The first known case of COVID-19 in the U.S. was confirmed by the CDC on January 21, 2020. The next day, the owner of the medical supply company Prestige Ameritech wrote to HHS officials to say he could produce millions of N95 masks per month, but the government was not interested. In a follow-up letter on January 23, the business owner informed the government that "We are the last major domestic mask company," without success.
On February 5, Trump administration officials declined an offer for congressional coronavirus funding. Senator Chris Murphy recalled that the officials, including HHS Secretary Alex Azar, "didn't need emergency funding, that they would be able to handle it within existing appropriations." On February 7 Mike Pompeo announced the administration donated more than 35,000 pounds of "masks, gowns, gauze, respirators, and other vital materials" to China the same day the WHO warned about "the limited stock of PPE (personal protective equipment)".
In February, the Department of Commerce published guidance advising U.S. firms on compliance with Beijing's fast-track process for the sale of "critical medical products", which required the masks shipped overseas meet U.S. regulatory standards. According to Chinese customs disclosures, more than 600 tons of face masks were shipped to China in February.
In early March, the country had about twelve million N95 masks and thirty million surgical masks in the Strategic National Stockpile (SNS), but the DHS estimated the stockpile had only 1.2% of the roughly 3.5 billion masks that would be needed if COVID-19 were to become a "full-blown" pandemic. A previous 2015 CDC study found that seven billion N95 respirators might be necessary to handle a "severe respiratory outbreak".
As of March, the SNS had more than 19,000 ventilators (16,660 immediately available and 2,425 in maintenance), all of which dated from previous administrations. Vessel manifests maintained by U.S. Customs and Border Protection showed a steady flow of the medical equipment needed to treat the coronavirus being shipped abroad as recently as March 17. Meanwhile FEMA said the agency "has not actively encouraged or discouraged U.S. companies from exporting overseas" and asked USAID to send back its reserves of protective gear for use in the U.S. President Trump evoked the Defense Production Act to prohibit some medical exports. Some analysts warned that export restrictions could cause retaliation from countries that have medical supplies the United States needs to import.
May 21: President Trump traveled to the Ford Rawsonville Components Plant in Ypsilanti, Michigan to tour the factory where ventilators were being produced.
By the end of March, states were in a bidding war against each other and the federal government for scarce medical supplies such as N95 masks, surgical masks, and ventilators. Meanwhile, as states scrambled to purchase supplies at inflated prices from third party distributors (some of which later turned out to be defective), hundreds of tons of medical-grade face masks were shipped by air freight to foreign buyers in China and other countries.
Medical organizations such as the American Medical Association and American Nurses Association implored Trump to obtain medical supplies, because they were "urgently needed". That led President Trump to sign an order setting motion parts of the Defense Production Act, first used during the Korean War, to allow the federal government a wide range of powers, including telling industries on what to produce, allocating supplies, giving incentives to industries, and allowing companies to cooperate. Trump then ordered auto manufacturer General Motors to make ventilators.
During this period, hospitals in the U.S. and other countries were reporting shortages of test kits, test swabs, masks, gowns and gloves (collective referred to as PPE.) The Office of Inspector General, U.S. Department of Health and Human Services released a report regarding their March 23–27 survey of 323 hospitals. The hospitals reported "severe shortages of testing supplies", "frequently waiting 7 days or longer for test results", which extended the length of patient stays, and as a result, "strained bed availability, personal protective equipment (PPE) supplies, and staffing". The hospitals also reported, "widespread shortages of PPE" and "changing and sometimes inconsistent guidance from federal, state and local authorities". At a press briefing following the release of the report President Trump called the report "wrong" and questioned the motives of the author. Later he called the report "another fake dossier".
