When the COVID-19 pandemic hit, the collapse of medical device supply chains was swift, visible, and consequential. Ventilators were rationed. Nursing homes ran out of masks. Families of medically fragile children scrambled through Facebook groups to find replacement tracheostomy tubes. The crisis was widely experienced, but its full scope — who was most affected, what it cost, and what stopgap measures were deployed — has until recently remained poorly documented.
A January 2025 landscape analysis from the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) offers one of the most systematic accounts to date of how medical device shortages during the pandemic cascaded through the U.S. healthcare system. Drawing on a targeted literature review and key informant interviews, the report maps the characteristics, costs, and coping strategies associated with shortages of critical devices ranging from N95 respirators and IV bags to ventilators and hemodialysis equipment.
Nursing Homes and Rural Hospitals Hit Hardest
Among health systems, the analysis found that nursing homes and rural hospitals faced the most severe impacts. In one study cited in the report, 98 percent of Medicare- and Medicaid-certified nursing homes experienced PPE shortages between May and July 2020, with 19 to 21 percent reporting severe shortages — defined as less than one week of supply on hand. For-profit facilities and those with confirmed COVID-19 cases among residents and staff were disproportionately affected.
Rural hospitals, already operating under significant financial strain, faced a compounding set of disadvantages: limited purchasing power, geographic isolation, minimal storage capacity, and a position at the tail end of distribution chains. Unlike large multi-state systems, rural facilities had little ability to shift resources internally or tap strategic reserves. When larger institutions engaged in panic buying, smaller rural and community hospitals were frequently left with nothing. According to informants cited in the report, manufacturers sometimes restricted purchases to existing customers, leaving new buyers with no recourse.
A Fragile System Under Stress: What Broke and Why
The ASPE analysis makes clear that the pandemic did not create these vulnerabilities — it exposed and amplified them. Prior to COVID-19, annual medical device shortage reports averaged roughly five per year between 2010 and 2019. In the first half of 2020 alone, that number surpassed 20. The underlying structural risks were already present: as of 2011, 63.7 percent of U.S. medical device manufacturers relied on at least one foreign-sourced critical component. Natural disasters had already strained the system — Hurricane Maria’s destruction of a major saline supplier in Puerto Rico in 2017 led to significant IV bag shortages long before the pandemic. Port congestion at Los Angeles and Long Beach in 2021 further disrupted supply chains already stressed by surging demand.
The pandemic layered unprecedented demand spikes onto these fragile systems. Mask prices reportedly rose twelvefold, from $0.50 to $6.00. Mechanical ventilator prices doubled, from approximately $25,000 to $50,000. Manufacturers themselves competed with hospitals for PPE needed to maintain sterile production environments, and some reportedly waited six to nine months for sourcing to stabilize.
Fourteen Strategies, All Resource-Intensive
The report identifies 14 distinct strategies that providers, health systems, patients, and manufacturers used to manage shortages. The range was wide: rationing and prioritizing device use, turning to unvetted or non-traditional suppliers, substituting alternative devices or procedures, deferring elective procedures, deploying telehealth, centralizing procurement, and drawing on state and national stockpiles. In one striking case, a hospital system installed 1,800 inpatient telehealth devices across seven facilities primarily to reduce PPE consumption. Telehealth utilization among Medicare patients surged from 1 percent to 43.5 percent at the pandemic’s outset.
Each strategy, however, came with hidden costs. Staff time was consumed finding suppliers, retraining on alternative procedures, reconfiguring care workflows, and responding to delayed or incorrect orders from unvetted sources. When kidney replacement therapy equipment ran short, clinicians pivoted to peritoneal dialysis — a procedure requiring new training and carrying different risk profiles. Elective procedure deferrals, recommended by both CMS and the American College of Surgeons, led to a 91 percent reduction in elective procedures at Veterans Affairs hospitals early in the pandemic — and to revenue losses that hit smaller and independent hospitals especially hard. One informant reported device sales fell 10 to 50 percent for some manufacturers, constraining the very financial capacity needed to invest in supply chain resilience.
Vulnerable Patients Faced the Sharpest Consequences
For patients, shortages translated into delayed procedures, forced reuse of single-use devices, exposure to alternative treatments, and higher out-of-pocket costs. The most vulnerable included children under 18, rural residents, home-based care users, patients dependent on ventilators or state-issued devices, and those managing chronic conditions. Pediatric patients faced a compounded disadvantage — fewer alternative device options exist for children, magnifying the impact of any given shortage.
The report also raises equity concerns. An analysis of ventilator allocation guidelines across three states found that two used creatinine-based kidney function metrics to triage patients — a measure that tends to yield higher readings in Black patients and may have functionally disadvantaged them in allocation decisions. The report does not quantify the scale of this disparity but flags it as an area warranting further investigation.
Patients themselves had minimal advance warning. Informants noted that patients typically learned of shortages through news coverage, receiving no formal notification from providers or federal agencies. Physicians, for their part, relied on inventory managers and suppliers rather than FDA channels.
Health Security Implications
The systemic nature of these failures carries direct implications for health security and national preparedness. The COVID-19 pandemic made visible what biosecurity analysts had warned about for years: concentrated foreign sourcing, single-supplier dependencies, and limited federal visibility into device supply chains create acute vulnerabilities during any large-scale public health emergency.
The CARES Act of 2020 granted FDA authority to require manufacturer notification of potential shortages during declared public health emergencies — authority that demonstrably helped mitigate impact when a 2021 Texas winter storm disrupted specialty plastics used in COVID-19 test kits. But that mandatory reporting requirement lapsed when the COVID-19 public health emergency expired in May 2023. FDA has since proposed making its shortage notification authority permanent and requiring manufacturers to maintain risk management plans — a legislative ask that remains unresolved.
For biosecurity practitioners and policymakers, the report offers a sobering baseline: the U.S. enters any future mass casualty event, pandemic, or major supply chain disruption without guaranteed visibility into where critical device inventories stand or how quickly they could be depleted.
Sources and further reading:
Thai L, Beleche T, Adetunji O. Understanding the Impact and Costs Associated with Medical Device Shortages During the COVID-19 Pandemic on Providers, Health Systems, Patients, and Manufacturers. HHS Assistant Secretary for Planning and Evaluation (ASPE). January 17, 2025.