There are still many lessons to be learned from the COVID-19 pandemic, including how to manage stockpiles of items such as N95 masks and needles and syringes. Rear Admiral John Polowczyk, vice director of logistics for the Joint Chiefs of Staff, said in a Senate hearing that the one solution to this dilemma might be to use federal taxpayer dollars to sustain inventories in private-sector warehouses with the proviso that those inventories are appropriately rotated so as to ensure that product spoilage is averted.
The June 9 hearing of the Senate Homeland Security and Governmental Affairs Committee was explicitly directed toward procurement and distribution of supplies for the pandemic, and committee chairman Ron Johnson (R-Wis.), thanked the witnesses for their efforts in “trying to deal with an overwhelming situation.” Johnson noted that demand for some personal protective equipment (PPE) items had increased by a factor of greater than three as the SARS-CoV-2 sickened millions, a level of demand he said cannot be readily met in normal manufacturing scenarios.
Polowczyk said a drastic expansion of global manufacturing capacity will be needed to manage future pandemics, but he also advised that U.S. reliance on sub-par products imported from overseas invites a number of preventable problems. Polowczyk did not specifically reference action taken by the FDA in connection with faulty imports, but the agency recently announced that it had ejected several manufacturers in China from the list of respirator masks due to poor quality. The FDA has undertaken a similar action to de-list some serological tests from the EUA program as well.
Objective is 300 million N95s for stockpile
The volume of N95 masks in the National Strategic Stockpile prior to the pandemic was about 18 million, Polowczyk said, while the objective now is to ensure that 300 million are available at any given moment. He recommended that the increase in stockpiles for respirator masks and other items be matched by increases in domestic production, but he noted that even needles and syringes have limited shelf lives. The Department of Health and Human Services has the authority to set up a system of repositories and fund the maintenance of inventories, Polowczyk said, but whether HHS has the funds is another matter.
There was something of a partisan divide on the Trump administration’s response to the pandemic, with chairman Johnson saying, “it’s awful easy to sit up here at the dais and be a Monday morning quarterback.” While the federal government’s performance was not perfect, Johnson said it was nonetheless extraordinary. Ranking member Gary Peters (D-Mich.), said few, if any, have challenged the charge that the executive branch had failed to adequately prepare for the pandemic. “As families across the country grieve, we must examine how we reached this heartbreaking point,” Peters said, citing the disproportionate impact COVID-19 has had on minority communities.
Also among the witnesses to testify was Brett Giroir, assistant secretary for health at the Department of Health and Human Services, who said the U.S. is on pace to provide as many as 50 million tests per month by the end of September. Giroir said HHS has worked to overcome issues of access to health care services and to testing for minority communities. In the decision to set up federally sponsored pharmacy testing sites, “we made sure the majority … are located in sites of high social vulnerability,” which is driven by both race and income.
Giroir said community health centers were already providing services to roughly 30 million Americans prior to the pandemic, and 92% of those centers are offering COVID testing. The HHS Office of Minority Health has a funding mechanism to address minority access, and Giroir said, “health disparities have plagued this country for decades,” adding that the pandemic has created “a magnification of the disparities we see” in more typical times.
Polowczyk said the Veteran’s Health Administration is prioritizing nursing homes for distribution of PPE, stating that there are more than 15,000 nursing homes in the U.S. The governors of each of the 50 states receive information routinely from the federal government regarding supplies that are delivered to nursing homes, and Polowczyk said fewer than one in 50 nursing homes have indicated they have less than a week’s supply of PPE on hand.
In response to a question about raw materials used in production of vials and syringes, Polowczyk said Veteran’s Health and Operation Warp Speed, the HHS effort to accelerate development of therapies and vaccines, have separate tracks for ensuring availability of supplies for administration of drugs. He said there is a secondary plan that would make use of a novel technology to produce a prefilled blister-pack product that can be opened and administered in the manner of a needle and syringe in one step. Defense Production Act monies have been allocated to this effort, and Polowczyk said there is also a federal government effort to beef up product of melt-blown medical gowns and other products that can be thus manufactured.
Despite allegations heard during the hearing that the Trump administration has deliberately favored states with Republican governors with supplies of PPE and tests, Polowczyk said he has never been instructed by anyone with the administration as to where to allocate supplies. Gaynor also denied any political interference when it comes to awarding contracts for supplies, as did Giroir. Giroir also remarked that high-capacity diagnostic systems are on every governor’s wish list, but that five units per month, if that many, might be the limit for production of many of these systems.
Giroir says SARS-CoV-2 ‘the best of the worst cases’
Giroir said recent data suggest that the global average infection fatality rate (IFR) is between 0.1% and 0.2%, although previous estimates provided a wider range, often 0.1% to 0.5%. The IFR still seems to vary considerably from one nation to another, but Giroir said he expects the IFR in the U.S. will ultimately land in the same range as these recent estimates of global IFR. Still, he said the world may have been handed “the best of the worst cases,” because the virus could have been substantially more lethal, and thus, “we need to prepare for a lot worse” in terms of mortality.
Johnson pressed the witnesses to be more communicative with his committee, noting that the Senate Health, Education, Labor and Pensions Committee seems to be the focus of near-exclusive interest where communications with the administration are concerned. Preparations for pandemics should be part of the routine agenda for the Senate Homeland Security Committee, he said, a sentiment seconded by Giroir and Polowczyk.