COVID-19 & the Medical Supply CrisisListen
NEWS ARCHIVE: Where are the ventilators, where are the gowns, where’s the PPE, where are the masks, where are they? … Crucial medical supplies needed to fight the coronavirus are running dangerously low in hospitals. Vice President Mike Pence says the government has ordered hundreds of millions of masks… They still do not have enough of those N95 masks in two thirds of the healthcare workers polled… Some of our healthcare professionals are still having to reuse masks inside local hospitals…
RANEY ARONSON: The coronavirus pandemic has highlighted the vulnerabilities of America’s medical supply chain. Perhaps one of the most challenging and dire of which is the country’s startling shortage of personal protective equipment — especially for healthcare workers.
JULIET LINDERMAN: We were seeing reports of nurses wearing garbage bags, and this advice to make your own mask. And we knew that doctors and nurses didn't have what they need. But we didn't know why.
That’s Associated Press reporter, Juliet Linderman.
For the past seven months she has been working with her colleague Martha Mendoza and journalists from Global Reporting Centre on a new FRONTLINE film, America’s Medical Supply Crisis, an investigation on how we ended up with such shortages, the deadly consequences, and who’s accountable.
I’m Raney Aronson, executive producer of FRONTLINE. And this is The FRONTLINE Dispatch.
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ARONSON: Martha and Juliet, it's so great to have you on The Dispatch, thanks for being with me.
MARTHA MENDOZA: We’re glad to be here.
JULIET LINDERMAN: Thank you so much.
ARONSON: So you know, in the piece that you guys wrote for the AP, which is just- it's phenomenal and very detailed, and, you know, seven months of reporting, and so much work went into that — Juliet, I was hoping you could help us understand a little bit of the process of your reporting. How did you begin? And how did you guys go about this massive subject?
LINDERMAN: Well, I mean, it really was one step at a time. I mean, it started when Martha and I were looking around the country, and we were seeing COVID, spreading across the states. And we were seeing reports of nurses wearing garbage bags, and this advice to make your own mask or wear a bandana. And we knew that doctors and nurses didn't have what they need. But we didn't know why exactly. And so, we decided, you know, knowing that China had shut down because of Wuhan, obviously manufacturing was shut down as well. We decided to look into import data to see, you know, what's actually coming into the country? Because we knew that the majority of our medical supplies are made overseas. And, we-, it was stunning to realize that in March, there were only a few shipments of medical grade N95 masks, when we are seeing this demand, just go through the roof. And we are seeing nurses and doctors pleading for protection.
ARCHIVE: PPE! What do we need? PPE! What do we want? What do we need? PPE! What do we want? PPE! When do we need it? Now!
LINDERMAN: And so, we really went from there. And tried to figure out what the issues were, how far back they went. And so, we really went administration by administration to see who was waving the flag? Who was talking about supply chains? Who was warning about what might happen in the case of a pandemic? And so, it brought us back to H1N1, but also we reviewed the Ebola after action report. You know, we went through and tried to understand, you know, who was talking about this. And what we found was that supply chains are fragile, but everyone knows that they're fragile. You know, that was information that people had. And in order to fortify them, it just takes a lot. And in our story, we spoke with former H.H.S. Secretary who said, you know, when the snake is not nipping at your ankles, you're focused on other things. And so, for a long time, the U.S. was focused on other things, and then all of a sudden, we found ourselves in a situation where people are dying en masse and the focus has now been shifted back onto this problem.
ARONSON: Right. I mean, I was thinking, you know, how vivid it was that you all started our film with Sandy Oldfield, so, you know, broken supply chains have real life consequences. And, you know, her story is one that, you know, will stick with anyone who watches it. Martha, talk to me about Sandy and that group of nurses that you guys met.
MENDOZA: Okay, I will start by saying, if I ever was sick, it would be Sandra Oldfield, who I would want at my side. She sounded like an amazing nurse.
Excerpt from America’s Medical Supply Crisis:
RACHEL SPRAY: Everybody knew Sandy. Every lab, X ray, the respiratory therapist…you know, she always had a smile for them, or a kind word for them.
