He fancied himself Caesar

He forgot the warning:  Beware the ides of March.

Trump's hubris and incompetence are taking him down, and us along with him.

On Feb. 5, with fewer than a dozen confirmed novel coronavirus cases in the United States but tens of thousands around the globe, a shouting match broke out in the White House Situation Room between Health and Human Services Secretary Alex Azar and an Office of Management and Budget official, according to three people aware of the outburst.

Azar had asked OMB that morning for $2 billion to buy respirator masks and other supplies for a depleted federal stockpile of emergency medical equipment.

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[T]he budget official [caimed] that Azar had improperly lobbied Capitol Hill for money for the repository, which Azar denied.

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The $2 billion request from HHS was cut to $500 million when the White House eventually sent Congress a supplemental budget request weeks later. White House budget officials now say the relief package enacted Friday secured $16 billion for the Strategic National Stockpile.

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States desperate for materials from the stockpile are encountering a beleaguered system beset by years of underfunding, changing lines of authority, confusion over the allocation of supplies and a lack of transparency from the administration.

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The stockpile holds masks, drugs, ventilators and other items in secret sites around the country. It has become a source of growing frustration for many state and hospital officials who are having trouble buying — or even locating — crucial equipment on their own to cope with the illness battering the nation.

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“The response contains enough for multiple emergencies,” said Richard Besser, a former acting director of the Centers for Disease Control and Prevention. [...] “Multiple does not mean 50 states plus territories and, within every state, every locality.”

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Massachusetts, which has had a serious outbreak in Boston, has received 17 percent of the protective gear it requested, according to state leaders. Maine requested a half-million N95 specialized protective masks and received 25,558 — about 5 percent of what it sought. The shipment delivered to Colorado — 49,000 N95 masks, 115,000 surgical masks and other supplies — would be “enough for only one full day of statewide operations,” Rep. Scott R. Tipton (R-Colo.) told the White House in a letter several days ago.

The Federal Emergency Management Agency inherited control of the stockpile barely a week ago from HHS.

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Florida has been an exception in its dealings with the stockpile: The state submitted a request on March 11 for 430,000 surgical masks, 180,000 N95 respirators, 82,000 face shields and 238,000 gloves, among other supplies — and received a shipment with everything three days later, according to figures from the state’s Division of Emergency Management. It received an identical shipment on March 23, according to the division, and is awaiting a third.

  WaPo

Gee, why would it be that Florida is getting everything it needs and pronto?

“We don’t know how the federal government is making those decisions,” said Casey Katims, the federal liaison for Washington state, the site of the nation’s first confirmed case on Jan. 21 and of an early deadly cluster at a nursing home.

Since the state made the first of several requests — 233,000 respirators and 200,000 surgical masks — the supplies have been arriving piecemeal and without any explanation of the numbers. The state is now awaiting more, including a plea for 1,000 ventilators, and has been told 500 are en route, Katims said.

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Explanations of the decision-making process have been inconsistent.

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While the stockpile was still under HHS as the virus began spreading in the United States, the department for the first time used a formula, according to individuals familiar with the system. Under that formula, 25 percent of a state’s requests were fulfilled based on its population and 25 percent on its number of covid-19 cases. The remaining supplies were held back so the stockpile would not be depleted.

Except for in the case of Florida, it seems.

Asked to explain the current process, a statement from FEMA on Wednesday said, “The allocation process of PPE (personal protective equipment) to states is now focused on meeting future demand models where patient levels are expected to strain state and local medical conditions in coming weeks.” Asked which models FEMA is relying on, Litzow said Thursday, “future modeling is mostly based off of data from HHS and CDC that is continually updated as more information about this emerging disease becomes available.”

That's as clear as mud.

President Trump repeatedly has warned states not to complain about how much they are receiving, including Friday during a White House briefing, where he advised Vice President Pence not to call governors who are critical of the administration’s response. “I want them to be appreciative,” he said.

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Trump and Pence also urge states to buy supplies on their own. During the March 19 briefing, Trump said governors “are supposed to be doing a lot of this work. . . . You know, we’re not a shipping clerk.”

State officials say the advice is unrealistic.

“Allowing the free market to determine availability and pricing is not the way we should be dealing with this national crisis at this time,” said Virginia Gov. Ralph Northam (D). “This is why we need a nationally led response.”

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Leaders in the District, Maryland and Virginia say their requests for aid from the stockpile have come up short. They have been competing with their counterparts to try to buy gear on the open market.

“The federal government has the keys to the front door,” said Nirav Shah, Maine’s state health officer and director of its own Center for Disease Control and Prevention. He said the state has been scouring the country and overseas for companies that can supply protective masks.

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“There is no [protective gear] to be bought on the private market through vendors,” said Kevin Donovan, president of Lakes Regional HealthCare, which has two hospitals in central New Hampshire. “We order but don’t have any money to pay for it,” because companies manufacturing masks and other emergency gear are demanding cash payments on delivery. Donovan said his hospitals, like others, are low on cash because they have canceled the elective procedures that are their moneymakers.

Medicare for all.

The last time it was deployed on a national basis was during the 2009 H1N1 influenza pandemic, when the stockpile distributed 85 million N95 respirators, along with millions of other masks, gowns and gloves. Afterward, trade groups and public health agencies called for the stock of masks to be replenished, but the supplies were not significantly restored, according to health-care industry and public health experts.

Officials at the CDC, which previously oversaw the stockpile, focused their annual budget of roughly $600 million over the past decade purchasing lifesaving drugs and equipment for bioterror and other attacks, rather than equipment vital in a viral pandemic.

In late 2018, the Trump administration transferred responsibility for managing the stockpile from the CDC to a different part of HHS — a controversial move resisted by the CDC that placed the stockpile under the assistant secretary for preparedness and response (ASPR).

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The CDC still oversees clinical guidance to state health departments responding to public health threats, including infectious diseases. But the stockpile’s resources are now under ASPR.

“The transition has been difficult because the left hand is not talking to the right hand,” said one state health official with more than a decade of experience in emergency preparedness.

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HHS officials have sparred for more than a year with White House budget officials over money to buy more stockpile supplies.

In February 2019, the White House was planning for a presidential executive order on preparing for a potential flu pandemic. HHS requested a more than $11 billion investment over 10 years for ASPR, including $2.7 billion for “treatment and control.” a

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But the executive order issued by Trump in September 2019 did not include that money.

In late January, Azar began telling OMB about the need for a supplemental budget request for stockpile supplies — and was rebuffed at a time when the White House did not yet acknowledge any supplemental money would be needed.

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In mid-March, Trump declared the coronavirus outbreak a national emergency. As a result, control of the stockpile shifted again — from HHS to FEMA.

...but hey, do what you want...you will anyway.