“As the first alarms sounded in early January
that an outbreak of a novel coronavirus in China might ignite a global
pandemic, the Trump administration squandered nearly two months that could have
been used to bolster the
federal stockpile of critically
needed medical
supplies and equipment.
“A review of
federal purchasing contracts by The Associated Press shows federal agencies
largely waited until mid-March to begin placing bulk orders of N95 respirator
masks, mechanical ventilators and other equipment needed by front-line health
care workers.
“By that time, hospitals in several states were
treating thousands of infected patients without adequate equipment and were
pleading for shipments from the Strategic National Stockpile. That federal
cache of supplies was created more than 20 years ago to help bridge gaps in the
medical and pharmaceutical supply chains during a national emergency.
“Now, three
months into the crisis, that stockpile is nearly drained just as the numbers of
patients needing critical care is surging. Some state and local officials
report receiving broken ventilators and decade-old dry-rotted masks. ‘We
basically wasted two months,’ Kathleen Sebelius, health and human services
secretary during the Obama administration, told AP.
“As early as
mid-January, U.S. officials could see that hospitals in China's Hubei province
were overwhelmed with infected patients, with many left dependent on ventilator
machines to breathe. Italy soon followed, with hospitals scrambling for
doctors, beds and equipment.
“HHS did not respond to questions about why
federal officials waited to order medical supplies until stocks were running
critically low. But President Donald Trump has asserted that the federal
government should take a back seat to states when it comes to dealing with the
pandemic.
Trump and
his appointees have urged state and local governments, and hospitals, to buy
their own masks and breathing machines, saying requests to the dwindling
national stockpile should be a last resort.
“‘The notion
of the federal stockpile was it’s supposed to be our stockpile,’ Jared Kushner,
the president's son-in-law and adviser, said at a White House briefing
Thursday. ‘It’s not supposed to be state stockpiles that they then use.’
“Experts in emergency preparedness and response
have expressed dismay at such statements, saying the federal government must
take the lead in ensuring medical supplies are available and distributed where
they are needed most. ‘States do not have the purchasing power of the federal
government. They do not have the ability to run a deficit like the federal
government. They do not have the logistical power of the federal government,’
said Sebelius, who served as governor of Kansas before running the nation's
health care system.
“Because of the fractured federal response to
COVID-19, state governors say they're now bidding against federal agencies and
each other for scarce supplies, driving up prices. ‘You now literally will have
a company call you up and say, ‘Well, California just outbid you,’ Gov. Andrew
M. Cuomo, D-N.Y., said Tuesday. ‘It’s like being on eBay with 50 other
states, bidding on a ventilator.’
“For nearly
a month, Trump rebuffed calls from Cuomo and others to use his authority under
the Defense Production Act to order companies to increase production of
ventilators and personal protective equipment. He suggested the private sector
was acting sufficiently on its own.
“More than
three months after China revealed the first COVID-19 cases, Trump finally
relented last week, saying he will order companies to ramp up production of
critical supplies. By then, confirmed cases of COVID-19 within the United
States had surged to the highest in the world. Now, the number of people
infected in the U.S. has climbed to more than 312,000 and deaths have topped
8,500.
“Trump spent January and
February playing down the threat from the new virus. He derided warnings of
pandemic reaching the U.S. as a hoax perpetrated by Democrats and the media. As
the World Health Organization declared the outbreak a global public health
emergency on Jan. 30, Trump assured the American people that the virus was ‘very
well under control’ and he predicted ‘a very good ending.’
“His administration was so confident that
Secretary of State Mike Pompeo announced on Feb. 7 that the government had
airlifted nearly 18 tons of donated respirator masks, surgical masks, gowns and
other medical supplies to China.
“On Feb. 24,
the White House sent Congress an initial $2.5 billion funding request to
address the coronavirus outbreak. The next day, federal health experts at the
Centers for Disease Control and Prevention warned that the virus was spreading
quickly in the U.S. and predicted that disruptions to daily life could be ‘severe,’
including school and business closures. Unfazed, HHS Secretary Alex Azar told
lawmakers on Feb. 27 that ‘the immediate risk to the American public remains
low.’
“During those crucial early weeks when the U.S.
could have been tracking the spread of the disease and containing it, hardly
anyone was being tested after a series of federal blunders led to a shortage of
tests and testing capacity, as AP reported last month. Without data showing how
widespread the disease was, federal and state governments failed to prepare.
“By the middle of March, hospitals in New York,
Seattle and New Orleans were reporting a surge in sick patients. Doctors and
nurses took to social media to express their alarm at dwindling supplies of
such basic equipment as masks and gowns.
“Trump
accused some Democratic governors of exaggerating the need and derided those
that criticized the federal response as complainers and snakes. ‘I want them to
be appreciative,’ Trump said on March 27.
“At the
start of the crisis, an HHS spokeswoman said the Strategic National Stockpile
had about 13 million N95 respirator masks, which filter out about 95% of all
liquid or airborne particles and are critical to prevent health care workers
from becoming infected. That's just a small fraction of what hospitals need to
protect their workers, who normally would wear a new mask for each patient, but
who now are often issued only one to last for days.
“Trump during a White House briefing on March
26 claimed that he had inherited an ‘empty shelf’ from the Obama
administration, but added that ‘we’re really filling it up, and we fill it up
rapidly.’
“Federal purchasing records, however, show the Trump administration
delayed ordering additional supplies until the virus had taken root and was
spreading. HHS first announced its intent to purchase 500 million N95 masks on
March 4, with plans to distribute them over the next 18 months. The following
day, Congress passed an $8.3 billion coronavirus spending bill, more than three
times what the White House had originally asked for.
