The Trump administration’s failure to stock up on PPE in the early days of the pandemic has left front-line medical workers at risk.
Celia Marcos was faced with a split-second decision when her COVID-19 patient stopped breathing: She could rush into the room wearing only her flimsy surgical mask—risking her own health—or she could use valuable time that could save the patient’s life to get a more protective N95 mask, which was locked away.
Marcos chose the former, and died 14 days later. Her coworkers at the Hollywood Presbyterian Medical Center in Los Angeles told the LA Times that Marcos wasn’t provided an N95 mask at the beginning of her shift because of a shortage. Hospital officials disputed this claim.
Marcos’ story underscores the consequences of the shortage of N95 masks, gowns, and other personal protective equipment (PPE) that medical workers have had to contend with during the coronavirus pandemic. Because of the Trump administration’s failure to stock up on masks and other PPE before the pandemic and its slowness in ramping up production after the scope of the crisis became clear, front-line healthcare workers risk contracting the deadly virus.
More than 9,000 healthcare workers had contracted the coronavirus as of April 14, the CDC reports. The real number is likely much higher.
President Trump, however, has refused to acknowledge the scarcity of PPE—despite the fact that his own administration has admitted there’s a “severe” and “widespread shortages” of personal protective equipment (PPE), ventilators, and COVID-19 testing supplies.
The federal government also had numerous opportunities to better prepare for the pandemic—as early as January and February before the crisis swept the country, according to several media reports.
In fact, federal officials had the opportunity to have a private manufacturer produce an additional 1.7 million N95 masks a week beginning in late January, the Washington Post reported over the weekend. They did not take the company up on its offer.
On Jan. 22, Michael Bowen, the head of a Texas medical supply company, wrote an email to top administrators in the Department of Health and Human Services, offering to produce an additional 1.7 million N95 masks a week. Bowen’s overture came as he was receiving requests for orders from abroad, some from as far away as Hong Kong, the Washington Post reported. Bowen wanted to give the federal government first crack at his services.
“We still have four like-new N95 manufacturing lines,” Bowen wrote. “Reactivating these machines would be very difficult and very expensive but could be achieved in a dire situation.”
Bowen felt he was brushed off by HHS officials, who didn’t appear interested. But he was worried about the spare level of domestic production of medical masks and followed up again the next day.
“We are the last major domestic mask company,” he wrote on Jan. 23. “My phones are ringing now, so I don’t ‘need’ government business. I’m just letting you know that I can help you preserve our infrastructure if things ever get really bad. I’m a patriot first, businessman second.”
The Trump administration did not accept Bowen’s offer and Bowen’s production lines, which could make more than 7 million masks a month, remain offline to this day.
Bowen’s proposal was described briefly in an 89-page whistleblower complaint filed last week by Rick Bright, former director of the Biomedical Advanced Research and Development Authority. Bright said he was demoted because he tried to “prioritize science and safety over political expediency,” and because he issued dire warnings about COVID-19 and the dangers of hydroxychloroquine, a malaria drug that Trump was championing without evidence.
Bright issued internal warnings about the mask shortages and wrote to a deputy that Bowen’s warnings “seem to be falling on deaf ears.” Emails obtained by the Washington Post show that Bright even warned Robert Kadlec, the assistant secretary for preparedness and emergency response, about the PPE shortages.
On Jan. 26, Bowen wrote to Bright: “U.S. mask supply is at imminent risk.” The next day, he followed up again. “Rick, I think we’re in deep s—,” he said.
Bright wasn’t the only Trump administration official sounding the alarms. On Feb. 5, Health and Human Services Secretary Alex Azar asked the Office of Management and Budget for $2 billion to replenish the depleted federal stockpile, also known as the Strategic National Stockpile. By the time the White House sent its supplementary budget to Congress, that number had been slashed by 75% to $500 million. Azar’s colleagues in HHS had also previously spent over a year arguing with White House budget officials over money to buy more stockpile supplies.
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A few weeks later, another high-ranking federal official warned that the United States did not have enough PPE for medical workers. The warning, issued via an email chain and first reported by Kaiser Health News, was sent to senior officials in the Department of Veterans Affairs, the State Department, the Department of Homeland Security and the Department of Health and Human Services, as well as outside academics and state health officials.
“We should plan assuming we won’t have enough PPE—so need to change the battlefield and how we envision or even define the front lines,” Dr. Carter Mecher, a physician and senior medical adviser at the Department of Veterans Affairs, wrote on Feb. 25.
Mecher’s warning came one day after President Trump reassured the American public that the coronavirus was “very much under control” and two days before Trump publicly said the U.S. was “totally prepared” to deal with the disease.
These warnings underscore a grim fact about the PPE shortage: The government should have seen it coming. “Every serious look at US pandemic readiness and global pandemic readiness has identified PPE shortages as a major issue,” Jeremy Konyndyk, senior policy fellow at the Center for Global Development, told Vox. “This is a known issue. We’ve seen it before.”
The Obama administration, which oversaw the response to the H1N1 outbreak in 2009 and the 2014 Ebola scare, prepared a 69-page playbook to help future administrations address future pandemics. Written by Obama’s National Security Council and finalized in 2016, the playbook detailed strategies for when and how to obtain protective equipment and included recommendations on how the government should move quickly to detect and contain potential outbreaks and secure additional funding. It even suggested possibly invoking the Defense Production Act, a Korean War-era law that gives the president enormous power over industry, to compel private companies to produce needed medical supplies.
The Trump administration ignored the playbook. Instead, as the Associated Press reported, the Trump administration wasted nearly two months that could have been used to bolster the federal stockpile of critically needed supplies and equipment.
During the months of March and April, state and local officials repeatedly called on the federal government to address the shortage by sending supplies from the national stockpile, but federal agencies 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.
That delay, and what followed, proved devastating. While the federal government finally began purchasing masks in March, it also tried to pass the buck to states on the matter of PPE, rather than invoke the Defense Production Act—which only the president can invoke—and lead a coordinated effort.
Instead, Trump said the federal government was merely a “backup” and that it was up to states and their governors to find PPE. “Try getting it yourselves,” Trump told the nation’s governors on March 16.
Having little alternative, states tried to procure their own equipment, only for the federal government to interfere and make it more difficult.
“When the federal government told us that we needed to go it ourselves, we started procuring every item we could get our hands on,” Michigan Gov. Gretchen Whitmer said in March. “What I’ve gotten back is that vendors with whom we had contracts are now being told not to send stuff here to Michigan. It’s really concerning.”
The federal government also confiscated three million masks that Massachusetts Gov. Charlie Baker, a Republican, had ordered for his state.
It wasn’t until early April, two months into the crisis, that Trump finally used the Defense Production Act to compel a handful of private companies, including 3M, to produce desperately needed PPE. This slow, scattershot, patchwork response has left doctors and nurses disillusioned. One ER doctor in Pennsylvania told Vox that the situation was a “total clusterfuck.”
At Hollywood Presbyterian Hospital in Los Angeles, where Celia Marcos worked and died, things have begun to change. Staffers have demanded better protections and some have even refused to work without proper gear, according to the LA Times. Supervisors are providing more PPE and staffers are now allowed to bring their own masks from home, a nurse at the hospital told the Times. “I love my job, but I’m not trying to die a hero,” she said.
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Proper protections may finally be being provided at Hollywood Presbyterian, but shortages remain elsewhere, and those changes weren’t implemented quickly enough to save Marcos’ life.
Marcos died on April 17, not long after telling her colleagues-turned-caretakers: “I don’t want to die.”