Virginia’s emergency network for health facilities across the commonwealth is a one-way street when it comes to personal protective equipment. Member facilities can enter in what they need — hand sanitizer, for instance, or surgical masks — and six regional health care coalitions, which partner with the Virginia Health Department and Virginia Hospital and Healthcare Association, will try to provide it.

“We don’t know what their stockpile looks like,” said Morris Funk, president and CEO of Beth Sholom Senior Living in Richmond. What he does know is that the need at Beth Sholom is becoming increasingly dire. The 350-person retirement community, which includes independent and assisted living along with a nursing home, is down to its last 12 bottles of hand sanitizer.

The lack of transparency is causing concern, particularly among nursing homes, who worry they won’t be a priority, and primary care doctors, who don’t appear on the network’s distribution list at all.

Funk said the facility is working feverishly to source more equipment, checking in with suppliers three times a day and sending employees to Walmart and Target in search of essentials such as disinfecting wipes. So far, they haven’t had much success. McKesson, a medical supply company, is limiting Beth Sholom to small orders — a few boxes of masks or wipes at a time, Funk said. Staff are resorting to mixing their own hand sanitizer with aloe and a few bottles of rubbing alcohol.

“Given the potential of coronavirus — thank God we don’t have any cases today,” Funk said. “But with the potential of having a significant number of individuals infected, we would not have enough personal protective equipment to meet the needs of our caregiving staff and to protect residents.”

It’s a nationwide problem as health care providers continue to battle the growing pandemic. The latest numbers from VDH show 290 cases across Virginia with 45 hospitalizations and seven deaths. State health officials haven’t provided the exact number of cases in nursing homes or assisted living facilities, but there are at least six, including four cases at Canterbury Rehabilitation and Healthcare in Richmond — right down the road from Beth Sholom, Funk said.

“We’ve been lucky,” he added. “But we’re not Pollyanna. We realize that could be us any day.”

Funk has been increasingly vocal in calling for the state to recognize nursing and assisted living facilities as medical providers. Melissa Andrews, president and CEO of LeadingAge Virginia, an association of nonprofit senior living services, said shortages were common at facilities across the commonwealth.

But it’s not just nursing homes feeling the crunch. More than a thousand health care providers signed a letter calling on Gov. Ralph Northam and Health Secretary Dr. Daniel Carey to solve “the desperate medical supply shortage that is thwarting our efforts to control this pandemic before it reaches the point of no return.” Dr. Paige Perriello, a pediatrician in Charlottesville who distributed the letter on Saturday, said she intended it as a “hopeful” push for state leaders to get innovative in their efforts to source equipment.

She, like many providers, is still in the dark about Virginia’s current supply of personal protective equipment. As the pandemic spreads, critical medical supply chains have been significantly disrupted, leaving facilities increasingly dependent on state authorities to source materials. State governments, in turn, have been increasingly reliant on the Strategic National Stockpile, a cache of medical supplies available for public health emergencies. 

The stash was intended to supply states and municipalities during crises “severe enough to cause local supplies to run out,” according to the U.S. Department of Health and Human Services. But with the unprecedented spread of COVID-19, all 50 states are drawing from the stockpile at the same time. 

President Donald Trump recently activated the federal Defense Production Act, which would allow him to require factories to produce medical equipment and sell it back to the government. So far, it’s unclear when and whether he’ll take advantage of the new ability.

On Sunday, Northam announced that Virginia had received and distributed its first shipment of supplies from the national reserve. So far, though, Virginia’s emergency response team has declined to comment on the number — and types — of supplies available for distribution.

In a Monday interview, Bob Mauskapf, director of the office of emergency preparedness for VDH, said he “won’t be sharing” how many pieces of equipment Virginia received in its first order, which was placed about a month ago. Health Commissioner Dr. Norman Oliver has previously told reporters that the team received roughly 200,000 face masks. Mauskapf did confirm that most of those were surgical masks, with a smaller number of N95 respirator masks, which can filter out airborne particles.

He declined to comment on the supply of other protective equipment, from gloves to hand sanitizer to disposable gowns and booties. Around the same time officials placed the initial order from the national stockpile, the state also distributed supplies from its own leftover reserve of equipment from the H1N1 pandemic in 2009, Mauskapf said.

“Some of it had a shelf life,” he added. “With masks, a lot of the elastic bands had disintegrated, but anything serviceable, we retained.”

Given the limited supply of equipment, Virginia health officials are also prioritizing certain providers. Mauskapf said hospitals were first on the list for distribution. Julian Walker, the vice president of communications for VHHA, said that long-term care centers were next on the list, followed by dialysis centers, behavioral health facilities, emergency medical services responders, local health departments, and home health and hospice centers.

But many providers still haven’t received any supplies from the state. Perriello said she wrote the letter partly out of concern for what she was seeing at her own practice, where she’s been seeing patients on some days with no protective equipment at all. 

Many providers have turned to crowdsourcing for basic items such as hand sanitizer and gloves. There’s been an outpouring of support in Charlottesville after Perriello put out a community call for more equipment, including local residents who have started hand-sewing surgical masks, she said. 

Andrews was less successful when she approached local gyms — closed under an executive order barring gatherings of 10 people or more — for supplies. One fitness center donated a box of cleaning wipes, but retirement communities are being innovative in other ways, including swapping or donating equipment between facilities, she said.

“In our daily update, we included a tutorial on how to make masks,” Andrews added. “We’re trying to get as creative as you can get.”

Perriello, Andrews, and Funk all said it’s important for state officials not to forget primary care providers or retirement facilities as vital components of the fight against coronavirus. “I think the overall idea is, ‘Let us do our part,’” Perriello said. “We can keep people out of emergency rooms if we can stay healthy and keep providing essential preventive care.”

Health Secretary Dr. Daniel Carey said state leaders were working to expand the supply of personal protective equipment over the next few weeks. The state has requested a second shipment from the Strategic National Stockpile and expects to receive it next week. It’s also ordered a million surgical masks and 500,000 respirator masks from a private supplier, he said at a briefing on Tuesday. 

Officials requested a 10-day delivery frame, though Carey acknowledged they couldn’t be sure when the order would arrive.

“In this environment, we’ll appreciate whenever it shows up,” he said.

Meanwhile, the state is “following leads” from other sources, including suppliers within industries (such as contracting and mining) that use similar respirator masks. Home Depot even delivered a shipment of protective equipment to the state.

“All the providers we’ve talked to around the commonwealth, and frankly today, talking to a health system in Massachusetts — they too are looking at weeks of supplies in their supply chains,” Carey said. “So, if we do not replenish that, we will be in a very severe situation.”