A White House Ventilator and PPE Sharing Plan Could Calm Future Political Battles

The country was staring down the barrel of a multifaceted crisis in March, chief among them a nationwide shortage of critical life-saving equipment. The number of confirmed coronavirus cases topped 25,000 in New York and was doubling every three days. New York Governor Andrew Cuomo was livid.

"'We're sending 400 ventilators.' Really? What am I going to do with 400 ventilators when I need 30,000?" he said March 24, criticizing the Federal Emergency Management Agency. "You pick the 26,000 people who are going to die because you only sent 400 ventilators." He would suggest days later New York needs 40,000 ventilators to meet its critical needs.

A week later, as projections said almost a million ventilators would be required and the White House forecasted a death toll that could nearly climb to a quarter-million people, President Donald Trump's son-in-law and senior advisor Jared Kushner would draw scrutiny for saying the Strategic National Stockpile of medical supplies was "our stockpile." Although some believed he was suggesting it was the states' responsibility to bear the brunt of the storm, Kushner was saying states shouldn't draw from the stockpile to hold ventilators in reserve while hard-hit areas foundered in need.

Yet as the Trump administration drew fire for its handling of the coronavirus pandemic, Kushner was setting the wheels in motion to create a new public-private partnership to establish a nationwide centralized database for hospitals to share medical supplies amid shortages. He phoned a friend—his one-time college summer roommate Adam Boehler.

ventilator PPE exchange programs
President Donald Trump speaks during the daily briefing of the coronavirus task force at the White House on April 22 in Washington, D.C. Photo by Drew Angerer/HollywoodTake

"[Boehler] gets stuff done," Andy Slavitt, who ran the Centers for Medicare and Medicaid Services under President Barack Obama, told Newsweek. He once labeled Boehler "one of the best innovators in health care."

Boehler, the former head of the Health and Human Services' Center for Medicare and Medicaid Innovation under Trump, now leads the administration's plan to create new exchange programs for ventilators and Personal Protective Equipment (PPE). Trump and Boehler announced the ventilator program last week, but the venture to include PPE has not been previously reported.

"There's plenty of PPE in the country, it's just where it sits and where it's needed," Boehler said. "Everyone has got [a ventilator] who's needed one. This is further ensuring that will continue, no matter what happens in the next months."

Yet while the nation scrambles to meet the immediate needs of the current crisis, Boehler's eyes are on the future to build the mechanisms that allow the government to respond quickly to any calamity—whether it be a second wave of the virus or a natural disaster. That means equipment from neither exchange will reach the sick and those caring for them during this wave of the pandemic.

And as some on the frontline warn, though the exchanges are good ideas—and long overdue—a quick turnaround is far from certain.

"For ventilators, it makes a lot of sense. You can send them back and they're reusable. PPE is less so. There's a need for a centralized marketplace," Dr. Shuhan He, an ER physician at Massachusetts General Hospital, told Newsweek. "What I don't think will happen is there's so much supply of PPE that [hospitals] will just give it up. There's not enough across the country right now. It just doesn't exist. That's painfully obvious."

Overstating shortages: "A ludicrous number of ventilators"

Given the forecasts at the time, Boehler said it's understandable why governors feared a shortage of the life-saving respirators. But local leaders and the media were largely wrong in foreshadowing a major deficiency. And Boehler said the states' appeals were, in hindsight, overstated.

"Every governor was requesting a ludicrous number of ventilators. If you're a governor, you want to over-prepare. A lot of people planned, prepared and were afraid," Boehler said, mirroring the president's remarks on the issue. "We were never really close. Where it felt close were in the initial projections."

ventilator PPE exchange programs
A ventilator and other hospital equipment is seen in an emergency field hospital to aid in the COVID-19 pandemic in Central Park on March 31 in New York, United States. Photo by Misha Friedman/Getty

It's easy to criticize states now, argued Bob Kocher, an Obama administration official who worked on health care and economic policy. He pointed to stay-at-home orders, such as in California, where the governor has tapped him to help boost virus test results, as a major reason for slowing the spread and not requiring more ventilators.

"In hindsight, it's easy to say they didn't need all that they ask for," Kocher told Newsweek. "If we had the same experience as other countries, I think we'd need all the ventilators that people were asking for."

