The job of a paramedic is already a stressful one, but first responders in North Carolina say the novel coronavirus and its disease, COVID-19, are causing a new level of anxiety.
"Definitely to me, the unknown of you going to somebody who has some of these symptoms and I put myself at the risk of going in," Victoria Huffman, a paramedic for Wake County EMS, told ABC11. "That's why we wear the PPE that we have."
The PPE, which stands for Personal Protective Equipment, is the unofficial uniform of these health care heroes on the front lines: masks, gloves, gowns and face shields, among other types of equipment.
Typically, PPE is ordered and stocked to support an EMS or Fire Department for a few months out, but an ABC11 I-Team and ABC Owned Television Stations collaborative investigation finds a nationwide shortage of that critical equipment that is forcing those entities to tap into an unknown market.
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"The CDC says that we should reuse our PPE and that's what we're supposed to do right now, because if we don't reuse it then we'll just be completely out of it then we put ourselves more at a risk than anything," Huffman said. "I think the extraordinary circumstances right now, reusing that, I have some of the anxiety that if I had a patient who might have had the COVID, then I put the mask back on to go to another patient that I have now put it back on my face even after I've Lysoled it."
Huffman, of course, is not alone, and neither is Wake County EMS. Health officials from several counties, including Wake, Chatham, Durham, Harnett, Orange and Johnston, plus administrators from WakeMed and Duke hospital systems, have banded together to combine their orders and search for new equipment together instead of compete with each other, which may inadvertently drive up costs.
"We've got staff who are working and spending 12 hour days, day after day after day, trying to locate stocks of PPE we can purchase on hand," Jeff Hammerstein, Assistant Chief of Wake County EMS, told ABC11. "Without a doubt there are people whose job is not looking for PPE, that's what they're doing right now. There's a lot of functions that don't go on as normal."
Mike Sprayberry, North Carolina Director of Emergency Management, confirms the state has placed orders for more than $100 million of personal protective equipment. To date, the state has received 48% of orders for N95 masks, 23% of face shields and 18% of gowns. Gloves (92%) and surgical face masks (119%) are a refreshingly different story.
Still, the urgency and rush to purchase equipment could also be making departments more vulnerable to scammers hoping to take advantage of the frantic search for product.
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"I think you've got to be worried about that," Hammerstein said. "We've got to pay attention to that - people who are making offers and demanding upfront payment for something that looks sketchy and is probably not a real thing."
Nationally, there are similar stories in cities large and small; local governments and health care providers left vying for the same equipment, creating competition for those materials and driving up prices through bidding wars.
"A system that's based on state and local governments looking out for themselves and competing with other state and local governments across the nation isn't sustainable and if left to continue, we'll certainly exacerbate the public health crisis we're facing," said John Cohen, an ABC News contributor and former Acting Undersecretary at U.S. Department of Homeland Security. "There's a very real possibility that those state and local governments that have the most critical need won't get the equipment they need."
In Texas, a large purchase order for PPEs wasn't honored after someone else offered to pay more and created a "bidding war," Houston Mayor Sylvester Turner said.
Houston Fire Department Chief Samuel Peña said he received a shipment of supplies from Mexico and has looked as far as the Middle East to secure more equipment for first responders.
In New Jersey, Governor Phil Murphy said his state is "desperate" for more PPE. Illinois Governor JB Pritzker told CNN the fight for supplies is like the "Wild West."
And on Monday, Pritzker said the federal government sent the wrong type of mask - they received surgical masks instead of N95s.
In Philadelphia, the Federal Emergency Management Agency only fulfilled 44 percent of the state's requested PPE, leaving them short more than 382,000 N95 respirators and still in need of more than half a million face and surgical masks, according to a report Thursday from the U.S. House Committee on Oversight and Reform.
North Carolina has received only a portion of the masks, gowns, gloves and face shields it requested from the federal government. Officials there are fighting back against scammers who are trying to take advantage of the need for PPE by "making offers and demanding up-front payment for something that looks sketchy and is probably not a real thing," said Wake County EMS Assistant Chief Jeff Hammerstein.
Wake County also "merged" orders with five other counties and two major hospital systems in an effort to order bigger bulk and decrease competition.
New York Governor Andrew Cuomo, whose state has more than 92,000 confirmed cases, said states are willing to pay whatever it takes to get their hands on supplies and even though that continues to increase costs, it is not even considered price gouging since it is private market competition among bidders.
The gear includes everything from gloves, face shields, gowns, sanitizers and N95 masks, a respiratory protective device that is the best way to prevent a COVID-19 positive patient from transmitting the virus to the workers treating them.
"Not only is it a lack of supplies would harm us or hurt us in the ability to take care of patients, but it would endanger the staff as well and if staff gets sick and they can't come in to take care of patients that makes it even doubly challenging," said Cliff Daniels, chief strategy officer for Methodist Hospital of Southern California.
