New York also had some masks tucked away at home. “We saw the situation in the hospitals and were thinking, Can we just donate some of our own?” Liu recalled. When she joined #NYCPPE, Liu and some of her friends began coördinating deliveries through the group. They sent masks to health-care workers in small batches—five, ten—often affixed with handwritten notes thanking them for their work.
The deliveries ramped up. In late March, a member posted that an acquaintance in Washington, D.C., had two thousand N95 masks to offer if someone could pick them up. Sarp Aksel, a thirty-two-year-old ob-gyn in a private practice on the Upper East Side, piped up. “I’ll go right now,” he wrote. He borrowed a colleague’s car and was on the road within forty-five minutes. (“The roads were fantastic, totally empty.”) He arrived in D.C. around 10 P.M., picked up the masks, went back to New York, and then started dropping them off at hospitals around the city: N.Y.U. Langone, Montefiore, Mount Sinai West. “From pickup to distribution, it was, like, ten hours, twelve hours, tops,” he told me.
Soon after, a management consultant named Lisa Cloitre contacted Wang. Cloitre, who is forty-eight, is immunosuppressed, and had been self-isolating with her three-year-old, Christophe, at her home in Boston for weeks already. She had heard about mask shortages, and wanted to get some for herself and for health-care workers. She learned that a friend in Shanghai, who runs an environmental-consulting business, had eighty thousand masks sitting in her office, and could sell them to her at a discount, for around a hundred and sixty-seven thousand dollars. After a “very messy week” working out logistics, Cloitre agreed to buy them. “Ship them all,” she told her friend.
When I spoke to Cloitre recently, she was on day thirty-eight of isolation with Christophe and speaking to me from her basement guest bedroom, which had been turned into a dry-foods bunker. After she decided to purchase the masks, she had to figure out what to do with them, she recalled. She would keep a thousand for herself and her own contacts. Beth Israel Lahey, a hospital system in Boston, agreed to accept forty thousand. That left thirty-nine thousand. The masks were already on their way to J.F.K. Aksel offered to have them delivered to his office on the Upper East Side, and Wang agreed to distribute them.
“Do you have a loading dock?” Cloitre asked Aksel.
No, he responded.
At 10 P.M. on March 30th, a truck arrived outside Aksel’s practice, on East Ninetieth Street. The driver unloaded two pallets of masks—eight hundred pounds’ worth, packed into cardboard boxes—onto the sidewalk, and Aksel began carrying them up to his office. It took him four hours to move the boxes inside.
The thirty-nine thousand masks donated by Cloitre propelled #NYCPPE into a more formal structure. When requests for the masks became overwhelming, the group created a “verifications team” to make calls to health-care workers to insure that the supplies would end up in the right hands and not on the black market. They developed guidelines for prioritizing hospital units based in part on the performance of certain high-risk procedures, such as intubation. Wang recruited a friend who works in supply chains, who advised on a “due diligence toolbox” to vet potential P.P.E. suppliers (among the requirements: product-level certifications, commercial-bank references, and filtration efficiency test reports). They drafted a code of conduct and a set of design principles. And they settled on a name, Last Mile, after the final leg of a supply chain, and a turquoise logo (“reminiscent of the common blue scrubs worn by medical staff and practitioners”), which resembles a medical cross formed out of a road.
In New York, Last Mile maintains a sophisticated database, which logs every delivery across the city, from request to hand-off, as well as information about volunteers, health-care workers, and the supply needs of individual hospital units. Recently, I met on Zoom with Wang and Bitsy Bentley, a data designer who created the database. Both women wore comfortable sweaters and serious expressions. Behind Wang was a bookshelf and a whiteboard covered in diagrams. “In terms of strategy, we want to make sure that we have full coverage of every single hospital facility in New York City, and right now we’re a little bit short of that,” Bentley said. Opening the database, she showed me a map of every completed delivery the group has made so far, with a function to design a specific route for a courier. Information was being collected on the types of supply-rationing hospitals were doing, “what kind of urgency they’re feeling, and what types of P.P.E. they need over time.” There was also space for volunteers to add notes on the thank-you texts and photos they received from health-care workers.