MENDOZA: So, these nurses in Fresno were all exposed to a COVID positive patient.
LORI RODRIGUEZ: And she would tell us that she was going to go to work with no fear. That she knew that God was with her and he was going to protect her.
MENDOZA: Dozens were exposed.
RACHEL SPRAY: It was hard. Our morale was pretty low. And we still weren't getting the PPE on our, on our floor. On our unit. It was tough.
LORI RODRIGUEZ: She didn’t feel safe. I even had made a comment to her. I said, “Just don't go to work.” She was like “We have to. We've already, I mean, you don't just not show up, you know?”
MENDOZA: 10 were sick, three were hospitalized, and Sandra Oldfield died from COVID.
LORI RODRIGUEZ: She told me, “The doctors are going to put me on a ventilator.” And I said, “We're gonna be right here when you open your eyes.” And I told her, I loved her. And that was the last time I spoke to her.
MENDOZA: None of them had adequate PPE They didn't have N95 masks because this patient was asymptomatic. And, the hospital was conserving those N95 masks for people on a COVID ward. And they were demanding change at the time that they were being exposed. Very scary situation for them, very upsetting. They, you know, they were wondering whether it's really worth it to be a nurse. And, you know, there's doctors and nurses who go into medicine, and they want to do like, humanitarian work in war zones. And then there's doctors and nurses who go into medicine, and they want to provide care in their community, and they're not looking for a big, risky adventure. And, and yet, this COVID pandemic has put them on the frontlines of some of the most dangerous situations medical experts ever have to get into.
ARONSON: And one of the things that I was thinking about watching them was, you know, certainly being a nurse is a calling, but I think the assumption that they all had, just from your interviews and reporting as if they would be taken care of. Can you talk a little bit about that? And again, just trying to focus on the real life consequences of these, of this, you know, profoundly broken supply chain.
MENDOZA: Yeah, Juliet and I spend a lot of time looking at data and trade records and old, you know, government reports and confidential emails. And for me to stand in a graveyard at the grave of a nurse with her grieving sister and her grieving friends. It was profound for me too, I need to say, because it was like I can understand and even articulate how these nerdy issues with medical supplies have profound human consequences. But it's really different to be in the graveyard at the grave and realize this person's life is gone. So, it was, it made an impact on me as well.
ARONSON: Well, I've been thinking deeply about that, you know, because for a long time, we've been talking about doing a supply chain film, right? Like, how do we do that? How do we articulate the need here? And suddenly, you know, COVID, obviously brings us into sharp relief. What are we looking at? Talk to me a bit about the present and the future?
LINDERMAN: Sure. Well, there is a need, obviously, for these products. And, I believe we have seen something like more than 2000 shipments of N95s from overseas, just this month. And so, supplies are coming. The need is there. And the White House, you know, we spoke to the White House, and they told us, you know, the US has all the PPE that it needs. But then, you know, less than a month ago, in late September, the Government Accountability Office released a report in which they said, “No, that's not, you know, there are still widespread shortages. Nurses are still reusing masks. There isn't enough of what we need.” So, you know, and then seeing all of these shipments from overseas sort of reinforces this chain, which is, we are super dependent on overseas manufacturing. And when it works, it works. And it provides a cheaper alternative to US made goods, but when it doesn't work, people die. And there really are consequences to not being able to have what we need when we need it.
ARONSON: Yeah, I mean, of course, there's also the issue of the counterfeit PPE that you all found as well. And I know you actually had some of it tested. And that's, we see that in our documentary. So, take me to that moment, and what made you guys actually think that you should get those masks tested? And what were the results of course?
MENDOZA: We had seen in the data that no N95 masks were getting shipped to the United
States. Day after day, week after week.
Excerpt from America’s Medical Supply Crisis:
LINDERMAN: What we're seeing here is, like pretty consistent: 25 shipments, 22 shipments, 23 shipments, and then just drops to three shipments in all of March.
LINDERMAN: Complete dropoff.
MENDOZA: And then we heard that there was going to be an airplane load full of them flown in, and we're able to watch video of that load arrive. Watch them, unbox them.
