Local officials and health-care workers are losing faith in the national response, and struggling to improvise their own solutions.
The federal government’s stockpile of medical supplies, gloves, and masks is nearly exhausted, President Donald Trump admitted at a White House briefing on Wednesday. Meanwhile, individual states are scrambling, bidding against one another for the equipment they need.
“The coronavirus pandemic is a damning indictment of this country’s health-care system,” Joseph Kantor, the assistant state health officer for the Louisiana Department of Health, told me. “The richest country in the world is scrounging around for ventilators” and personal protective equipment.
Kantor is one of a dozen health professionals across the country with whom I spoke this week. Taken together, those conversations reveal a federal government that has failed to protect, supply, and prepare the country and its cities. These health-care workers are looking with horror at the chaos in New York City as evidence of what can happen to a vibrant city in the absence of national strategy and preparedness. As they struggle to avoid a similar crisis, they’re losing faith in the federal government, and resorting to their own improvised solutions.
Louisiana, Kantor warned me when we spoke on March 30, is “in the exact situation, per capita, as New York City” and the state has witnessed one of the sharpest increases in coronavirus cases in the country.
This is an “absurd situation where every state and every hospital is competing with each other to buy supplies from the private market and the government,” Kantor said. He compared the situation to “a crazy flea market,” and called it “no way to manage a natural disaster like this.”
Louisiana is leaning on its experience, trauma, and resilience from Hurricane Katrina. The state is currently building a massive health-care facility with 2,000 hospital beds for COVID-19 patients inside the New Orleans Convention Center. Across the street from the center, work is under way on a new 250-patient facility for people awaiting test results. “We are working at a breakneck pace to expand acute-care capacity,” Kantor said.
Governor John Bel Edwards has ordered 14,000 ventilators, including 5,000 from the federal stockpile. As of Tuesday, the state had received only 300.
Yani Turang, a nurse in New Orleans, is working on the COVID-19 response at the convention center. She complains that health-care professionals and experts knew that a pandemic was inevitable in the United States, but even though the “writing was on the wall,” it had never been a priority for the country. In 2018, the Trump administration disbanded the National Security Council’s directorate focused on pandemics, and it has urged budget cuts to the Centers for Disease Control and Prevention.
In 2015, Turang worked in Sierra Leone during the Ebola outbreak, but says that experience was less stressful than what her colleagues are enduring now in the United States. In Africa, she said, “there wasn’t even a question that I would ever have to reuse any supplies.” Her colleagues are now forced to purchase their own protective eyewear and face masks. She blames privilege and arrogance for this chaotic mismanagement, a “consequence of living in a world where you think you’re kind of untouchable.”
And Turang worries about the future. “I see hospital beds being full,” she said. “I see our convention center being overrun by patients we can’t manage, because they are so sick. I see a lot of people dying.”
Louisiana is hardly alone. “Right now, we’re still in what I call a lull before the storm,” said Nauman Qureshi, a nephrologist and the chief of medicine at Athens-Limestone Hospital in Alabama. Being two to three weeks behind New York has given his facility time to learn and adapt.
Although his hospital has enough personal protective equipment, or PPE, for now, Qureshi says they are all “preparing for the worst.” His hospital has been accumulating masks and gowns, and has increased its stock of ventilators by 80 percent. Local physicians are discharging nonessential patients and postponing elective surgeries. Teams of physicians have already been organized to rotate when patients become sick with COVID-19.
Qureshi says towns in rural areas such as his present unique challenges. The population is older, and internet access is spotty. “When we try to get in touch with patients, a third of them are able to connect with us through Zoom. A third of them prefer a cellphone, so we had to buy extra phones, and a third of them don’t know how to use smartphones.”
His community puts more emphasis on what’s happening in Birmingham, 90 miles from Athens, than on what’s happening in New York. “Life is very local here,” he said. “Everybody thinks local.” Convincing people to stop congregating together in church has been a challenge. “Over here, life revolves around church,” he said. Qureshi, a Muslim immigrant from Pakistan, volunteered to explain the urgency of the situation to local church leaders. In Athens, he said, people stopped congregating in churches and mosques nearly three weeks ago. Governor Kay Ivey finally implemented a “stay at home” order on April 4, as Alabama surpassed 1,500 cases. A recent epidemiological model predicts that the state could have the highest per-capita death rate in the country and the fourth-highest total death count.