In early April, there was a widespread shortage of PPE, including masks, gloves, gowns, and sanitizing products. The difficulties in acquiring PPE for local hospitals led to orders for gowns and other safety items being confiscated by FEMA and diverted to other locations, which meant that in some cases states had to compete for the same PPE. The shortages led in one instance of a governor asking the New England Patriots of the NFL to use their private plane to fly approximately 1.2 million masks from China to Boston. At that time, Veterans Affairs (VA) employees said nurses were having to use surgical masks and face shields instead of more protective N95 masks. In May, Rick Bright, a federal immunologist and whistleblower, testified that the federal government had not taken proper action to acquire the needed supplies.
An unexpectedly high percentage of COVID-19 patients in the ICU required dialysis as a result of kidney failure, about 20%. In mid-April, employees at some hospitals in New York City reported not having enough dialysis machines, were running low on fluids to operate the machines, and reported a shortage of dialysis nurses as many were out sick with COVID-19 due to lack of sufficient PPE.
On May 14, a Trump administration official told reporters "we do anticipate having 300 million” N95 masks by autumn; however, at the end of September, there were only 87.6 million N95 masks in the government stockpile.
Supply problems persisted in August 2020, when a survey reported 42% of nurses were experiencing widespread or intermittent shortages of personal protective equipment, with 60% using single-use equipment for five or more days. A September report by National Public Radio found some items were in short supply but others widely available, depending on the difficulty of manufacturing. The DPA was effective in producing ventilators but less so in producing N95s. As of September, the DPA had stimulated N95 production mainly by existing major manufacturers and less so by smaller companies. Additionally, the DPA's provision that exempts manufacturers from antitrust laws had not yet been used to encourage collaboration in N95 production.
In response to demand, a number of domestic businesses retooled and due to lack of federal coordination ended up producing a glut of hand sanitizer and face shields, some losing money due to the oversupply. The federal government used the Defense Production Act to get a small number of large manufacturers such as 3M and Honeywell to increase production of the more difficult to manufacture N95 masks, but supply was still falling hundreds of millions of units short of demand. NPR found the shortage could be resolved by providing government guarantees to small and medium-sized manufacturers so they could increase production of N95 masks without the risk of losing money or going out of business due to oversupply or drop in demand when the pandemic ends. Instead, President Trump has denied the PPE shortages exist, calling them "fake news" in April and in September saying "we've opened up factories, we've had tremendous success with face masks and with shields". Demand has also increased since the early weeks of the pandemic as various industries reopened, including medical and dental offices, construction, and trucking. The 2020 California wildfires also increased demand for N95 masks for agricultural and other outdoor workers, due to state regulations requiring protection during poor air quality conditions.
The San Diego-based hospital ship Mercy arrived in Los Angeles in late March to help treat non-coronavirus patients
Exceeded hospital capacity
Uncontrolled community spread led some medical facilities to refuse new patients or start transferring patients out. In March and April, this happened in the Detroit, Michigan area and New York City area; Yakima, Washington in June; and in July it happened in Houston, the Boise, Idaho area, Lake Charles and Lafayette, Louisiana, and at dozens of hospitals across Florida. By August, some hospitals in Mississippi were transferring patients out of state.
Arizona declared crisis standards of care in July 2020, allowing hospitals to legally provide treatment normally considered substandard to some patients in order to save others.
A testing team in Charleston, West Virginia responds to a confirmed case in a nursing home
Federal, state, and local governments
Further information: U.S. federal government response to the COVID-19 pandemic and U.S. state and local government responses to the COVID-19 pandemic
The federal government of the United States responded to the pandemic with various declarations of emergency, which resulted in travel and entry restrictions. They also imposed guidelines and recommendations regarding the closure of schools and public meeting places, lockdowns, and other restrictions intended to slow the progression of the virus, which state, territorial, tribal, and local governments have followed.
Effective July 15, 2020, the default data centralization point for COVID-19 data in the U.S. is switching from the Centers for Disease Control and Prevention to Department of Health and Human Services. However, "hospitals may be relieved from reporting directly to the Federal Government if they receive a written release from the State stating the State will collect the data from the hospitals and take over Federal reporting."
- Nobita Nobi, Kiteretsu Daihyakka, Kenichi Mitsuba and Mitsuo, who are boys from different anime stories, with a level of character similarity