Excerpt from America’s Medical Supply Crisis:
THOMAS TIGHE: Yeah, this is the first shipment that we've got in from China in the past two months. These are the N95 masks that are in such high demand right now.
MENDOZA: And then we were like those masks have ear loops.
Excerpt from America’s Medical Crisis:
LINDERMAN: Looks like he's inspecting them, right, though?
MENDOZA: Those are ear loops, not a headstrap. I don't think they're supposed to have an ear loop.
LINDERMAN: No, they're definitely not.
MENDOZA: And they're labeled N95s. And we're looking back and forth at the CDC’s counterfeit page. And we were like, this CDC counterfeit page very specifically says ear loops. You remember that day, Juliet?
LINDERMAN: Oh, yeah. That was, that was really wild. I mean, we were reviewing the footage to go with our story. We were working on a story about how a nonprofit organization that usually operates overseas was filling a need in the U.S. because the demand was so high. That was the point of the story. And this footage was just supposed to go with that story. Seems like a pretty simple story. And then we're watching it and we're like, oh, my God, wait, wait a second. And we had a conversation. You know, our story was supposed to go in a couple of days. And we saw what, to us, seemed like something that was really concerning. And so, we had a discussion about, you know, what does it mean if we sit on this information, until our story goes out, and you know, God forbid, someone gets a counterfeit mask. And so, you know, we- we made the choice like we- we contacted the organization immediately and had a conversation with them about what we saw. And luckily, that shipment, you know, was quarantined. And it ultimately never, it never got sent out. But you know, a lot of other shipments inevitably did make it to the frontlines.
ARONSON: Right, I mean, one of the interesting things watching that and hearing about it as it was unfolding is, you guys are just paying attention, right? I mean, because so easily, we would not be paying attention to something like that, and the counterfeit PPE could make it into, you know, our country pretty easily.
MENDOZA: Let's be clear, we just kind of scratched the surface and saw them. What we found in the passing weeks is that they have seen flooding the U.S. market. And so, by the time we gathered a whole variety together, put them in a box and sent them to University of North Carolina for testing…
PHILLIP CLAPP: All of these products that arrived, even though they're labeled clearly N95. And they show the lady in the picture is wearing a mask with head straps. It has ear loops. So that's a dead giveaway that it's a counterfeit product. These were all counterfeit, that we tested.
MENDOZA: All of them, every single one he tested, were counterfeit, including the masks that I threw in that had been sent to AP for me.
ARONSON: Martha, I didn’t know that. I didn’t know that part about the masks sent for you guys.
MENDOZA: Yeah. Yeah. And then...
ARONSON: No kidding.
MENDOZA: No. And then when he told us okay, yes, even these Associated Press masks are counterfeit, then we had to like go back to our editor. Well, we actually, that box of masks we sent included some of our own. So how do we handle that?
ARONSON:: Right. And so what do you think now? I mean, is we just basically don't know the amount of counterfeit coming in? Or do you think things are more under control?
MENDOZA: I don't think things are more under control. I would say there's probably more counterfeit coming in now than ever. The FBI and the Department of Homeland Security both have initiatives to stop it. But there was more than 2000 shipments of N95s from Asia into the United States in the past month. That's up from 20 shipments during the same period a year ago. Those companies in Asia, primarily China, have ramped up so fast. I just can't believe they're all doing this in an approved way.
ARONSON: Yeah, I mean, this brings me to one of the biggest points in your film, which really it just turns everything on its head that you know, of course, this has led to a big call to bring back manufacturing of PPE to the U.S. I know that this is something Navarro spoke about a lot in his interview.
Excerpt from America’s Medical Supply Crisis:
WILL LYMAN: In August, we met with President Trump's trade adviser Peter Navarro. Navarro was one of the earliest officials to warn President Trump about the pandemic and has long expressed concerns about critical supplies like PPE being manufactured overseas.
PETER NAVARRO: We're dangerously dependent on the Chinese Communist Party for all sorts of masks, equipment, and we know that they, in terms of times of crisis, will hoard that stuff.
