Nurse Sandra Oldfield’s patient did not yet have the same COVID-19 symptoms, but she later tested positive for the virus and it became clear that Oldfield, a 53-year veteran caregiver, had been exposed.
He sent home through Kaiser Permanente officials with orders to take express notes on his condition. And he did.
“Temperature 97. 1,” he wrote on March 26, his first entry into a newspaper. Normal.
She and her colleagues stated that they felt unsafe in the paintings and had raised their considerations to their managers: they needed N95 masks, a hard coverage that opposes the COVID-19 contraction, Kaiser Permanente, not Oldfield. effective surgical mask, leaving her vulnerable to the fatal virus.
Many others were also vulnerable, and not just at this 169-bed hospital in Fresno. From the moment the pandemic reached the shores of the US, the Pandemic has reached the coast of the Us. The country wasn’t ready. Hospitals, nursing homes and other physical care services did not have the mask and apparatus to protect. your workers. Some were in bad shape and transmitted the virus. Some of them are dead.
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WRITING NOTE: This article is part of an ongoing investigation through the Associated Press, the PBS series “FRONTLINE” and the Global Reporting Center that examines the fatal consequences of the fragmented global medical chain and includes the film “U. S. Medical Supply Crisis,” released on PBS and online on October 6 at 10 pm EST/ nine p. m. Cst.
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Ap
The chains of medical sources that cover the oceans and continents are the fragile lifelines between raw fabrics and brands abroad, and fitness on the first line of COVID-19 in the United States. When one link was broken after another, the formula collapsed.
This catastrophic collapse was one of the country’s biggest problems with the virus and it was not unexpected: For decades, politicians and business leaders ignored warnings about the dangers related to America’s over-reliance on foreign production and a lack of a good enough preparation. at home, the AP and “FRONTLINE” found.
As the pandemic spread to the United States, Asian factories closed, stopping exports of medical supplies. Meanwhile, government stocks were depleted due to a flu epidemic a decade earlier, and there was no way to fill up quickly. people who don’t wear masks, looking to maintain the source of physical care workers.
Now, with more than 210,000 Americans killed and the president himself inflamed by the virus, the United States is in mourning the consequences, and nurses are told to reuse the mask designed to be discarded after each patient.
At home with her elderly dog with freckles through her side, Sandra Oldfield identified the symptoms by writing them down in her diary for days:
“Nice stay”
“Nice stay”
“Nice stay”
He’s lost his appetite. His writing is fragile. Someone called an ambulance. Others came here to pick up their pets.
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While it will take years for researchers to realize why the pandemic is disproportionately worse in the United States, early studies comparing responses from other countries show that shortages of masks, gloves, gowns, shields, verification kits, and other medical materials are gaining lives.
The lack of early testing was a major obstacle: first, testing from the US Centers for Disease Control and Prevention was a major obstacle: first, testing from the US Centers for Disease Control and Prevention was a major obstacle. But it’s not the first time They had flaws and then there weren’t enough. The Food and Drug Administration ran to pass more tests, but without access to reasonable disposable swabs, manufactured almost entirely in Italy and now in a very short time, they were useless. The worst fears of US public fitness are the only ones in the world to do so. But it’s not the first time They became a temporary reality.
Chrissie Juliano, executive director of the Big Cities Health Coalition, a forum for the largest public fitness departments, said the lack of available data on the actual burden of the virus “has delayed our country’s reaction in an order of magnitude that I will never know. “
Meanwhile, retirement home studies in China, Washington state, and the United States found that COVID-19 cases were particularly higher in spaces where non-public protective appliances or PPE were not good enough. Andrew T. Chan, a professor at Harvard Medical School, and his colleagues discovered that health care personnel who did not have good enough PPE were 30% more likely to be inflamed than their colleagues with enough supplies. the greatest threat of getting COVID-19, they discovered.
A review from the University of California, Berkeley estimated that at least 35% of fitness care personnel and other staff in California who tested positive for COVID-19 were inflamed at work due to scarcity.
“And those are unacceptable deaths, everyone could have been avoided if we had placed chains from good enough sources before the pandemic,” said William Dow, a professor at UC Berkeley.
Dow and his colleagues say human lives and tax dollars would be saved if the government invested more in the acquisition and storage of supply reserves.
