#juliet linderman

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Studies in nursing homes -- in China, Washington state and across the U.S. -- found that COVID-19 cases were significantly higher in places with shortages of personal protective equipment, or PPE. Harvard Medical School professor Dr. Andrew T. Chan and colleagues found health care workers who didn’t have adequate PPE had a 30% greater chance of infection than colleagues with enough supplies. Black, Hispanic and Asian staffers had the highest risk of catching COVID-19, they found. A University of California, Berkeley study estimated that at least 35% of health care and other essential workers in California who tested positive for COVID-19 were infected at work, amid shortages. “And these are unacceptable deaths, each of which could have been prevented if we had had adequate supply chains in place in advance of the pandemic,” said UC Berkeley Professor William Dow.

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press

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Now, with more than 210,000 Americans dead and the president himself infected with the virus, the U.S. grieves the consequences. And nurses are still being told to reuse masks designed to be thrown away after each patient. The lack of early testing was a major stumble. First, the U.S. Centers for Disease Control and Prevention’s tests were faulty. Then there weren’t enough. The Food and Drug Administration raced to approve more tests, but without access to cheap, disposable swabs -- made almost entirely in Italy and now in very short supply -- they were useless. U.S. public health departments’ worst fears were quickly realized. Chrissie Juliano, executive director of the Big Cities Health Coalition, a forum of the largest public health departments, said the lack of available information about the actual burden of the virus “set our country’s response back by an order of magnitude we will never know.”

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press

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Reshoring has become a rallying cry for both Republicans and Democrats in the run-up to the 2020 presidential election. At the Republican National Convention in August, Trump stood before the White House and declared, “Over the next four years, we will make America into the manufacturing superpower of the world. We will … bring home our medical supply chains, and we will end our reliance on China once and for all.” Similarly, Democratic nominee Joe Biden rolled out a plan to invest $700 billion to bolster U.S. manufacturing and purchase domestically made goods. Heading into winter, the government now needs hundreds of millions of needles and syringes to vaccinate the nation, items Peter Navarro warned earlier this year were in short supply. “We may find ourselves in a situation where we have enough vaccine but no way to deliver all of it,” he said in a February memo to the White House coronavirus task force. Now the Trump administration says needles and syringes are on order, but details of the contracts are shrouded in secrecy. the largest has gone to a company making a device that has not yet been cleared by the FDA, according to its own website. Another firm only incorporated in May, and has never before had a government contract nor imported needles and syringes. A third contractor in August reported disruptions in its overseas supply chain. Last week, the department of Health and Human Services refused to say if — or how many — needles and syringes have been delivered, claiming that information is “business sensitive.” Several contractors said the government has forbidden them from disclosing any information, even if they want to.... Each week the CDC receives forecasts of national COVID-19 deaths for the coming month from about 40 different expert modeling groups. The agency uses those to create a national ensemble forecast. To date, the predictions of total deaths keep going up, each dot on the graph a life, a family, a community.

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press

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During the Obama-Trump transition period, a group of newly appointed Trump aides gathered for an exercise in disaster preparedness hosted by top members of the Obama administration, including Nicole Lurie, a medical doctor who’d served as assistant secretary for preparedness and response. They discussed the supply chain, and the importance of securing necessary PPE in case of a pandemic. “There was not a lot of traction on the part of most of the people participating,” Lurie said. “One didn’t have the sense coming in that this was going to be high on the priority list.” In 2019, the Trump administration conducted an exercise dubbed “Crimson Contagion,” a pandemic flu simulation exercise involving 12 federal agencies, 74 local health departments and 87 hospitals across 12 states. Their key takeaways foreshadowed exactly what would happen less than a year later: In a pandemic, the U.S. would not have enough “on-hand stock of antiviral medications, needles, syringes, N95 respirators, ventilators, and other ancillary medical supplies.” Countries that make those supplies were going to keep them for their own citizens. And there wasn’t enough domestic manufacturing to fill that gap. As the U.S. outbreak started, Lurie said she repeatedly reached out to Trump administration officials to raise concerns and offer help, but was rebuffed. “So many thousands of people have died needlessly, and it didn’t need to be this way,” she said. “But I think if I reflect on what’s going on here, this is an administration that had policies, procedures, tools, plans, checklists, advance warning, all of those things, and it appears to have used almost none of it.” The Trump administration has blamed China, and its entry into the World Trade Organization in 2001, for the country’s dominance over America’s medical supplies. But the lure of cheap labor and lower production costs started drawing U.S. companies overseas in the 1970s. By 2020, almost all medical protection supplies in the U.S. were made in other countries.

