Richard Taaffe, who’s the CEO of West Hawaii Community Health Center, started getting nervous the moment his medical glove vendor slashed its shipments from 20 boxes down to three.

That was last week, right around the same time the health center erected a triage tent to isolate and test patients suspected of carrying the deadly COVID-19 coronavirus.

Since then, the gloves and masks needed to protect his staff — the doctors, nurses and technicians on the front lines of the coronavirus epidemic — have only become more sparse.

“They’re trying to ration their supplies,” Taaffe said. “That has a ripple effect on us.”

On Tuesday, when Taaffe feared they’d run out, a pallet of supplies from the Hawaii Healthcare Emergency Management coalition arrived in the afternoon.

“Fortunately we’ve had very few (COVID-19) positives on the Big Island, but once we do all bets are off,” Taaffe said.

Health care workers are at an increased risk for getting the virus due to their interactions with patients for prolonged periods.

Shortages Are Global

Hawaii hospital workers are already feeling the effects of national and global shortages of medical equipment and gear, especially personal protective equipment.

The Queen’s Health Systems put out a public plea for donations of goggles, face shields, masks and protective gowns on Tuesday.

A spokesman for The Queen’s Health Systems told Civil Beat its Punchbowl Medical Center’s supply of N95 masks and gowns as of Wednesday only covered the next 12 days, but they expect more deliveries to replenish their supply.

Hospitals across Hawaii are making requests directly to the Healthcare Association of Hawaii and the Hawaii Healthcare Emergency Management coalition, which holds the state’s stockpile of emergency medical supplies.

The public has not been made privy to those supply requests. The hospital association and Hawaii Healthcare Emergency Management would not provide an inventory of the state’s stock of personal protective equipment.

It is clear, however, that clinics and hospitals are already dipping into state supply as well as national supply. On Monday, the Hawaii Healthcare Emergency Management program received a shipment from the Strategic National Stockpile. It was the second delivery and a third is scheduled to arrive on Thursday.

Delivered in Monday’s boxes were approximately 50,000 surgical masks, 5,000 face shields, and gloves of various sizes, which have since been distributed to clinics across all islands, said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii.

“We do not know specifically what will be received in each shipment until each shipment arrives,” Raethel said. “While a shipment of ventilators has been ordered, we have not received any at this time.”

State Efforts

Hawaii is already short of doctors and has among the fewest hospital beds per capita in the nation.

The state has projections for how much supplies are needed for six months — the duration state officials believe Hawaii will need to deal with the virus, according to Maj. Gen. Kenneth Hara, Hawaii’s Emergency Management Agency director.

At a Senate Special Committee on COVID-19 meeting on Wednesday, Hara said the state Department of Budget and Finance has released $39 million for HI-EMA to respond to COVID-19. Hara said he’s used $13 million of those funds to order personal protective equipment and gear.

Hawaii only has 561 ventilators statewide, and neighbor islands have far fewer ventilators than Oahu.

Hara also said he’s put in a request for ventilators, protective equipment and test kits supplies with FEMA Region 9. That request is still pending.

National deliveries only come in 30-day batches, he said. All hospitals in the state are reporting their level of supplies, but not all report daily or leave some information requested by the state blank.

Hara said the state could implement stricter social distancing policies if 95% of supplies in the state are used. However, he doesn’t believe Hawaii is there yet.

“What we’re trying to do is build up that stockpile so we don’t get to that crisis,” Hara said, noting that he’s asked President Donald Trump to place Hawaii high on the list for federal disaster assistance.

A National Competition

Nationally, doctors are running out of supplies. Masks, gowns, and gloves are so hard to come by that the CDC recommends a bandana or scarf as a “last resort” if face masks are not available. 

New York Gov. Andrew Cuomo said this week he had no choice but to purchase about 2 million masks overseas for more than five times their normal price. New York is dealing with the worst of the outbreak in the U.S. to date.

As an island state in the middle of the Pacific Ocean, there’s almost always going to be a several day delay in getting supplies from the U.S. mainland.

All the more reason for state officials to act now, said Dr. Kai Matthes, a former professor at Harvard Medical School, now a doctor on Maui.

“I think we should activate resources early rather than too late,” he said. “Especially with federal resources, we’re not going to be the only ones who need them.”

Dr. Travis Parker, the emergency room medical director for the Kauai Veterans Memorial Hospital and Samuel Mahelona Memorial Hospital, said rural and critical access hospitals like the ones he works at are at an even higher risk for running out of PPE.

“I think a lot of providers are worried about running out of supplies because we’ve seen a lot of stories coming out of Washington and New York,” Dr. Parker said. “We’re being very judicious on how to keep us from running out of a stockpile. We’re trying to find good work-arounds to preserve what we have here.”

The state needs to build a PPE stockpile in the event there’s a spike in COVID-19 cases, said Tom Travis, former administrator of the Hawaii EMA. He has been serving in an advisory capacity during the outbreak.

“The unfortunate thing about Hawaii is that we’re not like everywhere else because it’s harder to get this stuff to us,” Travis said. “Reinforcements in terms of PPEs, will be slower and less overwhelming than if we were on the mainland.”

Hawaii may have to compete with larger states, such as California, Texas and New York, that have larger populations, more money and, especially in the case of New York, a more pressing need.

U.S. Sen. Brian Schatz shares that concern.

“We have a particular vulnerability given our distance,” Schatz said. “I am not at all comfortable in terms of us having the personal protective equipment we need over the long run, but I am comfortable that we are not immediately about to run out.”

Will The U.S. Ramp Up Protective Gear Production?

A stable supply won’t always be the case, especially when clinics such as Taaffe’s are already experiencing shortages.

That’s one reason why Schatz has joined a chorus of current and former public officials in calling for the president to nationalize the medical supply chain using the Defense Production Act of 1950.

He even introduced legislation with U.S. Sen. Chris Murphy, a Democrat from Connecticut, to force Trump to use the post-Korean War era law to order domestic manufacturers to produce more masks, gloves and other medical supplies necessary to help doctors and nurses stave off the virus.

“We are all racing to make sure that the resources arrive in the islands on time,” Schatz said.

“The president needs to utilize the Defense Production Act and nationalize the supply chain. Absent that the state of Hawaii and every other state is literally on the internet buying this stuff on the open market, which is no way to provide protection for our frontline health care workers.”

For his part, Trump has resisted calls to use the full power of the Defense Production Act, saying that companies have been producing medical supplies on their own initiative without government interference.

“We’re a country not based on nationalizing our business,” Trump said during a press briefing over the weekend. “The concept of nationalizing our businesses is not a good concept.”

A Bottleneck To Testing

If protective gear like masks run short, then the rate of testing is inhibited. Testing for the coronavirus has already been slow to roll out in Hawaii and across the country.

On Wednesday, state Epidemiologist Dr. Sarah Park tied a possible shortage of protective equipment to the state’s reasons for only testing individuals who show symptoms of COVID-19.

“Because of all the shortages throughout the continuum of testing, it’s about being judicious about who we test to make the most of the resources we have,” Park told the Senate Special Committee on COVID-19.