Damian Dovarganes / AP
When the first crush of COVID-19 sick people arrived at the Montefiore Medical Center in the Bronx, Benny Mathew According to the managers, two N95 masks and other nurses were issued to him per week. Instead of throwing protective masks after treating contagious patients, they stored them in paper bags.
“There is no way you can’t get it if you work in the emergency room with absolute minimum protection,” Matthew told NPR. He tested positive for COVID-19 on March 21 and said that many of his colleagues fell ill at work.
“Some of them stayed in the hospital for almost a week,” he said. “The nurses carried the virus home and made their partners, their children and their parents sick. “
According to the Centers for Disease Control and Prevention, at least 9,000 front-line nurses and other medical workers have contracted COVID-19. Federal agencies say dozens of nurses and other caregivers have died.
NPR wanted to understand how this situation came about. How did the world’s best funded health system end up sending nurses to rooms full of people with a mysterious new respiratory virus without basic personal protective equipment?
The first warning signs appeared in early February, weeks before the COVID-19 eruption in the United States. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, then warned of a “serious disruption” in the PPE supply chain.
“The demand is up to 100 times higher than normal,” said Tedros. “There are depleted stocks and arrears of four to six months. Global stocks of masks and respirators are now insufficient to meet needs. “
The United States is dependent on this same global supply chain, and some frontline medical workers appeared to be concerned.
“Our main concern is that healthcare employers are unprepared,” said Bonnie Castillo, executive director of National Nurses United, the country’s largest nursing union.
In an interview with NPR in late February, Castillo said his organization had interviewed nurses working in hospitals across the country. They reported a disturbing lack of personal protective equipment.
“Only 30% of nurses say there are enough supplies in stock,” said Castillo.
During these crucial first weeks of the pandemic, President Trump sent a different message, downplaying the threat of COVID-19 in the United States.
“In April or the month of April, heat in general kills this type of virus,” Trump said on February 10. “So it would be a good thing. But we are in great shape in our country. “
The hospitals also seemed confident.
“Everyone I have spoken to has taken substantial steps to ensure they are prepared,” said Nancy Foster of the American Hospital Association in an interview with NPR in late February.
But NPR found that as the coronavirus moved to the United States, many federal agencies were aware that a shortage of PPE was on the horizon. The CDC has started urging hospitals to ration masks and gowns. The CDC and other federal agencies have also relaxed safety guidelines, allowing the re-use of PPE and allowing hospitals to use approved masks for construction workers.
Meanwhile, NPR has found that little effort has been made to increase the overall supply of masks, gowns and other PPE. As Chinese factories closed, the Trump administration still did not report a “widespread shortage” of medical supplies in the United States. On February 27, 20 days after the WHO announced its warning, the United States Food and Drug Administration issued a public notice recognizing that COVID-19 “would likely have an impact on the product supply chain medical ”.
Even then, in late February and early March, little effort was made to increase domestic production of personal protective equipment to supplement the scarce supplies overseas. In an interview with NPR last week, Foster of the American Hospital Association acknowledged that hospitals are slow to grasp the magnitude of the problem.
“I think what we have not anticipated as fully as we should have been is that a pandemic like this would generate global demand,” she said.
Foster said hospitals have urged Trump to use his authority under the Defense Production Act to force companies “to really increase this country’s ability to make PPE”, but this request from the AHA and other health care groups did not take place until March 21, long after the rationing of masks and robes began.
The Trump administration sporadically used the Defense Production Act during this crisis and instead worked with companies on a voluntary basis. The Federal Emergency Management Agency also moved in late March and early April to buy more masks and dresses abroad, often competing with hospitals and states for the same scarce equipment. In late March, Trump suggested that adequate supplies of PPE already existed and were stolen or misused.
“I don’t think it’s a hoarding,” he told reporters. “I think it may be worse than hoarding. “
NPR has found no evidence of theft or misuse of PPE. Efforts to increase supplies only started weeks after the first warnings were issued, and government efforts to find new suppliers were often confused, opposing the agencies.
On April 8, the Trump administration announced that the national stock of protective equipment was 90% depleted and the remaining supplies would be kept in reserve. The hospital industry recognizes that even today, “critical” PPE shortages persist. Meanwhile, the Federal Department of Veterans Affairs hospital and clinic system still uses “austerity” measures to ration masks and gowns.
Castillo of National Nurses United, who sounded the alarm about PPE in February, said the nurses were angry. She said she feared a second wave of COVID-19 patients would strike before hospitals were ready.
“Nurses are not afraid to take care of our patients if we have the right protections,” she said. “But we are not martyrs sacrificing our lives because our government and our employers have not done their job. “