How Did the U.S. End Up with Nurses Wearing Garbage Bags?
On Saturday, March 21st, while Donald Trump was tweeting about the “Chinese virus” and circulating praise for the “great job we’ve done,” Eric Ries received a phone call from another Silicon Valley C.E.O. His friend Jeff Lawson, of the firm Twilio, told Ries that, to deal with the rapidly escalating coronavirus crisis, the White House was recruiting tech executives to help. Ries—the founder and C.E.O. of a new company, the Long-Term Stock Exchange, and the author of a best-selling book, “The Lean Startup,” which had made him a well-known figure in the Valley—was an obvious choice for someone looking to stand up a high-tech solution to the disaster quickly. He had long preached the virtues of going to market as fast as possible with what he called M.V.P.: minimum viable product.
America was watching, shocked, as doctors and nurses pleaded for protective gear and medical equipment such as ventilators. Ries was asked to help start a Web site that would match hospitals and suppliers. Sure, Ries said, he could have something up and running by Monday. What followed over the next two weeks was an inside glimpse of the dysfunction emanating from Trump’s Washington in the midst of the pandemic, a crash course in the breakdown that has led to nurses in one of the wealthiest countries in the world wearing garbage bags to protect themselves from a virus whose outbreak the President downplayed until it was too late to prepare for its consequences.
Ries’s first phone conversation demonstrated how awry things had gone. He reached out to a White House contact, and, when he mentioned the Trump Administration’s coronavirus task force that was asking for Silicon Valley’s help, the response was, “Which one?” Trump had enlisted his son-in-law, Jared Kushner, to help with the pandemic response, and his murky new effort, which was not yet public, was already seen as working at cross-purposes with the official task force, overseen by Vice-President Mike Pence. Ries also learned that the Web site he had been asked to create was, in fact, not needed. “It took me three hours on the phone to realize the world did not need another Web site to solve the problem,” Ries told me.
Numerous relief groups were already in place. Some of them were soliciting donations for urgently needed personal protective equipment, or P.P.E., in the medical argot that the rest of the country would soon learn. Others were organizing sewing-machine brigades to make masks, or teams of graduate students to create designs for 3-D-printed ventilators. Ries thought he could help bring a bit of order to the chaos by organizing the small army of relief groups and volunteers into an effective partner for the federal government, for when it actually took charge. “I thought, Eventually somebody will lead,” Ries said. He spent the weekend pulling together a new umbrella organization, the PPE Coalition, and, as promised, had its Web site up and running by that Monday morning, along with a hotline to field requests.
For the next few weeks, the requests flooded in. Eventually, thirty-one groups joined the new coalition, and the Web site provided links to organizations with names that tell the sad story of the crisis, from Operation We Can Sew It! to Get Them PPE. The sense of urgency was palpable. “Armageddon was coming in three weeks,” Ries remembers being told. There was a rush to help before early April, when deaths were predicted to peak in New York City and hospitals would potentially be overwhelmed in other hot spots around the country. But there was also a sense of disbelief: Where was the U.S. government? One of the volunteers kept saying, “There’s no way we should be doing this alone,” remembered Jennifer Pahlka, who founded the tech group Code for America, served as deputy chief technology officer in the Obama White House, and is now helping with a coronavirus-relief group, U.S. Digital Response, which advised the PPE Coalition. “In our community, we have sweatshirts and T-shirts and stickers that say, ‘No one is coming. It’s up to us.’ It’s really hard when they actually realize that’s true. It’s terrifying.” For ten days running, Ries was told that the Federal Emergency Management Agency would step in and take charge of distributing critical supplies, directing them to where they were most needed, but, as far as he could tell, it never happened. Kushner and his team had embedded at fema, along with a Navy rear admiral, John Polowczyk, to oversee the supply-chain crisis, but Ries managed only to speak with an aide to the admiral.
Eventually, at a White House briefing last week that will surely go down as one of the Administration’s most callous performances, Kushner said publicly what he had in effect told Ries’s Silicon Valley contacts a couple weeks earlier, in a private phone call with business leaders and government officials: the states were responsible, and the U.S. national stockpile was ours, not theirs. The President agreed. Governors should have prepared their states while there was still time. “We’re a backup. We’re not an ordering clerk,” Trump said at the same news conference.
For two weeks, Ries and his fellow-volunteers had believed that it was only a matter of time until the federal government came to the rescue. They planned to serve as a bridge for the desperate states and cities that started calling their hotline as soon as it was up and running, but, eventually, the federal government would take care of it, because isn’t that what the federal government is supposed to do? “We see ourselves like a backstop,” Joe Wilson, a prominent venture capitalist working with Ries on the PPE Coalition, told me. “We are like the Plan C or the Plan D. Like, if x, y, z don’t happen, then, sure, this network will be valuable. This is what we told people. Now it’s clear we are on Plan C or Plan D.”
