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COVID: What Northeast states are doing (and still need to do) to prepare as cases surge

David Robinson
New York State Team

In early April, Gov. Andrew Cuomo warned that New York only had enough ventilators left to last six days, despite waves of seriously ill coronavirus patients flooding into hospitals.

He quickly revealed a plan to take the lifesaving breathing machines from upstate communities with limited outbreaks to aid the greater New York City area hospitals hit hardest by the virus.

"I’m not going to let people die because we didn’t redistribute ventilators," Cuomo said at the time, announcing the National Guard would be deployed to take the ventilators.

It quickly ignited a firestorm over the chaotic response to dire shortages of medical supplies.

A nurse dons a face shield at a COVID-19 testing facility at the Town of Ramapo Senior Citizen Community Center in Suffern, N.Y., on July 22.

While New York narrowly avoided running out of ventilators after getting an 11th hour shipment of 1,000 devices from China, the episode revealed the consequences of U.S. over-reliance on overseas manufacturing.

A dearth of personal protective equipment, which is also often made in China, underscored the problem and contributed to the coronavirus death tolls in New York and New Jersey of about 32,600 and 15,825, respectively, the highest nationally.

Now — after all the death and suffering — the Northeast has the lowest infection rates in the country, and it is bracing for a second surge of COVID-19, the respiratory disease caused by the virus.

Yet record-high COVID-19 infection rates in other parts of the country have renewed reports of medical supply shortages, spanning from personal protective equipment (PPE) and testing supplies to disinfectant wipes and drugs.

Some health care workers and experts asserted all levels of government have failed to sufficiently shore up medical supply and distribution chains heading into the fall, complicating ongoing debates over reopening schools. 

“We have not done enough, and I am deeply concerned that we will have ongoing COVID with influenza as well,” said Dr. Lewis Kaplan, president of the Society of Critical Care Medicine.

“I am very concerned that we will reach that same place…where we will perhaps not have enough PPE again, and we will not have enough ventilators,” he said.

Dr. Aliaksei Pustavoitau, a critical care expert at Johns Hopkins University School of Medicine, said the Northeast’s response during the pandemic peak this spring exposed gaping holes in emergency preparedness in American medicine.

“The magnitude of what happened was not matched in the plans,” he said, adding the “supply chain was designed, in general, to move things just in time.”

“When those supply chains started breaking down, everyone started getting short,” he said.

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A Piermont, N.Y., first responder is decontaminated in July after an emergency call to protect against the COVID-19 virus.

In New York, state and federal officials have recently announced a series of measures to boost domestic production of medical supplies.

For example, about $11 million in grants have been awarded to 20 New York-based companies to retool operations and manufacture COVID-19 supplies. The deals aim to produce millions of N-95 protective masks, testing supplies and a broad range of other gear.

In announcing the grants, Cuomo said “the nation has learned a hard lesson about not having a supply chain for vital supplies based here at home in the U.S. and as a result we had to scour the globe for live-saving products.”

“That won't happen again in New York,” he added, citing the in-state manufacturing push underway.

But to understand the depth of problem, consider less than 10% of the masks used in the USA are made here. China makes almost half the world’s masks, gowns, gloves and other PPE.

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Further, New York state health officials issued orders July 21 requiring hospitals to maintain at least a 90-day supply of PPE by Sept. 30, and a similar directive mandated nursing homes to maintain a 60-day supply.

Any facilities that fail to meet the requirements could have their operating licenses suspended or revoked.

Many hospital operators, however, reported struggles earlier this month in obtaining protective gear.

Nurse Jennifer Tempo takes part in COVID-19 training with personal protective equipment (PPE) at Holy Name Medical Center in Teaneck, N.J., on Feb. 24.

“There is limited supply available, and prices remain very high,” said Bea Grause, president of the Healthcare Association of New York State, the Albany-based group that represents hospitals and nursing homes.

Grause asserted health care operators are working towards meeting the new stockpile mandate. Efforts underway to replenish state and federal government PPE stockpiles could also prove crucial as cases rise nationally, she added.

Yet as federal efforts to boost PPE production are expected to fall short, the status of many state stockpiles of medical supplies remain shrouded in secrecy.

Jill Montag, spokeswoman for Department of Health, said the agency’s policy prohibits commenting on its stockpile.

