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State and federal supplies of masks, gloves, & gowns arrive in KY

Ralph McCracken, preparedness coordinator for the Lexington-Fayette County Public Health Department, couldn’t sleep on Tuesday night.

He chalked it up to stress. The following morning, his department was slated to receive the largest delivery of personal protective equipment to date since the outbreak of novel coronavirus earlier this month in Kentucky, and it would be his job to coordinate distribution to health care and other service providers in Fayette and at least six surrounding counties.

So, he woke up and made a spreadsheet to streamline organization of millions of coveted N95 masks, faceshields, surgical masks, gloves, and gowns to health care providers, including the state’s largest hospital system, UK HealthCare.

As the COVID-19 pandemic spreads across the country, health-care providers are contending with the reality of thinning supplies of personal protective equipment, or PPE. And state and federal officials who hold the keys to stockpiles of these items, flooded with requests, are rationing what they can provide.

“It’s the big delivery because it’s our first one,” McCracken said the following morning in a Lexington warehouse where these and other supplies are stored. For this reason, its location is kept secret from the public.

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Ralph McCracken, Lexington-Fayette County Health Department preparedness coordinator, uses a forklift to unload supplies Wednesday, March 18, 2020. Fayette County received 27 pallets of personal protective equipment from the Strategic National Stockpile and state cache Wednesday. Ryan C. Hermens [email protected]

Lexington’s portion of the delivery — stacked boxes spread across nearly 30 pallets, some teetering as high as the ceiling — includes 875,100 banded and surgical tie masks; 186,200 N95 respirators; 5,028 faceshields; 1,460 gowns; and 53,500 sets of gloves.

The formula of who gets what is based on population, a spokesman for Fayette County’s public health department said. Lexington is the second largest city in Kentucky, accounting for about 7.5 percent of the statewide population.

Kentucky’s outbreak of the viral respiratory disease has so far infected at least 35 people and contributed to the death of a 66-year-old Bourbon County man earlier this week. Day-to-day state government operations have slowed with restrictions on in-person business, Gov. Andy Beshear has ordered bars and restaurants to temporarily close their doors to customers, churches to cancel services, child care centers to stop caring for little ones, senior centers and prisons to disallow visitors, K-12 schools to offer only online coursework for at least two weeks, and for employers everywhere to allow employees to work from home.

The unprecedented steps, each individually historic, are intended to “flatten the curve” of community spread, Beshear has repeated. At a time when capacity for COVID-19 testing in Kentucky is limited, and knowing that roughly 80 percent of people who contract the virus will show mild to moderate symptoms, or potentially none at all, maintaining extreme social distancing not only greatly diminishes community transmission, it lowers the risk that health care systems will be inundated with COVID-19-positive patients.

Already, Beshear said on Monday, “We don’t have enough personal protective equipment to do everything we want right now.”

PPE is often the first and most crucial line of defense for providers treating infected patients of any kind. COVID-19 is especially contagious, spreading as easily as influenza and, some health officials say, carries a higher mortality rate.

“Hey Ralph, they’re here,” one of McCracken’s employees shouted from the other end of the warehouse. The second truckload of the day carrying the remainder of Lexington’s supplies had arrived.

Another 25 pallets with different amounts of the same items were scheduled to arrive later Wednesday afternoon for Bourbon, Clark, Estill, Harrison, Madison, Nicholas, Powell, Scott and Lincoln counties.

The delivery, in total, exceeded 2 million pieces of protective equipment to divvy between places like hospitals, doctor’s offices, nursing homes, and service providers like the Blue Grass Airport.

Needing ‘as much as possible’

Wednesday’s haul, not just in Fayette but statewide, was a combination of equipment siphoned from the state’s cache of medical supplies in Frankfort and the U.S. Department for Health and Human Services’ Strategic National Stockpile, the country’s largest repository of medical supplies and drugs, only to be accessed during major public health emergencies.

What’s provided from the Strategic National Stockpile is augmented by the state, Lexington Fire Department Battalion Chief Rob Larkin said, and requests for these federal supplies typically have to come from a state’s public health commissioner.

In Kentucky, that person is Dr. Steven Stack. He requested PPE supplies from the federal stockpile last week, but state officials have repeatedly declined to release the letter or specifics of how much federal authorities decided to give. The Herald-Leader has asked the Cabinet for Health and Family Services, the Department for Public Health and the Governor’s Office for a copy of Stack’s letter.

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Lexington Fire Department Battalion Chief Rob Larkin sorts supplies delivered to the Lexington-Fayette County Health Department on Wednesday, March 18, 2020. Fayette County received 27 pallets of personal protective equipment from the Strategic National Stockpile and state cache Wednesday. Ryan C. Hermens [email protected]

Knowing what was requested would help provide insight into just how depleted PPE supplies are statewide, and whether HHS agreed to fill that order partially or in full.

