New documents released Thursday by the U.S. House of Representatives Committee on Oversight and Reform show that Virginia is receiving a fraction of the personal protective equipment it has ordered from the Federal Emergency Management Agency.
At the same time, more than a dozen Virginia hospitals are close to exhausting their own supplies. According to data being tracked by the Virginia Hospital and Healthcare Association, 13 hospitals said they would have difficulty obtaining or replenishing enough personal protective equipment to meet demand within the next three days without assistance.
The new information casts doubt on the state’s capacity for handling a significant increase of COVID-19 cases. As of Thursday, the Virginia Department of Health reported 1,706 known COVID-19 cases across the commonwealth, with 246 hospitalizations and 41 deaths. Virginia’s peak — the period when cases of the disease are expected to reach their highest levels — is not expected until late April to late May, Gov. Ralph Northam said in a news briefing on Wednesday.
FEMA data shows that Virginia is receiving only a fraction of the protective equipment it needs to respond to the growing crisis. The spreadsheet, which details the commonwealth’s orders for masks, gloves, surgical gowns and other critical equipment, shows that Virginia is often receiving less than 50 percent (in some cases much less that that) of what it requested.
As of March 30, for example, state officials had ordered nearly 3.4 million gloves from the federal stockpile. FEMA allotted Virginia 263,032 — roughly 7.7 percent of the total order.
“While we appreciate what we’ve received from the national stockpile, it isn’t close to enough,” Northam said in a statement to the Mercury on Thursday. “Virginia’s health care providers and first responders deserve basic protection, equipment and supplies. We need more, period. Virginia will continue to exhaust every option — including federal support — to get what we need on the front lines.”
FEMA did not respond to a request for comment.
As COVID-19, the disease caused by a new strain of coronavirus, continues to spread across the United States, killing and sickening a growing number of Americans, states have been relying on the federal government to relieve widespread shortages of personal protective equipment for frontline medical workers. Other states have also turned to unconventional sources.
Northam has been increasingly direct about the state’s dire need for supplies, but officials have not publicly provided hard numbers on the amount of equipment currently available.
The FEMA data — which includes two shipments that Virginia had received from the agency through March 30, according to a senior Democratic committee aide — provides more insight into the extent of the shortages. While Virginia ordered more than 2.2 million N95 respirator masks — considered the gold standard for COVID-19 care due to their ability to filter out viral particles — it received just 155,120 from FEMA. An order for 87,620 surgical gowns yielded a shipment of 59,886 from FEMA.
Virginia requested half a million surgical swabs — a vital tool in collecting samples from patients for testing — and received none.
State data reveals larger shortages than FEMA documents suggest
Data from the Virginia Department of Health, obtained by the Mercury on Thursday through a Freedom of Information Act request, shows that the state has even less personal protective equipment on hand from the federal government than reported by the House committee.
The spreadsheet includes three total shipments received by the state from the Strategic National Stockpile, a nationwide repository of equipment — administered by FEMA and the U.S. Department of Health and Human Services — intended for states and localities to use during public health emergencies.
As of Tuesday, VDH has a total of 78,920 N95-grade respirator masks available for distribution from the stockpile. The state also has 5,040 3M Model 8000 respirator masks — a slightly different style that was investigated by the National Institute for Occupational Safety and Health in 2010.
The investigation was prompted by reports from California health care workers who experienced difficulties properly fitting the masks during the H1N1 influenza epidemic. NIOSH “found no evidence of a defect in the respirators or any indication that the respirators will not achieve the expected level of protection,” but the California Department of Public Health recommended that use of the masks be discontinued, according to the Centers for Disease Control and Prevention.
VDH has a total of 312,000 surgical masks and 38,112 medical face shields, according to the inventory spreadsheet. The state also has 166,400 gloves in various sizes and made of various materials — including latex, vinyl and nitrile — available for distribution.
Other items are in staggeringly short supply. VDH has a total of 42 disposable coveralls from SNS in its “on-hand” inventory, which refers to personal protective equipment that is currently in the possession of VDH, wrote Joseph Hilbert, the department’s deputy commissioner for governmental and regulatory affairs, in an email on Thursday.
“With the exception of 3 percent that is being held in reserve, all of the ‘On-Hand Inventory’ is currently in the process of being distributed,” he continued. “VDH anticipates that the distribution will be completed by Monday.”
The department is holding 3 percent in reserve in case of “sudden disease developments,” Hilbert wrote, such as a local disease outbreak.
The dwindling number of supplies illustrate a larger crisis at the federal level. The Washington Post reported Wednesday that the SNS is nearly depleted due to the extent of the coronavirus crisis. With nationwide shortages and exhausted federal resources, all 50 states are competing with the Trump administration and individual health care systems for protective equipment.
“There’s no such thing as too much right now,” Northam said Wednesday. “And what has prompted that — and I speak on behalf of all governors — is we’re competing. We’re competing with each other, we’re competing with other countries, we’re competing with other states. And so while individuals have stepped up, businesses have stepped up, we’re still lacking the total number we need.”
As of Thursday, VDH has a larger stock of on-hand equipment purchased from other suppliers, Hilbert wrote. That includes 81,907 gowns, 176,420 N95 respirator masks, and roughly 1.5 million surgical masks, in addition to 552,900 gloves. The inventory shows that the state has no available hand sanitizer, wipes, soap, or cleaners.
But without reliable supply chains — and with a growing number of COVID-19 cases — it’s unclear how long the equipment will last. Medical workers throughout the state continue to report shortages. Shipments are distributed across a long list of providers, from hospitals and urgent care facilities to emergency medical responders to dialysis centers, said Julian Walker, the vice president of communications for VHHA, in an email last week.
Some providers, including primary care doctors and medical directors at retirement communities, report receiving little to no equipment from the state.
Even with other sources of equipment, Virginia Health Secretary Dr. Daniel Carey said the state was at risk of running out of supplies for its medical workers.
“Several weeks ago, our hospitals had a number of weeks [of supplies],” Carey said at the Wednesday briefing. “But what we’re hearing more and more is that those hospitals, as they go through the care of patients, they are burning through that supply.”
Northam, a pediatrician and former U.S. Army doctor, has also painted a stark picture of the amount of protective equipment consumed in the care of COVID-19 patients. On Wednesday, he said the average hospital could go through 240 sets of gear per patient per day in the intensive care unit.
Coronavirus patients with severe symptoms are often admitted to the ICU and can require ventilator support if the disease damages their lungs. Intubating a patient — in which a breathing tube is inserted through the mouth and into the airway — is one of the riskiest parts of care, potentially exposing medical workers to viral particles from the mouth and trachea.
Some hospitals are adapting on the fly, commissioning barrier devices to protect medical staff during the procedure.
On Wednesday, Health Commissioner Dr. Norman Oliver said that 145 Virginians are currently receiving COVID-19 care in the ICU. Those patients alone could require 243,600 sets of personal protective equipment for care providers over the course of a week, using Northam’s estimates.