Healthcare providers across the country are asking how they can access strategic stockpiles of critical equipment, bracing for the possibility of a shortage as the influx of patients grows amid the coronavirus outbreak.
Personal protection equipment meant to keep nurses and doctors healthy is already in short supply in some parts of the country, and as warnings from federal health officials suggest the spread of the novel coronavirus will get worse before it gets better, providers are expressing a growing fear that their needs could outrun demand in the coming weeks.
“The state desperately needs N95 masks, gowns, and gloves brought into the community,” Dr. Scott Lindquist told ABC News’ affiliate station in Washington State. “I think there is some indication we’ll get some. I just don’t think it’ll be enough fast enough."
Nearly a dozen state health officials reached by ABC News expressed varying degrees of concern about resource levels if the disease spreads. None of them anticipated having enough equipment in the event of a spike in transmissions.
In response, health officials in several states – from Washington State to Delaware -- have tapped the federal government for access to a network of storage facilities scattered across the country that houses the “largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out,” according to a page on the Department of Health and Human Services website.
It’s known as the Strategic National Stockpile (SNS), and for national security purposes the number of warehouses and their locations remain a secret. Its contents include pre-packed and transport-ready containers for delivery anywhere in the United States within 12 hours of a federal decision to deploy.
Federal agencies boast the stockpile “contains enough supplies to respond to multiple large-scale emergencies simultaneously,” but with states already sending in requests, that assurance is being put to the test.
In a statement to ABC News, HHS confirmed it “has received requests from multiple entities and is obtaining additional information regarding their intended use of the requested personal PPE.”
“Our goal is to prioritize the use of stockpiled PPE for the protection of health and medical personnel,” the statement read.
The results of a shortage of personal protective equipment could be consequential. Emergency response professionals explained that a lack of medical equipment is exactly the type of stress on the healthcare system that could launch COVID-19 from a manageable virus to a national crisis.
“I worry about the availability and the need for protective gear,” said Tom Bossert, a former Homeland Security advisor and ABC News contributor. “I worry about our healthcare providers who are in the trenches because any one of them could end up suffering an onslaught of more demand than they have supply. And in a medical capacity when that happens, people can die – and often do.”
In congressional briefings this week, federal health officials acknowledged a possible lack in critical personal protective equipment, or PPEs, including N95 respirator facial masks -- devices meant to filter airborne particles. The Department of Health and Human Services (HHS) has already announced its intention to procure an additional 500 million N95 masks, but as the disease permeates communities, those on the front lines cannot afford to wait.
“Emerging diseases like COVID-19 are a pressing occupational hazard for many workers on the front lines, especially healthcare workers,” read a letter from National Nurses United to the Center for Disease Control (CDC) last week. “Now is the time to use every possible tool available to guarantee the highest level of protection.”
In light of those concerns, several state officials told ABC News they have already been in touch with the Strategic National Stockpile for support.
Delaware state officials have ordered a 120-day supply of PPE from the Strategic National Stockpile. In Louisiana, a state official reported that companies it normally uses for PPE needs is on back order due to high demand.
In Missouri, officials said the state’s own stockpile contains 300,000 N95 respirators. But when the outbreak began, all of those masks were expired under the manufacturers’ warranty. After consulting the CDC and federal guidelines, the masks were determined safe for distribution. Still, Missouri has sought additional PPE from the Strategic National Stockpile, and officials learned Thursday that its request would be fulfilled.
While Missouri and other states have fared well with their orders from the stockpile, some states have been informed they would only receive partial orders.
In Washington, for example, where more deaths have been reported than any other state, officials only received half of their requested order of N95 masks last week. The remainder of that order was ultimately released after public outcry from lawmakers. Officials in Washington made a second request for PPE on Sunday and were told on Monday it would be fulfilled.
In Rhode Island, a state official said the Strategic National Stockpile has approved only a quarter of its request for 530,000 N95 masks.
“The reality is the National Stockpile alone is not going to be able to meet the demands of the full emergency nationwide,” said one state official who has been in touch with federal overseers of the stockpile.
“We’re working productively with them, we have a good relationship with them,” the official said, “but there are certain realities about the supply that are going to pose some long-term challenges. And it’s clear that can’t be the only place we’re looking to get supplies as a nation.”
Federal officials appear to recognize that reality. As part of their efforts to avoid gear shortages, government administrators are leaning on private sector manufacturers to scale up production of the most important equipment – and engaging other industries in a search for creative solutions.
A source who works closely with the HHS office responsible for overseeing the Strategic National Stockpile said federal officials have been in discussions with some manufacturers about repurposing equipment used in other industries for medical uses. HHS officials even floated the idea of modifying masks used in the automotive or industrial paint industry to meet medical needs, the source said.
Meanwhile, medical supply industry leaders are ploughing forward with their more traditional products.
The Minnesota-based conglomerate 3M, for example, has ramped up global production, running shifts 24-hours a day, hiring new workers, and activating more production lines, earning praise from Vice President Mike Pence.
Owens & Minor, another industry leader in PPE production, told ABC News it has also invested additional resources to expand the manufacturing capacity for N95 respirator masks.
Companies with an overseas footprint, however, have struggled with supply chain issues. Medline, another major PPE manufacturer, suffered a setback when its facilities near Wuhan closed down during the Chinese coronavirus outbreak. Those factories were scheduled to be back up and running this week.
“As numerous efforts are being undertaken within China to prevent further spread of the novel Coronavirus, we are seeing some impact on manufacturing operations,” read a statement from Medline earlier this month. “Restrictions on exporting certain items such as facemasks and other personal protective equipment (PPE) potentially could lead to a reduction in capacity or delayed shipments for these items throughout the industry.”
A spokesperson for Cardinal Health, another manufacturer with a footprint in China, said the company shifted production for an item of protective equipment to two sites in other countries.
As the private sector scrambles to meet demand, the federal government has sought to ease guidelines in an effort to streamline production and preserve existing equipment. The U.S. Trade Representative has agreed to ease tariffs on certain medical equipment imports, and the CDC has suggested limited reuse of N95 masks in the event of a shortage.
While industry insiders commended government agencies for their quick response, some criticized their preparedness. After the 2009 H1N1 outbreak, for example, the stockpile’s reserves of N95 masks was largely depleted, according to Charles Johnson, president of the International Safety Equipment Association.
“To our industry’s knowledge there has not been a significant effort to re-stock the stockpile since then, and we have called for that several times,” Johnson said.
“Our industry will do everything we can to fulfill the orders, but it’s not the same thing as preparedness,” Johnson added. “Preparedness will be getting that National Stockpile re-stocked in the future so that we are better prepared to respond to the next outbreak.”