(Associated Press) Nurse Sandra Oldfield’s patient didn’t have the usual symptoms of COVID-19 — yet. But then he tested positive for the virus, and it was clear that Oldfield — a veteran, 53-year-old caregiver — had been exposed.
She was sent home by Kaiser Permanente officials with instructions to keep careful notes on her condition. And she did.
“Temperature 97.1,” she wrote on March 26, her first log entry. Normal.
She and her colleagues said they had felt unsafe at work and had raised concerns with their managers. They needed N95 masks, powerful protection against contracting COVID-19. Kaiser Permanente had none for Oldfield. Instead, she was issued a less effective surgical mask, leaving her vulnerable to the deadly virus.
Many others were similarly vulnerable, and not just at this 169-bed hospital in Fresno. 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.
The Associated Press and “FRONTLINE” launched a seven-month investigation — filing Freedom of Information Act requests, testing medical masks, interviewing dozens of experts from hard-hit hospitals to the White House — to understand what was behind these critical shortages.
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, the AP and “FRONTLINE” found.
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.
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.
At home with her aged dog Freckles at her side, Sandra Oldfield recognized the symptoms as she recorded them in her log over 11 days:
She lost her appetite. Her handwriting grew shaky. Someone called an ambulance. Others came for her pets.
Although it will take years for researchers to understand why the pandemic was disproportionately worse in the U.S., early studies that compare different countries’ responses are finding that shortages of masks, gloves, gowns, shields, testing kits and other medical supplies indeed cost lives.
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.”
Meanwhile, 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.
Dow and his colleagues say there would be massive savings, in lives and tax dollars, if the government invested more in buying and storing stockpiles of supplies.
“This is a case where no individual health care organization is large enough to move the market and induce suppliers to invest in those types of supply chains,” said Dow. “So the government needs to be able to go in and guarantee a certain amount of purchases so that it will be in the self-interest of each one of these manufacturers to be willing to put in the investments into that supply chain.”
In 2005, newly appointed secretary of the Department of Health and Human Services Mike Leavitt began ringing pandemic alarm bells after a disturbing briefing from the CDC about a potentially lethal virus.
“Their concern was that it would begin to mutate in a way that would allow it to go from animal to person and then person to person. And once it achieved that capacity, it was a pandemic virus,” said Leavitt.
He went to the White House and told President George W. Bush, who rolled out at $7.1 billion pandemic preparedness plan. Leavitt, a Republican, spent the next three years traveling to all 50 states, warning health officials to get ready by stockpiling six to eight weeks of masks, gloves and other supplies.
If America’s supply chains were crippled or compromised, he cautioned, it would exacerbate the devastation of a pandemic.
In meetings, panels, even commencement addresses, Leavitt advised public officials to come up with back up plans. But they didn’t.
“Over time, when the snake is not at your ankle, you’re worried about other things that are dangerous. And this is not just a function of our generation. This has been the case in virtually every pandemic in human history,” said Leavitt.
The AP and “FRONTLINE” spoke with members of the Clinton, Bush, Obama and Trump administrations who were responsible for pandemic preparedness. All said they had worried and warned about inadequate supply chains. But solutions were expensive, and neither Congress nor the White House made this a priority.
“We learned during Ebola that speed matters. Outbreaks grow exponentially. You pay a tremendous penalty for inaction,” said Christopher Kirchhoff, an Obama advisor who wrote the National Security Council’s “lessons learned study” for the White House after the 2014-16 outbreak.
Among his 26 specific findings: The U.S. government needed to buy and stock protective equipment during an emergency, in the event that traditional supply chains failed.
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.