States all fell short in virus readiness

Experts say hindsight reveals gaps in preparedness as well as follies

JEFFERSON CITY, Mo — Last autumn, when schools were in session, sports stadiums were full and no one had even heard of covid-19, the Missouri health department made an eerily foreshadowing request.

It asked the state for $300,000 to buy supplies in case of a large-scale disease outbreak. The goal was to fill a gap between local and federal sources.

Today, as states spend billions of dollars in the fight against the coronavirus, that October funding request appears woefully insufficient. Yet, it highlights a stark fact: States were not stocked for a pandemic and have been scrambling to catch up.

An Associated Press review of more than 20 states found that before the coronavirus outbreak, many had at least a modest supply of N95 masks, gowns, gloves and other medical equipment. But those were often well past their expiration dates — left over from the H1N1 influenza outbreak a decade ago.

The supply shortage stemmed from a variety of factors — a decline in public health funding, a cost-saving dependence on having inventory on hand only for immediate use and a belief that the federal government could come to the rescue with its Strategic National Stockpile.

In hindsight, the federal stockpile proved insufficient for a nationwide viral outbreak, and a worldwide competition for scarce supplies revealed the folly of counting on rapid deliveries.

“You could see it in almost every state, in every locality, and the federal government level: depleting the resources, depleting the inventory, and hoping when you need them they will be available,” said Gerard Anderson, a health policy professor at Johns Hopkins University, which has tracked coronavirus cases and deaths around the world.

The crisis spawned a political blame game over the shortage of protective gear for medical workers and the hunt for ventilators. Some governors harangued the federal government for leaving them in the lurch. President Donald Trump faulted states, tweeting earlier this month: “The complainers should have been stocked up and ready long before this crisis hit.”

Before the World Health Organization issued a Jan. 9 advisory about the coronavirus emerging in China, Missouri

had a supply of 663,920 N95 respirator masks, 253,800 surgical masks, 154,000 gloves, 17,424 face shields and 14,048 gowns. All were leftovers provided by the Centers for Disease Control and Prevention after the H1N1 flu pandemic of 2009-10, and well beyond their shelf life.

Other states also were relying on old supplies. Officials in several states told the AP that their stashes included at least some leftovers from the H1N1 flu.

Missouri, like some other states, had spent nothing to replenish the expired equipment. And even when asking for $300,000 last October, the state Department of Health and Senior Services stressed that it wasn’t to build a big reserve.

“Since outbreaks and the resources needed are not predictable, purchasing a large stock of supplies that could expire or become obsolete is not a responsible use of state funds,” the health agency said in a budget document submitted to Gov. Mike Parson and state lawmakers.

That funding request for the fiscal year that starts in July still was pending in the state House when Missouri’s first coronavirus case was confirmed last month. Since then, Missouri has ordered about $40 million of protective medical supplies for health care workers and emergency responders.

Missouri Health Director Randall Williams told the AP that it didn’t make sense to load up on supplies without knowing what might be needed. For example, he said, bug spray would have been more useful than face masks during the 2015-16 epidemic of the Zika virus, which is spread by mosquitoes.

“If you spend money on prevention and whatever comes your way isn’t that, then you have less money for response” when an emergency occurs, Williams said.

Federal public health funding for states has been on a downward slide since new programs were launched after the 2001 terrorist attacks and anthrax scare. The Public Health Emergency Preparedness program provided $675 million last year — down 28% since 2003, according to the nonprofit Trust for America’s Health. The Hospital Preparedness Program provided $265 million last year — down by almost half during that same period.