Delayed use of Defense Production Act leads to ongoing shortages of protective gear

The Department of Health and Human Services has listed 19 companies that have received contracts under the Defense Production Act to produce emergency supplies, including 600 million N95 respirators and face masks. But experts say that it is not enough and that the effort started much too late.

Only about half of the masks ordered will be delivered by the end of this year.

This is a problem which, according to experts, could have been avoided. A former Defense Department official told CNN that the administration had lost months by not acting aggressively enough with the DPA at first, making it impossible to meet demand.

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“I think that a much more aggressive and early use of the Defense Production Act during the period of February probably would have saved many of the heartache that we are currently seeing with regard to PPE shortages in across the country, “said Kelly Magsamen, a former Pentagon official who was senior director of the National Security Council for strategic planning under the Obama administration.

In addition to awarding more contracts, Magsamen said, the government could have used other mechanisms within the DPA more aggressively, such as tax breaks or loan guarantees, to further encourage companies to speed up their production.

“The fact that there was no federal top-down response organized early enough and quickly enough, I think, put us in a position where practically everyone is playing catch-up, including the Trump administration,” said said Magsamen.

White House business advisor Peter Navarro defended the administration’s strategy. “We did not hesitate to use the defense production law when necessary,” he said. “One of the beauties of using the Defense Production Act when necessary is that it has reduced the need to have to rely on it because we get a voluntary contribution.”

The Federal Emergency Management Agency and HHS have ordered and delivered millions of pieces of PPE, including more than 102 million N95 masks and more than 139 million gloves. FEMA also helped speed up the shipment of supplies from overseas through its “Airbridge Project” effort. The agency terminated the initiative but left the door open to restart it if necessary. But, combined, the equipment brought in through various initiatives does not meet expectations. unprecedented demand for key products worldwide.
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The White House has been reluctant to play an overly active role in managing the production and distribution of supplies, falling more to the states. President Donald Trump says states have everything they need – something Vice President Mike Pence reiterated during a coronavirus briefing last week. Pence also said that the administration will issue new guidelines on the preservation and reuse of personal protective equipment.

Everything is done to inspire confidence in people on the front line.

“Fragile and overtaxed”

Several health care organizations with hospitals in or near current hot spots, including Jackson Health System in Miami, Houston Methodist and Valleywise Health, based in Arizona, told CNN that they currently have sufficient equipment. to protect their workforce. But others have warned of more serious situations.

The National Center for Assisted Living, an industry group, found in a survey of its members in June that more than half of assisted living facilities had less than two weeks of supplies of specific protective equipment.

David Voepel, CEO of the Arizona Health Care Association, which represents skilled nursing facilities and assisted living communities, told CNN that many assisted living facilities in his state have faced challenges because , unlike hospital networks and qualified nursing establishments, they did not have a contract or established a line of communication with distributors before the pandemic.

“The problem is that hospitals absorb more PPE and larger contracts will get PPE, while assisted living communities will not get as much,” said Voepel, noting that many assisted living communities are always required to reuse personal protective equipment. .

Nurses find themselves in a similar position, despite administration comments that hospital capacity remains strong and states have everything they need in terms of supplies.

Zenei Cortez, one of the presidents of National Nurses United, the largest nursing union in the United States, told CNN: “It is truly amazing that the leaders of our country are making a general statement like this. “

Cortez described situations where the lack of adequate supplies puts nurses on the front lines of the pandemic more at risk.

In particular, Cortez says that some nurses in Florida use N95 masks that have not been tested. “It really puts nurses at risk,” she says, because these masks do not form the seal around the nose, mouth and chin that would allow the mask to protect the wearer from the virus.

PPE shortages have already started to have a negative impact. Cortez cited a LA nurse who rushed in, just wearing a surgical mask, to help a coronavirus patient who had stopped breathing.

“So far, we have 148 nurses who died from coronavirus, simply because they did not have the proper PPE,” said Cortez, noting that this number is only what was reported to his and that the actual number of nursing deaths is likely to be higher.

A spokesperson for Banner Health, a Phoenix-based health network with 28 hospitals in the western United States, said it currently has an adequate supply of most protective equipment, but that challenges fluctuate and that there has recently been a shortage of disposable gowns. To solve this problem, the organization has deployed reusable blouses.

“Our supply chain has been disrupted in recent months, and we expect this to continue during the pandemic,” said the spokesperson.

Nancy Foster, vice president of the American Hospital Association for Quality and Patient Safety Policy, said the supply chain for protective equipment remains “fragile and overloaded” due to global demand.

“While in general we would say that the availability of PPE supply has improved, it is still fragile,” said Foster, who said that nitrile gloves, isolation gowns and N95 smaller remained a challenge. Foster said the American Hospital Association continues to advocate for the federal government to use DPA to further increase supply.

Dr. Susan Bailey, President of the American Medical Association, said she heard from doctors across the country that their biggest challenge in reopening their office was the shortage of protective equipment. Bailey said his organization has been urging the Trump administration since March to implement a coordinated national strategy for the production, acquisition and distribution of PPE supplies.

Fierce competition

An industry source familiar with the medical equipment supply chains told CNN that the search for equipment should continue to be extremely competitive in the weeks and months to come, particularly as school systems, the hospitality industry and others will enter the protective equipment market.

Manufacturers have increased production, but some warn that it is difficult to keep pace with demand.

“As we manufacture more respirators than ever before, the reality is that demand for respirators continues to exceed supply. This is an industry-wide challenge,” said Tim Post, spokesperson. from 3M, which he says produces N95 respirators at a rate of over 50 million per month in the United States.

The U.S. Centers for Disease Control and Prevention has issued guidelines on the reuse of N95 masks, but nurses who have spoken to CNN have argued that the rate of reuse of masks makes them vulnerable.

Michelle Brum, a nurse who works in Hyannis, Massachusetts, and co-chairs a nurses’ union, said that months after the virus emerged, her hospital continues to lock N95 respirators to prevent staff from using them. beyond the amount allocated.

“You are given a mask and they want you to use this mask several times,” she said. “The way we have been trained is that you use it once; when you leave this patient’s room, you take off the mask and it goes to the trash.”

CNN contacted health care or other administrative agencies in the 50 states to see how they were doing with personal protective equipment. Twenty-four states responded. Most said their states had adequate PPE in their inventory, but six – Missouri, Tennessee, Ohio, Minnesota, Vermont and Alabama – added that N95 masks remain difficult to acquire.

“Although we have heard that hospitals receive them from manufacturers, we are unable to purchase them from the state, and we understand that other health care providers are unable to obtain them in many cases, “said a spokesperson for the Missouri Department of Health and Senior. The services said, referring to the N95 masks.

A Minnesota Administration Department spokesperson said that in addition to the difficulties in obtaining N95 masks, there was an anticipated shortage of nitrile gloves. Although the state has about 40 million gloves awaiting delivery, state hospitals use nearly a million gloves a day. “Usage rates and tightening international supply chains are causing short-term concerns for gloves,” said the spokesperson.

Washington State Governor Jay Inslee is among those urging the administration to make more use of DPA.

“The broader supply chain issues have still not been addressed by the Trump administration. We are still dependent on foreign manufacturing and are forced to compete in the global market,” said Casey Katims, an agent for federal liaison for the State of Washington.

CNN’s Nelli Black and Tara Subramaniam contributed to this report.

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