“Doctors, nurses and caregivers at smaller and poorer hospitals and medical facilities across the country are still struggling to obtain the protective gear, personnel and resources they need to fight the coronavirus despite President Donald Trump’s repeated assertions that the problems are solved.
Health care workers at all types of facilities scrambled for scarce masks, gloves and other life-protecting gear at the beginning of the pandemic. The White House was letting states wage bidding wars against one another, rather than establish a central national manufacturing, supply and distribution chain.
But now, health care workers say a clear disparity has emerged and persisted. Larger and richer hospitals and practices outbid their smaller peers, sometimes for protective gear, sometimes to fill in staffing gaps. And some of those having the hardest time are precisely where the virus is spreading.”
“Over the past two decades, US health care has come to rely heavily on international suppliers, especially in China, for thousands of essential products, from surgical gowns to syringes. In fact, as of 2019, the US was the largest importer of medical goods — including of personal protective products — in the world.
Over the past few months as the pandemic raged, most US hospitals and health systems have responded by turning to domestic suppliers. They are more reliable given the difficulties with transportation and trade, which have become worse since the pandemic began.
This trend is likely to continue, as hospitals and health care systems try to ensure that they have a steady supply of essential products.
But this new domestic strategy has a particular disadvantage: In general, it is much more expensive. And this puts hospitals — and, potentially, their patients — in greater financial jeopardy.”
“In February, to ensure that the country had adequate domestic supply, the Chinese government took over the production and distribution of medical products. China was not the only country to do this, but because it is a leading global supplier of so many health care products — personal protective equipment (PPE) such as N95 masks, medical devices, antibiotics, and pharmaceutical ingredients, to name a few — the decision had major consequences. In 2019 alone, China supplied a quarter of the entire globe’s face masks.”
“An ongoing problem with PPE is that supplies still aren’t being distributed equally around the country and even within hot spots. Better-resourced hospitals have more supplies while other facilities struggle to find enough.
The federal Centers for Medicare and Medicaid say that one in five Florida nursing homes do not have a one-week supply of gowns or the N95 masks needed to care for Covid-19 patients and prevent transmission. According to WCNC Charlotte, North Carolina ran perilously low on gowns and masks in May even before its recent surge in cases, receiving only 99,000 of the 27 million N95 masks it had ordered. An internal report from the Federal Emergency Management Agency (FEMA) suggests “[t]he demand for gowns outpaces current U.S. manufacturing capabilities” and that the government plans to continue to ask medical staff to reuse N95 masks and surgical gowns intended to be disposed of after one use into July.”
“It’s not only hospitals that need more staff and PPE; many other areas of health care do too, including primary care facilities, homes for the disabled, and nursing homes — a fifth of which reported at the end of May that they had less than a week’s supply of critical PPE.”
“It’s true that by February 23, Trump had restricted travel from China. But the virus was already spreading within the United States. And Trump’s public statements belie the revisionist history he’s now offering about how he took the coronavirus seriously from the beginning.
For instance, during a news conference on February 26, Trump said, “when you have 15 [coronavirus cases], and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.”
But instead of going down “close to zero,” the United States now has nearly 400,000 cases less than two months out from Trump uttering those words. During Tuesday’s briefing, a reporter pressed him on this point.
“When Peter Navarro did circulate those memos, you were still downplaying the threat of coronavirus in the US,” the reporter said. “You were saying things like, ‘I think it’s a problem that is going to go away within a couple of days —’”
“Which I’m right about,” Trump interjected.
The reporter continued: “You said ‘within a couple of days the cases will be down to zero.’”
Given the current magnitude of coronavirus cases in the US, you might think Trump’s comment about coronavirus going away on its own would be too much even for him to try and defend. You’d be wrong.
“Well, the cases really didn’t build up for a while,” Trump replied.”
“Navarro’s memo recommended significant immediate federal investment in personal protection equipment (PPE) for health care workers. But federal agencies largely held off on such expenditures until mid-March, when the crisis was already spinning out of control. Trump’s line on that point has been that states should’ve done more to help themselves.
If Trump really didn’t learn of Navarro’s memo until media reports about it in recent days, it’s an indictment of his administration — after all, you’d expect a top official’s conclusion that as many as 2 million Americans could die from a deadly disease would be worth bringing to his attention. But if he did see it and not only didn’t act but told the public that the coronavirus would go away “like a miracle” as he did on February 27, then in some ways that’s even worse.
What we do know is that, for whatever reason, Trump was indulging in wishful thinking during a critical period in which more proactive measures could’ve saved lives. And as a result, the goalposts have now moved to a point where Trump is preparing to tout as many as 100,000 American deaths as a win.”
“One thing that happened is that after the 2009 H1N1 pandemic there were a lot of masks distributed to states and localities and they simply weren’t replenished. Then there was a plan to purchase thousands more ventilators. A contract was signed with a small medical equipment company in Southern California. That company was then bought by a different medical equipment company, and in the end the contract wasn’t fulfilled. The new ventilators never came in.
So there are these matters of prioritization and inattention that can affect whether in fact we have the supplies that have been recommended in the stockpile.”
“There’s a key period that a lot of people are now focusing on, which is late January to mid-February. This is a point at which we were already aware of what had happened in China, and the World Health Organization had declared Covid-19 a “global health emergency of international concern.”
That was really the time to consider whether we had the supplies we needed of these essential items and to figure out whether the stockpile needed to be replenished rapidly and do whatever it took to make sufficient supplies available — whether that meant purchasing supplies from other sources or even using the DPA to force manufacturers to shift to production of ventilators, for example.
