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 now 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 can’t 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 bring order and ensure the United States has the gear it needs to battle coronavirus. So far, the Trump administration has said federal intervention isn't needed.
"I can't find any more equipment. It's not a question of money," said New York Gov. Andrew 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.
His pleas are echoed by others, including the American Medical Association, Illinois Gov. JB Pritzker and Democratic presidential candidates Bernie Sanders and Joe Biden, who've 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.
And while the 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 Donald Trump and his trade adviser, Peter Navarro, have repeatedly said they don't need to force companies to produce under the DPA because so many manufacturers are volunteering to make medical supplies. But Trump seemed to acknowledge the chaos on Tuesday, calling the world market for masks and ventilators "crazy" in a tweet, and saying it was "not easy" to acquire them.
But he also tweeted that he hasn't had to use the DPA "because no one has said NO! Millions of masks coming as back up to States."
So far, the DPA has been used only for the targeted task of securing more coronavirus testing kits, something Peter Gaynor, head of the Federal Emergency Management Agency, told CNN on Tuesday.
"We're going to use it, we're going to use it when we need it, and we're going to use it today," Gaynor said.
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 which 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 made by other states and even the federal government.
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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 DPA to centralize the buying process.
In a phone interview Sunday, former Obama administration FEMA administrator Craig Fugate said 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 each other, he said.
Dr. Rhonda Medows, president of population health at Providence St. Joseph Health, a chain of hospitals and clinics based in Seattle and spanning 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 producer more PPEs [personal protective equipment] because we knew from our own modeling that there would be a serious shortfall," she said.
Soaring demand and competitive bidding is driving prices up. Premier Inc., which 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 that 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 executive at Vizient Inc., 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 coronavirus escaped China and spread around the globe.
Tufts is also part of a broader network of hospitals that purchase products in bulk, said Nick Duncan, its director of emergency management. "If we continue down this path of conserving PPE 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 the network is in "good shape" for now, but worried about rising costs for supplies and possible shortfalls if coronavirus infections rise sharply.
On Sunday, Noyes Health officials asked the local 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 chief executive Mary Barra said in a statement Friday.
And Navarro in recent days helped strike a deal with a group of U.S. T-shirt makers to convert manufacturing lines to producing 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.”