On March 24, Texas governor Greg Abbott spoke behind a podium at a warehouse in Austin to reassure the public, first responders, and medical personnel that he was taking action to protect their health amid the COVID-19 pandemic. Behind Abbott were several pallets of boxed medical masks. They were a made-for-TV image meant to reinforce the governor’s announcement that his “strike force” on procurement had allocated $83 million primarily for PPE, or personal protective equipment, and 100,000 masks would arrive each day in addition to those secured from the quickly shrinking Strategic National Stockpile. The first shipment, the governor said, would arrive by the end of the week.
“The state of Texas is rapidly accelerating the purchasing and delivery of essential personal protection equipment and other supplies to aid in our COVID-19 response,” Abbott said.
An hour and a half earlier, at a clandestine location six miles away near the Texas State Cemetery, a lobbyist for family physicians was meeting the driver of a truckload of N95 masks that had been brought across the border from Mexico. The masks were more appropriate for industrial use than medical and weren’t of operating room quality. But for many physicians—solo-practice doctors, group physicians, and doctors serving in small hospitals—the masks were a godsend. As the doctors most likely to first diagnose COVID-19 patients, they were in acute need of PPE. Even when masks do come to the state, the state’s guidelines for distribution of them indicate that hospitals are the first priority, EMS workers the second, and only then are first responders and community doctors in line.
Moreover, family care physicians don’t trust that the governor’s strike force is finding PPE in any substantial quantities for them. Despite Abbott’s announcement, physicians say state officials told them a different story about procurement in a conference call two days later: the strike force is failing to acquire masks in the quantity that Texas will require. At a news conference Friday, Abbott said in the past week Texas has distributed statewide 1.4 million face masks, 190,000 face shields, more than two million gloves and 160,000 gowns. Texas Division of Emergency Management Chief Nim Kidd said that was part of a supply of 3.8 million masks received from the Federal Emergency Management Agency. But the need for masks is still great: family care physicians report that they are still facing shortages and are waiting on a second shipment from Mexico.
In lieu of support from the state, an ad hoc procurement system has emerged. Doctors are helping doctors get the PPE they need. A ringleader of the effort to get masks from Mexico, Tom Banning, CEO of the Texas Academy of Family Physicians, is particularly distrustful of the strike force. “It sounds like you’ve got an $83 million gun with no bullets in it,” he said.
The national scarcity of PPE has been apparent for weeks. The Washington Post reported Wednesday that the national stockpile is almost depleted, and governors across the country are having trouble securing masks. It’s not clear how many masks will be required in Texas, but the need on the ground right now is apparent at hospitals and family practices.
During a pandemic, both patients and caregivers are supposed to wear masks to reduce the risk of the virus spreading, and doctors cannot reuse them for different patients. But with such a severe shortage of masks, that protocol is almost impossible to follow.
For example, at Village Medical, a group primary care practice in Houston of more than a hundred physicians, PPE is a scarce commodity. In normal times, Village Medical keeps PPE on hand for doctors to use when dealing with infectious diseases, most often for lancing boils. But the facility is under tremendous stress because of COVID-19. Two of the first six cases of the coronavirus in the Houston area were diagnosed by Village Medical doctors, and four of the practice’s physicians have had to self-isolate for two weeks after being inadequately protected when exposed to infected patients. Another doctor has tested positive for the coronavirus, chief medical officer Clive Fields told me. With the constant threat of COVID-19, the facility needs about eight hundred masks every day for its four hundred patients, and that’s not even counting what nurses and support staff require. But buying new PPE has proved almost impossible because of lack of availability and price.
Abbott’s strike force, with Dell Technologies global procurement director Keith Miears at the helm, was supposed to help address this difficulty. But two days after the governor’s announcement, a March 26 phone call between doctors and the state EMS director and head of the Health and Emergency Preparedness Response team dashed community physicians’ hopes of receiving substantial help from the state.
