California lacked enough medical equipment for COVID-19 surge as disease hit state, records show
On March 18, as a wave of new coronavirus-related shutdowns crashed across California and hospital equipment shortages raised concerns around the country, the Sutter Health hospital chain was portraying optimism.
There were “a number of proactive measures in place” to make sure supplies didn’t run out, a hospital spokeswoman told The Sacramento Bee at the time. Sutter’s hospital nonprofit network of two-dozen facilities were “working together to prepare for and address issues that may unfold.”
But behind the scenes just one week beforehand, Sutter officials had already begun raising alarms with the state, records obtained by The Bee show.
The staff was already reusing face shields. They’d exhausted their supply of masks. And the cache of gloves was dwindling by the hour.
A Sutter Medical Center official also told the state’s health department that the facility was short of some two-dozen employees, about half of whom were quarantined due to potential infections.
Hospital leaders, the official said, needed clearer guidelines from federal, state and local governments about the rules regarding furloughs and how to handle workers who were exposed to the virus inundating hospitals coast-to-coast.
“The influx of patients needing negative-pressure rooms can be difficult,” the official wrote to the state in response to a state health department survey. It was of increasing concern, the official said, whether the hospital would have “the right amount of staff with the correct skill mix.”
Sutter Medical Center was not alone in reporting a precarious predicament to state health officials.
Approximately one-in-ten hospitals across California by the second week of March said they were already gravely concerned about their supply of N95 masks being “exhausted,” according to a California Department of Public Health survey of hospital inventories and supply needs The Bee obtained through a public records request. Several said they had only enough for the next few days.
Some 300 hospitals responded to the voluntary survey by the end of that second week in March, disclosing their assessment of existing supplies and outlining concerns they had about the looming crisis.
The survey documents offer a window into how state officials and hospitals across California were scrambling to prepare as coronavirus began sweeping through the state. As of Tuesday, nearly 16,000 people in the state have been infected, and more than 370 have died.
At the time of the state survey, only about 160 had been infected and two people had died.
The hospitals’ responses “helped inform our understanding of the current capacities of the healthcare system and what hospitals would need in terms of beds and equipment as COVID-19 spread,” a spokesperson for the Department of Public Health said in an emailed statement without providing his or her name.
“Based in part on this data, we determined that California needs to add 50,000 beds over time to our existing nearly 75,000 beds to accommodate an anticipated surge in patients,” the agency said.
The survey results also show, possibly for the first time in a single document, how many ventilators each hospital had available in California in mid-March as cases began spiking and the state began issuing widespread shutdown orders. Academic research has estimated how many devices there are nationally and how many are necessary for certain pandemic scenarios, The Bee reported.
But more detailed information has been obscured in California and elsewhere. Hospitals previously refused to answer questions about ventilator data, offering vague statements such as “a substantial number.”
Responding hospitals said they had a combined 6,254 ventilators. UC Davis Medical Center in Sacramento reported having 174 of the devices. Sutter Medical Center said it had 40.
California hospitals have increased the number of ventilators on-hand in recent weeks to more than 11,000, Gov. Gavin Newsom said Tuesday. Officials have been working to find an additional 10,000 ventilators, which the Newsom administration predicts will be needed by mid-May in what his team calls “Phase One” of the coronavirus surge. After that, the state may need an additional 20,000 ventilators, according to projections from Newsom’s office.
“We feel we’re adequately resourced for the moment,” Newsom said.
Across California, hospital officials in their open-ended responses said supply of the devices was of particular concern. One in the Bay Area said simply: “We will need more gloves, hand sanitizers and ventilators.”
There were other non-material requests, too. A large hospital in Southern California requested “key talking points and communication to the public with potential exposure or symptoms regarding appropriate steps to take and COVID-19 testing options.”
A week after hospitals filled in that survey, Newsom began issuing a series of orders that limited crowd sizes and, eventually, shuttered vast swaths of the state’s economy.