“This is a case where no individual fitness care organization is large enough to move the market and inspire suppliers to invest in such chain sources,” Dow said. “Therefore, the government will have to be able to interfere and guarantee a series of purchases so that it is of interest to each of those brands to be willing to invest in this chain of origin. “
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In 2005, newly appointed Secretary of the Department of Health and Human Services, Mike Leavitt, began sounding the pandemic alarm after a disturbing CDC briefing on a potentially fatal virus.
“They were afraid that he would begin to mutate in a way that would allow him to move from one animal to another and then from one user to another. And once it reaches that capacity, it becomes a pandemic virus,” Leavitt said.
He went to the White House and told President George W. Bush, who implemented a $7. 1 billion pandemic preparation plan. 8 weeks of masks, gloves and other supplies.
If U. S. chains were damaged or compromised, he warned, it would exacerbate the devastation of a pandemic.
During meetings, panels, and even keynote addresses, Leavitt officials proposed contingency plans, but they did not.
“Over time, when the snake isn’t on your ankle, you worry about other things that are dangerous. And it’s not just a service of our generation. This has been the case in virtually every pandemic in human history. “Leavitt said.
The AP and “FRONTLINE” met with members of the Clinton, Bush, Obama, and Trump administrations who were guilty of a pandemic. Everyone said they were involved and warned about insufficient source chains. But the answers are costly, and neither Congress nor White. House has made them a priority.
“We learned that Ebola is important. Speed is important. Epidemics are developing exponentially. A huge fine is paid for inaction,” said Christopher Kirchhoff, an Obama adviser who wrote the examination of classes the National Security Council learned for the White House after the 2014-16 outbreak. . .
Among its 26 express discoveries: The United States government had to acquire and purchase emergency protection devices, in case of failure of classic chains.
During the Obama-Trump transition period, a newly appointed Trump aid organization met for crisis preparedness training organized through high-level members of the Obama administration, adding Nicole Lurie, a doctor who had been undersecretary of preparation and intervention. chain of origin and the importance of securing PPE in the event of a pandemic.
“There’s not much traction of the maximum number of participants,” Lurie said. “It doesn’t make sense that I’m going to be at the top of the priority list. “
In 2019, the Trump administration conducted a training called “Crimson Contagion,” a pandemic influenza simulation training involving 12 federal agencies, 74 local fitness agencies, and 87 hospitals in 12 states.
Its main classes were to announce precisely what it would do less than a year later: In the event of a pandemic, the United States would not have sufficient “available inventory of antiviral drugs, needles, syringes, N95 respirators, ventilators, and other medical aids. ” “The countries that provided those materials would leave them for their own citizens. And there was not enough domestic production to fill that gap.
When the epidemic began in the US, Lurie said she had continually contacted Trump’s management officials to raise considerations and offer help, but declined.
“So many thousands of people died unnecessarily, and it didn’t have to be,” he said. “But I think if I think about what’s happening here, it’s an administration that had policies, procedures, tools, plans, checklists, a previous warning, all that, and it turns out that almost nothing has been used.
Trump’s leadership blamed China and its access to the World Trade Organization in 2001 for the country’s dominance over U. S. medical supplies, but the appeal of reasonable hard work and declining production prices began to attract U. S. corporations in the 1970s.
By 2020, almost all health coverage in the United States was manufactured in other countries.
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“Dear Mr. President, the purpose of this letter is to raise awareness of a little known risk to national security. “
That was in 2010, the president was Barack Obama and the letter was Mike Bowen, a medical mask manufacturer in Fort Worth, Texas, on the brink of bankruptcy after temporarily expanding his factory to supply enough mask for H1N1 flu just a year ago.
“The other people we hire, the many other people who interfere to save the United States, to save America. They were rewarded by entering an unemployment line. I lost everything I had. I literally ruined the farm,” Bowen’s business partner said. Dan said Reese. Su retirement account only $72, he said.
The history of his company, Prestige Ameritech, explains why the United States has not achieved a solid production base from national medical sources.
Bowen and Reese had worked for mask manufacturer Technol, which until the 1990s manufactured 87% of surgical masks in the United States. In 1997, Kimberly Clark bought Technol and moved the production to Mexico. At the same time, other U. S. mask manufacturers added 3M. and Johnson
Each year, Prestige Ameritech asked the Department of Defense to acquire its mask, raising the Berry Amendment that dictates that the military buy U. S. -made clothing. In response, the Department of Defense told them their mask was clothing.
“Year after year after year, until the last offer is added. It’s unbelievable,” Reese said.
In 2014, a confidential filing received through AP and “FRONTLINE” from HHS warned that the U. S. source of “almost depleted” medical masks would be needed and that $5. 3 billion would be needed in the event of a pandemic.
