While it has not yet triggered a war between the states, the COVID-19 pandemic is sure to set up a competition among them as they scramble for limited federal resources.

As it becomes clearer the country doesn’t have the equipment it needs to test for or treat COVID-19, state and local officials are urging Congress and administration to prioritize funding and supplies to sustain a continued public health response.

The Strategic National Stockpile, a program managed by the Department of Health and Human Services, allots supplies to states and four large metropolitan areas — New York, Los Angeles County, Chicago and the District of Columbia — based on population figures from the 2010 Census. But states seeking equipment like respirator masks, gowns and gloves for health care workers who treat potential COVID-19 cases are already reaching their full allotment, exposing a difficult aspect of the pandemic.

“That’s what the challenge is going to be,” said Juliette Kayyem, a professor at Harvard’s Kennedy School of Public Policy and former assistant secretary for Homeland Security in the Obama administration. “How do you have a united approach with 50 states vying for limited resources?”

The first $8.3 billion federal relief package included $950 million for state and local health agencies. But with Seattle’s King County spending $100 million, Matthew Chase, executive director of the National Association of Counties, said that should be considered a “down payment” as continued funding would be needed to help local health officials treat the crisis for months.

Governors and local officials had hoped Congress would use the third COVID-19 response package to make direct payments to cover expenses and to increase production of personal protective equipment. But such payments did not appear to be included in the Senate draft bill (S 3548) introduced Thursday night.

Maryland Gov. Larry Hogan said earlier Thursday he would ask the White House and congressional leaders to send half of the trillion-dollar aid package under consideration directly to states. The bill should also add to the supply of medical supplies, he said.

Particularly hard-hit states are asking the federal government to prioritize their needs, even as they recognize the pandemic is putting a strain on resources across the country. The lack of supplies means first responders would be asked to treat contagious COVID-19 patients without equipment to protect themselves from infection.

The Centers for Disease Control and Prevention suggested Wednesday that nurses use bandanas instead of masks. A spokesman for Oregon Gov. Kate Brown said she would sign an order Thursday requiring all health care workers, including dentists and veterinarians, to halt nonemergency procedures. Other states have also asked for suspension of nonemergency procedures.

Connecticut’s congressional delegation told the Department of Health and Human Services in a Thursday letter that the state’s hospitals were only days away from running out of key supplies.

The shortage highlights the stresses on the public health aspect of the crisis, which Chase and Kayyem urged be treated before an economic stimulus.

“Can we not talk about money now until we get through the goddamn response?” Kayyem said.

Competition

Kayyem said we have “not yet” seen states truly compete with each other for scarce resources.

But states are making requests from the federal government and recognizing there may not be enough to go around.

Washington state, the epicenter of the U.S. outbreak, has made three requests for equipment from the national stockpile. The state received its first request, which it sent to HHS on Feb. 29, in full. Information on the levels requested in its second order was not immediately available from the state and the third hasn’t arrived.

The state’s House delegation wrote to HHS this week asking the department to prioritize the state as other hotspots may divert federal attention. Connecticut’s delegation, and surely others, did the same.

“It’s really, really important that Washington state is still front and center in the minds of the administration as being a real epicenter,” an aide to a delegation member said. “We’re obviously a biased party here. I understand that California and certainly New York seem to be going that way, but it is bad in Seattle and the surrounding areas and we just don’t want the administration to lose focus on that.”

Other states are already seeing problems with their requests from the national stockpile. Connecticut requested 250,000 respirators March 11. It received less than 35,000, Gov. Ned Lamont’s office said Wednesday.

At a Wednesday news conference, Florida Gov. Ron DeSantis said his top priorities were to acquire more testing equipment and personal protective equipment, or PPE. He’d requested 500,000 more testing swabs from the federal government but hadn’t yet received them.

“I’m not the only governor that said the exact same thing about PPE, about swabs and about some of these other items,” he said, in response to a question about discussions with federal officials.

Authorities at the state and federal levels made moves this week that acknowledged a shortage of medical supplies was a distinct possibility.

The limit on resources could set off competition among states and local governments. Strong federal coordination could mitigate that, Chase said.

The lack of testing capacity presents another complication, he said. Although there’s a demonstrated need to send supplies to current hotspots, there are likely other places where the virus has spread but hasn’t been notice because people haven’t been tested.

“We need a national strategy,” he said. “We need a clear national game plan. We need the equipment targeted to hot spots, but we also need broader public access.”