Safety gear roadblocks remain
Supply chain to health care providers can snag, stall counties’ reopening
More than two months into the COVID19 pandemic, county officials and health care providers across the Bay Area are still facing bewildering roadblocks in their efforts to procure sufficient supplies of personal protective equipment, or PPE.
Accessing steady streams of vast amounts of medical gowns, gloves, masks and disinfectant has presented unprecedented logistical challenges that officials are only now starting to smooth out, thanks largely to their ability to buy from reliable suppliers
— a process that took considerable time to figure out.
About the time the Bay Area shelterinplace started in midMarch, “everyone out there, whether it’s a fire department or a boardandcare home, they weren’t getting what they needed,” said Jim Morrissey, a tactical medical program director who’s helping coordinate the procurement of PPE for Alameda County’s Emergency Operations Center.
Particularly in the early weeks of the pandemic’s local spread, when counties and health care providers were
scrambling to stock enough equipment to stay ahead of a projected surge in COVID19 cases, there were pitfalls everywhere.
Middlemen and profiteers squirmed in between links in the global supply chain, selling fictional caches of equipment. Chinese officials abruptly tightened customs inspections for medical gowns, creating choke points that slowed shipment times. Pallets of equipment would arrive only to be rejected because they didn’t meet medical standards.
“We’ve had countless, countless occurrences of trying to navigate around what could be lemons,” said Josh Sullivan, a logistics chief for Contra Costa County’s health department. “We’ve had orders we placed on March 2 (and the shipment was) bumped to as late as May 20. We’ve been playing a lot of whackamole.”
The problems caused by those supplychain snags carry serious consequences in the region’s efforts to shift slowly back to a reopening of the economy and a more normal way of life. One of the central questions guiding Bay Area public health officials’ decisions about reopening is whether all acute care hospitals, outpatient clinics, nursing homes and medical firstresponders have a 30day supply of PPE on hand.
The fragmented response to the pandemic and PPE procurement — caused in part by a lack of direction from the federal government, some officials complain — make it difficult to know how close the region is toward that goal.
But those in charge of buying up PPE say they’re making headway, thanks in large part to the painstaking vetting of vendors and suppliers they were forced to do over the past two months.
“We’ve gotten to a much better place with the vetting process,” said San Francisco City Administrator Naomi Kelly. “That has helped us to avoid the pitfalls — the bad actors out there, selling products they don’t have, and the price gouging.”
In general, counties are acting as PPE backstops for health care providers, doling out equipment when hospitals — public and private — run short. The equipment is also needed for government workers, like firefighters, paramedics and bus drivers, whose jobs put them at risk of infection.
Morrissey said Alameda County has about a 90day supply on hand to meet current levels of demand. Kelly said San Francisco also has a threemonth supply in most PPE categories.
Accessing reliable sources of PPE has also helped keep costs down, Kelly said. Ordering equipment in regular cadences allows them to be shipped at lower expense on cargo ships, rather than flying in an emergency order, which costs more.
Contra Costa officials were still setting up their data and reporting systems and could not immediately estimate their supplies. San Mateo County officials would not answer specific questions about their PPE supplies, and officials in Santa Clara County did not respond to multiple interview requests. Officials in Marin could not make anyone available for an interview.
For health care providers, the picture is more opaque. While the region may have so far staved off an overwhelming surge in cases, health care workers are still pleading with their hospitals for adequate PPE supplies. Shortages last month forced some nurses in Oakland to cut holes in trash bags in an attempt to fashion makeshift gowns in the absence of medicalgrade ones.
Zenei Cortez, a nurse at Kaiser Permanente in South San Francisco, said things have not improved much since then. Nurses there have been forced to reuse N95 respirator masks and hospital gowns, which are meant to be singleuse and disposable. The masks, she said, are decontaminated by a chemical process that’s left some nurses complaining of nasal irritation and headaches. Some nurses have resorted to purchasing masks on their own, sometimes at steep costs given the high demand for PPE.
“We need to start protecting ourselves and our patients by having the optimum PPE,” said Cortez, who is also the president of both the California Nurses Association and National Nurses United. “The people making these decisions are not out there on the front lines,” she said.
California Nurses Association/National Nurses United released results from a survey on Thursday showing that of 3,800 nurses queried, 88% reported having to reuse a singleuse disposable respirator or mask with a COVID19 patient.
Kaiser officials declined to answer specific questions about their PPE supplies. In an email, Michelle GaskillHames, senior vice president of Health Plan and Hospital Operations for Kaiser Permanente Northern California, said the hospital’s “top priority continues to be the safety of our patients and staff. We have adequate supplies to make sure we provide our staff with the right level of protective equipment they need to deliver care safely, aligned with the latest science and guidance from public health authorities. We are prudently managing our resources to ensure this equipment is available for our health care workforce for the duration of this pandemic.”
Sutter Health, another large Bay Area health care system, also declined to answer specific questions about their PPE supplies. A spokeswoman sent an email saying: “We continue to closely manage our supply of PPE and work round the clock to secure additional PPE, so we can meet critical community need while maintaining patient and frontline staff safety. PPE is a significant concern still acutely felt by health care organizations across the nation, including us, and we are doing everything we can to secure additional supplies.”
“According to our employer, they need to be mindful of our stockpiles — ‘we don’t want to run out’ — that’s what they’re saying. What’s the use of having stockpiles if all our nurses are dead?” Cortez said.