Gov. Ralph Northam toured a warehouse last month housing state supplies of personal protective equipment. (Governor's office)

At a news conference on Monday, Gov. Ralph Northam called nursing homes, which have accounted for more than half of the state’s COVID-19 deaths, a “top priority,” adding that his administration is doing “everything we can” to take care of them, including the provision of personal protective equipment.

“If they need more PPE, we have the PPE,” he added. “And hopefully they’ll know the proper channels to go through and we’ll be able to deliver it.”

But hours earlier, the Virginia Hospital and Healthcare Association — a key player in the state’s emergency management program for health care systems — sent an email to long-term care facilities, warning that coronavirus was continuing to limit supplies.

“The COVID-19 pandemic has caused shortages of certain PPE necessary for treating highly infectious residents with the virus and impacted health care facilities’ ability to respond,” wrote Kelly Parker, VHHA’s director of emergency preparedness, in a Monday morning email. 

The message explained the process for requesting protective equipment from the state, which would be distributed based on “urgent need” or in cases of critical shortages.

“‘Urgent need’ is defined as [seven days] or fewer days of available PPE, an unplanned shortage of supplies (e.g., a backorder/cancellation of ordered PPE), or an outbreak in your facility,” Parker wrote. An attached document from the state’s emergency management program emphasized that state-provided protective equipment “is a last resort and should not replace the normal supply chain.”

In a statement to the Mercury, Julian Walker, VHHA’s vice president of communications, wrote that the message was specific to a “particular scenario in which providers have been unable to acquire needed PPE through traditional supply chains and are therefore making a special application to the state for assistance.”

But nursing homes across the state are experiencing disruptions in usual supply chains that make sourcing their own equipment uncertain at best, said CEO Melissa Andrews of LeadingAge Virginia, an association of nonprofit senior living centers. 

At the same time, they’re bearing the brunt of Virginia’s COVID-19 epidemic. A total of 182 outbreaks — more than half of those reported in the state — have occurred in long-term care facilities, according to data from the Virginia Department of Health. The same facilities account for just over 13 percent of the state’s known 31,140 cases, as of Tuesday, and more than half of its 1,014 deaths.

In April, the COVID-19 death toll at Canterbury Rehabilitation and Healthcare Center in Henrico became one the highest known in the nation at a longterm care facility. (NBC12)

“Even if a facility doesn’t have any cases, they have to prepare for it,” Andrews said. And in some cases, supplies can be elusive. According to new public data released Monday by VHHA, at least 11 facilities are reporting difficulties obtaining N95 masks, considered the gold standard in viral protection for their ability to filter out airborne particulates. 

Four are reporting difficulties obtaining surgical masks, and 18 are having trouble sourcing isolation gowns — disposable plastic coverings that protect health care providers from bodily fluids.

Industry leaders are also concerned that the data is an undercount of the true supply needs across Virginia’s long-term care facilities. In a joint statement on Monday, three of the state’s largest senior living associations — LeadingAge Virginia, the Virginia Assisted Living Association and Virginia Health Care Association–Virginia Center for Assisted Living — wrote that the dashboard presented “only a partial picture of the ongoing needs of Virginia’s long-term care facilities.” 

Northam said during the briefing that a “minority” of long-term care facilities were having difficulties sourcing supplies. But Andrews pointed out that it’s difficult for the state to know the true number, given the limitations of VHHA data. The new dashboard doesn’t include data from assisted living facilities, which are struggling with many of the same caseload and supply chain problems. She also noted that VHHA’s reporting comes from the Virginia Healthcare Alerting Status System, an optional portal where facilities can request equipment. 

According to LeadingAge Virginia, which reports on system response rates in its daily COVID-19 newsletter, participation can vary dramatically by the day. On Friday, 90 percent of the state’s 287 long-term care facilities had recently updated the system. By Monday, participation dropped to 66 percent. 

“Reporting isn’t required and not every field is required,” Andrews said. “And what we’ve discussed with VHHA for weeks now is that there’s no way to know if it accurately represents the need out there for nursing homes.” 

For nursing homes struggling to contain or prevent the virus, reporting itself can also become a challenge. As the pandemic continues, facilities are held accountable to an increasing number of agencies, from local health departments to the U.S. Centers for Medicare & Medicaid Services. According to documents from the Virginia Healthcare Emergency Management, requesting supplies from the state also requires them to estimate the “burn rate” for each product — another time barrier for overburdened facilities, Andrews said.

“They’re already required to report on so many different things,” she added. “And the reality is, when I’ve spoken to my members and ask if they’ve reported, they say, ‘We are, but we’re still not getting the supplies.’”

While nursing homes are among the health care facilities eligible for state-provided equipment, they aren’t allocated an additional share of supplies — even though they account for a disproportionate share of Virginia’s coronavirus cases. Northam’s spokeswoman, Alena Yarmosky, said the state determines PPE distribution through a facility’s seven-day assessment of need, which considers burn rate in addition to caseload. Equipment is routed to facilities with the most urgent need, regardless of the type of patients they serve.

The state is making efforts to help facilities source equipment through commercial supply chains. The state’s Department of General Services has compiled a list of vendors, and the Virginia Emergency Support Team has a partnership with Amazon to “ensure organizations on the frontlines of the COVID-19 response” can purchase equipment from Amazon Business on a priority basis, according to documents from the state’s emergency management program.

But the same document notes that “PPE supplies through Amazon are limited depending based on current demand and inbound shipments.” Supply chain shortages are a consistent issue that LeadingAge Virginia’s members continue to grapple with, Andrews said. 

One of her members spent $180,000 on protective equipment in a single week to keep up with demand, she added. A few weeks ago, the CEO of a facility in Richmond personally drove extra supplies to another nursing home in the city — part of an informal quid pro quo network that’s emerged as members navigate continued shortages and untested suppliers.

“There’s always the uncertainty — will the whole order come and will it be high-quality?” Andrews said. “There are a ton of scam artists out there.”