The outbreak of the COVID-19 pandemic in March left most U.S. hospitals scrambling to cope in a number of ways — most notably, to equip staff with personal protective equipment (PPE), including gowns, medical supplies, ventilators. Now evidence is emerging that for one high-profile healthcare system, the PPE crisis was just one of many challenges created by the pandemic.

The lack of masks was a symptom of larger failures at the U.S.Department of Veterans Affairs (VA), the agency overseeing the medical care of 9 million veterans. The hospitals lacked staff and scrounged to find PPE, which was crucial in battling COVID-19, according to ProPublica.

The VA’s lack of an effective system for tracking and delivering supplies made it particularly vulnerable, according to a recent examination by the federal Government Accountability Office. When the pandemic hit, the agency relied on a few big contractors to supply everything from N95 masks to needles to isolation gowns. Those few big contractors fell victim to a global shortage of masks. And the VA had no reliable tracking system to tell officials what hospitals have, what they need or what was expired.

As COVID-19 overwhelmed the antiquated system, VA leadership asked employees at more than 170 hospitals to enter inventory by hand into spreadsheets every day and did “not have insight” into how resources were being deployed, the report said.

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