As the coronavirus outbreak spreads across the country, leading to fears of overrun hospitals and shortages of key items in ERs, many have begun to look for help from something they didn't previously know existed: the Strategic National Stockpile.
The Strategic National Stockpile was established in 1999 as a key piece of America's disaster-response infrastructure. It's a series of warehouses in undisclosed locations across the country, containing huge stores of medicines, vaccines, and equipment in preparation for a national disaster, like a hurricane or an epidemic.
In 2016, VICE News Tonight was the first television news crew allowed inside one of these facilities, although we couldn't reveal where it was or what exactly it had inside. It looked like a prepper’s Ikea, with row after row of containers filled with mystery medications and equipment — including that one item everyone’s been talking about lately, ventilators.
If worst-case projections for the coronavirus are true, as many as 1 million people could require ventilation, according to one expert, far outstripping the roughly 100,000 to 200,000 ventilators believed to be currently available in the country. Another recent model suggested that by early May, some hospitals could have up to 75 people on ventilators every day.
But if you’re looking for the SNS to save us from our current coronavirus crisis, former director Greg Burel has a message: Don’t hold your breath.
Burel, who ran the stockpile program for more than a decade until his retirement in January, says the stockpile was never really meant to play that role.
"The role of the SNS right now is to try to help bridge the gaps that currently exist between what the supply chain should be doing and what it's not able to do," Burel told VICE News. "We receive limited appropriations from Congress, and we've tried to make it clear to public health officials, locally and at the state level, that we can't buy everything, we can't afford everything, and the SNS is really not going to be the right place to be the answer to everything we need."
Burel wouldn't say how many ventilators the stockpile currently holds — that, like just about every precise detail about the stockpile itself, is classified. But Richard Branson, a respiratory care specialist at the University of Cincinnati who has consulted with the SNS on its ventilator supply, estimated that it may have reached 20,000 by the end of Obama's first term. Other officials say the number today could be even higher.
"Everyone wants to know why didn't we have 100,000 ventilators in the SNS. It's a matter of cost: It's very expensive to buy them, and then to test and maintain them over the years — especially if you never use it."
"Everyone wants to know why didn't we have 100,000 ventilators in the SNS," Branson said. "It's a matter of cost: It's very expensive to buy them, and then to test and maintain them over the years — especially if you never use it."
Other products needed for the response to the coronavirus have seen their supply levels go down over the years, including respirators like the N95 masks that doctors and nurses wear while treating patients.
According to the Washington Post, more than 85 million of those masks were distributed back in 2009, during the H1N1 outbreak -- and never replenished. Instead, in the years that followed, the stockpile focused on using its limited budgets to buy up pharmaceuticals, including vaccines and flu medications. Today, according to HHS officials, the stockpile has about 12 million N95 masks on hand.
"They're horrible decisions," Burel says of the choices he and other top officials had to make in the aftermath of H1N1. "We had to trade off those funds that we had, and we chose to invest in those lifesaving drugs that would not be available from any other source, in the quantity needed, and in time. I definitely want to see my healthcare workers protected; that's very important. But if I'm thinking, 'Do I buy this many masks to protect this many workers, or do I buy this many medicines to keep people safe that we can't get elsewhere?' there's no easy answer here."
As the nation attempts to ramp up its medical equipment to meet the growing need posed by the pandemic, several public health experts say the bigger issue being exposed is a medical supply chain that's grown far too thin -- and a failure of public health officials to tackle systemic problems in how key products are manufactured and distributed.
"We cannot solve the problem we have now with the stockpile," said Tara O'Toole, a former Homeland Security official under Obama and now executive vice president at the intelligence firm In-Q-Tel, who led a National Academy of Sciences review of the stockpile in 2016. "The real problem is the medical supply itself, of which the stockpile is one small piece of the chain."
That chain has become increasingly efficient, O'Toole and others say, to the point where manufacturers produce barely enough of any given product to meet demand, and suppliers purchase only what they know they will need to sell, meaning there simply aren't backlogs of supply to tap into in an emergency.
"It was very clear to the committee that a lot of people were under the misapprehension that the feds were going to come in and rescue them," O'Toole said. "But what the executives we met with told us is, if you have an emergency or crisis in one region, we could redirect all our supplies to address needs of that one place. But if you have a problem that covers the entire world, like we have now with the coronavirus, we won't be able to get you what you need."
Burel says that's a problem he's been trying to point out for years, to both government procurement officials and the hospitals that would inevitably call him in an emergency.
"You have to invest in some kind of cushion," he said. "This is something we're going to have to struggle with for a while, and to point to stockpile and say, 'Well, they didn't buy enough masks,' I think that's really disingenuous."
It's always possible the U.S. won't end up needing that extreme level of ventilators -- or, if it does, that it won't happen all at once. Branson, the respiratory specialist, says this is why the priority should still be on hygiene and social distancing -- actions that could reduce how many people need the health system simultaneously.
"If you have a 50 percent increase in need in, say, San Francisco, Seattle, and Denver, while no change in Miami, Orlando, and Atlanta -- then as it comes across as a wave, you might actually be able to meet that need," he said. "But if it really is catastrophic, we're going to be short by quite a few ventilators."
But, he added, in a true worst-case scenario, the needs for treating patients suffering from acute stages of the virus will go far beyond ventilators -- and if you can't get enough of all of the necessities, including IV fluids and healthy caregivers, it may not matter anyway.
"If somehow ventilators came from heaven like manna, that's not going to fix the problem," he said.
For Burel, it’s been a surreal experience to have spent a decade preparing for something like this -- and to now be missing it.
"I'm not going to say I'm sorry not to be in the midst of this, but I feel really guilty," he said. “If I had any indication that this was about to happen, I would have stayed in the job."
Cover: Inside one of six Strategic National Stockpile warehouses which hold thousands of masks, ventilators, and vaccines in temperature-controlled vaults. (Image: VICE News Tonight/VICE News)