Putting the past aside, Boehler's current role is to help the government prepare for what health experts warn could be a second wave of the coronavirus pandemic later this year. Two of the country's top health officials—Dr. Anthony Fauci of the National Institute of Health and Dr. Robert Redfield of the Centers for Disease Control and Prevention—warned Wednesday that a subsequent spike in infections this winter is all but certain, and the reemergence of the virus coinciding with flu season will bring added challenges. As of Thursday morning, upwards of 46,000 people have died from the illness in the United States.

ventilator PPE exchange programs
(L-R) Robert Redfield, Director of the Centers for Disease Control and Prevention, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, attend a briefing on the administration's coronavirus response in the press briefing room of the White House on March 2 in Washington, D.C. Photo by Drew Angerer/Getty

Boehler is confident the new exchanges will be complete in the coming months, in time for whatever major health disaster may follow.

But the new PPE program, though applauded by health care experts, poses more challenges: dire shortages of masks, gowns and gloves, along with bidding wars between, local, state and federal governments.

"If we don't have it, people die"

The concept of hospitals sharing ventilators isn't new. States are already doing this on their own, such as California and New York, which are both on a downward trend for new COVID-19 cases.

The forthcoming federal exchange will be run by the American Medical Association with the government assurance that hospitals which lend their respirators to other facilities will have them returned. The hospitals in need would cover the logistical costs like shipping, Boehler said. Nearly two dozen health systems have already pledged to participate with more than 4,000 ventilators.

But doling out PPE amid a crisis when it becomes difficult—and expensive—to acquire may be a more arduous task for medical institutions, doctors and experts told Newsweek.

For one, they said given the rapid pace PPE is used amid such a contagious illness like coronavirus, the sheer volume of reserves needed by medical facilities could be overwhelming to obtain.

ventilator PPE exchange programs
Registered nurses who are members of National Nurses United, the largest nurses union in the United States, protest in front of the White House April 21 in Washington, D.C. Photo by Win McNamee/Getty

Hospitals should have a surplus able to withstand 15 consecutive days of what was required during the apex of a region's outbreak, Lieutenant General Russel Honoré, who led the military recovery efforts in the wake of Hurricane Katrina in 2005, told Newsweek.

And doctors on the frontlines say the government would need to guarantee PPE reimbursement and replenishment because the gear can't be returned. The administration would likely need to step in to provide a lifeline, just as it's done during the pandemic to allocate hundreds of billions of dollars for medical facilities.

The price tag for gear once considered mundane to health care workers has increased five- to tenfold, according to Dr. Megan Ranney, an ER physician at Brown Emergency Medicine in Rhode Island. She told Newsweek that gowns now cost them $2 to $10 each and a single N95 respiratory mask is averaging $5.

For each COVID-19 patient, medical personnel use PPE 10 to 15 times faster than they would otherwise, said Dr. He."If we don't have it, people die."

But many hospitals across the country have indicated they lack enough day-to-day PPE, much less a two-week reserve, as Honoré recommended.

Amid the health crisis, Dr. He created GetUsPPE.org and operates it with the help of Dr. Ranney and others. It's similar to what Boehler is working to create: a database for health institutions to get the gear they so desperately require. Responses they received from hundreds of medical facilities earlier this month painted a bleak picture. The majority lack two weeks of PPE; nearly a quarter have zero remaining N95 face masks while more than one-third have a one-week supply or less; 36 percent lack any face shields; 20 percent have no gowns; and more than one-third have a one week or less supply of gloves.

"I don't see the supply chain being able to fill that right now," Dr. Ranney said. "PPE is a much higher potential risk for the donating hospital. If there's not enough reserves, you'll be caught as a hospital system truly shorthanded."

Boehler does not characterize his task as an easy one. But as states begin to develop plans to reopen portions of the economy by relaxing social distancing guidelines, he looks forward to the day when he's completed his work helping the administration during one of the most challenging times in modern history.

"I think looking back, I'm sure it will be one of the most meaningful—if not the most meaningful—things we do. During it, you are really in the heat of things," Boehler said. "For now, we're focused on the day-to-day."