Few domestic industries have been devastated by floods of cheap Chinese imports than face masks, test gloves and other disposable medical tools that protect healthcare workers from infectious pathogens.
The industry's end mise had calamity during the COVID pandemic when Beijing halted exports and American hospital workers were at the mercy of a deadly airborne virus that quickly filled the country's emergency rooms and Morgie.
But the few companies making protective gear in the US were almost unsettled as President Trump announced his tariff remedy earlier this month, and Beijing retaliated with 84% tax on American imports.
“I've been pretty crazy,” said Lloyd Armbrust, CEO of Armbrust American, a pandemic-era startup that produces N95 respirator masks at its Texas factory. “On the one hand, this is the kind of medicine we need if we are truly independent of China. On the other hand, this is not an industrial policy.”
The United States once dominated the field of personal protective equipment. Or, while the PPE in the virus filtering N95 mask and disposable nitrile gloves is an American invention, China currently produces more than 90% of the medical supplies worn by American healthcare workers.
It pledges to end US dependence on foreign medical products and to reinforce dozens of domestic manufacturers born during the pandemic. Federal agencies and state governments have resumed their reliance on cheap Chinese imports. Earlier this year, when California purchased millions of N95 masks for people affected by the Los Angeles wildfires, it chose masks made in China.
Industry experts say the country's new dependence on imported medical products is particularly concerning given the widening measles outbreak, the threat of avian flu, and the trade war with China could affect global supply chains.
“It's the same film over and over,” said Mike Bowen, whose company, Prestige Ameritech, was one of the few domestic mask makers before the pandemic and repeatedly warned Congress about the risk of relying on foreign-made PPE.
Bowen, who retired four years ago but still maintains a stake in Prestige Ameritech, said the rise and decline in the US PPE sector over the past few years is completely predictable. “We didn't learn anything,” he said.
Shocked by images of nurses wearing garbage bags, John Vieramowich, a commercial real estate broker in Texas, opened an N95 factory with a friend near Fort Worth, and eventually spent hundreds of thousands of dollars on a machine that clad in 12 million masks a month.
“It just seemed right,” said Viera Mowich, a US mask company, who was one of more than 100 startups born in the first horrifying year of the pandemic.
Five years later, most of the US masks and other startups were gone. Businesses have been hit hard by slowing demand for PPE as the pandemic has set back and masks have become a symbol of government overreach and loss of freedom for many Americans. However, the blow of death was apparently pre-determined. This is the return of Chinese gear.
According to a review of the membership list created by the American Medical Manufacturers Association, only five of the 107 companies created during the pandemic make masks and gloves.
Eric Axel, executive director of the association, said tariffs on Chinese-made protective gear would step into American producers if they remain high. “I think that changes behavior because people have to adapt to the reality that you can no longer purchase sub-market price charges from China,” he said.
However, other industry executives are worried that escalating retaliatory moves by the US and China could lead to supply chain disruption and a return to PPE shortages. Many say the economic uncertainty spurred by Trump's rollout of tariffs will cool new investments.
“We've seen a lot of people who have had a lot of trouble with our healthcare industry,” said Scott McGall, a healthcare industry expert at consulting firm Grant Thornton.
Given the ability of Chinese manufacturers to avoid trade restrictions with support from their own government, many executives have not been persuaded that tariffs will have a lasting impact. What they say is a legislative and policy mandate that encourages government agencies and hospital networks to purchase American-made masks and gloves.
“Even with 100% tariffs, Chinese masks sold at Penny will be cheaper than American-made ones sold at 8 cents,” Armbust said.
The silvery tale of how altruistic entrepreneurs recovered to respond to a critical public health emergency was not intended to end this way.
Political leaders from both sides of the aisle vowed to never again allow the country to rely on foreign-made medical equipment, and the Department of Defense spent $1.3 billion to help American companies make N95 respiratory masks and nitrile test gloves in the United States.
In 2021, Congress drafted a law ensuring federal agencies purchase domestically made medical devices to maintain the sector through the valley of inevitable demand.
This is a long-standing model the Pentagon has embraced, spending hundreds of millions of dollars each year on contracts to maintain defense-related businesses in an era of war and peace.
However, the PPE measurement folded into the 2021 Infrastructure Investment and Employment Act included a loophole that experts said made it effective as federal agencies sought an exemption from purchasing cheaper imports.
When Axel, a medical manufacturers association traveled recently to John F. Kennedy International Airport in New York, he was surprised to discover that masks used at the federal health screening station were made in China.
“Our national security is at risk because we are once again at the mercy of hostile, non-democratic countries,” he said.
Trump has not mentioned personal protective equipment since taking office, but during his first term he often spoke about the need to separate the country from foreign-made medical equipment as part of his “America First” economic policy.
“Another president will never inherit the empty shelf again,” he said in May 2020 at a Pennsylvania mask facility run by Owens & Minor. “My goal is to create everything America needs for itself and then export it to the world.”
Experts say the tariffs Trump imposed on Chinese goods during his first term have rarely leveled the playing field as Beijing's generous industrial policy helped Chinese companies maintain their price advantage.
The Trump administration did not respond to requests for comment.
At this time, the majority of masks purchased by hospital chains, federal agencies and state governments are imported primarily from China and, to a lesser extent, from Thailand, Vietnam and Mexico.
Owens & Minor, a healthcare logistics company that Trump singled out due to praise during the pandemic, sells assembled masks in Mexico. The company refused to discuss production.
According to the company's CEO, Luis Aguero, Demetech Corporation, a Florida medical supplies company, is one of the losers of bidders on a California contract to supply N95 respiratory tracts to those affected by Wildfires.
A spokesman for Gov. Gavin Newsom's office did not respond to requests for comment.
Demetech's mask production line employed 3,000 people during the pandemic, but the company removed the equipment, Make more profitable surgical sutures and hernia mesh.
Arguello said buying multi-year government contracts and American orders for both state and federal agencies is the only way to save remaining players.
There are a few exceptions to the story. SafeSource Direct, one of the few companies that manufacture nitrile testing gloves in the United States, has survived, primarily because of its partnership with hospital network Ochsner Health, according to Justin Hollingsworth, CEO of Safesource Direct. Ochsner said the investment in SAFESource is aimed at ensuring a reliable source of medical supplies in hospitals and clinics.
Armbrust American, another pandemic-era startup that is still in business, gets it from buyers from untrustworthy travelers and bulk purchases from retailers' targets. Armbrust said Target executives are willing to pay 50% more for masks and gloves because they saw value when making quality products in US soil.
Like most Americans, Dan Isakey, a former wholesale distribution executive in New York, was unfamiliar with the acronym PPE when he complained about the decline in mask supply and testing gloves at the hospital where his friends worked.
Six months later, United Safety Technology, which he created to create the PPE, won a $96 million federal contract to build a Nitrile Glove factory outside of Baltimore.
The company quickly equipped its huge 700,000 square feet warehouse and machined its machinery, producing 200 million gloves a month, but pandemic-related supply chain issues caused spiral costs for steel beams, computer chips and shipping containers, which required an additional $50 million to complete the project.
Federal officials didn't move, he said.
“One or two long-term government purchase agreements would have won us at the finish line, but the HHS team was no longer interested,” he said, referring to the Department of Health and Human Services.
And by the time federal officials pulled the plug, Chinese-made nitrile gloves were once again piled up, and they charged 1.3 cents of gloves.
Still, Isakie said he was cautiously optimistic about Trump's tariffs. “Things are on the right track,” he said Friday. “I wish they were a bit confused.”