Similarly, New Jersey state officials have refused to disclose many details of their PPE strategy.

That includes how many days’ supply of protective gear the state aims to have on hand or how close it is to achieving that goal.

State officials cited “homeland security concerns” as the reason for not publicly revealing the information.

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What health care workers say about COVID surge, PPE shortages

Amy Purpura Smith, an emergency room nurse at St. John's Riverside Hospital, looks on as her colleague Liya Robin, a registered nurse at St. Johns, demands personal protective equipment (PPE) to safely care for patients and slow the spread of COVID-19 April 7, 2020 at St. Joseph's Hospital  in Yonkers.

Reports of PPE shortages have triggered pushback from nurses in the Northeast and across the county.

Health care unions have demanded state governments and hospitals disclose PPE supply information and improve safety standards and training for front-line workers.

Judy Sheridan-Gonzalez, president of New York State Nurses Association, said the current situation evoked memories of hospitals and health care leaders ignoring nurses’ concerns about unsafe conditions at the beginning of the pandemic.

“They basically say we have a supply of PPE and we’re prepared, but that’s what they said six months ago,” she said, adding the outcome was that many nurses “didn’t feel protected at work and a lot of us got sick.”

Nationally, only 24% of nurses think their employer is providing a safe workplace, a National Nurses United survey in July found, noting more than 165 nurses have died in connection to COVID-19.

Further, the Health Professionals and Allied Employees union in New Jersey asserted the lack of proper protective gear, inadequate training and lax government enforcement of safety requirements caused hundreds of front-line health workers to fall sick with coronavirus infection.

The union members also said a massive PPE shortage remains today, even as the state reopens and braces for a possible resurgence in cases.

“We know if we are not safe, neither are our patients,” said Debbie White, the union president said.

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Why COVID requires more than boosting testing, ventilator supply

Gov. Andrew Cuomo spoke on CNN on March 19, 2020, standing next to a ventilator to urge the federal government to provide more of them to states amid the coronavirus pandemic.

New York’s desperate scramble to find ventilators, in many ways, prompted federal officials to pay nine companies $2.9 billion for 187,000 of the breathing machines to boost national stockpiles during the pandemic.

But some health care experts have expressed concerns that problems with distributing the ventilators, as well as deploying clinicians trained to use the devices across the country, remain unresolved.

“Globally the ventilator supply is good,” Pustavoitau said. “But the problem that we have seen is how they were distributed to the areas of greatest need.”

A ventilator helps a COVID-19 patient breathe inside the coronavirus unit at United Memorial Medical Center July 6 in Houston.

Meanwhile, some Democratic lawmakers have pushed legislation seeking to federalize management of the medical supply chain, citing reported shortages throughout the pandemic.

The White House has defended its handling of PPE and ventilator distribution, and touted efforts to produce medical goods stateside, such as the $765 million government loan going to Rochester, New York based Eastman Kodak Co. to help expedite the domestic production of generic drugs.

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Mounting concerns about surging COVID-19 cases today, however, have some health experts, unions and hospital trade groups warning that local and state leaders could lack the tools to contain the virus this fall.

For example, New York's nation-leading COVID-19 testing infrastructure recently surpassed 6 million diagnostic tests since March. But challenges remain for contact-tracing programs attempts to identify people potentially exposed to the virus and convince them to quarantine.

Further, a Centers for Disease Control and Prevention survey last month found 54% of people infected with coronavirus were unable to pinpoint who may have infected them.

Experts said the survey results underscored how community and asymptomatic spread is complicating contact tracing during the pandemic. In New Jersey, officials this week said there's an extra hurdle because people do not want to give key information to contact tracers, hampering efforts to control the spread of the virus.

And it all comes together as renewed strains on medical supplies and interstate travel endanger outbreak mitigation strategies across the country.

“This really needs to be a federal effort,” said Kaplan, adding it would entail better coordinating the flow of everything from drugs and ventilators to doctors and nurses.

“We have a national health care crisis,” he said. “And I'd like to hear someone say we don’t have a national health care system, but in these key and important ways we’re going to weld one together for all of us.”

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USA TODAY Network reporters Lindy Washburn, Terrence McDonald and Alexis Shanes contributed to this report.

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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached atdrobinson@gannett.com and followed on Twitter:@DrobinsonLoHud