President Donald Trump boasted on May 1 that his success in responding to the coronavirus pandemic has made ventilator, test kit and mask shortages a thing of the past, and that much of the country is ready to quickly send people back to work.
“We’ve ensured a ventilator for every patient who needs one,” he said. “The testing and the masks and all of the things, we’ve solved every problem. We solved it quickly.”
But that same day, his own health and emergency management officials were privately warning that states were still experiencing shortages of masks, gowns and other medical gear, according to a recording of an interagency meeting between FEMA and HHS officials across the country, conducted by conference call, which was obtained by POLITICO.
Trump’s federal “Stay at Home” guidelines had quietly expired the night before, leaving states to manage the pandemic as they saw fit. The officials also expressed concern that governors moving to reopen their economies while cases were still prevalent threatened to plunge the nation into a new and potentially deadlier chapter of the outbreak.
“The numbers of deaths definitely will be high,” Daniel Jernigan, director of the Center for Disease Control’s influenza division, said at the start of a May 1 conference call. Jernigan did not respond to an emailed request for comment.
Minutes later, another official underscored the risk facing the U.S.: If all the states moved to lift their social distancing restrictions, hospitals nationwide could see a surge of new coronavirus cases, creating the potential for severe ventilator shortages within weeks.
“If, at the end of stay-at-home orders, you were to lift everything and go back to normal business, and not have any community mitigation, you would expect to see in the second week in May we begin to increase again in ventilator uses,” the official said. “Which means cases increase, and by early June, we surpass the number of ventilators we currently have.”
Those internal anxieties came as dozens of states prepared to reopen their economies over the coming weeks, a push that won’t immediately return the nation to business as normal yet that’s still occurring against the advice of many public health experts. Even Trump himself, who encouraged states to move fast, has acknowledged the pace will likely lead to a greater death toll.
But the daily “HHS/FEMA Interagency” conferences also served as a counterpoint — though one the public did not hear — to the different story that Trump has sought to sell, of a swift and effective response that’s so successfully cleared the path for a restart of the economy that the task force managing the crisis may no longer be needed.
POLITICO obtained audio recordings of three conference-call meetings held between April 24 and May 1, led by HHS and FEMA officials and designed to keep a wide range of federal agencies apprised of the government’s coronavirus response. The meetings included updates from internal task forces focused on various elements of the response — like data and analytics, testing sites and community mitigation efforts — as well as from regional FEMA and HHS leaders in offices around the nation.
In the calls, officials in Washington and their regional counterparts were blunt about their struggle to keep pace with a flood of requests from governors for more medical equipment, even as the president touted the administration’s actions to secure sufficient gear from foreign and domestic producers.
“Now we’re loaded up,” Trump said during a late April press briefing. “The federal government loaded up hospitals with things to take care of people.”
“We have millions and millions of masks,” he added on May 1. “That was something, four weeks ago, was difficult, and now we have millions of masks coming in and already here.”
Despite steps the administration has taken to buy and distribute millions of masks and other gear, health care workers across the country continued to report shortages in recent weeks that put both them and their patients at risk of infection.
A ‘Significant Challenge’
In a meeting on April 24, administration officials noted ongoing shortages of hospital gowns, predicting it would be a “significant challenge in the days and weeks ahead” and warning that a plan was needed to come up with “alternatives that can be used in this period of sparse numbers of gowns.”
Officials again flagged the gown shortages on multiple subsequent calls about the flow of personal protective equipment, known as PPE.
“Our main PPE shortfalls continue to be along the lines of gloves and gowns,” one official from FEMA’s region 4, which covers parts of the Southeast, told call participants on May 1. “I know everyone is working hard on that.”
Officials on an April 28 call said they also briefed the leaders at CDC and HHS’ preparedness and response agency “on the need for cloth masks in nursing homes and outpatient settings.”
Federal officials assigned to FEMA’s Mid-Atlantic region said on April 24 that their member states were worried that a PPE fact sheet FEMA sent out that week encouraged critical infrastructure operators to contact their states if they were unable to obtain masks and other protective gear through their normal suppliers.
“Some of the states are a little torqued about that because PPE is very limited,” one of the regional officials said at the meeting. “Given the other priorities, they feel it’s put them in a bad spot.”
Other regions reported on that call that dental offices and food and agricultural facilities in states moving now to reopen have complained that they can’t access masks, gloves and other PPE from their normal suppliers and have pleaded for government assistance.
And as the Trump administration moved earlier this month to distribute more protective gear to nursing homes that have seen staggering death tolls over the last few months, little has been done for the millions of patients who receive home health services, clinics, and other community-based health providers, outside of hospitals. Officials on the calls said they were still struggling to understand what is needed.
“We don’t have full visibility on health care settings outside of hospitals and nursing homes, and we don’t have baseline data to understand what ’normal’ looks like,” said CDC epidemiologist Capt. John Redd on the May 1 call. Redd did not respond to an emailed request for comment.
In a statement, a White House official touted the administration’s efforts to ensure health care providers get the supplies they need to manage the pandemic.