“Eight days later, on March
13, Trump declared the outbreak a national emergency. That was almost six weeks
after the WHO's action. By then, thousands of U.S. schools had closed, the
National Basketball Association had put its season on temporary hiatus and
there were 1,700 confirmed cases of COVID-19 in the country.
“The government had already
sent tens of thousands of masks, gloves and gowns from the stockpile to
Washington state, which was hit early with a coronavirus outbreak. But state
officials even then said the supplies weren't enough.
“Federal contracting records
show that HHS had made an initial order March 12 for $4.8 million of N95 masks
from 3M, the largest U.S.-based manufacturer, which had ramped up production
weeks earlier in response to the pandemic. HHS followed up with a larger $173
million order on March 21, but those contracts don't require 3M to start making
deliveries to the national stockpile until the end of April. That's after the
White House has projected the pandemic will reach its peak.
“On Thursday, Trump
threatened in a Tweet to ‘hit 3M hard’ through a Defense Production Act order,
saying the company ‘will have a big price to pay!’ He gave no specifics.
“HHS declined this past week
to say how many N95 masks it has on hand. But as of March 31, the White House
said more than 11.6 million had been distributed to state and local governments
from the national stockpile — about 90% of what was available at the start of
the year.
“Dr. Robert Kadlec, the
assistant secretary for preparedness and response at HHS, testified before
Congress last month that the country would need roughly 3.5 billion N-95
respirators to get through the pandemic, but the national supply chain then had
just about 1% of that amount.
“Greg Burel, director of the
Strategic National Stockpile from 2007 until his retirement at the start of
this year, said the cache was only ever intended to serve as a short-term ‘bridge-stock.’
“The stockpile was created in
1999 to prevent supply-chain disruptions for the predicted Y2K computer
problems. It expanded after 9/11 to prepare for chemical, biological,
radiological and nuclear attacks. Congress provided money in 2006 to prepare
for a potential influenza pandemic, though Burel said much of that stock was
used during the H1N1 flu outbreak three years later.
“‘There’s never enough money
to buy everything that we want to see on those shelves,’ said Burel, who
stressed the stockpile uses its annual funding to prepare for a wide array of
potential threats. ‘Most of the time, commercially available products like
masks can be bought in quantity at the time of an event.’
“This time, it hasn’t worked
out that way. As AP reported last month, much of the world’s supply of N95
masks and other basic medical supplies is made in China, the first nation hit
by COVID-19. As a result, the Chinese government required its producers to
reserve N95 respirators for domestic use. China resumed exports of the
precious masks only in recent days.
“Experts
are now worried the U.S. will also soon exhaust its supply of ventilators,
which can cost upward of $12,000 each. The White House said Tuesday that it had
already distributed nearly half the breathing machines in the stockpile, which
at the beginning of March had 16,660; some of them dated back to the flurry of
post-9/11 purchasing. An additional 2,425 were out for maintenance.
“Cuomo
said New York may need as many as 40,000 ventilators to deal with the outbreak
that is already overwhelming hospitals there. Throughout March, governors and
mayors of big cities urged Trump to use his authority under the Defense
Production Act to direct private companies to ramp up production of
ventilators. It wasn't until last week that Trump finally said he would use
that power to order General Motors to begin manufacturing ventilators — work
the company had already announced was underway. But GM says its first
ventilators won’t be available before the summer.
“The federal government had
made an effort to prepare for a surge in the need for ventilators, but it was
allowed to languish. Since 2014, HHS has paid a private company, Respironics
Inc., $13.8 million to develop a cheaper, less complicated ventilator that
could be bought in bulk to replenish the national stockpile. In September, HHS
placed a $32.8 million order with the Dutch-owned company for 10,000 of the new
model, set for delivery by 2022, federal contracts show.
“Respironics' parent company,
Royal Philips, said it's planning to double U.S. production of ventilators to
2,000 a week by the end of May. Steve Klink, a spokesman for Royal Philips in
Amsterdam, said the company is now focused on producing its other commercial
models and will deliver the first ventilators to the national stockpile by
August, long after the White House projects COVID-19 cases will peak.
“Trump, who pledged on March
27 that his administration would ensure that 100,000 additional ventilators
would be made available ‘within 100 days,’ said on Thursday that he'll use the
Defense Production Act to order Respironics and other ventilator makers to step
up production.
“It's not clear that Trump's
order would translate into the 100,000 new ventilators he promised. In a House
Oversight and Reform Committee briefing last week, top Federal Emergency
Management Agency officials hedged, saying 100,000 ventilators would be
available by late June ‘at the earliest.’
“Cuomo predicted on Friday
that New York would run out within days. With coronavirus deaths in his state
surging, the governor vowed to use his authority to seize ventilators, masks
and protective gear from private hospitals that aren’t utilizing them.
“Meanwhile, federal health
authorities are lowering standards. New guidance from the Food and Drug
Administration allows hospitals to use emergency ventilators typically used in
ambulances and anesthesia gas machines in place of standard ventilators. The
agency also said nightstand CPAP machines used to treat sleep apnea and snoring
could also be used to keep coronavirus patients breathing, as a last resort.
“The CDC advised health care
workers last month to use homemade masks or bandanas if they run out of proper
gear. Across the country, hospitals have issued urgent pleas for volunteers who
know how to sew.
“President Trump provided his
own input, suggesting that Americans without access to factory-produced masks
could cover their faces with scarves. ‘A scarf is highly recommended by the
professionals,’ Trump said during a White House briefing Wednesday. ‘And I
think, in a certain way, depending on the fabric — I think, in a certain way, a
scarf is better. It’s actually better.’”
Associated
Press writers John Hanna in Topeka, Kansas, and Ricardo Alonso-Zaldivar
contributed to this report.
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