It all started gradually.
In the month of February 2020, officials in the soon-to-be pandemic epicenter of New York City fielded 41 requests for personal protective equipment (PPE) from a range of entities, including hospitals, the fire department, and a handful of nursing homes.
Specifically, 14 requests for PPE were made in February by skilled nursing facilities or entities representing them, according to a spreadsheet detailing such requests kept by New York City Emergency Management (NYCEM) and obtained by Skilled Nursing News through a Freedom of Information Law request.
And even though New York would not hit crisis levels of COVID-19 until March 2020, cracks in the supply chain were already starting to show.
On February 7, 2020, for example, the Greater New York Health Care Facilities Association (GNYHCFA) made two requests for face masks, 8,000 for the New Franklin Center for Rehabilitation and Nursing and 15,000 for the Ozanam Hall of Queens Nursing Home.
“Any style mask used in the treatment of a patient under contact or droplet precautions is permissible,” the request for the New Franklin Center notes.
The New York City Department of Health and Mental Hygiene (DOHMH) delivered 6,000 masks to the New Franklin Center on February 11, 2020, and 10,000 to Ozanam Hall on the same day.
But when a request for latex gloves came on February 18 from GNYHCFA on behalf of the Phoenix Rehabilitation and Nursing Center, the DOHMH was able to estimate a February 27, 2020 delivery — but added a notation that “they will not be able to fulfill any resources other than face masks until further notice.”
“Requ[est]ed items are available in the marketplace and cannot be filled via emergency requ[est],” the sheet notes for the request.
There’s a similar notation for requests for GNYHCFA’s request for gowns and surgical masks, also made on behalf of the Phoenix Rehabilitation and Nursing Center, on February 18. Deliveries of some kind do appear to have been made, according to the spreadsheet, with the quantities delivered listed at 8,000 for the gowns, gloves, and masks.
Eastchester Rehab was not so lucky. When GNYHCFA requested 17,500 gloves on February 20, 2020, after Eastchester’s supplier cut its weekly deliveries, the note about the requested items being available on the marketplace is once again present, and the DOHMH delivery quantity is listed at zero.
But all of that was in February of last year. COVID-19 would not make itself fully felt in New York’s nursing homes until the next month, March 2020 — and when the coronavirus struck, it was with incredible force. Nursing homes made just 14 requests for PPE from NYCEM in February 2020, but the spreadsheet shows 279 requests for PPE — from nursing homes alone in the New York City area — through March 26.
Some of these requests are duplicates, or split out from other tickets, but even with that caveat, the jump in requests is staggering. When other sources of requests for PPE are included, the number goes from 41 emergency requests in February 2020 — starting from February 6 — to 1,118 in March alone, through March 26.
And for nursing homes, the tone shift in March becomes clear from the very first entry, a request for 5,600 surgical-grade N95 masks made by GNYHCFA for the Beacon Rehab & Nursing Center on March 2.
“Vendors entity has reached out to Gerimedix who informed us that we can only receive 6 cases of masks a week and he only has enough supply to provide for a Max of 5 weeks,” the details of the request note. “[C]urrently we have a flu outbreak and one of our units of 60 residents is under quarantine. All staff on that unit are wearing [sic].”
That same day, New York City Mayor Bill de Blasio sent out a tweet suggesting movies for New Yorkers to check out as they “get out on the town despite Coronavirus.”
Meanwhile, at least some kind of delivery was made to Beacon Rehab as of March 8, according to the spreadsheet, which lists 5,600 N95s as being delivered by the state of New York.
The first requests from a nursing home that was listed as “denied” in the month of March was in response to the Continuing Care Leadership Coalition (CCLC), on behalf of the Rebekah Rehab & Extended Care Center. The requests, made on March 2, were for 144 cases of surgical-grade N95 masks and 30 cases of Purell Advanced Hand Sanitizer.
