It’s a ten hour drive from the Bronx to Morganton, in the Appalachian Mountains of western North Carolina. But, desperate to acquire more personal protective equipment, Morganton is where Adria Powell found a source of reasonably-priced face masks that would be suitable for use in home health care.
Powell is CEO of Cooperative Home Care Associates, based in the Bronx. It’s the largest worker-owned cooperative in the country, with 1,000 worker-owners as well as another 1,200 home care workers, nurses, and other staff on its payroll. She started at the company in 1993, and has been CEO since 2017.
“Lots of people are seeing the strain of COVID-19 on hospitals and nursing care facilities, but not a lot of people are seeing the strain on home care services,” Powell says. But strained they are. “About 300 of our workers are on quarantine watch because they have symptoms of COVID-19 or have been providing care to folks who later tested positive.”
Some clients are simply going without home care services for now, whether to save money or for social distancing purposes. Powell estimates with lost hours served, the cooperative’s revenues are down about 15 percent — a temporary downturn the company could probably otherwise take, if not for the fact it also has been ramping up spending in order to acquire the necessary PPE to keep providing home health care safely for the 1,000 or so of their clients who can’t go without it.
Powell says a box of gloves that went for $39 before the crisis is now going for $139. She also estimates they go through about 2,000 face masks per week. Hospitals and nursing homes get first dibs on any PPE procured by the city or the state. Powell isn’t complaining about that, but it does leave home care companies mostly to fend for themselves out on the market.
“We need more masks, need more gloves than we’ve ever needed before. Face shields, gowns, thermometers, it’s just ballooned,” Powell says. “In order to protect our workers, we could be bankrupted.”
In mid-March, Powell put in a call to Morganton, to another key player she knew in the worker-owned cooperative space — Molly Hemstreet, who in 2008 co-founded Opportunity Threads. With 45 workers, it’s currently the largest worker-owned cut and sew facility in the country. It turned out Opportunity Threads was already working with a network of small manufacturers in western North Carolina to respond to PPE needs in the region.
By the end of March, the first shipment of 500 face masks came up to the Bronx. Another 500 the following week. Powell hopes to be ordering 1,000 washable, limited-reuse masks per week from western North Carolina — at a cost of less than $5 per mask. Each box of masks comes with proper washing and care instructions, in Spanish and English. She’s also procured 500 face shields and 500 disposable gowns from the same North Carolina suppliers.
“The beauty of it was, since Opportunity Threads was already in connection with this regional health system, they had the doctors and the folks who were vetting the masks being made,” Powell says. The idea was to replicate the standard hospital face mask, not N95 masks.
Western North Carolina has a history of being a textile production hub going back to at least the 1800s. Cotton produced in the state was taken up to the mountains where watermills provided initial power, and later, coal mined nearby would power the industrial capacity that helped position the region as a key supplier for the Confederate Army during the Civil War.
While western North Carolina has not been immune to the globalization of the textile industry that hollowed out garment manufacturing in places like New York City, North Carolina statewide still has more than 600 textile manufacturers, employing 27,500 people, according to the state’s economic development agency.
In 2013, Opportunity Threads came together with a dozen or so companies in the region to form the Carolina Textile District. The idea was to operate as a single point of contact for brands and other clients outside the region to tap into the entire region’s supply chain of mill owners, pattern makers, label producers, cut and sew facilities and other suppliers without having to go around and negotiate with each individual company.
In 2015, Hemstreet co-founded The Industrial Commons, an umbrella nonprofit to administer the Carolina Textile District and run a range of other programs to support and cultivate smaller and sustainable textile manufacturers in the region, especially those that empower workers.
In early March, local doctors in Morganton and other regional health care facilities reached out to the Carolina Textile District about producing PPE for health care workers in the region. Doctors, nurses and others in the region helped test prototypes and provide other guidance to the manufacturers on the right materials and right design.
Then, The Industrial Commons secured a $300,000 grant from the Appalachian Regional Commission to purchase supplies and equipment and provide some working capital to pay for labor and other costs to get PPE production started. Established by an act of Congress in 1965, the commission is a regional economic development agency that represents a partnership of federal, state, and local governments across 13 states.
To satisfy the demand for PPE, the Carolina Textile District had to reach far beyond its 14 current members to build a new supply chain for masks. So far, at least 60 other small manufacturers representing 600 workers in the region are all somewhere in the process of being integrated into supply chains for face masks. Carolina Textile District is also organizing other supply chains for face shields, gowns and booties, including some of the same manufacturers.
Sewing shops, which can be as small as five or fewer people, need to make a set of sample products first to show they can maintain the uniform quality standards before being integrated into the main production line. Through The Industrial Commons, Hemstreet is overseeing the onboarding of sewing shops.
