The administration handled the potential shortage deftly.
At a coronavirus-task-force briefing at the beginning of April, White House adviser Jared Kushner explained the approach that would — as events proved — get the country through its ventilator crisis.
He was relentlessly pilloried, mocked, and distorted in the press for it.
After nearly four years of unrelieved Trump hysteria in the media, it’s hard to rank the worst journalistic outrages, but how Kushner’s remarks were misreported and misinterpreted belongs high on the list.
Much of the press coverage and subsequent commentary focused on one sentence at that April 2 briefing: “The notion of the federal stockpile was it’s supposed to be our stockpile. It’s not supposed to be states’ stockpiles that they then use.”
Cue the outrage. As CNBC put it, correctly, in a headline, “Jared Kushner slammed for saying the federal medical supply stockpile isn’t meant for states.”
The blue-checkmarks on Twitter descended in force. Representative Ted Lieu tweeted, “Dear Jared Kushner of the @realDonaldTrump: We are the UNITED STATES of America. The federal stockpile is reserved for all Americans living in our states not just federal employees. Get it?”
Former director of the United States Office of Government Ethics Walter Shaub thundered, “Who the hell does the nepotist think ‘our’ refers to? It is for the American people.”
Partisan outlets piled on. “Jared Kushner, President Donald Trump’s son-in-law and White House adviser,” Salon wrote, “claimed that the federal stockpile of medical supplies is not for individual states to ‘use,’ even though that is exactly the reason why the stockpile exists.”
And so did mainstream outlets. ABC News rapped Kushner for his “inaccurate description” of the stockpile, which “actually is intended for states’ use.”
In a piece for The New Yorker, Susan Glasser went even further. She wrote that the press briefing “will surely go down as one of the Administration’s most callous performances.” It was symptomatic, she argued, of a federal response that was a “failure by design — not a problem to be fixed but a policy choice by President Trump that either would not or could not be undone.”
All of this was completely ridiculous and wrong. With even a little context, it was obvious what Kushner was saying: States shouldn’t be drawing on the federal stockpile just to hold ventilators in their own reserves while hard-pressed cities were running low.
This was obvious from the very next sentence from Kushner: “So we’re encouraging the states to make sure that they’re assessing the needs, they’re getting the data from their local — local situations and then trying to fill it with the supplies that we’ve given them.”
The proximate reason for Kushner’s comment about the state stockpiles was a dispute between the Trump administration and New York governor Andrew Cuomo. New York City was running out of ventilators. The administration had sent 4,400 but learned that 2,000 of them were being held by the state and hadn’t made their way to the city.
The controversial sentence was part of a long answer setting out the administration’s strategy on ventilators that has, despite all the hue and cry, clearly worked. The emphasis — with Jared Kushner and his team in the middle of it, and capable leadership from Rear Admiral John Polowczyk at FEMA and Admiral Brett Giroir at HHS — was on data and shrewd allocation, so that ventilators did not go to states simply on request.
There’s no doubt that the lockdowns, in bending the curve of cases downward, have played a role in averting any shortage — one of the points of the lockdowns in the first place, of course. But there was no guarantee that we would get to this place where we are today, with ventilators no longer a significant worry.
At the outset, the country was looking at a daunting, perhaps impossible challenge. A chilling briefing at FEMA early on posited that the U.S. could be short 130,000 ventilators by April 1. The federal government had about 16,000 ventilators on hand in its stockpile and several thousand more from the Veteran’s Administration and the Department of Defense.
It was possible the government could perform at the highest level — and still fall short. A couple of insights drove the administration’s effort to get its arms around the problem.
Officials realized, as one White House adviser puts it, that there was “too much guesstimating” going on. New York, for instance, said it needed 40,000 ventilators. Then, the administration interrogated the request. What was that based on? It’s coming from public-health officials. Okay, how are they getting that number? Models. Plus, we don’t want to be short.
It became clear that many governors didn’t know how many ventilators their states had, and they were driven by early models that were “doomsday scenarios,” as one senior administration official puts it. Governors were also acting on the normal impulse to want to be safe, and have more than enough ventilators on hand, just in case. “If you are a governor, which is natural, you are going to over-ask because you want to be over-prepared,” the official explains.
A data team drawn from various government agencies and at the White House was created to get to the truth on the ground. It used hospital billings at the Centers for Medicare & Medicaid Services to estimate how many ventilators were in each state and how many were being utilized on any day, giving administration officials a more granular picture of what was happening in states than many governors had themselves.
Another important realization was that FEMA could do just-in-time delivery. It could get states and hospitals ventilators within 24 or 48 hours. This created a lot of flexibility. The administration could wait to see how things really played out rather than making decisions based on models that forecast what the demand might be two weeks in the future. “When you started looking at it like that,” the official says, “the numbers went down dramatically.”
And this is the key thing: The strategy was based on not sending states what they requested on their say-so. That was the opposite of the normal FEMA operating procedure. Usually, state and counties ask for things in a natural disaster, and FEMA sends them along as a matter of course. With an epidemic threatening the entire country, that way of doing things would have exhausted the federal resources immediately.
This also meant that much of the press coverage get it exactly backward. The media portrayed as an inherent failure the fact that the administration gave states a portion of their requests. (“Trump sent Arizona a fraction of the ventilators it sought,” a Vox headline said. “Republicans still framed it as a big win.”) In reality, not giving governors what they wanted was integral to the success of the overall operation.
If, for instance, the administration had tried to fulfill New York’s initial stated need for 40,000 ventilators, everything would have gone out the door to New York, and for no good reason. There was immense political pressure to send the ventilators anyway, although it would have been a mistake. “In the moment, that wasn’t 100 percent clear,” says the senior administration official. “There was a lot of pressure to send them all, because the pressure is basically, ‘How is it going to look if you’re holding in a stockpile and people need them?’”
None of this is to say there weren’t real needs in New York and New Jersey. Some 8,000 ventilators were sent out from the reserve, many of them to those two places, which were at times operating on very thin margins.
Another insight was that most ventilators out in the country weren’t being used, since the virus hot-spots were geographically limited. That meant there was a tremendous capacity to be tapped. This led to the Dynamic Ventilator Reserve. States and hospitals with a safe margin of ventilators not in use could lend them to places that needed them.
The lubricant for the system was a federal guarantee that a hospital lending a ventilator would get a replacement in 24 or 48 hours if it turned out that it needed it back. This removed the fear and the risk of giving up ventilators. It also allowed the administration to effectively leverage in the here and now the ventilators that it will have in the future, when production ramps up. “A ventilator today is more valuable than a future ventilator,” the White House adviser explains.
As for the future ventilators, FEMA acted quickly — much faster than is possible in the regular process — to get so-called notifications to purchase to ventilator manufacturers, so they could start work and hold their inventory, which ensured it wasn’t lost to foreign countries. The Defense Production Act was invoked with General Motors to get production moving as quickly as possible, and not back-loaded later in the summer.
Last year, according to administration figures, the country produced 30,000 ventilators. This year, it’s going to produce something on the order of 200,000, and they are already coming in. “The balance now is growing daily,” the White House adviser says of the federal stockpile. “We are going to be swimming in ventilators.”
By any measure, that’s a success, certainly compared with where we thought we’d be less than a month ago. If the media weren’t so devoted to gotcha idiocy, more people might know about it.