Five Months Later, Where is the PPE?

Has anything materialized from the Defense Production Act?

Billions of dollars have been spent by way of the Defense Production Act in the past few months. Let's take a look at how well (or poorly) the money has been spent.

Updated:   Published

Has anything materialized from the Defense Production Act?

Earlier this month, The National Nurses United held a day of action to demand that hospitals and elected officials better protect them with Personal Protection Equipment (PPE) and a safe number of patients during the COVID-19 pandemic. Nurses in sixteen states including California, Florida, Georgia, Illinois, North Carolina, New York, Texas, and Washington, D.C. were involved.

For a virus which has been within the borders of the United States since January, how is PPE availability even an issue in August? After over seven months, any rational person would expect that the companies who routinely produce these items – gowns, N95 masks, goggles, safety shields, and more – would have had plenty of time to ramp up production both in the United States and globally to provide the life-saving equipment for healthcare workers. The sad reality, though, is that this is just one piece of the response to this pandemic that has been severely botched.

With each state and sometimes each healthcare company or even each facility being left to fend for themselves early on, procurement of PPE became a money game. With states bidding against each other to obtain oftentimes scarce PPE, it became a case of the haves versus have-nots.

In a country where profits reign supreme, the COVID-19 pandemic became just another way for companies to profit on the suffering and death of others. It’s shameful but sadly all too real.

While many will recall images of nurses in New York City from March and April donning garbage bags in lieu of proper disposable gowns, maybe things have changed. Maybe.

What about the Defense Production Act?

The very act to be used during times of national crisis which was supposed to spur companies to ramp up emergency production of the very equipment necessary to protect nurses in COVID wards appears to have yielded mixed results, at best. According to a July 10th press release from the Department of Defense, $84.4 million was appropriated for COVID-19 but appears to have gone for basically anything but PPE for healthcare workers.

What is the Defense Production Act?

The Defense Production Act is the primary source of presidential authorities to expedite and expand the supply of materials and services from the U.S. industrial base needed to promote the national defense. DPA authorities are available to support: emergency preparedness activities conducted pursuant to title VI of the Stafford Act; protection or restoration of critical infrastructure; and efforts to prevent, reduce vulnerability to, minimize damage from, and recover from acts of terrorism within the United States. DPA authorities may be used to:

  • Require acceptance and preferential performance of contracts and orders under DPA Title I. (See Federal Priorities and Allocations System (FPAS).)
  • Provide financial incentives and assistance (under DPA Title III) for U.S. industry to expand productive capacity and supply needed for national defense purposes;
  • Provide antitrust protection (through DPA voluntary agreements in DPA Title VII) for businesses to cooperate in planning and operations for national defense purposes, including homeland security.
  • AirMap, located in Santa Monica, California, received $3.3M to aid product development and engineering support for integration of sUAS mission planning, post-mission analysis, and unmanned traffic management software.
  • ModalAI, located in San Diego, California, received $3M to develop their next generation U.S.-made flight controller that will enable advanced autonomy including GPS-denied navigation, and all-environment obstacle avoidance.
  • Skydio, located in Redwood City, California, received $4M to improve the flight controller hardware/software and data link for their sUAS so that highly capable components can be purchased and used across U.S. Government unmanned systems.
  • Graffiti Enterprises, located in Somerset, New Jersey, received $1.5M to modify their commercial data link for DoD’s sUAS use including operation in restricted frequency bands, reduction in the size, weight, and power of the hardware, and software developments to improve security and resiliency of their data link.
  • Obsidian Sensors, located in San Diego, California, received $1.6M to build a low-cost, dual thermal sUAS camera that can be mounted onto a stabilization gimbal and then integrated and flown on small, packable, ISR systems. (source)

It doesn’t end there, though. An additional $15 million was awarded to LeoLabs to strengthen the country’s Domestic Space Industrial Base. $56 million more went to ArcelorMittal, Inc. to “sustain critical domestic industrial base shipbuilding capability and capacity”. While this example of where $84.4 million of Title III COVID-19 funds went is only a portion of Defense Production Act spending somehow tied to the pandemic response, it is part of the puzzle of why nurses are still protesting over a lack of PPE.

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What has been approved so far?

While the above example portrays an excellent example of rather questionable spending tied to the Defense Production Act under the guise of COVID-19 response, hundreds of millions of dollars have been handed out in the name of COVID-19 PPE production. Or has it?