As the so-called curve continues to bend, and hospitals build up the capacity to handle a swell in patients, supply chain problems have lingered.
Newsom on Monday announced he would loan 500 ventilators to other states, but he cautioned that California was in no way flush with medical equipment. Emergency stockpiles nationwide have been depleted. And states have begun bidding against one another for gear in a marketplace he and others have described as the Wild West.
“We’re doing everything we can to procure more PPE,” Newsom said in his Monday afternoon news conference. “But we’re not naive. We need to continue to procure more ventilators, not just gowns, masks, coveralls, shields, these N95 masks in particular. We continue to do everything in our power to build out that inventory.”
And in a Tuesday night interview with MSNBC host Rachel Maddow he announced the state had signed contracts with manufacturers that would bring in 200 million more masks. That level of new supplies means California could handle needs in the state and possibly provide masks to others in need, Newsom said.
“We decided enough with the small ball,” he said.
Survey says: ‘Exhausted supplies’
The California Department of Public Health in a March 8 letter asked hospitals to complete an online form from SurveyMonkey. The goal, officials wrote in their letter, was to help assess California’s surge capacity and understand the state of play at the state’s 416 hospitals.
They sent a similar survey to hospitals on Jan. 27.
Officials were asked how long their cache of equipment would last. The survey polled them on their ventilator supply. And it requested that officials grade on a one-to-five scale their supply of masks, gloves, and gowns for the next eight weeks. A “five” signaled the least concern and meant hospitals were procuring equipment as normal. A “one” spelled particular concern and meant a facility had “exhausted” its options.
Officials said that since it was self-reported information, some of the questions were open-ended, and hospitals were relying on potentially outdated information about supplies, some information might have been inaccurate by later in the month.
Still, some in early March reported hurting more than others.
Dignity Health, which operates Bakersfield Memorial Hospital and Mercy Medical Center in Merced said facilities had exhausted the options for N95 masks and other essential PPE. A spokeswoman did not return emails and phone calls for this story.
UC Irvine Medical Center, likewise on March 9, said it was running short of N95 masks when it filled in the survey. On top of that, officials said, it had no supply chain and was having to reuse eye protection — a “two” on the rating scale. John Murray, a hospital spokesman, said they had eliminated non-urgent surgery and procedures and tried to find ways to reduce how much gear was being worn.
“In general, we’re as concerned as everyone else is about long-term supplies of N95s and other personal protective equipment,” Murray said.
Wade Nogy, senior vice president and area manager of Kaiser Permanente Fresno, said officials reported their mask supplies were “exhausted” because, at the time, the hospital used a different type of mask. The hospital has since reintroduced N95 masks and retrained staff on how to wear them.
“We are managing all of our protective personal equipment prudently,” Nogy said.
And in Sacramento, Sutter Medical Center said staff reportedly had exhausted supply options on masks, gowns and ventilators. Face shields and gloves, the hospital said, had no supply chain and were being reused and were in need of replacing, a “two” on the scale.
“Even during the extreme shortage, no sites went without necessary personal protective equipment (PPE),” said Jeremy Eaves, logistics section chief for the Sutter Health Emergency Management System.
The shortages as of this week, he said, remained “a significant concern still acutely felt by healthcare organizations across the nation, including us, and we are doing everything we can to secure additional supplies.”
Sutter Health has shifted supplies across its facilities as needed, he said.
That did not go unnoticed.
Renee Altaffer, a trauma and intensive care nurse and union leader at Sutter Roseville Medical Center, said the hospital had been discussing shortages of personal protective equipment, testing kits and a lack of a clear-cut pandemic plan in February.
“The management and some of the physicians were going around, ‘Nobody can wear masks anymore. Unless you’re actively taking care of someone who is infected, you can’t just walk around wearing a mask.’ ” Altaffer said.
