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Scramble for medical equipment descends into chaos as U.S. states and hospitals compete for rare supplies

With prices rising and supplies uncertain, governors and health-care officials are urging the Trump administration to use the Defense Production Act to bring order

The Washington Post spoke to doctors throughout the country who say shortages of medical equipment and supplies could cost lives. (Video: The Washington Post, Photo: Kolin Pope/The Washington Post)

A mad scramble for masks, gowns and ventilators is pitting states against each other and driving up prices. Some hard-hit parts of the country are receiving fresh supplies of N95 masks, but others are still out of stock. Hospitals are requesting donations of masks and gloves from construction companies, nail salons and tattoo parlors, and considering using ventilators designed for large animals because they cannot find the kind made for people.

The market for medical supplies has descended into chaos, according to state officials and health-care leaders. They are begging the federal government to use a wartime law to bring order and ensure the United States has the gear it needs to battle the coronavirus. So far, the Trump administration has declined.

“I can’t find any more equipment. It’s not a question of money,” said New York Gov. Andrew M. Cuomo, whose state is battling the nation’s worst outbreak. “We need the federal help and we need the federal help now.”

At best, Cuomo said, his team has secured enough protective gear for health workers to last a few weeks. It’s been unable to buy most of the 30,000 ventilators it estimates it will need to keep hospitalized patients breathing at the peak of the crisis, he said.

Amid the coronavirus pandemic, New York Gov. Andrew M. Cuomo said March 22 that President Trump should "order factories to manufacture" medical equipment. (Video: New York state)

His pleas are echoed by others, including the American Medical Association, Illinois Gov. JB Pritzker and Democratic presidential candidates Sen. Bernie Sanders (I-Vt.) and Joe Biden, who have called on the Trump administration to use the Defense Production Act to order companies to mass produce medical supplies. The law, enacted during the Korean War, allows the government to require companies to manufacture certain goods and to pay them for it.

Although governors and hospital leaders welcome the many U.S. companies stepping forward to make masks and ventilators, they fear the voluntary efforts will be too scattershot without federal coordination.

“When we went to war, we didn’t say, any company out there want to build a battleship? Who wants to build a battleship?” Cuomo said.

President Trump and his trade adviser, Peter Navarro, have repeatedly said they don’t need to force companies to produce under the Defense Production Act because so many manufacturers are volunteering to make medical supplies. Trump seemed to acknowledge the chaos on Tuesday, however, calling the world market for masks and ventilators “crazy” in a tweet, adding that it was “not easy” to acquire them.

But he also tweeted that he hasn’t had to use the Defense Production Act “because no one has said NO! Millions of masks coming as back up to States.” In a briefing Tuesday evening, Trump added: “Companies are heeding our call to produce medical equipment and supplies because they know that we will not hesitate to invoke the DPA in order to get them to do what they have to do. It’s called leverage.”

Early Tuesday, Peter Gaynor, the head of the Federal Emergency Management Agency, told CNN the government planned to use the DPA to acquire 60,000 coronavirus test kits. But later, FEMA Press Secretary Lizzie Litzow said the agency “at the last minute” had been "able to procure the test kits from the private market without evoking the DPA.”

In the meantime, states and hospitals are describing extraordinary efforts to secure equipment. In a briefing this week, Pritzker said he had a team of people working the phones seven days a week trying to buy medical supplies all over the globe. He asked nail salons, tattoo parlors and elective surgery centers to donate their stockpiles of masks and gloves while they are closed for business.

Pritzker said his team has made progress, including a big purchase of 2.5 million N95 masks, the government-certified masks that can screen out small particles and that are favored by health-care workers dealing with the virus. But he said his team is “running up against obstacles that shouldn’t exist,” including orders by other states and the federal government.

In conversations with ventilator makers, one company “told me I was competing with FEMA to get ventilators,” Pritzker said. “I called another manufacturer of ventilators, and he pointed out to me that I would be competing with countries other than the United States. … I better put in as big an order as possible in order to put myself higher on the list of priority.”

Pritzker also called on the White House to use the Defense Production Act to centralize the buying process.

