Medical Supply Chain Shortages Led To Deadly Consequences
Despite decades of warnings about the fragility of the supply lines that brought protective gear from overseas factories to America´s health care workers, the U.S.
was unprepared for the coronavirus pandemic and failed to react quickly. With the death toll at over 210,000 and rising, the collapse of medical supply chains continues to cost lives.
Nurse Sandra Oldfield in Fresno, California, was among the first to become sick with COVID-19 after caring for an infected patient.
She had asked for more protection, but was only provided a flimsy surgical mask. Oldfield is one of more than 1,700 health care workers who have died from COVID-19, according to a National Nurses United study released in September.
__
EDITOR´S NOTE - This story is part of an ongoing investigation by The Associated Press, the PBS series "FRONTLINE," and the Global Reporting Centre that examines the deadly consequences of the fragmented worldwide medical supply chain and includes the film " America´s Medical Supply Crisis," premiering on PBS and online Oct.
6 at 10 p.m. EST/9 p.m. CST.
Full Coverage: Deadly Shortages
___
Lori Gonzalez, left, and Rachel Spray carry flowers to the temporary grave marker of Gonzalez's sister and Kaiser Permanente Fresno Medical Center nurse, Sandra Oldfield, at the Sanger Cemetery in Sanger, Calif., Saturday, Aug.
29, 2020. Oldfield died after being exposed to the novel coronavirus. Workers at the hospital said they did not have the proper personal protective equipment. (AP Photo/Gary Kazanjian)
Internal memos show administration officials were concerned about the country's ability to meet urgent medical supply needs as early as January.
It wasn't until late March that the White House used the Defense Production Act - a law that allows the government to compel companies to increase manufacturing and prioritize federal contracts - to ramp up production of N95 masks and other supplies.
Yet hospitals and healthcare workers say they´re still lacking.
And both the Food and Drug Administration and the Government Accountability Office contradict White House claims that the U.S. now has all the medical supplies needed to keep nurses and doctors safe from the virus.
"Shortages of certain types of personal protective equipment and testing supplies remain due to a supply chain with limited domestic production and high global demand," said the GAO report, published Sept.
21.
And now new studies show healthcare workers without adequate personal protective equipment, or PPE, are more likely to catch the virus from their patients.
The global medical supply chain began to fracture in January, when Chinese factories that supply the U.S.
with the majority of its N95 masks and other medical supplies shut down. Then, in the weeks that followed, those factories kept supplies for domestic use.
The impact was catastrophic, but not unpredicted.
Fifteen years ago, newly appointed Health and Human Services Secretary Mike Leavitt began ringing pandemic alarm bells after a disturbing briefing from the U.S.
Centers for Disease Control and Prevention.
He told President George W. Bush, who rolled out at $7.1 billion pandemic preparedness plan. Leavitt, a Republican, spent the next three years traveling to all 50 states, warning health officials to stockpile masks, gloves and other supplies.
If America´s supply chains were crippled or compromised, he cautioned, it would exacerbate the devastation of a pandemic.
"Over time, when the snake is not at your ankle, you´re worried about other things that are dangerous," said Leavitt.
The AP and "FRONTLINE" spoke with members of the Clinton, Bush, Obama and Trump administrations who were responsible for pandemic preparedness.
All said they had worried and warned about inadequate supply chains.
"Outbreaks grow exponentially. You pay a tremendous penalty for inaction," said Christopher Kirchhoff, who wrote a "lessons learned study" for the White House after the 2014-16 Ebola crisis.
Among his 26 specific findings: The U.S.
government needed to buy and stock protective equipment, in the event that traditional supply chains failed.
During the Obama-Trump transition period, a group of newly appointed Trump aides gathered for an exercise in disaster preparedness hosted by top members of the Obama administration, including Dr.
Nicole Lurie, who´d served as assistant secretary for preparedness and response. They discussed the supply chain, and the importance of securing necessary supplies in case of a pandemic.
"One didn´t have the sense coming in that this was going to be high on the priority list," Lurie said.
"So many thousands of people have died needlessly, and it didn´t need to be this way."
Domestic manufacturers have also for years been signaling disaster and begging for government support.
In 2010, Prestige Ameritech, a Fort Worth, Texas, medical mask maker, was on the verge of bankruptcy after rapidly ramping up their factory to respond to needs for the H1N1 flu just a year before.
"The people that we´d hired, these hundreds of people that step in to save the United States, to save America, they were rewarded by getting in an unemployment line. I lost everything that I owned. Literally hocked the farm," said president Dan Reese.
As the pandemic rolled in this year, expected shipments of testing swabs, surgical gowns, protective masks and hand sanitizer didn´t arrive just as demand was soaring.
