Sitting in a Washington state government warehouse are more than 30 million N95 masks — enough to provide every one of the state’s health care workers nearly 100 masks each.
They’re sitting there even though nearly all of the state’s hospitals are reusing their N95s or otherwise conserving supply, as the nation faces a looming shortage and Washington’s COVID-19 cases spike to the highest levels in the pandemic.
Does the stockpile represent careful planning by state officials for this surge, or a missed opportunity to provide about $90 million of needed masks?
Some in the industry support the state’s reserves, but others suggest the stockpile has grown because the masks are too large for a mostly female health care workforce. And some providers have been unable to obtain them because the ordering process is a bureaucratic maze.
Nearly all of the state’s N95s are a model unfamiliar to hospitals, developed during the pandemic by a Chinese auto manufacturer.
Since April, state officials have maintained strict qualifications on who can receive the free N95s, and have recently said they are intentionally maintaining an emergency supply.
Without N95s, providers struggle to follow workplace safety laws and employees risk their own health while caring for patients.
“I have referred to the stockpile multiple times as a unicorn,” said John Ficker, executive director of the Adult Family Home Council, which represents more than 3,000 long-term care facilities. “I haven’t talked to anybody who can show me how to actually get access to it.”
Building a stockpile
In the spring, as the first coronavirus wave blazed through Washington, Gov. Jay Inslee’s administration launched a frantic effort to find personal protective equipment, awarding no-bid contracts to some companies with little experience manufacturing health care supplies.
Hospitals’ normal supply chains had run bare, especially for the N95 respirator mask, the most critical piece of protective equipment for front-line medical staff, and the Strategic National Stockpile failed to quickly fill the gaps.
So far the state has purchased more than $407 million of equipment — including gowns, gloves and sanitizer — and has received some donations and shipments from the national stockpile. About half of the equipment acquired by the state has already been distributed.
N95 masks make up the largest category of spending. Washington has distributed about 6 million N95s to county emergency managers, prisons, dentists, fruit farmers and other groups. More than 80% of the masks, though, remain in an undisclosed warehouse.
Reed Schuler, a senior adviser to Gov. Jay Inslee, said the state did not make a “determination to hold back a large level of inventory.” Instead, he said, the mask stockpile reflected the small number of “qualified requests received” compared to the large number of respirators ordered. The state has viewed its supply as an “emergency backstop,” he said.
State guidelines for distributing N95s prioritize organizations based on their level of interaction with COVID-19 patients and their remaining supplies. If a hospital has less than a two-week stock of masks, they may qualify for an emergency batch.
But not all facilities receive top priority. Long-term care homes, for instance, only qualify if they have active COVID cases and their PPE supplies are also nearly depleted.
Under these strict controls, the state has received so few orders that it has been able to supply 95% of the N95s requested by high-priority facilities like hospitals over the last three months, Schuler said.
Almost all of the state’s hospitals are operating under a “contingency” status, in which they have to conserve N95 supplies, said Cassie Sauer, president of the Washington State Hospital Association. That could mean workers wearing the same mask for repeated close-contact encounters with several different patients.
Instead of leaning on the state, hospitals have scraped by ordering masks from their existing suppliers. The international supply of N95s has improved since the spring, but hospitals are warily watching the market, Sauer said.
If China or India experience a surge in cases, supply could be significantly constrained, she said, because those countries are home to a bulk of the mask manufacturers.
“We would love to partner with the state to figure out how to get the masks that the hospitals want, to get out to hospitals for the fall surge,” Sauer said.
Others are cautioning against releasing the stockpile. Holding back some masks could prevent a repeat of the spring, when health care providers didn’t have enough protective equipment to see patients, said Bracken Killpack, executive director at the Washington State Dental Association.
“It’s not just hoarding for the sake of hoarding,” said Killpack, who has attended discussions on the subject convened by the governor. “We don’t want to necessarily dip into that unless things get really bad on the market.”