To date, Last Mile has delivered some hundred and eighty thousand masks across the country, along with thousands of gloves, gowns, goggles, and face shields. Practitioners in New York City alone have received over ninety-six thousand masks from around six hundred and fifty individual deliveries made by Last Mile volunteers. The group has begun to partner with other organizations, including Get Us PPE, to share insights and resources, and one of its long-term goals is to make the data structure for New York City open-source, so that other locations might replicate its structure. Variations have already cropped up in Boston, New Orleans, Chicago, Los Angeles, and San Diego, where volunteers also work long hours. “All our spouses are mad at us,” Aminlari, the doctor who started a Last Mile group in San Diego, joked.
Last Mile volunteers are fastidious about protecting the data of the health-care workers on the receiving end of their deliveries. Many of the practitioners making requests for supplies are doing so outside the official procurement channels at their hospitals, and are fearful of repercussions. For this reason, Last Mile volunteers most often deliver directly to the homes of doctors and nurses, not to their workplaces. One doctor I spoke with, an ob-gyn at a hospital in the Bronx who requested anonymity, had received two deliveries from Last Mile, for a total of fifteen hundred N95 masks. “I just felt so supported and so thrilled that I would be able to provide these masks for my colleagues,” she told me recently. “To be able to say ‘It’s O.K., guys, I’ve got us covered’ was so gratifying.”
Becca Cleary, a third-year law student at CUNY School of Law, oversees the “macro” team, for large deliveries. Cleary, who is twenty-eight, grew up on Long Island and has lived in Brooklyn for the past six years, where she has often worked as a courier, dropping off takeout or pharmacy orders by car or bicycle. “I know the city really well from delivering and just being here for my entire life,” she told me. She’s currently planning out dozens of routes a day using Bentley’s mapping software. She asks volunteers to follow strict safety protocol: make contactless deliveries, wear a face covering, and maintain six feet of distance at all times.
Cleary told me she feels like she knows the other volunteers intimately, though she’s never met most of them. “We’ll be in our pajamas talking” on Zoom, she said. “I can’t wait until this is over so we can actually go get a drink and meet each other.” Christina Tung, a fashion publicist and jewelry designer who has been consolidating the group’s funding streams, said, “I speak more with them than anyone else in my life right now.” The group gives many a sense of purpose. Jon Wiley, a musician and carpenter who lives in Bed-Stuy and has been volunteering with Last Mile for around a month, said that he sometimes works a hundred hours a week on the effort. “I have not been bored once since this crisis started,” he said.
Liu now runs the “micro” delivery team, overseeing smaller drop-offs usually made by bike or motorcycle. When I spoke to her over Zoom the other day, she paused our conversation to facilitate a pickup. (Her apartment has become a kind of warehouse.) She walked over to her dining-room table, which was covered in stacks of masks wrapped individually in plastic. She picked up a bundle of twenty and left them outside her front door for a volunteer, who was headed to a health-care worker’s house in Queens. She closed the door and waved through a window as the volunteer picked up the masks. “Thank you!” she called out.
A previous version of this piece misspelled Bitsy Bentley’s name.
A Guide to the Coronavirus
- Twenty-four hours at the epicenter of the pandemic: nearly fifty New Yorker writers and photographers fanned out to document life in New York City on April 15th.
- Seattle leaders let scientists take the lead in responding to the coronavirus. New York leaders did not.
- Can survivors help cure the disease and rescue the economy?
- What the coronavirus has revealed about American medicine.
- Can we trace the spread of COVID-19 and protect privacy at the same time?
- The coronavirus is likely to spread for more than a year before a vaccine is widely available.
- How to practice social distancing, from responding to a sick housemate to the pros and cons of ordering food.
- The long crusade of Dr. Anthony Fauci, the infectious-disease expert pinned between Donald Trump and the American people.
- What to read, watch, cook, and listen to under quarantine.