What they did not foresee was that the federal government might never come to the rescue. They did not realize this was a government failure by design—not a problem to be fixed but a policy choice by President Trump that either would not or could not be undone. “No one can believe it. That’s the No. 1 problem with the whole situation: the facts are known, but they are inconceivable,” Ries told me. “So we are just in denial.”
Independent reporting has corroborated what Ries and other volunteers saw for themselves: “a fragmented procurement system now descending into chaos,” as the Associated Press put it. The news agency found that not a single shipment of medical-grade N95 masks arrived at U.S. ports during the month of March. The federal government was not only disorganized; it was absent. Federal agencies waited until mid-March to begin placing bulk orders for the urgently needed supplies, the A.P. found. The first large U.S. government order to the big U.S. producer 3M, for a hundred and seventy-three million dollars’ worth of N95 masks, was not placed until March 21st—the same day that Ries got his first phone call about the Kushner effort. The order, according to the A.P., did not even require the supplies to be delivered until the end of April, far too late to help with the thousands of cases already overwhelming hospitals.
Earlier this week, the office of the inspector general for the Department of Health and Human Services released a survey of three hundred and twenty-three hospitals in forty-six states, D.C., and Puerto Rico, and it found “widespread shortages of PPE,” and also of other equipment. After the report was released, Trump claimed it was “wrong,” tweeted that it was “Another Fake Dossier!,” and attacked the principal deputy I.G. who prepared it because she had also served during the Obama Administration. Trump, of course, omitted the fact that she is a career official who also served in the Clinton and George W. Bush Administrations.
All of this was predicted. On February 13th, the Center for Global Development, a nonpartisan Washington think tank, warned in a report about the “urgent but closing window” for the U.S. government to prepare, including specifically recommending an immediate review of the P.P.E. supply chain; the creation of a plan for distribution of supplies and the public communication of that plan; and the development of “options for addressing PPE shortfalls,” which ranged from increasing manufacturing to coming up with new “parameters for reuse in crisis conditions.” This was in mid-February, a full month before Trump deputized Kushner to step in and the first orders went out.
Jeremy Konyndyk, a former Obama Administration official, who co-authored the Center for Global Development report, pointed out that, although he had accurately foreseen supply-chain problems and overwhelmed hospitals, he had not imagined the widespread confusion that the U.S. is now experiencing regarding such basic questions as who is in charge of the pandemic response. Were the states, as Trump now claims, really supposed to have been stockpiling masks and ventilators when there is a national stockpile for doing just that? “It would never have occurred to anyone that the President would abdicate the leadership role of the federal government,” Konyndyk told me. A pandemic playbook he helped develop during the Obama Administration “very explicitly” states that “the federal government has to lead in this kind of an event and there will be an expectation that the federal government will lead.”
A few weeks ago, it was already apparent that the federal response to the pandemic was late, disorganized, and putting large numbers of American lives at risk. What is becoming apparent now is something just as unthinkable: Trump’s reluctance to have the federal government play the role for which it was designed in such an emergency. At his press briefing last week, Kushner introduced Polowczyk, the Navy rear admiral, as “the best man we have in the country for logistics and supplies.” This week, a senior Administration official told me that not only have supplies been flowing from the federal government to where they are needed but the worst-case scenarios of hospitals literally running out of ventilators appear to have been averted for now. But Kushner’s public statements, and those of the President over the past couple weeks, griping about various Democratic governors and complaining about their inflated demands on the national stockpile, suggest states and cities are stuck in a Darwinian competition with one another, and with the federal government, for scarce supplies, and there is little transparency in how or why fema’s decisions are being made.
States, not surprisingly, have taken matters into their own hands. In California, Governor Gavin Newsom announced this week a deal to spend nearly a billion dollars to buy two hundred million medical masks a month. In New York, Governor Andrew Cuomo is calling for states to form a new consortium, under the aegis of the National Governors Association, to buy the supplies that the federal government has told them to get on their own. It’s an idea that sounds an awful lot like what one imagines fema is supposed to be doing. In the pandemic, Cuomo said, there needs to be a “master strategist” and chief “purchasing entity,” and that would normally be the federal government. The current status quo of cities and states bidding against one another, Cuomo added, is “just madness.”
The consortium, if it materializes, will come too late for New York City and New Orleans, for Albany, Georgia, and Everett, Washington. The mad dash for supplies set off by Trump’s incomprehensible handling of the crisis cannot help those already in the thick of the outbreak; the help that is on the way now, finally and belatedly, will be for the next cities and states to face it. There was a window for action. It wasn’t just closed. It was slammed shut.