In February 2017, more than two years before the pandemic, Prestige Ameritech tried again: “Dear President Trump: 90% of the protective mask in the United States is lately manufactured abroad!”
Once again, Prestige Ameritech ignored. And with the onset of the pandemic, shipments of control swabs, surgical gowns, protective masks and hand sanitizers plummeted as demand increased. themselves in a bidding war for what’s left.
In March, Prestige Ameritech founders were furious that CDC fitness care providers wore homemade masks, such as scarves or scarves, to treat COVID-19 patients as a last resort.
“I felt like the government was deliberately cheating on other people because they didn’t prepare the way they did and the products aren’t available,” Reese said.
Full of calls, Prestige Ameritech closed its online sales page: orders increased from two to three per month to thousands per day. They hired new ones and bought raw materials, accelerating production.
In 8 months of this year, the national manufacture of medical products in the United States has accelerated. Hospitals and laboratories, including public libraries, have used 3-D printers to make swabs. Needle and syringe factories paint overtime. Clothing corporations now make dresses. Alcohol distillers produce hand sanitizer.
But Chinese and Asian production accelerated even faster, flooding U. S. markets with less expensive alternatives. According to Panjiva Inc. , a service that independently tracks world trade, there were more than 2,000 N95 shipments from Asia in the following month, compared to 20 shipments at the same time a year ago.
Experts agree that a solution is a large investment in U. S. production that not only allows existing corporations to grow, but also promises a long-term market for medical materials that are more expensive than those manufactured through Asian competitors. it’s going to happen.
“The challenge is that China has 50% of the world’s production capacity, especially masks. So, are we going to move a total font chain?” Cameron Johnson, a Shanghai-based business consultant, said. “It may not happen. Manufacturing, as we know it, will never come back. “
At Fort Worth, Prestige Ameritech is focused on the moment, preparing for increased demand for mask as others return to school, paintings and indoor events, but the long run seems bleak.
“Ultimately, China can sell masks in the U. S. market on my territory at a price under the charge of my raw materials,” Reese said. “People can stand up and wave the flag, and we all do, but the fact is that it has to be a basic replacement for all this to happen. “
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Even when she had fallen ill, Sandra Oldfield was worried about the shortage of masks. This spring, when paramedics rushed home, his mind was with paramedics. Would they have the mask they wanted or would they be exposed to the infection??
“Let them know that I am HIV-positive so that they are as much as possible,” she told her sister.
UC San Francisco Medical Director Dr Josh Adler also worried: the more non-public protective devices needed his staff, the harder it was to find. They handled counterfeits, external and unauthorized donations. Medical academics were running EPI readers.
“In a moment, I thought, how come we can’t have any more?” he said. In life, when you’re low, you get more. “
Months earlier, an email on January 27, 2020 received as a component of a Freedom of Information Act application made it clear that some members of the federal government were aware that a medical grade mask would be required.
“We will see a spread of the virus from person to person in the United States in the near future; CDC will begin gently articulating this message in its public position,” said a Memorandum from the Department of Homeland Security.
At the same time, worldwide in China, factories that make the most of U. S. medical supplies have been shut down because the accountant has closed to detect its own epidemic. When they were restarted, these important materials remained for the Chinese market, leaving U. S. hospitals unsathed and desperate as COVID-19 cases multiplied.
Chinese exports would take several weeks to resume, while the United States needed billions of N95 masks that were available.
Despite initial internal White House warnings, the federal government failed to substantially mobilize national brands until April, three months after the virus began spreading exponentially across the United States.
The effect of the virus varies significantly from country to country. But it is now transparent that those with well-managed, diversified, and flexible source chains were able to protect themselves from the fatal extent of the way the United States failed.
Amid the chaos, AP and “FRONTLINE” discovered that counterfeit masks flooded the market, tracking some to a factory in China. Philip Clapp of the University of North Carolina tested a handful of other masks collected through APs, adding those imported through a nonprofit humanitarian organization, others donated to frontline staff through giant-generation corporations and the mask AP had given its own staff.
“All this counterfeiting, as explained through OSHA’s definition of counterfeiting or fraudulently labeled,” Clapp said. Some were effective at less than 50%, roughly the same as a cotton T-shirt.
The AP sent a new mask to whoever had won fakes.
Warnings about the White House’s near-fatal and potentially fatal source shortage began confidentially in February when White House industrial adviser Peter Navarro wrote to the COVID-19 working group, urging management to stop exports and accelerate the production of N95 masks.
