The Department of Health and Human Services listed 19 companies that have received contracts under the Defense Production Act to produce emergency supplies, including 600 million N95 respirators and face masks. But experts say it is not enough and that the effort started too late.
Only about half of the masks ordered will be delivered later this year.
It’s a problem that experts say could have been avoided. A former Defense Department official told CNN that the administration wasted months by not acting aggressively enough with the DPA from the start, making it impossible to keep up with the lawsuit.
“I think that a much more aggressive and earlier use of the Defense Production Law, probably in the February time frame, would have saved many of the anguishes we are seeing right now regarding the shortage of PPE across the country. “said Kelly Magsamen, a former Pentagon official who served as chief director of the National Security Council for strategic planning during the Obama administration.
In addition to awarding more contracts, Magsamen says, the government could have more aggressively used other mechanisms within the DPA, such as tax exemptions or loan guarantees, to further incentivize companies to speed up production.
“The fact that there is no top-down organized federal response fast and fast enough, I think, has put us in a position where essentially everyone is catching up, including the Trump administration,” said Magsamen.
White House business adviser Peter Navarro defended the administration’s strategy. “We have not hesitated to use the Defense Production Law when necessary,” he said. “One of the beauties of using the Defense Production Law when necessary is that it has reduced the need to invoke it because we get a voluntary contribution.”
The White House has been reluctant to take an overly active role in managing the production and distribution of supplies, and it is up to the states instead. President Donald Trump says states have everything they need – a point that Vice President Mike Pence echoed during a coronavirus briefing last week. Pence also said the administration will issue a renewed guide on the preservation and reuse of personal protective equipment.
Everything is done little to inspire confidence among those on the front line.
‘Fragile and overloaded’
Multiple healthcare organizations with hospitals at or near current hot spots, including Jackson Health System in Miami, Methodist Houston and Arizona-based Valleywise Health, told CNN that they currently have enough equipment to protect their workforces. But others have warned of more serious situations.
The National Center for Assisted Living, an industry group, discovered in a survey of its members in June that more than half of assisted living facilities had supplies for less than two weeks of specific protective equipment.
David Voepel, CEO of the Arizona Health Care Association, which represents skilled nursing facilities and assisted living communities, told CNN that many healthcare facilities in his state have faced challenges because, unlike networks of hospitals and skilled nursing facilities, had no contracts or lines of communication established with distributors prior to the pandemic.
“The problem is that hospitals absorb more of that personal protective equipment and larger contracts will get personal protective equipment, while assisted living communities won’t get as much,” said Voepel, noting that many living communities assisted women are still forced to reuse personal protective equipment. .
Nurses are in a similar position, despite management comments that the hospital’s capacity remains strong and that states have everything they need in terms of supplies.
Cortez described situations where a lack of adequate supplies is putting nurses at the forefront of the pandemic in greater danger.
In particular, Cortez says that some nurses in Florida are wearing N95 masks that are not tested. “That is really putting nurses at risk,” he says, because those masks do not form the seal around the nose, mouth, and chin that would allow the mask to protect the wearer from the virus.
The EPP shortage has already begun to have an adverse impact. Cortez summoned a nurse in Los Angeles who rushed, simply wearing a surgical mask, to help a coronavirus patient who had stopped breathing.
“So far, we have 148 nurses who died from the coronavirus, simply because they did not have adequate PPE,” Cortez said, noting that that number is just what was reported to his union and that the actual number of deaths of nurses is likely. make it bigger.
A spokesperson for Banner Health, a Phoenix-based health network with 28 hospitals in the western United States, said it currently has an adequate supply of most protective equipment, but that challenges are fluctuating and has recently There has been a shortage of disposable robes. To address the problem, the organization implemented reusable cloth robes.
“Our supply chain has been disrupted in recent months, and we expect this to continue during the pandemic,” said the spokesperson.
Nancy Foster, vice president of the American Hospital Association for patient safety and quality policy, said the protective equipment supply chain remains “fragile and overloaded” due to global demand.
“While overall we would say the availability of PPE supply has improved, it is still fragile,” said Foster, who said nitrile gloves, isolation gowns, and smaller N95s remain a challenge. Foster said the American Hospital Association continues to advocate that the federal government use DPA to further increase supply.
Dr. Susan Bailey, president of the American Medical Association, said she heard from doctors across the country that her biggest challenge in reopening her practices is the shortage of protective equipment. Bailey said her organization has urged the Trump administration since March to implement a coordinated national strategy on the production, acquisition and distribution of PPE supplies.
Fierce competition
An industry source with knowledge of medical equipment supply chains told CNN that the search for equipment is expected to continue to be fiercely competitive in the coming weeks and months, particularly as school systems, the hospitality industry and others enter the protective equipment market.
Manufacturers have increased production, but some warn that keeping pace with demand is difficult.
“While we are manufacturing more respirators than ever before, the reality is that the demand for respirators continues to exceed supply. This is a challenge for the entire industry,” said Tim Post, a spokesman for 3M, which he says is producing N95 respirators to a rate of over 50 million per month in the United States.
The U.S. Centers for Disease Control and Prevention has released a guide on reusing N95 masks, but the nurses who spoke to CNN argued that the rate at which they are reusing the masks has left them vulnerable.
Michelle Brum, a nurse working in Hyannis, Massachusetts, and co-chair of a nurses union, said that months after the virus outbreak, her hospital continues to keep N95 respirators closed to prevent staff from using them beyond the allotted amount.
“They give you a mask and they want you to reuse that mask multiple times,” he said. “The way they trained us is that you use it once; when you leave that patient’s room, you take off the mask and throw it away.”
CNN contacted health departments or other administrative agencies in all 50 states to see how they were doing with personal protective equipment. Twenty-four states responded. Most said their states have adequate PPE in their stocks, but six (Missouri, Tennessee, Ohio, Minnesota, Vermont, and Alabama) added that N95 masks are still difficult to acquire.
“Although we have heard that hospitals receive some of the manufacturers, we cannot obtain them for the state purchase, and we understand that other health care providers cannot obtain them in many cases,” said a spokesman for the Missouri Department of Health and Seniors. The services said, referring to the N95 masks.
A spokesperson for the Minnesota Department of Administration said that in addition to the challenges of acquiring N95 masks, there is a projected shortage of nitrile gloves. Although the state has about 40 million gloves waiting for delivery, hospitals in the state wear nearly 1 million each day. “Use rates and the tightening of international supply chains are raising concerns about gloves in the short term,” the spokesperson said.
“The Trump administration has not yet addressed the broader supply chain problems. We still depend on foreign manufacturing and we are compelled to compete in the global market,” said Casey Katims, a federal liaison for Washington state.
CNN’s Nelli Black and Tara Subramaniam contributed to this report.
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