Editor’s Note: This story has been updated to clarify that hospitals are covered by the state mandate to keep a 90-day stockpile of PPE. New York City officials have set a similar goal to provide backup supplies to hospitals across the city, but are not covered by the state mandate.
Local hospitals are still struggling to amass a required 90-day supply of protective gear for front-line medical staff after blowing the state’s Sept. 30 deadline, THE CITY has learned.
The problem appears to be supply and demand: The hospitals are having trouble obtaining needed high-quality masks, gowns and other PPE — hoping to avoid a repeat of shortages from the chaotic first wave coronavirus last spring.
The new scramble comes as COVID-19 infections rise — prompting the reopening of a field hospital in hard-hit Staten Island and Mayor Bill de Blasio’s statement that the state could soon declare the city a heavily restricted orange zone as winter approaches.
After missing the Sept. 30 cutoff, some hospitals in the city also failed to make an extended Oct. 30 deadline. The 90-day supply mandate was issued by the state Health Department in July.
Jonah Bruno, a state Department of Health spokesperson, blamed PPE suppliers that have so far been unable to provide local hospitals with enough protective gear.
“Recognizing that there continues to be supply chain challenges, the [state Health] Department, in its role as regulator, continues to work with all facilities to achieve sufficient PPE and will track that process,” monitoring the supply at hospitals through the state’s Health Electronic Response Data System, he wrote in response to questions from THE CITY.
The city Department of Health & Mental Hygiene, which is coordinating the de Blasio administration’s response to the pandemic, provides a backup stockpile to hospitals in the city. While it’s not required to have a 90-day supply on hand, the department is striving to do so. As of this week, it had yet to reach that goal.
Masks Rationed Again
There are signs of equipment supply strains as the city’s COVID numbers have grown worse, reaching the 3% seven-day test positivity average that spurred the recent closure of public school buildings.
Last week, medical workers on Staten Island and other locations told THE CITY that top-quality face masks known as N95s are being rationed at some hospitals.
At the Northwell-run Staten Island University North, nurses get one N95 per shift but note such masks are intended to be single-use for each patient.
At Bellevue Hospital in Manhattan, the city Health & Hospitals system provides each nurse three masks per week, forcing those who have to work a fourth day every other weekend to re-use the equipment.
On July 21, the state issued an order requiring all hospitals to possess and maintain a 90-day supply of “all necessary items of personal protective equipment (PPE) sufficient to protect health care personnel” by Sept. 30.
On July 22, the state ordered all nursing homes to collect a 60-day PPE supply by the same deadline. The available supply was to be based on peak use that occurred in April.
The state allowed for a one-month extension if the hospital or nursing home could show a supply-chain problem.
The state’s July edict stipulates that the failure to meet the PPE supply requirement “may result in the revocation or suspension of the hospital’s license” after a 14-day “grace period.”
The grace period expired Nov. 13.
As of this week, the city Department of Health & Mental Hygiene was working to bring its stockpile up to the 90-day level in an effort to ensure that all front-line nurses, doctors and medical technicians have what they need.
“We are well on our way to reaching and in most cases exceeding these 90-day stockpile goals in the next few weeks,” Patrick Gallahue, a department spokesperson, wrote in an emailed response to THE CITY’s questions.
He noted that city officials are coordinating with the state to boost PPE supplies.
National Stockpile Low
Last spring’s flood of seriously ill COVID-19 patients in local hospitals made clear the need for an adequate supply of protective gear, as medical personnel were forced to reuse masks and other equipment.
At the pandemic’s peak in early April, a Cuomo task force issued a directive requiring all hospitals to provide medical workers with an N95 on demand.
And when the number of hospitalizations subsided in the summer, de Blasio ordered the city health department to come up with a plan so there wouldn’t be a nightmarish rerun of the spring scramble.
“Following the spring peak, we have used the time we had to prepare for any future resurgence,” Gallahue wrote.
The city relied on three sources for protective gear and medical equipment: state- and city-purchased items, and the Strategic National Stockpile.
Questions have arisen about the adequacy of the national pipeline. Rear Admiral John Polowczyk — who recently retired as head of the supply chain commander — said two weeks ago the National Stockpile has 115 million N95s, far short of the 300 million officials had “hoped to amass by winter.”
The city Department of Health and Mental Hygiene created a Medical PPE Service Center to supply the city’s entire health care sector with adequate protective gear. The department also set specific goals “based on peak daily burn rates across the full set of PPE used to treat COVID-19 in medical settings,” Gallahue wrote.
The goals include stockpiling 13.5 million N95 masks, 37 million isolation gowns, 54 million three-ply surgical masks, 185 million nitrile gloves, 900,000 goggles, and six million face shields.
Gallahue did not respond to THE CITY’s request to provide information on exactly what is currently in the city’s stockpile.
The state Department of Health’s Bruno also did not say which hospitals have not yet reached the 90-supply requirement or what actual supplies they currently have on hand.
Short on Ventilator Goal
Another crucial item that was in-demand last spring as the virus sent patients to hospitals across the city: ventilators.
For several weeks, both Cuomo and de Blasio worked feverishly to scrape up an adequate supply of the breathing machines. At one point in late March, as the number of seriously ill COVID-19 patients surged, Cuomo revealed the state had 6,000 ventilators but needed 30,000.
At times, both the city and state spent millions to buy these desperately needed machines from brokers with no prior experience providing medical supplies. In several cases, multi-million dollar orders wound up cancelled when the brokers couldn’t deliver what they’d promised.
Gallahue said DOHMH is currently “building up our city-owned ventilator fleet,” while tapping into the national Strategic National Stockpile and existing hospital inventory to provide vents for over 8,500 patients.
As of Friday, they had a ways to go.
To date, the city has obtained just over 3,300 vents beyond its current supply: 2,400 from the National Stockpile and another 905 from the state. And the agency must make sure the machines function, so they’re reaching out to hospitals citywide to return vents that are due for maintenance.
As of last week, they’d replaced 300 of the overdue vents at the Health & Hospitals Corporation, the quasi-city agency that runs New York City’s 11 public hospitals.
‘No One Should Apologize’
Last spring, DOHMH distributed 53 million face masks, 33 million gloves, seven million N95s, five million gowns, and 3,100 ventilators obtained via the National Stockpile, the state, and through city purchases via the Department of Citywide Administrative Services.
At times, however, the city wound up with items sitting in the city’s huge storehouse in Ridgewood, Queens, that went unused, as an investigation by THE CITY found.
City officials lost track of some COVID-related gear purchased via $1.4 billion in emergency, no-bid contracts at the pandemic’s height — and at times paid for surgical masks that turned out to be non-surgical and unusable in a medical setting, THE CITY reported.
DCAS workers fretted about what to do with dozens of unopened boxes of lower-quality masks the hospitals didn’t want. They also weren’t sure what to do with $10 million in devices known as BiPAPs that could be repurposed for ventilators. The Health & Hospitals didn’t wind up using the BiPAPs.
During one virtual staff meeting, a DCAS manager asked why the city couldn’t try to get its money back for an item the hospitals no longer wanted: “If the hospitals won’t use them, what’s the point of the stockpile for this item?”
Gallahue defended the $10 million purchase, writing, “Multiple specialists said these devices could be used as ventilators, or ‘bridge vents’ if necessary, and the needs — both projected and existing — during peak were immense. In the end, ventilation needs were met through other means and these were not needed.”
He added, “Under intense pressure and a disruption to the global supply chain, no one should apologize for procuring any and all equipment that might save a New Yorker’s life.”