Countries that did make personal protective equipment were keeping it for their own citizens, and U.S. governors found themselves in a bidding war for what was left.
In March, the Prestige Ameritech founders were furious to see the CDC advise health care providers might use bandannas when caring for patients with COVID-19 "as a last resort."
"I felt that the government was intentionally misleading the people because they had not prepared as they should have, and the products are not available," said Reese.
This year, Prestige Ameritech and other domestic manufacturers of medical supplies have grown. Hospitals and labs, even public libraries, used 3D printers to make swabs.
Needle and syringe factories are working overtime. Apparel companies are now making gowns. Alcohol distillers produce hand sanitizer.
But Chinese and Asian manufacturing has ramped up even more quickly, continuing to flood U.S. markets with less expensive alternatives.
There were more than 2,000 shipments of N95 from Asia over the past month, up from 20 shipments during the same period a year ago.
A massive investment in U.S. manufacturing would allow existing companies to expand, and guarantee a long-term market for medical supplies that are more expensive than Asian competitors.
Both presidential candidates have said they will bring that manufacturing home.
But experts say that doesn´t seem realistic.
"It´s just not going to happen. Manufacturing, as we know it, is never going to return," said Cameron Johnson, a trade consultant based in Shanghai.
___
Contributors to this story included AP writers Candice Choi in New York, Matthew Perrone in Washington, D.C., and Allen G.
Breed in Chapel Hill, North Carolina, and Global Reporting Centre executive director Peter Klein in Vancouver, Canada, and "FRONTLINE" co-producer Kate McCormick in Stamford, Connecticuty.
___
Contact AP´s Global Investigative Team at Investigative@ap.org
___
Contact the reporters on Twitter at @mendozamartha and @JulietLinderman
Lori Gonzalez wipes a tear away after visiting the temporary grave marker of her sister and Kaiser Permanente Fresno Medical Center nurse, Sandra Oldfield, at the Sanger Cemetery in Sanger, Calif., Saturday, Aug.
29, 2020. Oldfield died after being exposed to the novel coronavirus. Workers at the hospital said they did not have the proper personal protective equipment. (AP Photo/Gary Kazanjian)
Rachel Spray, a nurse at the Kaiser Permanente Fresno Medical Center, sits near the grave of colleague and friend, Sandra Oldfield at the Sanger Cemetery in Sanger, Calif., Saturday, Aug.
29, 2020. Oldfield died after being exposed to the novel coronavirus. Workers at the hospital said they did not have the proper personal protective equipment. (AP Photo/Gary Kazanjian)
This undated photo provided by Rachel Spray in October 2020, shows fellow nurse Sandra Oldfield at the Kaiser Permanente Fresno Medical Center hospital in Fresno, Calif.
Oldfield died of COVID-19 in May 2020 after being exposed to the virus at work, her family says. The nurse's union says the hospital did not provide adequate masks, gowns and other equipment to protect her from the virus. Kaiser Permanente says it has followed state and federal guidelines and is "prudently managing PPE supplies." (Rachel Spray via AP)
Lori Gonzalez, right and her daughter, Mariah Rodriguez, Lạc Sơn Đại Phật hold hands at the temporary grave marker of her sister and Kaiser Permanente Fresno Medical Center nurse, Sandra Oldfield, at the Sanger Cemetery in Sanger, Calif., Saturday, Aug.
29, 2020. Oldfield became ill and then died after being exposed to a patient who had COVID-19. Workers at the hospital said they did not have the proper personal protective equipment. (AP Photo/Gary Kazanjian)
FILE - In this Tuesday, April 21, 2020 file photo, nurses Michael Gulick, center, and Angela Gatdula, right, hold their arms up in protest outside of Providence Saint John's Health Center in Santa Monica, Calif.
The hospital suspended ten nurses, including Gulick, from their jobs the previous week after they refused to care for COVID-19 patients without being provided protective N95 face masks. Gatdula says she contracted COVID-19 and has recovered. (AP Photo/Marcio Jose Sanchez)
FILE - In this July 22, 2020, file photo, people line up behind a health care worker at a mobile coronavirus testing site at the Charles Drew University of Medicine and Science in Los Angeles.
Although it will take years for researchers to understand why the pandemic was disproportionately worse in the U.S., early studies that compare different countries' responses are finding that U.S. shortages of masks, gloves, gowns, shields, testing kits and other medical supplies indeed cost lives.
(AP Photo/Marcio Jose Sanchez)
FILE - In this Saturday, April 11, 2020 file photo, used protective medical masks are prepared for disinfecting at the Battelle N95 decontamination site in Somerville, Mass.