JULIET LINDERMAN: You have been talking about the potential dangers of us manufacturing moving offshore for a very long time. Is this the type of scenario you were worried about?
PETER NAVARRO: No, this is what I was worried about on steroids. This pandemic has shone a bright light on the dangers because something like over 80 countries during this pandemic has put some form of export restrictions on what we need as a country to protect our public health.
ARONSON: And both Trump and Biden have been talking about this now on the campaign trail.
DONALD TRUMP: We're taking our business out of China, we are bringing it home…
JOE BIDEN: We'll make the medical supplies that our country needs…
DONALD TRUMP: Bring home our medical supply chain…
ARONSON: Actually, how realistic is that? I mean, is this even a potential considering the fact there's so much counterfeit coming in, is it actually, you know, realistic to bring manufacturing back to the US?
MENDOZA: Not without significant policy changes. There is no incentive for a hospital that needs to buy hundreds of thousands of N95 masks to pay twice as much for them, as they ordinarily would. Right now there's incentive, but come on, a couple of years from now? No. So there's, you know, there would have to be huge, huge changes in policy and spending and at great cost. And so those are going to be tough decisions. Yeah.
ARONSON: Yeah. I mean, it's, you kind of wondered, obviously, you know, going back to the beginning of your reporting and research, when you look at some of the warning signs that came through with the H1N1 flu scare, right, which is 2009.
ARCHIVE: The world is now at the start of the 2009 influenza pandemic… H1N1 has spread to 46 states, more than 1000 Americans have died. And more than 20,000 have been hospitalized… Public health experts are expressing concern about whether hospitals could handle the onslaught…
ARONSON: That's when we did have a stockpile. But then after that point, no action was taken. So what do you think's gonna happen now?
LINDERMAN: I mean, we spoke with some people who said that funding for the Strategic National Stockpile should not be discretionary, that it should be automatically funded every single time. And that's not what the system looks like right now. And, you know, we spoke with the person who ran the SNS, and he identified that as a flaw…
Excerpt from America’s Medical Supply Crisis:
GREG BUREL: We bought the N95 masks there in the stockpile, with funds that were appropriated in the early 2000s. They've passed their expiry date, but we didn't have additional funds to buy more. So we made the difficult decision to hold on to those, you can't be prepared if you're not funded to be prepared.
LINDERMAN: Why do you think you didn't receive those appropriations?
BUREL: You'd really have to ask the Congress.
LINDERMAN: You know, that means that it's not a guarantee.
ARONSON: Right, because otherwise, the stockpile is just not there, or you're reverting to using old PPE or like you show in the film, all of this is being imported from overseas. I mean, one of the things we learned a lot about in this film sounds very wonky, but it's really important to understand with the supply chain, are these groups called group purchasing organizations. And, and I know we were, you know, in the edit, really trying to figure out — how do we make this into film speak, right? Like, how do we get people to understand what this is? Why are they so important in this crisis?
MENDOZA: Hospitals team up together to do their purchasing under these group purchasing organizations. So the biggest ones have thousands and thousands of hospitals working together, collaborating to buy supplies all together at a lower price. It's a simple negotiating strategy. But by using them during a pandemic to get them their supplies, as needed, they found some real problems. I mean, this was definitely a source of some of the major fractures in the medical supply chain.
LINDERMAN: An issue that hospitals had is they order what they need when they need it, and they get shipments of what they need when they need it. And not every hospital is lucky enough to have a warehouse of its own, where they can really have their own stockpiles of material and products, just in case, you know? And so it didn't quite work in this instance, because, well, A: there wasn't enough. So, you know, we are talking to GPOs who say they couldn't get what they needed. And so they obviously can't, they can't send those products to hospitals unless they have what they need, right? So, it really is a system that really does depend on a nimble supply chain that doesn't collapse.
ARONSON: We'll be right back after this message.
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ARONSON: So, I'm still trying to grasp what it means for today. So after all this reporting, tell me about where we're headed into the fall right now, in terms of PPE, let's start there.
