This note was published on April 17, 2020, at NEJM.org: “As a chief physician executive, I rarely get involved in my health system’s supply-chain activities. The Covid-19 pandemic has changed that. Protecting our caregivers is essential so that these talented professionals can safely provide compassionate care to our patients. Yet we continue to be stymied by a lack of personal protective equipment (PPE), and the cavalry does not appear to be coming. Our supply-chain group has worked around the clock to secure gowns, gloves, face masks, goggles, face shields, and N95 respirators. These employees have adapted to a new normal, exploring every lead, no matter how unusual. Deals, some bizarre and convoluted, and many involving large sums of money, have dissolved at the last minute when we were outbid or outmuscled, sometimes by the federal government. Then we got lucky, but getting the supplies was not easy…”

See also this related article via the NYMag Intelligencer: “…You could call this piracy. You could call it sanctions. The federal government is choking supply chains to states like it chokes supply chains to Iran and North Korea. These blockades aren’t as complete as those surrounding sanctioned regimes, of course, and some amount of the disruption may be honest confusion in a time of crisis. But the disruption is being brought about by federal interference, and unlike the kind of disruptions you’d want to engineer against antagonistic states, the purpose seems completely unclear — indeed the policy is inexplicable and indefensible…”