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press

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From the very moment the pandemic reached America’s shores, the country was unprepared. Hospitals, nursing homes and other health care facilities didn’t have the masks and equipment needed to protect their workers. Some got sick and spread the virus. Some died. Medical supply chains that span oceans and continents are the fragile lifelines between raw materials and manufacturers overseas, and health care workers on COVID-19 front lines in the U.S. As link after link broke, the system fell apart. This catastrophic collapse was one of the country’s most consequential failures to control the virus. And it wasn’t unexpected: For decades, politicians and corporate officials ignored warnings about the risks associated with America’s overdependence on foreign manufacturing, and a lack of adequate preparation at home. As the pandemic rolled into the U.S., Asian factories shut down, halting exports of medical supplies. Meanwhile, government stockpiles were depleted from a flu outbreak a decade earlier, and there was no way to rapidly restock. The federal government dangerously advised people not to wear masks, looking to preserve the supply for health care workers. Counterfeits flooded the market.

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press

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“Dear Mr. President, The purpose of this letter is to make your office aware of a little-known national security threat.” The year was 2010. The president was Barack Obama. The letter writer was Mike Bowen, a Fort Worth, Texas, medical mask maker on the verge of bankruptcy after rapidly ramping up his factory to supply enough masks for the H1N1 flu just a year before. “The people that we’d hired, these hundreds of people that step in to save the United States, to save America. They were rewarded by getting in an unemployment line. I lost everything that I owned. Literally hocked the farm,” said Bowen’s business partner, Dan Reese. His retirement account had just $72, he said. The story of their company, Prestige Ameritech, explains why the U.S. has failed to maintain a robust domestic medical supply manufacturing base. Bowen and Reese had worked for the mask maker Technol, which until the 1990s made 87% of the surgical masks in the U.S. In 1997, Kimberly Clark bought Technol, and moved manufacturing to Mexico. Around the same time, other American mask makers shuttered their U.S. factories, moving mostly to China. Reese and Bowen bought the now-vacant Texas factory. But within 10 years, 90% of U.S. medical masks were being made overseas. Every year, Prestige Ameritech asked the Defense Department to buy their masks, citing the Berry Amendment that dictates the military buy U.S.-made apparel. In response, the Defense Department told them their masks aren’t apparel. “Year after year after year after year after year, up to and including the last bid. It was unbelievable,” said Reese. In 2014, a confidential presentation by Department of Health & Human Services (HHS) warned that the U.S. supply of medical masks was “nearly exhausted” and that 5.3 billion would be needed in a pandemic.

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press

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In February, White House trade adviser Peter Navarro wrote to the COVID-19 task force, urging the administration to halt exports and ramp up production of N95 masks. The U.S. “faces the real prospect of a severe mask shortage!” he wrote on Feb. 9. In addition to halting exports and prohibiting the sale of N95 factory equipment to China, Navarro pleaded that the U.S. government must provide “immediate purchase guarantees for all U.S. supplies at maximum production capacity.” President Donald Trump initially rebuffed calls from states, medical workers, Congressional Democrats and domestic manufacturers to invoke the Defense Production Act, which allows the federal government to boost manufacturing. He said it wasn’t necessary, but then abruptly reversed course in the spring, giving a few U.S. factories support they needed to expand production of N95s and the raw materials used to make them. But even now, those manufacturers haven’t received long-term purchase guarantees. according to health care workers, the Government Accountability Office and even the FDA, N95 masks continue to be in short supply. The White House denies this. Rear Admiral John Polowczyk, supply chain task force lead at the Federal Emergency Management Agency, said they were diverting N95s originally ordered for the Strategic National Stockpile to hospitals, which should have plenty by now. “Why any individual hospital would choose to have a nurse or doctor reuse a mask today ... I can’t reconcile that for you,” he said. Navarro also insisted that medical supply chains have now stabilized, but stressed the dangers of relying so heavily on Chinese goods. “We cannot forget the lesson, the key lesson, which is we need to bring our pharma home and our equipment home.”

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press

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A Jan. 27, 2020, email obtained through a Freedom of Information Act request makes it clear that some in the federal government were well aware medical-grade masks were going to be needed. “We are likely to see person-to-person spread of the virus in the U.S. in the near future; CDC will begin to gently articulate this message into their public posture,” said a Department of Homeland Security memo. At the same time, across the world in China, factories that make most of America’s medical supplies were shuttered as the country locked down to try to control its own outbreak. When they did start up again, those lifesaving supplies were kept for the Chinese market, leaving U.S. hospitals understocked and desperate as cases of COVID-19 shot up. It would be many weeks before China’s exports resumed. Meanwhile, the U.S. needed billions of N95 masks that simply weren’t available. Despite early warnings from inside the White House, the federal government failed to substantially mobilize domestic manufacturers until April, three months after the virus began spreading exponentially across the U.S. The impact of the virus varies greatly from country to country. But it is now clear that those with well-managed, diverse and flexible supply chains were able to protect against the deadly spread in ways the U.S. failed.

Juliet Linderman and Martha Mendoza, 'US medical supply chains failed, and COVID deaths followed', Associated Press