California Gov. Gavin Newsom said the state needs more than 100 million N95 masks just to meet needs. He said governors across the U.S. are starting to form partnerships and consider connecting procurement teams to work together and ensure "none of us are being greedy at this moment and that we have the capacity to move things around."
"We want to help other states even as large as Illinois and Washington State, some of the largest states in our nation, to see if we can help procure not only a reduction in costs per unit, but also procure a mindset where we're not playing in the margins of a zero sum where it's us versus them," Newsom said.
There were nearly 240,000 confirmed COVID-19 cases in the U.S. as of Thursday afternoon, according to the John Hopkins University's Coronavirus Resource Center. In addition to protection for frontline workers, the equipment to keep critically ill patients alive is also at the center of the bidding war.
"When I showed you the price of ventilators went from $25,000 to 45,000. Why? Because we bid $25,000. California says, 'I'll give you $30,000' and Illinois says, 'I'll give you $35,000' and Florida says 'I'll give you $40,000,'" Cuomo said during a press conference Saturday. "We're literally bidding up the prices ourselves."
Cuomo called on the federal government - or even states themselves - to get organized and eliminate private market competition.
"You can't have the states competing against the states, and then by the way, when the federal government goes out to buy the same equipment for their stockpile, now it's 50 states competing against the states and the federal government competing against the states," Cuomo said. "This is not the way to do business. We need a nationwide buying consortium."
The federal government says it is providing some relief. The U.S. Department of Health & Human Services announced last month that it would purchase 500 million N95 respirators over the next 18 months for the Strategic National Stockpile.
But, health care workers say they need the equipment now and a FEMA spokesperson acknowledges its Strategic National Stockpile can't fulfill every state and local government's requests.
Now, the government is relying on additional funding to "exhaust all means to identify and (obtain) medical and other supplies needed to combat the virus."
The Coronavirus Aid, Relief, and Economic Security Act, which was signed by President Trump last week, allocates $27 billion "for the development of vaccines and other response efforts, including $16 billion to build up the SNS with critical supplies, including masks, respirators, and pharmaceutics," according to FEMA.
U.S. governors join President Donald Trump at least once a week for a conference call about the latest on the coronavirus pandemic and where current supply of personal protective equipment stands.
In a tweet Thursday morning, Trump pushed back on states' claims that the federal government isn't providing enough equipment, fast enough.
"Some have insatiable appetites & are never satisfied (politics?). Remember, we are a backup for them. The complainers should have been stocked up and ready long before this crisis hit. Other states are thrilled with the job we have done," he tweeted. "Sending many Ventilators today, with thousands being built. 51 large cargo planes coming in with medical supplies. Prefer sending directly to hospitals."
Even when FEMA shares materials from its stockpile, it is sometimes only enough to get cities through a few more days and at times has left cities discussing the possibility of shutting down testing sites due to lack of supplies.
Amid the shortage, the federal government is encouraging the reuse of PPE and creating guidelines for how to adequately clean and recycle the equipment, including some items that healthcare professionals have said are typically intended for one-time use.
During a press conference Monday, Trump said national companies across the U.S. are donating tens of thousands of pieces of PPE to FEMA and ramping up production. Hospitals across the U.S. are also accepting donations of this equipment to help meet supply demands.
Earlier this week, FEMA said 80 tons of PPE supplies were delivered to New York, New Jersey and Connecticut, which have become one of the U.S.' hotspots for cases. Supplies were also delivered this week to Chicago and FEMA says items will be distributed across the U.S. based on the greatest need, such as "areas experiencing the greatest increase in COVID-19 cases with the largest forecast capacity shortfalls."
But, cities say the materials aren't getting in the hands of healthcare workers quick enough.
Cohen said the pandemic is unlike any other natural disaster. It is taking over the entire U.S.; not just one localized region.
It's something FEMA is tasked and prepared to handle, he said, but the government was too slow to act, leaving critical need areas struggling to acquire equipment and establish hospital overflow areas.
"They were created to deal with situations like this and they're beginning to manage this disaster in the way that they prepared to do so. The only question I have is why did it take so long for the administration to activate FEMA at this level? This should've been done months ago," Cohen said. "We've lost time and when you lose time in a natural disaster or any type of public health crisis, people die."
For paramedics like Victoria Huffman at Wake County EMS, there's no time on the front lines to worry about what could have been. She also says there's no way she will allow any of her anxiety to affect her job.
"People look at us right now as we're trying to be calm, cool and collected. If we're anxious, then everyone else is a little bit more anxious."
'12-hour days:' Nationwide PPE shortage has first responders on frantic search for supplies
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