Since March, the Hawaii Emergency Management Agency has tracked down $81.5 million worth of personal protective equipment and supplied it for free to recipients, including hospitals, state agencies, schools, elderly and child care facilities, medical or dental offices, nonprofits and small businesses.

But in the midst of the massive undertaking, HI-EMA sent out hundreds of respirators with exhalation valves — the type of mask that could actually do more harm than good by propelling the virus further. 

The respirators with valves were acquired by the Hawaii PPE program in a mad dash for supplies, the program’s officials said. Protective equipment across the nation has perpetually run short.

Respirator masks with valves are not advised for public use to prevent COVID-19 transmission. Ku‘u Kauanoe/Civil Beat/2020

David Hafner, the logistics manager of the Hawaii PPE Distribution Program, believes it was the largest emergency medical supply drive in Hawaii since World War II. He likened the bidding wars in March, April and May to the “Wild West.”

In September, the program’s warehouse received 27,072 10-pack boxes of respirators with valves. Realizing they do not prevent COVID-19 transmission, program managers told staff to stop sending them out and to remove them from the inventory, according to Douglas Carroll, a spokesman for the HI-EMA.

Then, after what Carroll called an “inventory control error,” 3,691 more boxes of the valve respirators somehow got back into the inventory and were shipped as part of 417 orders. Carroll did not specify when, or to whom, the valve respirators were sent, nor how long customers had the faulty masks before being notified. Civil Beat, which received some of the ineffective masks, got an email about the error on Dec. 23. 

“Given the rapid ramp-up of this program and the fact that we had to create a medical supply distributor from the ground-up in a very short time, delivery errors were part of the experience,” Hafner told Civil Beat. 

HI-EMA officials said those who received the faulty masks were either offered a replacement or told to return or dispose of them.

An email describing the error was sent to those who got the faulty masks on Dec. 23. Honolulu Civil Beat

The PPE program was originally created to serve health industry and state agencies, but when smaller operations continued to report that supplies were either too expensive or unavailable, the program expanded in September to allow certain small businesses and nonprofits to apply for the free supplies online.

It’s been difficult to get supplies to everyone eligible for the help. As of mid-December, about half of the 4,550 orders placed have either been filled or partially filled because of disrupted supply chains and deliveries. 

The most effective masks, N95s, are intended for health care workers and first responders only because they are in such short supply. The U.S. Food and Drug Administration advised that N95 respirators should not be used by the general public

Those who don’t face direct exposure risks have been asked by federal and state authorities to wear cloth masks with at least two layers.

Respirators are thick, cupped filtration masks, medically certified, and must be fitted properly to assure efficacy. When valves are added, an infected wearer’s breath may escape. The Centers for Disease Control and Prevention discourages their use during the COVID-19 pandemic because they may protect the wearer but allow others to be infected.  

The University of Hawaii, for example, doesn’t allow exhalation valves, nor does Hawaiian Airlines.

In case of future hospital shortages, HI-EMA may hold on to some as emergency reserves, since they can be modified to be more effective with an additional covering, according to a CDC bulletin that outlines crisis scenarios.

The vendors who supply equipment to the program were vetted by the state’s purchasing office, Hafner said. Most were mainland-based companies that bid for products manufactured abroad — much protective equipment is made in China. One recent shipment came from Turkey.

“When you scale it up, the issue is that the third party seller doesn’t have complete quality control over the packing,” Hafner said. “Sometimes you’ll get completely unorganized palette loads.”

Other products, like cloth masks and face shields, were purchased within the islands as local companies shifted gears and used grant funding to produce protective gear. At least a quarter of the supplies have been purchased from in-state sellers or vendors.

The state’s PPE Distribution Program has supplied equipment to the Department of Education and others, and maintained a 60-day emergency supply for Hawaii’s major hospitals. Jonathan Hilts/2020

Due to national and international competition, the program includes a disclaimer on its online shop: If the supplies aren’t available, it will send the next best thing.

The state’s orders to suppliers must be placed months in advance, which requires guesswork about what will be most needed. 

Jim Brown, a logistics unit leader for the program, likened the process to “forecasting an unknown future.” In some cases, Hawaii has been outbid by other states that request larger quantities of supplies. 

The program wasn’t “buying products off the shelf,” he said. “We were buying queues in the production line for future production and delivery.”

The program also has struggled with the shortages seen nationwide. Gloves are among the products currently most in demand. The program is short of plastic bottles for sanitizer, wipes and forehead thermometers. 

PPE Program

Maribel Tan, the president of the Adult Foster Homecare Association of Hawaii, said her group was grateful to receive masks, booties and gowns, but caregivers didn’t get all the gloves they asked for. She and other caregivers have instead relied on Costco or Sam’s Club.

The program needs more funding to continue through next year if current demand continues.

Hafner estimates the program has enough supplies on hand to meet current requests and re-orders among registered participants through March, but to replenish supplies past that time, the state needs to put in orders this month. Rising case numbers on the mainland could affect Hawaii’s ability to secure more supplies, he said.

“As we head into this austerity period the state is trying to marshal the resources,” he said. “We’re sort of in a holding pattern waiting for future developments.”

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