At first, it seemed like a promising lead.
In late March, the Virginia Department of Health — a key player in the state’s unified command team responding to the COVID-19 pandemic — reached out to the U.S. Navy, which operates its largest base in Norfolk.
Bob Mauskapf, the director of VDH’s Office of Emergency Preparedness, had gotten a tip that the Norfolk Naval Shipyard (actually located in nearby Portsmouth) could use its 3D printer to manufacture plastic face shields. It was less than a month after the state confirmed its first known case of coronavirus, but supplies of personal protective equipment were already a major concern.
At the time, Virginia had “completely spent” the limited number of supplies it had received through the Strategic National Stockpile, Mauskapf said — a national cache of medical equipment that was quickly depleted as states rushed to respond to their own growing caseloads. The state had also distributed its remaining stockpile of protective equipment left over from the H1N1 influenza pandemic more than a decade earlier.
Around the same time, the Federal Emergency Management Agency had changed its reporting standards for future shipments, requiring states to calculate their “burn rate” for personal protective equipment before receiving new supplies.
“We were having to answer what our burn rates were, we were having to answer what our current stocks were,” Mauskapf said. “And this meant that we’d have to go back to 101 hospitals, 284 long-term care facilities, 35 health departments, blah blah blah, to recreate these data so that we could get some FEMA supplies.”
It was a policy FEMA had announced the day before, according to an email passed down from MaryAnn Tierney — one of the agency’s regional administrators — to state emergency coordinators. The Mercury obtained the email through a Freedom of Information Act request for communications related to the distribution of personal protective equipment.
Early communications between Virginia emergency coordinators and federal liaisons highlighted the extent of the medical supply shortages that have continued to hinder COVID-19 response efforts at a local, state and national level. “To ensure we are using scarce resources in the most effective way,” Tierney wrote, states would have to provide FEMA with daily supply inventories and projected burn rates.
“If you cannot provide a daily inventory and corresponding usage data we will be unable to review and process your requests for PPE,” she added. In the absence of a stable federal supply chain, states like Virginia were forced to pursue their own avenues for increasingly coveted medical supplies.
The tip seemed like it might be one of those avenues. Emily Falone, a regional emergency coordinator for the U.S. Department of Health and Human Services — which assists states and local partners during times of emergency — had recently gotten a call from the Naval Shipyard’s Technology Innovation Lab about the face shields. An HHS spokesperson confirmed Wednesday that Falone “virtually introduced” the NNS team to Mauskapf after the call, hoping Virginia could work directly with the shipyard without pulling in other agencies.
“The offer from NNS seemed like an expeditious way to get PPE to front line hospital workers in the community who were in need of the PPE,” the spokesperson wrote in an email on Wednesday. Falone herself had “advocated for direct local support” from the Navy, according to a March 31 email obtained by the Mercury.
“Also was concerned about the poor distribution processes from federal to state,” she wrote to Mauskapf. Those concerns were justified just a few days later, when documents released by the U.S. House of Representatives Committee on Oversight and Reform showed that Virginia — like other states in the region — was getting a fraction of the protective equipment it ordered from FEMA.
At a time when the state was struggling to secure protective equipment, new faceshields seemed like a possible lifeline. But the planned partnership didn’t go through. Initially, Mauskapf said he was able to connect with a contact at the shipyard. “I called that individual and we started talking about numbers, time, how long it would take,” he added. “I’m a happy camper, and I said, ‘Sounds great.’”
Then, the Department of Defense stepped in. In her initial email to Mauskapf, Falone had included both FEMA and the DOD coordinating officer for Region 3, which includes Virginia. Once both agencies became aware of the order, “DOD indicated that this request needed to go through the formal FEMA system for PPE,” HHS’ spokesperson wrote Wednesday.
Terri Davis, the public affairs officer for the Naval Shipyard, said the state would have needed to submit what’s called a Defense Support of Civilian Authorities request — a formal written process that would have required approval from FEMA and the DOD.
“It’s actually illegal for us to provide support without one of those requests,” she added in a phone interview earlier this week. “Unless it’s life-threatening. If someone was actually dying, the military could step in. But making face shields wouldn’t rise to that level.”
That put a damper on plans to work directly with the Naval Shipyard. In a March 31 email to Falone and her colleague, Harry Mayer, Mauskapf wrote that he was “gonna get an upfront shipment” of 1,000 face shields before the Navy asked for a formal request.
“Great idea at first, but bureaucratic now,” Mauskapf wrote. “Can you unscrew this? Or should I just tell the Navy NO THANKS?”
Ultimately, the state abandoned the plan — along with the idea of asking if other military bases would be able to share protective equipment, he said in an interview last week. Around the same time Mauskapf was communicating with the Naval Shipyard, other officials were in the process of negotiating a contract with Northfield Medical Manufacturing, a civilian logistics company that’s become the primary provider of the state’s personal protective equipment. The unified command was also able to source face shields from another private manufacturer, he added.
Shipments from FEMA are still arriving in Virginia, but supplies have remained limited, especially when it comes to testing components and certain kinds of protective equipment. Over the last few weeks, the state has received approximately 402,000 cloth face masks, 8,250 coveralls, and 10,000 Tyvek suits from FEMA, according to VDH spokeswoman Tammie Smith. But the federal government hasn’t provided high-demand items like N95 respirator masks or disposable gowns.
Mauskapf said that the state is scheduled to receive a total of 470,000 swabs (used to perform COVID-19 tests) over May and June, but it’s unclear how many have actually arrived. In late April, the state received a fraction of the 500,000 swabs it originally requested from the agency, VPM reported. Over the last few weeks, FEMA has delivered an additional 111,376 swabs of various types. Over 18,000 appear to be regular cotton swabs, which can’t be used by every laboratory conducting diagnostic testing.
“FEMA is still delivering to where the biggest threats are,” Mauskapf said, “like New York, New Jersey. So, they’ve been providing the rest pro rata after they address the states with the highest cases.”
Over the last several weeks, as parts of Virginia moved towards loosening social distancing restrictions, Gov. Ralph Northam repeatedly emphasized that the state has been able to maintain a stable supply of protective equipment. One of the biggest indicators has been the number of hospitals reporting shortages, which has fallen to zero — and remained there — over the last several weeks.
But some nursing homes are still experiencing supply issues, and industry leaders remain concerned that public reporting by the Virginia Hospital and Healthcare Association may be an underrepresentation of the overall need. The state has refused to release its contract with McKinsey, the global consulting firm hired to help establish a stable supply chain, and its contract with Northfield is scheduled to expire in late June, according to Brian Moran, the state’s secretary of public safety.
“We’re still in the process of ordering and acquiring as much PPE as possible,” Moran said after a news conference last week. Northam’s spokeswoman, Alena Yarmosky, said additional contracts would likely be required, but the state hasn’t yet extended its contract with Northfield or finalized any new agreements.
Still, the outlook is markedly better than it seemed weeks into the pandemic, when the failed Navy partnership dealt a major blow to the officials working to procure equipment for the state.
“Between this and the new reporting mandates, we’ll be lucky to distribute PPE,” Mauskapf emailed HHS coordinators on March 31.