Letter to Alex Azar, Secretary of the Dept. of Health and Human Services - McAdams calls on federal government to order more personal protective equipment

Letter

Dear Secretary Azar,

As the coronavirus (COVID-19) pandemic intensifies throughout the United States, we have
become increasingly concerned by the effect that supply shortages are having on patients and
those charged with caring for them. To minimize these shortages, we request that you
expeditiously issue a guaranteed order for materials identified as necessary to combat COVID19.

We appreciate your efforts to increase the supply of N95 respirators by issuing a guaranteed
order to manufacturers in March. Not only will this order reduce supply shortages for the current
crisis, but it will help replenish the Strategic National Stockpile (SNS) and stimulate our
economy through domestic manufacturing. A study of the demand for N95s during a
hypothetical influenza pandemic estimated that, in the most optimistic scenario, 3.5 billion N95s
could be required for health care personnel and patients.1 We thus request that you increase your
order to meet this potential need.

We strongly urge you to issue similar guaranteed orders for other supplies critical to addressing
COVID-19 and commit to replenishing the SNS with any leftover supplies once the crisis ebbs.
Guaranteed orders from the Department of Health and Human Services (HHS) serve as an
important signal to private industry that a buyer exists. This in turn incentivizes manufacturers to
dramatically ramp up production, secure in the knowledge that they will be able to sell their
products even if there is a surplus. The orders placed must be enough to incite companies to
manufacture these supplies, meet the needs to address this unpredictable pandemic, and
contribute toward restocking the SNS. In addition to employing the Defense Production Act to
increase supplies, guaranteed purchase orders should be used to incentivize companies to
respond to demand.

The following materials are necessary to protect health care workers from infection, provide
appropriate care to patients, conduct adequate testing, and support facilities. Based on public reporting and requests from states and localities, we believe that HHS should issue production
orders for no fewer than the quantities below. Where estimates are not provided, we request that
HHS exercise its discretion to issue orders to best meet communities' needs. Additional demand
may also result as the pandemic develops.

Health Care Provider Safety

The United States currently has over 240,000 cases of COVID-19, double the number of cases of
just six days ago.2 Rates are skyrocketing and show no sign of slowing. At this critical juncture,
it is imperative that we equip our nation's health care personnel with the tools they need to
address this crisis. A recent report shows that 20% of healthcare professionals in Italy contracted
COVID-19.3 Hundreds of hospital workers in New York City alone have already been infected,
and health care workers in Georgia and New York have died. It is unacceptable that medical
personnel are being told to reuse protective equipment or are forced to improvise their own from
garbage bags or bandanas. On top of the grueling hours and overwhelming caseloads, health care
workers should not also be forced to risk their personal safety to treat patients. As such, we
believe guaranteed purchase orders for the following items should be issued:
● N95 respirators - 3,000,000,000
● Goggles - 100,000
● Face shields - 20,000,000
● Medical gowns- 20,000,000
● Aprons - 10,000,000
● PPE coveralls - 10,000,000
● Medical exam gloves - 500,000,000 pairs
● Surgical masks - 50,000,000

Patient Care

While most COVID-19 infections are not severe, a study of Seattle-area hospitals found that
75% of patients admitted for COVID-19 required mechanical ventilation.4 Hospitals are not
equipped to respond to this need, and some have made plans to use alternatives, including
positive airway pressure machines (CPAPs), which can dangerously aerosolize the virus, and bag
valve masks, which must be pumped manually. Tragically, some localities have had to develop
triage guidelines in the event of a shortage to determine which patients will receive a ventilator
and which will not. In addition to ventilators, sterilization and disinfecting equipment is vital to
reduce the spread of the virus. A new study indicates that N95 masks can be safely reused after being sterilized.5 As such, we believe guaranteed purchase orders for the following items should
be issued:
● Ventilators - 200,000
● Single-use ventilation tubes
● Sterilizing and disinfecting equipment and materials

Testing

Robust COVID-19 testing is imperative to track new cases of the disease, know where resources
must be directed, and understand the efficacy of preventive measures. Since January, only
roughly 182,000 tests have been completed; far too few in a nation of 327 million, where many
symptomatic individuals and exposed health care workers are ineligible to learn whether they
have been infected.6 Testing supplies must be procured to meet the urgent demand. As such, we
believe guaranteed purchase orders for the following items should be issued to address
immediate testing needs:
● Nasopharyngeal swabs
● Viral transport media
● RNA testing kits
● Reagents
Rapid testing that can be conducted at the point-of-care should be prioritized; people should not
have to wait up to a week to learn if they have been infected by the virus. As testing evolves,
HHS should prioritize purchasing more efficient testing methods that can process samples
quickly and accurately. These would also contribute to our future readiness through inclusion in
the SNS.
● Rapid testing devices

Other Items for Facilities

Patients are quickly outnumbering beds at hospitals, leaving cities to convert convention centers
and parks into care facilities. Additional resources are needed to equip those field hospitals, as
well as protect health care workers in all settings from infection. As such, we believe guaranteed
purchase orders for the following items should be issued:
● Beds - 100,000
● Body bags - 250,000

Thank you for your urgent consideration of this request.

Sincerely,