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What It's Like To Negotiate For Coronavirus Medical Supplies


This weekend, the Illinois Public Health Department reported 81 new deaths, bringing the total close to 700. The infections are also rising, with over 19,000 people testing positive. Cook County, where Chicago is, is preparing a 66,000-square-foot refrigerated warehouse in anticipation of a surge of deaths.

Anne Caprara is hoping to avoid that. She's chief of staff to Illinois Governor J.B. Pritzker, and she's part of the team negotiating deals for medical supplies. She joins us now from Chicago.

Thanks for being with us.

ANNE CAPRARA: Thanks, Lulu. Good morning.

GARCIA-NAVARRO: Good morning. And NPR's Eric Westervelt is also with us. He's part of our team of NPR reporters following the supply crisis, so he'll also have some questions to ask.

Good morning, Eric.

ERIC WESTERVELT, BYLINE: Good morning, Lulu.

GARCIA-NAVARRO: Anne Caprara, give us some context. What are your state's needs right now, and how does that compare to a few weeks ago? And what are you predicting?

CAPRARA: Well, I think, fortunately, we feel that at least given we've had a stay-at-home order in place for almost three weeks now, that we are at least seeing some leveling off of cases here in Illinois and hopefully some sense of flattening this curve. It's hard to tell because you really need days upon days upon days of data.

And as - I know you've talked about it on here quite a bit - we don't have the level of testing that we would feel comfortable with to know really kind of what the arc of this disease is. But we do feel like we're at least trending towards a better place than we might have been two weeks ago.

GARCIA-NAVARRO: How much equipment have you gotten from the federal stockpile?

CAPRARA: Not enough. We get about a fraction of what we ask for. We're never sure if it's coming from the stockpile or from other locations. And I think - you said it best. The ventilators is really the item that everybody is looking for and the most difficult thing to obtain. I think we would be comfortable in Illinois if we knew we had about 4,000-plus ventilators on hand. Right now, that number is under 2,000. And when we do get a hold of ventilators, you're talking about maybe 20, 30, 40, a hundred at a time if we're lucky.

WESTERVELT: And the Trump administration has set up this hybrid system where FEMA is working with private distributors, private manufacturers to try to direct much-needed supplies to hot spots. The feds say, you know, we're adding volume to this existing supply chain, but we're not here to disrupt it.

From - you and many governors are saying that's clearly not working. Supplies are still going, you know, at times to the highest bidder or a long-standing customer. Given that this crisis is going to go on for many weeks, what does Governor Pritzker think the federal government can and should do right now to better help states and improve this supply chain?

CAPRARA: Well, let me start by saying the current system is a total mess. States are bidding against each other. They're bidding against other nations. I listened to my boss on a call two weeks ago where the person he was talking to was telling us about the order that they had just gotten in from the Israelis. And clearly, the subtle indication to us was we needed to kind of either up our order or probably lose out on the supplies we were trying to get.

It really - as my boss has said over and over, it really, really is the wild, Wild West. You're asking states who are putting together procurement teams who - truthfully, in normal times, state procurement goes through a long, kind of drawn-out bureaucratic process in order to get supplies in. And you're taking that entire process, compressing it into really hours sometimes, if not days, and talking to companies that are bidding up the prices of really fundamental medical equipment.

For example, N95 masks, which, before all this began - you know, prices were usually about under a dollar for a mask. We've been quoted 6-, 7-, $8 a mask, which, as you might imagine, when you're buying millions upon millions of masks - how expensive that gets for states. So I don't know how this is a long-term sustainable system to have.

What we really have said we needed is the federal government to use the Defense Production Act to really normalize the production chain and give everybody a decent shot of purchasing these supplies at a price that's not exorbitant or really just out of reach for some states.

GARCIA-NAVARRO: I have a question. How does it look for you? I mean, you describe it as the Wild West. Is it - if someone calls out of the blue and says, hey, I've got a line on some medical gowns, do you take that call? And, you know, you might not know exactly who they are or how much they can really give you.

CAPRARA: We do. We actually take every call, email, suggestion. I think I probably get anywhere from a hundred to 200 emails and text messages about this every two days. We set up a procurement team inside the governor's office where all of that - those outreaches get relayed.

And then we start the process of trying to vet these people, which has become increasingly difficult, I will tell you, because oftentimes - almost always, you're not talking to the actual manufacturer of the product. You are talking to a middleman who may be working for another middleman. Often, they're venture capital people. They're folks who I'm just guessing have seen an opportunity here, and they're playing the connectors. They're also taking a cut off the top of whatever, you know, we end up paying for the masks or the ventilators or whatever supply we're getting in.

And you know, you're trying to really vet these folks to make sure that they're real, that it's not a scam. And you know, I would say the other difficulty here is a lot of these supplies are being manufactured overseas. And in fact, a lot of them are being manufactured in China. So getting them out of China at the moment is also a huge hurdle that we have to leap in order to get the supplies in the front door here in Illinois.

WESTERVELT: Anne, has there been any discussion among governors, given that, clearly, there's a lack of leadership at the federal level - have states sort of joined forces, set up a kind of cooperative clearinghouse to buy this critical equipment and supplies and stop these sort of bidding wars?

CAPRARA: There has, actually. My boss has reached out to a couple of Midwestern governors, and I know he's had conversations with some folks on the coast. I think the problem is all of these states have different procurement rules. A lot of the providers and manufacturers - they want money upfront. You know, they either want you to pay the entire bill as soon as you place the order, or they want a substantial amount of money before they will fulfill the order.

And it's very difficult to work among states who all have different procurement rules and frankly have - all have different abilities to pay. You're trying to keep people, you know, kind of all in the same room when they need, you know, these really critical supplies. And I would say particularly with anything involving ventilators, it's hard to collaborate because, again, you're looking at 20, 30, maybe 40 ventilators at a time. And, you know, every state's kind of looking at that, going, I need that supply for my people. So it makes it very difficult to collaborate.

I would also say there's obviously a disparity among states that can front huge upfront costs. I did see that the governor of California was able to bring in a huge number of supplies, but basically, that was 'cause he was able to put half a billion dollars down...

GARCIA-NAVARRO: I was about to ask...

CAPRARA: ...In order to get things.


CAPRARA: Yeah, so...

GARCIA-NAVARRO: ...We only have 20 seconds left. What is this doing to your state's budget?

CAPRARA: You know, look. We've been able to free up the funds that we need in order to take care of this, but it is going to be a blow to the budget. I think my boss has said this over and over again - you're taking on huge, unexpected costs at the same time that you're losing a lot of your sales tax revenue. And we've pushed back the date for people to file state income tax. So, you know, that - your revenue flow isn't what it normally would be.

GARCIA-NAVARRO: That's Anne Caprara, chief of staff to Governor Pritzker.

Thank you so much.

CAPRARA: Thank you.

GARCIA-NAVARRO: And NPR's Eric Westervelt. Thanks to you.

WESTERVELT: You're welcome. Transcript provided by NPR, Copyright NPR.

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