W. Craig Fugate, the FEMA administrator under President Barack Obama, said in a phone interview Sunday that the response should be led by governors but directed and funded by the federal government. That includes a more coordinated process for buying and distributing supplies so that states and the federal government can stop trying to outbid one another, he said.

Rhonda Medows, president of population health management at Providence St. Joseph Health, a chain of hospitals and clinics based in Seattle that spans seven states, said her health system is considering requesting veterinary ventilators used to treat large animals because it is concerned that it will not have enough ventilators designed for humans.

“We have Third World countries who are better equipped than we are now in Seattle,” she said in an interview. “For weeks we have been asking the federal government to compel manufacturers to produce more [personal protective equipment] because we knew from our own modeling that there would be a serious shortfall.”

Soaring demand and competitive bidding is driving prices up. Premier, a health-care company that purchases equipment and supplies for 4,000 acute-care hospitals, used to pay about 30 cents for an N95 mask but is now seeing prices between $3 and $15 per mask, Group Vice President Chaun Powell said in an interview.

The United States typically uses up to 25 million of the masks a year but is on track to use four times as many over the next year, he said.

“There has been a global run on production. And there’s been a decrease in supply … after factories in Wuhan closed” he said, referring to the Chinese manufacturing city where the coronavirus outbreak originated late last year.

Some of the hardest-hit hospitals are using between four and 10 times as much equipment as two weeks ago, according to David Gillan, a sourcing operations executive at Vizient, an intermediary that helps more than 3,000 hospitals and other health-care centers purchase supplies.

His company is “vetting any source that even makes a noise” to find masks. His team managed to find 500,000 N95 masks last week from a source he did not disclose, which Vizient then helped 37 hospitals acquire, an amount he said hardly met the need.

Some hospital systems said they remain hopeful about their access to supplies. That includes Tufts Medical Center in Boston, which began in February to cache and conserve critical supplies as the coronavirus spread outside China and around the globe.

Tufts is also part of a broader network of hospitals that purchase products in bulk, said Nicholas Duncan, its director of emergency management. “If we continue down this path of conserving [personal protective equipment] appropriately … we shouldn’t run out,” he said.

Tamara West, vice president of patient services and chief nursing officer at Noyes Health, which runs a hospital and other facilities in Upstate New York, said that the network is in “good shape” for now but that she worried about rising costs for supplies and possible shortfalls if coronavirus infections rise sharply.

On Sunday, Noyes Health officials asked the community via Facebook to donate spare masks and “equipment to protect them over the long haul.” Construction companies sent unused masks — N95 masks are also used for industrial work — and food-service workers shipped over gloves because “nothing’s open,” West said.

Noyes Health workers are “being very careful in when they wear PPE, and I’m afraid they’re being too careful and not wearing when they should. They could get sick because of that,” West said.

Voluntary manufacturing efforts are multiplying by the day, sometimes in coordination with the White House. General Motors announced a partnership with Ventec Life Systems, a Seattle-based company that makes ventilators, to help it step up production.

“We are working closely with Ventec to rapidly scale up production of their critically important respiratory products to support our country’s fight against the COVID-19 pandemic,” General Motors Chairman and CEO Mary Barra said in a statement Friday.

Navarro in recent days also helped strike a deal with a group of U.S. T-shirt makers to convert manufacturing lines to produce millions of protective masks.

HanesBrands is making a thick cotton fabric for the masks and distributing it to sewing factories for stitching. The Food and Drug Administration has determined that the masks may be used in a health-care setting, though not in a surgical setting, the agency said in an emailed statement.

“FDA has given Hanes a pathway forward to manufacture and distribute these face masks during the COVID-19 emergency response,” the agency said.

Bayard Winthrop, founder of the clothing company American Giant, said the mask-sewing effort required a complete retooling of the company’s manufacturing lines in North Carolina, which typically make T-shirts and sweatshirts.

The company has stopped production of much of its normal clothing, he said. “It’s been very disruptive but also an easy decision to make,” he said. “The message we are getting out of Navarro’s office is, make as many as you can, as fast as you can, as long as you can.”

Winthrop said he is “honored” to help health-care workers. But he added: “I don’t think American Giant ought to be in the mask-producing business. I think it’s crazy we are in this situation and I hope it is causing all of us to ask the question, why we have so thoroughly lost the ability to make things in this country.”