The federal government is preparing guidance on how hospitals should function if they run out of supplies and equipment, a precaution and an acknowledgment that some medical facilities could be overwhelmed by the rapidly escalating covid-19 pandemic.
As the country taps the strategic national stockpile and ramps up efforts to produce more protective equipment for health-care workers, Giroir said, he hopes that day never arrives. But he acknowledged it could and said the government needs to be ready.
In recent days, White House officials have solicited advice from emergency physicians, officials in the state of Washington who handled the first deadly outbreak of the coronavirus that causes covid-19 and others about the previously unthinkable prospect of health-care workers without masks, eye shields and ventilators, according to seven people inside and outside the administration with knowledge of the discussions.
William Jaquis, president of the American College of Emergency Physicians, said federal officials have asked him and his colleagues to “talk through strategies” for what hospitals could do if faced with total depletion of personal protective equipment.
“In terms of options, there aren’t good ones,” he told them.
The deliberations reflect desperate reports from health-care workers in New York and elsewhere that they are reusing masks, switching to less effective methods, quickly running out of ventilators and barely keeping up with a crush of patients.
At a Long Island hospital, employees have been instructed that they each will receive one mask and must take care of it themselves because it “will not be replaced on a daily basis,” according to a memo shared with The Washington Post.
“Do not assume a replacement mask will be available and take care of your mask accordingly,” the memo advises.
At a Northern Virginia hospital, clinical staff said they are reusing old masks for the day or even the week and storing them in brown paper bags after cleaning them. Several workers said they were threatened with termination if they did not comply.
At Beth Israel Lahey Health, which has several locations in metropolitan Boston, workers were told to wear surgical masks and N95 respirators “for as long as they can tolerate” and to save them in special bins while the hospital system looks at ways to sterilize them.
At Harper Hospital in Detroit, food service workers who bring trays to patients’ rooms said they had been told not to use gloves and masks as they normally do because of the shortage.
Terri Hooks, who works there, said several of her co-workers were told they were in contact with a patient who may have the coronavirus. She said people were crying and worried for their families.
“We don’t know who has it or anything. To me, I feel that we all have been exposed,” she said.
Giroir said the administration is taking a separate approach to ventilators, the breathing machines that help critically ill patients breathe when their covid-19 disease becomes severe. No hospital, he said, can afford to run out of them or have a shortage of people who know how to use them.
“We need to make sure they don’t run out,” he said.
He said only New York, experiencing the country’s worst outbreak, is pressing for large numbers of additional ventilators.
Though health-care workers are always heavily affected in any outbreak of infectious disease, the administration’s coronavirus task force understands that supply shortages are among its biggest problems at the moment, according to two people familiar with the discussions who spoke on the condition of anonymity. It was a topic in a task force meeting Friday, they said.
The behind-the-scenes scramble over supplies is at odds with the increasingly reassuring posture the coronavirus task force has adopted when it briefs the media and public each day. On Friday, Vice President Pence, the task force’s leader, emphasized efforts to find supplies for hospitals and their workers.
“On the subject of medical supplies, we continue, at the president’s direction, to pursue every means to expand the supply of personal protective equipment for the extraordinary and courageous health-care workers that are ministering to the needs of people impacted by the coronavirus,” Pence said. “We have a policy of procuring, allocating, as well as conserving the resources that we have in our system.”
The task force has compared the need for ventilators, masks and other protective equipment against the current supply and knows the nation is far short, the people said. More discussion and efforts to boost supply are expected this weekend. The Centers for Disease Control and Prevention has guidance on its website for how hospitals can stretch out the use of equipment such as eye protections, gowns and masks.
Most disturbing for some people is the idea that the wealthiest nation in the world is leaving its caregivers unprotected in this crisis because it did not plan for it and wasted precious weeks before responding.
CDC Director Robert Redfield heard from Chinese counterparts on Jan. 3 that a spreading respiratory illness could be caused by a novel coronavirus. Redfield told Health and Human Services Secretary Alex Azar, who sought to immediately notify the White House National Security Council, according to four senior administration officials who spoke on the condition of anonymity to discuss internal government actions. Azar briefed Trump on Jan. 18 about the virus, but the president was said to be quickly disinterested. The CDC, HHS, National Institutes of Health, State Department, National Security Council and other agencies and aides began meeting to discuss the virus in January.
Yet Trump and several of his aides were reluctant to take the virus seriously until the first confirmed U.S. case surfaced on Jan. 21, according to two senior administration officials. Trump continued to downplay the threat of the virus until this month.
Not until the first week of March did the administration and Congress agree to an $8.3 billion supplemental spending bill to address the outbreak, wasting weeks that could have been used to respond to equipment shortages, the four officials said. Some in the White House were hesitant to appropriate significant funding out of fear of spooking stock markets or being viewed as alarmist, they said.
Hospitals want advice they can implement, including how to move patients, increase the number of intensive-care beds, set up triage space and find resources when supplies are running out, said Lauren Sauer, director of operations for the Johns Hopkins Office of Critical Event Preparedness and Response.
But ventilators are crucial because hospitals need specially trained workers to operate them. “Not any nurse can do it,” she said. “You need respiratory therapists and critical-care nurses with vent management experience.”
Lack of clarity from the White House has been frustrating, she said. “It feels like every decision that is being made from the administration is the first decision they’ve had to make on this.”
Some vendors of equipment such as cleaning supplies and beds critical to accommodating a surge of patients are insisting on cash payments. But with federal recommendations to reduce elective surgeries, some hospitals are reporting they have limited revenue coming in or are unable to pay up front.
Supplies are arriving intermittently. With New York City hospitals possibly in the worst shape, Gov. Andrew M. Cuomo tweeted Saturday that “we are sending 1 million N95 masks to New York City. 500,000 N95 masks will go to Long Island. We are purchasing 6,000 additional ventilators and gathering supplies from every source we can get.”
And when a small delivery of protective equipment arrived at an Everett, Wash., hospital last week, it was “met with elation and joy,” said Ali Santore, group vice president for government affairs at Providence St. Joseph Health in the state, where hundreds of suspected coronavirus patients are hospitalized.
The Federal Emergency Management Agency is now leading the response effort, with one group dedicated to supplies. Trump said at a Saturday briefing that companies, such as clothing manufacturer Hanes, are retrofitting facilities to make masks and other critical material. He pointed repeatedly to efforts to obtain more masks, including an order of 500 million that HHS placed earlier this month. But even under prodding from Trump, other officials could not say when the masks will reach hospitals.
“They’re out there now. We’re trying to match supply with demand,” said acting FEMA chief Peter T. Gaynor.
But as the number of infected people expands exponentially in some places, planners around the country are turning to workarounds that occasionally recall volunteer efforts during wartime.
Pence on Saturday called on businesses with masks and N95 respirators in their storage rooms to “load them up and drive them to your local hospital.” He said that is already happening around the country. He also urged dentists to make their supplies of surgical masks available to hospitals.
After Providence St. Joseph fashioned its own protective equipment from hospital surgical wrap and material purchased at fabric and hobby stores, the health system enlisted the aid of a local furniture store to produce 100,000 kits containing those supplies. Those are being sent to volunteers with sewing machines around the country, who will fashion them into surgical masks and ship them back to the hospital system in prepaid envelopes.
The “million mask challenge” was started “as a grass-roots effort, and we have been overwhelmed by the support,” Santore said. The system has more volunteers than it needs. As a country,“how we were set up was not designed to respond to this public health crisis.”
Shirley Wang in Iowa City contributed to this report.