The only insight into what federal authorities have given Kentucky can be gleaned from a spokeswoman from Baptist Health Lexington, who said the hospital’s Lexington and Louisville locations each received 200 gowns; 1,000 N95 masks; 1,200 isolation masks and 400 face shields from the federal stockpile.

Baptist’s Richmond location received 100 gowns, 500 N95 masks and 600 isolation masks, she said, and LaGrange got 200 gowns, 150 N95 masks and 1,200 isolation masks.

Major health care providers in Lexington have been noting for weeks that supply is low. Late on March 6, hours after Kentucky confirmed its first COVID-19 patient who was treated at UK Chandler Hospital, UK Executive Vice President for Medical Affairs Dr. Mark Newman asked UK HealthCare staff by email to “please be frugal” with their use of protective gear, citing an “exceedingly low” supply of the equipment.

Last week, roughly a week after this email was sent, U.S. Rep. Andy Barr, R-Lexington, said he was contacted by state epidemiologists “with concerns that [personal protective equipment] stock in local hospitals would run low in the wake of increased health care needs due to the outbreak of COVID-19,” Barr’s office Monday afternoon said in a news release.

Barr’s spokeswoman said the epidemiologists who initially made the federal request were from UK HealthCare, CHI Saint Joseph Health, and Baptist Health. Lexington-Fayette County Public Health Department officials, also consulted for that request, said they “requested as much as possible.”

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The Lexington-Fayette County Health Department received 27 pallets of personal protective equipment, including masks, from the Strategic National Stockpile and state cache Wednesday, March 18, 2020. Ryan C. Hermens [email protected]

On a Tuesday morning in a radio interview on NewsTalk 590 WVLK, Barr said the epidemiologists who contacted him “saw an impending stress on the system, and they said, look, we’re running through our [PPE] at a pretty fast pace.”

Barr said he helped connect Commissioner Stack with Assistant Secretary for Preparedness and Response at HHS, Dr. Robert Kadlec.

Stack’s request for stockpile supplies arrived to Kadlec on March 13, Barr said. The request was approved, and the first semi-truckload of additional PPE arrived in Kentucky on Monday afternoon.

Barr, himself, hasn’t even seen Stack’s letter, despite repeatedly asking for it.

A spokeswoman for the congressman said on Tuesday that he has “asked several times for the letter but has not received a copy of it.”

Other states facing similar dwindling supply dilemmas have made similar requests of HHS, but they don’t always get what they ask for. Washington state, the epicenter for the virus in the United States, asked for more than a quarter of a million respirators and 200,000 surgical masks in early March, according to the Washington Post. But HHS only half filled half of the northwestern state’s requested amount.

In addition to PPE, hospitals are stocking up on ventilators, which can provide life-saving breathing assistance to someone who can’t breath on their own.

Unlike PPE items, which can be manufactured and restocked more easily, hospitals across the country have a limited number of ventilators, and getting more requires jumping through more complex hoops. The Trump administration and top HHS officials have begun planning for how to meet an influx of demands, which will likely involve more rationing.

LEX_200318ProtectiveEquipKY (2)
The Lexington-Fayette County Health Department received 27 pallets of personal protective equipment, including gloves, from the Strategic National Stockpile and state cache Wednesday, March 18, 2020. Ryan C. Hermens [email protected]

On Friday, hours after UK HealthCare discharged Kentucky’s first confirmed patient with COVID-19, a 27-year-old woman from Cynthiana, Kim Blanton, director of Infection Prevention & Control and Patient Safety, said UK currently had 140 ventilators, and all but 55 were being used by patients. That morning, she had ordered another 25.

On Wednesday afternoon, Blanton said UK’s number of ventilators was up to 193. Though the federal stockpile contains ventilators, Lexington’s share didn’t include those devices.

Back at the warehouse, as McCracken’s team arranged the pallets, he said he’s not sure whether this bulk supply delivery was a one time thing.

“Right now, depending on how long the outbreak lasts, we may have to request more,” McCracken said. “We just don’t know at this point in time how long it’s going to last and how many individuals in Fayette County become cases.”

Alex Acquisto covers health and social services for the Lexington Herald-Leader and Kentucky.com. She joined the newspaper in June 2019 as a corps member with Report for America, a national service program made possible in Kentucky with support from the Blue Grass Community Foundation. She’s from Owensboro, Ky., and previously worked at the Bangor Daily News and other newspapers in Maine.
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