How ad hoc supply workarounds became US pandemic response

Christopher Sakezles didn’t expect to enter the business of making face-mask respirators in a pandemic. But here he is.  

Last week he decided to tap his Tampa, Florida-based company’s expertise in 3D printing to make protective gear for front-line workers. The first small shipment is now just days away.

“I’m a medical device engineer by vocation. The plan was always to move back into medical device design,” alongside the business of synthetic cadavers for education, Dr. Sakezles says. But not this product. Not this moment in time.

“We’re witnessing firsthand the beauty of the American system right here. We’re all members of the same family. I’m one small part of that,” he says. 

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In fact, the unexpected shift for SynDaver is one piece in a vast mosaic of adaptation by companies across America, and worldwide. While focused on medical and personal protective equipment, which are in desperately short supply nearly everywhere, a kind of “wartime economy” is emerging in the fight against the COVID-19 virus. It’s a “MacGyver” moment for everyone from shop-floor technicians to university students. 

But, as in a time of military conflict, the logistical demands are vast – raising questions about whether the federal government should be playing a stronger role guiding production and distribution of key supplies.

With desperate pleas rising from state governors, the U.S. is entering what may become a period of maximum stress on overloaded health care systems in hard-hit areas like New York, Florida, and Louisiana. Many experts say that, despite efforts by past administrations to prepare for a pandemic, President Donald Trump has failed on many of the basic tasks in an existing playbook that includes coordinating emergency supplies.

“There’s a lot of ingenuity. … Everyone wants to help out, and also wants to keep their business going,” says David Kendall, a health policy expert at the center-left think tank Third Way. But “the federal government needs to be helping organize that supply chain and making sure that everything is getting distributed efficiently and fairly.”

In New York City, 3,200 deaths have already been attributed to COVID-19. In Maryland, Republican Gov. Larry Hogan is decrying a shortage of COVID-19 tests. And many governors are lamenting their need to bid against one another for supplies they have for weeks been urging the federal government to deliver to them. 

“They call this the Airbridge” to obtain vital supplies, but the Trump administration is using private companies as distributors, J.B. Pritzker, the Democratic governor of Illinois, told “PBS NewsHour” Monday. “We’re bidding, unfortunately, for all of these items of equipment against the federal government and against the other states and against other countries.” 

Some corporations such as Medtronic, a global maker of ventilators used in hospitals, have similarly said they would like federal guidance on where to send their limited supplies in the U.S.

Experts on both ends of the political spectrum argue that a pandemic is a rare and pressing national crisis that calls for a strong federal role, not just state or private marketplace response.

“The president didn’t want to own this. So he didn’t want to be in charge. His instinct at the beginning was this is a state problem,” says Katrina Mulligan, managing director for national and international security at the left-leaning Center for American Progress in Washington.

Mixed signals, frayed trust

President Trump early on downplayed the likely severity of COVID-19’s threat to America. Since February he and his administration have sent mixed signals to corporations as well as the public – often blaming states for failing to have built their own stockpiles of essential items.

Tapping his son-in-law, Jared Kushner, to oversee key actions has also frayed public trust in whether a national stockpile of medical equipment is being deployed based on states’ needs or perhaps partly based on political concerns. 

“The federal government should have initiated Defense Production Act (DPA) industrial measures when the virus first surfaced in Wuhan to hedge against the possibility of the medical emergency we now face,” says Mackenzie Eaglen, a security expert at the conservative American Enterprise Institute, by email. Federal responsibilities include assessing supply needs, she adds, and having “purchase agreements put in place for surge production to execute when needed.” 

The DPA, dating from the Korean War in the 1950s, allows the federal government to steer American industry for reasons of national security, such as by requiring companies to prioritize government contracts over those with other customers. 

Mr. Trump has used the act before, including for disaster relief as well as materials for Pentagon weaponry. But in response to the coronavirus, whether because of business lobbying or his own views, he was initially reluctant to deploy that tool. In recent days, he has invoked the act to demand that General Motors produce ventilators for patients in intensive care, and that manufacturer 3M make more N95 masks for hospital workers. 

Coupled with an upwelling of action by the private sector responding to the apparent needs, this means a surge in production is beginning. The “wartime” analogy is being almost universally invoked, yet supplies are ramping up too late to meet some of the needs in hard-hit states, notably in the Northeast. 

Necessity is the mother of invention

Still, the response of private sector companies has been remarkable and widespread. GM was starting to make ventilators even before the DPA was invoked. Other firms are also entering that market. And a contest called the CoVent-19 Challenge, organized with support from Massachusetts General Hospital physicians, aims to stimulate invention of a rapid-fire way of making existing ventilators serve two patients rather than one.  

Similar actions are happening in the quest for everything from hospital gowns to vaccines. And of course, for respirators or face masks and shields.

“Companies like mine can move quickly to help. … We’re absolutely rising to meet the need,” says Dr. Sakezles.

In some ways, says Chris Edwards of the libertarian Cato Institute, what’s needed from the government now is clear communication and getting out of industry’s way. 

“It’s widely agreed now that the FDA really screwed up by trying to keep a monopoly on coronavirus testing,” Mr. Edwards argues. Now, with the Food and Drug Administration having relaxed its rules, there’s the promise of easing that important shortage as companies respond to the demand, he says.

Wartime pivots

In U.S. history, wartime economies have involved similar dramatic pivots by industry. Still, manufacturers can’t turn on a dime. 

In World War II, it took Ford Motor Co. a year and a half from initial contract to actual production of B-24 bombers. But President Franklin Roosevelt, with an eye on the war in Europe and Asia, had called for a military production drive in May 1940, long before Pearl Harbor. 

“Eight weeks ago, 10 weeks ago,” security expert Ms. Mulligan says, a survey of states could have revealed “exactly what our shortfalls were likely to be and where. And we could have used the Defense Production Act to place a giant government order.” 

Now, instead, the production surge is building in a less orderly fashion. But it is happening. And for many companies, it’s offering a sense of purpose and potential revenue at a time when “stay home” orders have slashed their ordinary business. 

ABC Imaging in Alexandria, Virginia, is a nationwide printing company with a new product line: face shields, alongside books and store displays. 

Public service was the inspiration. As Medi Falsafi, the company’s president tells it, his wife, Luda, suggested they make some face shields and donate them to the local hospital where their son was born 17 years ago.

The orders started rolling in. Now he has an entire COVID-19 line: banners and adhesive “stand here” decals for grocery stores, plexiglass shields for checkout lines, and temporary walls for makeshift hospitals.

The company’s survival still hangs by a thread. After having to lay off 250 employees, the remaining staff of 200 are working at reduced salaries. But “it’s been a rewarding thing” to pivot toward the national emergency, says Mr. Falsafi. “Helping people is wonderful.”

Staff writer Francine Kiefer contributed to this story from Pasadena, California.