The United States “faces the genuine prospect of severe mask shortages,” he wrote on February 9.
In addition to stopping exports and banning the sale of appliances from the N95 plant to China, Navarro argued that the U. S. government will need to provide “promises of immediate procurement for all U. S. materials with the highest production capacity. “
President Donald Trump first rejected calls from states, medical workers, Congressional Democrats, and national brands to invoke the Defense Production Act, which allows the federal government to give more flavor to manufacturing. He said it wasn’t necessary, but then reversed the course in the spring, giving some American plants the help they needed to expand N95 production and raw fabrics used to make them. But even now, these brands have not obtained long-term acquisition guarantees.
And for fitness care workers, the Government Accountability Office, and even the FDA, the N95 mask remains rare. The White House denies it.
Rear Admiral John Polowczyk, head of the chain of sources working group at the Federal Emergency Management Agency, said they were diverting the orderly N95 first for national strategic inventory to hospitals, which deserve to have many now.
“Why would a particular hospital ask a nurse or doctor to reuse a todayArray mask. . . I can’t reconcile that with you?” he said.
Navarro also that chains of medical sources have stabilized, but the risks of relying so much on Chinese products.
“We can’t lesson, the key lesson, that is, we have to take our pharmacy and gadgets home,” Navarro told AP and FRONTLINE.
The relocation has a war cry for Republicans and Democrats in the run-up to the 2020 presidential election.
At the Republican National Convention in August, Trump gave the impression to the White House and said, “Over the next four years, we will make America the world’s production superpower. We’ll bring our chains of medical sources back to China once and for all. all of them. “
Similarly, Democratic candidate Joe Biden has presented a $700 billion investment plan for U. S. production and the purchase of locally produced products.
As winter approaches, the government now wants tons of needles and syringes to vaccinate the country, Navarro warned this year, parts were missing.
“We would probably be in a scenario where we have enough vaccines but there is no way to deliver everything,” he told the White House Coronavirus Working Group in a February memorandum.
Now, Trump’s management says needles and syringes are in order, but the main points of the contract are secretly wrapped. AP and “FRONTLINE” learned that the largest was for corporate production, a device that has not yet been authorized by the FDA, according to their own website. Another company did not join until May and never had a contract with the government or imported needles and syringes. A third contractor reported outages in its supply chain in August.
Last week, the Department of Health and Human Services refused to say whether (or how many) needles and syringes had been delivered, saying the data was “business-sensitive. “Several contractors said the government had banned them from disclosing data, even if they sought to.
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Each week, CDC receives national death forecasts from COVID-19 for next month from about 40 other modeling expert groups. The signature uses them to create a national overview. To date, predictions of the total number of deaths continue to increase, with a point on the chart representing a life, a family, a community.
One can discuss how Sandra Oldfield, the nurse from Fresno, a point in this picture. Kaiser Permanente claims to have followed state and federal rules and “carefully manage PPE supplies. “
For weeks, while Oldfield was fighting for his life in the intensive care unit, his circle of relatives sat outside in the hospital parking lot, praying and adapting, discouraged and terrified. When his dog Freckles died, they didn’t tell him anything.
“They’re going to put a fan on me,” Oldfield told his sister, Lori Rodriguez, on a phone call.
Rodriguez knew this was going to happen. ” We’ll be here when you open your eyes,” he said.
Two months after Oldfield’s illness, Rodriguez knew he had to let his sister go. A nurse took the phone to Oldfield’s ear.
“I told her that everything was fine, that she didn’t need to take it anymore, that we were going to be okay and that we would see her again,” Rodriguez said. And that’s when he took his last breath. “
Oldfield’s friends and family circle say there’s a lot to blame for: the hospital deserves to have it. And if the government hadn’t failed in its legal responsibility to maintain chains of sources for an essential team, it might not have finished fighting for his life, in the same hospital where he helped save so many others.
Hundreds of others wanted to come to oldfield’s funeral rite (colleagues, family circle, friends), but COVID-19 limited service to ten. In his coffin, his circle of relatives placed an urn, the ashes of freckles.
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Contributors to this story, AP Candice Choi writers in New York, Matthew Perrone in Washington, DC and Allen G. Breed at Chapel Hill, North Carolina, and global reporting center ceo Peter Klein in Vancouver, Canada, and “FRONTLINE” production company Kate McCormick in Stamford, Connecticut.