Seth Christensen, chief of communications for the state’s emergency management office, told me the call was intended to inform the doctors about how to apply for equipment through their local emergency management office. He said the state also was making doctors understand there would not be enough for everyone and they should be seeking assistance elsewhere. “The main point from an emergency measure perspective is we have everybody put their fishing lines out there and see how many bites we can get on every single one of them,” he said, “so that we’re not ‘let’s just rely on the state of Texas to pull stuff in.’”
Banning said the state officials on the call were far more blunt about what Abbott’s strike force had been able to achieve. Banning said they told the doctors that “the reality is, is that the supplies aren’t there. Every email that we have taken, every offer that has been made to us, we’ve gone out and looked. And it’s been a snipe hunt. There’s been no supplies there.”
“The gist of it was that basically the masks aren’t coming. The state of Texas can’t get them. And basically it’s, you know, fend for yourselves,” said Austin surgeon Mark Glover. “We were told that we need to find solutions locally.”
This was all a mistake of understanding, said Chris Van Deusen, a spokesman for the Department of State Health Services. He said the agency personnel on the call were merely trying to emphasize that the first order had not yet arrived; it was coming the next day. Van Deusen said the agency representative “went on to say that the strike force is a world operation. They’re working on it. They’re making orders and they’re expecting things to be delivered. So it was it was kind of like he was making a current assessment.”
John Wittman, a spokesman for Abbott, did not respond to Texas Monthly‘s questions about the procurement of masks.
I asked Van Deusen and Christensen just how many PPEs the strike force had been able to buy for Texas. “I don’t have the number in front of me,” Christensen said. “I do know that there was PPE that was delivered on Friday, and I know that there is PPE being delivered today, tomorrow, and for the rest of the week. A day here, a day there when we’re placing such large orders from around the world, you know, it is what it is.”
With no clear supply line for PPE from the government, Texas doctors have improvised. Some have relied on donations of industrial-grade N95 masks and bunny suits typically used by spray painters. Village Medical benefited from a patient who drove two hours to his country home to retrieve two cartons of masks from a shed. Then there was Tom Banning and his masks from Mexico.
Banning received a phone call on Monday, March 23, from one of his golfing partners who told him that his brother did some work in the Lower Rio Grande Valley and had gotten a line on an oil field equipment company in Mexico that had switched its operations over to making masks and hand sanitizer. “Do you have any thoughts on folks that might need that?” the golfer asked. Banning responded, “I think, yeah, there’s like the whole state.”
Exactly where the masks originated in Mexico or how they got across the border in Brownsville Banning declined to say, though he hinted at some skullduggery. His friend had arranged to sell them at a cost of about $1.25 per mask. When the truck arrived, he said, it contained 525,000 masks.
As soon as he saw the masks were legitimate, Banning started texting executives from other medical associations. John Henderson of the Texas Organization of Rural and Community Hospitals, who said his hospitals are at the end of the line for distribution, rushed over. Jeff Barnhart, the CEO of the Hereford Regional Medical Center in the Panhandle and a private pilot, decided that securing seven thousand masks for his 42-bed hospital was worth a two-and-a-half-hour flight. A Dallas physicians group sent a driver to Austin to pick up masks, and he also took a load down to the United Physicians of San Antonio before returning home. The doctor-to-doctor network was in full swing.
But just as state health services and emergency management officials were trying to reassure doctors that medical equipment for personal protection and sanitation will be available, another state agency—the Texas Department of Public Safety—was begging doctors for help protecting state troopers. At 4:30 p.m. Tuesday, Banning’s association of family practitioners received an email from the DPS asking for PPEs and sanitation supplies. “We are trying to secure supplies and equipment necessary to keep our Texas Highway Patrol Troopers around the State of Texas safe and functioning,” the DPS email said. “Let us know if you have any of the following items listed below. Texas DPS will purchase the items from you.”
Maybe the state troopers would also like some masks and hand sanitizer from Mexico.
Note: This story has been updated with the latest numbers from the state on personal protective equipment procurement.