As Maine prepares for a surge of coronavirus cases, hospitals and first responders are scrounging for medical supplies and authorities have learned the state will likely receive little of what it sought from a largely exhausted federal emergency stockpile.

Federal Emergency Management Agency officials have revealed that allocations to states from the Strategic National Stockpile – a trove of emergency supplies held in secret locations around the country – have been based strictly on their populations, not on the sizes of their requests or the demographic characteristics of their populations. The stockpile’s supply of personal protective equipment is nearly exhausted, The Washington Post reported Wednesday.

Maine has already received most of the masks, respirators, gowns, gloves and other gear essential to protect medical workers from infection that it will get from the stockpile, state officials have learned. The state is being asked for more information about its request for more ventilators, which are needed to keep acutely affected patients alive.

State officials and medical providers are seeking alternate sources of supplies – including from Maine manufacturers pivoting to produce needed items – but it is uncertain if those efforts will be sufficient, because nobody knows how big the coming patient surge will be.

Those on the front lines of the effort to procure critical medical items say there was little Maine officials and institutions could have done differently to avoid a supply crunch created by a rapidly unfolding international crisis.

Representatives of three of Maine’s largest hospital groups and the state’s biggest emergency medical service resource agency said supplies of personal protective equipment have been difficult to obtain commercially in any quantity since early March. They all said the normal distribution channels for these materials began to seize up in early February as the pandemic – which had already cut production and exploded demand for masks and other gear in China – spread around the world.

“We were able to secure what I think was a decent supply, but we are nervous as everyone else is with the coming surge of patients,” said John Whitlock, chief financial officer of Lewiston-based Central Maine Healthcare, which operates seven clinics and three hospitals, including Central Maine Medical Center. “We’re looking at all types of alternatives, including local manufacturers.”

Authorities have already distributed the contents of the state’s own emergency stockpiles and have received what may be the state’s last allocation for some time from the federal stockpile, Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said in his public briefings this week. Maine and other states have looked to the federal stockpile for protective equipment and ventilators, but the FEMA-administered cache wasn’t stocked with a simultaneous worldwide event in mind and has been overwhelmed by requests.

Maine asked for 410,000 N95s masks and 400 ventilators, Shah has said, but has received only 85,000 masks, about 21 percent what it requested. Florida, by contrast, received more than it asked for, leading to confusion among state authorities about how the limited stockpile was divvied up.

There have been concerns that political criteria could be at play. At his news conference Friday, President Trump advised governors to be “appreciative to me” and said he had told Vice President Mike Pence – whom he put in charge of his coronavirus response – not to call the governors of Washington and Michigan because they had failed to do so.

The Washington Post reported Tuesday that an administration official had told them political affiliations were not a consideration, but that “Trump has occasionally made promises over the phone that FEMA has had to accommodate.” But a White House official told them that Florida Gov. Ron DeSantis’ loyalty has focused the president’s attention on that state.

While some states’ requests go unfulfilled, others have received materials they have not asked for. Oklahoma requested 16,000 face shields but received 120,000, the Post reported. Trump has dismissed governors’ complaints, saying the federal government isn’t “a shipping clerk” and that they should find stocks themselves.

FEMA’s explanation is that the allocations have nothing to do with what states ask for. Rather, each state’s share has been set strictly according to its share of the overall U.S. population in the 2010 census, according to FEMA spokesman Michael Hart. “These allocations are not based on requests, but rather a pro rata allocation,” he said in a written statement, and reported that every state already has or was about to receive 90 percent of its allotment.

Maine had 1.3 million people in 2010, or 0.4 percent of the U.S. population. The Trump administration’s formula does not take into account demographics, which could prove harmful to Maine: Coronavirus has proved particularly deadly for older people, and Maine has the oldest population in the country.

Maine CDC spokesman Robert Long said Maine has received no ventilators from the federal stockpile. “We have not been told we won’t get them,” he said. “We are being asked to provide further justification for the request.”

Maine has 348 ventilators, and as of Wednesday 271 were available. The state also has 128 of an alternative type of ventilators that the U.S. Food and Drug Administration is allowing states to use in the emergency, Shah said. It is not clear whether this number will be sufficient.

With the arrival of a shipment of personal protection equipment from the federal stockpile Monday, the Maine CDC has a supply that it is distributing to hospitals, first responders and “congregate settings” such as nursing homes. The agency is also purchasing supplies where they can be found, and made orders Feb. 11, Feb. 27 and Feb. 28 with Grainger, the industrial supplier, for more than 14,000 N95s, which he said are arriving in small shipments.

But even commercial supply chains remain constrained. Tim Plossay, associate vice president for supply operations at Northern Light Health, which operates 10 hospitals and an EMS service, said they’re currently receiving about 2 to 3 percent of the N95s they order. “Our reserve is getting us through some of this, and we’re trying to source from alternative manufacturers,” he said. “There are a lot of fraudulent scams out there, so we are closely vetting all of them.”

Some Maine companies are retooling to help make crucial supplies, with distilleries making hand sanitizer and L.L. Bean and other firms making surgical masks.

Rick Petrie, executive director of Atlantic Partners EMS, a service agency for the emergency medical services in 10 of Maine’s 16 counties, said many EMS services lacked the money to stock up large supplies ahead of time.

“The overwhelming number of EMS services work hand to mouth every week – their budgets are very tight – so they have always looked to the state and national stockpiles to be there if they ever needed it in a crisis,” he said. “The reality is that a fair amount of our stuff comes out of China, and that’s where this whole thing hit right off the bat. By February you started seeing gowns and N95s (masks) not be available.”

“I have had services contact me and say, ‘We’re down to our last 4 or 5 gowns,’ so they are going to auto supply stores to buy Tyvek suits or going to local lumber yards and businesses to see if they have any kind of N95 masks out there,” he said.

MaineHealth, which operates Maine Medical Center and eight other hospitals, increased its inventory of personal protection equipment before the flow from their distributors choked off, spokesman John Porter said.

“At a high level, I think people are feeling good about where we are and the work we are doing both to conserve and to ensure additional supply,” he said. “That’s not to say there isn’t more work to do and we do need more help, because we don’t know what the demand surge is going to be.”

Maine’s dental industry is essentially shut down, in part to divert the masks and gowns it normally uses in quantity to front-line medical workers. Jonathan Shenkin of Augusta Pediatric Dentistry, a former vice president of the American Dental Association who advises the national group on coronavirus policy, said the global supply chain is expected to ramp up production in the next few months.

“This is an international crisis, so there needs to be a government intervention,” Shenkin said. “It’s kind of frightening to think how the health care system is about to be stretched.”

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