As coronavirus cases in Washington state mounted and the country’s first death was announced Saturday, health authorities scrambled to get more specialized masks for front-line clinicians who need to protect themselves from the highly contagious disease.

Washington state authorities sent an urgent request for 233,000 respirators and 200,000 surgical masks to be released from the federal government’s Strategic National Stockpile. The stockpile is a repository of drugs and supplies for deployment in major public health emergencies, such as an infectious disease outbreak.

Within 24 hours, Washington state’s liaison to the federal government, Casey Katims, was told his state would get assistance. But it would be less than half the amount they requested — 93,600 N95 respirators and 100,200 surgical masks.

“They did not tell us the reason for why they were fulfilling half the request,” Katims told The Washington Post.

Gov. Jay Inslee (D) has declared a state of emergency. By Thursday, the case count rose to 70, up from 39 on Wednesday, with a another fatal case in King County, in the greater Seattle area, bringing the death toll in Washington state to 11.

After lawmakers criticized the shortages in recent days, the official at the Department of Health and Human Services in charge of coordinating materials for the stockpile announced Thursday that Washington state would receive more masks.

“A second shipment is arriving today,” Robert Kadlec, the assistant secretary of health for preparedness and response, told the Senate Homeland Security and Government Affairs Committee. The state will be getting the remainder of its request.

Washington’s experience highlights one of the country’s biggest gaps in preparedness for battling the respiratory virus that causes the disease known as covid-19. The United States has about 1 percent of the 3.5 billion respirators that experts estimate the health-care system needs a year to fight a severe influenza pandemic. That translates to 12 million N95 respirators and 30 million surgical masks, Health and Human Services Secretary Alex Azar has said. An additional 5 million N95 respirators may be expired, he has said.

Underfunded public health departments and budget-conscious health systems don’t keep large volumes of masks and other supplies in reserve for the possibility of a pandemic. Since the coronavirus outbreak, major U.S. hospital systems have been burning through their supplies of N95s, in part because federal protocols call for them to be thrown out after a single use in required practice sessions, health-care leaders have said. Some hospitals have just a week’s inventory of the tightfitting N95 face masks, which filter out 95 percent of all airborne particles.

State and local officials rely on the federal stockpile for public health emergencies. But the federal government has not maintained the more than 1,000 items at the fullest levels in the stockpile. Biodefense experts blame bureaucracy and a lack of funding. Experts have also disagreed on the best way to replenish items because many supplies, including masks, have limited shelf lives. N95 masks last between five to six years, experts say.

The outbreak has focused new attention on some of the critical shortages.

“Who is in control of the stockpile?” Sen. Ron Johnson (R-Wis.), chairman of the Senate Homeland Security and Government Affairs Committee, asked Kadlec on Thursday. Ultimately, it’s Azar, Kadlec said.

Kadlec, whose office is supposed to coordinate stockpile inventory and purchases among several governmental agencies, said some people have been “fixated by what we can buy, what we can afford to buy, rather than what we need.”

Johnson said Congress needs to review the existing inventory and how much should be spent, and acknowledged it will require legislation and appropriation.

Biodefense experts say it’s not simply a matter of buying more masks.

“Those things have expiration dates and they are not good forever,” said James Lawler, an infectious disease and biosecurity expert at the University of Nebraska Medical Center. “If you buy a ridiculous amount of them, it’s a tremendous amount of money … the life cycle cost is enormous. It’s not a reasonable expectation that we are going to have enough for a nationwide pandemic.”

The stockpile was never intended to provide 100 percent of the necessary medical countermeasures indefinitely during a pandemic, said Ali Khan, dean of the College of Public Health at the University of Nebraska Medical Center and a former top public health preparedness official at the Centers for Disease Control and Prevention. The federal government shouldn’t make decisions that would “bankrupt America,” he said.

But officials need to explain what data, evidence and strategies are behind decisions on deploying material from the stockpile. “Someone needs to say, this is what the national data are on the current reserves, this is what we have in the supply chain, and this is where we can fill in the gaps with the SNS until routine market forces take over,” Khan said. “We have lots of agencies who know how to count things. Maybe they can work on ‘this is what is being made.’”

In recent days, Trump administration officials have rushed to get more masks. Vice President Pence visited Minnesota on Thursday and met with officials at 3M, a major manufacturer of N95 respirators. He credited 3M with increasing capacity of N95 respirators, but added, “we think there’s work to be done” alluding to other producers and steps that can be taken.

Asked about the concern over the mask shortage, Pence said: “We are ready today, but we want to be ready tomorrow.” Pence went on to Washington state later Thursday to meet with officials overseeing the coronavirus response.

Late Wednesday night, HHS announced it would be buying 500 million N95 respirators over the next 18 months for the stockpile, “part of a broader effort to maximize the availability of personal protective equipment for health care workers who are on the front lines” fighting spread of the virus. In such large volumes, the cost should be less than $1 per mask, experts say. A few weeks ago, customers could buy two N95s at Walmart for under $6.

N95 respirators are the masks recommended by the CDC for front-line health-care workers. They are more expensive than the loosefitting and more common surgical masks and must be custom-fitted over a person’s nose, cheeks and chin.

Hospital officials said the lack of N95 respirators poses a serious problem for the ability of caregivers and other workers to do their jobs during a respiratory disease outbreak.

“I think it shows that we need to start considering what we’re going to do if we run out of respirators,” said Lauren Sauer, who oversees emergency preparedness for Johns Hopkins Medicine Health System and the Johns Hopkins Health System. “We need to start seriously considering how we’ll conserve these resources now, while we can. I think there will not be enough respirators for a protracted covid-19 response and we need to have contingency plans.”

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