Although it will take years for researchers to understand why the pandemic was disproportionately worse in the U.S., early studies that compare different countries' responses are finding that U.S. shortages of masks, gloves, gowns, shields, testing kits and other medical supplies indeed cost lives.
Because of shortages in 2020, the Centers for Disease Control and Prevention has revised its guidance to allow health care workers to reuse protective equipment, contradicting manufacturers' guidance. (AP Photo/Michael Dwyer)
FILE - In this Thursday, May 14, 2020 file photo, Prestige Ameritech Executive Vice President Mike Bowen testifies before the House Energy and kynghidongduong.vn Commerce Subcommittee on Health hearing on Capitol Hill in Washington to discuss protecting scientific integrity in response to the coronavirus outbreak.
Prestige Ameritech is the largest producer of surgical masks in the United States. For several years, Bowen's company has asked the Defense Department to buy their masks, citing the Barry Amendment that dictates the military buy U.S.-made apparel. In response, Bowen says, the Defense Department told them their masks aren't apparel.
(Shawn Thew/Pool via AP, File)
FILE - In this Wednesday, May 13, 2020 file photo, Ford Motor Co.
employees work on a ventilator at the Rawsonville plant in Ypsilanti Township, Mich. The plant was converted into a ventilator factory, as hospitals battling the coronavirus reported shortages of the life-saving devices. (AP Photo/Carlos Osorio, File)
FILE - This Wednesday, May 13, 2020 file photo shows work stations in the Ford Rawsonville plant in Ypsilanti Township, Mich.
An area of the plant was converted into a ventilator factory, as hospitals battling the coronavirus reported shortages of the life-saving devices. (AP Photo/Carlos Osorio, File)
FILE - In this April 7, 2020 file photo, workers carry boxes at Oklahoma's Strategic National Stockpile warehouse in Oklahoma City.
UC Berkeley Professor William Dow and his colleagues say there would be massive savings, in lives and tax dollars, if the government would help stockpile supplies. (AP Photo/Sue Ogrocki, File)
FILE - In this Feb.
7, 2020 file photo, workers pack surgical masks at a factory in Suining city in southwest China's Sichuan province. For decades, warnings about the risks associated with America's overdependence on foreign manufacturing of medical supplies, and a lack of adequate preparation at home, have gone unheeded, The AP found.
(Chinatopix via AP, File)
Isaac Larian, CEO of MGA Entertainment, helps to load a shipment of N95 masks at a Flexport warehouse Thursday, April 23, 2020, in Los Angeles.
Larian was able to secure N95 masks through the Chinese supplier of his toy company, to distribute to health workers and first responders amid the COVID-19 pandemic. (AP Photo/Marcio Jose Sanchez)
Researcher Phillip Clapp monitors a colleague inside a sealed chamber in a lab at the University of North Carolina in Chapel Hill, N.C., on Friday, Aug.
7, 2020. Clapp tested several different medical masks collected by the AP, including ones imported by an NGO, others donated to frontline workers by major tech firms, and masks AP had handed out to its own staff. "All of it was counterfeit, as defined by OSHA's definition of counterfeit or fraudulently labeled," said Clapp.
Some were less than 50% efficient, about the same as a cotton T-shirt. (AP Photo/Allen G. Breed)
Researcher William Bennett tilts his head back to test the fit of a mask inside a sealed chamber in a lab at the University of North Carolina in Chapel Hill, N.C., on Friday, Aug.
7, 2020. Working with Dr. Philip Clapp, Bennett tested several different masks collected by the AP, including ones imported by an NGO, others donated to frontline workers by major tech firms, and masks AP had handed out to its own staff. "All of it was counterfeit, as defined by OSHA's definition of counterfeit or fraudulently labeled," said Clapp.
Some were less than 50% efficient, about the same as a cotton T-shirt. (AP Photo/Allen G. Breed)
FILE - In this Friday, April 3, 2020 file photo, a face mask is printed at 3D-Standard LLC in Houston. The company has transitioned to making reusable masks that can be washed and have a replaceable filter to help ease the shortage during the COVID-19 outbreak.
(AP Photo/David J. Phillip)
In this March 26, 2020 photo provided by Rachel Spray, fellow nurse Sandra Oldfield holds a "#FlattentheCurve" sign at the Kaiser Permanente Fresno Medical Center hospital in Fresno, Calif.
She and her colleagues said they had felt unsafe at work and had raised concerns with their managers. They said they needed N95 masks, the most powerful protection against contracting COVID-19. Oldfield died May 25, 2020 from COVID-19. She became sick after caring for an infected patient in March 2020.
(Courtesy of Rachel Spray via AP)
