In February, few people outside of health care settings and those who work among chemicals and hazardous materials knew what “PPE” meant.
Then the novel coronavirus pandemic hit and not only did personal protective equipment become a familiar term, everyone in the world was trying to buy it. N95 respirators, medical gowns, gloves, shoe coverings, face shields and safety glasses were needed by health care workers as they treated those infected with a virus that no one knew much about.
Toss in the need for other equipment — ventilators, BiPAP machines, infrared thermometers, pulse oximeters, swaps, virus testing supplies and even hand sanitizer — and procurement became a full-time job for a team of state workers. With state funds alone, they bought 227,000 N95s, 550 ventilators, 11.4 million surgical masks, 400,000 cloth masks, 353,000 face shields, 35.2 million gloves, 6.9 million gowns, 1.5 million testing swabs, and more.
The head of that team is Alice Roberts-Davis, the commissioner of the Minnesota Department of Administration. In normal times, her department is the state’s landlord, purchasing agent, fleet manager and risk manager. But once COVID-19 hit, Gov. Tim Walz put Roberts-Davis in charge of a multi-agency Critical Care Supplies Working Group, which is housed in the state Emergency Operations Center in downtown St. Paul.
MinnPost spoke with Roberts-Davis this week and asked her to look back over the last nine months.
MinnPost: Maybe you can hit me with some numbers as far as what has been procured in nine months.
Alice Roberts-Davis: Just in the commodities that we’ve purchased, meaning face shields, gloves, masks, respirators, and gowns, I think that we’ve purchased about $86 million worth of PPE. That doesn’t include cloth masks, sanitizers, and thermometers or ventilators. I’m pretty sure it’s well over a hundred million dollars total.
MP: When was the first time you heard the initials “PPE?”
ARD: That would have been in March, probably. The first time that it was clear for me was when I was called up to talk about leading the critical care supplies group. We had had a couple of requests from the governor’s office for team members to come over and lead this critical care supplies work group. And finally they said, “I think it actually is going to need to be you, to come over and lead it.” I was happy to do that. It was terrifying of course, because I knew the climate of the world at that point in time was one where it was frankly chaos and pandemonium, the people trying to source PPE all over the world, and I knew that this was not going to be an easy thing to do.
I was really concerned about how Minnesota would be able to play on that stage. And so it was actually a really daunting task. I called in two really great team members from the Department of Administration. They were able to assign (to) me through the state emergency operations center a couple of logisticians from the National Guard and then a data scientist from our results team within the state. And that was the team that we moved forward with. So we were a tiny, tiny team. We worked around the clock because of course, Asia is awake while Minnesota is normally sleeping. We were turning over rocks.
MP: The governor in the spring spoke about getting help from Minnesota companies with worldwide operations. How did they help?
ARD: We had some great partners here in the state. Minnesota is really fortunate to have a wealth of corporate partners, corporate citizens I should say, who have an international presence and who are willing to support the state. (They would) say, ‘We have boots on the ground in Asia, we’re happy to go and check out facilities for you. We’re happy to go and talk to vendors for you and make sure that they are in fact legitimate vendors and that there is actually fabrication happening in these factories that you’re dealing with and even transport some of those goods for you to assure that they make it as quickly as possible to Minnesota.’ So we were very fortunate in that sense.
MP: You mentioned in your comments earlier that you were concerned about Minnesota’s ability to compete in that game. Is that because of the size of the state versus larger governments and larger states, the location of the state? Why did you at first feel Minnesota maybe wasn’t as well-placed as you would like it to be?
ARD: I just understand supply and demand. That was at a time when … Italy was going through an especially horrific time. And just understanding what the international crisis looked like at that point in time, every country was looking for the exact same goods. And I just didn’t know without some sort of consortium approach, how many of the states, especially if we weren’t in a severe crisis situation, were going to be able to rise to the top of any of these vendors that were sourcing and selling.
MP: Was there a formal partnership with other states that let you be bigger and buy that way?
ARD: The first approach that we took was trying to work with some surrounding states to source ventilators. And that just was not very effective. We all had different needs, different types and models of ventilators that we were interested in sourcing. So we all decided that we needed to source separately. And that was the same thing that happened when we started looking for different PPE items as well.
Now, what I will say that Minnesota did that I think was very wise is that within the state emergency operations center, we had the state Healthcare Coordination Center presence there. Dr. (John) Hick leads that, and he was there almost daily in the state emergency operation center. And we were able to go to him with any sort of PPE and say, OK, here is an offer that came in from a vendor. Here’s a glove. Here’s a mask. Here’s a ventilator. What do you think? And we were able to get from him on-the-spot expert opinions on whether or not this was the quality that they were looking for, was this going to meet medical grade, was this going to be something that would be useful or not. We found a lot of things that the vendors were pushing and saying that this is what you need, this is what the hospitals are using, that did not meet the (Healthcare Coordination Center) standards.
MP: You keep mentioning on-the-spot. Were you all there physically?
ARD: Yes. We were there at the state emergency operation center, physically, many, many, many hours.
MP: Given COVID and work from home, how did you make that safe?
ARD: We were physically distant in the emergency operations center. There were not a lot of people there. It was spread out. We were all masked. It’s a large wide open space. … There were protocols. You had to do hand washing as soon as you walked into the building. They were doing temperature testing throughout the day. So there were definitely a lot of protocols in place in order to enter the building.
MP: Give me an example of, in the process of purchasing something, it turned out to be counterfeit or not authorized by, say, 3M, or were just shoddy goods.
ARD: We did have one instance where we received gloves that were shoddy, and we were able to work with the vendor and send those back and have those exchanged for a product that was going to meet our specifications and our qualifications. That was not a difficult process, even though gloves are very difficult to source right now. We were fortunate to have a good vendor partner and a good actor who was able to work with us.
