Network Evolution Stage
As the pandemic spread in each city, exponentially growing case counts,
closed businesses, and stay-at-home orders revealed a dire need for PPE.
A clinician in Stilton described a moment of realization in mid-March,
“[The N-95 masks] weren’t coming in from the top, from the federal
government… That’s when I realized that it’s gonna take a
grassroots effort to be able to at least brace for the incoming surge.”
Many informants in maker communities readily grasped the urgent need and
prioritized expediency in their response, but they also came face to
face with a scale they were ill-equipped to address. A volunteer maker
in Midburg explained, “You have these institutional levels of [large
hospitals] who can use in the order of 10,000 gowns in a single day.
And for us, we were producing things in the order of dozens a day, one
hundred a day.” Indeed, maker resources paled in comparison to the
problems, and makers were small-scale, often unknown players compared to
the large institutions they dealt with. Many came to see their efforts
as a temporary “stop-gap” until more traditional supply chains could
take over. The monthly involvement of our informants in PPE production
and distribution activities illustrates the initial wave of maker
response in March to June, followed by declining but continued
participation by some (see Appendix C, Figure C2).
Response effectiveness. The maker networks in our cases
responded rapidly to the need, launching production of cloth masks, face
shields, and gowns in mid-March. This was weeks or months ahead of
federal announcements that permitted emergency use authorization (EUA)
for non-certified PPE (EUA dates were April 3, April 9, and May 22 for
each type of PPE, respectively). Makers demonstrated their ability to
produce a variety of the most urgently needed PPE and to adapt their
designs based on local feedback (Dutton et al., 2006). In our data, the
cumulative production in Midburg was the greatest across the widest
variety of PPE types, while Edgeville produced the least amount and
variety of PPE. Table 2 summarizes the quantities and types of PPE as
well as the top categories of PPE recipients according to each case.
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INSERT TABLE 2 ABOUT HERE
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Most makers targeted their initial PPE supplies for hospitals, which
immediately presented challenges in terms of gaining permission to
deliver supplies in the quantities needed. Private clinics and nursing
homes were high on the list of recipients by volume of PPE received,
although the targeted recipients varied between maker groups within each
case. The next tier of recipients varied between cases, with the
following categories uniquely emphasized by informants: first responders
and food pantries (Midburg), individual citizens (Edgeville), poll
workers during the U.S. election and the incarcerated population
(Triport), and local schools (Stilton). Notably, informants from
individual nodes did not always know where their PPE went if they relied
on other parts of the network for distribution.
The lag between the initial recognition of local needs for PPE and
federal EUAs exemplifies the dilemma for institutions between addressing
the immediate void with non-authorized supplies of potentially unknown
quality and origin or waiting for authorized supplies. Many institutions
officially prohibited non-certified PPE, while others did not take an
official stance. Many individual recipients and decision makers within
institutions contended that “anything is better than nothing” when it
came to being equipped with PPE. In our data, recipients’ opinions of
the quality and usefulness of the PPE ranged from viewing it as superior
to traditional supplies to viewing it as inadequate or
counterproductive, although this feedback did not always reach the
makers. In some cities, the negative or lukewarm response from
recipients further heightened makers’ concerns about being perceived as
lacking legitimacy.