MENDOZA: The situation is unclear because there is a lack of transparency. We filed Freedom of Information Act requests for months and have had no response, we were told that asking how many of a particular item has been delivered or put in the National Stockpile is business sensitive, and the federal government cannot tell us how our own tax dollars are being spent. I've been reporting for a long time, I've never encountered that type of just blocking of information.
LINDERMAN: You know, we spoke with contractors, government contractors, who told us that they were essentially forbidden from disclosing that information to us.
ARONSON: So you can't really tell us right now, like if there is a continued, you know, increase and potential surge, even this winter of COVID, whether or not the hospitals in our country will be prepared with PPE.
MENDOZA: We can tell you that the Government Accountability Office just released a report that showed that shortages persist. We can tell you that the American Hospital Association and the American Medical Association, say shortages persist. In fact, the head of the American Medical Association said the situation is maybe worse than ever. And at the very frontlines, I'm hard pressed to find a nurse who is using an N95, as the manufacturing guidelines suggest, which is single use put it on, take it off after the patient. Anybody who I know who's, you know, the National Nurses United, the union also backed this up, nurses are being told to reuse their N95s. That only is occurring because there's not enough.
ARONSON: It's such a grave situation. And it's not over. So what's the next step in your reporting?
LINDERMAN: We're starting to look into what we're going to need next, right, you know, we know that we needed N95s, we know, we needed gowns and gloves, and that there wasn't enough. And now, you know, the conversation is shifting towards a vaccine. We're going to need a means to administer that vaccine. And Martha and I have started looking into needles and syringes because the vaccine is likely to be administered that way. And so, you know, we are trying to figure out, you know, what we have, and what we're going to need, and again, I mean, as Martha said, there's not a lot of information about where we are right now. But that is certainly something that we are going to be tracking in the weeks to come.
ARONSON: So you know, what I read in your story and also in the film, you know, clearly as it doesn't look like a sure bet when it comes to syringes. And that at least one executive that you interviewed expressed real concern to you. So what does your reporting show, specifically, when it comes to the syringe supply?
LINDERMAN: What we know so far is that the government has contracts to import needles and syringes, but they have not told us how many they have so far and whether they're on track, really. So, you know, there's a lot of information that we don't know. But what we do know is that the supply chain, and these supply chain issues are going to still be a serious issue. One company that has a contract to import needles and syringes actually wrote a note that they had a supply chain disruption in one of their factories overseas. And we spoke to them again, this was in August, we spoke to them again more recently and they said that they had resolved that issue, but they warned that it could have been a catastrophic problem. So there is still reason to be concerned about this.
ARONSON: What are you left thinking right now, what feels most urgent to you?
MENDOZA: You know, the fact that there still is not clear federal leadership, as we head into a fall and winter where we are being warned that there's going to be a surge in COVID cases, makes me really worried. I have plenty of friends who are nurses and doctors, not to mention the thousands who I don't know, and I just hate to think of them being in their COVID wards, trying to do CPR on somebody who may be a relative of mine, or somebody in my own family, without proper protection. And so, without one air traffic controller at the top of all this directing where the supplies go, not to mention directing where the vaccines go, and having a rollout that is clear and transparent, is… Can be anxiety provoking for sure.
ARONSON: Right, and I think that, you know, the commitment that we have is that we're gonna just we're gonna have to keep reporting this, you know, we're finding time and time again, with these investigations, especially with you guys at the AP that, you know, we start reporting on something and the more that you all find, the more we need to keep at it. So we'll all keep in touch going forward. And I really appreciate you guys coming on The Dispatch.
MENDOZA:Thank you very much, Raney.
LINDERMAN: Thank you so much.
ARONSON: America’s Medical Supply Crisis is now streaming in full at frontline-dot-org, where you can read, watch, and listen to all of our original reporting around the coronavirus pandemic, and many other stories.
Our podcast producers are Max Green and James Edwards.
Our production assistant is Lucie Sullivan.
Katherine Griwert is our editorial coordinating producer.
Frank Koughan is senior producer.
Our senior editors are Lauren Ezell and Sarah Childress.
Andrew Metz is our managing editor.
I’m Raney Aronson, executive producer of FRONTLINE.
Original music in this episode by Stellwagen Symphonette.
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