PPE Shortages 101: A (Very) Brief Overview

Ever since the crisis was declared a pandemic in March 2020, American news has been riddled with stories on PPE shortages. In addition to traditional news stories, healthcare workers turned to social media to share their subpar work conditions. For example, pediatrician Dr. Vidya Ramanathan spoke about reusing masks and face shields and running short of disinfectants. In an NPR article, an ER physician in New York City suggested that being in the hospital is “ like walking into Chernobyl without any gear.” Nurses demonstrated their frustration with the lack of access to PPE through marches across the nation. That these struggles were widespread is evident in the results of a survey of approximately 23,000 nurses conducted by National Nurses United (NNU), which found that 87% of test subjects reused single-use masks and respirators.

In an examination of the causes for PPE shortages, Jennifer Cohen and Yana van der Meulen Rodgers argue that the lack of PPE is not simply a workers’ rights issue but “a system-wide public health problem.” Healthcare workers without ad- equate protection are more likely to contract Covid-19, thus leading to “a decline in the supply of healthcare due to worker illness” while also adding to viral transmission, thus “increas[ing] the demand for care while simultaneously reducing health system capacity.”

The unsatisfactory circumstances resulted in movements like Project N95 and Get Us PPE. The latter establishment is “the largest national organization getting personal protective equipment (PPE such as masks, gloves, and isolation gowns) to frontline workers who need it most.” Additionally, Get Us PPE also provides updates regarding the status of PPE shortages nationwide. Their recent statement, titled “The PPE Shortage Crisis and Rationing,” outlined the dramatic increase of 260% in the company’s requests for PPE between November and December 2020. Nitrile gloves, disinfecting wipes, and hand sanitizer consist of the most requested commodities, with surgical masks and N95 respirators remaining in high demand." The piece continues, “The rationing and reuse of PPE are profound and continue to be utilized among many facilities, placing their frontline workers at risk.”

Cohen and van der Meulen Rodgers identified four major causes of the shortage: “a dysfunctional budgeting model in hospital operating systems [that] incentivizes hospitals to minimize costs rather than maintain adequate inventories of PPE;” “a major demand shock triggered by healthcare system needs as well as panicked marketplace behavior [that] depleted PPE inventories;” the failure of the U.S. federal government in “maintain[ing] and distribut[ing] domestic inventories;” and the “major disruptions to the PPE global supply chain [that] caused a sharp reduction in PPE exported to the U.S.”

The federal government was already unprepared for a large public health crisis before the pandemic’s start. George Burel, the former Director of the Strategic National Stockpile (SNS), stated that the program was not prepared for a crisis of this magnitude. Additionally, the former Trump Administration had only sparingly used the Defense Production Act to help increase PPE production, leaving states to compete with one another for equipment. Without federal intervention, the United States was not capable of handling supply shortages, in part because of the budgeting model and sudden increase in demand, but also because the U.S. is the largest importer of face masks.