“The president has been clear that when the need for PPE arises, the administration has developed an historic public-private partnership designed to secure and deliver these critical supplies to everyone who needs them in record time,” the official said.
FEMA similarly emphasized to POLITICO that the federal government is pursuing many strategies at once to obtain supplies, and that shortages are not unique to the U.S. An HHS spokesperson said the department has closely coordinated with FEMA and the White House’s coronavirus task force to ensure a "locally executive, state managed, and federally supported response."
“This is a global pandemic — demand continues to outweigh supply across the globe, not just in the U.S.,” the FEMA spokesperson said. “Considering that, FEMA and HHS are both working hard to ensure federal contracting efforts don’t compete with states’ abilities to acquire PPE and other supplies.”
‘A Massive Undertaking’
Trump and his top officials have touted the nation’s testing ramp-up, stating repeatedly that the U.S. is doing more tests than any other country in the world. On May 1, top Trump health appointee and testing coordinator Brett Giroir joined the interagency group’s meeting to praise an initiative to expand drive-through test sites across the country as a “great success.”
Yet in the days prior, officials cautioned that states trying to test scores of patients were hampered by equipment and gear shortages. Reporting on conversations he’d had with health officials in the mid-Atlantic region, one regional official told the interagency group on April 24 that states’ “supply appears to be the main limiting factor.”
The story was similar among the Northeastern states, an official representing that region concurred.
“Funding and staff is not an inhibitor,” the official said on the same call. “It’s the ability to secure testing supplies and PPE.”
Indeed, while the nation’s testing figures have risen over the last month after lagging for much of February and March, public health experts broadly agree that the U.S. is still not testing enough people to have an accurate picture of the virus’ spread.
The administration was only just beginning to shift its efforts from scrambling to import supplies to trying to boost domestic production of key materials like protective equipment, one official said on May 1, speaking on behalf of an internal task force focused on supply chain issues. Some of those supplies are in demand not just in the health care system, but also by businesses trying to reopen while keeping workers and customers safe.
It was, the official said, “a massive undertaking.”
Participants on that May 1 call — which focused on the theme of “Opening Up America Again” — also spent much of the meeting grappling with the likelihood that as states began to lift their distancing restrictions, new coronavirus outbreaks would follow.
Nearly all of FEMA’s regional teams reported continued increases in both cases and deaths as governors moved to terminate stay-at-home orders, flagging on the calls new hot spots in prisons, meat processing plants, and other high-risk facilities.
At least two states at the time — South Carolina and Georgia — were among those planning to reopen despite logging zero consecutive days of decreasing cases, according to one slide distributed to the group and obtained by POLITICO, much less meeting any of the other basic reopening recommendations or “gates” laid out by the CDC. In Georgia, according to another slide the group saw, new Covid-19 cases were up 65 percent and deaths were up nearly 103 percent over a two-week period.
Trump Praises Reopenings
Trump has vacillated between praising and criticizing Georgia Gov. Brian Kemp’s decision to reopen the state, but on the same day as regional officials expressed concerns in the meeting, the president broadly championed states’ push to reopen.
“I like the states opening. They will be opening,” he said. “They’re going to open safely and quickly, I hope, because we have to get our country back.” Later that week, after widespread blowback to Georgia’s move, including from several Republicans, Trump said Kemp was moving too fast by opening businesses like tattoo parlors and nail salons.
Though some in the administration have publicly acknowledged, and even expressed concern, that states were lifting restrictions before slowing the virus’ spread, the president and his top advisers have largely cheered on the reopening states. They have also suggested that the CDC’s criteria are guidelines, not mandates, that states can use as they see fit.
Health officials in the meantime continued to scramble to stand up new tools to monitor for outbreaks — pulling data from various parts of the government in an attempt, as Redd described it, to “respond to the increased demand and burden on the system” should new clusters of cases pop up. The odds of such virus clusters cropping up, he added, “we of course consider inevitable.”
During that meeting, the officials also confronted a particularly bleak scenario: that the fresh waves of coronavirus cases could threaten once again to overwhelm the nation’s health system.
The U.S. has nearly 104,000 ventilators, according to one slide distributed to the group — of which only about 30,000 were currently in use. Yet while Trump has latched onto that surplus in recent weeks as evidence of the administration’s successful response — dubbing the U.S. “the king of ventilators” — officials on the call were focused on new modeling that predicted yet another ventilator crisis if Americans quickly resumed their pre-pandemic lives.
The model, outlined in a presentation slide obtained by POLITICO, illustrated a worst-case scenario that showed the rash of new cases maxing out and soon exceeding the nation’s ventilator supplies by the first week of June.
The potential crisis was just one of the dangers officials on the call emphasized would require continuous monitoring — and that, despite Trump’s wish for a rapid return to normal, they warned could force the nation back into another damaging lockdown.
“As we lift mitigation, it’s going to be critical to monitor local transmission, public health capacity and health system capacity over time,” one official said on May 1, “and if needed, reinitiate mitigation in the coming weeks.”