North Carolina also has a stay-at-home order, but it is not enough to assuage Amy Marietta, the medical director of Blue Ridge Health in Polk County. “I don’t feel confident,” she told me. “I’m scared. The reason I’m scared is because we don’t have the capacity to meet the numbers we are going to see.”
Marietta works in a rural community in North Carolina where many physicians are older and nearing retirement. Unlike in larger cities, she said, if medical practices and hospitals cut elective surgeries or clinic work to accommodate a surge of COVID-19 patients, they lack “a financial cushion or parachute” to absorb the lost revenue. Her local hospital was already making cuts before the coronavirus, she said, even though it serves as a vital health-care facility for patients who can’t afford to travel out of the county.
Nearly 35 percent of her patient population is age 65 or older, and many have health conditions that put them at greater risk. After seeing what happened in New York and Seattle, she said, local providers are “frantically” increasing bed capacity, creating crisis-response centers, and seeking to deploy health-care professionals to provide services in surge locations.
The limitations of rural health care have forced Marietta and her team to come up with creative solutions. Because 60 percent of her patients don’t have reliable internet access and a third of them don’t have reliable cellphone access, the patients come to the clinic parking lot for their telehealth appointments. Her clinic purchased a single iPad and keeps it in a plastic bag; patients can drive up and use it for their visits. It’s a creative solution, but the pandemic has prompted her to ask, “Why can’t everyone, especially people in rural communities, have better Wi-Fi?”
In Michigan, Governor Gretchen Whitmer is asking why her residents can’t have access to crucial supplies and resources.
“It’s a very dire situation we are confronting right now in Michigan,” Whitmer told me in a phone interview last week. Michigan has the third-highest number of coronavirus-related deaths in the U.S., behind New York and New Jersey, and federal officials estimate that anywhere from 1,000 to 4,500 Michigan residents may die from the pandemic. “Like every single state in the nation, we are struggling to get what we need out of our federal national stockpile,” she said.
Meanwhile, Trump has attacked governors as “complainers” with “insatiable appetites.” He has reserved his harshest criticism for Whitmer, whom he has referred to as a “big problem” and a “woman governor” who blames the government. “We are not each other’s enemy,” she told me. “The enemy is COVID-19.” She said she is using every possible avenue to secure necessary supplies and masks for health-care workers. “It’s a source of strain on every governor in the nation,” she said. “We really would be served if we had a national strategy.”
That’s a common complaint of political leaders and health-care professionals across the country, but they will have to keep waiting. During Thursday’s press conference, Trump said the federal government is a “backup” and “not an ordering clerk.” Jared Kushner, who is advising the coronavirus-response team with zero experience and credentials, stated that the federal stockpile of supplies was “supposed to be our stockpile” and not that of the states. In fact, the stockpile was created specifically to help states in need during a crisis.
Not all states are suffering from the same degree of neglect. Some states, such as Florida and Oklahoma, have had all their supply requests fulfilled, while others have been left begging. Is it favoritism, putting states with pro-Trump Republican governors ahead of those governed by Democrats? “I don’t have an answer,” Whitmer said. “I know this: COVID-19 doesn’t discriminate along state lines, or party lines, or socioeconomic lines. COVID-19 is ravaging our country.” She wishes she could secure for Michigan all the test kits it needs, and provide PPE for all her frontline responders.
Asha Shahjahan could benefit from that magic. “[Our] medical supply is adequate for a normal situation. This is a war-zone situation,” she told me. She’s a primary-care doctor in Detroit, Michigan. To preserve supplies, she and her colleagues have been wearing one set of PPE for an entire shift, instead of changing for each new patient. “First, we didn’t want to be like Italy. Now it’s ‘We don’t want to be like New York City,’” she said. “It’s going to get worse and we have to be prepared.”