“Hand Sanitizers are still available to purchase in the general marketplace,” the Additional Notes section of the spreadsheet indicates. “Since self-procurement should still be an option, we cannot fulfill those items as an emergency requ[est].”
The N95 request by Rebekah Rehab was marked as denied, but according to the spreadsheet, it does appear that a delivery of 23,040 masks was made by the state at some point. The request was ‘escalated to State’ on March 2 and ‘saved by NYS EOC [Emergency Operations Center] Mission Assignment Specialist,’ with notes to place the call on hold.
More requests would soon be pouring in. Out of 293 requests that SNN was able to identify as coming from nursing homes from February through March 2020, 126 were for face coverings, running the gamut from face shields and non-surgical grade masks to surgical masks and N95s.
Out of those 293 requests from nursing homes that SNN could find, 279 were made in March 2020.
And nursing homes were far from the only entities making emergency requests for PPE from NYCEM in March. Across the city of New York, the middle of March saw the department deluged with calls for help from a range of sources, specifically:
- March 14, 2020: 91 requests for PPE
- March 15, 2020: 138 requests
- March 16, 2020: 113 requests
- March 17, 2020: 168 requests
Some of these entries could be duplicates, and one entity could make more than one request, but the spike in volume illustrates the surge in demand — and the incapacity of the state or the providers requesting aid to meet that demand.
In June 2020, New York passed a law requiring nursing homes to develop a pandemic preparation plan, which includes a stipulation that they prove they can secure a two-month supply of PPE.
In March 2020, however, many were turning to the emergency department for assistance. One of them was the Cobble Hill Health Center, which requested 7,200 face masks on March 21, 2020. That request was marked as ‘sourcing,’ which an NYCEM spokesperson told SNN indicates that “Logistics is attempting to identify providers for the resource.”
It is not clear whether any masks were delivered. Cobble Hill’s request for isolation gowns on March 23, 2020, was marked as denied. By April 20, 2020, NBC News reported that the facility had had 55 deaths presumably caused by COVID-19 — at the time, the highest death toll at any senior care center in the city.
New York has come under fire for how it handled the COVID-19 crisis in the early months with regard to nursing homes in particular. The state in April 2020 passed a law that shielded hospitals, nursing homes, and other health care providers from liability related to treating COVID-19 patients.
After a public outcry, that law was partially repealed in June 2020, and on this past March 24, the New York Senate passed legislation rolling back “previous immunity protections that prevented health care facilities, administrators, and executives from being held accountable for harm and damages incurred at facilities.”
The legislation includes a bill sponsored by Sen. Gustavo Rivera to reform the review process “for change of ownership or operations proposals brought before the Public Health and Health planning Council,” with the goal of ensuring nursing home asset and ownership information are public.
Reports also surfaced last week that the Federal Bureau of Investigation (FBI) is investigating whether Gov. Andrew Cuomo and his aides provided false data on the deaths of nursing home residents to the Department of Justice.
Cuomo has been under a steady barrage of criticism related to New York’s nursing homes in COVID-19 and other scandals, but the prominence of the nursing home issue rose after a report from New York attorney general Letitia James found that COVID deaths in the facilities were undercounted by 50%.
Cuomo and his aides have also been accused of a politically motivated cover-up, with administration official Melissa DeRosa admitting that the state “froze” when the federal government asked for more data about nursing home deaths last year. DeRosa and others were concerned that the calls from the Trump Justice Department were politically motivated, she said; the former president and other Republican politicians had repeatedly criticized Cuomo and other Democratic governors for policies that required facilities to accept COVID-positive residents during the early months of the pandemic.
The issue became a partisan wedge during the lead-up to the November 2020 presidential election, particularly as Cuomo shot to national prominence in the media, where he was generally portrayed as a sober, pragmatic counterweight to Trump.
In February, Cuomo hinted at reforms targeting for-profit nursing homes amid the criticism, and announced nursing home reform legislation focused on ownership transparency — as well as caps on profit and executive pay — a few days later.