Every cutting or sewing shop has a unique set of skills and specialities, often based on the machines it has in-house. Jimi Combs is owner of Tsuga, a 15-person cut and sew facility and a member of the Carolina Textile District. After going through the sample product specs, his assessment was his company would be better suited using its two big Eastman cutting machines to cut the specialized fabric patterns and then send those off to the smaller sewing facilities for final assembly.
“We said we’re not as good with lighter fabrics so let us cut and let the others sew,” Combs says.
Combs says Tsuga can cut up to 25,000 face mask patterns in five days at Tsuga, given other work orders they do still have coming in. Those other orders include 4,000 one-time use surgical respirator masks per week that Tsuga is cutting and sewing entirely in-house as part of the Carolina Textile District.
“The key for me is, I want to keep my employees off unemployment, get them a paycheck, get them out of the house a little bit, keep my doors open and my lights on,” Combs says.
Physical and mental health are huge concerns, of course.
“Luckily we had just moved into a much larger facility in July so we weren’t on top of each other like we used to be,” Combs says. “Once this all started we adjusted the floor plan to spread out even more, employees wear masks at all times, and no one else is allowed into the facility.”
Combs says employees clean their work area and equipment with hydrogen peroxide at least three times a day, and late at night his son, also employed full-time at Tsuga, goes through and disinfects the facility after-hours. They’re running two shifts a day, 7-3 and 3-11.
Combs also says he’s encouraging his employees to take mental health days off. One employee he noticed was having a rough week, he sent home for the rest of the week and told him to come back Monday.
Tsuga is running weekend shifts as well, and offering overtime pay for it. Combs says he’s not forcing anyone to come in on the weekend, but he tries to be as honest as he can about the situation. Weekend shifts now mean money in employees’ pockets that can help cover for later.
“If one of us comes up symptomatic, I personally will want to shut the shop down for at least two weeks for everyone’s safety,” Combs says. “I say we don’t know what Monday holds for us so be thinking and taking care of yourselves. We’re offering overtime pay, you can take the hours, and next week we might not have anything.”
As part of the upfront cost, the Industrial Commons also has two couriers hired to safely transport supplies between cutting facilities, sewing facilities, and the temporary distribution facility housed in a warehouse space donated by EJ Victor, a furniture company in Morganton. From there, the final PPE gets shipped off, mostly to health care facilities in the region, but also to the Bronx.
The production goal for face masks is 30,000 a week, and they’re taking bulk orders (minimum of 1,000) as well as retail orders for as little as one pack of five reusable masks for $25. The last week of April, the collaboration produced 47,000 masks. Out of the $5 price per mask (or slightly less than that for bulk orders), Carolina Textile District says $2.75 goes to pay workers.
The masks have not been tested for approval by the FDA, “but may be used when FDA-cleared masks are unavailable,” according to the Carolina Textile District. Housed on the 13th floor at the worker-owned cooperative’s headquarters in the Bronx, the clinical nursing department of Cooperative Home Care Associates deemed them suitable for home health care worker use.
So far, a parallel campaign to raise donor funds for PPE has covered all of the Bronx cooperative’s mask orders so far, according to Powell.
“It was a great collaboration and it got us some masks, but it’s not the amount of masks that we need, we still need more,” Powell says. “Navigating and managing the suppliers out there are just ridiculous, the prices are extraordinary and still going up.”
The story of this partnership doesn’t mean federal, state or local governments are off the hook for doing more to meet the PPE needs that remain unmet. This one partnership isn’t nearly enough, not even for just one home care company’s needs.
But what this story does show is how an interconnected network of small but highly specialized firms was able to reorient and reorganize themselves into an entirely new supply chain in just a few weeks — almost as fast as the economic disruption from the pandemic itself. And some federal government funding did in fact play a key role in getting the ball rolling on that shift.
But it also begs the additional question of what policies or forces might lead to having more of these smaller manufacturer networks around the country.
“It’s the little guys that are making all this shit happen,” Combs says. “We’re all losing money here, but we’ve got to come together to help the whole. The smaller businesses can always turn things around fast, we’re able to turn our ships around more quickly than a bigger company.”
This article is part of The Bottom Line, a series exploring scalable solutions for problems related to affordability, inclusive economic growth and access to capital. Click here to subscribe to our Bottom Line newsletter. The Bottom Line is made possible with support from Citi Community Development.
Oscar is Next City's senior economics correspondent. He previously served as Next City’s editor from 2018-2019, and was a Next City Equitable Cities Fellow from 2015-2016. Since 2011, Oscar has covered community development finance, community banking, impact investing, economic development, housing and more for media outlets such as Shelterforce, B Magazine, Impact Alpha, and Fast Company.