Since mid-March, Washington state, one of the first hit by the coronavirus outbreak, has ordered more than 300 million items of personal protective equipment from the private market, desperate to shore up enough supplies to meet demand.
Weeks later, Washington has received less than 10 percent of those items and there's no guarantee when the other millions of products will arrive, according to Casey Katims, a federal liaison for the state.
Orders "are just not being filled in a manner that's timely or predictable," Katims said. "That poses real challenges in our ability to meet the needs of providers and emergency management and first responders in our state."
Going into yet another month of the pandemic, some states, like Washington, are still facing the challenge of obtaining critical protective equipment that debilitated them at the start of the outbreak -- this time, as they move toward re-opening. While President Donald Trump has publicly said that supply shortfalls have been met, many of the same obstacles remain for those trying to acquire supplies they need.
"It's been a tremendous challenge getting PPE into the state," a Washington state official echoed. "The demands are everywhere and the ability to get PPE at the state level has been challenging and frustrating and way insufficient to meet the demand. It's been a nearly insurmountable challenge."
States still face supply shortages
In Georgia, one state official said there was still a need for gowns. According to data from the state's emergency management agency, Georgia requested more than 3 million gowns from the Federal Emergency Management Agency, but to date, had only received a little under 200,000. The state also received less than requested of other personal protective items like surgical masks and coveralls.
And California ran into issues ordering from the private market, announcing Wednesday that the state will be refunded $247 million it paid to a Chinese firm to deliver 200 million N95 respirator masks under a secretive contract which had not been disclosed to the public.
After weeks of questions and pressure, the state disclosed the refund and released the contract with BYD, a Chinese car maker with offices in downtown Los Angeles, worth nearly $1 billion. The contract, which included an upfront payment of $495 million, called for the production of 500 million face masks over a two-and-a-half month period.
At a press conference Wednesday, Gov. Gavin Newsom told reporters the state had received 15 million surgical masks from the company but was still waiting on tens of millions of N95 respirator masks that were expected to arrive in California this week but had failed to meet a delivery deadline.
In some instances, states have banded together to develop a regional supply chain. Over the weekend, for example, governors from New York, New Jersey, Connecticut, Pennsylvania, Delaware, Rhode Island and Massachusetts announced their joint multi-state agreement.
"Our states should never be in a position where we are actively competing against each other for life-saving resources," said New Jersey Gov. Phil Murphy in a statement. "By working together across the region, we can obtain critical supplies as we begin the process to restart our economies, while also saving money for our taxpayers."
The move is indicative of the persisting supply issues. The Centers for Disease Control and Prevention also acknowledges shortages in protective gear for health care personnel on its website.
Defense Production Act controversy
Washington Gov. Jay Inslee criticized the administration on Wednesday for not widely invoking the Defense Production Act, which gives the government more control during emergencies to direct industrial production.
Inslee said in an interview with CNN that Washington and other states have been forced into "scrambling around the world" to purchase PPE "because the federal government would not accept the responsibility to help purchase this material. And most importantly, they would not help to manufacture it."
The war-time era law has been a point of contention between states and Trump, who has invoked it only in some instances, like for testing supplies. The union representing FEMA employees also urged the administration to use the law to shore up equipment.
That is the most viable way forward, Katims said.
"Mandate domestic production. This is the power the administration has if they choose to exercise it," Katims added.
"I get angry at thinking about the fact that we can't seem to create a domestic manufacturing capability for a critical supply that people's lives depend on. To me, that's a national tragedy that we can't do this," the Washington state official said.
Trump hasn't indicated that he would invoke the DPA for protective gear and has appeared frustrated when told the lack of supplies remains a problem. As he honored nurses in the Oval Office Wednesday, Trump seemed to get irritated with one nurse who called supplies of personal protective gear around the country, "sporadic."
The administration's strategy to procure supplies has come under increased scrutiny. Trump's son-in-law Jared Kushner assembled a supply-chain task force that included a group of young, inexperienced volunteers brought in to secure much-needed medical supplies, the Washington Post and New York Times reported.
They were assigned to winnow the best leads for protective gear out of a thousand and send those to a FEMA procurement team for final approval, a source familiar confirmed. That slowed down efforts, the source said. "You don't change processes mid stream. That adds to the confusion and it costs lives," the source said.
Trump defended the team Wednesday, saying he didn't "know anything about the details" of how the group operated, but called it a "well-oiled machine."
"We were able to get gowns and gloves and masks at a very early point," Trump said, repeating that he "wasn't involved in the details" but knows that the equipment "started flowing."
Governors still jockeying for supplies
FEMA, an agency in the Department of Homeland Security, has been at the helm of the federal operations response. The agency has rolled out initiatives to try and provide relief. In late March, FEMA launched "Project Airbridge" to expedite the shipment of supplies overseas to the US.
As of May 4, millions of supplies, including gloves, surgical masks, surgical gowns, and face masks have arrived in the US on 117 flights, according to FEMA. Nineteen additional flights to bring in more equipment are tentatively scheduled, the agency said.
But while the supplies are flown in by FEMA, the allocation is split between the administration's designated hotspots and the distributors' customers, some of whom might also be in those critical areas.
Even with the initiative in place, governors nationwide continue jockeying for critically needed equipment -- at times blasting the administration for not handing the supplies directly over to the states, instead of to customers within the state.
The administration pledged to provide a county-by-county breakdown of the supplies delivered to each state. While the breakdown provides some visibility on the supplies arriving, it doesn't include the final destination, leaving questions unanswered about which hospital, nursing home or other facility received supplies from distributors, Katims said.
Despite that effort, and others, states continue to be in a position of having to fend for themselves, worried, in some cases, that re-opening might exacerbate the already-dire shortages.
"This is more than a medical issue, it's a national security issue," the Washington state official said.