HOW DID THE U.S. END UP WITH NURSES WEARING GARBAGE BAGS?
By
Susan B. Glasser
April 9, 2020
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.
Susan B. Glasser, a staff
writer, was the founding editor of Politico Magazine. In May, she will publish,
with Peter Baker, “The
Man Who Ran Washington.