Jahan Fahimi, an emergency-medicine doctor at UC San Francisco, feels the same. “New York is the canary in the coal mine,” he told me. “We can see what’s going to happen.” Like other health professionals, he is using the limited time before the anticipated surge to prepare. He said doctors are developing work groups and doing dry runs, so that if a surge hits, they won’t be “caught flat-footed.” They are rushing to repurpose the hospital and are changing inpatient wards into negative-pressure isolation wards to accommodate the needs of COVID-19 patients. He praised San Francisco Mayor London Breed and California Governor Gavin Newsom, who implemented stay-at-home policies “in the nick of time,” which bought them crucial weeks and helped flatten the curve.
Fahimi, though, is distressed by the unevenness of the national response. He cringes at the packed beaches in Florida. “It’s insulting to the health-care professionals who will have to deal with the consequences and irresponsibility of everyone who said this was business as usual,” he said. Florida Governor Ron DeSantis finally ordered a statewide shutdown on April 2. He kept the beaches open for more than two weeks after Trump declared a national pandemic.
Kris Okumu, the chair of orthopedic surgery at Seton Medical Center in Daly City, California, told me that even though community physicians have been “banding together” like the Avengers and communicating with the local academic centers, such as UCSF and Stanford University, they are still not fully prepared.
Okumu is originally from Uganda, which he described as the “the country known for having viruses,” such as Zika, Ebola, and HIV. He’s long dealt with death, but the coronavirus is uniquely frightening for him. “It’s ironic to come to the U.S., the most developed country in the world, and deal with a pandemic, with a virus, affecting my life here and not in Uganda,” he said with a sigh.
His hospital, which has been leased by the state to treat COVID-19-positive patients, has a shortage of PPE. His wife is a physician who worked in Milan, Italy, and has kept in touch with her Italian colleagues over the past three months. She had been warning him that the U.S. was not prepared for the virus. He said his hospital currently has less than a week’s worth of isolation gowns, “which we should have for every health-care professional treating a COVID-positive patient or person under investigation.” He also said they don’t have enough N95 masks.
He told me the crisis is forcing them to ask difficult questions, such as “Who is going to be treated when we don’t have enough space to treat everyone?” If an older patient breaks her hip, will he still be able to help her? Where will she stay? He is still searching for the answers.
In Boston, Mary Ann Dakkak doesn’t have time to ask questions. She’s busy trying to save lives at Boston University’s medical center, where she’s an assistant professor and a family-medicine physician. Her state is expecting its peak caseload in the next two weeks.
Dakkak has rearranged her entire life to fight against the virus. In order to protect herself and others from potential contamination, Dakkak has stopped eating in the clinic and hospital during her 10-hour shifts. On March 9, after being informed she’d be starting COVID-19 service on March17, she arranged to have her husband and children stay with her parents in California. Like every health professional I interviewed, she is deeply worried she will be exposed to the virus and then come home and infect her family and local community. “I didn’t send my family to California so I can quarantine and be sick. I sent my family to California so I can be healthy and work,” she said.
Her peers call her tough, but she admits to crying every day. “Sometimes I cry because of something I’ve seen. Sometimes I cry because I’m exhausted. Sometimes I cry because I’m scared.” She said the last time she felt this helpless was when she worked in Chad, near the Sudanese border, in 2007. Back then, she felt that despite all her knowledge, she couldn’t stop people from dying. In the face of the coronavirus, she says, “I’m using everything I know, and I can’t do anything except hold a patient’s hands while they’re intubated.” She said all her colleagues went into medicine to help people and use science to fight diseases. However, she concedes, “I’ve never faced anything like this. This is so much more rapid-fire.”
She worries about resource-poor communities and rural hospitals that don’t have the same infrastructure or supply of doctors that Boston enjoys. Even in Boston, though, she told me, “we are pushing our backs against a dam that is breaking, and it might break over us anyway.”
Earlier this week, she asked her husband, Jason, to leave their children with their grandparents and rejoin her in Boston, realizing the stress had become too much to handle alone. She told me that Jason, a former marine, says his entire job right now is to make sure she is ready. He calls her the “spear.”
Ordinarily, the wealthiest and most powerful country in the world would support its “spears”—its health-care workers—during a crisis. In the Trump administration, however, TV ratings seem to take priority over tests. Americans are being left to rely on one another.