The absence of coherent guidelines from the White House has created a battle among states and hospitals, which have been hooked into bidding wars over key provisions to combat the coronavirus pandemic, driving up their prices and raising worries that regions in desperate need of immediate aid, like New York City, could be squeezed out and patients left to die.
What is not working, political and public health leaders on the front lines say, is the current, scattershot approach which appears to rely on shaky verbal commitments from major companies, which can turn around and shop for higher prices, and rich individuals, who do not have a clear view of where the greatest need for life-saving equipment resides.
Governors, members of Congress, reality TV stars and private business leaders are all swimming in the void.
Elected officials, like those in New York, have been pleading publicly for President Donald Trump to intervene as the price of medical equipment soars. Georgia GOP Rep. Doug Collins, identifying competition abroad, asked the State Department Tuesday to “impose a temporary ban on all exports” of crucial testing and diagnostic supplies, along with personal protective equipment and more.
The search for resources and provisions has grown increasingly frantic over the past few days, as Trump refuses to exercise his powers under the Defense Production Act, which allows him almost unilateral authority to redirect private industry toward work in the public interest. By leaving the supply chain open to such a wide variety of potential buyers, including the federal government itself, the officials tasked with providing tools to health care workers are being either outbid or overrun by competing interests.
“It is a challenge,” Beshear said. “The federal government says ‘states, you need to go find your supply chain’ and then the federal government ends up buying from that supply chain.”
After more than a week of tamping down his rhetoric in a bid not to ruffle the President, New York Gov. Andrew Cuomo on Tuesday sounded the alarms and argued that, contrary to the rumblings coming from the White House, businesses would welcome the contracts – and cash – that come with a presidential directive.
“I need the ventilators in 14 days. Only the federal government has that power. And not to exercise that power is inexplicable to me,” Cuomo said. “Volunteerism is nice and it is a beautiful thing, and it’s nice that these companies are coming forward and saying they want to help. But that is not going to get us there.”
Trump, during his daily news conference hours later, showed no inclination to take further action under the auspices of the Defense Production Act, saying it was already working as “leverage” with industry leaders.
Cuomo, along with other governors who have been underwhelmed by initial deliveries from the federal government, skewered the limited stock he’s received from officials at the Federal Emergency Management Agency, as the state races the clock to obtain critical medical equipment.
“FEMA is sending us 400 ventilators. I saw it on the news this morning. ‘We are sending 400 ventilators to New York.’ 400 ventilators? I need 30,000 ventilators,” Cuomo said. “You want a pat on the back for sending 400 ventilators? What are we going to do with 400 ventilators when we need 30,000 ventilators? You’re missing the magnitude of the problem, and the problem is defined by the magnitude.”
Rather than address Cuomo’s material concerns, Trump on Tuesday during a virtual town hall with Fox News instead criticized the governor for not ordering more ventilators years ago, before the coronavirus crisis.
“We are building in hospitals, we are building … medical centers, and he was complaining – we are doing differently more than anybody else,” Trump said. “(Cuomo) was talking about the ventilators. But he should have ordered the ventilators, and he had a choice. He had a chance.”
Later in the day, New York Mayor Bill de Blasio said at a news conference that the number of ventilators directed to the state had been upped to 4,000, with half headed to the city – an increase from previous reports, but still far short of requests from Cuomo and medical experts.
Fears transcend partisan divide
The anxiety does not simply run down partisan lines.
Earlier in the day, Rep. Liz Cheney, a conservative Republican from Wyoming, rejected Trump’s suggestions he would “open up” the country in a couple of weeks in a bid to revive the economy.
“There will be no normally functioning economy if our hospitals are overwhelmed and thousands of Americans of all ages, including our doctors and nurses, lay dying because we have failed to do what’s necessary to stop the virus,” Cheney tweeted.
But her message didn’t land.
Trump doubled down Tuesday afternoon on his claim that he wants the country “opened up and just raring to go by Easter,” just over two weeks from now – or about the amount of time that White House coronavirus task force member Dr. Deborah Birx said out-of-towners who have recently visited New York should self-quarantine.
State leaders from Iowa to New Mexico, and Oklahoma to Virginia have been sounding similar alarms over dwindling or difficult to restock medical supplies.
Oklahoma Secretary of Health and Human Services Jerome Loughridge told reporters during a briefing that the state will be out of personal protective equipment in nine days. He added that a private company was now chipping in 3D printing abilities to manufacture valves for ventilators.
Rhode Island Gov. Gina Raimondo told reporters that her state is building its own supply chain network “to scour the world to find all the supplies we need in order to do the testing.”