We did have an unfortunate situation where we received some masks that were not authentic 3M respirators, and it is a situation that we’re continuing to work through. It is not a vendor that is a bad actor. The vendor does believe that they are still authentic 3M masks. And so we continue to work with them. Of course, we’re cooperative with 3M and we will turn the product back over to 3M so that we can assure that there are not any counterfeit products out on the streets. (The department announced Tuesday, after this interview, that it was working with the company to remove 500,000 fake N95 respirator masks from circulation). But I think that this is an instance where they were working with a foreign manufacturer who guaranteed authenticity of the product. And there’s still some question whether or not that’s true. They continue to believe that they are authentic.
MP: Tell me about Udder Tech (a Rosemount, Minnesota, dairy supply company that sold the state 2,300 gowns initially meant for milking that was mentioned in an Associated Press article on state PPE purchases).
ARD: We purchased Udder Tech — I’ll call them gowns — very early in the pandemic at a point in time where there were absolutely no gowns to be had. And we were in a crisis situation for gowns. That is obviously a critical piece of personal protective equipment for people who are working with people who may be COVID positive. I’ll balance that by saying we were also purchasing rain ponchos at the same time. I mean, we were all over the place as far as just ensuring that there was some protective equipment that people who are frontline health care workers dealing with sick people had. It’s a little bit unfair to compare the Udder Tech gowns to a disposable gown because these are really high-quality reusable, wipeable gowns. These are something that we had approved through the (state Healthcare Coordination Center) as a really high quality gown that we sent out to long-term care facilities, and these gowns have paid for themselves.
Again, we had purchased rain ponchos. And the last thing that I wanted to do was send out rain ponchos to our frontline health care workers. And these were an option that we felt were durable, reusable, wipeable, washable and just highly protective for our frontline health care workers. And at that point in time, not knowing much about COVID, we wanted to ensure that they had the highest protection level possible.
MP: Let’s talk about ventilators. When you were starting that was the big worry, that there wouldn’t be enough. Treatment has changed over the course of the pandemic to the point where doctors are not using ventilators as much as they might have. Did we have enough? Do we have too many? What evolved over the course of the spring and summer regarding ventilators?
ARD: We did evolve our approach quite a bit on ventilators. We had some great partnerships with Medtronic where they were able to assist us in getting out some orders that had been previously placed by hospitals … So about 169 ventilators went out to hospitals directly without the state placing an order. The state placed orders for about 800 ventilators. And as we started to look at the hospital capacity around the state, we realized that there were a lot of ventilators that were inactive around the state that could be activated in a hospital surge situation. We had quite a few that we could leverage in a crisis situation. We were able to also purchase some BiPAP (BiLevel Positive Airway Pressure) machines. As the care for the virus evolved, we were seeing that putting patients on BiPAP machines (which deliver air through a mask rather than an intubation tube into the trachea) would allow us to step them up to and down from a ventilator, which meant that the time on a ventilator was abbreviated. We didn’t need as many ventilators because people weren’t on them for as much time. We were able to supplement the ventilators with BiPAP machines, which we purchased quite a few of as well. So we were able to revise our orders down. At the end of the day, I think that we ended up purchasing about 550 ventilators instead of 800.
MP: What’s still hard to find?
ARD: That’s been a moving target. It depends on the cycle of the virus. Like we talked about a few minutes ago, at one point it was gowns that were very difficult to source … N95s have been chronic, that I should say for sure. We’ve always had difficulty sourcing N95s. For some time now it’s been gloves. That seems to be getting just a little bit better. We still weren’t able to get those in as readily as we’d like, but at least it’s not a dire situation. We can find some vendors that are able to source them.
The thing that I love about our Minnesota companies is that so many of them were able to pivot from their normal operations to making things that have been useful during this pandemic. So we had many companies that pivoted to making cloth masks, for example, and face shields and also disposable masks. And so those things for us have been fairly low barrier to entry. If we’re looking for those types of commodities, we’re able to find those within a number of days and usually at really competitive prices. And so that’s been really fortunate.
MP: You’ve been spending from the state COVID fund: $200 million. It appears from the orders through the Legislative Advisory Committee that there’s been federal CARES Act money as well. Both of those pots are close to being drained. What do you do going forward into 2021? Are there other sources of money that you will need to keep this going?
ARD: The goal for us has been to have about a 30-days supply on hand, and we’re really close to having that right now. The other thing that we’re seeing is that hospitals have been able to stabilize their own supply chains. This has always been intended to be supplemental to hospitals. They’ve always been asked to continue to supply their own needs, and if they get to a crisis point, we would be able to supplement whatever they need. We’re seeing them in really good shape as far as inventories go.
A lot of our work now has shifted toward long-term care. We see a lot of congregate care settings that need assistance. And schools have needed a lot of assistance as well. As long as we don’t see really intense surges in the hospital system, I think that we’ll be able to sit with a fairly close to 30-day supply for some time. That’s about where we want to be going forward. So I don’t know that we’ll need a lot more money at this point in time.
MP: When do you envision going back to what maybe was a normal work life? I mean, how long does this setting exist?
ARD: I don’t know how much longer this exists, but I do know that there are still more things that need to be taken care of as it relates to the pandemic response for the state. Now what this team has shifted toward is thinking about our educators and ensuring that because we do have the warehouse set up, we are the ones who are going to be responsible for ensuring that (COVID) testing supplies get to the educators as they start their weekly or bi-weekly testing. So we have much more work to do. It may not be about shipping out PPE, but it will be about shipping out testing supplies and ensuring that teachers have what they need for that.