States are Being Forced Into a Bidding War for Ventilators
A daily Covid-19 update from Andy Slavitt, former head of the Centers for Medicare and Medicaid Services
Pulled from my daily COVID-19 updates on Twitter
Today I talked to two governors about their plans. I also spoke with the national security team about what they’re seeing around corners. I learned some concerning stuff about Trump on Medicaid, and more information about testing.
Two governors and a Senator both called with a similar set of questions: How do we find ventilators? My questions back: When is your peak? What’s your most likely shortage? What price are you paying?
They answered, they don’t know when their peak is. It depends on how compliant people are with staying home. If people are compliant at least through April, they have a shot at NOT needing more ventilators. If not, they will be short in thousands and thousands.
If the peak demand is in May, they’re in better shape, I tell them. Yet in each case, they want to buy some “just in case.” Buying some just in case is a big problem, I say. But they don’t know how many they will need and want to prepare for the worst.
So we discuss their scenarios. I tell them they should aim for 10%-20% above their likely need before May, but to forward purchase from new manufacturers after May at a much lower price. I put one on the phone with the CEO of a manufacturer.
One of the governors tells me about price. FEMA is buying all the vents in the market. “We can’t buy any”, one tells me. The other has found a manufacturer in state who has produced 10 to see if they work. Trump was on TV complaining that it was the states’ fault, yet it’s FEMA who is making the ventilators hard to find.
So I contact someone at FEMA. They tell me that states and cities are over stating their needs and they require a bottoms up analysis. OK, but how do you assess? I worry some of it may be political so I ask who makes the final call. There are two choices: A career civil servant or a political appointee. I think I know.
One of the governors is trying to buy them at $45,000 per ventilator. The typical cost is $15,000 per ventilator. The other can’t even find them at that price (hence the manufacturing). They are all bidding against each other. State vs. state.
FEMA and the states trying to do the right thing on the surface but hurting each other. Some corporations like @Medtronic have published their design so others can make them.
I tell each governor to have their Attorney General’s send letters asking to see an increase in their costs and profit margins. But I’m afraid nothing is going on except “capitalism.” Prices will come down in May/June when production is up and the Defense Production Act kicks in. In the meantime, life has a price-tag.
As I tweeted the other night, there are plans to bring in more from more sources, to fill the gaps. But black markets happen when shortages and lack of information meets lack of policing. Another thing I didn’t know. While Trump refused to declare COVID-19 a problem, US manufacturers sold tons of ventilators and Personal Protective Equipment to China.
We are trying to do things in April we could have more easily done in February. That’s the difference between planning & improvising.
Now, on my podcast, In the Bubble, we kicked up some dust about questions 3M should answer regarding masks that could be protecting people instead of making people millions of dollars and sitting in warehouses. More below:
So they issued a press release.
Some are not happy and want answers. Public pressure seems like a good idea. It’s either that or watch the 2018 Browns-Lions 10–0 romp again on TV. If it were me I would want to save every single nurse and doctor. I’m mixing apples & oranges here, but c’mon. No press releases except ones that announce ‘we’re doubling delivery to hospitals & nursing homes.’
I’m going to make a subtle transition to my national security conversation. National security professionals are different than most people I talk to. They talk about casualty levels, shock events, rebound impacts, scenarios, and social unrest.
I found it only modestly useful. I’m not sure the quality of the sources of information and speculation. On the other hand, these are serious people. So I listen. What I learned:
- Some believe Trump planned to sandbag the death toll estimate but couldn’t help himself and went to the low end of the range he was presented with.
- Models are entirely dependent on effectiveness of the population staying home.
- Governors told me today that no way people can stay home past April 30.
- They expect a possible summer spike as people let up and go back to work, but also expect transmission to be down.
- Many more people worry about a bad bounce up in the Fall months.
(Tomorrow I will share an update about the work of two states regarding what they plan to try to do in May and Fall.)
Apparently people monitor the potential that we will rebel against the government and protest in the streets. Here I made what I believe to be a wise contribution: Maybe they will if people don’t have any food or medical care? (I’m no professional clearly.)
Some people complained that my updates over the last few days were about solutions instead of facts. An agenda. (See this post.) The Administration keeps trying to cut SNAP and Medicaid in the middle of a crisis. I’d call that a risk.
On to Covid-19 testing: Jeff Huber offered to be my go-to on scientific things I don’t understand — which is a lot. He explained to me that the tests have a high false negative. He sent me papers I couldn’t understand. Science people do that. Show proof.
73% accuracy. So 1 out of 4 times, test will tell you you’re ok, when you’re not. I called a few other people and heard similar findings. If I could understand the papers he sent, I probably would have understood how these applications (swabs) are tricky.
One state did tell me they are getting way more accuracy. And the commercial labs have over a week’s backlog for test results. Wait until we have more tests. Did I mention we weren’t prepared?
What about the famed 15 minute Abbott test? I have no confirmation of this, but one state had their labs do some trial with it & found it like 50–60% accurate. The Abbott people can feel free to please rebut. I did not call them.
Fall tests promise greater accuracy when this returns.
We briefed Congress. United States of Care is bringing one of the architects of the path forward, a great doctor serving under-served communities, and a public health leader — all on our Founders’ Council. Everything they do is transparent. So here’s the notes:
Stay healthy. We will get through this.