“Every state is vying for the resources. Frankly, every country. Most countries are vying for the same resources, so it’s a challenge,” said Raimondo, a Democrat.
Oregon is facing a similar crunch.
“Both in our requests for personal protective equipment from the national stockpile and our conversations with private suppliers,” Oregon Gov. Kate Brown’s press secretary, Charles Boyle said, “we find ourselves competing with larger states with more immediate needs due to the size and scope of their COVID-19 outbreaks: New York, California, Washington, and others.”
In his Tuesday letter to Secretary of State Mike Pompeo, Collins, the Republican House member pushing for a pause on sales abroad of coronavirus prevention and treatment products, said that he was “informed by Northeast Georgia Health System that it faced uncertainty in the fulfillment of its recent purchase of high-speed testing equipment from a domestic company that is refusing any new customers because of a surge in orders from Europe.”
Collins also pointed out that other countries, like the United Kingdom, South Korea, Germany, France and India, had all taken similar steps to preserve their stockpiles.
“The private sector has been an incredible partner in our nationwide effort to combat the coronavirus pandemic. Its contribution during these times cannot be overstated,” Collins wrote. “I do feel it necessary, however, that we provide clear guidance that all production of necessary medical supplies must first be sent to purchasers in the United States until domestic demand has been satisfied.”
By late Tuesday afternoon, Ohio’s top health official, Dr. Amy Acton, sounded the alarm for her own state. She called the over 560 confirmed coronavirus cases there “the tip of the iceberg” and warned that the state’s reserves of personal protective equipment had all been put into the field with health care workers.
“There is a limited supply. That is the truth,” Acton said. “We’ve placed it where it is needed. We are working to determine how to extend use of PPE.” (Commonly used personal protective equipment, like masks, is not designed for extended or repeated use).
Now, as time winds down on patients in New York and other hard-hit areas, the search for supplies has increasingly moved outside the usual political and governmental channels.
Facebook, Tesla and ‘Real Housewives’
Desperate health care workers are fundraising on their own and pleading with private citizens to donate what had been common supplies.
There has also an upswing in uncoordinated efforts from rich donors, like Facebook, which is tapping its own “emergency reserve” of medical grade masks, according to CEO Mark Zuckerberg, and “working on sourcing” millions more. Former “Real Housewives of New York” star Bethenny Frankel has also become an unlikely source of aid, with a pledge to donate more than 1.5 million masks.
Elon Musk, the Tesla CEO, delivered more than 1,000 ventilators to California, but the confusion that followed the news underscored broader communication issues. In response to a Twitter thread speculating on where the equipment came from, Musk said he had purchased it from overseas.
“China had an oversupply, so we bought 1255 FDA-approved ResMed, Philips & Medtronic ventilators on Friday night & airshipped them to LA,” Musk said. “If you want a free ventilator installed, please let us know!”
Frustration over the Wild West-style market for these essential medical goods has bubbled up with increasing heat over the past few days. Speaking to reporters, Illinois Gov. J.B. Pritzker underscored the absurd push-and-pull between government officials and manufacturers.
“In one case (a ventilator maker) told me I was competing with FEMA to acquire ventilators. So they told me I’m competing against the federal government to get ventilators from the state of Illinois. And the federal government is not distributing ventilators to the state of Illinois, so I’m literally working against a competitor,” Pritzker said, relaying a story he told Trump.
Before he could answer a question about the President’s response, Pritzker offered a second example.
“I called another manufacturer of ventilators and he pointed out to me that I would be competing with countries other than the United States as I put an order in,” Pritzker said, and “that I better put in as big of an order as possible in order to put myself higher on the list of priority to get ventilators from that manufacturer.”
Like other governors in states facing shortages, California’s Gavin Newsom has said his administration is striking out on its own in search of supplies.
“I want to just be sober and direct to you and those who may be watching: We are not counting on the (federal government’s) strategical stockpile to solve this problem,” Newsom said during a news conference from Sacramento on Monday. “We’re out there procuring the PPE from sources domestically within the state of California, already repurposing businesses that are already stepping up to meet this need, and going across the world to address our supply chain.”
But that process, as both Pritzker and Cuomo have said, can create a destructive clash of supply and demand. Without intervention from Trump, the states – which operate on tighter budgets than the federal government – are repeatedly being drawn into bidding wars.
“Many of us are competing for the same limited supplies, and as a consequence of that, people are tripping over themselves to make deals that ultimately are raising the cost of these supplies,” Newsom told reporters Monday night.