The federal government set out to add thousands of medical workers to its emergency reserve nearly two years before COVID-19 was declared a national emergency in the United States, citing a critical need.

These workers are supposed to act as a safety net for the country’s health-care system, ensuring that hospitals are not overburdened in the event of disasters like the pandemic.

However, by the time the pandemic hit and the government had set a hiring goal of 10,300 people, it only had half that number, and even fewer to deploy during the tragic omicron surge that would strain hospitals across the country. The Trump administration had failed to hire enough federal medical workers during non-pandemic times to provide more than a meager backstop for struggling hospitals when the pandemic hit, resulting in inter-agency confusion and finger-pointing. When President Joe Biden took office, his 200-page COVID plan made no mention of efforts to increase their numbers.

The federal reserve of medical personnel, even at full strength, was not designed to meet all of the country’s emergency needs during a once-in-a-generation pandemic, but the failure of two administrations to meet that hiring target had far-reaching consequences when omicron struck. Thousands of medical professionals were laid off as Omicron flooded hospitals with patients, resulting in the loss of 44,000 staffed hospital beds across the country – enough to treat the entire population of Huntsville, Texas. Patients were denied admission. The treatment was postponed. The death toll skyrocketed.

With a limited pool of federal medical personnel, hospitals were forced to call for assistance that simply didn’t exist. The federal government’s ability to ensure that more personnel were distributed where they were most needed was hampered by the shortage. As a result of the void, a staffing war erupted, pitting hospitals and states against one another in a dog-eat-dog fight for scarce health-care personnel.

In early December, when confronted with the crisis, Biden declared that help was on the way. The president announced that he would dispatch enough personnel to assist 60 hospitals. It wasn’t nearly enough. An analysis of federal data shows that more than 1,000 hospitals in 48 states reported critical staff shortages at the time.

Requests for federal assistance had to be prioritized and weighed against available resources, according to administration officials. In some cases, states did not receive as much assistance as they requested, but they claimed that by the second week of March, every state that requested assistance had received something. Paramedics were used in some cases to assist in the transfer of patients between hospitals.

According to the White House, the administration has made significant investments to strengthen the health-care workforce as a whole, including incentives to encourage health-care worker recruitment and retention. The federal government also helped states meet staffing needs by reimbursing the costs of activating National Guard troops and hiring temporary workers.

During the pandemic, federal medical teams “served as an emergency lifeline to hospitals by providing temporary relief to staff, adding bed capacity, decreasing wait times, and improving patient outcomes,” according to Dawn O’Connell, assistant secretary for preparedness and response at the US Department of Health and Human Services.

Federal officials, on the other hand, refused to say how many workers were available for deployment, how many states requested, or why expanding their ranks was not included in Biden’s COVID plan when he first took office or in his new plan released earlier this month.

Only 1,127 federal workers were deployed to 22 states, territories, and tribal areas between Thanksgiving and January 21, the peak months of the omicron surge. As hospitalization rates fell over the next seven weeks, 12 more states received workers, bringing the total number of workers to 2,150.

The additional workers, if deployed correctly, would have gone a long way toward alleviating the January bed shortage, at least temporarily, according to the retired Air Force colonel and physician who served as assistant Secretary of Health and Human Services for Preparedness and Response under Trump.