As COVID-19 surges, NY health care leaders concerned about repeat of PPE shortages

Medical masks and gloves are becoming increasingly scarce and costly as COVID-19 cases surge, raising concerns among New York health care leaders striving to prevent a repeat of the protective gear shortages that fueled coronavirus infections this spring.

The supply chain gaps are most acute for thousands of independent doctors who struggle to compete with hospitals, nursing homes and government agencies that are scrambling to stockpile personal protective equipment, or PPE.

In fact, about one-third of physicians in New York say PPE access and affordability issues are impacting their ability to care for patients, according to new survey results obtained by USA TODAY Network New York.

Among the Medical Society of The State of New York survey findings:

• About 40% of doctors said wait times to get PPE span at least four weeks. Nearly 20% said it takes at least six weeks between placing an order to delivery.
• Nearly two-thirds of doctors are at least sometimes finding it difficult to obtain needed PPE.
• About half of the doctors said the cost of PPE has gone up by at least 25% compared to pre-pandemic levels.

For some doctors, the situation evoked memories of watching health care workers donning garbage bags and reusing the same protective mask for days at a time, as they desperately tried to avoid being infected during the pandemic peak nearly eight months ago.

“It’s disappointing that we aren’t farther along, and that we’re still having difficulties,” said Dr. Andrew Kleinman, a plastic surgeon in Westchester County.

“If the winter is as bad as some of the epidemiologists predict, it’s going to be terrible to not be able to get supplies to take care of our patients,” he added.

Dr. Bonnie Litvack, president of the group, expanded on the dire consequences if government and manufacturers fail to shore up protective gear supplies as rising coronavirus infections strain the entire medical system.

“We need to make sure our physicians’ offices stay open, so we don’t have a twin pandemic where patients can’t get in to see their physicians and their other health conditions unrelated to COVID worsen,” she said.

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What hospitals, nursing homes say about COVID surge and PPE

Meanwhile, some hospitals have struggled to stockpile the 90-day supply of PPE required under new state orders that took effect this fall, according to the Healthcare Association of New York State, which represents hundreds of hospitals statewide.

“Hospitals have made purchases to meet the requirements, and the shipments have been delayed or arrive with half the order,” said Jim Clancy, the group’s senior vice president of state policy.

The vast majority of hospitals, however, have secured at least a 60-days’ supply of PPE, Clancy said, adding the trade group plans to coordinate efforts to share supplies among hospitals, if the need arises.

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About 95% of nursing homes currently have the 60-day stockpile of PPE required of the facilities by the state, said Stephen Hanse, president and CEO of the Health Facilities Association, representing many of New York’s 613 nursing homes.

The other 5% of nursing homes have stockpiled varying amounts of PPE and are working daily to meet the requirements, Hanse added.

In addition to supply chain shortages, however, the rising cost of PPE has further complicated efforts to keep pace with the new wave of coronavirus infections.

The cost of a box of 150 vinyl gloves, for instance, has more than tripled from pre-pandemic prices, rising to nearly $13 from $4, the hospital group noted.

The PPE price spikes joined other COVID-19 economic damage to the health care industry, such as the more than $20 billion in extraordinary costs and lost revenue facing New York hospitals through April 2021, according to a Kaufman, Hall & Associates analysis conducted for the group.

In other words, Clancy said: “Hospital finances have been pummeled by COVID-19.”

As for nursing homes, the PPE costs compounded pandemic-related spending on staff COVID-19 testing, hazard pay and other infectious-disease safety measures, as well as various fiscal problems that preceded the crisis.

“That’s what wakes me up at night is the financial constraints that providers are facing in the thick of this pandemic that are unsustainable,” Hanse said.

New York hospitals and nursing homes have received portions of the roughly $2.5 trillion in federal COVID-19 aid approved so far this year, but they are pushing state and federal officials for further funding to offset the pandemic’s ongoing fiscal burden.

What state Health Department says about COVID and PPE

In response to questions about the situation, state Department of Health officials asserted in a statement that New York’s medical system is sufficiently prepared with PPE.

Jonah Bruno, an agency spokesman, said the Health Department "continues to work closely with all facilities to ensure they are providing the appropriate PPE to keep residents and staff safe."

To date, nursing homes statewide have collected a net total of about 88 million pieces of PPE, a roughly 300% increase since the end of April, the agency noted.

Hospitals statewide have collected a net total of 291 million pieces of PPE, a roughly 400% increase since the end of April.

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But the drastic stockpile increases since the spring were expected because the medical supply chain system was previously designed, in general, to move PPE just in time to be used, experts said.

In coming weeks, Bruno noted PPE supply numbers will “fluctuate as facilities have regular need of the equipment, in addition to continuing to use it in their responses to localized COVID-19 outbreaks, while also preparing for a second wave.”

Further, state health officials are aware of the continued PPE supply chain challenges and plan to respond to any issues as medical facilities report daily through the state Health Emergency Response Data System, or HERDS, Bruno added.

What we know (and don’t know) about NY’s strategic PPE stockpile

Some details related to PPE supplies in New York remain shrouded in secrecy, however, because the state Department of Health has declined to release specifics on the state’s strategic stockpile deployed during a crisis.

By contrast, New Jersey state officials have released detailed accounts of the amount of specific PPE gear obtained for the state’s stockpile, as well as outstanding orders and goals.

New York’s decision to withhold its stockpile details comes despite some advocates and health professionals asserting state officials prioritized hospitals over nursing homes and independent physicians for receiving PPE as supplies ran short this spring.

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The issue of PPE shortages, for instance, came up during state legislative hearings in August over the pandemic response in nursing homes.

At the time, Jim Clyne, president and chief executive of LeadingAge New York, said state officials delivered 14 million of pieces of personal protective equipment to nursing homes, but it lasted a matter of days.

“It’s simply not enough,” he said, citing how nursing homes burned through 12 million pieces of PPE in a week during the pandemic peak in April.

Kleinman, whose Rye Brook plastic surgery practice aims to treat more wounds and other injuries to keep patients from getting infected in emergency rooms focused on COVID-19, expanded on concerns about equitable access to emergency supplies.  

“The larger institutions have always had more political clout, where they were able to essentially get more supplies early on,” he said, adding hospitals “were getting inadequate supplies, but at least they had something.”

The nursing home trade group has not had discussions with state officials related to the strategic stockpile of PPE, Hanse said.

“Providers in New York are really relying on their own stockpiles and continually purchasing,” he said.

But the use of the strategic stockpile and all state policies involved in the COVID-19 battle, Hanse said, must consider the needs of the entire medical system.

“It’s essential that nursing homes and assisted living be treated with equal priority of hospital because we truly care for the most vulnerable in our communities,” he said.

Bruno asserted New York’s strategic stockpile, also called the medical emergency response cache, "has the resources to meet the current demands of the ongoing COVID-19 pandemic response."

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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached atdrobinson@gannett.com and followed on Twitter:@DrobinsonLoHud