So even if it had not been replenished prior to this administration, there was a chance to do a better job at the outset.”
“Certified N95 respirators are special. Unlike a conventional surgical mask, N95 masks are built so that 95 percent of very small airborne particles can’t get through. These masks also need to be approved by the CDC’s National Institute for Occupational Safety and Health and, depending on the type, the Food and Drug Administration. In order to fulfill those requirements, N95 masks must be constructed so that they seal tightly around one’s mouth and nose, unlike surgical or cloth masks which are loose-fitting.
The United States is now confronted with a shortage of N95 masks for a number of reasons. The masks themselves are difficult to make, in part because they require specialized equipment to meet stringent regulatory standards. Many of the companies that can make the masks are also in China. That supply chain wasn’t prepared for a pandemic, especially one that originated in the same country where many of these masks are produced. And as the novel coronavirus spread throughout China, the country’s government bought its domestically produced masks, ensuring they weren’t exported. That’s made the gap between supply and demand in the US much larger.
In the absence of a pandemic, the US has typically not produced enough of these N95 masks to meet the needs of its own workers. Prestige Ameritech and 3M are the two primary companies that do end-to-end production of medical-grade N95 masks in the US, and both are both ramping up production. Another American company, Honeywell, recently started producing N95 masks at its Rhode Island and Phoenix facilities. Still, these three companies won’t solve our mask shortage.”
“America is suffering from a shortage of almost everything it needs to combat the spread of COVID-19. Hospital beds, ventilators, gloves, and gowns are all in short supply.
That’s particularly true of the N95 masks that help medical professionals avoid catching and spreading the virus as they tend to patients. The N95 designation refers to the ability of these masks to filter out 95 percent of airborne particles.
In early March, the U.S. Department of Health and Human Services (HHS) said that the country’s stockpile of N95 masks was enough to meet about 1 percent of the three billion masks we would need during a true pandemic.”
“government regulations are stifling the ability of manufacturers to set up new N95 mask production facilities—handicapping the private sector’s ability to respond to the current crisis.”
“The production of N95 masks is regulated by the CDC’s National Institute for Occupational Safety and Health (NIOSH). Prospective makers of N95 masks must submit detailed written applications to NOISH, and send finished products to its Personal Protective Technology Laboratory for testing. NIOSH staff must also personally inspect new manufacturing sites before they’re allowed to start pumping out masks.
Chisholm says regulators have told the Open PPE Project that getting agency approval could take anywhere from 45 to 90 days.”
“3M, one of the largest makers of N95 masks, says that it is producing 35 million respirators per month in the U.S. and that within 12 months it plans to double global production capacity to 2 billion masks a year. It also says it is exploring coalitions with other companies to expand mask production further.
Honeywell, another major mask manufacturer, claims it has more than doubled its mask production, according to The New York Times.
That’s a lot of masks, but nowhere near enough to meet the current demands of the country’s medical sector, let alone the demands of other essential workers and volunteers who are out in public right now, potentially dealing with sick people.”
“The world is experiencing a shortage of surgical masks and respirators. Countries around the globe are scrambling to bulk up their mask supplies to help curb the spread of the novel coronavirus and allow medical professionals to safely treat infected patients. It’s crucial for health care workers, doctors, and nurses on the front lines of the disease to have the proper protective gear to lower the risk of contracting Covid-19, but America’s mask supply is being so rapidly depleted that even the Centers for Disease Control and Prevention has suggested homemade masks, like bandanas or scarves, “as a last resort” for health care providers in “settings where face masks are not available.”
Public health officials warned about a strain in the supply chain for masks and other equipment in late February, when the pandemic started to spread in the US, which prompted regular people to snatch up medical supplies. By hoarding masks and respirators, civilians have contributed to the shortage of personal protective equipment (PPE) for health workers. (The US government is also partly to blame for overwhelming the health care system by not taking fast enough action to test citizens.)”
“So why is it so hard to produce new masks? The New York Times reported that China made half of the world’s masks before the outbreak, and while factory production has increased nearly twelvefold, the country has kept most of its inventory as it sought to control the virus. US mask manufacturers are also seeing unprecedented demand for masks, with Prestige Ameritech, the country’s biggest producer, aiming to make 1 million masks a day, compared to an average 250,000 before the pandemic.
Despite these efforts, the short-term future appears grim.”
“Doctors, nurses, and hospital administrators have been warning that they might run out of PPE for weeks now, but the warnings have become more urgent in recent days. For many hospitals, running out of masks is no longer something that “might happen.” The shortage is here.
Among the resources running dangerously low are N95 respirators, the masks that cup the face closely and have been approved by the National Institute for Occupational Safety and Health (NIOSH) to block the inhalation of 95 percent of small airborne particles.
According to NIOSH guidance for extending N95 supply, hospitals should advise their staff to, “discard N95 respirators following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions.” But as the shortage worsens, reusing these masks is becoming the go-to method of preservation.”
” To avoid having to reuse N95 masks, many hospitals are allocating them only to staff members who are directly entering patient rooms — which, in turn, means limiting the number of staff members who enter patient rooms in the first place.”
“”The management is telling the nurses to wear masks that are not N95, even though most of us would feel more comfortable and safer with the N95,” says another nurse, who works at Baptist Health in Miami. “We are trying to fight for what’s right but when the CDC says you can wear a bandana or scarf in the place of a mask, it’s hard,” referring to the CDC’s guidance for optimizing the supply of facemasks. It notes, “In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort.””
” “We are desperate,” said another nurse who works at a New York hospital, who said she had spent her one day off running around collecting donations for PPE. “Please urge anybody who can donate any masks, but most importantly N95s, to do so.””