As the coronavirus pandemic spread in an unprepared US, states rushed to acquire masks and other protective gear.
Three years later, as the pandemic's grip has loosened, many states are now scrambling to deal with a surplus of protective gear, dumping their stockpiles en masse.
With expiration dates passing and few requests to use the inventory, Ohio auctioned off 393,000 gowns for just $2,451 and ended up throwing out another 7.2 million, along with expired masks, gloves and other materials. The now expiring supplies had cost about $29 million in federal money.
A similar reckoning is happening across the country. Items are aging, and as the deadline for allocating federal COVID-19 money approaches next year, states must decide how much to invest in maintaining warehouses and inventory supplies.
An Associated Press investigation found that at least 15 states, from Alaska to Vermont, have thrown away some of their hoard of personal protective equipment due to expiration dates, surpluses and a lack of willing buyers.
More than 18 million masks, 22 million gowns, 500,000 gloves and more went into the trash. That doesn't count states that didn't give the AP exact numbers or respond to cases or other measures. Rhode Island said it has eliminated 829 tons of personal protective equipment; Maryland has thrown away more than $93 million in supplies.
“What a real waste. That's what happens when you don't prepare, when you have a public health care system in turmoil,” where a lack of emergency planning leads to panicky overbuying, said Dr. Georges Benjamin, executive director of the American Public Health Association . “It shows that we really need to manage our inventories better.”
The AP has sent questions about personal protective equipment supplies to all fifty states in recent months. About half responded.
States emphasize that they have distributed far more items than they have thrown away, and that they have gone to great lengths to donate the leftovers. Washington state sent hundreds of thousands of items to the Marshall Islands last year, but ended up throwing away millions more items after their expiration date.
Many states are retaining at least some, and sometimes all, of their remaining protective equipment. Some are even planning to update their inventories.
But others say the vagaries of the pandemic and the supply of personal protective equipment left no choice but to acquire the items and now throw them away, however reluctantly. Expiration dates are set because materials can deteriorate and may not function as intended. The Federal Emergency Management Agency has set the fair market value of expired supplies at zero dollars.
“Anytime you're put in a situation where you remember how hard it was to get something, and then have to see it go or not be used in the way it was intended, there's definitely some frustration in that” , said Louis Eubank, who leads the South Carolina Health Department's COVID-19 coordination office. The state has thrown away more than 650,000 expired masks.
When the virus hit, demand for N95 masks, gloves and gowns skyrocketed. The U.S. government's Strategic National Stockpile was inadequately equipped, and states became embroiled in global bidding wars.
The AP found in 2020 that states spent more than $7 billion in a few months on personal protective equipment, ventilators and some other high-demand medical devices in a seller's market. Ultimately, the federal government paid for many of the supplies.
“At the time of purchase, it was impossible to know how long the supply shortage would last or what quantities would be needed,” said Ken Gordon, spokesman for the Ohio Department of Health.
Ohio has distributed more than 227 million pieces of protective equipment during the pandemic. But as the supply shortage and health crisis subsided, demand decreased, especially for dresses.
Now “states, hospitals, manufacturers – everyone across the system – have additional products,” says Linda Rouse O'Neill of the Health Industry Distributors Association.
Given the abundance, the stocked items are sold at bargain prices, if at all. Vermont received $82.50 for 105,000 shoe covers and 29 cents each for thousands of pairs of safety glasses.
Finding a balance between preparedness and surplus is “a big dilemma” for governments, says Scott Amey of the Project on Government Oversight, a Washington DC-based watchdog group. And while politicians in 2020 vowed never to be surprised again, “memories are short and budgets are tight,” Amey noted.
In Wisconsin, a legislative committee has cut $17.2 million from the budget that would have funded a warehouse with a continuous 60-day supply of personal protective equipment for two years.
The Health Ministry said it is now “demobilizing the warehouse” and trying to donate the supplies. Wisconsin has already thrown away nearly 1.7 million masks and nearly 1 million gowns.
The Minnesota Department of Health has been allocated some money this year to conserve and replenish personal protective equipment and is in the process of developing a strategy. For now, emergency management official Deb Radi says the agency expects to throw out a few expired coats.
The Health Industry Distributors Association recommends product distributors maintain 60 to 90 days of inventory to protect against spikes in demand. But the group says it's probably not necessary for everyone in the system — from manufacturers to doctor's offices — to have such a big cushion.
The Missouri Health Department has maintained a 90-day supply, even keeping expired materials under the assumption the federal government will approve their use in an emergency. That happened during COVID-19.
“If you don't make the investment — and perhaps the investment that is never used — then you may not be prepared to help the public when it is needed,” said Missouri Health Director Paula Nickelson.
Pennsylvania officials, by contrast, are aiming for a 15-day supply after frank conversations about what they can afford to not only keep but also continue to replace as items expire, said Andy Pickett, director of emergency response and preparedness for the Department of Health.
And Nevada can't get rid of its outdated personal protective equipment fast enough.
Department of Administration Director Jack Robb said the state is trying to dispose of the supplies safely and without wasting money, but has already thrown out some.
But Robb said officials made “the best decisions they could” when faced with a disease that has killed nearly seven million people worldwide, including some of his close friends.
“And I hope we never see anything like that again in our lifetimes,” he said.