N95 Masks

On April 13th it was announced that a $15 million contract for 60 N95 Critical Care Decontamination Units was awarded. These units are touted as having the capacity to decontaminate 80,000 N95 masks per day. These reportedly allow N95 masks to be reused up to 20 times. This would allow for decontamination of up to 34 million N95 masks per week. Only weeks later, the Battelle Critical Care Decontamination System came under fire.

“After 20 cycles, the company’s testing showed, the masks’ straps fragmented during stretching, which “may potentially impact the fit or comfort of the respirator exposed to the (vaporized hydrogen peroxide) cycles.

While NBC News questioned the size of this particular federal contract, they found “That contract ballooned from a total of $60 million for 60 systems on April 3 to up to $413 million a few days later, according to the network.”

To their credit, Battelle had deployed 50 of the 60 promised units by early June.

On April 21, $133 million was awarded to 3M, O&M Halyard, and Honeywell to increase N95 production by over 39 million units over the course of 90 days. That 90 day window would end on or around August 21. (via)

May 6th saw a second contract awarded to 3M for production of N95 masks – this time for $126 million. The contract stated that 3M would manufacture an additional 26 million N95 masks per month beginning in October. This new contract was expected to increase N95 respirator production by at least 312 million units annually within the next twelve months. (via)

Testing Swabs

April 29th saw the announcement that $75.5 million would be invested to increase swab production to 20 million per month starting in May. Puritan Medical Products in Maine stated that they would establish a new manufacturing facility to produce the swabs used for Coronavirus testing. The company also stated that they would add 150 employees in May to meet the stated production capacity which would soon ramp up to 40 million swabs per month.

This ramping-up phase in May, though, is claimed by many to have been too late. For a virus that was already spreading in February, a two-plus month delay in something as seemingly basic as swab production is just one in a long list of items that contributed to the spread of COVID-19. According to many of the nation’s governors, the federal government’s delay caused a shortage of tests early on which hampered initial phases of the pandemic response. (via)

Prefilled Syringes

On May 12th, ApiJect Systems America was awarded a $138 million contract to produce over 100 million Blow-Fill-Seal aseptic plastic injection devices. These would be produced for use with the yet-to-be-developed COVID-19 vaccine. An ultimate production goal of over 500 million profiled syringes was expected in 2021.

For a company whose CEO says “The fact of this matter is, it would be crazy for people to just rely on us. I would be the first to say it, we should be America’s backup at this point, but probably not its primary,” (via) that should certainly raise some questions about the award of this no-bid contract. Add in the fact that the contract could grow by an additional $456 million to bring several new factories online, that is a substantial sum for a company who has, to date, only produced 1,000 prototypes. Oh, and there’s the small detail that ApiJect doesn’t have a manufacturing facility yet.

PPE for Nursing Homes

Good news for nursing homes across the country arrived on May 13th as Federal Resources Supply Company was awarded a $134 million contract. Federal Resources Supply Company would be supplying PPE kits including 1.2 million goggles, 64.4 million pairs of gloves, 12.8 million gowns, and 13.8 million masks. (via)

There were almost immediately problems with the PPE distributed by Federal Resources Supply Company. Many of the masks which were delivered appeared to have been made of an underwear material – even arriving sometimes in packaging donning the Hanes brand name. Other surgical masks were outfitted with flimsy paper loops, leaving caregivers at risk due to the ill fit. Many gowns that arrived were compared with trash bags and routinely lacked arm holes. Many of the gloves which did arrive in the first wave of distributions were essentially useless – size extra-small – entirely too small for even the smallest healthcare workers.

When complaints were made, the responses from FEMA officials ranged from “It was one of those things, I’ll be honest, that just slipped through the cracks” to “[you] just don’t know how to use them.”

The examples of both good and bad outcomes from the Defense Production Act keep coming and are too numerous to detail. Some of the most angering and wasteful are the examples of money being explained away as for the nation’s COVID-19 response being handed out to companies for defense and military projects – specifically those detailed to benefit the Navy, Coast Guard, various aerospace systems, ship manufacturing and more.

For a federal government whose national response to what rapidly became a global pandemic was massively delayed, some of these expenditures are simply disappointing. The amount of money being spent on items and given to companies who lack experience in anything remotely related to what is clearly a medical crisis is appalling. This, however, is what happens when a nation’s priorities move from caring about its citizens to profits for companies.

For a complete rundown of Defense Production Act contracts, download the Fall 2020 issue of allnurses Magazine for FREE!

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londonflo

2,342 Posts

Specializes in oncology. Has 46 years experience.

And where is the ANA?

