FEMA's leader in Philly on what states still need to deal with coronavirus

Apr. 22--The Federal Emergency Management Agency, best known for taking trailers and rations to Mississippi River floods, Texas tornadoes, and Atlantic hurricanes, is coordinating federal aid to states and cities during the mass closures of the coronavirus pandemic.

"Never before has every state been under a major disaster declaration," says MaryAnn Tierney, Philadelphia-based boss of the FEMA region that includes Pennsylvania, Virginia, and three other states, plus D.C. "We have just over 3,000 people deployed to support COVID" efforts nationally.

"I have been personally frustrated at the [administration's] lack of clear coordination with our states around the deployment of our national stockpile of personal protective equipment and medical equipment," says U.S. Sen. Chris Coons, a Democrat from Delaware.

He said his state, one of the smallest, had to scramble to arrange more supplies for hospitals and nursing homes as virus cases spread. "I hear that from other senators and governors," added the senator. "This may well exceed FEMA's scale. They are charged with responding to multiple regional disasters, but not a national disaster."

At the end of February, two weeks before President Donald Trump declared a national emergency, state officials from across Tierney's district started asking about coronavirus preparations at a routine meeting in Washington. "Everyone could see something significant was happening," said Tierney.

She said state health and emergency officials brought coronavirus concerns to her staff -- outside the prepared agenda -- at that routine regional meeting.

Tierney said states in this area have enough ventilators, but still lack some of the personal protective equipment health-care providers say they need. She laid out what's been done, and what's ahead.

"There are currently more than 5,100 ventilators in the system, and less than 1,500 are in use," said Nate Wardle, spokesman for the Pennsylvania Department of Health. Still, the department's hospital needs list notes institutions expect to need an additional 1,000 ventilators, which have not yet been located.

"The first one is supporting expansion of medical care capacity by helping hospitals add intensive care unit sites," like the one built at Temple's Liacouras Center without needing the Army Corps of Engineers design support that FEMA offered, said Tierney.

"Second, prioritizing and distributing personal protection equipment, and things like ventilators."

FEMA is also supposed to check on the most vulnerable communities. "Almost half the deaths in Pennsylvania have been in nursing homes, long-term care facilities, [and other] institutional settings -- wherever you have a group environment and the potential for the virus to spread quickly," Tierney said. That's why schools were closed and some prisoners released.

"Population density is a big factor in transmission. The virus spreads easily. New Jersey and New York City are extremely dense," said Tierney.

"In this region, people are staying home. They are helping stop the spread. We have data to support that."

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Through "Project Airbridge," FEMA is "covering the cost to fly distributors' critical medical supplies into the U.S. from overseas factories, cutting shipment times from weeks to days," said Tierney.

"These are not manufactured in the United States. Of gloves, there is almost zero manufacturing in the United States. Being so reliant on foreign sources for personal protective equipment creates a challenge for us. So 'Project Airbridge' is bringing things to the U.S. faster," and that costs more. "So far there have been 65 flights."

"Half go to FEMA [priority] areas, designated by case counts. The other 50% has to be fed into the supply chain" for the manufacturers' current customers.

"Part of being good in emergency management is being good at continuous improvement. We take time to learn, for next time."

But she deferred on policy recommendations. "This is so unprecedented. The supply chain will require analysis. And the demand is so large. Everyone wants the same five to 10 things at a time."

"A month in, the requests have gotten more refined and more driven by data. All FEMA regions have asked states to identify their critical needs and to support that. We've worked with all states in Region 3 to see how much they have on hand, how much they are using, and their 10- to 14-day requirements. Do they need additional support? Can the federal government support them, yes or no? If we can't support their request, they need to find an alternative."

"I get a report every day [on ventilator use and expected needs]. Now that I've seen that for two or three weeks, you can see if something pops out as abnormal. Right now there isn't a state in Region 3 that has a critical ventilator need."

"PPE is scarce. Everybody needs it. In particular, surgical gowns. Pennsylvania has asked for gowns.

"With N95 masks, I feel we have leveled off. Surgical masks are more in the supply chain the last couple of weeks. I won't tell you we are fine -- you can find people that are not fine. There are shortages."

"Food is a huge issue, as part of coronavirus. Pennsylvania has experienced that." (As of April 20, FEMA had delivered 900,000 ready-to-eat or stable-shelf-like meals to Pennsylvania food banks and providers, enough to feed 15,000 people twice a day for a month, and is reimbursing some other food costs.)

"Economic recovery and mental health. And we have to be ready for hurricane season, which is less than 45 days away."

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