“Since at least mid-February we knew something was going on with the masks. The basic simple droplet masks that they’re talking about now, we knew at least mid-February something was wrong. ‘Where did all the masks go?’”
Eaves said progress had been made in recent weeks, both in acquiring new gear and minimizing the use of existing gear because better testing is making it possible to know who is, and is not, sick with COVID-19.
“While we are encouraged by this progress — and our supply is currently adequate to match the current need — our job is far from over,” Eaves said. “Our teams will not rest until this crisis is over.”
With dire situation known, shutdowns commence
As hospitals were filling out the survey March 8-11, concerns about the new coronavirus were escalating across the country. And an outbreak in Washington state, a series of cruise ship quarantines and an increasing number of infected people in communities up and down the West Coast heightened concerns about personal protective equipment.
President Donald Trump on March 11 said that the national strategic stockpile of medical equipment was already facing depletion of hard-to-come-by N95 masks. He ordered Health and Human Services Secretary Alex Azar to “take all appropriate and necessary steps” to increase emergency availability.
Newsom on March 17 called attention to the limited bedspace and drastic short supplies in the starkest terms yet. Citing conversations with health care leaders and assessments of supplies, Newsom warned that Californians’ behaviors over the next eight weeks would determine just how overwhelmed they might get.
“We had a very candid and sober, if not sobering, conversation about where we may be and where we need to go,” Newsom said, referring to his conversations with health care officials. “The good news is none of it surprised any of us.”
Two days later, he issued a statewide stay-at-home order,
In the weeks since, concerns over a dearth of masks and ventilators have blurred with the free-for-all marketplace of states and hospitals vying for limited medical supplies. Supply shortages and heightened demand in essentially every single state were straining an already stressed system.
Staff members at UC Davis Medical Center began testing positive for the new coronavirus by the third week of March, when the hospital’s CEO cautioned they were the “first of what will be many” to contract COVID-19.
Nurses across the region voiced their concerns. Most recently, they gathered last week outside Sutter Roseville Medical Center and other local hospitals to protest what they consider unsafe working conditions, driven in part by shortages of protective equipment.
And the CDC issued guidelines on how health workers can make their own homemade masks.
“We all went into this profession for the desire to help people. I do not feel that it was a mistake to have entered into emergency room nursing. But I will admit that I am very scared,” said Ramona Moll, a UC Davis Medical Center nurse who believes she was infected by the new coronavirus at work. “The uncertainty is difficult. If I have to put it in nursing terms on a scale of one to 10, 10 being very concerned, I would say it’s a 10.”
Elsewhere, similar findings, different response
It’s unclear whether hospitals in other states filled out similar surveys from health departments about their inventories and supplies. But a national study from the final week of March echoed many of the concerns from California’s own survey earlier that month.
The U.S. Department of Health and Human Services Office of Inspector General asked officials at 323 hospitals in 46 states, including several in California, what challenges they were experiencing and how they were overcoming supply shortages.
Limited testing supplies coupled with lengthy delays were the top frustration hospitals reported.
Widespread shortages of personal protective equipment and staffing were also significant concerns, the report found. Hospitals said they were turning to “new, sometimes un-vetted, and non-traditional sources of supplies and medical equipment.”
“To try to make existing supplies of PPE last, hospitals reported conserving and reusing single-use/disposable PPE,” investigators wrote in their 41-page report. “Hospitals also reported turning to non-medical-grade PPE, such as construction masks or handmade masks and gowns, which they worried may put staff at risk.”
Multiple reporters tried to ask Trump on Monday about the new report.
“That’s just wrong,” Trump said, ridiculing multiple reporters who mentioned the report’s findings. He doubled down on the attacks Tuesday, alleging without evidence in a statement on Twitter that the report was a partisan effort against him. “Another Fake Dossier!”
This story was originally published April 8, 2020 at 5:00 AM with the headline "California lacked enough medical equipment for COVID-19 surge as disease hit state, records show."