Look, ANA, you didn’t work on getting PPE to nurses who needed it. By your own statements, you “wrote letters” and developed webinars to help nurses decrease their stress. You did not use any dues money or certification fees to create written or TV ads shaming the federal government for “keeping their own stockpile for themselves” per Kushner. And now, with so many nurses being furloughed..from “hero to zero-pay” that NEED your help..start talking to journalists - both written and television. Spend some money! Protect the nurses you say you represent. Do something for those at the bedside that help them in a meaningful way. 

Specializes in Community health. Has 5 years experience.

At my work (FQHC), the HR director’s office has been converted into a PPE supply storage closet. This isn’t a rumor; I went in for another reason and saw it for myself. Palettes and palettes of gowns, masks, and gloves. 

Meanwhile, the staff doing Covid testing is being told to put their used gowns in their lockers and re-wear them for the whole week. At the moment, I’m not Covid testing, so I’m not affected by this. I’m not sure what to do, or how much to get involved. (Other than gossiping all over the building about the PPE stockpile, which I’ve been doing. Very professional behavior, I realize.)

londonflo

2,342 Posts

Specializes in oncology. Has 46 years experience.

Maybe HR is saying "this is our stockpile" not the staffs. Are they expecting to have to interview hundreds of Covid positive applicants for staff positions?

 

Glad you are participating in calling them out.

OUxPhys, BSN, RN

1,203 Posts

Specializes in Cardiology. Has 8 years experience.

PPE hasn't been an issue at my hospital, for the most part anyways. The only thing that seems to be "missing" is N95's. It's weird. A few years ago if you had a rule out TB or an airborne precaution there was no problem with leaving a box or 2 of N95 masks outside the room. Now all of a sudden there is a shortage? I dunno about that. 

Kitiger, RN

1,776 Posts

Specializes in Private Duty Pediatrics. Has 44 years experience.

In which states is PPE an issue? Do most hospitals have everything except N95s? Gowns? etc..

Specializes in Community health. Has 5 years experience.
On 9/1/2020 at 4:10 PM, Kitiger said:

In which states is PPE an issue? Do most hospitals have everything except N95s? Gowns? etc..

I am in Connecticut. I don’t work in a hospital but my friends do. They say there’s a shortage— reusing gowns and masks etc. It’s central CT, I don’t know if it’s the same in other areas of the state. 

Has 8 years experience.

Funny how there used to be people assigned to monitor compliance of PPE use when entering contact rooms with MRSA, VRE, etc. - and now they tell us not to wear gowns in rooms with antibiotic resistant infections and even try to scold people who still opt to use them in rooms with C-diff.  Apparently, all non-covid19-related infections have just magically disappeared... ***Exits MRSA room to draw STAT labs from central line...***

Missingyou, CNA

718 Posts

Specializes in Long term care. Has 20 years experience.
On 9/1/2020 at 4:10 PM, Kitiger said:

In which states is PPE an issue? Do most hospitals have everything except N95s? Gowns? etc..

Still an issue in mid Michigan. I work in a nursing home. There are currently 0 cases in our facility but, residents are in & out for apptts (dialysis, etc) & New patients arrive almost daily. We wear KN 95 masks x5 shifts. It is OK to wear exam masks if we do not come in contact with a new patient or one that has been in the community. It's wrong there are still not enough PPE for us.

At the 1st hint of covid returning to our facility, I'm done. I've saved up enough $ from working 60+ hours a week at the height of the infection rate at our facility to get me thru financially til Spring.......I risked my health & my families health & they can't /won't protect me or the patients.....NOT going thru that again, not ever. 

Kitiger, RN

1,776 Posts

Specializes in Private Duty Pediatrics. Has 44 years experience.

https://www.bandgdiscount.com/

If you don't mind providing your own, you have the option of getting gloves and masks, both procedure masks and KN95s, by calling in an order, pay over the phone, and they will mail it to you.

At least it's an option. They are located in Schoolcraft, Michigan.

Lizardqueen13

50 Posts

On 9/2/2020 at 7:39 PM, CommunityRNBSN said:

I am in Connecticut. I don’t work in a hospital but my friends do. They say there’s a shortage— reusing gowns and masks etc. It’s central CT, I don’t know if it’s the same in other areas of the state. 

I’m in Southern CT. We did really well (compared to most) with PPE throughout the pandemic despite having 400 Covid cases in the hospital at one point. We’re back to using PPE as normal and have been for a few months.

Specializes in ICU. Has 24 years experience.

in Canada we have adequate supply but are fearful a second wave will overwhelm our supply