Trump’s coronavirus team says supplies are coming. The question is where to send them
The Trump administration says it has purchased plenty of medical supplies in response to the coronavirus outbreak. Hospitals are still complaining of shortages. The difficulty is in matching the two.
The challenge at hand, according to White House officials, is not necessarily purchasing more material, but building a system that can identify which individual hospitals need what specific equipment and when.
The Trump administration only began tracking those needs in a comprehensive, data-driven way two weeks ago, well into the pandemic and up against the first wave of cases set to overwhelm New York City.
President Donald Trump appointed Admiral John Polowczyk at that time to lead a coronavirus supply chain task force at the Federal Emergency Management Agency.
Days into the job, he said, “I, as leader of FEMA’s supply chain task force, am blind to where all the product is.”
Polowczyk on Thursday said he had spent the past 13 days collecting data from states and U.S. territories on the volumes they need of each item, in order to get a comprehensive picture of what will be required where and at what stage in the rolling crisis.
FEMA had now set up a “supply chain tower,” Polowczyk said, using data from seven major distributors of health equipment and based on a Defense Department system formerly used “to manage a supply chain for a very complex weapon system.”
That control center will now track orders being fulfilled down to the county level, but the goal is to acquire data down to the hospital level, he said.
“It’s a matter of distribution to need,” Deborah Birx, the White House coronavirus task force coordinator, said this week.
“Every county will move through this differently, and that allows us to move around these vital issues that protect the frontline healthcare workers and protect the patients, through the ventilators, to make sure that the supply chain is aligned with the need as it happens,” she said.
COLLECTING DATA
The federal government is trying to catch up to unprecedented demand that consecutive administrations warned would be inevitable in the event of a once-in-a-century pandemic: shortages of virtually every item required to combat the outbreak.
That extensive list of material begins with tests, diagnostic equipment, gloves, gowns and masks, and ends with beds, ventilators and oxygen.
None of those tools were stockpiled at the capacity necessary to handle a pandemic of this scale – a problem that Trump said in March was “unforeseen.”
“There’s never been an instance like this where no matter what you have, it’s not enough,” he said.
Some of the material – including half of all respiratory masks produced worldwide before the crisis hit – are manufactured overseas. One of the many decisions that confronted Trump in recent days was whether to focus on ramping up U.S. production or convince foreign governments facing their own outbreaks, such as China, to export those items.
Other equipment, such as ventilators, take time and significant funding to produce. Roughly 13,000 ventilators that were stored for years in the National Strategic Stockpile require upkeep, and approximately 2,000 of those have been found to no longer work.
Several critical items have supply chains of their own, requiring multiple parts that have been bottlenecked in production.
The earliest tests that were made available to state laboratories to detect whether patients had COVID-19, for example, required chemical reagents that were in shorter supply than the tests themselves. In some hospitals, where testing kits were available, health care workers experienced shortages of the pipe tips, masks and gloves required to perform them.
Trump initially told governors to try and find material on their own. But that prompted confusion over whether local governments were meant to report their purchases back to Washington. States started competing with each other in the private marketplace that later forced the federal government to intervene.
After weeks of pressure from state officials and members of Congress, Trump this week used the Defense Production Act to compel a number of companies to produce masks and ventilators.
But the administration has only achieved a thorough sense of the national need in recent days.
In total, Vice President Mike Pence said this week that the federal government had “distributed more than 11.6 million N95 masks, more than 8,100 ventilators around the nation, millions of face shields, surgical masks, and gloves.”
Additionally, dozens of cargo planes were scheduled to arrive over the coming days with international shipments of commercial equipment not in the existing hospital supply chain – available for purchase, Polowczyk told reporters at a media briefing.
But while the administration is taking credit for increasing equipment production, and for the construction of a supply chain tower to direct deliveries, Trump and his aides are also repeating their refrain that states – not the federal government – are primarily responsible for obtaining the medical material they need.
“We’re a backup, we’re not an ordering clerk,” Trump said.
Jared Kushner, the president’s son-in-law and senior adviser, said at the media briefing that federal equipment was not meant to be stockpiled for use by the states – and questioned whether governors were, in fact, making requests based on demonstrated needs.
“He wanted us to be very rigorous, to make sure we were studying the data, collecting data,” Kushner said. “A lot of things in this country are happening very quickly, and we want to make sure that we’re trying to keep updating our models and making sure that we were making informed decisions and informed recommendations based on the data.”
“Some governors you speak to or senators, and they don’t know what’s in their state,” Kushner added.
VENTILATOR BACKLOG
Many of the items in short supply are relatively easy to make.
The administration received “dozens” of offers from textile and fashion companies, such as Ralph Lauren and Brooks Brothers, to produce gowns, gloves and body bags that do not require elaborate retrofitting of their factories and warehouses, a White House official said.
The federal government has largely deferred to state and local officials to find additional beds on their own through the rental of empty hospitals, dormitories, or other similar facilities.
FEMA reported to members of Congress this week that only a fraction of those simpler items had been delivered to states in need.
Offering numbers for some of the equipment provided to Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia, FEMA said that less than 10% of the requested face masks, less than 1% of gloves, and no body bags had been provided as of April 1.
Respirator masks for health care workers and ventilators for severely ill patients still pose the greatest challenge for the supply chain task force.
The Trump administration says it has partnered with 11 manufacturers to produce ventilators and compelled several major companies – including General Motors, General Electric, Hill-Rom, Medtronic, ResMed, Royal Philips, and Vyaire Medical – to expedite production with the authorities of the Defense Production Act.
But states are being told that the vast majority of ventilators currently on order will not be produced until June, after the first wave of cases hit hospitals in the nation’s existing hotspots.
Even those hospitals with ventilators on hand are running out of the oxygen required to use them.
While the National Strategic Stockpile has delivered thousands of ventilators to states, 10,000 remain in reserve, Trump said, for rapid, last-minute deployments to sudden regional outbreaks as the unpredictable crisis unfolds.
“We have requests for ventilators in hospitals and in states and cities that don’t need them, in our opinion. They don’t need them. They won’t need them at the top. So we’re holding it back for flexibility,” he said. “But we have close to 10,000.”
The Trump administration argues that the stockpile is so low because the vast number of ventilators on order are being directly shipped, as of next week and on a rolling basis, to the areas of need, instead of to the stockpile itself.
After the first “waves” of patients pass in the coming days, cities like New York, which should see cases taper off, will be able to provide their ventilators no longer in use to other cities and states facing their own case surges at different times.
That shared use policy could eliminate the need to produce the exact number of ventilators requested of each state and locality.
“You know, a ventilator is a very precious piece of equipment right now,” Trump said. “It’s hard to make. It takes a long time to make it. It’s complex.”
This story was originally published April 3, 2020 at 1:07 PM with the headline "Trump’s coronavirus team says supplies are coming. The question is where to send them."
